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Objective:To investigate the clinical efficacy of pancreaticoduodenectomy (PD) for periampullary diseases.Methods:The retrospective cohort study was conducted. The clinico-pathological data of 2 019 patients with periampullary diseases who underwent PD in the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were collected. There were 1 193 males and 826 females, aged 63(15) years. Observation indicators: (1) surgical situations; (2) postoperative conditions; (3) postoperative pathological examinations; (4) prognosis of patients with periampullary carcinoma. Regular follow-up was conducted by telephone interview and outpatient examination once every 3 months within the postoperative first year and once every 6 months thereafter to detect the survival of patients with periampullary carcinoma. The follow-up was up to December 2021. Measurement data with skewed distribution were represented as M(IQR) or M(range), and comparison between groups was analyzed using the rank sum test. Count data were described as absolute numbers and (or) percentages, and comparison between groups was analyzed by the chi-square test or Fisher exact probability. Kaplan-Meier method was used to draw survival curves and calculate survival rates, and Log-Rank test was used to conduct survival analysis. Results:(1) Surgical situations: of 2 019 patients, 1 116 cases were admitted from 2016-2018 and 903 cases were admitted from 2019-2020. There were 1 866 cases undergoing open PD and 153 cases undergoing laparoscopic or robot-assisted PD. There were 1 049 cases under-going standard PD and 970 cases undergoing pylorus-preserved PD. There were 215 cases combined with portal mesenteric vein resection, 3 cases combined with arterial resection. The operation time of 2 019 patients was 255(104)minutes and the volume of intraoperative blood loss was 250(200)mL. The intraoperative blood transfusion rate was 31.401%(623/1 984), with the blood transfusion data of 35 cases missing. The proportions of pylorus-preservation, combination with portal mesenteric vein resection, intraoperative blood transfusion were 585 cases(52.419%), 97cases(8.692%), 384 cases(34.941%) for patients admitted in 2016-2018, versus 385 cases(42.636%), 118 cases(13.068%), 239 cases(27.006%) for patients admitted in 2019-2020, showing significant differences between them ( χ2=19.14,10.05,14.33, P<0.05). (2) Postoperative conditions: the duration of postoperative hospital stay of 2 019 patients was 13 (10) days. One of 2 019 patients lacked the data of postopera-tive complications. The overall postoperative complication rate was 45.292%(914/2 018), of which the incidence rate of grade B or C pancreatic fistula was 23.439%(473/2 018), the rate of grade B or C hemorrhage was 8.127%(164/2 018), the rate of grade B or C delayed gastric emptying was 15.312%(309/2 018), the rate of biliary fistula was 2.428%(49/2 018) and the rate of abdominal infection was 12.884%(260/2 018). The reoperation rate of 2 019 patients was 1.932%(39/2 019), the in-hospital mortality was 0.644%(13/2 019), the postoperative 30-day mortality was 1.238%(25/2 019), and the postoperative 90-day mortality was 2.675%(54/2 019). There were 541 cases(48.477%) with overall postoperative complications, 109 cases(9.767%) with grade B or C hemorr-hage, 208 cases(18.638%) with grade B or C delayed gastric emptying , 172 cases(15.412%) with abdominal infection, 39 cases(3.495%) with postoperative 90-day mortality of 1 116 patients admitted in 2016-2018. The above indicators were 373 cases(41.353%), 55 cases(6.098%), 101 cases(11.197%), 88 cases(9.756%), 15 cases(1.661%) of 902 patients admitted in 2019-2020, respectively. There were significant differences in the above indicators between them( χ2=10.22, 9.00, 21.30, 14.22, 6.45 , P<0.05). The in-hospital mortality occurred to 11 patients(0.986%) of 1 116 patients admitted in 2016-2018 and to 2 cases(0.221%) of 903 patients admitted in 2019-2020, showing a significant difference between them ( P<0.05). (3) Postoperative pathological examinations. Disease area of 2 019 patients reported in postoperative pathological examinations: there were 1 346 cases(66.667%) with lesions in pancreas, including 1 023 cases of carcinoma (76.003%) and 323 cases(23.997%) of benign diseases or low potential malignancy. There were 250 cases(12.382%) with lesions in duodenal papilla, including 225 cases of carcinoma (90.000%) and 25 cases(10.000%) of benign diseases or low potential malignancy. There were 174 cases(8.618%) with lesions in bile duct, including 156 cases of carcinoma (89.655%) and 18 cases(10.345%) of benign diseases or low potential malignancy. There were 140 cases(6.934%) with