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Objective:To assess the prognostic value of the collateral status and clot burden score based on four-dimensional computed tomography angiography(4D CTA)in anteriorcir culation is chemics troke patients with large ischemic core after endovascular treatment.Methods:Clinical and imaging data of 36 anterior circulation ischemic stroke patients with large infarct core (infarct core≥50.0 ml) after endovascular treatment at our institution from March 2016 to September 2020 were retrospectively reviewed. According to the modified Rankin Scale (mRS) score, patients were divided into the good outcome (mRS score 0-2) and poor outcome (mRS score 3-6) groups. Mann-Whitney U and Fisher tests were used to compare the 4D CTA collateral circulation score, clot burden score, and baseline clinical data between the good and poor outcome groups. Multivariate logistic regression was used to analyze the risk factors associated with the poor outcome (mRS score 3-6) and mortality in patients with large infarct core stroke. Finally, based on the 90-day outcome, a ROC curve was used to obtain the cut-off values for poor prognosis (mRS 3-6) and death, respectively. Results:Ten patients (27.8%) had good outcome and 26 (72.2%) had poor outcome. The patients in the poor outcome group had older median age, higher blood glucose, lower 4D CTA collateral circulation score, lower clot burden score, larger infarct core volume, and higher hemorrhagic transformation and brain hernia (all P<0.05). Multivariate logistic regression showed that the poor collateral circulation score on 4D CTA( OR=0.18, 95% CI: 0.03-0.99, P<0.05)and clot burden score( OR=0.64, 95% CI: 0.44-0.93, P<0.05) were independent predictors of the poor prognosis. The ROC curves revealed that the cut-off value of infarct core for distinguishing between good prognosis and poor prognosis was 63.7 ml, while that for distinguishing between survival and death was 130.3 ml. Conclusions:Endovascular treatment may improve the prognosis of patients with large infarct core of anterior circulation is chemic stroke if the patients have good 4D CTA collateral circulation score and high clot burden score.
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Objective To compare the efficacy between three-layer suture and Allg(o)wer-Donati suture on wound healing.Methods From September 2016 to June 2018,patients with Sanders type Ⅲ calcaneal fracture were randomly divided into two groups:three-layer close suture group (26 cases,18 males and 8 females,aged 19-48 years,with an average age of 33.69±8.84 years) and Allg(o)wer-Donati group (26 cases,19 males and 7 females,aged 19-49 years,with an average age of 32.38±8.45 years).The traditional L-shaped incision was used in all patients.The inflammatory reaction area of incision,skin temperature change at the corner of L-shaped incision line and the healing grade of incision were compared between the two groups.Results 52 patients were followed up for 6 months.At 2 weeks after operation,the inflammatory reaction area of incision skin in the three-layer close skin suture group (26.46±9.37 mm2) was smaller than that in Allg(o)wer-Donati suture group (33.16±9.33 mm2).There was a significant difference between the two groups (t=2.584,P=0.013).There was no difference in skin temperature at the comer of Lshaped incision between the two groups before and on the first day after operation.However,the incision skin temperature of the three-layer close suture group on the 2nd and 3rd day after operation [(36.47±0.33)℃ and (36.54±0.22)℃] was higher than that of Allg(o)wer-Donati group [(36.20±0.42)℃ and (36.22±0.43)℃].The difference was statistically significant (t=2.61,P=0.01;t=3.48,P=0.001).There were 25 cases of Class A healing and 1 case of Class B healing in three-layer close suture group,with Class A healing rate of 96.15％ (25/26).In Allg(o)wer-Donati group,there were 22 cases of Class A healing,1 case of Class B healing,and 3 cases of Class C healing,with Class A healing rate of 84.62％ (22/26).Among all grade B healing incisions,1 case had a small amount of local hemorrhagic exudation in the three-layer close suture group,while 1 case had a black necrosis at the edge of the incision,3 cases had a purulent incision and exposed steel plate in the Allg(o)wer-Donati group.Conclusion In the treatment of L-shaped incision of calcaneal fracture,three-layer close suture is a better method than Allg(o)wer-Donati suture because of smaller inflammatory reaction area of incision,higher skin temperature change at the comer of L-shaped incision on the 2nd and 3rd day after operation,higher rate of first-degree healing of incision and slighter incision complications.