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 analyze the clinical characteristics, treatment, and prognosis of seven pediatric patients with Acute myeloid leukemia (AML) positive for the t(16;21)(p11;q22) FUS::ERG fusion gene. METHODS: A retrospective analysis was carried out on the clinical data, treatment, and prognosis of seven AML patients with t(16;21)(p11;q22) FUS::ERG fusion gene admitted to Henan Children's Hospital between June 2015 and November 2024. Relevant literature was also reviewed. This study was approved by the Medical Ethics Committee of the Hospital (Ethics No.: 2024-102-001). RESULTS: Among 297 pediatric patients with AML, 7 cases (2.36%) were positive for the t(16;21)(p11;q22) FUS::ERG fusion gene, including 3 males and 4 females, with a median age of 11 years (range: 3 ~ 12 years). According to the FAB classification, these included 1 case of M2, 3 cases of M5, and 3 cases of AML-not otherwise specified (non-M3). All 7 patients were found to harbor the t(16;21)(p11;q22) translocation, with 3 cases showing additional chromosomal abnormalities. Immunophenotyping revealed universal expression of CD13, CD33, CD34, and CD117, with partial expression of CD56, CD4, CD64, CD123, CD15, CD38, CD11b, HLA-DR, cMPO, and CD16. One patient achieved complete remission (CR) after the first course of DAE (cytarabine + daunorubicin + etoposide) induction chemotherapy but relapsed and discontinued the treatment. Six patients received DAH (cytarabine + daunorubicin + homoharringtonine) induction therapy, of whom 2 achieved CR after two courses and underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT), resulting in an overall CR rate of 42.86%. Five children did not receive allo-HSCT and had a median overall survival of 9 months (range: 6 ~ 18 months). Two children who underwent transplantation achieved bone marrow morphological and molecular biological relapse at 6 and 9 months post-transplantation, respectively. After receiving combined chemotherapy and donor lymphocyte infusion, one child failed to achieve remission and died at 22 months post-transplantation, while the other has been followed up to date with positive fusion gene status. Their overall survival was 25 months and 30 months, respectively. CONCLUSION The t(16;21)(p11;q22) FUS::ERG fusion gene is rare in pediatric AML and associated with poor prognosis. Allo-HSCT may mitigate the adverse prognostic impact of the FUS::ERG fusion gene and contribute to prolonged survival.
Humans ; Male ; Child ; Female ; Leukemia, Myeloid, Acute/drug therapy* ; Oncogene Proteins, Fusion/genetics* ; Translocation, Genetic ; Retrospective Studies ; RNA-Binding Protein FUS/genetics* ; Chromosomes, Human, Pair 16/genetics* ; Adolescent ; Child, Preschool ; Chromosomes, Human, Pair 21/genetics* ; Prognosis ; Treatment Outcome

