Objective To investigate the association of the total burden of cerebral small vessel disease （CSVD） with the level of tumor necrosis factor-α（TNF-α） and prognosis in patients with ischemic stroke （AIS）. Methods A total of 120 patients with AIS who were admitted to our hospital from January 2022 to December 2023 were enrolled as subjects， and all patients underwent cranial MRI scanning. Baseline data and TNF-α level were compared between the patients with different total burden scores of CSVD， and the correlation between TNF-α level and CSVD total burden score was analyzed. TNF-α level and CSVD total burden score were compared between the AIS patients with different prognoses to investigate the influence of TNF-α and CSVD total burden score on the short-term prognosis of AIS， as well as their value in predicting the short-term prognosis of AIS. Results There were significant differences in age， the proportion of patients with hyperlipidemia， the proportion of patients with smoking， and the levels of TNF-α and Hcy between the patients with different CSVD total burden scores （P<0.05）. The level of TNF-α was positively correlated with the number of lacunar cerebral infarcts， Fazekas score of white matter lesions， and EPV score （r=0.654， 0.775， 0.820， P<0.05）， but it had no linear correlation with the number of cerebral microbleeds （r=-0.035，P>0.05）. The logistic regression analysis showed that before correction， age， hyperlipidemia， smoking， TNF-α，and Hcy were significantly correlated with lacunar infarction， white matter lesions， EPV severity， cerebral microbleeds，and CSVD total burden score （P<0.05）， and after correction， TNF-α was still significantly correlated with lacunar infarction， white matter lesions，cerebral microbleeds， EPV severity， and CSVD total burden scores （P<0.05）. There were significant differences in CSVD total burden score and TNF-α between the patients with a good prognosis and those with a poor prognosis（P<0.05）.TNF-α combined with CSVD total burden score had the largest area under the receiver operating characteristic curve（AUC） of 0.912 in predicting the short-term prognosis of AIS，which was significantly higher than the AUC of TNF-α or CSVD total burden score used alone（P<0.05）. Conclusion The increase in TNF-α level has a certain relationship with CSVD total burden score and short-term prognosis in AIS patients， and the combination of TNF-α level and CSVD total burden score has a relatively high clinical application value in predicting the short-term prognosis of AIS patients.
Prognosis

Objective To investigate the association between the pattern of carotid artery calcification and the prognosis of patients with acute cerebral infarction after 3 months of treatment. Methods A total of 112 patients who were diagnosed with acute ischemic stroke （AIS） in our hospital from March 2021 to September 2022 were enrolled as subjects. CT angiography was performed within 24 hours after admission， and the carotid artery was assessed in terms of calcification pattern （no calcification， intimal calcification， and medial calcification） and calcification load （low and high calcification）. After 7 days of treatment， CT reexamination was performed to evaluate hemorrhagic transformation and infarct volume. The patients were followed up for 3 months， and according to the modified Rankin Scale （mRS） score， they were divided into good prognosis group （82 patients with an mRS score of <3 points） and poor prognosis group （30 patients with an mRS score of ≥3 points）. Results Compared with the good prognosis group， the poor prognosis group had a significantly higher proportion of patients with an age of ≥70 years， a mean systolic blood pressure of ≥165 mmHg， a fasting blood glucose level of ≥7.5 mmol/L， an NIHSS score of ≥12 on admission， intimal calcification， medial calcification， high calcification， hemorrhagic transformation， and an infarct volume of ≥50 mm3 （P<0.05）. The multivariate logistic regression analysis showed that NIHSS score ≥12 on admission， intimal calcification， hemorrhagic transformation， and infarct volume ≥50 mm3 were risk factors for poor prognosis （P<0.05）. Conclusion Intimal calcification of the carotid artery may be associated with the poor short-term prognosis of AIS patients， which can be used as a new noninvasive indicator for predicting prognosis.
Prognosis

