Admission Motor Strength Grade Predicts Mortality in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

Background: The mortality due to mechanical thrombectomy (MT) in the acute treatment of intracranial arterial occlu- sions can be up to 45%. The SWIFT (Solitaire FR with the Intention for Thrombectomy) and Multi MERCI (mechani- cal embolus removal in cerebral ischemia) trials have evaluated the safety and efficacy of MT. It may be important to determine pre-procedural factors that help predict post-intervention prognosis. We sought to determine if admission medical research council (MRC) motor strength grade along with other factors can be used as predictor of mortality after MT for acute ischemic stroke. Methods: Retrospective analysis of stroke database assessing outcomes in all 62 patients who underwent MT as an intervention for acute ischemic stroke, with or without concurrent intravenous thrombolysis was done. Five baseline variables were included in univariate and multivariate analyses to define the in- dependent predictors of mortality during current hospitalization. The medical research council (MRC) motor grade (0 - 5);modified collateral flow (CS) grading (0 - 3);age;acute and chronic co-morbidities were used as the baseline vari- ables. If motor strength grade were different in upper and lower extremities, then the lower grade was used. Age was analyzed independently as well as dichotomized using 80 as cut-off value. Relevant stroke related acute and chronic co-morbidities were given 1 point each and mean calculated. Results: In the univariate analysis, low (0 - 1) motor strength grade (OR, 0.11;95% CI, 0.021 - 0.33;p = 0.001) and age (OR, 1.06;95% CI, 1.02 - 1.12;p = 0.011) was sig- nificantly associated with mortality. The presence of collateral flow, acute and chronic co-morbidities were not signifi- cantly associated with mortality. In the multivariate analysis, motor grade retained its statistical significance for morta- lity (OR, 0.09;95% CI, 0.01 - 0.32;p = 0.003) along with chronic co-morbidity (OR, 1.52;95% CI 1.05 - 2.43;

Bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion

BACKGROUND Intravenous thrombolysis is an important treatment for cerebral infarction.However,it is difficult to achieve good results if the patient is complicated with anterior circulation macrovascular occlusion.In addition,the vascular recanalization rate is low,so mechanical thrombectomy,that is,bridging therapy,is needed AIM To investigate the efficacy and safety of bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion.METHODS Ninety-six patients in our hospital with cardiogenic cerebral infarction with anterior circulation macrovascular occlusion from January 2017 to July 2020 were divided into a direct thrombectomy group(n=48)and a bridging group(n=48).Direct mechanical thrombectomy was performed in the direct thrombectomy group,and bridging therapy was used in the bridging treatment group.Comparisons were performed for the treatment data of the two groups(from admission to imaging examination,from admission to arterial puncture,from arterial puncture to vascular recanalization,and from admission to vascular recanalization),vascular recanalization rate,National Institutes of Health Stroke Scale(NIHSS)and Glasgow Coma Scale(GCS)scores before and after treatment,prognosis and incidence of adverse events.RESULTS In the direct thrombectomy group,the time from admission to imaging examination was 24.32±8.61 min,from admission to arterial puncture was 95.56±37.55 min,from arterial puncture to vascular recanalization was 54.29±21.38 min,and from admission to revascularization was 156.88±45.51 min,and the corresponding times in the bridging treatment group were 25.38±9.33 min,100.45±39.30 min,58.14±25.56 min,and 161.23±51.15 min;there were no significant differences between groups(P=0.564,0.535,0.426,and 0.661,respectively).There was no significant difference in the recanalization rate between the direct thrombectomy group(79.17%)and the bridging group(75.00%)(P=0.627).There were no significant differences between the direct thrombectomy group(16.69±4.91 and 12.12±2.07)and the bridging group(7.13±1.23) and(14.40±0.59)in preoperative NIHSS score and GCS score(P=0.200 and 0.203,respectively).After the operation,the NIHSS scores in both groups were lower than those before the operation,and the GCS scores were higher than those before the operation.There was no significant difference in NIHSS and GCS scores between the direct thrombectomy group(6.91±1.10 and 14.19±0.65)and the bridging group(7.13±1.23 and 14.40±0.59)(P=0.358 and 0.101,respectively).There was no significant difference in the proportion of patients who achieved a good prognosis between the direct thrombectomy group(52.08%)and the bridging group(50.008%)(P=0.838).There was no significant difference in the incidence of adverse events between the direct thrombectomy group(6.25%)and the bridging group(8.33%)(P=0.913).CONCLUSION Bridging therapy and direct mechanical thrombectomy can safely treat cardiogenic cerebral infarction with anterior circulation macrovascular occlusion,achieve good vascular recanalization effects and prognoses,and improve the neurological function of patients.