lesions in ampulla, including 134 cases of carcinoma (95.714%) and 6 cases(4.286%) of benign diseases or low potential malignancy. There were 91 cases(4.507%) with lesions in duodenum, including 52 cases of carcinoma (57.143%) and 39 cases(42.857%) of benign diseases or low potential malignancy. There were 18 cases(0.892%) with carcinoma in other sites. Postoperative pathological examination showed carcinoma in 1 608 cases(79.643%), benign diseases or low potential malignancy in 411 cases(20.357%). The histological types of 1 608 patients with carcinoma included adenocarcinoma in 1 447 cases (89.988%), intra-ductal papillary mucinous carcinoma in 37 cases(2.301%), adenosquamous carcinoma in 35 cases(2.177%), adenocarcinoma with other cancerous components in 29 cases(1.803%), neuroendocrine carcinoma in 18 cases(1.119%), squamous carcinoma in 1 case (0.062%), and other histological malignancies in 41 cases(2.550%). The histological types of 411 patients with benign or low poten-tial malignancy included intraductal papillary mucinous neoplasm in 107 cases (26.034%), chronic or autoimmune inflammatory disease in 62 cases(15.085%), neuroendocrine tumor in 58 cases(14.112%), pancreatic serous cystadenoma in 52 cases(12.652%), pancreatic solid pseudopapillary tumor in 36 cases(8.759%), gastrointestinal stromal tumor in 29 cases(7.056%), villous ductal adenoma in 20 cases(4.866%), pancreatic mucinous cystadenoma in 2 cases(0.487%), pancreatic or duodenal trauma in 2 cases(0.487%) and other histological types in 43 cases(10.462%). (4) Prognosis of patients with periampullary carcinoma. Results of survival analysis of 1 590 patients with main locations of periampullary carcinoma showed that of 1 023 patients with pancreatic cancer, 969 cases were followed up for 3.0-69.6 months, with a median follow-up time of 30.9 months. The median overall survival time, 1-year, 3-year and 5-year survival rates of pancreatic cancer patients were 19.5 months [95% confidence interval ( CI) as 18.0-21.2 months], 74.28%, 29.22% and 17.92%. Of 225 patients with duodenal papillary cancer, 185 cases were followed up for 3.0-68.9 months, with a median follow-up time of 36.7 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were unreached, 94.92%, 78.87% and 66.94%. Of 156 patients with distal bile duct cancer, 110 cases were followed up for 3.0-69.5 months, with a median follow-up time of 25.9 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 50.6 months (95% CI as 31.4 to not reached), 90.37%, 56.11% and 48.84%. Of 134 patients with ampullary cancer, 100 cases were followed up for 3.0-67.8 months, with a median follow-up time of 28.1 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 62.4 months (95% CI as 37.8 months to not reached), 90.57%, 64.98% and 62.22%. Of 52 patients with duodenal cancer, 38 cases were followed up for 3.0-69.5 months, with a median follow-up time of 26.2 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 52.0 months (95% CI as 30.6 months to not reached), 93.75%, 62.24% and 40.01%.There was a significant difference in overall survival after PD between patients with different locations of periampullary malignancies ( χ2=163.76, P<0.05). Conclusions:PD is safe and feasible in a high-volume pancreas center, but the incidence of overall postoperative complications remains high. With the increase of PD volume, the incidence of overall postoperative complications has significantly decreased. There is a significant difference in overall survival time after PD among patients with different locations of periampullary malignancies. The 5-year survival rate after PD for duodenal papillary cancer, ampullary cancer, duodenal cancer and distal bile duct cancer is relatively high, whereas for pancreatic cancer is low.
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Laparoscopic surgery is a revolution in the fields of surgery in the 21st century. The concept of minimally invasive surgery has been widely accepted. Nowadays, the commercial robot-assisted laparoscopic instrument operating system, commonly known as "surgical robot", does not yet have the attributes of a real robot and still needs further optimization. We are still far from claiming that we are in the "surgical robot era". A new generation of surgical robots with more developed artificial intelligence and simulation functions are worth working on for. "Minimally invasive approach" does not necessarily mean "minimally invasive surgery". The real benefit of patients is the most important indicator for evaluating minimally invasive surgery. The essence of science is discovery but not technological fashion. In the face of rapid technological development, the Chinese surgeons should remain rational and enterprising.
