Cognitive Disorders, Depression and Anxiety in Temporal Lobe Epilepsy: An Overview

Partial epilepsies, originating in a specific brain region, affect about 60% of adults with epilepsy. Temporal lobe epilepsy (TLE) is the most prevalent subtype within this category, often necessitating surgical intervention due to its refractoriness to antiepileptic drugs (AEDs). Hippocampal sclerosis, a common underlying pathology, often exacerbates the severity by introducing cognitive and emotional challenges. This review delves deeper into the cognitive profile of TLE, along with the risk factors for cognitive disorders, depression, and anxiety in this population.

A Unique Modelling Strategy to Dynamically Simulate the Performance of a Lobe Pump for Industrial Applications

The performance of a newly designed tri-lobe industrial lobe pump of high capacity is simulated by using commercial CFD solver Ansys Fluent. A combination of user-defined-functions and meshing strategies is employed to capture the rotation of the lobes. The numerical model is validated by comparing the simulated results with the literature values. The processes of suction, displacement, compression and exhaust are accurately captured in the transient simulation. The fluid pressure value remains in the range of inlet pressure value till the processes of suction and displacement are over. The instantaneous process of compression is accurately captured in the simulation. The movement of a particular working chamber is traced along the gradual degree of lobe’s rotation. At five different degrees of lobe’s rotation, pressure contour plots are reported which clearly shows the pressure values inside the working chamber. Each pressure value inside the working chamber conforms to the particular process in which the working chamber is operating. Finally, the power requirement at the shaft of rotation is estimated from the simulated values. The estimated value of power requirement is 3.61 BHP FHP whereas the same calculated theoretically is 3 BHP FHP. The discrepancy is attributed to the assumption of symmetry of blower along the thickness.

Temporal lobe malacia as a rare cause of gelastic seizure:A case report

BACKGROUND Gelastic seizure(GS)is a rare type of epilepsy that most commonly appears in patients with hypothalamic hamartoma.It is rarely associated with other types of brain damage.This particular type of epilepsy is relatively rare and has few links to other brain lesions.Temporal lobe malacia is mostly caused by cerebral infarction or cerebral hemorrhage,which can lead to seizures.We report a case of GS in a woman with temporal lobe malacia which was reported for the first time in the literature.CASE SUMMARY A 73-year-old female,diagnosed case of GS,presented with repetitive stereotyped laughter a month prior to presentation,happening multiple times daily and with each time lasting for 5-15s.Electroencephalogram displayed a focal seizure seen in the right temporal region.Magnetic resonance imaging head with contrast showed a right temporal lobe malacia.The patient was started on levetiracetam daily.The patient indicated that they had fully recovered and were not experiencing any recurrent or stereotyped laughter during their daily routines.These results remained consistent even after a one-year follow-up period.CONCLUSION GS can be caused by temporal lobe malacia,which is an uncommon but potentially grave condition.The outcome of this present case exhibited the importance of the temporal lobe in the genesis of GS.

Regulation of specific abnormal calcium signals in the hippocampal CA1 and primary cortex M1 alleviates the progression of temporal lobe epilepsy