Gelfoam embolization for distal, medium vessel injury during mechanical thrombectomy in acute stroke: A case report

BACKGROUND Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions,and even distal,medium vessel occlusions.A distal,medium vessel has a tortuous course and thinner wall compared to large arteries,making it more susceptible to damage.Here,we review the treatment strategies for arterial perforation during mechanical thrombectomy,and we report the case of a patient treated with gelfoam embolization.CASE SUMMARY A 63-year-old woman presented to the emergency department with sudden neurologic symptoms of right hemiparesis and global aphasia.The initial National Institutes of Health Stroke Scale score was 15.Computed tomography(CT)and CT angiography revealed hyperacute infarction and emergent arterial occlusion of the left middle cerebral artery M2-3 portion.During endovascular mechanical thrombectomy,arterial rupture occurred.The patient’s vital signs were stable,but delayed angiography showed persistent active bleeding.Therefore,selective embolization of the injured artery was performed using gelfoam.Subsequent left vertebral and internal carotid angiography was performed to confirm hemostasis.A localized subarachnoid hemorrhage(SAH)was confirmed on a follow-up CT scan.A repeated CT scan after 12 d showed resolution of the SAH,and rebleeding did not occur.CONCLUSION Rescue embolization with gelfoam could be considered an additional option in distal,medium vessel perforation.

Anticoagulant treatment for pulmonary embolism in patient with cerebral hemorrhage secondary to mechanical thrombectomy: A case report

BACKGROUND Cerebral hemorrhage secondary to cerebral embolism after mechanical thrombectomy is characterized by high morbidity,disability and mortality.If the patient also has severe pulmonary embolism(PE)at the same time,the treatment becomes more complex.This report describes the treatment strategy for a patient with PE and cerebral hemorrhage secondary to cerebral embolism after mechanical thrombectomy.CASE SUMMARY A 70-year-old woman presented to our emergency department with right-sided hemiplegia and mixed aphasia of 2.5 h duration.She was diagnosed with left cerebral embolism,left internal carotid artery occlusion,PE and left calf intramuscular vein thrombosis.Following mechanical thrombectomy,brain magnetic resonance imaging showed cerebral infarction with basal ganglia hemorrhage.We observed changes in cerebral hemorrhage on serial monitoring of brain computed tomography and adjusted the dose of anticoagulant drugs.After 3 wk of treatment,the patient’s neurological and respiratory symptoms significantly improved,and a favorable prognosis was obtained.CONCLUSION Anticoagulation could be a potential option for PE accompanied by hemorrhagic transformation of an ischemic infarct.

Mechanical thrombectomy for acute occlusion of the posterior inferior cerebellar artery: A case report

BACKGROUND Mechanical thrombectomy(MT)has been demonstrated to be useful for the treatment of ischemic stroke in patients with large vessel occlusions.However,recanalization by MT is not recommended for distal vessels such as second-order branches of the middle cerebral artery and posterior inferior cerebellar artery(PICA).Because of the small size and tortuosity of these arteries,the risks of using the available endovascular devices outweigh the benefits of treatment.However,MT appears to be effective in patients with primary distal vessel occlusion in eloquent areas,those with a high National Institutes of Health Stroke Scale score,and those ineligible for recombinant tissue plasminogen activator therapy.Here,we report the use of MT for treating acute occlusion of the PICA using a directaspiration first-pass technique(ADAPT).CASE SUMMARY In this case,the patient received acute occlusion of the PICA with ADAPT when right internal carotid artery stenting was performed.CONCLUSION With the introduction of advanced endovascular devices,MT may now be a feasible treatment for acute occlusion of the PICA.

