1.Comparative efficacy of internal brace-augmeted reconstruction combined with tape tail-folding anterolateral ligament reconstruction and isolated internal brace-augmented reconstruction for high-grade pivot-shift anterior cruciate ligament injuries
Xiaocheng MAO ; Yanan HUANG ; Qingnan HONG ; Ruijin YOU ; Feng ZHAO
Chinese Journal of Trauma 2025;41(11):1086-1093
Objective:To compare the efficacy of internal brace-augmeted reconstruction combined with tape tail-folding anterolateral ligament reconstruction (ALL) and isolated internal brace-augmented reconstruction for high-grade pivot-shift anterior cruciate ligament (ACL) injuries.Methods:A retrospective cohort study was conducted to analyze the clinical data of 60 patients with high-grade pivot-shift ACL injuries who were admitted to 910th Hospital of Joint Logistics Support Force of PLA between March 2021 and March 2023, including 48 males and 12 females, aged 18-40 years [(28.4±5.6)years]. All ACL injuries were at grade III. The pivot-shift test results were classified as grade 2 in 42 patients and grade 3 in 18. According to the surgical technique, 30 patients underwent artificial internal brace-augmented ACL reconstruction combined with tape tail-folding ALL reconstruction (joint ACL reconstruction group), while the other 30 received isolated internal brace-augmented ACL reconstruction (simple ACL reconstruction group). The two groups were compared in terms of operative duration, intraoperative blood loss, improvement rate of pivot-shift at 3 months postoperatively, rate of sports function recovery at the last follow-up, Tegner and Lysholm scores preoperatively, at 3 months postoperatively, and at the last follow-up, and incidence of postoperative complications.Results:All the patients were followed up for 6-24 months [(14.8±5.8)months]. The operative duration and intraoperative blood loss were (44.6±8.2)minutes and (45.3±4.6)ml in the simple ACL reconstruction group, significantly shorter or less than (58.0±7.4)minutes and (61.8±9.1)ml in the joint ACL reconstruction group ( P<0.01). At 3 months after surgery, the improvement of pivot-shift test was 93%(28/30) in the joint ACL reconstruction group, higher than 73%(22/30) in the simple ACL reconstruction group ( P<0.05). At the last follow-up, the recovery rate of motor function was 100%(30/30) in the joint ACL reconstruction group, significantly higher than 80%(24/30) in the simple ACL reconstruction group ( P<0.05). There were no statistically significant differences in Tegner or Lysholm scores between the two groups before surgery ( P>0.05). At 3 months after surgery and at the last follow-up, the Tegner scores were (3.8±0.5)points and (5.7±1.1)points in the joint ACL reconstruction group, significantly higher than (2.5±0.6)points and (3.9±0.9)points in the simple ACL reconstruction group ( P<0.01). At 3 months after surgery and at the last follow-up, the Lysholm scores were (67.2±5.7)points and (89.4±6.4)points in the joint ACL reconstruction group, significantly higher than (56.4±5.0)points and (72.6±5.7)points in the simple ACL reconstruction group ( P<0.01). Both groups demonstrated gradual improvement in Tegner and Lysholm scores at all postoperative time points, compared to preoperative values ( P<0.05). After operation, one patient in the joint ACL reconstruction group had superficial tibial infection, with a complication rate of 3% (1/30), whereas there was one patient with superficial tibial infection, and one with ligament injury in the simple ACL reconstruction group, with a total complication rate of 7% (2/30)( P<0.05). Conclusion:For high-grade pivot-shift ACL injuries, internal brace-augmented reconstruction combined with tape tail-folding ALL reconstruction can significantly improve knee rotational stability, promote motor function recovery, and enhance knee joint outcomes, compared to isolated internal brace-augmented reconstruction.