摘要 目的 探讨孤立性基底节区腔隙性脑梗死早期神经功能恶化（END）的相关影响因素。方法 连续性收集2020年1月—2023年12月就诊于郑州大学人民医院的孤立性基底节区腔隙性脑梗死患者236例，临床资料完整，根据是否出现END将患者分为END组59例及非END组177例，比较患者一般资料，使用多因素二元Logistic回归分析基底节区腔隙性脑梗死患者发生END的影响因素。结果 急性孤立性基底节区腔隙性脑梗死END发生率为25%（59/236），END组病灶累及内囊后肢患者比例、入院NIHSS评分、HbA1c水平、收缩压、女性均高于非END组，两组比较差异有统计学意义（P<0.05）。多因素二元Logistic回归模型分析显示病灶累及内囊后肢（OR=3.167，95%CI 1.305~7.690，P=0.011）是END发生的独立危险因素，HbA1c水平（OR=6.368，95%CI 1.555~26.075，P=0.010）、入院NIHSS评分（OR=2.019，95%CI 1.236~3.299，P=0.005）、收缩压（OR=1.626，95%CI 1.373~1.926，P<0.001）是END发生的相关危险因素。结论 孤立性基底节区腔隙性脑梗死END发生率较高，与病灶累及内囊后肢、入院NIHSS评分高、HbA1c水平升高、收缩压高相关。 Abstract Objective To identify influencing factors for early neurological deterioration （END） in isolated basal ganglia lacunar infarction （iBGLI）. Methods Clinical data were continuously collected from 236 patients with iBGLI confirmed by magnetic resonance imaging between January 2020 and December 2023. The patients were divided into END group （n=59） and non-ED group （n=177） according to the presence or absence of END. General patient information was compared between the two groups， and factors influencing the occurrence of END in patients with iBGLI were identified by multivariate binary logistic regression. Results The incidence of END in acute iBGLI was 25% （59/236）. The percentage of patients with lesions affecting the posterior limb of the internal capsule， admission NIHSS score， HbA1c level， systolic blood pressure， and number of females were significantly higher in the END group than in the non-END group （all P<0.05）. Multivariate binary logistic regression showed that lesions affecting the posterior limb of the internal capsule （odds ratio （OR=3.167，95%CI 1.305~7.690，P=0.011） was an independent risk factor for the development of END，whereas HbA1c level（OR=6.368，95%CI 1.555~26.075，P=0.010）， admission NIHSS score（OR=2.019，95%CI 1.236~3.299， P=0.005）， and systolic blood pressure（OR=1.626，95%CI 1.373~1.926，P<0.001） were associated risk factors for END. Conclusion The higher incidence of END in iBGLI is associated with lesions affecting the posterior limb of the internal capsule， admission NIHSS score， HbA1c level， and systolic blood pressure.
Prognosis

Stroke is a cerebrovascular disease with high fatality and disability rates， which brings heavy psychological burden along with physical disorder to patients. In recent years， transcranial magnetic stimulation （TMS） has attracted great attention in the research on functional prognosis of stroke patients. TMS can reveal the degree of corticospinal tract injury from a neurophysiological point of view and provide key information for functional recovery， and it is widely used in the rehabilitation treatment of post-stroke dysfunction. This article reviews the basic principle， classification， mechanism of TMS in promoting functional recovery of stroke， as well as its application in rehabilitation treatment， so as to lay a foundation for individualized neurological rehabilitation and improve the long-term prognosis of patients to the largest extent.
Stroke ; Prognosis

Objective To investigate the clinical features and treatment of anti-myelin oligodendrocyte glycoprotein-IgG associated disorders （MOGAD） and the risk factors for recurrence and poor long-term prognosis. Methods A total of 91 patients who were diagnosed with MOGAD in The First Affiliated Hospital of Zhengzhou University from January 2018 to March 2023 were enrolled，and their clinical features and auxiliary examinations were analyzed，as well as the risk factors for recurrence and long-term prognosis. Results Among the 91 patients，69 experienced the first attack of MOGAD，and there were 39 female patients and 47 children （aged<18 years）. The proportion of patients with acute disseminated encephalomyelitis among children was significantly higher than that among adults （42.6% vs 18.2%，P=0.012），while the proportion of patients with transverse myelitis among adults was significantly higher than that among children （29.5% vs 2.1%，P<0.001）. The proportion of patients receiving hormones combined with immunoglobulins during hospitalization among children was significantly higher than that among adults （36.2% vs 11.4%，P=0.006），and the children had a significantly better Expanded Disability Status Scale （EDSS） score than the adults at discharge [1（0，1） vs 2（0，4.75），P=0.007]. Visual impairment was an independent risk factor for increased recurrence risk （OR=4.215，95%CI 1.236-14.377，P=0.022）. A higher EDSS score at discharge （OR=5.05，95%CI 1.27-20.07，P=0.021） and a higher number of attacks （OR=9.235，95%CI 1.352-63.10，P=0.023） were independent factors for poor long-term prognosis，while a steroid maintenance time of >5 weeks at initial diagnosis （OR=0.001，95%CI 0.00-0.33，P=0.001） was an independent factor for improving long-term prognosis. Conclusion For patients newly diagnosed with MOGAD，especially those with a high EDSS score at discharge and features indicating a high risk of recurrence （such as visual impairment），it is recommended that they receive an appropriate course of steroid maintenance treatment after acute-stage treatment.
Recurrence ; Prognosis