Carotid-cavernous fistula following mechanical thrombectomy of the tortuous internal carotid artery:A case report

BACKGROUND A carotid-cavernous fistula(CCF)is an abnormal connection between the internal carotid artery(ICA)and the cavernous sinus.Although direct CCFs typically result from trauma or as an iatrogenic complication of neuroendovascular procedures,they can occur as surgery-related complications after mechanical thrombectomy(MT).With the widespread use of MT in patients with acute ischemic stroke complicated with large vessel occlusion,it is important to document CCF following MT and how to avoid them.In this study,we present a case of a patient who developed a CCF following MT and describe in detail the characteristics of ICA tortuosity in this case.CASE SUMMARY A 60-year-old woman experienced weakness in the left upper and lower limbs as well as difficulty speaking for 4 h.The neurological examination revealed left central facial paralysis and left hemiplegia,with a National Institutes of Health Stroke Scale score of 9.Head magnetic resonance imaging revealed an acute cerebral infarction in the right basal ganglia and radial crown.Magnetic resonance angiography demonstrated an occlusion of the right ICA and middle cerebral artery.Digital subtraction angiography demonstrated distal occlusion of the cervical segment of the right ICA.We performed suction combined with stent thrombectomy.Then,postoperative angiography was performed,which showed a right CCF.One month later,CCF embolization was performed,and the patient’s clinical symptoms have significantly improved 5 mo after the operation.CONCLUSION Although a CCF is a rare complication after MT,it should be considered.Understanding the tortuosity of the internal carotid-cavernous sinus may help predict the complexity of MT and avoid this complication.

Mechanical thrombectomy and postoperative complications after acute ischemic stroke with large vessel occlusion

Acute ischemic stroke is one of the common discases in Chinese,among which acute ischemic stroke with large vessel occlusion(AIS-LVO)has thc most serious complications and has the risk of death.Studies have shown that reperfusion is a first-line treatment for the effective rescue of ischemic brain tissue,usually mainly by mechanical|hrombectomy(MT),supplemented by intravenous thrombolysis.However,there are still complications after large blood vessel occlusion and MT.such as blecding and infection at the puncture point,vasospasm,vascular dissection,subarachnoid hemorrhage,hcmonhagic transfomation,reembolization,and massive cerebral infarction,ctc.The high risk factors and corresponding measures of complications after MT by revicwing the rescarch analysis.

A Unique Case of Successful Mechanical Thrombectomy and Stenting of Cabrol Graft: A Case Report

Cabrol technique and its modification are used as second line or bailout procedure in reimplantation of coronary arteries after aortic root replacement. Percutaneous interventions of Cabrol graft with aspiration thrombectomy and stenting have been previously described. We report a patient who successfully underwent percutaneous intervention on the graft by rheolytic thrombectomy followed by stenting in the setting of ST elevation myocardial infarction.

Image-based visualization of stents in mechanical thrombectomy for acute ischemic stroke:Preliminary findings from a series of cases

BACKGROUND Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window.Typically,an arteriogram does not show the localization of the stent after release and whether a thrombus is captured or not.Thus,improving the visualization of a stent in interventional therapy will be helpful for clinicians.AIM To analyze stent imaging findings to enhance clinicians’understanding of a special circumstance,wherein a Solitaire AB retrievable stent was visible during the imaging of a thrombus capture that improved the success rate of stent-based mechanical thrombectomy.METHODS This was a retrospective study with four acute ischemic stroke(AIS)patients who underwent stent-based mechanical thrombectomy.RESULTS Patient 1 was a 64-year-old man admitted after 5 h of confusion;angiography revealed basilar artery occlusion.We inserted a stent into the left posterior cerebral artery-P2 segment and visualized the expanded stent that successfully captured a thrombus.Patient 2 was a 74-year-old man admitted with confusion,which lasted approximately 3 h.Angiography revealed a left middle cerebral artery(MCA)-M1 segment occlusion.A stent was deployed in the distal M2 segment,and we could visualize the stent by capturing the thrombus.Patient 3 was a 74-year-old woman admitted after experiencing left hemiplegia for 3 h.We deployed a stent at the distal right MCAM2 segment,and the developing stent captured a large thrombus.Patient 4 was an 82-year-old man who presented with confusion for 3 h.A developing stent was placed in the distal left MCA-M1 segment,which captured a large thrombus and several fragmented thrombi.CONCLUSION To the best of our knowledge,this is the first report of stent imaging in patients with AIS.We demonstrated the usefulness and substantial potential of stent imaging in stent-based mechanical thrombectomy for AIS.