2.Comparative efficacy of internal brace-augmeted reconstruction combined with tape tail-folding anterolateral ligament reconstruction and isolated internal brace-augmented reconstruction for high-grade pivot-shift anterior cruciate ligament injuries
Xiaocheng MAO ; Yanan HUANG ; Qingnan HONG ; Ruijin YOU ; Feng ZHAO
Chinese Journal of Trauma 2025;41(11):1086-1093
Objective:To compare the efficacy of internal brace-augmeted reconstruction combined with tape tail-folding anterolateral ligament reconstruction (ALL) and isolated internal brace-augmented reconstruction for high-grade pivot-shift anterior cruciate ligament (ACL) injuries.Methods:A retrospective cohort study was conducted to analyze the clinical data of 60 patients with high-grade pivot-shift ACL injuries who were admitted to 910th Hospital of Joint Logistics Support Force of PLA between March 2021 and March 2023, including 48 males and 12 females, aged 18-40 years [(28.4±5.6)years]. All ACL injuries were at grade III. The pivot-shift test results were classified as grade 2 in 42 patients and grade 3 in 18. According to the surgical technique, 30 patients underwent artificial internal brace-augmented ACL reconstruction combined with tape tail-folding ALL reconstruction (joint ACL reconstruction group), while the other 30 received isolated internal brace-augmented ACL reconstruction (simple ACL reconstruction group). The two groups were compared in terms of operative duration, intraoperative blood loss, improvement rate of pivot-shift at 3 months postoperatively, rate of sports function recovery at the last follow-up, Tegner and Lysholm scores preoperatively, at 3 months postoperatively, and at the last follow-up, and incidence of postoperative complications.Results:All the patients were followed up for 6-24 months [(14.8±5.8)months]. The operative duration and intraoperative blood loss were (44.6±8.2)minutes and (45.3±4.6)ml in the simple ACL reconstruction group, significantly shorter or less than (58.0±7.4)minutes and (61.8±9.1)ml in the joint ACL reconstruction group ( P<0.01). At 3 months after surgery, the improvement of pivot-shift test was 93%(28/30) in the joint ACL reconstruction group, higher than 73%(22/30) in the simple ACL reconstruction group ( P<0.05). At the last follow-up, the recovery rate of motor function was 100%(30/30) in the joint ACL reconstruction group, significantly higher than 80%(24/30) in the simple ACL reconstruction group ( P<0.05). There were no statistically significant differences in Tegner or Lysholm scores between the two groups before surgery ( P>0.05). At 3 months after surgery and at the last follow-up, the Tegner scores were (3.8±0.5)points and (5.7±1.1)points in the joint ACL reconstruction group, significantly higher than (2.5±0.6)points and (3.9±0.9)points in the simple ACL reconstruction group ( P<0.01). At 3 months after surgery and at the last follow-up, the Lysholm scores were (67.2±5.7)points and (89.4±6.4)points in the joint ACL reconstruction group, significantly higher than (56.4±5.0)points and (72.6±5.7)points in the simple ACL reconstruction group ( P<0.01). Both groups demonstrated gradual improvement in Tegner and Lysholm scores at all postoperative time points, compared to preoperative values ( P<0.05). After operation, one patient in the joint ACL reconstruction group had superficial tibial infection, with a complication rate of 3% (1/30), whereas there was one patient with superficial tibial infection, and one with ligament injury in the simple ACL reconstruction group, with a total complication rate of 7% (2/30)( P<0.05). Conclusion:For high-grade pivot-shift ACL injuries, internal brace-augmented reconstruction combined with tape tail-folding ALL reconstruction can significantly improve knee rotational stability, promote motor function recovery, and enhance knee joint outcomes, compared to isolated internal brace-augmented reconstruction.
