HPA axis alterations in mental disorders: impact on memory and its relevance for therapeutic interventions

Dysfunctions in hypothalamic-pituitary-adrenal (HPA) axis have been reported for several mental disorders that are also often characterized by memory disturbances. It is now well established that glucocorticoids influence cognitive processes by enhancing memory consolidation and impairing memory retrieval. There is further evidence for an association between HPA axis related disturbances and memory function in mental disorders. The present selective review provides a brief overview of HPA axis dysfunction and its impact on memory function in major depressive disorder, posttraumatic stress disorder, and borderline personality disorder. Furthermore, the relevance of these findings for therapeutic intervention is discussed.     

Neural correlates of impulsive responding in borderline personality disorder: ERP evidence for reduced action monitoring

Patients with borderline personality disorder (BPD) are characterized by marked impulsive behaviour. The impulsive response style of patients with BPD may be associated with diminished action monitoring, which can be investigated by measuring the error-related negativity (ERN). The ERN is an ERP component generated in the anterior cingulate cortex (ACC) following erroneous responses. Behavioural and ERP measurements were obtained during performance on a speeded two-choice reaction task in a group of patients with BPD (N=12) and in a group of age-matched controls (N=12). The ERP results showed that ERN amplitudes were reduced for patients with BPD, as were the P300 amplitudes after late feedback. The behavioural results confirmed a more impulsive response style for the BPD group, reflected in larger RT differences between correct and incorrect responses and in an increase in erroneous responses to the easy congruent stimuli. Additionally, analyses on post-error congruency effects demonstrated that controls adjusted their behaviour following errors, but patients with BPD did not. The attenuated ERNs indicate reduced action monitoring in patients with BPD. This suggests that the ACC, or the action-monitoring network it is part of, is not functioning optimally. Due to this reduced action monitoring, patients with BPD do not learn from their errors as well as controls. Consequently, they do not adjust their behaviour when necessary and thus maintain their impulsive response style.     

巨大卵巢交界性黏液性囊腺瘤的CT特征

目的:探讨巨大卵巢交界性黏液性囊腺瘤的相对CT特征,以提高对巨大卵巢交界性黏液性囊腺瘤的认识。材料与方法:回顾性分析10例经病理证实为巨大卵巢交界性黏液性囊腺瘤的多层螺旋CT平扫及增强影像,并行多平面重组(MPR)、冠状面和矢状面最大密度投影(MIP)及容积再现(VR)图像重组。结果:10例巨大卵巢交界性黏液性囊腺瘤的多层螺旋CT影像均表现为与卵巢关系密切的巨大多房囊性病变,囊内可有稍不规则分隔及实性乳头状结节,增强后囊壁、分隔及实性结节强化。重建图像上有助于清晰显示肿瘤全貌。结论:巨大卵巢交界性黏液性囊腺瘤CT表现具有良恶交界性肿瘤的特征,仔细分析其CT特征有助于术前正确诊断。     

卵巢浆液性和黏液性交界性肿瘤36例临床病理特点

目的探讨卵巢浆液性和粘液性交界性肿瘤的临床病理特点。方法对钦州市第一人民医院收治的36例卵巢浆液性和粘液性交界肿瘤临床资料及病理特点进行回顾性分析。结果浆液性和黏液性交界性肿瘤缺乏特异的临床表现。Ⅰ期浆液性交界瘤17例（81%）,黏液性交界瘤12例（80%）。Ⅱ期浆液性交界瘤3例（14.3%）,黏液性交界瘤2例（13.3%）。Ⅲ期浆液性交界瘤1例（4.8%）,黏液性交界瘤1例（6.7%）。有4例浆液性交界瘤淋巴结受累。有3例浆液性交界瘤为非浸润性种植,1例浆液性交界瘤为浸润性种植,1例黏液性交界瘤为浸润性种植。治疗以手术为主。术后随访110年,有1例Ⅲ期黏液性交界瘤患者术后5年死亡,其余健在。结论卵巢浆液性交界瘤预后较好,肿瘤在卵巢表面生长常有腹膜种植。     

