RESUMEN
Objective:To develop a nomogram model based on clinical and imaging parameters to predict the etiological type of acute ischemic stroke (AIS).Methods:Patients with AIS received endovascular treatment in Beijing Hospital from March 2016 to December 2021 were retrospectively included. According to the etiological type, they were divided into large artery atherosclerosis (LAA) and cardioembolism (CE). The clinical and imaging parameters mostly relevant to the etiological type were selected by LASSO regression, and a nomogram model for predicting the etiological type of AIS was established by multifactorial logistic regression to investigate the predictive value of relevant clinical imaging parameters. In addition, the diagnostic efficacy of the prediction model was assessed by receiver operator characteristic (ROC) curves, calibration curves, and clinical decision curves. Results:A total of 136 AIS patients with anterior circulation large vessel occlusion received endovascular treatment were included, including 62 patients with CE (45.6%) and 74 with LAA (54.4%). Variables with P<0.10 in the univariate analysis were included in LASSO regression to screen for relevant variables. The gender, baseline National Institute of Health Stroke Scale (NIHSS) score, penumbra to ischemic core ratio, brain natriuretic peptide (BNP), and platelet (PLT) count were included into the multivariate logistic regression model. The results revealed that gender (odds ratio [ OR] 2.632, 95% confidence interval [ CI] 1.048-6.607; P=0.039), baseline NIHSS score ( OR 1.078, 95% CI 1.002-1.160; P=0.043), BNP ( OR 1.004, 95% CI 1.002-1.007. P<0.001), PLT ( OR 0.991, 95% CI 0.982-0.999; P=0.031) as the predictors to distinguish LAA from CE. In addition, the penumbra to infarct core ratio ( OR 0.886, 95% CI 0.785-1.000; P=0.050) also played an important role in predicting the model. The diagnostic efficacy of this predictive model was analyzed by the ROC curves, with an area under the curve of 0.881 (95% CI 0.815-0.930, P<0.001). Bootstrap internal validation showed that the good compliance with a mean absolute error of 0.027 for true versus predicted value compliance. Calibration curves, clinical decision curves, and Hosmer-Lemeshow test ( P=0.562) showed good agreement between the predicted and actual values of the model. Conclusion:Patients with CE are more common in women, have higher NIHSS scores and BNP, and have lower PLT and penumbra to ischemic core ratio. The nomogram model combining the above indicators can better identify LAA and CE, and maybe helpful in clinical decision making.
RESUMEN
Purpose To explore the application value of forward projected model-based iterative reconstruction solution(FIRST)algorithm improving image quality of 100 kV low-dose head and neck CT angiography(CTA).Materials and Methods A total of 32 patients who underwent head and neck CTA examinations in the Beijing Hospital from September to October 2021 were retrospectively recruited.All patients were divided into three groups based on different reconstruction,including the filtered back projection(FBP)group,the adaptive iterative dose reduction 3D(AIDR 3D)group,and the FIRST group.The average CT value,image noise,signal-to-noise ratio,contrast to noise ratio and other objective indicators of the main blood vessels images(including common carotid artery,vertebral artery,internal carotid artery C1,C4,middle cerebral artery M1,M3 and anterior cerebral artery A1,A3)and background(including muscle,brain tissue)in the head and neck of the three groups were recorded and analyzed,respectively.The subjective imaging evaluation was scored and analyzed.Digital subtraction angiography(DSA)was used as the gold standard to evaluate the detection of vascular stenosis in the head and neck by each reconstruction algorithm.Results Compared with the AIDR 3D group and the FBP group,the FIRST group significantly reduced the image noise of the blood vessels and the background(muscle,brain tissue)(t=-13.19--7.28,all P<0.001).The signal-to-noise ratio and contrast to noise ratio of the FIRST group were significantly higher than those of the FBP group,AIDR 3D group(t=2.17-9.67,all P<0.001).The CT values of FIRST group were significantly higher than those of AIDR 3D group in the common carotid artery,internal carotid artery C1 and C4,middle cerebral artery M1,and anterior cerebral artery A1 segment(t=1.28-3.60,all P<0.05).The CT value of background(muscle,brain tissue)in FIRST group was significantly lower than those in the FBP group and the AIDR 3D group,with statistically significant difference(t=-7.63--4.03,all P<0.001).The images of FIRST group and AIDR 3D group met the diagnostic requirements,and the subjective scores of the two groups were significantly higher than those of the FBP group images(all P<0.05).The imaging scores of FIRST group were significantly higher than those of AIDR 3D group(P<0.05).Compared with DSA,FBP was ineffective for mild and moderate stenosis;FIRST and AIDR 3D algorithms were consistent with DSA.Conclusion Compared with traditional FBP and AIDR 3D reconstruction algorithms,FIRST algorithm can effectively improve the image quality of low-dose head and neck CTA and obtain better image quality and meet the diagnostic performance of head and neck vascular diseases.
RESUMEN
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.
RESUMEN
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.