3.Effect of long non-coding RNA-ROR mediating epithelial-mesenchymal transformation on radiotherapy resistance of nasopharyngeal carcinoma cells in vitro
Xiaocheng XUE ; Xue ZHANG ; Shuixian HUANG ; Yi ZHANG ; Dan LU ; Xiaoping CHEN
Academic Journal of Naval Medical University 2024;45(10):1218-1225
Objective To investigate the role of long non-coding RNA(lncRNA)-ROR in mediating epithelial-mesenchymal transformation(EMT)and its impact on radiotherapy resistance in nasopharyngeal carcinoma cells.Methods Nasopharyngeal carcinoma cells CNE2 were divided into blank group,negative control(NC)group and lncRNA-ROR siliencing group;or were divided into blank group,radiotherapy group,radiotherapy+NC group,and radiotherapy+lncRNA-ROR overexpression group(radiotherapy treated with 6 Gy radiation for 24 h).The CNE2 proliferation was detected by cell counting kit 8 method.The cell migration was detected by cell scratch test and Transwell cell migration test.The apoptosis ratio was detected by flow cytometry,and the apoptosis-related proteins and epithelial-mesenchymal transition proteins were detected by Western blotting.Results Compared with the blank group and NC group,the proliferation ability of nasopharyngeal carcinoma cells CNE2 was decreased after inhibition of lncRNA-ROR expression for 48 and 72 h(all P<0.05).The mobility of CNE2 cells after lncRNA-ROR expression inhibition was lower than that in the NC group(P<0.05).The migration ability of CNE2 cells in the radiotherapy+lncRNA-ROR overexpression group was higher than that in the radiotherapy group and radiotherapy+NC group(both P<0.05).Compared with the radiotherapy group and radiotherapy+NC group,the apoptosis rates of CNE2 cells in the radiotherapy+lncRNA-ROR overexpression group was decreased(both P<0.05).After lncRNA-ROR inhibition,the expression of activated caspase 3 and caspase 9 proteins was increased(both P<0.05),while the expression of activated caspase 3 and caspase 9 proteins was decreased in the radiotherapy+overexpressed lncRNA-ROR group(both P<0.05).Inhibition of lncRNA-ROR increased the expression of epithelial marker proteins(E-cadherin,β-catenin),and decreased the expression of interstitial marker proteins(N-cadherin,vimentin).The epithelial marker protein expression was decreased and interstitial marker protein expression was increased in CNE2 cells in the radiotherapy+lncRNA-ROR overexpression group compared with the radiotherapy group and radiotherapy+NC group(all P<0.05).Conclusion lncRNA-ROR can affect the radiotherapy resistance of nasopharyngeal carcinoma cells by regulating their proliferation,migration,apoptosis and EMT,and it is a potential target for reversing the radiotherapy resistance of nasopharyngeal carcinoma cells.
4.Intravenous ultrasound for evaluating atherosclerotic plaque characteristics of different type traditional Chinese medicine syndrome of coronary heart disease
Guoyou HUANG ; Xiaocheng LI ; Du XIONG
Chinese Journal of Medical Imaging Technology 2024;40(1):51-54
Objective To observe characteristics of atherosclerotic plaque of coronary heart disease(CHD)with different traditional Chinese medicine(TCM)syndrome type based on intravenous ultrasound(IVUS).Methods Data of 116 CHD patients were retrospectively analyzed.The patients were divided into syndrome of blood stasis due to qi deficiency(n=33),syndrome of blockade of phlegm-turbidity(n=42)as well as syndrome of intermin-gled phlegm and blood stasis(n=41)according to TCM syndrome differentiation.IVUS was performed to compare lesion vessel and plaque characteristics among different syndromic types of CHD.Results The lipid pool area,extravascular elastic membrane area,remodeling index,plaque eccentricity index of CHD with syndrome of blood stasis due to qi deficiency were all larger than those of syndrome of blockade of phlegm-turbidity as well as syndrome of intermin-gled phlegm and blood stasis(all P<0.05).The proportion of fibrous-fatty within plaques of syndrome of blood stasis due to qi deficiency was bigger than that of syndrome of intermin-gled phlegm and blood stasis(P<0.05).The lipid pool area,extravascular elastic membrane area and plaque eccentricity index of CHD of syndrome of blockade of phlegm-turbidity were smaller than,while the proportion of necrotic core within plaques was bigger than those of syndrome of intermin-gled phlegm and blood stasis(all P<0.05).Conclusion Atherosclerotic plaque characteristics in CHD with different TCM syndrome types were different,and the plaque stability of syndrome of blood stasis due to qi deficiency was the worst.