Temporal lobe epilepsy is a multifactorial neurological dysfunction syndrome that is refractory,resistant to antiepileptic drugs,and has a high recurrence rate.The pathogenesis of temporal lobe epilepsy is complex and is not fully understood.Intracellular calcium dynamics have been implicated in temporal lobe epilepsy.However,the effect of fluctuating calcium activity in CA1 pyramidal neurons on temporal lobe epilepsy is unknown,and no longitudinal studies have investigated calcium activity in pyramidal neurons in the hippocampal CA1 and primary motor cortex M1 of freely moving mice.In this study,we used a multichannel fiber photometry system to continuously record calcium signals in CA1 and M1 during the temporal lobe epilepsy process.We found that calcium signals varied according to the grade of temporal lobe epilepsy episodes.In particular,cortical spreading depression,which has recently been frequently used to represent the continuously and substantially increased calcium signals,was found to correspond to complex and severe behavioral characteristics of temporal lobe epilepsy ranging from gradeⅡto gradeⅤ.However,vigorous calcium oscillations and highly synchronized calcium signals in CA1 and M1 were strongly related to convulsive motor seizures.Chemogenetic inhibition of pyramidal neurons in CA1 significantly attenuated the amplitudes of the calcium signals corresponding to gradeⅠepisodes.In addition,the latency of cortical spreading depression was prolonged,and the above-mentioned abnormal calcium signals in CA1 and M1 were also significantly reduced.Intriguingly,it was possible to rescue the altered intracellular calcium dynamics.Via simultaneous analysis of calcium signals and epileptic behaviors,we found that the progression of temporal lobe epilepsy was alleviated when specific calcium signals were reduced,and that the end-point behaviors of temporal lobe epilepsy were improved.Our results indicate that the calcium dynamic between CA1 and M1 may reflect specific epileptic behaviors corresponding to different grades.Furthermore,the selective regulation of abnormal calcium signals in CA1 pyramidal neurons appears to effectively alleviate temporal lobe epilepsy,thereby providing a potential molecular mechanism for a new temporal lobe epilepsy diagnosis and treatment strategy.

Modified hepatic left lateral lobe inversion in laparoscopic proximal gastrectomy: An analysis of 13 cases

BACKGROUND In laparoscopic proximal gastrectomy(LPG),the prolapse of the hepatic left lateral lobe near the lesser curvature and esophageal hiatus can obstruct the field of vision and operation.Therefore,it is necessary to retract or obstruct the hepatic left lateral lobe to ensure a clear field of vision.AIM To investigate the safety and clinical efficacy of the modified hepatic left lateral lobe inversion technique for LPG.METHODS A retrospective analysis was conducted on the clinical data of 13 consecutive patients with early-stage upper gastric adenocarcinoma or adenocarcinoma of the esophagogastric junction treated with LPG from January to December 2023 at the Department of Gastrointestinal Surgery,Second Affiliated Hospital of Fujian Medical University.The modified hepatic left lateral lobe inversion technique was used to expose the surgical field in all patients,and short-term outcomes were observed.RESULTS In all 13 patients,the modified hepatic left lateral lobe inversion technique was successful during surgery without the need for re-retraction or alteration of the liver traction method.There were no instances of esophageal hiatus occlusion,eliminating the need for forceps to assist in exposure.There was no occurrence of intraoperative hepatic hemorrhage,hepatic vein injury,or hepatic congestion.No postoperative digestive complications of Clavien-Dindo grade≥II occurred wi-thin 30 days after surgery,except for a single case of pulmonary infection.Some patients experienced increases in alanine aminotransferase and aspartate aminotransferase levels on the first day after surgery,which significantly decreased by the third day and returned to normal by the seventh day after surgery.CONCLUSION The modified hepatic left lateral lobe inversion technique has demonstrated satisfactory results,offering ad-vantages in terms of facilitating surgical procedures,reducing surgical trauma,and protecting the liver.

MicroRNAs as potential biomarkers in temporal lobe epilepsy and mesial temporal lobe epilepsy