Evaluation of vascular recanalization rate and nerve injury of mechanical thrombectomy combined with rt-PA thrombolysis in treatment of acute cerebral infarction

Objective:To investigate the vascular recanalization rate of mechanical thrombectomy combined with recombinant tissue-type plasminogen activator (rt-PA) thrombolysis in the treatment of acute cerebral infarction and the effect on the nerve injury in patients.Methods:A total of 90 patients with acute cerebral infarction who were treated in our hospital between January 2016 and January 2019 were retrospectively analyzed and divided into the control group (n=46) receiving rt-PA thrombolysis and the observation group (n=44) receiving mechanical thrombectomy combined with rt-PA thrombolysis. The differences in vascular recanalization rate 24 h after treatment as well as serum levels of inflammatory mediators [interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-7 (IL-7), interleukin-17 (IL-17) and hypersensitive C-reactive protein (hs-CRP)], nerve injury markers [brain-derived neurotrophic factor (BDNF), neuron-specific enolase (NSE) and S100B protein (S100B)] and neurotransmitters [glutamate (Glu) and 5-hydroxytryptamine (5-HT)] before and after treatment were compared between the two groups of patients.Results: 24 h after treatment, the vascular recanalization rate of the observation group was higher than that of the control group (P<0.05). 24 h after treatment and 1 week after treatment, serum IL-1, IL-6, IL-7, IL-17 and hs-CRP levels in the observation group were lower than those in the control group;BDNF level was higher than that in the control group, while NSE and S100B levels were lower than those in the control group;Glu and 5-HT levels were lower than those in the control group (P<0.05). Conclusions: Mechanical thrombectomy combined with rt-PA thrombolysis can increase the early postoperative vascular recanalization rate in patients with acute cerebral infarction, and it also plays an active role in alleviating nerve injury.

Efficacy of percutaneous mechanical thrombus removal in acute lower extremity deep venous thrombosis

BACKGROUND Acute lower extremity deep venous thrombosis(LEDVT)is a common vascular emergency with significant morbidity risks,including post-thrombotic syndrome(PTS)and pulmonary embolism.Traditional treatments like catheter-directed thrombolysis(CDT)often result in variable success rates and complications.AIM To investigate the therapeutic efficacy of percutaneous mechanical thrombus removal in acute LEDVT.METHODS A retrospective analysis was performed to examine 58 hospitalised patients with acute LEDVT between August 2019 and August 2022.The patients were categorised into the percutaneous mechanical thrombectomy(PMT)group(n=24)and CDT group(n=32).The follow-up,safety and treatment outcomes were compared between the two groups.The main observational indexes were venous patency score,thrombus removal effect,complications,hospitalisation duration and PTS.RESULTS The venous patency score was 9.04±1.40 in the PMT group and 8.81±1.60 in the CDT group,and the thrombus clearance rate was 100%in both groups.The complication rate was 8.33%in the PMT group and 34.84%in the CDT group,and the difference was statistically significant(P<0.05).The average hospitalisation duration was 6.54±2.48 days in the PMT group and 8.14±3.56 days in the CDT group.The incidence of PTS was lower in the PMT group than in the CDT group;however,the difference was not statistically significant(P<0.05).CONCLUSION Compared with CDT,treatment of LEDVT via PMT was associated with a better thrombus clearance rate,clinical therapeutic effect and PTS prevention function,but the difference was not statistically significant.Moreover,PMT was associated with a reduced urokinase dosage,shortened hospitalisation duration and reduced incidence of complications,such as infections and small haemorrhages.These results indicate that PMT has substantial beneficial effects in the treatment of LEDVT.