5.Relationship of serum 5-MTP and HDAC3 levels with myocardial fibrosis in elderly patients with acute myocardial infarction
Jingxia TIAN ; Na HUANG ; Xiaocheng HUANG ; Xiongsheng LÜ
Chinese Journal of Geriatric Heart Brain and Vessel Diseases 2024;26(12):1409-1413
Objective To investigate the relationship of serum levels of 5-methoxytryptophan(5-MTP)and histone deacetylase 3(HDAC3)with myocardial fibrosis in elderly patients with acute myocardial infarction(AMI).Methods A prospective study was conducted on 261 elderly AMI patients(observation group)admitted in our hospital from January 2021 to March 2024.Ano-ther 60 matched individuals who took physical examination in our hospital during same period served as control group.The AMI patients were further divided into myocardial fibrosis subgroup(104 cases)and non-myocardial fibrosis subgroup(157 cases)according to cardiac magnetic reso-nance imaging.The baseline data were collected for all participants,and late gadolinium enhance-ment(LGE)was used to evaluate myocardial fibrosis.The correlation of serum 5-MTP and HDAC3 levels and LGE score was analyzed.Univariate and multivariate logistic regression analy-ses were employed to identify the factors affecting myocardial fibrosis in elderly AMI patients.ROC curve was applied to evaluate the diagnostic performance of serum 5-MTP and HDAC3 lev-els for myocardial fibrosis.Results The observation group had significantly lower serum 5-MTP level and higher HDAC3 level than the control group(P<0.01).Pearson correlation analysis showed that serum 5-MTP(r=-0.891,P=0.000)was negatively,and HDAC3 was positively correlated with LGE score(r=0.732,P=0.000).The serum 5-MTP level was significantly lower,and the HDAC3 level was obviously higher in the myocardial fibrosis subgroup than the non-myo-cardial fibrosis group(P<0.01).Logistic regression analysis indicated that 5-MTP(OR=0.522,95%CI:0.361-0.754,P=0.001)and HDAC3(OR=2.024,95%CI:1.354-3.025,P=0.001)were predictors for myocardial fibrosis in elderly AMI patients.ROC curve analysis revealed that when the cutoff value of 5-MTP was 14.45 ng/L,the sensitivity and specificity were 83.65%and 78.98%,respectively,and the AUC value was 0.755(95%CI:0.618-0.892);when the cutoff value of HDAC3 was 150.40 μg/L,the sensitivity and specificity were 77.88%and 75.16%,respectively,and the AUC value was 0.809(95%CI:0.685-0.932);further regression analysis showed that the sensitivity and specificity were 95.17%and 96.82%,respectively,and the AUC value was 0.994(95%CI:0.977-1.000).Conclusion Serum 5-MTP and HDAC3 are abnormally expressed in elderly AMI patients,and they can be used to evaluate the occurrence and develop-ment of myocardial fibrosis.
6.Relationship of serum 5-MTP and HDAC3 levels with myocardial fibrosis in elderly patients with acute myocardial infarction
Jingxia TIAN ; Na HUANG ; Xiaocheng HUANG ; Xiongsheng LÜ
Chinese Journal of Geriatric Heart Brain and Vessel Diseases 2024;26(12):1409-1413
Objective To investigate the relationship of serum levels of 5-methoxytryptophan(5-MTP)and histone deacetylase 3(HDAC3)with myocardial fibrosis in elderly patients with acute myocardial infarction(AMI).Methods A prospective study was conducted on 261 elderly AMI patients(observation group)admitted in our hospital from January 2021 to March 2024.Ano-ther 60 matched individuals who took physical examination in our hospital during same period served as control group.The AMI patients were further divided into myocardial fibrosis subgroup(104 cases)and non-myocardial fibrosis subgroup(157 cases)according to cardiac magnetic reso-nance imaging.The baseline data were collected for all participants,and late gadolinium enhance-ment(LGE)was used to evaluate myocardial fibrosis.The correlation of serum 5-MTP and HDAC3 levels and LGE score was analyzed.Univariate and multivariate logistic regression analy-ses were employed to identify the factors affecting myocardial fibrosis in elderly AMI patients.ROC curve was applied to evaluate the diagnostic performance of serum 5-MTP and HDAC3 lev-els for myocardial fibrosis.Results The observation group had significantly lower serum 5-MTP level and higher HDAC3 level than the control group(P<0.01).Pearson correlation analysis showed that serum 5-MTP(r=-0.891,P=0.000)was negatively,and HDAC3 was positively correlated with LGE score(r=0.732,P=0.000).The serum 5-MTP level was significantly lower,and the HDAC3 level was obviously higher in the myocardial fibrosis subgroup than the non-myo-cardial fibrosis group(P<0.01).Logistic regression analysis indicated that 5-MTP(OR=0.522,95%CI:0.361-0.754,P=0.001)and HDAC3(OR=2.024,95%CI:1.354-3.025,P=0.001)were predictors for myocardial fibrosis in elderly AMI patients.ROC curve analysis revealed that when the cutoff value of 5-MTP was 14.45 ng/L,the sensitivity and specificity were 83.65%and 78.98%,respectively,and the AUC value was 0.755(95%CI:0.618-0.892);when the cutoff value of HDAC3 was 150.40 μg/L,the sensitivity and specificity were 77.88%and 75.16%,respectively,and the AUC value was 0.809(95%CI:0.685-0.932);further regression analysis showed that the sensitivity and specificity were 95.17%and 96.82%,respectively,and the AUC value was 0.994(95%CI:0.977-1.000).Conclusion Serum 5-MTP and HDAC3 are abnormally expressed in elderly AMI patients,and they can be used to evaluate the occurrence and develop-ment of myocardial fibrosis.