Objective To investigate the association between beat-to-beat blood pressure variability（BPV）and prognosis in patients with acute ischemic stroke（AIS）undergoing mechanical thrombectomy（MT）. Methods A retrospective study was conducted among 52 AIS patients who underwent MT in Stroke Center of The First Hospital of Jilin University，and beat-to-beat BPV was monitored during hospitalization. The patients were followed up to observe modified Rankin Scale（mRS）score on day 90 after disease onset，and the patients were divided into good prognosis group（mRS≤1）and poor prognosis group（mRS>1）. The two groups were compared in terms of beat-to-beat BPV during hospitalization. A multivariate logistic regression analysis was used to investigate the association between beat-to-beat BPV and prognosis. Results Compared with the good prognosis group，the poor prognosis group had significantly higher beat-to-beat successive variation（SV）and average real variability（ARV）of systolic blood pressure（SBP）[SBP-SV： 2.63（1.84，3.48）vs 3.28（2.87，4.08），P=0.032； SBP-ARV： 2.06（1.30，2.55）vs 2.59（2.23，3.53），P=0.006]. After adjustment for confounding factors such as age，sex，risk factors for stroke，and baseline NIHSS score，the multivariate logistic regression analysis showed that beat-to-beat SBP-SV（OR=2.760，95%CI 1.168-6.522，P=0.021）and SBP-ARV（OR=3.916，95%CI 1.278-12.002，P=0.017）were associated with the poor prognosis of patients. Conclusion Beat-to-beat BPV is independently associated with 90-day poor prognosis in AIS patients undergoing MT，and therefore，it can be used as a predictive factor for prognosis.
Prognosis

OBJECTIVES: To develop and validate a preoperative clinical-radiomics model for predicting overall survival (OS) and disease-free survival (DFS) in patients with extrahepatic cholangiocarcinoma (eCCA) undergoing radical resection. METHODS: In this retrospective study, consecutive patients with pathologically-confirmed eCCA who underwent radical resection at our institution from 2015 to 2022 were included. The patients were divided into a training cohort and a validation cohort according to the chronological order of their CT examinations. Least absolute shrinkage and selection operator (LASSO)-Cox regression was employed to select predictive radiomic features and clinical variables. The selected features and variables were incorporated into a Cox regression model. Model performance for 1-year OS and DFS prediction was assessed using calibration curves, area under receiver operating characteristic curve (AUC), and concordance index (C-index). RESULTS: This study included 123 patients (mean age 64.0 ± 8.4 years, 85 males/38 females), with 86 in the training cohort and 37 in the validation cohort. The OS-predicting model included four clinical variables and four radiomic features. It achieved a training cohort AUC of 0.858 (C-index = 0.800) and a validation cohort AUC of 0.649 (C-index = 0.605). The DFS-predicting model included four clinical variables and four other radiomic features. It achieved a training cohort AUC of 0.830 (C-index = 0.760) and a validation cohort AUC of 0.717 (C-index = 0.616). CONCLUSIONS The preoperative clinical-radiomics models show promise as a tool for predicting 1-year OS and DFS in eCCA patients after radical surgery.
Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Cholangiocarcinoma/mortality* ; Prognosis ; Bile Duct Neoplasms/mortality* ; Tomography, X-Ray Computed/methods* ; Aged ; Radiomics