基于MTS-BiGRU-DMHSA的工业负荷预测方法

工业用电占我国全社会用电量比重大,通过工业负荷预测了解负荷趋势和用电量信息,有助于电网安全稳定运行,为电力部门发电规划提供依据,且有助于工业用户优化生产工艺和降低成本。为了兼顾工业负荷波动的不确定性以及工业用户用电行为的规律性特征,提出一种基于多时间尺度(MTS)特征的工业负荷预测方法MTS-BiGRU-DMHSA,利用MTS特征融合挖掘工业负荷的周期趋势特征和局部波动特征,提升工业负荷表征的可解释性。此外,双层多头自注意力(DMHSA)机制利用注意力权重聚焦重要特征,在挖掘输入特征关联性的同时捕捉时序关联性,强化重要特征变量与关键时间步的信息表达。在中国某工业企业五面受总柜实采数据上完成实验验证,采用2种评价指标对所提方法及5种基于神经网络的预测方法进行对比分析。实验结果表明,所提方法相较于对比方法平均误差降低逾20%,其中4.67%得益于对MTS特征的运用。通过对比各方法计算效率证实了所提方法的综合性能优势,可视化实验结果与对比分析也验证了其在工业负荷预测任务上的可行性。

MTS-05 PDM多频代播机核心技术及应用

深入探讨MTS-05 PDM 5 kW多频代播机的研发背景、核心技术、应用价值及其对广播技术领域的影响。在中波广播技术面临频率固定性和调频机制局限的挑战背景下,MTS-05 PDM 5 kW多频代播机作为技术创新的产物,通过集成复杂可编程逻辑器件(Complex Programmable Logic Device,CPLD)逻辑频率选通技术、直接数字合成(Direct Digital Synthesizer,DDS)高频激励机制和智能多频网络切换技术,实现了多频次高效、安全播出。设备不仅克服了传统发射机的调频烦琐和空间限制问题,还提升了播出质量和安全播出效率,展示了智能化运维与资源优化的典范。

基于MTO-MTS生产模式的钢铁企业合同计划建模与优化策略

在MTO-MTS混合生产模式下,合理协调生产和库存是合同计划需要解决的关键问题。本文将多级库存匹配引入合同计划,同时考虑半成品库存、成品库存和多工序生产,以最小化合同的库存匹配费用、提前/拖期惩罚、交期惩罚、产能均衡惩罚和合同取消惩罚为目标建立联合优化数学模型。基于该模型,构造了PSORe M算法,采用重匹配协同策略提高搜索空间的全局性,改进粒子群算法的求解性能。通过仿真实验确定相关参数,采用某著名钢厂的多组算例分析了多级库存匹配策略对库存管理和生产计划的协调作用,并验证了本文算法的有效性。

MTS冷却系统研制

力学测试与模拟系统在理论研究和实践应用中发挥着越来越大的作用,其配套冷却系统的设置对整个设备能否正常运行至关重要。根据实验室具体情况技术经济比较,采用合理方案,完成和主机完全匹配的冷却系统研制。监测结果表明系统运行良好。

Cerebral fat embolism following autologous fat injection in facial reconstruction:A case report

BACKGROUND Autologous fat injection in facial reconstruction is a common cosmetic surgery.Although cerebral fat embolism(CFE)as a complication is rare,it carries serious health risks.CASE SUMMARY We present a case of a 29-year-old female patient who developed acute CFE following facial fat filling surgery.After the surgery,the patient experienced symptoms including headache,nausea,vomiting,and difficulty breathing,which was followed by neurological symptoms such as slurred speech and left-sided weakness.Comprehensive physical examination and auxiliary investigations,including blood tests,head and neck computed tomography angiography,and cranial magnetic resonance diffusion-weighted imaging,were performed upon admission.The clinical diagnosis was acute cerebral embolism following facial fat filling surgery.Treatment included measures to improve cerebral circulation,dehydration for intracranial pressure reduction,nutritional support,and rehabilitation therapy for left limb function.The patient showed a significant improvement in symptoms after 2 weeks of treatment.She recovered left limb muscle strength to grade 5,had clear speech,and experienced complete relief of headache.CONCLUSION Our case highlights the potential occurrence of severe complications in patients undergoing fat injection in facial reconstruction.To prevent these complications,plastic surgeons should enhance their professional knowledge and skills.

