Vascular cognitive impairment has been a research hotspot in the field of neurology in recent years.The Montreal Cognitive Assessment is a rapid screening tool for detecting mild cognitive impairment.Now it has been widely used in the evaluation of vascular cognitive impairment.This article reviews the content,features,application status,and development prospects of the Montreal Cognitive Assessment.

The optimal therapeutic regimen for patients with asymptomatic carotid artery stenosis (ACS) has been controversial.Early research suggests that carotid endarterectomy (CEA) is effective for the treatment of patients with severe ACAS.In recent years,as a minimally invasive treatment,carotid artery stenting (CAS) is as effective as CEA.It has a trend of replacing CEA.In recent 10 years,medicine standardized treatment has made great progress.Recent studies have shown that the risk of stroke is lower using the optimal medical treatment in patients with ACAS compared with CEA and CAS.The key of choosing optimal therapeutic regimen is to identify the high risk patients with stroke.

Objective To investigate the incidence,characteristics and risk factors of cognitive impairment in patients with transient ischemic attack(TI A) or minor stroke.Methods Montreal cognitive assessment(MoCA) was carried out in 279 patients with TIA or minor stroke and 150 healthy controls to assess their cognitive function.Results (1) Compared with the healthy controls,the TIA/minor stroke patients scored significantly lower on MoCA total score((23.98±2.55) vs (26.60±0.99),t=12.084,P＜0.01) and subtests including visuoexecutive function((3.68±0.94) vs (4.41±0.64),t=8.483,P＜0.01),digital span ((1.81±0.40) vs (1.95±0.23),t=3.771,P＜0.01),attention((0.84±0.37) vs (0.95±0.23),t=3.357,P＜ 0.01),repetition((1.59±0.62) vs (1.89±0.37),t=5.496,P＜0.01),verbal fluency((0.88±0.33) vs (0.95 ± ±0.23),t=2.286,P＜0.05),abstraction((1.55±0.64) vs (1.91±0.34),t=6.357,P＜0.01) and recall ((2.87±1.13) vs (3.18±0.41),t=3.281,P＜0.01) were significantly decreased.(2) Of 279 TIA/Minor stroke patients,213 (76.3％) suffered from cognitive impairment.The incidence of cognitive impairment was positively correlated with the gender,age,educational level,smoking,course,leukoaraiosis,comorbidities such as hypertension,diabetes mellitus(P＜0.05),and negatively correlated with hyperlipidemia(P＞0.05).Conclusion Extensive impairments of cognitive functions occur along with the incidence of TIA or minor stroke.It is thus suggested that cognitive assessment and interventions may be carried out at an early stage.

Objective To investigate the efficacy and safety of cladribine in the treatment of patients with refractory/relapsed acute myeloid leukemia (AML). Methods The data of 8 patients with refractory/relapsed AML treated with regimens containing cladribine at a dose of 5 mg/m2 per day for 5 consecutive days were retrospectively analyzed. The efficacy and adverse reactions were observed during treatment. Results Among the 8 patients, 5 patients achieved complete remission (CR), 1 patient achieved partial response (PR), and 2 patients obtained non remission (NR). The adverse reactions could be tolerated. Conclusion Regimen containing cladribine is an effective treatment procedure for the patients with refractory/relapsed AML, and its adverse reactions can be tolerated, which requires further clinical study.

Objective:To investigate the expression and prognostic significance of CD19 in patients with Acute myelogenous leukemia with AML1-ETO positive. Methods: Clinical data of 66 patients AML with AML1-ETO positive who were newly diagnosed from Jan 2010 to Dec 2015 were collected. To retrospectively analyze the relationship between clinical characteristics and expression of CD19,so dose the prognosis. Results:The positive rate of CD19 expressing in AML with AML1-ETO positive was 50. 0%. There were no statistically significant differences in terms of age,gender,hemoglobin,platelet,percentage of bone marrow blasts,accompanied with chromosome ,gene mutations between patients with and without CD19 expression(P>0. 05). The white blood cell count(WBC) of the CD19 negative group was higher than CD19 positive group,while showed significant difference(P=0. 027). Although the relapse-free survival (RFS) of patients with CD19 expression was higher than those without,no significant difference was calculated (P=0. 105). Patients with CD19 expression had superior overall survival ( OS ) compared to those without CD19 expression ( P = 0. 030 ) . Multivariable analysis for OS identified CD19 positivity as an independent predictor associated with better prognosis. Conclusion: The expression of CD19 in AML with AML1-ETO positive may be an indicator associated with better prognosis.