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Objective:To investigate the application value of TRIANGLE operation in radical resection of pancreatic cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 30 patients with pancreatic cancer who underwent TRIANGLE operation in the First Affiliated Hospital of Nanjing Medical University from March 2020 to July 2020 were collected. There were 18 females and 12 males, aged from 41 to 79 years, with a median age of 65 years. After assessment of the resectability and dissection of the hepatoduodenal ligament, the superior mesenteric artery, celiac axis, common hepatic artery, portal vein and superior mesenteric vein of patients were exposed. According to the location of tumor, patients were performed pancreaticoduodenectomy, distal pancreatectomy or total pancreatectomy combined with dissection of putatively tumor-infiltrated lymphatic and neural tissue from the triangular space. During the TRIANGLE operation, it required to at least finish the skeletonization of right semi-circumference of the superior mesenteric artery and celiac axis in cases of pancreatico-duodenectomy, whereas the left semi-circumference in cases of distal pancreatectomy. In principle, both of the superior mesenteric artery and celiac axis were circumferentially skeletonized for cases of total pancreatectomy. Lymphatic, neural and fibrous tissues between the superior mesenteric artery and the celiac artery were completely dissected in all patients. Observation indicators: (1) surgical conditions and postoperative histopathological examination; (2) postoperative recovery situations; (3) follow-up. Regular follow-up was conducted by telephone interview or outpatient examinations to understand tumor recurrence and metastasis of patients up to January 2021. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages, Fisher exact probability method was used for comparison between groups. Results:(1) Surgical conditions and postoperative histopathological examination: all patients underwent open operation, including 21 cases of pancreaticoduodenec-tomy, 6 cases of distal pancreatectomy, 2 cases of total pancreatectomy, 1 case of mid-segment preserving pancreatectomy. There were 16 cases combined with portal vein-superior mesenteric vein resection and 3 cases combined with left adrenal resection. For the dissection area of superior mesenteric artery-celiac axis, one cycle was conducted in 5 of 30 patients, one and a quarter cycle in 8 patients, one and a half cycle in 8 patients, one and three quarters?two cycles in 9 patients. There were 16 cases with left gastric vein dissection and 14 cases with left gastric vein preservation. The operative time of 30 patients was 287 minutes (range, 165?495 minutes) and the volume of intraoperative blood loss was 275 mL(range, 50?800 mL). Nine patients received intraoperative transfusion of red blood cells or frozen plasma. Postoperative histopathological examination showed that the tumor diameter was 3.4 cm (range, 1.2?7.3 cm), the number of harvested lymph nodes was 20 (range, 9?35), the number of positive lymph nodes was 2 (0?19). Of the 30 patients,20 cases had moderately differentiated tumor and 10 cases had poorly differentiated tumor. R 0 resection was achieved in 9 patients, 1 mm R 1 resection in 17 patients, and R 1 resection in 4 patients. Postoperative pathological T stages: 3 of 30 patents were in stage T1, 18 cases were in stage T2, 5 cases were in stage T3, and 4 cases were in stage T4. Postoperative pathological N stages: 9 of 30 patents were in stage N0, 13 cases were in stage N1, and 8 cases were in stage N2. Postoperative pathological TNM stages: 2 of 30 patents were in stage Ⅰa, 2 cases were in stage Ⅰb, 3 case were in stage Ⅱa, 11 cases were in stage Ⅱb, 12 cases were in stage Ⅲ. (2) Postoperative recovery situations: 20 of 30 patients had postoperative complications, including 6 cases of Clavien-Dindo grade I complications, 9 cases of grade Ⅱ complications, 3 cases of grade Ⅲa complications, 2 cases of grade V complications. The incidence of postoperative diarrhea was 0 in cases with one cycle dissection of tissues around superior mesenteric artery-celiac axis, 1/8 in cases with one and a quarter cycle dissection, 4/8 in cases with one and a half cycle dissection, 9/9 in cases in with one and three quarters-two cycles dissection, showing a significant difference between the four groups ( P<0.05). The incidence of delayed gastric emptying was 5/16 in patients with left gastric vein dissection, versus 1/14 in patients with left gastric vein preservation, showing no significant difference between the two groups ( P>0.05). Nineteen of 30 patients received adjuvant chemotherapy.Twenty-eight of 30 patients were successfully discharged from hospital, with the duration of postoperative hospital stay of 15 days(range, 8?68 days) and the rest of 2 patients died. Three patients had unplanned readmission within postoperative 90 days. (3) Follow-up: all the 28 patients discharged from hospital were followed up for 1.0?9.0 months, with the median follow-up time of 6.5 months. During the follow-up, one patient with locally advanced pancreatic cancer had local recurrence, 9 patients had liver metastasis (including 4 cases with resectable pancreatic cancer, 4 cases with borderline resectable pancreatic cancer, 1 case with borderline resectable pancreatic cancer), and 1 patient with borderline resectable pancreatic cancer had peritoneal metastasis. The rest of 17 patients survived without tumor recurrence. Conclusions:TRIANGLE operation in the radical resection of pancreatic cancer has high radicality and low postoperative local recurrence, but a slightly high morbidity and mortality rate. Its long-term efficacy needs to be further evaluated. It is recommend that this procedure should be performed for selected patients after neoadjuvant chemotherapy in high-volume pancreatic surgery centers.
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Recanalization therapy is the standard treatment for acute ischemic stroke. However, sometimes blood flow reperfusion not only fails to restore brain function, but also leads to further necrosis and apoptosis of neurons, thereby aggravating brain tissue damage and brain dysfunction of the patients, that is, reperfusion injury. Remote ischemic conditioning (RIC) is a simple, safe, convenient and easy method to protect brain tissue, improve cerebral blood flow and alleviate ischemia-reperfusion injury by giving multiple transient ischemic treatments to remote organs (usually limbs). This article reviews the application of RIC in the field of acute ischemic stroke in recent years.
