Résumé
Objective:To investigate the efficacy and safety of intravenous thrombolysis based on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) mismatch in patients with wake-up stroke (WUS).Methods:Patients with acute ischemic stroke received alteplase intravenous thrombolysis in the Stroke Center, the Second People's Hospital of Hefei from July 2019 to June 2021 were enrolled retrospectively. According to the time of finding the symptoms, they were divided into WUS group and non-WUS group. The demographic and baseline clinical data were documented and compared between the two groups. The efficacy endpoint was the clinical outcome assessed by the modified Rankin Scale (MRS) score at 90 d after onset. 0-2 was defined as a good outcome, and >2 were defined as a poor outcome. The primary safety endpoint was symptomatic intracranial hemorrhage (sICH); the secondary safety endpoint was death within 90 d after onset. Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcome. Results:A total of 256 patients with acute ischemic stroke were enrolled, including 155 males (60.5%), aged 63.0±8.53 years. The median time from symptom onset to intravenous thrombolysis was 130.5 min, and the median baseline National Institutes of Health Stroke Scale (NIHSS) score was 7. Forty-eight patients (18.7%) were WUS and 208 (81.3%) were non-WUS; 186 (72.7%) had a good outcome and 70 (27.3%) had a poor outcome. There were no significant differences in 90 d good outcome rate (79.2% vs. 71.2%; χ2=1.260, P=0.262), sICH incidence (4.2% vs. 5.3%; χ2=0.102, P=0.750) and 90 d mortality (2.1% vs. 3.4%; χ2=0.000, P=1.000) between the WUS group and the non-WUS group. The baseline NIHSS score, the time from symptom onset to intravenous thrombolysis and the proportion of patients with cardiogenic embolism in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that the baseline NIHSS score (odds ratio 1.670, 95% confidence interval 1.453-1.919; P<0.001) and the time from symptom onset to intravenous thrombolysis (odds ratio 1.007, 95% confidence interval 1.000-1.015; P=0.043) were the independent risk factors for the poor outcome. Conclusion:The efficacy and safety of intravenous thrombolysis in DWI-FLAIR-mismatched wake-up stroke patients are comparable to those of acute ischemic stroke within the time window.
Résumé
Objective To compare the short-term follow-up cu ra tive effect of primary total hip replacement (THR) in treating fresh and old fem oral neck fractures. Methods Double follow-ups with an in terval of 13 months were performed in patients with femoral neck fractures under going THR in our department from January 1997 to October 1999. Results After a follow-up for 37-62 months (mean 44 months), we obtained f ull data of 47 patients [41-77 years old, (61.8?5.22) years old] with preoperative Harris score of 28.40?10.14 and postoperative score of 85.20?7. 91. The Harris score of patients with fresh femoral neck fractures (FFNF) incr eased from 21.60?8.73 preoperatively to 82.50?9.81 postoperatively〔at age of (63.50?5.53) years〕 and that of patients with old femoral neck fracture (O FNF) from 37.70?13.50 to 90.63?5.79, [at age of (58.90?7.81) years]. Of 47 patients, only one case had dislocation once within six weeks postoperative ly during function exercise and recovered after manual reduction. Another one wi th excellent function evaluation was given again internal fixation three years a fter THR because of femoral shaft fracture and obtained satisfactory recovery. N o complications were found in other patients. The mean Harris score in patients with OFNF was significantly higher than those with FFNF ( P