Objective:To compare the therapeutic efficacies of mechanical thrombectomy (MT) and intravenous thrombolysis (IT) in patients with acute vertebrobasilar occlusive cerebral infarction.Methods:A prospective inclusion of 111 patients with acute vertebrobasilar artery occlusion admitted to our hospital from February 2014 to December 2019 was performed; these patients were divided into MT group ( n=66) and IT group ( n=45) according to the wishes of their families. MT was performed directly in patients from the MT group; IT was performed firstly in those from the IT group, and MT (also known as bridging treatment) was then used for those who showed no efficacy in IT when condition permission and having family member's willing. Vascular recanalization rate, incidence of symptomatic intracranial hemorrhage, National Institutes of Health Stroke Scale (NIHSS) scores, modified Rankin Scale (mRS) scores and mortality rate were assessed in the two groups after treatment. Results:During the course of the study, 7 patients (4 in the MT group and 3 in the IT group) dropped out, and finally 104 (62 in the MT group and 42 in the IT group) were included in the statistical analysis. Fifty-four patients in MT group had succeeded recanalization, and the recanalization rate (87.1%) was statistically higher than that in IT group (61.9%, P<0.05). There were 8 patients (12.9%) with symptomatic intracranial hemorrhage in MT group and 6 patients (14.3%) in IT group, without significant difference ( P>0.05). The treatment effective rate (difference value of NIHSS scores before and after treatment≥4 or NIHSS score after treatment=0) in patients from MT group (67.7%) was significantly higher than that in IT group (38.1%), the good prognosis rate (58.1%) was statistically higher than that in IT group (28.6%), and the mortality rate (3.2%) was statistically lower than that in IT group (14.3%, P<0.05). Among the 16 patients who did not receive IT, 14 patients changed to accept bridging treatment (2 family members refused re-thrombectomy); the vascular recanalization rate (78.6%), intracranial hemorrhage rate (14.3%), treatment effective rate (50.0%), good prognosis rate (57.1%), and mortality rate (7.1%) showed no significant differences as compared with those in the MT group ( P>0.05). Conclusion:For patients with acute vertebrobasilar occlusive cerebral infarction, MT can improve the vascular recanalization rate and clinical prognosis; even after the failure of IT, re-thrombectomy (bridging treatment) is still safe and effective.

Objective:To investigate the influence factors of poor efficacy after flap repair operation in patients with pressure ulcers.Methods:The retrospective case series study was conducted. From January 2011 to June 2021, 125 patients with stage Ⅲ and Ⅳ pressure ulcers treated in Hainan General Hospital met the inclusion criteria. There were 82 males and 43 females, aged 15-90 (57±20) years. According to the postoperative effects, the patients were divided into poor efficacy group (47 cases) and good efficacy group (78 cases). The clinical data of patients in the two groups were collected, including the age, gender, location, stage, size, and bone exposure of pressure ulcers, preoperative microorganism culture results of wound exudate sample, whether combined with osteomyelitis, diabetes, lower limb paroxysmal myospasm, and gatism or not, the number of surgical debridement combined with negative-pressure wound therapy, type of surgical flap, postoperative position, and preoperative albumin, leukocyte, C-reactive protein (CRP), and hemoglobin. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test. The binary multivariate logistic regression analysis was conducted to screen the independent risk factors influencing the poor efficacy after flap repair operation in 125 patients with stage Ⅲ and Ⅳ pressure ulcers. Results:The ratio of patients with lower limb paroxysmal myospasm in poor efficacy group was 22/47, which was significantly higher than 3/78 in good efficacy group ( χ2=33.83, P<0.01). The preoperative hemoglobin level of patients in poor efficacy group was (102±17) g/L, which was significantly lower than (113±20) g/L in good efficacy group ( t=-3.24, P<0.01). The preoperative CRP level of patients was 39.1 (14.1, 91.6) mg/L in poor efficacy group, which was significantly higher than 15.3 (6.6, 42.0) mg/L in good efficacy group ( Z=-3.04, P<0.01). There were no statistically significant differences in other indexes between patients in the two groups ( P>0.05). Multivariate logistic regression analysis showed that age, lower limb paroxysmal myospasm, and preoperative hemoglobin level were the independent risk factors for poor efficacy after flap repair operation in patients with pressure ulcers (with odds ratios of 1.03, 40.69, and 0.97, 95% confidence intervals of 1.00-1.06, 9.18-180.39, and 0.95-1.00, respectively, P<0.05 or P<0.01). Conclusions:Poor efficacy after flap repair operation in patients with pressure ulcers is affected by many factors, among which the age, lower limb paroxysmal myospasm, and preoperative hemoglobin level are the independent risk factors.