ObjectiveTo predict the in-hospital mortality risk among patients with ischemic stroke combined by dysphagia using interpretable machine learning methods, so as to provide more evidence-based support for the prognosis prediction of patients with ischemic stroke combined by dysphagia. MethodsMedical record of 308 patients diagnosed with ischemic stroke combined by dysphagia in the Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) (2.0) in the United States were retrospectively analyzed. Features of the research data were screened based on the least absolute shrinkage and selection operator, and which were randomly divided into a training set and a test set at a ratio of 7∶3. Then ten models, including logistic regression, random forest, K-nearest neighbor, linear discriminant analysis, naive bayes (NB), neural network, quadratic discriminant analysis, recursive partitioning tree, extreme gradient boosting tree, and support vector machine, etc. were constructed. The predictive effect was measured by calculating the area under the curve (AUC) of receiver operating characteristics. In addition, the calibration curve and Brier score were used to evaluate the calibration degree of the model, and the decision curve was drawn to reflect the clinical net benefit. The Shapley additive explanation method was used to analyze the interpretability of the black box model and explore the important decision-making factors. ResultsThe NB model in the test set showed better predictive ability compared with other models (AUC=0.85, 95%CI: 0.83‒0.88). After interpretability analysis, it was found that blood urea nitrogen (BUN), age, sequential organ failure assessment, bicarbonate, chloride, and hypertension were important risk factors for in-hospital mortality in patients with ischemic stroke combined by dysphagia. ConclusionThe comprehensive performance of the NB model is better than that of the other nine models in predicting the risk of in-hospital mortality in patients with ischemic stroke combined by dysphagia. The interpretability of the model can help clinicians better understand the reasons behind the results and take further reasonable intervention measures for risk factors to improve the survival probability of patients.

Celastrol is extracted from the traditional Chinese medicine Tripterygium wilfordii Hook.f..It is a kind of traditional Chinese medicine monomer with extensive pharmacological activity and has anti-tumor,anti-inflammation,anti-oxidation and neuroprotective effects.Studies have found that celastrol is not only closely related to obesity,tumor and cardiovascular diseases,but also plays a neuroprotective role in the cerebrovascular system by regulating various signaling pathways.At present,effective drugs for stroke are still limited,but with the deepening of the research on celastrol,its therapeutic potential in stroke has received more and more attention,especially in ischemic and hemorrhagic stroke,which has shown good therapeutic effects.Therefore,this is the first time to systematically summarize the therapeutic effects of celastrol on stroke and the underlying mechanisms involved,in order to provide further directions and references for the neuroprotective effects of celastrol.

Purpose/Significance To investigate and analyze the current status and influencing factors of digital health literacy(DHL)of the elderly,and to provide references for relevant departments.Method/Process The eHEALS scale is used to investigate the DHL status of 419 elderly people aged 60 and above in Shanghai through convenience sampling,and the influencing factors are explored through binary logistic regression analysis.Result/Conclusion Low education,smoking,and health anxiety are risk factors,while regular physical exami-nation is protective factor.Relevant departments should focus on the elderly people with lower education,and strengthen research and edu-cation on health examinations,smoking hazards,and the alleviation of anxiety.

