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.

Objective To conduct a retrospective cohort study on the influencing factors of poor prognosis of young and middle-aged patients with pulmonary tuberculosis. Methods Selecting 426 young and middle-aged patients who were diagnosed with pulmonary tuberculosis in our hospital from January to December 2018 as the research subjects. Collecting the social demography information of all patients and the information of potential factors affecting the prognosis (allergy history, smoking history, drinking history, BMI level, disease information, treatment information, etc.) and discussing the factors affecting the prognosis of young and middle-aged pulmonary tuberculosis patients and their effects. Results The average age of 426 patients was (41.93±5.17) years old, the average BMI of them was (21.97±3.15) kg/m2, and an average course of disease of them was (2.76±0.99) years. There was no significant difference in the basic sexual information between men and women. In this study, a total of 128 patients with poor prognosis were retrospectively followed up, including 90 males and 38 females. The detection rate of males was significantly higher than that of females (χ²=16.976, P<0.05). The detection rate of poor prognosis was lower in patients with lower BMI levels (F=12.774, P<0.001) and longer disease course (F=3.704, P<0.001). In addition, the proportion of patients with poor prognosis who had a history of smoking (χ²=18.850, P<0.001) and had comorbidities was higher (χ²=38.924, P<0.001), and the proportion of patients with ≥ 3 lung field lesions (χ²=127.207, P<0.001) and those with pulmonary cavities (χ²=32.566, P<0.001) were also higher, with statistically significant differences compared to those with good prognosis. Among those with poor prognosis, the proportion of regular treatment was lower (χ²=16.715, P<0.001), and the proportion of adverse reactions was higher (χ²=17.315, P<0.001). At the same time, a total of 128 cases with poor prognosis were retrospectively followed up in this study, and the incidence of poor prognosis was higher in males than in females (χ²=16.976，P<0.05) . At the same time , research has shown that the detection rate of poor prognosis has a potential positive correlation with lower BMI, longer disease duration, smoking history, comorbidities, ≥ 3 lung field lesions, and the presence of pulmonary cavities, while there is a potential negative correlation with regular treatment, both P<0.05. In the study, univariate regression equations were used to discuss the impact of potential factors on adverse prognosis. It can be seen that male, emaciated body type, disease course ≥ 5 years, smoking history, number of lung field lesions ≥ 3, pulmonary cavities, and comorbidities are potential risk factors, with HR>1 and P<0.05; Regular treatment suggests a potential protective factor, with an HR of 0.341 and P<0.05. Multivariate regression analysis further suggests that male, emaciated body type, smoking history, pulmonary cavities, and comorbidities are potential risk factors, with HR>1 and P<0.05; Regular treatment still showed potential protective factors, with an HR of 0.408, P<0.05. Conclusion: Male, emaciated body type, disease course ≥ 5 years, smoking history, number of lung field lesions ≥ 3, presence of pulmonary cavities and comorbidities are potential risk factors, while regular treatment suggests potential protective factors. Conclusion More targeted disease control and management should be implemented for middle-aged and young patients with pulmonary tuberculosis based on the aforementioned influencing factors to improve their prognosis.

Objective To establish an optimal limiting dose for dose limiting rings placed in the anterior and posterior regions of the neck for reducing head and neck lymphedema under intensity-modulated radiation therapy(IMRT)for early nasopharyngeal carcinoma(NPC)from a dosimetric perspective.Method Fifteen newly diagnosed early-stage nasopharyngeal carcinoma patients who underwent CT localization for radiotherapy at the Cancer Hospital of Guangzhou Medical University from January to September 2022 were included in the study.Each case was designed with five sets of radiotherapy plans.Plan A consisted of conventional unlimited-field plans,while Plans B-E consisted of limited-field plans with dose constraints set at 20,18,16,and 14 Gy,respectively,with the remaining parameters consistent with Plan A.The impact on target coverage and organ-at-risk constraints was evaluated through variance analysis and pairwise multiple comparisons using a randomized block design to determine the optimal dose limits.Results The gradient of 16Gy was determined as the optimal dose limiting cutoff point for achieving the balance between target coverage and organ limiting dose.Compared with the conventional plan,The plans with the placement of a cervical anterior and posterior dose limiting ring(16Gy)did not change the target dose coverage(P>0.05),but only yielded a slight change in the homogeneity index(P<0.05).It did not cause any changes of the dosage in the inner ear,mandible,and brainstem(all P>0.05),but lead to statisti-cally significant reductions in the oral cavity,throat,and thyroid(all P<0.05).It caused a slight increase of the dose in the parotid gland and spinal cord(both P<0.05),but the increased dose was anyhow within the tolerance range.Conclusion The dosimetric investigation determines an optimal dose limit cutoff point for the cervical ante-rior and posterior dose limiting rings.It is expected to provide a design method for IMRT plans to reduce head and neck lymphedema after radiotherapy for early NPC.