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Objective:To evaluate the role of synapsin-Ⅰ phosphorylation in herkinorin-induced reduction of oxygen-glucose deprivation/restoration (OGD/R)-caused damage to cortical neurons and the relationship with conventional protein kinase C (cPKC)γ in newborn mice.Methods:Primary cortical neurons of cPKCγ + /+ and cPKCγ -/- mice (within 24 h after birth) were cultured for 7 days.Each type of neurons were then divided into 3 groups ( n=5 each) using a random number table method: control group (group C), OGD/R group and herkinorin group (group H). The neurons were subjected to oxygen-glucose deprivation (OGD) for 1 h followed by restoration of oxygen-glucose supply for 24 h. Herkinorin 10 μmol/L was added immediately after onset of OGD, the neurons were then incubated for 1 h, and herkinorin was washed out at the end of OGD in group H. At 24 h of oxygen-glucose restoration, cells were collected for measurement of the cell survival rate by methyl thiazolyl tetrazolium assay, and immunofluorescence was used to measure the number of neurites and the length of dendrites.Western blot was applied to detect the expression of phosphorylated synapsin-Ⅰ (p-synapsin-Ⅰ). Results:Compared with group C, the cell survival rate and the number of neurites were significantly decreased, the length of dendrites was shortened, and the expression of p-synapsin-Ⅰ was down-regulated in cPKCγ + /+ and cPKCγ -/- mice in group OGD/R and group H ( P<0.05). Compared with group OGD/R, the cell survival rate and the number of neurites were significantly increased, the length of dendrites was prolonged, the expression of p-synapsin-Ⅰ was up-regulated in cPKCγ + /+ mice in group H ( P<0.05), and no significant change was found in the parameters mentioned above in cPKCγ -/- mice in group H ( P>0.05). There was no significant differences in the expression of synapsin-Ⅰ in neurons among the three groups of cPKCγ + /+ mice and among the three groups of cPKCγ -/- mice ( P>0.05). Conclusion:Herkinorin can reduce OGD/R-caused damage to cortical neurons through decreasing cPKCγ membrane translocation and inhibiting synapsin-Ⅰ phosphorylation in newborn mice.
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Objective To investigate the effect of insular on the addiction of nicotine after insular infarction. Methods Totally 35 patients with lesions involving insular infarction were enrolled in insular damage group. The patients matched with the demographic data of the study subjects who did not involve in-sular infarction were the control group(n=114). All patients were given the internationally popular question-naire of smoking urges ( QSU) and fagerstrom test for nicotine dependence( FTND) during hospitalization, and they were followed up 3 months after stroke. The QSU and the minnesota nicotine withdrawal scale ( MNWS) were assessment for patients who did not smoke again and did not relapse,and the QSU and FTND scale were used for the patients who still smoke. Results After 3 months follow-up,the rate of withdrawal from insular damage was 77. 14%,and that in non-insular damage was 52. 63%(χ2=6. 62,P=0. 01),and the MNWS in two groups(insular damage patients (0. 59±0. 97) and non-insular damage patients(1. 15± 1. 29)),the difference was statistically significant (t=-2. 00,P=0. 04). All subjects were evaluated by questionnaire of smoking urges (QSU),among which QSU score was (19. 40±9. 63) in insular damage group and (24. 47±10. 39) in non-insular group,the difference was statistically significant (t=-2. 57,P=0. 01) . Conclusion Patients with insular lesion are more likely to cause withdrawal of nicotine addiction, suggesting that insular may be involved in cognitive processing of addiction.
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Objective To investigate the emotional memory changes in patients with thalamic infarction on different laterals and explore the impact of different emotional valence pictures on the thalamic infarction(TI) patients' memory.Methods 28 patients with thalamic infarction (TI group)and 28 patients who were hospitalized without TI during the same period (control group) were given emotional memory test,a test where they use their emotional memory to evaluate and recognize pictures with different emotional valence,including positive,neutral,and negative valence.Results (1) At the stage of evaluating emotional images,there were no significant difference between patients with TI and control group in positive evaluation (P＞0.05).Compared with control group (neutral(12.96±1.62),negative(13.57±1.37),respectively),neutral and negative recognition scores for emotional pictures of patients with TI (neutral (10.79±2.07),negative (10.96±2.05),respectively) were decreased significantly (positive t =-4.5 and negative t=-5.6,both P＜0.05).(2)At the stage of emotional images memorizing tests,TI group's total scores on re-accessing total emotional pictures were significantly lower than those in control group ((36.14 ± 3.24) vs(41.89 ± 3.43) respectively)) (t=-6.44,P＜0.05).Compared with control group (positive (14.04± 1.29),neutral (13.68±1.56)),patients with TI (positive (10.93± 1.96),neutral(11.25± 1.67)) were decreased significantly in the emotional pictures memorizing tests (t=-7.00,5.61,P＜0.05).But there were no difference in negative stimulus between the two groups (P＞0.05).(3)The score of emotional pictures recognition in patients with LTI (34.43 ± 3.48) were decreased significantly than that in patients with RTI (37.86± 1.83) (t =3.26,P＜ 0.05).The score in recognizing neutral valence images in patients with LTI(10.43± 1.55) were significantly decreased than those in RTI (12.07± 1.38) (t=2.95,P＜0.05).Conclusion Patients with TI may rely on different neural mechanisms to affect the different valence of the emotional memory loop process.The emotional memory impairment in patients with TI at different sides is different.The left thalamus has a greater influence on memory.