Objective To investigate the methylation status of Zonula occludens-1(ZO-1)gene promoter and discuss its role in the pathogenesis and progression of acute leukemia(AL)as a general gene marker.Methods The methylation pattern in promoter region of ZO-1 gene was detected with methylation specific PCR in AL cell lines HL60.Molt4 and NK92 as well as in 121 clinical bone marrow samples including 81 cases of AL and 40 non malignant cases.Resuits The promoter region of ZO-1 gene was completely methyrlated in HL60.Molt4 and NK92 cells:but it was unmethylated in 40 non malignant bone marrow samples.The total methylation frequency of ZO-1 gene promoter region in 81 cases of AL was 60.49%(49/81),there was significant statistic difference among the relapsed AL group(92.86%, 13/14),the newly diagnosed AL group(65.85%,27/41)and the complete remission group(34.62%, 9/26).but no difference between the cases with acute myelocytic leukemia and acute lymphocytic leukemia. Conclusion The hypermethylated status of ZO-1 gene promoter region was specifically detected in human AL,it was closely correlated with the pathogenesis and progression of the disease and will become a general clinical molecular marker of leukemia.

Objective To explore the inflnence of autologous peripheral blood hematopoietic stem cell transplantation (auto-HSCT) for lymphoma process on the quality of patients blood coagulation.Methods Plasma samples were collected before the conditioning and on day 0,7,14,28,35 follow auto-HSCT from 20 patients.The following parameters were measured:prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB) and D-dimer(D-Di).Results Compared with the values before conditioning,a significant rise in the FIB values was detected on day 7 and day 14 after auto-HSCT,no essentially change in the FIB values was detected on day 21 and day 28 and day 35 after auto-HSCT.Other coagulation parameters investigated(PT.APTT.D-Di) remained essentially unchanged.All of the patients not concurrent thrombotic disease.Conclusion Lymphoma patients with autologous peripheral blood hematopoietic stem cell transplantation appear abnormality in coagulant function.Clinical doctors should concern.

10.3969/j.issn.1000-8179.2013.12.006

Objective:The implementation of a multidisciplinary team (MDT) approach for palliative treatment of patients with multi-ple primary carcinomas (MPCs) was evaluated in Tianjin Medical University Cancer Institute and Hospital. Methods:A total of 40 pa-tients with MPCs who attended the consultation by MDT in our hospital from January 1, 2014 to April 21, 2016 were analyzed retro-spectively. Clinical data of the 40 cancer patients were reviewed. The essential characteristics and results of MDT treatment decisions were summarized and expected outcomes were evaluated. Results:A total of 40 cases with MPCs were included in MDT assessment, accounting for 6.4%of the 629 patients who were handled by the MDT. A total of 39 MDT decisions were followed up successfully. Among these MDT decisions, 26 (65%) were fully implemented, 7 (17.5%) were partially implemented, and 6 (15.0%) were unimple-mented. Expected outcomes were achieved in 25 (96.2%) patients of the fully implemented concordant group, 4 (57.1%) patients of the partially concordant group, and 1 (16.7%) patient from the unimplemented group. Conclusion:MDT specializing on palliative treat-ment can provide recommendations for standardized individualized comprehensive treatment of patients with MPCs. MDT modality should be further improved and widely used for palliative treatment.

ObjectiveTo investigate the variation of peripheral blood CD34+ cells during the hematopoietic stem cell mobilization,and its influence on the collecting timing and results.Methods Twenty-seven cases of peripheral blood hematopoietic stem cell mobilization and collection from April 2010 to December 2011 were analyzed,including 13 autologous cases mobilized with chemotherapy combined with granulocyte colony-stimulating factor (G-CSF,10 μg· kg-1 · d-1) and 14 cases of healthy donors mobilized with only G-SCF (7.5 μg · kg- 1 · d- 1 ).The number of peripheral blood CD34+ cells was counted,and its correlation with the yield of mononuclear cells (MNCs) and CD34+cells was analyzed.ResultsMNCs (5.84 ± 1.48) × 108/kg and CD34+ cells (3.93 ± 2.16) × 106/kg were obtained in healthy donors,and (6.58 ± 3.72) × 108/kg MNCs and (3.98 ± 3.06) × 106/kg CD34+ cells were obtained in autologous cases,respectively.There was only 1 failure in autologous cases.The peak of peripheral blood CD34+ cells in autologous cases appeared at day 4 after the treatment of G-CSF,and in healthy donors the number of peripheral blood CD34+ cells at day 5 was still in ascendant phase.The CD34+ cells/kg in the collection products were positively correlated with the percentage and absolute value of peripheral blood CD34+ cells.The cases ratio of CD34+ cells≥2× 106/kg in the products of single collection was up to 76.2％ (16/21) in the cases with peripheral blood CD34+ cells absolute value greater than 20/μl.ConclusionThe number of peripheral blood CD34+ cells was an important monitoring indicator in hematopoietic stem cell mobilization and collection,CD34+ cell absolute value ≥20/μl could be used as collection threshold.