阿托伐他汀和普罗布考联合治疗对冠脉临界病变患者冠脉病变程度的协同作用

目的 研究冠脉临界病变患者血浆胱抑素C水平(plasma cystatin C concentration,PcyC)的变化,探讨阿托伐他汀和普罗布考的联合治疗对其PcyC水平和冠脉病变严重程度的影响.方法 连续入选2006年5月至2010年11月在北京安贞医院住院经定量冠脉造影检查确诊冠脉临界病变130例(borderline coronary lesion,BCL),136例无冠脉病变的受试者纳入对照组( controls,CTR).BCL组患者被随机(随机密封信封法)分为常规治疗组(routine treatment,RTT,n =60)和联合治疗组(combined treatment,CBT,n=70),连续治疗6个月.联合治疗组除常规药物治疗外,每日加用阿托伐他汀20 mg和普罗布考1.0g.各组性别、年龄等一般资料间比较差异均无统计学意义,具有可比性.检测其血PcyC和高敏C-反应蛋白(high-sensitive C-reactive protein,hs-CRP)水平,以及总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)及甘油三酯( triglycerides,TG)浓度.其中BCL组104例受试者复查冠脉造影.两组间均数比较采用t检验和方差分析,计数资料使用X2检验,以P＜0.05为差异具有统计学意义.结果 BCL组PcyC水平明显高于CTR组(P＜0.05).与RTT组相比,CBT组PcyC水平、TC、LDL-C、TG、和hs-CRP明显降低(P＜0.05,P＜0.01).此外,治疗6个月后RTT组冠脉临界病变的平均狭窄程度(meanpercent stenosis,MPS)有所下降(P＞0.05),而CBT组却见明显减低(P＜0.05).结论 PcyC参与冠状动脉疾病的病理过程,且与冠脉病变的严重程度密切相关.阿托伐他汀和普罗布考的联合应用可降低PcyC水平,其可能是冠脉临界病变治疗的选择.     

多因素干预对临界高血压合并代谢综合征影响的临床研究

目的 探讨不同治疗方式对临界高血压合并代谢综合征(MS)病变发展的影响。方法 将90例临界高血压合并MS患者按随机数字表法分为对照组、常规治疗组和强化治疗组,每组30例。对照组仅给予定期监测各项临床指标;常规治疗组根据病情服用相关药物;强化治疗组制定达标目标,予控制饮食、运动、健康教育及药物等综合治疗措施。各组均随访治疗1年,比较患者治疗前后各项临床指标的变化情况。结果 随访治疗1年后,对照组空腹血糖(FPG)、餐后2h血糖(2h PG)、24h尿微量白蛋白(24 h mAlb)、颈动脉内膜中层厚度(IMT)较治疗前明显升高,差异有统计学意义(P＜0.05),其余各项指标治疗前后比较差异无统计学意义(P＞0.05)。常规治疗组治疗后FPG、2hPG、总胆固醇(TC)、三酰甘油(TG)较治疗前明显下降,颈动脉IMT较治疗前明显升高,差异有统计学意义(P＜0.05),其余各项指标治疗前后比较差异无统计学意义(P＞0.05)。强化治疗组治疗后收缩压(SBP)、舒张压(DBP)、脉压(PP)、FPG、2hPG、TC、TG、高敏C反应蛋白(hs-CRP)、24 h mAlb、HOMA模型胰岛素抵抗指数(HOMA-IR)较治疗前明显下降,高密度脂蛋白胆固醇(HDL-C)、踝臂指数(ABI)较治疗前明显升高,差异有统计学意义（P＜0.01或＜0.05）。与常规治疗组治疗后比较,强化治疗组ABI、HDL-C升高,SBP、DBP、PP、TG、hs-CRP、24 h mAlb、HOMA-IR、颈动脉IMT下降(P＜ 0.01或＜0.05)。结论 临界高血压合并MS,一般药物治疗可获得部分临床指标的好转,给予综合强化治疗,能显著改善胰岛素抵抗,控制高血压的发生和发展,延缓血管病变。     

Neoadjuvant therapy for patients with borderline resectable pancreatic cancer: A systematic review and meta-analysis of response and resection percentages