Objective:To establish the ultra-high performance liquid chromatography (UPLC) fingerprint and high performance liquid chromatography (HPLC) content determination method of Curcumae Radix standard decoction; To predict the quality markers of Curcumae Radix standard decoction combined with network pharmacology.Methods:UPLC method was used to establish the fingerprint of Curcumae Radix standard decoction, and the common peaks were determined. Combined with chemical pattern recognition techniques such as similarity analysis and clustering analysis, Curcumae Radix standard decoction from different producing areas was studied, and curcumol was used as an index to determine the content of 24 batches of Curcumae Radix standard decoction. At the same time, network pharmacology was used to predict potential of curcumol and (1S, 6β)-1β-Methyl-4-(1-methylethylidene)-7β-(3-oxobutyl) bicyclo [4.1.0] heptan-3-one.Results:A total of 24 batches of Curcumae Radix standard decoction from different habitats were compared and analyzed, and 10 common peaks were calibrated. The similarity of 24 batches of samples ranged from 0.982 to 0.999. Clustering analysis and principal component analysis divided them into three categories. Heat map analysis showed that peak 8 (curcumol) and peak 9 ((1S, 6β)-1β-Methyl-4-(1-methylethylidene)-7β-(3-oxobutyl) bicyclo [4.1.0] heptan-3-one) were the main components. The content of curcumol in 24 batches of Curcumae Radix standard decoction was 0.69-1.87 mg/g; curcumol and (1S, 6β)-1β-Methyl-4-(1-methylethylidene)-7β- (3-oxobutyl) bicyclo [4.1.0] heptan-3-one may regulate the neuroactive ligand-receptor interaction signaling pathway, calcium signaling, and excitation by regulating neuroactive ligand-receptor interaction signaling pathway, calcium signaling, and excitation. It was preliminarily predicted that curcumol and (1S, 6β)-1β-Methyl-4-(1-methylethylidene)-7β-(3-oxobutyl) bicyclo [4.1.0] heptan-3-one were potential quality markers of Curcumae Radix.Conclusion:Curcumol and (1S, 6β)-1β-Methyl-4-(1-methylethylidene)-7β-(3-oxobutyl) bicyclo [4.1.0] heptan-3-one are potential quality markers of Curcumae Radix standard decoction, and the established fingerprint can be used for the quality control of Curcumae Radix standard decoction.

Objective To explore the diagnostic value of CD4 cell count and IL-6/IL-10 ratio in combination for the diagnosis of AIDS complicated with Pneumocystis pneumonia. Methods A total of 100 AIDS patients with pneumocystis pneumonia admitted to the Nanchong Central Hospital from January 2018 to May 2019 were enrolled in the AIDS pneumonia group, 100 AIDS patients were enrolled in the AIDS group, and 100 healthy subjects were included in the control group. The number of CD4+T cells in serum was detected by flow cytometry, and the expression levels of IL-6 and IL-10 in serum were detected by enzyme-linked immunosorbent assay. The AUC of receiver operating characteristic curve (ROC) was used to analyze the CD4 cell count and the diagnostic significance of IL-6/IL-10 detection in AIDS with pneumocystis pneumonia. Results The number of CD4 cells in the serum of AIDS patients with Pneumocystis pneumonia was significantly lower than that of AIDS patients and healthy subjects (t=28.31, P<0.0001; t=36.90, P<0.0001), but the ratio of IL-6/IL-10 was higher than that of AIDS patients and healthy individuals (t=7.184, P<0.0001; t=19.03, P<0.0001). The sensitivity of CD4 cell count and IL-6/IL-10 ratio in the diagnosis of AIDS patients with Pneumocystis pneumonia was 92.00%, the specificity was 88.00%, and the accuracy was 89.33%. Conclusion The detection of CD4 cell count and IL-6/IL-10 ratio can be used as a potential marker for the diagnosis of AIDS with Pneumocystis pneumonia.

Objective To investigate the clinical value of bone metabolism biochemical marker N-MID,TP1NP and beta-CTx combined with whole body bone scintigraphy in early diagnosis of bone metastasis of tumor.Methods The concentration of the 3 markers were measured by the electrochemical luminescence analysis method in 30 cases of healthy control group and 210 cases of patients with malignant tumor,which were divided into non bone metastasis group(45 cases) and bone metastasis group(165 cases).The bone metastasis group were divided into 4 grades(0-grade Ⅲ) by Soloway classification according to whole body bone imaging.Results The levels of serum N-MID,TP1NP and beta-CTx in 165 malignant tumor patients with bone metastasis were significantly higher than in 45 malignant tumor patients with bone metastasis and in 30 healthy control group,the difference was statistically significant(P<0.05).With the increase of the number of metastatic lesions in the bone metastasis group,the serum levels of N-MID,TP1NP,and beta-CTx were increased gradually,and they were positively correlated with the progression of the disease.According to the analysis of ROC curve,the cut-off value,sensitivity and specificity in the diagnosis of tumor bone metastasis were 17.59 ng/mL,70.3％,88.9％ for serum N-MID,43.04 ng/mL,78.2％,95.6％ for TP1NP,and 0.48 ng/mL,73.9％,93.3％ for beta-CTx.Under the ROC curve(AUC) was 0.831 for serum N-MID,0.890 for TP1NP,and 0.869 for beta-CTx.The sensitivity and specificity of three bone metabolic markers in the diagnosis of bone metastasis of malignant tumor were significantly higher.Conclusion Bone metabolism biochemical markers:Serum N-MID,TP1NP and beta-CTx for diagnosis of bone metastasis of malignant tumor are sensitive,accurate and simple,which can significantly improve the efficiency of diagnosis of bone metastasis,and can be combined with whole-body bone scintigraphy in early diagnosis of bone metastasis with malignant tumor.