Objective:To construct a systematic quality control management model for insulin pump and analyze its clinical application effect.Methods:To construct a systematic quality control management model for insulin pumps,that is,to manage the whole process of insulin pump equipment installation process,fault detection and pipeline replacement,comprehensively monitor the patient'daily medication and physical condition,timely detect and deal with faults,so that insulin pumps can better serve patients to effectively control blood sugar.32 insulin pumps configured by Shanghai Sixth People's Hospital were selected.120 patients with type 2 diabetes who used insulin pumps and equipment in conventional management mode from July 2022 to October 2022 were included in the control group,and 120 patients with type 2 diabetes who used insulin pumps and equipment in systematic quality control management mode from October 2022 to July 2023 were included in the observation group.The common faults of the two groups,the treatment effect of the equipment,and the patient compliance before and after the use of the equipment were compared.Results:The incidence of common faults such as redness rate at implantation site,tube blockage rate,tube dislocation rate and instrument damage rate in the observation group were lower than those in the control group,with significant differences(x2=6.737,6.664,9.955,6.793,P<0.05).The installation time,fault discovery time and tube replacement time of the observation group,with significant differences(t=6.078,5.428,5.786,P<0.05).The scores of diet control,exercise,blood sugar monitoring and medication compliance in the observation group were higher than those in the control group,with significant differences(t=6.816,12.627,20.169,15.317,P<0.05).Conclusion:Applying the systematic quality control management model to insulin pump management can reduce the incidence of insulin pump failures,shorten installation time,and enable insulin pumps to better serve patients to effectively control blood sugar and protect their health.

Objective:To study the influence of time-dependent acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on 14-day death risk in patients with severe stroke, and to provide reference for clinical diagnosis and treatment.Methods:Data of 3 229 patients with severe stroke were enrolled from Medical Information Mart for Intensive Care-Ⅲ (MIMIC-Ⅲ). According to the main types of stroke, the patients were divided into subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic stroke (IS) and other groups. According to age, patients were divided into > 60 years old and ≤ 60 years old subgroups. According to the baseline of sequential organ failure assessment (SOFA) score, they were divided into subgroups of > 3 and ≤ 3. The daily measured values of APACHE Ⅱ scores in each patient were recorded. And all-cause death within 14 days after admission to intensive care unit (ICU) was used as the outcome index to obtain the survival status and survival time of patients. Joint models for longitudinal and time-to-event data were established to evaluate the effect of APACHE Ⅱ score measured at multiple time points on the death risk of patients, and a subgroup analysis was performed.Results:Among the joint models, the one which include APACHE Ⅱ score, and the interaction items between APACHE Ⅱ and age showed the better fitting. Further analysis showed that APACHE Ⅱ score was affected by age, gender, hospital admission, baseline SOFA score and smoking history. After controlling for these confounding factors, APACHE Ⅱ score was significantly associated with 14-day all-cause death in patients with severe stroke [hazard ratio ( HR) = 1.48, 95% confidence interval (95% CI) was 1.31-1.66, P < 0.001], which indicated that the risk of death increased by 48% (95% CI was 31%-66%) for each 1-point increase in APACHE Ⅱ score. Subgroup analysis showed that for different types of severe stroke patients, APACHE Ⅱ score had a greater impact on the risk of 14-day death in SAH patients ( HR = 1.43, 95% CI was 1.10-1.85), but had a smaller impact on ICH and IS groups [HR (95% CI) was 1.37 (1.15-1.64) and 1.35 (1.06-1.71), respectively]. There was no significant difference in APACHE Ⅱ score on the risk of 14-day death between the patients aged > 60 years old and those aged ≤ 60 years old [ HR (95% CI): 1.37 (1.08-1.72) vs. 1.35 (1.07-1.70), respectively]. Compared with patients with SOFA score > 3, APACHE Ⅱ score had a greater impact on the risk of 14-day death in patients with SOFA score ≤ 3 [ HR (95% CI): 1.40 (1.16-1.70) vs. 1.34 (1.16-1.55)]. Conclusion:Time-dependent APACHE Ⅱ score is an important indicator to evaluate the risk of death in patients with severe stroke.

Single-cell RNA sequencing is a method for transcriptome profiling at the single-cell level,and is a hotspot technology in the field of biological research currently.Compared with the common high-throughput RNA sequencing,single-cell RNA sequencing can distinguish the biological differences between single cells,and identify rare cell populations and subpopulations.This review mainly describes the single-cell RNA sequencing method,summarizes current application of this technique in the field of dermatology,and discusses limitations and prospects of this technique.

