This paper reviewed the Methods of evaluation and rehabilitation of mild cognitive impairment (MCI) after stroke. The Results showed that the Methods of evaluation included Mini Mental State Examination(MMSE), three Methods designed by The National Institute for Neurological Disorders and Stroke(NINDS) and The Canadian Stroke Network(CSN), and Montreal Cognitive Assessment (MoCA) and category test. The MoCA as the focus is brief, practical and effective as the major advantages. Many Methods of rehabilitation existed are still lack of evidence to support their efficacy.

To observe the expression of CD40/CD40L on peripheral blood mononuclear cells (PBMC) in patients with condyloma acuminatum (CA), flow cytometry was employed to examine the expression of CD40 and CD40L on PMBC in 36 patients with CA and 20 healthy controls. Our results showed that mean level of CD40 expression in CA patients was significantly lower than that in the controls (6.58% +/- 2.74% vs 14.81% +/- 6.12%, t = 5.703, P < 0.05); the average level of CD40L in CA patients was also significantly lower than that in the controls (0.73% +/- 0.54% vs 2.67% +/- 2.43%, t = 3.532, P < 0.05). Our results suggest that the reduced costimulatory interaction of CD40 and CD40L in CA patients may be one of the important factors responsible for the low cellular immunity.

【Objective】To evaluate the impact of stent implantation on proliferation and apoptosis in media vascular smooth muscle cells and to explore the mechanism of restenosis after stent implantation.【Methods】Fifty male New Zealand rabbits were randomized into balloon group and stent group.Control group were set up.The materials were harvested on 3,7,14,28 and 56 day after operation and the following investigation were carried out.① Assessing the expression of proliferating cell nuclear antigen (PCNA) and Cyclin E of media smooth muscle cells with immunohistochemistry;② Analyzing apoptosis of media smooth muscle cells by TUNEL technique.【Results】The expressions of PCNA,Cyclin E and apoptosis in stent and balloon groups were markedly increased compared to control groups.① Stent group induced significant increased expression of PCNA and Cyclin E in the media smooth muscle cells compared to balloon group.On day 7,the positive rates of PCNA and Cyclin E were 24.36±0.55% vs 18.74±1.09% (P<0.01) and 22.65±1.00% vs 17.68±1.10% (P<0.01) respectively;② Stent group induced much more significant apoptosis than balloon group.The highest rate of apoptosis appeared on day 7:12.46±1.13% vs 5.54±0.53% (P<0.01);③By calculating the ratio of positive rates of PCNA to apoptosis and Cyclin E to apoptosis respectively,the ratio of balloongroup was higher than that of stent group.【Conclusion】Stent group induces augmented proliferation and much more significant apoptosis of media smooth muscle cells compared to balloon group.It shows that the severity of restenosis is relieved after stent implantation.

Objective To explore mood disorders after left and right cerebral hemisphere injury,to search for possible mechanisms and to provide the basis for designing rehabilitation protocols and assessing prognosis.Methods Fifty-one cases with brain injury were recruited from a rehabilitation center and divided into left and right hemisphere injury groups with 26 and 25 cases,respectively.Hamilton rating scale for depression (HRSD) scores were analyzed. Results The left hemisphere patients had significantly higher HRSD total scores and higher scores indicating 15 kinds of mood disorders (depression,feelings of guilt,suicidal thoughts etc.).Right hemisphere injury patients had significantly higher diurnal variation,depersonalization or derealization and paranoid symptoms. Conclusions The lateralization of the cerebral hemispheres may display itself in mood and emotion.After left or right hemisphere injury,the depression presentation is different,so treatment,prognosis assessment and psychological intervention should be different for left and right hemisphere injuries.

To report a case of retinoic acid syndrome due to tretinoin in the treatment of psoriasis.A 32-year-old male patient presented with psoriasis vulgaris for more than 10 years.In recent 10 years,he experienced erythema,plaques covered with multi-layered scales on the scalp,trunk,extremities accompanied by pruritus.The patient was diagnosed as psoriasis and given long-term treatment with oral vitamins,traditional Chinese medicine,and topical drugs,which resulted in a status of remission and exacerbation.Half a year prior to the presentation,the patient was given acitretin 10 mg twice daily due to the exacerbation of condition;20 days later,the dose increased to thrice daily;after another 30 days,the lesions were improved,and the frequency decreased to twice daily again;finally,a disappearance of the lesions was achieved after half a year of maintenance treatment with acitretin 10 mg twice daily.One week prior to the presentation,the treatment strategy was altered from acitretin to viaminate 50 mg twice daily;after three days with viaminate,the patient experienced a sudden worsening of psoriatic lesions with an obvious inflammatory reaction;subsequently,the lesions rapidly spread to the whole body surface and fused into large patches,accompanied with the following signs:marked edema,massive desquamating,high fever (＞39℃),hypotension,respiratory distress,pulmonary edema,pleural and pericardial effusions,renal dysfunction,peripheral blood leukocytosis.The patient was diagnosed as retinoic acid syndrome(RAS).After given oral glucocorticoid,symptomatic and supportive treatment,he experienced a relief of symptoms.These findings indicate that RAS is an entity with an abrupt onset and poor prognosis.For patients with RAS,early diagnosis and prompt management with corticosteroids,symptomatic and supportive treatments are essential to avoid potential fatal complications.