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Objective To investigate the emotional memory changes in patients with thalamic infarction on different laterals and explore the impact of different emotional valence pictures on the thalamic infarction(TI) patients' memory.Methods 28 patients with thalamic infarction (TI group)and 28 patients who were hospitalized without TI during the same period (control group) were given emotional memory test,a test where they use their emotional memory to evaluate and recognize pictures with different emotional valence,including positive,neutral,and negative valence.Results (1) At the stage of evaluating emotional images,there were no significant difference between patients with TI and control group in positive evaluation (P＞0.05).Compared with control group (neutral(12.96±1.62),negative(13.57±1.37),respectively),neutral and negative recognition scores for emotional pictures of patients with TI (neutral (10.79±2.07),negative (10.96±2.05),respectively) were decreased significantly (positive t =-4.5 and negative t=-5.6,both P＜0.05).(2)At the stage of emotional images memorizing tests,TI group's total scores on re-accessing total emotional pictures were significantly lower than those in control group ((36.14 ± 3.24) vs(41.89 ± 3.43) respectively)) (t=-6.44,P＜0.05).Compared with control group (positive (14.04± 1.29),neutral (13.68±1.56)),patients with TI (positive (10.93± 1.96),neutral(11.25± 1.67)) were decreased significantly in the emotional pictures memorizing tests (t=-7.00,5.61,P＜0.05).But there were no difference in negative stimulus between the two groups (P＞0.05).(3)The score of emotional pictures recognition in patients with LTI (34.43 ± 3.48) were decreased significantly than that in patients with RTI (37.86± 1.83) (t =3.26,P＜ 0.05).The score in recognizing neutral valence images in patients with LTI(10.43± 1.55) were significantly decreased than those in RTI (12.07± 1.38) (t=2.95,P＜0.05).Conclusion Patients with TI may rely on different neural mechanisms to affect the different valence of the emotional memory loop process.The emotional memory impairment in patients with TI at different sides is different.The left thalamus has a greater influence on memory.
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Objective@#To explore the clinical effect of a novel artery first and uncinate process first approach for laparoscopic pancreaticoduodenectomy(LPD), emphasizing the left lateral and posterior dissection of uncinate process (UP) via Treitz ligament approach.@*Methods@#From April to November 2016, 18 patients received LPD with a novel approach in Pancreas Center of the First Affiliated Hospital with Nanjing Medical University. All patients were diagnosed as pancreatic head or peri-ampulla tumor, without major vessel invasion nor distant metastasis. For resection, routine caudal view was used in the first step, to dissect the anterior medial border between uncinate process and superior mesenteric vein(SMV). Lymphatic tissues were completely dissected form anterior surface of hepatoduodenal ligament. In the second step, left lateral view with camera from left para-umbilical trocar was used, Treitz ligament was incised, SMA root was exposed. After anticlockwise rotation and retraction of mesentery, the anatomic relationship between SMA trunk, inferior pancreaticoduodenal artery(IPDA), jejunal branch of SMV, and distal part of UP, could be perfectly exposed from left lateral view. SMA was dissected from its root until the position above the uncinate process and duodenum, IPDA was transected, distal part of UP was freed from SMA. In the third step, right lateral view and caudal view were alternatively used; proximal UP mesentery was completely dissected out from SMA root, CA root and posterior surface of hepatoduodenal ligament. Pancreaticoduodenectomy was completed in the forth step after transection of pancreatic neck and common hepatic duct.@*Results@#The SMA root and distal UP were successfully dissected out via Treitz ligament approach in all 18 patients, among them, distal UP was completely excised in 8 patients from left view. Postoperative pathology showed R0 resection rate in 69%. Postoperative complication included intra-abdominal hemorrhage in 1 patient, pancreatic fistula in 7 patients(6 cases with grade A and 1 case with grade B), delayed gastric emptying in 4 patients (2 cases with grade A, 2 cases with grade B). Average postoperative hospital stay was (15.5±6.8)days.@*Conclusion@#The novel artery first and uncinate process first approach through Treitz ligament could help surgeons to completely dissect the full length of meso-pancreas along celiac axis-SMA axis in LPD.