Temporal lobe epilepsy is the most common form of focal epilepsy in adults,accounting for one third of all diagnosed epileptic patients,with seizures originating from or involving mesial temporal structures such as the hippocampus,and many of these patients being refractory to treatment with anti-epileptic drugs.Temporal lobe epilepsy is the most common childhood neurological disorder and,compared with adults,the symptoms are greatly affected by age and brain development.Diagnosis of temporal lobe epilepsy relies on clinical examination,patient history,electroencephalographic recordings,and brain imaging.Misdiagnosis or delay in diagnosis is common.A molecular biomarker that could distinguish epilepsy from healthy subjects and other neurological conditions would allow for an earlier and more accurate diagnosis and appropriate treatment to be initiated.Among possible biomarkers of pathological changes as well as potential therapeutic targets in the epileptic brain are micro RNAs.Most of the recent studies had performed micro RNA profiling in body fluids such as blood plasma and blood serum and brain tissues such as temporal cortex tissue and hippocampal tissue.A large number of micro RNAs were dysregulated when compared to healthy controls and with some overlap between individual studies that could serve as potential biomarkers.For example,in adults with temporal lobe epilepsy,possible biomarkers are miR-199a-3p in blood plasma and miR-142-5p in blood plasma and blood serum.In adults with mesial temporal lobe epilepsy,possible biomarkers are miR-153 in blood plasma and miR-145-3p in blood serum.However,in many of the studies involving patients who receive one or several anti-epileptic drugs,the influence of these on micro RNA expression in body fluids and brain tissues is largely unknown.Further studies are warranted with children with temporal lobe epilepsy and consideration should be given to utilizing mouse or rat and non-human primate models of temporal lobe epilepsy.The animal models could be used to confirm micro RNA findings in human patients and to test the effects of targeting specific micro RNAs on disease progression and behavior.

HD-Zip Transcription Factor is Responsible for No-Lobed Leaf in Watermelon(Citrullus lanatus L.)

Leaf is a vital organ of plants that plays an essential role in photosynthesis and respiration.As an important agronomic trait in leaf development,leaf shape is classified into lobed,entire(no-lobed),and serrated in most crops.In this study,two-lobed leaf watermelon inbred lines WT2 and WCZ,and a no-lobed leaf watermelon inbred line WT20 were used to create two F_(2)populations.Segregation analysis suggested that lobed leaves were dominant over the no-lobed leaves,and it was controlled by a signal gene.A locus on watermelon chromosome 4 controlling watermelon lobed/no-lobed leaves was identified through BSA-seq strategy combined with linkage analysis.The candidate gene was fine-mapped to a 61.5 kb region between 21,224,481 and 21,285,957 bp on watermelon chromosome 4 using two F_(2)populations.Four functional genes were annotated in the candidate region,while sequences blast showed that there was a single-base deletion(A/-)only in the exon of Cla018360,which resulted in premature termination of translation in the no-lobed leaf lines.Function prediction showed that Cla018360 encodes an HD-Zip protein that has been reported to regulate the development of leaf shape.The single-base deletion also occurred in the HD-Zip domain.We inferred that the Cla018360 gene is the candidate gene for regulating the development of lobed/no-lobed leaves in watermelon.Gene expression analysis showed that Cla018360 was highly expressed in young leaves.Phylogenetic analysis showed that Cla018360 had a close genetic relationship with AtHB51,which had been reported to regulate the formation of leaf shape in Arabidopsis.Furthermore,transcriptome analysis showed that a total of 333 differentially expressed genes were identified between WT2 and WT20,of which 115 and 218 genes were upregulated and downregulated in no-lobed leaved watermelon WT20.This study not only provides a good entry point for studying leaf development but also provides foundational insights into breeding for special plant architecture in watermelon.

Polyethylene glycol crosslinked decellularized single liver lobe scaffolds with vascular endothelial growth factor promotes angiogenesis in vivo

