Objective To observe the value of hypoperfusion intensity ratio(HIR)of CT perfusion(CTP)for predicting infarct core progression and prognosis of acute ischemic stroke(AIS).Methods Totally 271 AIS patients were retrospectively enrolled and divided into rapid progression group(group A,n=92)and slow progression group(group B,n=179)according to infarction growth rate(IGR).Clinical data,CTP parameters,treatment strategies and patients' outcome were compared between groups.Receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to evaluate the efficacy of HIR for predicting rapid progression in infarct core of AIS.The mediating relationships among HIR,IGR and modified Rankin scale(mRS)90 days after treatment were analyzed.Results Significant differences of National Institute of Health stroke scale(NIHSS)score,Alberta stroke program early CT score(ASPECTS),also of interval time between onset and CTP,infarct core volume,hypoperfusion volume,HIR,whether intravenous thrombolysis and mRS score 90 days after treatments were found between groups(all P＜0.05).The AUC of HIR for predicting infarct core progression of AIS was 0.856,with sensitivity and specificity was 73.91％and 81.56％,respectively,when the optimal cutoff value was 0.42.IGR was a complete mediating variable between HIR and mRS score 90 days after treatment.Conclusion HIR of CTP could be used to effectively predict infarct core progression of AIS,which completely affected prognosis through mediating variable IGR.

Objective To observe the value of hypoperfusion intensity ratio(HIR)of CT perfusion(CTP)for predicting infarct core progression and prognosis of acute ischemic stroke(AIS).Methods Totally 271 AIS patients were retrospectively enrolled and divided into rapid progression group(group A,n=92)and slow progression group(group B,n=179)according to infarction growth rate(IGR).Clinical data,CTP parameters,treatment strategies and patients' outcome were compared between groups.Receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to evaluate the efficacy of HIR for predicting rapid progression in infarct core of AIS.The mediating relationships among HIR,IGR and modified Rankin scale(mRS)90 days after treatment were analyzed.Results Significant differences of National Institute of Health stroke scale(NIHSS)score,Alberta stroke program early CT score(ASPECTS),also of interval time between onset and CTP,infarct core volume,hypoperfusion volume,HIR,whether intravenous thrombolysis and mRS score 90 days after treatments were found between groups(all P＜0.05).The AUC of HIR for predicting infarct core progression of AIS was 0.856,with sensitivity and specificity was 73.91％and 81.56％,respectively,when the optimal cutoff value was 0.42.IGR was a complete mediating variable between HIR and mRS score 90 days after treatment.Conclusion HIR of CTP could be used to effectively predict infarct core progression of AIS,which completely affected prognosis through mediating variable IGR.

Objective:To investigate the long-term outcomes of laparoscopic ventral rectopexy (LVR) for obstructive defecation with overt pelvic structural abnormalities.Methods:The retrospective cohort study was conducted. The clinical data of 31 obstructive defecation patients with overt pelvic structural abnormalities who were admitted to the Renji Hospital of Shanghai Jiaotong University School of Medicine from June 2014 to August 2020 were collected. There were 6 males and 25 females, aged 59(range, 32?81)years. All 31 patients underwent LVR through transabdominal approach. Observation indicators: (1) the Cleveland clinic constipation score (CCCS); (2) severity of obstructive defecation; (3) patients assessment of constipation quality of life (PAC-QoL). Follow-up was conducted using telephone interview and outpatient examination up to October 2021. One professional researcher assessed the constipation symptoms and quality of life of patients through outpatient interview or mobile software platform of Questionnaire Star. Measurement data with skewed distribution were represented as M(range), and comparison before and after operation was conducted using the Wilcoxon sign rank test. Results:(1) The CCCS. All 31 patients underwent LVR for the first time and were followed up for 61.8(range, 11.0?87.0)months. The constipation symptoms of the 22 patients were improved. The CCCS of the 31 patients before surgery and at the last follow-up time were 15.8(range, 8.0?26.0) and 10.7(range, 2.0?20.0), respectively, showing a significant difference ( Z=?3.98, P<0.05). (2) Severity of obstructive defecation. The severity scores of frequency of bowel movements, difficult of bowel movements, sensation of incomplete defecation, abdominal distension or pain, time of each bowel movements, daily unsuccessful times of defecation, artificial assisted defecation for the 31 patients were 2.9(range, 1.0?4.0), 3.0(range, 1.0?4.0), 1.9(range, 0?3.0), 0.5(range, 0?3.0), 2.6(range, 2.0?4.0), 2.0(range, 0?4.0), 0.9 (range, 0?2.0) before surgery, versus 1.7(range, 0?4.0), 1.6(range, 0?4.0), 1.2(range, 0?4.0), 0.3(range, 0?3.0), 1.7(range, 0?3.0), 1.4(range, 0?3.0), 0.7(range, 0?2.0) after surgery, respectively. There were significant differences in the frequency of bowel movements, difficult of bowel movements, sensation of in-complete defecation, abdominal distension or pain, time of each bowel movements, daily unsuccessful times of defecation for the 31 patients before and after surgery ( Z=?3.38, ?3.80, ?2.54, ?2.31, ?3.64, ?2.75, P<0.05) and there was no significant difference in the artificial assisted defecation for the 31 patients before and after surgery ( Z=?1.31, P>0.05). (3) PAC-QoL. The score of physical discomfort, satisfaction, worries and concerns, psychological discomfort for the 31 patients were 2.3(range, 1.0?4.0), 3.2(range, 1.0?4.8), 2.2(range, 0.6?4.0), 1.8(range, 0.4?3.9) before surgery, versus 1.6(range, 0?4.0), 2.3(range, 0?4.0), 1.7(range, 0?4.0), 1.3(range, 0?4.0)after surgery, respectively, showing significant differences before and after surgery ( Z=?3.49, ?2.17, ?2.50, ?3.05, P<0.05). Conclusions:The long-term outcomes of LVR for obstructive defecation with overt pelvic structural abnorma-lities are satisfactory. Symptoms as frequency of bowel movements, difficult of bowel movements, sensation of incomplete defecation, abdominal distension or pain, time of each bowel movements and daily unsuccessful times of defecation will be significantly improved after LVR and the constipation quality of life of patients will be improved.