BackgroundWe systematically reviewed and performed a meta-analysis of the available data regarding neoadjuvant chemo- and/or radiotherapy with special emphasis on tumor response/progression rates, toxicities, and clinical benefit, i.e. resection probabilities and survival estimates.Methods and findingsTrials were identified by searching PUBMED, MEDLINE, and the Cochrane Central Register of Controlled Trials from 1966 to Feb 2015. A total of 18 studies (n = 959) were analyzed. the estimated fraction of patients with complete response was 2.8% (CI 0.8–4.7%) and with partial response 28.7% (CI 18.9%–38.5%). Stable disease was averaged to 45.9% (CI 32.9%–58.9%) in all patients and tumor progression under therapy occurred by estimation in 16.9% (CI 10.2%–23.6%) of the patients. The weighted frequency of those who underwent resection was 65.3% (CI 54.2%–76.5%), and the proportion of R0 resection amounted to 57.4% (CI 48.2%–66.5%). The weighted mean of median survival amounted to 17.9 months (range: 14.7–21.2 months) for the overall cohort of patients, 25.9 months (range: 21.1–30.7 months) for those who were resected, and 11.9 months (range: 10.4–13.5 months) for unresected patients.ConclusionsThe resection and R0 resection rates in the group of borderline resectable tumor patients after neoadjuvant therapy are similar to the resectable tumor patients, much higher than those in unresectable tumor patients. The survival estimates of borderline resectable tumor patients after neoadjuvant therapy were similar to resectable tumor patients. Patients with borderline resectable pancreatic cancer should be included in neoadjuvant protocols and subsequently be reevaluated for resection. How to find chemo-responsiveness before neoadjuvant chemotherapy so as to give individualized treatment is still an important issue.     

Quelle place pour la radiothérapie dans la prise en charge des cancers du pancréas localisés ?

At diagnosis, about 15% of patients with pancreatic cancer present with a resectable tumour, 50% have a metastatic tumour, and 25% a locally advanced tumor (non-metastatic but unresectable due to vascular invasion) or borderline resectable. Despite the technical progress made in the field of radiation therapy and the improvement of the efficacy of chemotherapy, the prognosis of these patients remains very poor. Recently, the role of radiation therapy in the management of pancreatic cancer has been much debated. This review aims to evaluate the role of radiation therapy for these patients.     

FFR CT对CCTA判定冠状动脉临界狭窄病变血流动力学变化的分析

目的评价基于冠状动脉CT血管成像（CCTA）的冠状动脉血流储备分数（FFR_CT）对CCTA判定临界狭窄病变冠状动脉血流动力学变化的诊断价值。方法回顾性分析了18例同时进行CCTA和有创冠状动脉造影（ICA）的病人,男13例,女5例,年龄49~76岁,平均（61±9）岁。选择冠状动脉临界狭窄病变（狭窄率为50%~70%）为靶血管,经ICA测定血流储备分数（FFR）;记录CCTA影像数据,计算FFR_CT。FFR及FFR_CT均以≤0.80表示受累冠状动脉出现血流动力学改变并需要进一步治疗。以FFR为金标准,计算CCTA及FFR_CT的诊断准确度、敏感度、特异度、阴性预测值及阳性预测值,通过绘制受试者操作特征（ROC）曲线并采用Bland-Altman分析及Spearman相关分析评价CCTA狭窄及FFR_CT对冠状动脉缺血的诊断效能。结果18例病人共27段冠状动脉接受评价,以FFR为金标准,FFR_CT诊断准确度88.9%,敏感度100%,特异度62.5%,阳性预测值86.4%,阴性预测值100%;FFR_CT与FFR呈中等程度相关（r=0.663,P<0.001）;Bland-Altman分析显示FFR_CT与FFR的一致性较好（95%CI：-0.23~0.20）,96.3%（26/27）的点落在一致性界限内,3.7%（1/27）的点在?95%一致性界限外。FFR_CT?ROC曲线下面积大于CCTA的（分别为0.947、0.500,P<0.001）。结论对于冠状动脉临界狭窄病变血流动力学变化的评价,FFR_CT能够提高CCTA在冠状动脉临界狭窄病变缺血方面的诊断能力。