Background: Improving the mechanical properties and angiogenesis of acellular scaffolds before transplantation is an important challenge facing the development of acellular liver grafts. The present study aimed to evaluate the cytotoxicity and angiogenesis of polyethylene glycol(PEG) crosslinked decellularized single liver lobe scaffolds(DLSs), and establish its suitability as a graft for long-term liver tissue engineering. Methods: Using mercaptoacrylate produced by the Michael addition reaction, DLSs were first modified using N-succinimidyl S-acetylthioacetate(SATA), followed by cross-linking with PEG as well as vascular endothelial growth factor(VEGF). The optimal concentration of agents and time of the individual steps were identified in this procedure through biomechanical testing and morphological analysis. Subsequently, human umbilical vein endothelial cells(HUVECs) were seeded on the PEG crosslinked scaffolds to detect the proliferation and viability of cells. The scaffolds were then transplanted into the subcutaneous tissue of Sprague-Dawley rats to evaluate angiogenesis. In addition, the average number of blood vessels was evaluated in the grafts with or without PEG at days 7, 14, and 21 after implantation. Results: The PEG crosslinked DLS maintained their three-dimensional structure and were more translucent after decellularization than native DLS, which presented a denser and more porous network structure. The results for Young’s modulus proved that the mechanical properties of 0.5 PEG crosslinked DLS were the best and close to that of native livers. The PEG-VEGF-DLS could better promote cell proliferation and differentiation of HUVECs compared with the groups without PEG cross-linking. Importantly, the average density of blood vessels was higher in the PEG-VEGF-DLS than that in other groups at days 7, 14, and 21 after implantation in vivo. Conclusions: The PEG crosslinked DLS with VEGF could improve the biomechanical properties of native DLS, and most importantly, their lack of cytotoxicity provides a new route to promote the proliferation of cells in vitro and angiogenesis in vivo in liver tissue engineering.

Evolution of Coulomb failure stress in Sulaiman Lobe,Pakistan,and its implications for seismic hazard assessment

In this research work,we present the evolution of Coulomb failure stress(CFS)in the Sulaiman Lobe and its implications for seismic hazard assessment.The Chaman transform fault,~1,000 km long,is the major active fault that marks the western boundary between Pakistan and Afghanistan on the Indian Plate.To date,few studies have been conducted to unveil the interactions among earthquakes and the implications of these interactions for seismic hazard assessment in the region.We thoroughly investigated the published and online catalog to construct a sequence of major earthquakes that occurred in this region during the past.The final earthquake sequence was composed of 15 earthquakes of M_(w)≥6.0,beginning with the 1888 earthquake.We used the stress-triggering theory to numerically simulate the evolution of CFS caused by these earthquakes.The numerical results revealed that 8 out of 15earthquakes were triggered by the preceding earthquakes.The earthquakes in 1908,1910,1935,1966,and 1997 were rather independent earthquakes in this sequence.Although the epicenters of the 1975a and 1975b earthquakes were in the stress shadow zone,the partial rupture segments of both these earthquakes were in high-CFS regions.The CFS induced by the 1935 earthquake was notable,as it later triggered the 2008 doublet.Moreover,our results revealed that the northern segment of the Chaman Fault,the southern segment of the Ghazaband Fault,and the northwestern segment of the Urghargai Fault demonstrated a high change in CFS that could trigger seismicity in these regions.The necessary arrangements must therefore be made to mitigate any possible seismic hazards in the region.

Activation of medial septum cholinergic neurons restores cognitive function in temporal lobe epilepsy

Cognitive impairment is the most common complication in patients with temporal lobe epilepsy with hippocampal scle rosis.There is no effective treatment for cognitive impairment.Medial septum cholinergic neurons have been reported to be a potential target for controlling epileptic seizures in tempo ral lobe epile psy.However,their role in the cognitive impairment of temporal lobe epilepsy remains unclear.In this study,we found that patients with temporal lobe epile psy with hippocampal sclerosis had a low memory quotient and severe impairment in verbal memory,but had no impairment in nonverbal memory.The cognitive impairment was slightly correlated with reduced medial septum volume and medial septum-hippocampus tra cts measured by diffusion tensor imaging.In a mouse model of chronic temporal lobe epilepsy induced by kainic acid,the number of medial septum choline rgic neurons was reduced and acetylcholine release was reduced in the hippocampus.Furthermore,selective apoptosis of medial septum cholinergic neurons mimicked the cognitive deficits in epileptic mice,and activation of medial septum cholinergic neurons enhanced hippocampal acetylcholine release and restored cognitive function in both kainic acid-and kindling-induced epile psy models.These res ults suggest that activation of medial septum cholinergic neurons reduces cognitive deficits in temporal lobe epilepsy by increasing acetylcholine release via projections to the hippocampus.