Mitochondria are the convergence point of multiple pathways that trigger programmed cell death (PCD). Mitochondrial-associated PCD (mtPCD) is involved in the pathogenesis of several diseases. However, the role of mtPCD in the prognostic prediction of cancers including non-small-cell lung cancer (NSCLC) remains to be investigated. Here, 12 mtPCD patterns were analyzed in transcriptomics, genomics, and clinical data collected from 4 datasets containing 977 patients. A risk-score assessment system containing 18 genes was established. We found that NSCLC patients with a high-risk score had a poorer prognosis. A nomogram was constructed by incorporating the risk score with clinical features. The risk score was further associated with clinicopathological information, tumor-mutation frequency, and immunotherapy responses. NSCLC patients with a high risk score had more Treg cells infiltration. However, these patients had higher tumor-mutation burden scores and may be more sensitive to immunotherapy. Moreover, receptor-interacting serine/threonine protein kinase 2 (RIPK2) was selected from mtPCD gene model for validation. We found that RIPK2 exhibited oncogenic function, and its expression level was inversely associated with the overall survival of NSCLC. Taken together, our results indicated the accuracy and practicability of the mtPCD gene model and RIPK2 in predicting the prognosis of NSCLC.
Humans ; Carcinoma, Non-Small-Cell Lung/pathology* ; Lung Neoplasms/pathology* ; Prognosis ; Male ; Female ; Nomograms ; Middle Aged ; Mitochondria/metabolism* ; Apoptosis/genetics* ; Mutation ; Biomarkers, Tumor/genetics* ; Aged

The cooccurrence of NPM1, FLT3-ITD, and DNMT3A mutations (i.e., triple mutation) is related to dismal prognosis in patients with acute myeloid leukemia (AML) receiving chemotherapy alone. In this multicenter retrospective cohort study, we aimed to identify whether allogeneic hematopoietic stem cell transplantation (allo-HSCT) could overcome the poor prognosis of DNMT3A^mutNPM1^mutFLT3-ITD^mut AML across four transplant centers in China. Fifty-three patients with triple-mutated AML receiving allo-HSCT in complete remission were enrolled. The 1.5-year probabilities of relapse, leukemia-free survival, and overall survival after allo-HSCT were 11.9%, 80.3%, and 81.8%, respectively. Multivariate analysis revealed that more than one course of induction chemotherapy and allo-HSCT beyond CR1 were associated with poor survival. To our knowledge, this work is the largest study to explore the up-to-date undefined role of allo-HSCT in patients with triple-mutated AML. Our real-world data suggest that allo-HSCT could overcome the poor prognosis of DNMT3A^mutNPM1^mutFLT3-ITD^mut in AML.
Humans ; Nucleophosmin ; Leukemia, Myeloid, Acute/mortality* ; Hematopoietic Stem Cell Transplantation/methods* ; Male ; Female ; DNA Methyltransferase 3A ; Adult ; China ; Retrospective Studies ; DNA (Cytosine-5-)-Methyltransferases/genetics* ; Middle Aged ; Prognosis ; fms-Like Tyrosine Kinase 3/genetics* ; Mutation ; Young Adult ; Transplantation, Homologous ; Nuclear Proteins/genetics* ; Adolescent ; Aged