To observe the expression of CD40/CD40L on peripheral blood mononuclear cells (PBMC) in patients with condyloma acuminatum (CA), flow cytometry was employed to examine the expression of CD40 and CD40L on PMBC in 36 patients with CA and 20 healthy controls. Our results showed that mean level of CD40 expression in CA patients was significantly lower than that in the controls (6.58%±2.74% vs 14.81%±6.12%, t=5. 703, P＜0.05); the average level of CD40L in CA patients was also significantly lower than that in the controls (0.73% ±0.54% vs 2.67%±2.43%, t=3. 532, P＜0.05). Our resutls suggest that the reduced costimulatory interaction of CD40 and CD40L in CA patients may be one of the important factors responsible for the low cellular immunity.

Objective To observe the effects of acupuncture therapy with finger on back-shu point on acid reflux and lower esophageal sphincter pressure (LESP) of the patients with gastroesophageal reflux disease (GERD). Methods Totally 120 patients of GERD were randomly divided into treatment group and control group through random number table method, 60 cases in each group. Patients in the treatment group were treated with the acupuncture therapy with finger on back-shu point, and patients in control group were treated with lansoprazole tablets and dispersible mosapride citrate for two weeks. Total percentage of acid reflux time, the long time acid reflux episodes, and the longest acid reflux time of two groups were observed six months after the treatment. At the same time, the LESP variation of two groups was followed up six months after the treatment. Results The total percentage of acid reflux time, the long time acid reflux episodes, and the longest acid reflux time decreased significantly in all patients after treatment (P<0.01), while the comparison between groups showed no significant difference (P>0.05). After treatment, LESP of two groups was significantly improved (P<0.05) than before treatment. After stopping treatment half a year, the treatment group had obvious difference (P<0.05) compared with before treatment, while the control group had no significant difference (P>0.05). Conclusion The acupuncture therapy with finger on back-shu point can reduce acid reflux, and achieve the goal of treatment of GERD by improving the lower esophageal sphincter pressure. The duration of improving LESP is longer.

Objective:To evaluate risk factors and available treatments of extramedullary relapse (EMR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with myeloid leukemia.Methods:A total of 280 patients were retrospectively analyzed from January 2008 to December 2018 in Affiliated Cancer Hospital of Zhengzhou University. Clinical data were collected including disease patterns, pre-transplantation status, chromosome karyotype, conditioning regimen, types of donor, extramedullary disease before transplantation and graft-versus-host disease (GVHD). The log-rank test and Cox proportional hazard model were uesd for univariate analysis and multivariate analysis, respectively.Results:Twenty patients developed EMR (7.14%). The median time of EMR was 7.5 (1-123) months after allo-HSCT. The mortality of EMR was 80% (16/20). Univariate analysis identified disease patterns, second complete remission (CR2) or progressive disease before transplantation, extramedullary disease, abnormal karyotype and conditioning regimen without total body radiation as significant factors correlated to EMR ( P<0.05). Multi-variable analysis revealed that CR2 or progressive disease ( RR=3.468,95% CI 2.189-7.786), abnormal karyotype ( RR=1.494,95% CI 1.020-2.189) and extramedullary disease before transplantation ( RR=8.627,95% CI 3.921-18.452) were independent risk factors of EMR. Conclusions:The clinical outcome of EMR after allo-HSCT is poor.It is crucial to comprehensively assess and identify EMR as early as possible.