7.A prospective multicenter clinical trial study of a domestic HeartCon third-generation magnetic and hydrodynamic levitation LVAD for the treatment of 50 cases of end-stage heart failure
Xiaocheng LIU ; Chunsheng WANG ; Xinmin ZHOU ; Bin YANG ; Liangwan CHEN ; Qi AN ; Tianxiang GU ; Zhiyun XU ; Jinsong HUANG ; Xiangrong KONG ; Yongfeng SHAO
Chinese Journal of Thoracic and Cardiovascular Surgery 2023;39(5):273-278
Objective:To analyze and evaluate the safety and efficacy of a Chinese domestically manufactured Heart Con-type implantable third-generation magnetic and hydrodynamic levitation left ventricular assist device(LVAD) for the treatment of end-stage heart failure(ESHF), by reporting the results of eleven-center clinical trial on 50 cases.Methods:This study was a multicenter clinical trial, designed by means of prospective, multicenter and single-group target value. 50 subjects with ESHF were competitively enrolled and treated with HeartCon as the LVAD in eleven centers. The primary efficacy measure was survival, defined as either the subjects experiencing the transition to heart transplantation(HT) or myocardial recovery assisted by the device within 90 days, or as successfully assisted by the LVAD for full 90 days after implantation. The target survival rate was 60%, other observations included implantation success rate, mortality, pump failure needing replacement or emergency heart transplantation.Results:All enrolled 50 patients received LVAD implantation successfully, 46 survived with the pump for 90 days, 1 patient transitioned to heart transplantation, and 3 patients experienced pump thrombosis, within which 2 patients underwent pump replacement and continued to live with the pump for 90 days, and the other one received emergency heart transplantation. There were no dropout subjects. The survival rate at full 90 days after HeartCon implantation was 100%. The survival rates with pump in the full set analysis and the protocol set analysis were 96.00% and 95.92% respectively, which were higher than the target value of 60%. The differences were both statistically significant( P<0.05). Conclusion:The results of the multicenter clinical trial with the largest sample size in China using domestically manufactured third-generation LVAD has demonstrated that, HeartCon is a safe and effective LVAD to treat ESHF patients.
8.Role of transesophageal echocardiography in the intraoperative monitoring of left ventricular assist device implantation
Shutang REN ; Xiaocheng LIU ; Zhengqing WANG ; Shifu WANG ; Jin LONG ; Yunzhou HUANG ; Zhigang LIU
Chinese Journal of Ultrasonography 2022;31(9):746-752
Objective:To evaluate the clinical value of intraoperative transesophageal echocardiography (TEE) in monitoring left ventricular assist device (LVAD) implantation.Methods:Between March 2019 and November 2021, 23 consecutive patients from TEDA International Cardiovascular Hospital, including 21 cases with dilated cardiomyopathy, 1 case with myocardial noncompaction and 1 case with ischemic cardiomyopathy, underwent HeartCon blood pump, a type of third generation LVAD implantation for severe heart failure. TEE was preformed in all cases before and after cardiopulmonary bypass. The dimensions of left-sided and right-sided cardiac chamber, ventricular function, de-airing, interventricular septal position, inlet cannulae position and the function of device were observed and recorded during LVAD implantation. Paired t test was used for statistical analysis of left-sided and right-sided heart parameters in pre- and post-operative measurements. Results:The left heart was dilated significantly and coexistent with right heart enlargement in some degree before LVAD implantation in total 23 cases. More than moderate mitral regurgitation (MR) in 16 cases and less than moderate MR in 7 cases were present. Mild or trace aortic regurgitation (AR) existed in 13 cases. More than moderate tricuspid regurgitation (TR) in 4 cases and less than moderate TR in 16 cases were observed. Left atrial appendage thrombosis was detected in 2 cases. After LVAD implantation, TEE revealed that the left ventricular end-diastolic diameter reduced significantly (42 mm/m 2 vs 32.8 mm/m 2, P<0.05) and left ventricular ejection fraction increased accordingly (22.2% vs 34.0%, P<0.05). There were no significant differences in right ventricular diameter and fractional area change between pre- and post-operative findings(all P>0.05). The ratio of left ventricular inner diameter to right ventricular inner diameter (2.09 vs 1.69, P<0.05) decreased in total 23 cases after LVAD implantation.Interventricular septal position became neutral position instead of pre-oprative rightward position. The severity of MR decreased in varying degrees in total 23 cases after LVAD implantation. All patients underwent tricuspid valvuloplasty with residual mild regurgitation in 8 cases. Conclusions:HeartCon blood pump can effectively unload the left ventricle with sufficient cardiac output in patients with severe congestive heart failure. TEE plays a major role in the clinical decision making during LVAD implantation, which can evaluate pre-operative cardiac abnormalities, intra-operative air embolism, inlet cannulae position, cannulas patency and cardiac function, especially blood volume status and the balance between double ventricles, which is critical for optimal functioning of the device.