基于MTS/COM+的OPC安全机制研究

在深入分析安全机制基础:Windows操作系统的安全机制、COM/DCOM的安全机制和MTS/COM+的安全机制基础上,提出了基于MTS/COM+的OPC安全机制,包括安全调用机制和角色安全机制,并研究了各机制的作用范围,给出了它们程序实现的具体过程。企业不仅可以根据OPC接口标准统一访问系统低层资源,OPC安全机制又可以保证OPC客户端与OPC服务器之间访问的安全性。

TIPS联合PMT在复杂性门静脉血栓中的应用

目的探讨经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunts,TIPS)联合机械性血栓清除(percutaneous mechanical thrombus,PMT)在复杂性门静脉血栓(portal vein thrombosis,PVT)治疗中的有效性和安全性。方法收集2016年8月至2018年5月在本科行TIPS联合PMT治疗的PVT患者资料,共有15例门静脉主干伴肠系膜上静脉血栓(superior mesenteric vein thrombosis,SMVT)患者纳入本研究,均因抗凝治疗效果不佳,腹痛持续存在而接受手术治疗。疗效评估主要包括技术成功率、门静脉通畅程度及腹痛症状缓解情况;安全性评估主要包括术中及围手术期相关并发症。结果 15例患者均成功接受TIPS联合PMT治疗,技术成功率100%;2例因PMT后SMV狭窄程度仍>70%,门静脉支架延续至SMV中段,其余均行标准TIPS治疗;术中造影显示门静脉系统及肝内支架血流通畅;腹痛缓解率93.3%。1例术后开腹探查+肠切术,其余围手术期无不良事件发生。随访中1例再次门静脉血栓,1例死于肝衰竭。结论急性PVT除了一线的抗凝治疗;PMT有助于门静脉的再通,TIPS可降低门静脉压力,有利于维持门静脉血流通畅,降低门静脉高压相关并发症的发生;TIPS联合PMT治疗复杂性PVT早期临床效果令人满意,是一种安全、可行的方法。

基于大地测量和MT技术分析吉林龙岗火山区现今地壳运动特征及其机理

位于吉林长白山西麓龙岗山脉中段的龙岗火山群是中国近代主要火山活动区之一.通过对火山区2010—2020年多期GNSS(Global Navigation Satallite System)观测资料及1970—2010年多个时段的一、二等水准资料进行解算,获取现今三维地壳运动速度场.GNSS获取的水平运动速率从西向东增大,东部主要以拉张运动为主,连续面应变率场结果反映火山区位于膨胀区;一等水准路线长抚线和丹抚线资料显示火山区以垂直上升运动为主,主要速率为0.55~1.83 mm/a,其中抚松—仙人桥—老山队一带为主要隆升区,速率多大于1.0 mm/a;该区域分布丰富的地热资源,也是地震多发地区.邻近区域的二等水准路线梅通线速率相对较小,为0.23~0.77 mm/a.结合对99个测点大地电磁数据三维反演得到的火山区深部电性结构:与隆升区对应的中下地壳赋存相对较浅的岩浆系统,电性边界带推测的浑江断裂北向延伸.断裂附近的低阻体规模最大,向下延伸至地幔尺度.最浅的低阻体位于最年轻的金龙顶子火山大约10 km以下位置,以上的高阻结构认为是岩浆溢流结束后的后撤和固结.综合分析认为现今火山区地壳的膨胀隆升、地震活动与幔源物质的上涌、间断性的运移引起断层活动有关.

轨道车辆用SUS301L-MT不锈钢等离子-MAG复合焊接头的力学性能研究

分别采用等离子-MAG复合焊方法和普通MAG焊方法,均选用ER308LSi焊丝,对轨道车辆用SUS301L-MT不锈钢板进行了焊接试验,并对这两种接头进行了拉伸、弯曲和疲劳试验。结果表明：与普通MAG焊方法相比,等离子-MAG复合焊接头的屈服强度有所提高,而抗拉强度和伸长率略有降低,所有拉伸试样均破断在强度较低的焊缝区。经正弯与背弯试验,这两种焊接接头均无裂纹出现;等离子-MAG复合焊接头在指定寿命N_f=2×10~6周次时疲劳强度为317.2 MPa,相对于普通MAG焊接头的疲劳强度（268.9 MPa）,其疲劳强度提高近18%。