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Objective To investigate the emotional memory characteristic in patients with leuloaraiosis(LA) and explore the neurobiological mechanisms through observing the changes of emotional memory.Methods Different valence images (including positive,neutral and negative pictures) were used to test twenty-four patients with Leuloaraiosis(LA group)and twenty-four healthy colltrols(HC group) at the same time.The emotional memory was evaluated by the recognition of emotional pictures.Results In appraisal of the emotional pictures,there was no significant difference between patients with LA (positive (10.42±2.30) and neulral (12.87±2.29),respectively) and healthy controls (positive (11.38 ± 3.25) and neutral (12.75 ± 2.86),respectively) in positive and negative appraisal (all P＞0.05).But the negative appraisal decreased between LA group (11.63 ± 1.81) and HC group (12.75 ± 2.02) (P＞ 0.05).Compared with healthy controls (38.08+±5.45),patients with LA(33.67±7.10) showed sharply decline in the emotional images memorizing task(P＜0.05).And the accuracy in recognizing positive and netural valence pictures in patients with LA ((Positive(11.04±2.40) and neulral (10.42±2.93)) was significantly lower than that in healthy controls ((positive(12.79±2.17) and neutral(12.08±2.59))(P＜0.05).But in negative stimulus,there was no significant difference between LA group(13.20± 1.86)and HC group(12.20±2.65) (P＞0.05).In addition the total correct recognition,positive and neutral valence in pictures recognition were negativly correlated with the se verity of white matter lesions in the LA patients group(r=-0.308,P=0.033;r=-0.462,P=0.003;r=-0.352,P=0.014).Conclusion The emotional memory is impaired in patients with LA,and the degree of damage is accompornied with the severity degree of LA.The emotional memory for positive and neutral vanlence pictures is impaired but the emotional memory for neutral is relatively reserved in patients with LA in pictures recognition phase.It suggests that impaired emotional memory with different valences may be related to different neuromechanisms.
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Objective To investigate the emotional memory impairment in patients with primary insomnia (PI) and explore the neurobiological mechanisms underlying primary insomnia through emotional memory tasks involving different valance of emotional pictures.Methods Thirty patients with primary insomnia(PI group) and twenty healthy controls(HC group) were given emotional memory tasks using positive,neutral and negative valence images.The emotional memory was evaluated by the recognition of emotional pictures.Results Compared with healthy controls (positive (11.60±4.00) , neutral (11.05± 3.73) and negative (12.60± 2.06) , respectively), patients with PI (positive (11.30±3.75),neutral (11.47±3.21) and negative (11.43±4.12) ,respectively) showed no significant difference in appraisal of the emotional pictures (P＞0.05).Compared with healthy controls (43.40± 4.88) for the emotional images memorizing task,patients with PI (39.40±6.43) exhibited evident deficit of all emotional images (P＜0.05).Furthermore, the accuracy in recognizing both positive (12.60± 2.42) and neutral (12.87±3.18) valence pictures were significantly lower in patients with P1 than those in healthy controls(positive (14.05±2.19) and neutral (14.75± 1.80)) (P＜0.05).There was no significant difference in negative stimulus between PI group(13.93±1.76) and HC group(14.70±1.59) (P＞0.05).Conclusion The results suggest thant emotional memory is impaired in patients with PI.Moreover,the emotional memory for positive and neutral vanlence pictures is impaired but the emotional memory for negative is relatively spared in patients with primary insomnia.The results also indicate that impaired emotional memory with different valences may relate with distinct neuromechanisms.
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<p><b>BACKGROUND</b>Episodic memory includes information about item memory and source memory. Many researches support the hypothesis that these two memory systems are implemented by different brain structures. The aim of this study was to investigate the characteristics of item memory and source memory processing in patients with Parkinson's disease (PD), and to further verify the hypothesis of dual-process model of source and item memory.</p><p><b>METHODS</b>We established a neuropsychological battery to measure the performance of item memory and source memory. Totally 35 PD individuals and 35 matched healthy controls (HC) were administrated with the battery. Item memory task consists of the learning and recognition of high-frequency national Chinese characters; source memory task consists of the learning and recognition of three modes (character, picture, and image) of objects.</p><p><b>RESULTS</b>Compared with the controls, the idiopathic PD patients have been impaired source memory (PD vs. HC: 0.65 ± 0.06 vs. 0.72 ± 0.09, P = 0.001), but not impaired in item memory (PD vs. HC: 0.65 ± 0.07 vs. 0.67 ± 0.08, P = 0.240).</p><p><b>CONCLUSIONS</b>The present experiment provides evidence for dissociation between item and source memory in PD patients, thereby strengthening the claim that the item or source memory rely on different brain structures. PD patients show poor source memory, in which dopamine plays a critical role.</p>
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Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cognição , Fisiologia , Memória , Fisiologia , Testes Neuropsicológicos , Doença de ParkinsonRESUMO
Objective To investigate the ability of social cognition in patients with right temporal lobe infarction.Methods Fifteen patients with temporal lobe infarction (TLI) and 20 healthy controls (HC) were examined with the recognition of faux pas and reading the mind in the eyes tasks for assessing the ability of social cognition.Results The TLI group performed significantly worse when compared with the HC group (28.6 ± 6.1,36.4 ± 4.3 respectively) as revealed in the total faux pas-related scores (U =41.00,P ＜0.01).For the control question,there was no significant difference between the TLI group and the HC group (9.86 ±0.35,10.00 ± 0.00 ; U =130.00,P =0.097).In the reading the mind in the eyes task,patients with TLI performed worse than the HC group(17.13 ±6.41,29.75 ±2.07 respectively),and the difference had statistical significance (U =0.00,P ＜ 0.01).But there was no significant difference in gender recognition judgment (30.37 ± 1.16,31.35 ± 1.08 respectively; U =106.00,P =0.129).Conclusions The right temporal lobe involves in social cognition.Moreover,the right temporal lobe not only involves in the verbal related social cognitive processing,but also involves in the no-verbal related social cognitive processing.