9.Establishment of the prediction models of malignant brain edema after vascular recanalization in anterior circulation acute large vascular occlusion stroke
Jun CHENG ; Hu LI ; Xiaocheng HUANG ; Haihua WANG
International Journal of Surgery 2022;49(1):15-23,F3
Objective:Based on Logistic regression and XGBoost algorithm, the prediction model of malignant brain edema (MBE) after vascular recanalization of anterior circulation acute great vessel occlusive stroke (ALVOS) was constructed, and the prediction performance was compared.Methods:A retrospective selection of 382 patients with anterior circulation ALVOS who underwent early endovascular treatment (EVT) in our hospital from March 2014 to June 2020 and successfully recanalized the occluded blood vessel was selected. The patients were divided into the training group ( n=267) and the test group ( n=115) according to the ratio of 7∶3 by the random number table method. According to whether the patients had MBE after successful recanalization of the occluded blood vessels, the training group was divided into the MBE group ( n=41) and non-MBE group ( n=226). The baseline data, treatment and brain computed tomography perfusion(CTP) results of MBE group and non-MBE group in training group and test group were compared respectively, including age, admission score of National Institutes of Health Stroke Scale (NIHSS), grade of cerebral collateral circulation, cerebral blood volume, and so on. Logistic regression model and XGBoost algorithm model were used to screen the predictors of MBE in ALVOS patients with occluded vessels successfully recanalized, and the discrimination and calibration of the two models were compared. The measurement data conforming to the normal distribution were expressed as mean ± standard deviation ( ± s), and the independent sample t test was used for comparison between the two groups. Non-normally distributed measurement data were represented by M ( Q1, Q3), using independent sample Mann-Whitney U test. The chi-square test was used to compare the count data between groups. Results:There was no significant difference in baseline data, treatment status, and cranial computed tomography perfusion (CTP) imaging results of the training group and the test group ( P>0.05). The age, admission systolic blood pressure, admission NIHSS score, proportion of hypertension, proportion of cerebral collateral circulation 0-2, proportion of thrombus removal times> 3 times, time from onset to recanalization, and cerebral blood volume (CBV) of MBE group were (68.95±8.04) years old, (146.71±22.73) mmHg, 17(13, 21) min, 87.80%, 82.93%, 68.29%, (365.64±87.83) min, (32.56±5.73) mL/100 g, obvious higher than the non-MBE group [(60.27±7.13) years old, (137.92±19.58) mmHg, 14(10, 18) points, 73.01%, 60.62%, 2.65%, (307.59±74.05) min, (27.49±5.46) mL/100 g] ( P<0.05). The results of Logistic regression model showed that age, NIHSS on admission, grade of cerebral collateral circulation, times of thrombectomy and time from onset to recanalization were the predictors of MBE after successful recanalization of occluded vessels after EVT in patients with anterior circulation ALVOS ( P<0.05). The top five important feature scores of XGBoost algorithm model were cerebral collateral circulation classification 34, embolectomy times 27, onset to vascular recanalization time 25, admission NIHSS score 22, age 16.In the training set, the area under the curve of the Logistic regression model was 0.816(95% CI: 0.749-0.883), and the Hosmer-Lemeshow test showed that χ2=1.547, P=0.438. The area under the curve of the XGBoost algorithm model was 0.856(95% CI: 0.799-0.913), and the Hosmer-Lemeshow test showed that χ2=1.021, P=0.998. Conclusion:Logistic regression model and XGBoost algorithm model had similar prediction performance for MBE after successful recanalization of occluded vessels after EVT in patients with anterior circulation ALVOS, and collateral circulation classification, number of thrombolysis, time from onset to recanalization, NIHSS score on admission, and age could be used as predictors.