The M and S segment cDNAs of hantavirus Z5 strain was amplified by RT-PCR,and the purified PCR products were cloned into vector pGEM-T and then sequenced.It was demonstrated that the M genome segment of Z5 was found to be 3 616 nucleotides in length with a single open reading frame encoding 1 135 amino acids.And the S genome segment was 1700 nucleotides in length with a single open reading frame encoding 429 amino acids.As demonstrated by the homologous analysis of nucleotides and amino acids,it was showed that the Z5 strain belonged to hantaan viruses HTN type and was the same subtype of the Z10 strain.It is conclouded that difference in nucleotide sequence exists between Z5 strain with other Hantavirus strains but high level of homology in amino acid sequences is still present.

Objective To investigate the influence of metformin on metabolic syndrome in patients with coronary artery disease.Methods 52 patients with coronary artery disease and metabolic syndrome were randomly assigned into 2 groups.the control group with 20 cases and the study group with 32 cases.All the patients were treated with standard coronary artery disease therapy and meanwhile the study group was administered with metformin in addition to the basic therapy above.The follow-up time is one year.FPG,2h postprandial glucose,FINS,TG,TC,HDL-C,insulin resistance index and other standards were compared before and after the therapy,and between the 2 groups when the observation was finished.The rate of cardiovascular events was also compared between the 2 groups.Results Compared with the control group,the study group had lower levels of FPG,2h postprandial glucose,FINS,TG and insulin resistance index when the therapy was completed(P<0.05),and the rate of cardiovascular events was also lower(P<0.05).Conclusion Metformin could lower the levels of glucose,FINS,BMI,TG and insulin resistance index in patients with coronary artery disease and metabolic syndrome.Thus,it could reduce and undermine cardlovascular risk factors,protect the cardiovascular system,reduce the rate of cardiovascular events,which fully benefits the patients.

One strain of Hantavirus(HV) was isolated from patients with hemorrhagic fever with renal syndrome (HFRS) in Zhejiang province and its S-segment was cloned and submitted to nucleotide sequence analysis in order to determine the type of strain and extent of genetic variation for further study on its evolution and mutation .The HV antigen was detected from mouse lungs in endemic area by direct immunofluorescene test and the HV-positive sample of mouse lung was inoculated to Vero-E6 cells to isolate virus. The total cellular RNA was extracted from infected cell culture and the S segment gene was amplicated by RT-PCR. Then, the purified PCR product was cloned into T vector for sequencing. The result showed that the full-length sequence of the S segment was 1 700 bp with one open reading frame (ORF) encoding 429 amino acids. Comparison with Hantavirus HTN type showed 85.7%-91.9% homology at the nucleotide level. In comparison with the SEO type of viruses, the homology at nucleotide level was shown to be 71.2%-75%. This new HV strain may be typed as to HTN virus and may be a new subtype of this virus.

Objective To observe the therapeutic effect of trimetazidine on patients with ischemic cardiomyopathy heart failure and the changes of plasma level of N-terminal pro-B type natriuretic peptide(NT-proBNP).Methods 62 patients with ischemic cardiomyopathy heart failure were randomly assigned to regular treatment group(3 1)and trimetazidine treatment group(31).All of them were given either regular medicine treatment or trimetazidine for 4 weeks.Concentration of NT-proBNP and echocardiography were detected before and after treatment and the correlation between NT-pmBNP and ultra-sound values was studied.Results There was no statistic difference in the NT-proBNP level between two groups before treatment,but after 4-week treatment the NT-proBNP level in both groups were deCreased(P＜0.05),the decline in the trimetazidine group was more significant.The NT-proBNP level was significantly correlated to LVEF and LVEDD(γ=-0.472、0.45 1;P＜0.05).Conclusions Trimetazidine has a positive effect on patients with ischemic cardiomyopathy heart failure,and decreases the plasma NT-proBNP level.NT-proBNP Can be used as a follow-up index.