OBJECTIVE: To analyze the clinical characteristics of elderly patients with sepsis, identify the key factors affecting their clinical outcomes, construct a death risk assessment scale for elderly patients with sepsis, and evaluate its predictive value. METHODS: A retrospective case-control study was conducted. The clinical data of sepsis patients admitted to intensive care unit (ICU) of the First Affiliated Hospital of Wenzhou Medical University from September 2021 to September 2023 were collected, including basic information, clinical characteristics, and clinical outcomes. The patients were divided into non-elderly group (age ≥ 65 years old) and elderly group (age < 65 years old) based on age. Additionally, the elderly patients were divided into survival group and death group based on their 30-day survival status. The clinical characteristics of elderly patients with sepsis were analyzed. Univariate and multivariate Logistic regression analyses were used to screen the independent risk factors for 30-day death in elderly patients with sepsis, and the regression equation was constructed. The regression equation was simplified, and the death risk assessment scale was established. The predictive value of different scores for the prognosis of elderly patients with sepsis was compared. RESULTS: (1) A total of 833 patients with sepsis were finally enrolled, including 485 in the elderly group and 348 in the non-elderly group. Compared with the non-elderly group, the elderly group showed significantly lower counts of lymphocyte, T cell, CD8⁺ T cell, and the ratio of T cells and CD8⁺ T cells [lymphocyte count (×10⁹/L): 0.71 (0.43, 1.06) vs. 0.83 (0.53, 1.26), T cell count (cells/μL): 394.0 (216.0, 648.0) vs. 490.5 (270.5, 793.0), CD8⁺ T cell count (cells/μL): 126.0 (62.0, 223.5) vs. 180.0 (101.0, 312.0), T cell ratio: 0.60 (0.48, 0.70) vs. 0.64 (0.51, 0.75), CD8⁺ T cell ratio: 0.19 (0.13, 0.28) vs. 0.24 (0.16, 0.34), all P < 0.01], higher natural killer cell (NK cell) count, acute physiology and chronic health evaluation II (APACHE II) score, ratio of invasive mechanical ventilation (IMV) during hospitalization, and 30-day mortality [NK cell count (cells/μL): 112.0 (61.0, 187.5) vs. 95.0 (53.0, 151.0), APACHE II score: 16.00 (12.00, 21.00) vs. 13.00 (8.00, 17.00), IMV ratio: 40.6% (197/485) vs. 31.9% (111/348), 30-day mortality: 28.9% (140/485) vs. 19.5% (68/348), all P < 0.05], and longer length of ICU stay [days: 5.5 (3.0, 10.0) vs. 5.0 (3.0, 8.0), P < 0.05]. There were no statistically significant differences in the levels of inflammatory markers such as C-reactive protein (CRP), procalcitonin (PCT), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and interleukins (IL-2, IL-4, IL-6, IL-10) between the two groups. (2) In 485 elderly patients with sepsis, 345 survived in 30 days, and 140 died with the 30-day mortality of 28.9%. Compared with the survival group, the patients in the death group were older, and had lower body mass index (BMI), white blood cell count (WBC), PCT, platelet count (PLT) and higher IL-6, IL-10, N-terminal pro-brain natriuretic peptide (NT-proBNP), total bilirubin (TBil), blood lactic acid (Lac), and ratio of in-hospital IMV and continuous renal replacement therapy (CRRT). Multivariate Logistic regression analysis indicated that BMI [odds ratio (OR) = 0.783, 95% confidence interval (95%CI) was 0.678-0.905, P = 0.001], IL-6 (OR = 1.073, 95%CI was 1.004-1.146, P = 0.036), TBil (OR = 1.009, 95%CI was 1.000-1.018, P = 0.045), Lac (OR = 1.211, 95%CI was 1.072-1.367, P = 0.002), and IMV during hospitalization (OR = 6.181, 95%CI was 2.214-17.256, P = 0.001) were independent risk factors for 30-day death in elderly patients with sepsis, and the regression equation was constructed (Logit P = 1.012-0.244×BMI+0.070×IL-6+0.009×TBil+0.190×Lac+1.822×IMV). The regression equation was simplified to construct a death risk assessment scale, namely BITLI score. Receiver operator characteristic curve (ROC curve) analysis showed that the area under the ROC curve (AUC) of BITLI score for predicting death risk was 0.852 (95%CI was 0.769-0.935), and it was higher than APACHE II score (AUC = 0.714, 95%CI was 0.623-0.805) and sequential organ failure assessment (SOFA) score (AUC = 0.685, 95%CI was 0.578-0.793). The determined cut-off value of BITLI score was 1.50, while achieving a sensitivity of 83.3% and specificity of 74.0%. CONCLUSIONS Elderly patients with sepsis often have reduced lymphocyte counts, severe conditions, and poor prognosis. BMI, IL-6, TBil, Lac, and IMV during hospitalization were independent risk factors for 30-day death in elderly patients with sepsis. The BITLI score constructed based above risk factors is more precise and reliable than traditional APACHE II and SOFA scores in predicting the outcomes of elderly patients with sepsis.
Humans ; Sepsis/mortality* ; Aged ; Retrospective Studies ; Risk Assessment ; Case-Control Studies ; Prognosis ; Male ; Female ; Intensive Care Units ; Risk Factors ; Aged, 80 and over ; Logistic Models ; Middle Aged