基于遗传算法的不等间距阵优化方法

阵元数一定情况下,针对不等间距拖线阵高频信号处理存在的空间增益和无栅瓣兼容问题,提出一种基于遗传算法的不等间距拖线阵阵型优化方法。该方法以频带交互下最大旁瓣级最小作为约束因子,通过模拟生物自然进化过程搜索全局最优解,得到优化后的阵元位置。优化后阵型在保证低频信号处理空间增益不变情况下,实现对高频信号高空间增益、无栅瓣处理。计算机仿真结果表明:相比未优化阵型,在高频信号处理方面,优化后阵型在无栅瓣情况下,空间增益提升值近似理论值提升值;在低频信号处理方面,优化后阵型具有相同的空间增益。为实际不等间距拖线阵阵型优化和应用提供了一种思路。

分析矩形瓣用于大鼠胆道闭锁术对肠造瘘肠液引流及肠道菌群的影响

目的研究矩形瓣用于SD大鼠胆道闭锁术对肠造瘘肠液引流及肠道菌群的影响。方法选取SPF级级SD大鼠30只,随机将SD大鼠均分为矩形瓣组和非矩形瓣组,两组各15只;矩形瓣组SD大鼠均行肝门空肠Roux.Y吻合,矩形瓣组行空肠胆支防返流瓣成形术、非矩形瓣组不做改良矩形瓣,两组均做近端空肠造瘘造口接引流管,收集反流液,比较两组术后30 d引流量;于术后第30天时取胆支段肠壁组织采用16S rDNA扩增子测序技术分析肠道菌群特征,采用RDP Classifier贝叶斯算法对测序数据包括物种的多样性、组成和样本比较进行分析,并根据香浓指数和观测物种指数分析细菌群落多样性、种类和丰度,比较两组肠道菌群种类、多样性及相对丰度的差异;大鼠胆支段肠壁组织切片采用苏木精-伊红(HE)染色观察组织学变化。结果矩形瓣组每日引流量及30 d总引流量均显著低于非矩形瓣组(t=9.918,P<0.001;t=14.212,P<0.001);矩形瓣组厚壁菌门丰度、梭菌纲丰度、梭菌目丰度、链球菌科丰度高于非矩形瓣组,差异有统计学意义(P<0.05);矩形瓣组肠道变形菌门、放线菌门丰度、腈基降解菌目、立克次体目、消化球菌科低于非矩形瓣组,差异有统计学意义(P<0.05);矩形瓣组弯曲菌属、厌氧螺菌属丰度高于非矩形瓣组,差异有统计学意义(P<0.05)。结论矩形瓣可明显减少SD大鼠胆道闭锁术中肠造瘘肠液引流量,并影响肠道菌群丰度,对预防术后肠内容物反流具有一定的临床价值。

颞叶内侧胶质瘤的手术治疗策略分析

目的:依据颞叶内侧区解剖及各种辅助技术,探讨该区胶质瘤的手术切除策略与近期疗效。方法:回顾性分析手术切除的17例颞叶内侧区胶质瘤病人的临床资料,包括临床及影像学表现、术前评估、手术入路及技术要点、近期预后等情况。术前根据病人头颅多模态MRI成像指导手术入路和切除策略,术后早期复查头颅CT和MRI,出院前、术后1个月评价病人临床恢复情况。结果:根据术前评估结果采取改良颞前下入路12例、颞中回入路4例、颞上沟入路1例。肿瘤全切除15例(88.2%),次全切除2例(11.8%)。术后新发肢体活动障碍2例(合并感觉性失语1例)、动眼神经损伤1例,术后1个月随访上述症状均有改善;其余14例病人术后表现均较术前改善,无昏迷和死亡病人。结论:颞叶内侧区位置深在、解剖复杂,对其解剖结构的深入理解、采取合理的手术策略有助于该区胶质瘤的全切及病人神经功能保护,而多模态神经影像及术中神经导航技术的辅助价值较大。