OBJECTIVE: To analyze the clinical characteristics of patients with 11q23 rearrangement acute lymphoblastic leukemia (ALL) with non-KMT2A::AFF1 fusion genes. METHODS: The clinical data of 10 patients with KMT2A fusion gene positive and partner gene non-AFF1 ALL admitted to Henan Cancer Hospital from December 2016 to December 2024 were retrospectively summarized. The immunophenotype, molecular genetic characteristics, clinical manifestations and disease prognosis of these patients were analyzed. This research has been approved by the Medical Ethics Committee of Henan Cancer Hospital (Ethics No.: 2019342). RESULTS: Among the 10 patients, the fusion genes were KMT2A::MLLT1 in 7 cases, KMT2A::MLLT4, KMT2A::MLLT3 and KMT2A::MLLT10 in 1 case each. The European Group for the Immunological Classification of Leukemias (EGIL) classification included 6 cases of T-ALL, 2 cases of pro-B-ALL, 1 case of Common-B-ALL and 1 case of pre-B-ALL. 4 cases of B-ALL all expressed CD19, cCD79a, CD38 and HLA-DR, and some expressed CD34 and CD22, without expression or weak expression of CD10, without expression of CD20. One case was accompanied by myeloid marker CD15 expression. 6 cases of T-ALL all expressed CD34, CD7, most expressed CD38, and some expressed CD3, CD5, CD2, CD4 and CD8, and 1 case expressed CD4 and CD8 together. Chromosomal abnormalities were detected in 3 cases, 5 cases were positive for WT1 fusion gene, and 6 cases had gene alterations. 9 patients achieved the first complete remission (CR1) during chemotherapy, and 1 patient relapsed within 6 months after CR1. At the last follow up, 1 patient (the fusion gene was KMT2A::MLLT4) remained unrelieved. There were 2 cases of KMT2A rearrangement (KMT2A-r) persistent positive (+/+) and 8 cases of KMT2A-r negative (+/-). The overall survival (OS) rate and leukemia-free survival (LFS) rate of patients with KMT2A-r persistent positive were significantly lower than those of patients with negative change, and the differences were statistically significant (P values were all < 0.05). Among the 3 patients who received chemotherapy+allogeneic hematopoietic stem cell transplantation (allo-HSCT), no relapse was observed until the follow up day. The OS rate and LFS rate of patients with KMT2A::MLLT1 and chemotherapy+allo-HSCT were higher than those of non-KMT2A::MLLT1 and single chemotherapy patients, and the differences were not statistically significant (P values were all ≥ 0.05). There was no significant difference in OS rate and LFS rate between T-ALL and B-ALL patients (P values were all ≥ 0.05). The median LFS time of the 10 patients was 32 (0 ~ 100) months, and the median OS time was 36 (1 ~ 101) months. CONCLUSION The 11q23 rearrangement ALL with non-KMT2A::AFF1 transcript is mainly KMT2A::MLLT1, T-ALL is more common, and the rate of chromosomal karyotype detection is relatively low. Persistent positive KMT2A-r is unfavorable for patient survival, and allo-HSCT during the CR1 period may improve patient survival.
Humans ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics* ; Female ; Male ; Myeloid-Lymphoid Leukemia Protein/genetics* ; Histone-Lysine N-Methyltransferase/genetics* ; Adult ; Adolescent ; Chromosomes, Human, Pair 11/genetics* ; Child ; Transcriptional Elongation Factors/genetics* ; Gene Rearrangement ; Oncogene Proteins, Fusion/genetics* ; Retrospective Studies ; Young Adult ; Middle Aged ; Prognosis ; Child, Preschool ; DNA-Binding Proteins/genetics*

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

Objective Sentinel headache（SH） refers to new-onset headache or existing headache with altered characteristics that occurs within seven days before stroke in patients， and this study aims to investigate the incidence rate and clinical features of SH in stroke patients and its association with prognosis. Methods A total of 145 stroke patients who were admitted to Department of Neurology， The First Affiliated Hospital of Xi’an Jiaotong University， from August 2022 to April 2023 were enrolled based on inclusion/exclusion criteria， and general information was collected. According to the presence or absence of SH， they were divided into headache and control group. The features of SH were summarized， and follow-up was performed after 1 year to analyze the association between SH and prognosis. Results Among the 145 patients with stroke，30（20.7%） developed SH， with the subtypes of intracerebral hemorrhage（9 patients， 25.7%）， cerebral infarction （15 patients，18.9%）， transient ischemic attack（3 patients，14.3%）， and subarachnoid hemorrhage （3 patients， 30.0%）. Conclusion SH may occur in all stroke patients， with a prevalence rate of 20.7%. The manifestations of SH include migraine-like headache， tension-type headache， and cluster-like headache. The results of this study do not establish an association between SH and 1-year prognosis in stroke patients，and further studies are needed in the future.
Stroke ; Prognosis

Objective To investigate the prognosis of patients with brain abscess and related influencing factors. Methods A retrospective analysis was conducted for the patients with brain abscess who were consecutively admitted to Department of Neurology， Xijing Hospital of Air Force Medical University， from January 2010 to March 2022， and according to the Glasgow Outcome Scale（GOS） score at discharge， the patients were divided into good prognosis group （GOS score>3 points） and poor prognosis group（GOS score≤3 points）. The t-test， the Wilcoxon rank-sum test， the chi-square test， and the Logistic regression analysis were used to investigate the influencing factors for prognosis. Results Among the 173 patients with brain abscess，69（39.9%） had a poor prognosis， and 104 （60.1%） had a good prognosis. There were significant differences between the two groups in age， headache， seizure， coma events， focal neurological deficits， dexamethasone treatment， and cerebellar abscess （P<0.05）.The multivariate logistic regression analysis showed that age （OR=0.042，95%CI 1.001‒1.041，P=0.042）， seizure（OR=2.881，95%CI 1.172‒7.083，P=0.021）， and coma events （OR=2.694， 95%CI 1.195‒6.072， P=0.017） were significant predictive factors for poor prognosis. Conclusion Age， seizure， and coma events are major factors associated with poor prognosis. Age is an uncontrollable factor， and therefore， timely prevention and management of seizure and coma events can reduce the incidence rate of poor prognosis.
Prognosis