Objective To investigate the predictive factors of symptomatic intracranial hemorrhage(SICH) and the effect on outcomes after mechanical thrombectomy in patients with acute ischemic strokecaused by anterior circulation tandem occlusion. Methods From January 2014 to September 2018, patients with acute ischemic stroke caused by anterior circulation tandem occlusion and treated by endovascular mechanical thrombectomy from the Departments of Neurology in 5 general hospitals (the First Affiliated Hospital of Henan University of Science and Technology, the Affiliated Hospital of Yangzhou University,General Hospital of Eastern Theatre Command of PLA, Yijishan Hospital of Wannan Medical College,Xinqiao Hospital of Army Medical University of PLA) were enrolled retrospectively. SICH was evaluated according to the criteria of Heidelberg Bleeding Classification. The functional outcome was assessed by the modified Rankin Scale score at 90 d after onset, and 0-2 was defined as good outcome. Multivariate logistic regression analysis was used to determine the effect of SICH on the outcome at 90 d and the independent risk factors for SICH. Results A total of 124 patients with acute ischemic stroke caused by anterior circulation tandem occlusion and treated by endovascular mechanical thrombectomy were enrolled in this study. Among them, 19 (15. 3％) had SICH, 60 (48. 4％) had good outcomes, and 28 (22. 6％) died. The incidence of poor outcomes (94. 7％ vs. 43. 8％; χ2 = 16. 708, P < 0. 001 ) and mortality (57. 9％ vs.16. 2％; P < 0. 001 ) in the SICH group were significantly higher than those in the non-SICH group.Multivariate logistic regression analysis showed that SICH was an independent risk factor for poor outcome(odds ratio [OR] 27. 78, 95％ confidence interval [CI] 2. 60-96. 70; P = 0. 006), while larger infarct core(low ASPECT score) was the only independent predictor of SICH (OR 2. 63, 95％ CI 1. 18-5. 88; P =0. 018). Conclusion In patients with acute ischemic stroke caused by anterior circulation tandem occlusion and treated by endovascular mechanical thrombectomy, SICH is associated with poor outcome and higher mortality at 3 months, and larger preoperative infarction core is an independent predictor of SICH.

Objective: To investigate the clinical efficacy of arthroscopic irrigation combined with surgical debridement in the treatment of shoulder infection after arthroscopic rotator cuff repair. Methods: Data of 4 post-operative infected patients [(male 3 cases, female 1 case; 55 years (51-61 years)] after arthroscopic rotator cuff repair who underwent arthroscopic irrigation combined with surgical debridement from January 2016 to June 2019 were retrospectively analyzed. Less than 1 month after surgery, swelling, pain in the surgical area occurred and all patients had fever, abscess and sinus. Hematology and radiology were conducted immediately after admission. Antibiotic treatment was applied, and adjusted according to the culture results timely. All patients underwent arthroscopic irrigation combined with surgical debridement. Antibiotics continued accordingly after the operation. Blood routine, erythrocyte sedimentation rate, C-reactive protein, X-ray, etc. were rechecked regularly to evaluate the symptomatic relief of the infection and prognosis. Visual analogue scale (VAS) and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder function during the pre-operative and post-operative follow-up period. Results: The surgery was successfully completed in all 4 patients. One was treated with VSD for vacuum suction and the wound was closed one week later. The results of microbial culture showed that 2 cases were Mycobacterium tuberculosis positive, 1 case Pseudomonas aeruginosa positive, and 1 case was Staphylococcus aureus positive. After treatment, the shoulder sinuses of all patients were healed, without swelling, pain, etc. The follow-up time was 3, 4, 32, and 33 months, respectively. There was no recurrence of infection until the latest follow-up. The joint mobility and scores were better than the situation of preoperative. The VAS score and ASES score of 2 patients with early debridement (< 1 month duration of infected symptoms) were respectively improved significantly from 5 and 40, 6 and 23 before operation to 1 and 80, 1 and 73 respectively at the latest follow up. The VAS score and ASES score of other 2 patients (> 6 months duration of infected symptoms) were respectively improved from 6 and 28, 6 and 32 to 1 and 62, 2 and 65 respectively. All patients were satisfied with the results. Conclusion Early arthroscopic irrigation combined with surgical debridement is an effective method to treat the post-operative infections after arthroscopic rotator cuff repair.