昆虫视叶结构与功能的研究进展

视觉在昆虫飞行、识别寄主和配偶,及寻找产卵位点等行为中起着重要的作用。视叶是昆虫脑内视觉中枢,具有复杂的解剖结构和神经元构成模式,并在接受整合视觉信息方面起重要作用,但具体的视觉神经回路及机制尚未被阐明。本文系统综述了视叶解剖结构类型及神经元构成、及在颜色识别、偏振光检测和运动检测功能等方面的研究进展,提出视叶未来的研究方向,旨在为深入开展基于视觉的昆虫对环境的适应性机制及害虫行为调控提供科学依据。

凹腔构型对超声速气-固两相富燃燃气掺混燃烧的影响

凹腔作为燃烧增强装置,在超声速气-固两相富燃燃气掺混燃烧中发挥着重要作用。基于火焰稳定凹腔和斜劈装置,提出了波瓣凹腔构型,通过数值模拟深入分析了凹腔构型在超声速气流中对气-固两相富燃燃气掺混燃烧的影响。通过对流场参数、流场云图及颗粒运动轨迹等的分析,发现富燃燃气中的气相组分和凝相颗粒在空间分布和释能过程中表现出分区运动和分区燃烧的特点。结果表明:随着燃烧过程的深入,颗粒的空间分布逐渐分散;流场参数在燃气喷口附近变化剧烈、流场下游变化缓慢;波瓣结构具备增强流场湍动能和降低流场不均匀性的能力,进而促进了各组分的掺混燃烧;采用双波瓣凹腔时展现出最优的促进效果。波瓣结构能够扩大流场中高温区域的空间分布,有效延长凝相颗粒在高温区域的停留时间,为凝相颗粒的燃烧和能量释放提供了更为有利的条件。

局灶性癫痫围发作期心率变异性变化特点

目的探讨局灶性癫痫围发作期心率变异性变化特点。方法收集2014年9月至2019年9月在首都医科大学附属北京天坛医院癫痫中心进行术前评估并完成手术的癫痫患者102例,选择局灶性发作198次,手动测量相邻两个心电活动的RR间期,计算心率变异性时域参数-相邻正常心跳间期差值平方和的均方根(RMSSD),比较发作前60 s、发作期、终止后60 s RMSSD差异,并比较不同心率变化类型、不同发作类型、不同发作前状态以及不同致痫灶部位和侧别RMSSD差异。结果发作期和发作前60 s及终止后60 s RMSSD相比差异有统计学意义(P<0.001),提示发作期RMSSD降低;心率增快类型癫痫发作期RMSSD降低(P<0.001);复杂部分性癫痫发作期RMSSD降低(P<0.001);颞叶内侧癫痫发作期RMSSD降低(右颞叶内侧P<0.001;左颞叶内侧P<0.001);心率无变化(P=0.556)和心率减慢(P=0.983)类型癫痫发作、单纯部分性癫痫(P=0.869)、颞叶外侧癫痫(右颞叶外侧P=0.204;左颞叶外侧P=0.849)和颞叶外癫痫(右颞外P=0.188;左颞外P=0.068)发作期RMSSD无降低。发作期和发作前60 s RMSSD差值在睡眠期更明显(P=0.039)。结论心率增快类型癫痫发作、复杂部分性癫痫、颞叶内侧癫痫发作期易发生心率变异性下降,提示癫痫发作期副交感活性下降;睡眠期状态下发生的癫痫发作期心率变异性下降相比清醒期显著,提示睡眠期癫痫发作副交感活性下降更加明显。