10.Predicting the prognosis of patients with cardiogenic acute stroke based on the nomogram model
Haihua WANG ; Xiaocheng HUANG ; Ye QIAN ; Jun CHENG
International Journal of Surgery 2022;49(4):248-255
Objective:A nomogram model was constructed to predict poor prognosis and death risk of mechanical thrombectomy in patients with cardiogenic acute stroke.Methods:Selected 276 patients with cardiogenic acute stroke who were treated by Jiangyin Hospital of Traditional Chinese Medicine from January 2016 to June 2020 who underwent mechanical thrombectomy as the research objects, and recorded their general information and laboratory test results. On the 90th day, the subjects were divided into a good prognosis group ( n=122) and a poor prognosis group ( n=154) according to whether the prognosis was poor or not; according to whether they died, the subjects were divided into the survival group ( n=208) and the death group ( n=68). The differences in patient related data were compared, Logistic regression analysis was used to screen for risk factors for poor prognosis and death, the line chart prediction model was established, and the ability of the column chart model to predict poor prognosis and death was evaluated by using the subject work characteristic (ROC) curve. The independent factors selected by multivariate regression analysis were used as predictors to construct a nomogram model to predict the prognosis of mechanical thrombectomy surgery in patients with cardiogenic acute stroke. The degree of calibration and validity of the nomogram model established in this study Make an evaluation. The measurement data that obey the normal distribution were represented by the Mean ± standard deviation ( ± s), and the two independent sample t test was used for the comparison between groups; The comparison of enumeration data between groups adopted chi-square test. Results:Multivariate logistic regression analysis showed age ( OR=1.165; 95% CI: 1.046-1.284; P=0.001), diabetes ( OR=1.123; 95% CI: 1.021-1.225; P<0.001), hemorrhage transformation ( OR= 2.394; 95% CI: 1.857-2.931; P=0.001), recanalization ( OR=0.418; 95% CI: 0.410-0.552; P=0.001), NIHSS score ( OR=1.502; 95% CI: 1.373-1.631); P=0.001), neutrophil count (NEUT) ( OR=1.024; 95% CI: 1.009-1.139; P=0.001), NEUT/lymphocyte count (NLR) ( OR=1.235; 95% CI: 1.112-1.358; P=0.001), D-dimer ( OR=1.939; 95% CI: 1.328-2.551; P=0.001) was an independent risk factor for poor prognosis in patients with cardiogenic acute stroke; age ( OR=1.153; 95% CI: 1.080-1.226; P<0.001), hemorrhage transformation ( OR=6.330; 95% CI: 4.904-7.754; P=0.001), recanalization ( OR=0.418; 95% CI: 0.323-0.514; P=0.001), NIHSS score ( OR=2.051; 95% CI: 1.784-2.338; P=0.001), NEUT ( OR=1.399; 95% CI: 1.275-1.523; P=0.001), NLR ( OR=1.528; 95% CI: 1.414-1.642; P=0.001), D-dimer ( OR=2.391; 95% CI: 1.948-2.834; P=0.001) was an independent predictor of death in patients with cardiogenic acute stroke. The established nomogram model predicted poor prognosis and the area under the ROC curve of death were 0.814 (95% CI: 0.800-0.828) and 0.842 (95% CI: 0.828-0.857). Conclusions:Age, hemorrhage transformation, recanalization, NIHSS score, NEUT, NLR, and D-dimer are all important for the prognosis of patients with cardiogenic acute stroke by mechanical thrombectomy. Diabetes only has a suggestive effect on poor prognosis. The nomogram model established based on these factors can effectively help clinicians evaluate the prognosis of patients, formulate reasonable treatment plans for them, and improve the prognosis.

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