Objective To evaluate the effect of bilateral subthalamic nuclei deep brain stimulation (STN-DBS) on anxiety and depression of patients with Parkinson's disease(PD).Methods Forty-one consecutive patients with refractory motor fluctuations and dyskinesia were assessed with Hoehn & Yahr scale, Unified Parkinson’s Disease Rating Scale Ⅲ (UPDRSⅢ), HADS, PD Questionnaire Chinese version (PDQ-39) a week before surgery and 12 months after the surgical procedure. Results The scores of UPDRSⅢ, HADS and PDQ-39 significantly increased after STN-DBS treatment (all P

Objective:To study memory changes in patients with non-demented Parkinson disease(PD) without depression.Methods:The Nissen Version(serial reaction time task,SRTT) software(as a task of procedural learning),the WMS-CR and two tasks of implicit memory were applied in 16 PD patients(Hoehn-Yahr score I~Ⅱdegrees).Normal controls enrolled for the Nissen Version either.Results In the explicit WMS-CR and the implicit(word stem completion and degraded picture naming) tasks,the patients' scores fell within normal limits(Memory Quotient 97.1?10.6).In the SRTT,normal control group displayed significantly reduced response times(F=2.54,P=0.008) and error rates(3.2 ?0.9% to 6.8 ?2.7%,t=-2.08,P=0.045) across the blocks of repeated sequence trials.By contrast,PD patients only showed a reduction in error rates(4.7?2.0% to 3.7?1.8%,t=-2.15,P=0.038) but no change in response times.Conclusion:Impairment of nigrostriatal pathways selectively affects performance in visuo-motor learning tasks such as the SRTT,but not in the explicit tasks of WMS-CR and the implicit tasks such as word stem completion and degraded picture naming.

Objective To evaluate the result of percutaneous internal fixation in treatment of uncomminuted ankle fractures (inner malleolus,extemal malleolus and ventral condyle). Methods A total of 26 patients with uncomminuted ankle fractures at age range of 20-55 years(mean 35.2 years)were treated with closed reduction and percutaneous internal fixation by screws,eannulated screws or Kirschuer pins under C-arm X-ray scan.All patients were followed up for 12-24 months(mean 14 months).Results All fractures were healed successfully.with healing time of 8-24 weeks(mean 10.3 weeks).According to Bourne Standard,excellent ankle function results were reposed in 15 patients,good in 9 and fair in 2,with excellence rate of 92%.There was no implant failure,postoperative infection or dehiscence. Conclusions With advantage of early rehabilitation and minor incision of the affected ankles,closed reduction and percutaneous internal fixation can be selected for transverse or oblique uncomminuted ankle fractures,especially for those patients with severe swelling or skin injury.

Obsessive-compulsive disorder (OCD) is a chronic,disabling,mental disorder,which has been linked to significant abnormalities in certain brain areas,including the orbital frontal cortex and the anterior cingulate cortex.Neuroimaging studies have also shown that brain areas related to the decision-making function include the orbital frontal cortex and the dorsal prefrontal lobes.Furthermore,the association between OCD and decision-making function has been consistently demonstrated from a neurobiological perspective.Clinically,impaired decision-making ability is commonly observed in OCD patients,and there is a correlation between OCD and abnormal decision function.Decision-making tasks are typically divided into two types,decision-making under risk and decision-making under ambiguity,with the former commonly evaluated using the Iowa Gambling Task (IGT) and the latter using the Game of Dice Task (GDT).In this article the neural mechanism and evaluation methods of decision making in OCD were reviewed.

10.3969/j.issn.2095-4344.2013.23.011

Objective To investigate the application of carotid artery resection and reconstruction in surgical management of thyroid carcinoma with carotid artery involvement.Methods We conducted a retrospective cohort study involving 10 patients whose common carotid arteries were invaded by thyroid carcinoma.All patients underwent tumor en bloc resection and carotid arteries reconstruction.Patients were evaluated by muhidisciplinary team and surgeries were cooperated by general surgeons,orthopedists and vascular surgeons.The perioperative complications and surgical outcomes were also recorded and analyzed.Results No patient had complications of central nervous system.One patient suffered Horner syndrome and one presented hoarseness postoperative.Two patients had wound infection,two patients presented carcinoma recurrence and two patients presented distant metastasis during the follow-up.Conclusion En bloc resection of tumor and carotid artery reconstruction is a feasible modality in treatment of thyroid carcinoma with carotid artery invasion.