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Objective To characterize social-perceptual component and social-cognitive component of theory of mind(TOM) in patients with Parkinson's disease.Methods A total of 19 patients with idiopathic PD and 20 demographic-matched health subjects were included in this study.They were assessed by using Reading the Mind in the Eyes and Faux Pas task involving ToM socialperceptual component and social-cognitive component.The severity of PD was assessed by the Hoehn and Yahr scale.Results Significant difference was found between PD group and health controls in task involving ToM social-perceptual component (mind Reading:17.1 ± 3.1 vs.30.4 ± 1.7,F =278.756,P＜ 0.001),test involving social-cognitive component (Faux Pas Questions:29.0 ± 4.0 vs.41.2±4.4,F=81.647,P＜0.001).While the ability to identify sex and control questions of the Faux Pas showed no significant difference as compared to health controls group (F=3.508,P=0.069;F=1.063,P =0.309).Conclusions The ToM social-perceptual component and social-cognitive component are both impaired in patients with Parkinson's disease.
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Objective To characterize social-perceptual component and social-cognitive component of theory of mind in patients with Parkinson's disease.Methods A total of 19 patients with idiopathic PD and 20 demographic-matched health subjects were included in this study.They were assessed using Reading the Mind in the Eyes and faux pas task involving ToM social-perceptual component and social-cognitive component.The severity of PD was assessed on the Hoehn and Yahr scale.Results Significant difference was found between PD group and health controls on task involving ToM social-perceptual component (mind Reading:17.1 ± 3.1 vs.30.4 ± 1.7,F=278.756,P ＜0.001),test involving social-cognitive component (Faux pas Questions:29.0± 4.0 vs.41.2 ± 4.4,F =81.647,P＜0.001).While the ability to identify sex and control questions of the faux pas showed no significant difference compared to health controls group (F =3.508,P =0.069 ; F =1.063,P =0.309).Conclusions The ToM social-perceptual component and social-cognitive component are both impaired in patients with Parkinson's disease.
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Objective To investigate the expression of pSTAT5 in 7 pancreatic carcinoma cell lines,and the change of expression of pSTAT5 in pancreatic carcinoma cells SW1990 after growth hormone (GH) treatment, and explore its molecular mechanism. Methods Human pancreatic carcinoma cell lines (SW1990, Cap-1, Colo, Mia, AsPc, P3, PANC1) were cultured in vitro, and Western blotting was used to detect the expression of pSTAT5 in these cell lines. SW1990 in exponential growth phase was collected and nude Balb/c mice were inoculated with SW1990 cells. When tumors became palpable after inoculation, mice (normal saline group). 1 h, 2 h and 24 h after the last dose of GH treatment, the mice were sacrificed.Western blotting was used to detect the expression of pSTAT5 in SW1990 and inoculation tumor cells after GH injection. Results Positive expression of pSTAT5 was observed in all human pancreatic carcinoma cell lines (SW1990, Cap-1, Colo, Mia, Aspc, P3, PANC1). 5 minutes after GH (50 ng/ml) stimulation, the expression of pSTAT5 in SW1990 was 0.57 ±0.05, which was significantly increased; and it reached 0.64 ±0.04 at 10 minutes, then decreased to 0.39 ±0.03 at 15 minutes, however, it remained higher than that in the control group at 1 h (0.33 ± 0.02 vs 0.25 ± 0.06), and its expression at 2 h was 0.26 ± 0.03 and returned to the normal level. The expression of pSTAT5 in xenograft was not significantly changed. Conclusions GH could rapidly up-regulate the expression of pSTAT5 in SW1990 but the effect lasted for a relatively short period. GH had no significant effect on the expression of pSTAT5 in xenograft.