Objective To investigate the impact of simultaneous percutaneous transluminal renal artery stenting (PTRAS) and percutaneous coronary artery interventions (PCI) on cardiac and renal function in patients with renal artery stenosis (RAS) and coronary artery disease (CAD),and explore the factors affecting the long-term prognosis.Methods This retrospective cohort study enrolled 169 patients with RAS and CAD from January 2006 to January 2010,149 patients were intervened with PTRAS and PCI simultaneously (combined group) and the remaining 20 patients were treated with PCI (PCI group).All patients were followed up for at least 2 years.Clinical data including blood pressure,estimated glomerular filtration rate (eGFR),echocardiography and major adverse events were obtained.Results The average stenotic ratio of the left and right renal artery in PCI group were significantly lower than those in combined group (both P ＜ 0.01).After 2 years,there was a significant decrease in systolic blood pressure compared to baseline level in the combined group (P ＜ 0.01).In the PCI group,both systolic blood pressure and diastolic blood pressure were significantly lower during follow-up than at the baseline level(both P ＜ 0.01).Echocardiography examination showed that left ventricular mass index (LVMI) during follow up was significantly lower than the baseline value in both groups,and the reduction extent in the combined group was larger than in PCI group(-55.6 g/m2 vs.-12.8 g/m2,P ＜ 0.01).In the combined group,the eGFR value decreased from (44.7 ± 17.4) ml · min-1 · 1.73 m-2 to (41.7 ± 18.9) ml · min-1 · 1.73 m-2 (P ＜ 0.01).eGFR level remained unchanged in PCI group(P ＞ 0.05).Multivariate Cox regression analysis demonstrated that baseline renal dysfunction was not significantly related to the long-term adverse prognosis in combined group (HR =0.986,P ＞ 0.05).Conclusions Simultaneous PTRAS and PCI are safe and effective for treating patients with RAS and CAD.Simultaneous PTRAS and PCI are beneficial on controlling blood pressure and reducing left ventricular mass index but has no impact on renal function change.

OBJECTIVETo study the relationship between carbon dioxide combining power(CO₂-CP) and contrast-induced acute kidney injury (CI-AKI) in patients with ST segment elevation myocardial infarction and undergoing percutaneous coronary intervention.

METHODSWe retrospectively analyzed 174 patients admitted to our hospital from March 2012 to August 2013 with ST segment elevation myocardial infarction and underwent emergency percutaneous coronary intervention. Patients were divided into three tertiles according to pre-operative CO₂-CP: T1 (CO₂-CP < 22.62 mmol/L), T2(CO₂-CP 22.62-24.30 mmol/L), T3(CO₂-CP > 24.30 mmol/L). Baseline clinical data, CI-AKI incidence, in-hospital mortality and dialysis rate were compared among groups. An increase in serum creatinine of >26.4 µmol/L and/or >50% from baseline within 48 hours after contrast exposure was defined as CI-AKI. Univariate logistic regression analysis was used to identify the risk factors of CI-AKI. The relationship between CO₂-CP and CI-AKI was assessed by multivariate logistic regression analysis. Receiver operating characteristic curve was used to identify the optimal cutoff of the CO₂-CP for predicting CI-AKI.

RESULTSCI-AKI occurred in 25 (14.4%) patients, and lower CO₂-CP was related to higher incidence of CI-AKI (27.6% (16/58) in group T1, 5.3% (3/57) in group T2, 1.7 % (1/59) in group T3, P = 0.002) and higher in-hospital mortality (10.3% (6/58) vs. 0 and 1.7% (1/59), P = 0.010). Dialysis rate was similar among 3 groups (5.2% (3/58) vs. 0 and 1.7% (1/59), P = 0.168). The incidence of CI-AKI was significantly associated with CO₂-CP < 22.00 mmol/L in univariate analyses (OR = 6.767, 95% CI 2.731-16.768, P < 0.001). After adjusting for potential confounding risk factors, CO₂-CP < 22.00 mmol/L remained significantly associated with the incidence of CI-AKI (OR = 5.835, 95%CI 1.800-18.914, P = 0.003) in multivariate logistic regression. ROC analysis revealed that the optimal cutoff of CO₂-CP to predict CI-AKI was 22.00 mmol/L (sensitivity 64.0%, specificity 79.1%, AUC = 0.714).

CONCLUSIONSPre-percutaneous coronary intervention CO₂-CP in patients with ST segment elevation myocardial infarction undergoing percutaneous coronary intervention is related to CI-AKI. CO₂-CP < 22.00 mmol/L predicts higher risk of CI-AKI in this patient cohort.

Acute Kidney Injury ; etiology ; Carbon Dioxide ; analysis ; Contrast Media ; Hospital Mortality ; Humans ; Incidence ; Kidney ; Logistic Models ; Myocardial Infarction ; complications ; physiopathology ; Percutaneous Coronary Intervention ; ROC Curve ; Retrospective Studies ; Risk Factors