Thyroid cancer is one of the most common malignant tumors.Advanced thyroid cancer usually invades encroachs nerves,blood vessels,trachea,esophagus,and other organs,and needs muhidisciplinary team for better effect.The disease center of diagnosis and treatment provides a good platform for multidisciplinary treatment of advanced thyroid cancer.

Objective To discuss the feasibility of totally transoral video-assisted thyroidectomy (TO-VAT).Methods Data of 30 hyperthyroidism patients treated with TOVAT from Jan.2014 to Dec.2016 were retrospectively analyzed.Index such as operative time,intraoperative blood loss,hospital stay,complication were recorded.Results No neck scar was found,and patients were satisfied with the cosmetic effects.The average surgical time was (97.3±13.4) min,blood loss 24.0(12.3～28.3)ml,hospital stay (2.0±0.5)d,cosmetic score 8.2± 0.3.No hoarse voice,drinking cough,bleeding,convulsion,or parathyroid injury happened.Two patients had swelling in the anterior cervicaarea,2 patients showed lower jaw numbness and 1 patient showed temporary hypoparathyroidism.During the follow up of 1 to 35 months,all were subjected to symptomatic management and recovered.Conclusion TOVAT is a safe and effective technique with the advantages of minor iniury,quicker recovery,fewer complications and good cosmetic effect.

Objective To study the clinical effect of bilateral anterior internal capsulotomy on patients with refractory anxiety disorders.Methods Twenty-one patients with anxiety disorders,failed to pharmacological and cognitive behavior therapies for 5 years and admitted to our hospital from November 2009 to January 2012,were chosen; they received MRI-guided stereotactic bilateral anterior capsulotomy.The coordinates of the lesion target were determined under high resolution MRI directly and confirmed by intra-operative impedance test and high frequency stimulation.The lesions were received radiofrequency at 80 ℃ for 60 seconds.Pre-and post-operative mini-mental state examination (MMSE),self-rating anxiety scale (SAS),Hamilton depression rating scale (HAMD) and Hamilton anxiety rating scale (HAMA) were performed by the same psychiatrists.Results In the 21 patients,8 had anxiety-free,10 had significant improvement,and 3 had no significant improvement.No serious surgery-related complications were noted.Nine patients had mild cognitive deficit and transient dysmnesia only at 1-2 weeks after operation.Personality changes,such as lack of motivation,apathy and indolence,appeared in 4 patients.Psychiatric evaluations demonstrated significant decrease of SAS,HAMD and HAMA scores after operation as compared with those before operation (P＜0.05).However,the difference of MMSE scores between pre-and post-operation was not statistically significant (P＞0.05).Conclusion MRI guided stereotactic bilateral capsulotomy is precise,safe and much an effective treatment for refractory anxiety disorders,whcih is promising to alleviate the symptoms of anxiety and depression,as well as improving the quality of life.

Objective To investigate the complications of deep brain stimulation (DBS) internal pulse generator (IPG) replacement procedures and discuss the reasons,preventive measures and treatments.Methods From 2012 to 2016,285 procedures (according to the number of replacement IPG) were performed for 211 patients in our hospital.Among them,178 patients were with Parkinson's disease,29 patients were with dystonia,3 patients were with tic disorder,and one with essential tremor.Thirty-two patients previously used Medtronic replaced with local DBS with brand of PINC and Sceneray,and the other 179 patients remained the use of Medtronic brand.Furthermore,36 patients got extension cable reimplantation along with IPG replacements.Results Replacement surgeries were divided into 3 types:IPG replacement in situ;bilateral side single-channel IPG was replaced by double-channel IPG or double-channel IPG was replaced by bilateral single-channel IPG;extended cables and IPG replacement were carried out simultaneously.The follow up period was from one to 6 years for these 211 patients,and 15 got surgical-and hardware-related complications:6 with sack hemorrhage,2 with skin erosion,one with IPG rejection,3 with adaptor fracture,and 3 with impedance abnormality were recorded;no infection was noted.Twenty-six patients got significant improvement after new IPG replacement.Conclusions DBS IPG replacement operations is a regular surgery with certain safety.Personalized surgical procedures,rigorous intraoperative operation and correct postoperative management can effectively reduce and prevent the complications of IPG replacement surgery.