Aging and the encoding of changes in events: The role of neural activity pattern reinstatement

When encountering unexpected event changes, memories of relevant past experiences must be updated to form new representations. Current models of memory updating propose that people must first generate memory-based predictions to detect and register that features of the environment have changed, then encode the new event features and integrate them with relevant memories of past experiences to form configural memory representations. Each of these steps may be impaired in older adults. Using functional MRI, we investigated these mechanisms in healthy young and older adults. In the scanner, participants first watched a movie depicting everyday activities in a day of an actor’s life. They next watched a second nearly identical movie in which some scenes ended differently. Crucially, before watching the last part of each activity, the second movie stopped, and participants were asked to mentally replay how the activity previously ended. Three days later, participants were asked to recall the activities. Neural activity pattern reinstatement in medial temporal lobe (MTL) during the replay phase of the second movie was associated with detecting changes and with better memory for the original activity features. Reinstatements in posterior medial cortex (PMC) additionally predicted better memory for changed features. Compared to young adults, older adults showed a reduced ability to detect and remember changes and weaker associations between reinstatement and memory performance. These findings suggest that PMC and MTL contribute to change processing by reinstating previous event features, and that older adults are less able to use reinstatement to update memory for changed features.     

缺血性结肠炎30例临床分析

目的：探讨缺血性结肠炎的临床特征、内镜表现及治疗,以提高对该病的认识和临床诊治水平。方法对30例缺血性结肠炎患者的临床资料进行回顾性分析。结果30例患者中男6例、女24例,年龄42～83岁。73．3％（22/30）既往有一项或几项基础疾病,有高血压11例、冠心病4例、糖尿病2例。27例出现腹痛,28例出现便血症状,6例出现腹泻,12例出现恶心呕吐。6例腹部CT检查显示肠管异常。结肠镜检查发现病变累及降结肠18例,乙状结肠24例,横结肠、降结肠6例,降结肠、乙状结肠13例;镜下病变多呈节段性分布,表现为不同程度黏膜充血水肿、斑片状糜烂及不规则浅表溃疡形成、黏膜血管网消失,病变黏膜与正常黏膜分界清楚。病理组织学检查显示,黏膜多水肿,毛细血管扩张充血,间质内中性粒细胞浸润,黏膜下出血;当病程较长时部分可见炎性肉芽肿形成。结论缺血性结肠炎好发于女性,尤其是伴有糖尿病、高血压等基础疾病者。腹痛、腹泻及便血为主要临床表现。内镜检查病变多位于左半结肠,呈节段性分布,一过型,黏膜充血、水肿、糜烂为主要表现。多数患者预后良好。     

神经肌肉促进技术对脑卒中后偏瘫患者肢体骨质疏松的疗效及作用机制

目的：通过检测脑卒中后偏瘫患者的骨密度（ BMD ）及血清瘦素（ LP ）、碱性磷酸酶（ ALP ）、骨钙素（BGP）、白介素-6（IL-6）水平,观察神经肌肉促进技术（NFT）对其肢体骨质疏松的影响。方法将52例脑卒中偏瘫患者随机分为治疗组和对照组,对照组行常规治疗,治疗组在常规治疗基础上早期给予NFT治疗。采用双能X线吸收法检测两组入院第2天及治疗6个月后的BMD,采用ELISA法检测两组血清LP、ALP、BGP、IL-6水平,并进行比较。结果6个月后两组患肢BMD、对照组健肢与患肢BMD比较差异均有统计学意义（P均＜0．05）;两组血清LP、ALP、BGP、IL-6水平比较差异均有统计学意义（P＜0．05或＜0．01）。结论 NFT能影响脑卒中后偏瘫患者骨代谢指标,增加偏瘫肢体BMD;NFT对防治脑卒中后偏瘫患者的骨质疏松有效。     

Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) has become a primary tool for the treatment of biliary and pancreatic ductal diseases. It is essential for the endoscopist carrying out the ERCP to have a thorough understanding of the potential adverse events. Typically, endoscopists are well familiar with common adverse events such as post‐ERCP pancreatitis, cholangitis, post‐sphincterotomy bleeding, post‐sphincterotomy perforation, and sedation‐related cardiopulmonary compromises. However, there are other less common adverse events that arecritical to promptly recognize in order to provide appropriate therapy and prevent disastrous outcomes. This review focuses on the presentation and management of the less common and rare adverse events of an ERCP from the perspective of the practicing endoscopist.     

Elevated risk of death and major cardiovascular events in subjects with newly diagnosed diabetes: Findings from an administrative database

AimsTo investigate the incidence of major cardiovascular complications and mortality in the first years of follow-up in patients with newly diagnosed diabetes.Methods and resultsWe examined incidence rates of hospitalization for cardiovascular reasons and death among new patients with diabetes using the administrative health database of the nine million inhabitants of Lombardy followed from 2002 to 2007. Age and sex-adjusted rates were calculated and hazard ratios (HR) were estimated with a matched population without diabetes of the same sex, age (±1 year) and general practitioner.There were 158,426 patients with newly diagnosed diabetes and 314,115 subjects without diabetes. Mean follow-up was 33.0 months (SD ± 17.5). 9.7% of patients with diabetes were hospitalized for cardiovascular events vs. 5.4% of subjects without diabetes; mortality rate was higher in patients with diabetes (7.7% vs. 4.4%). The estimated probability of hospitalization during the follow up was higher in patients with diabetes than in subjects without for coronary heart disease (HR 1.4, 95% CI 1.3–1.4), cerebrovascular disease (HR 1.3.95% CI 1.2–1.3), heart failure (HR 1.4, 95% CI 1.3–1.4) as was mortality (HR 1.4, 95% CI 1.4–1.4).Younger patients with diabetes had a risk of death or hospital admission for cardio-cerebrovascular events similar to subjects without diabetes ten years older.ConclusionsThe elevated morbidity and mortality risks were clear since the onset of diabetes and rose over time. These data highlight the importance of prompt and comprehensive patients care in addition to anti-diabetic therapy in patients with newly diagnosed diabetes.