分叶游离下腹部皮瓣移植乳房再造的血管吻合方式选择

目的总结分叶游离下腹部皮瓣移植再造乳房的适应证和血管吻合方式选择。方法自2019年10月至2023年6月,在17例女性乳腺癌患者中完成分叶游离下腹部皮瓣移植乳房再造,包括10例即刻乳房再造和7例延期乳房再造。全部采用分叶游离下腹部皮瓣移植完成,包括M1型游离腹直肌皮瓣20侧,M2型6侧,M3型8侧。血管吻合方式具体包括:外增压方式9例,内增压方式8例。受区血管包括胸廓内血管近心端14侧,胸背血管主干10侧,前锯肌支3侧,胸外侧动静脉2例,胸廓内血管远心端5侧。结果每侧皮瓣长(14.2±0.4)cm、宽(11.5±1.0)cm、厚(4.9±0.3)cm。所有皮瓣血运良好,全部顺利成活。术后随访6~38个月,平均20.7个月,乳腺癌未见复发,再造乳房外形可,质地满意,无皮瓣挛缩变形,与健侧乳房外形基本对称;皮瓣供区及乳房受区仅遗留线性瘢痕,腹壁功能无明显影响。结论分叶游离下腹部皮瓣适用于底盘及垂度凸度都较大的乳房再造,选择合理的血管吻合方式可以确保皮瓣的自由摆放和满意的乳房塑形。

雷达抗前门耦合攻击防护能力对比分析

针对雷达遭受高功率微波武器攻击时容易损伤的问题,理论分析了雷达最远防护边界和雷达天线增益及接收机限幅器能力的关系,从空间滤波的角度,对比了反射面雷达和有源相控阵雷达抗前门耦合攻击的能力。分析得出只有高功率微波武器处于反射面雷达天线的主瓣范围附近时,对其前门耦合攻击效果才强于有源相控阵雷达;反之,要弱于有源相控阵雷达。由于反射面天线雷达主波束很窄,造成攻击的时机很短,所以反射面雷达在面对高功率微波武器时防护能力更强。

肝尾状叶切除在机器人辅助腹腔镜下腔静脉癌栓切除术中的应用:单中心经验

目的:探讨机器人辅助腹腔镜下腔静脉癌栓切除术联合肝尾状叶切除术治疗301Ⅱ~Ⅲ级下腔静脉癌栓的可行性和有效性。方法:回顾性分析2021年1月至2022年6月于解放军总医院第一医学中心行机器人辅助腹腔镜下腔静脉癌栓切除术的5例患者的临床资料,所有患者术中均联合部分肝尾状叶切除以显露肝后段下腔静脉。其中男性2例,女性3例,中位年龄61(60~75)岁;中位体质量指数24.8(21.7~25.3)kg/m2。根据301分级,Ⅱ级癌栓患者1例,Ⅲ级癌栓患者4例。下腔静脉癌栓中位高度10.8(10.4~13.1)cm,癌栓中位最大径2.0(1.5~3.9)cm。结果:5例患者手术均顺利完成,无中转开放。中位手术时间510(290~795)m i n,中位失血量1500(900~2000)ml。患者术后中位重症监护室(intensive care unit,ICU)住院时间4(0~7)d,中位总住院时间11(6~13)d。术后出现Ⅰ级并发症2例,Ⅱ级并发症3例,无围术期死亡病例。出院时该5例患者的肝、肾功能均降至基线水平。中位随访时间8.3(2.5~16.1)个月,无肿瘤复发、进展、转移等情况。结论:对于肾肿瘤伴高度毗邻第二肝门的粗大下腔静脉癌栓的患者,术中切除肝尾状叶能够更好地显露肝后段下腔静脉,有利于术中尽早控制癌栓近心端下腔静脉,从而提高手术的安全性。

强迫症反应抑制缺陷(综述)

强迫症是一种常见的高致残性精神障碍,伴随多种认知功能的缺陷。其中,反应抑制缺陷可能是强迫症的一种潜在的内表型,对于理解强迫症的病理生理机制和开发新的临床治疗方法具有重要意义。本文综述了强迫症反应抑制缺陷及其神经机制和临床干预效果,以期为进一步理解强迫症反应抑制缺陷和促进强迫症的临床诊疗提供依据。