PurposeTo explore the value of gemstone spectral imaging (GSI) in diagnosis of thyroid nodule hemorrhage.Materials and Methods Seventeen patients with surgery and pathology confirmed thyroid nodule hemorrhage underwent thyroid spectrum CT scan. The CT value, iodine concentration value, water concentration value and the effective atomic ordinal value as well as spectral curve slope of hemorrhagic nodules and surrounding normal thyroid tissue were measured respectively.Results Hemorrhagic thyroid nodules showed equal or high CT value, low concentration of iodine, high concentration of water, low spectral curve slope, and low effective atomic ordinal value on spectral CT imaging. There were statistically significant differences in concentration of iodine value, concentration of water value, and spectral curve slope between hemorrhagic nodules and surrounding normal thyroid tissue (Z=-5.438,-4.679 and-5.317,P<0.01), and there were statistically significant differences in CT value and effective atomic ordinal value (Z=-2.097 and-2.230,P<0.05).Conclusion Energy spectrum CT scan is important in detection and accurate diagnosis of thyroid nodule hemorrhage.

BACKGROUND:Autologous hematopoietic stem celltransplantation is an effective treatment for multiple myeloma. After chemotherapy, autologous hematopoietic stem celltransplantation becomes a standard therapeutic regimen for multipla myeloma, and numerous units and centers have reported that. How to reduce toxic and adverse reactions of the drugs, transplantation-related complications and improvement of long-term survival have been present foci.
OBJECTIVE:To summarize the new progress of autologous hematopoietic stem celltransplantation in the treatment of multiple myeloma.
METHODS:We retrieved PubMed and China National Knowledge Infrastructure database, Vip database, Wanfang database, free medicaljournals.com source for articles published from January 2006 to November 2012 concerning autologous hematopoietic stem celltransplantation in the treatment of multiple myeloma. The key words were“autologous hematopoietic stem celltransplantation, multiple myeloma”. A total of 46 articles were included.
RESULTS AND CONCLUSION: Large-dose chemotherapy combined with autologous hematopoietic stem celltransplantation for multiple myeloma obtained better outcomes compared with the traditional chemotherapy. However, many patients could not relieve after single autologous hematopoietic stem celltransplantation, and the disease recurred final y. Al ogeneic hematopoietic stem celltransplantation was limited by donor source, and treatment-associated fatality rate was high, so its use was confined. Therefore, present new development direction included twice autologous hematopoietic stem celltransplantation, autologous transplantation combined with al ogeneic transplantation with reduced-intensity conditioning regimens as wel as drug on the basis of single autologous hematopoietic stem celltransplantation. Novel drug proteasomes inhibitor and immunomodulator in inducer remission, pretreatment and sustaining stages obviously improved total reaction rate of multiple myeloma therapy and long-term survival.

Objective To investigate integrated status of community inpatients with type 2 diabetes mellitus.Methods 240 cases of type 2 diabetic patients in the Zhangjiagang Aoyang Hospital were included in the study from May 1,2007 to Dec 31,2008.A uniform questionnaire was applicated.Gender,disease duration,age,academic qualifications,occupation,education,height,weight,waist circumference,hip,relevant medical history and so on were collected.Results The onset age of inpatients with type 2 diabetes was (48.91 ± 12.38),onset age of male was(46.32 ±12.08),which was significantly lower than female (52.42 ± 11.97) (P ＜ 0.01).The onset age female and male proportion also had significant differences,age onset of male was in advance.The average body mass index was (24 ±3.47)kg/m2,most of the inpatients were workers and farmers,the level of education was primary and secondary.Multiple regression analysis hints,risk factor of onset age is the family history of diabetes,the history of hypertension,male,low academic qualifications.Percentage of newly diagnosed patients was 28.3％,about one-third in patients were with the metabolic syndrome,hyperlipidemia,high blood pressure,fatty liver.Conclusions Education level of the inpatients was lowe in the community,so strengthening diabetes education was required.The persons in the commuities who were male,or with the family history of diabetes,with high blood pressure history were of the communities require for early screening of diabetes mellitus,so the occurrence and development of diabetes woule be controlled.

10.3969/j.issn.2095-4344.2013.26.013