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Objective To explore the impairment of time perception in patients with Parkinson's disease (PD).Method Thirty-two individuals with idiopathic PD were compared with 32 matched healthy controls using a time reproduction task.Result Compared with healthy controls for the 3-second duration reproduction task, PD patients in the setting of a delay by 1 s ( (2.78 ±0.31 ) s and (2.15 ±0.34) s,respectively) and a delay by 5 s ( (2.74 ±0.32) s and (2.08 ±0.37) s, respectively) showed impairment in time perception with a significant under-estimation of the duration ( t = - 7.459, - 7.533, both P ＜0.01 ).When compared with healthy controls for the 5-second duration reproduction task, PD patients in the setting of a delay by 1 s ( (3.99 ±0.39) s and (3.11 ±0.52) s) and 5 s ( (4.05 ±0.40) s and (2.96 ±0.54) s) also showed impairment in time perception with a significant under-estimation of the duration (t =-7.609 and - 9.120, both P ＜ 0.01 ).When compared with healthy controls for the 600-millisecond duration reproduction task, PD patients in the setting of delay by 1 s ((0.91 ±0.18) s and (0.90 ±0.18) s, respectively) and by 5 s ( (0.89 ± 0.16) s and (0.91 ± 0.17 ) s, respectively) did not have impaired time perception, and the difference was not significant ( t = 0.347, P = 0.730; t = - 0.519, P =0.606, respectively).Conclusion Our data indicates that time perception is impaired in PD patients.Impaired time perception is mainly an under-estimation of the time interval in seconds rather than milliseconds.
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Objective To explore visual-spatial working memory deficits of patients with basal ganglia damage, based on which tried to provide the new method for detecting the injuries in basal ganglia. Methods Twenty-five patients with lesions in the basal ganglia and twenty-five healthy controls performed visual-spatial working memory tasks, including a face-recognition and a spatial delayed-response. Results For the basal ganglia damage group ,the correct rate of both visual- face ( 54.5 ± 9.6 ) % and visual-spatial ( 80.0 ± 11.7 ) % working memory tasks was significantly lower than that of the control group ( ( 64.3 ± 9.5 ) %, ( 93.6 ± 4.9) %, respectively) ,and the difference was statistically significant ( u= - 147.5,80.5, P＜0. 01 ). For the patients injured in the left basal ganglia, the correct rate of visual- face working memory (48.5 ± 5.4 )% was obviously lower than that of patients injured in the right basal ganglia ( 59.2 ± 9.8 ) %, and the difference was statistically significant ( u =25.5, P＜0. 01 ) ;but the difference of correct rate for the visual-space working memory was not statistically significant( u = 52.5, P＞ 0.05 ). In contrast to the controls, both the visual-face and visual-space working memory of the group with injuries in basal ganglia,had appeared to be disable. Conclusions The results confirmed that patients with lesions in basal ganglia had deficits of visual-spatial working memory,and that injuries either in the left or the right basal ganglia can probably cause the shiftiness of cognitive function. Therefore, the injuries in basal ganglia can be detected by the visual-spatial working memory tests.
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Objective To investigate the characteristics of the executive function and working memory in patients with mild cognitive impairment (MCI), and the relations between working memory and executive function and the effects of working memory on patient' s daily functioning.Methods Thirty patients with MCI and 30 healthy elderly subjects were tested with a wide neuropsychoingical battery of tests including those of executive function, working memory and other cognition domain tests.Executive function was evaluated by using the verbal fluency test (VFT), color trail test (CTT), digital span (DS).Results The results showed the presence of significant executive function and working memory impairment in MCI patients as compared with the healthy controls.The scores of executive function test in MCI patients were decreased significantly in CTT (130.8±58.2 vs 52.0±13.5), CTT-B (210.2±81.8 vs 121.0±33.4),DS (3.4±0.9 vs 4.2±1.1), VFT (8.9±5.4 vs 16.4±5.4) and visuo-objective working memory (0.73±0.12 vs 0.85±9.18) respectively (t = 7.108, 5.159,-2.544,-4.879, and-4.351, all P <0.01 or P < 0.05) .In the stepwise liner regression analysis objective working memory test made a significant independent contribution to ADL (β =-0.720, t =-3.571, P < 0.01).Conclusion The patients with MCI have the deficit in executive function and working memory.Visuo-objective working memory is closely correlated with general cognitive function such as daily function, resulting in daily function decline.
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OBJECTIVE To observe the controlled hypotensive effect of remifentanil in patients of different age groups undergoing FESS. METHODS Forty-seven ASAI-II patients were divided into two groups: young-middle aged group(18～55yr,n=24)and elderly group(60～72yr,n=23). Both groups received remifentanil by continuous infusion. Their systolic blood pressures (SBP) were reduced to 30～35 % of the base values and sustained throughout surgery. SBP,diastolic blood pressure (DBP) and heart rate (HR) were monitored throughout surgery. The surgical field quality score, total dose of remifentanil and postoperative complications of each patient were recorded after the operation. RESULTS The SBP and DBP of two group were reduced to the target pressure at the beginning of the operation(P0.05). CONCLUSION Remifentanil enabled controlled hypertensions and offer superior surgical field conditions for FESS in patients of different age groups. Moreover,it was a more suitable alternative for elderly patients because HR did not increase during controlled hypotension.