Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on the negative symptoms of chronic schizophrenia and on the P300 component of schizophrenics' event-related potentials (ERPs).Methods Ninety convalescing schizophrenia patients were randomly divided into a 5 Hz group,a 10 Hz group and a 15 Hz group,each of 30.The three groups were treated with the corresponding 5 Hz,10 Hz or 15 Hz rTMS once a day,five times a week for five consecutive weeks.The P300 ERPs of all three groups were tested before and after the treatment.Any curative effect was evaluated using the scale for the assessment of negative symptoms (SANS).Results After the treatment,the average SANS score of the 10 Hz group was significantly different from that before the treatment and also from those of the other two groups after the treatment.After the treatment,significant improvement was also observed in the amplitude of P300 in the 10 Hz group.The treatment's effectiveness was negatively correlated with age and longer course of the disease.Conelusion rTMS at 10 Hz is the most effective of the protocols tested for improving the negative symptoms of schizophrenia and improving cognitive functioning.

Objective To explore the use of CA199,CEA,CA50 and ALP combined with magnetic resonance imaging (MRI) in diagnosis of intrahepatic bile duct stones with early bile duct carcinoma.Methods The clinical diagnosis of 36 cases of patients with hepatolithasis-associated intrahepatic cholangiocarcinoma (HICC) and 118 cases with intrahepatic duct stone (IHDS) were analyzed retrospectively.Serum CA199,CEA,CA50,ALP and magnetic resonance (MRI,MRCP) were performed and the results were analyzed.Results Abdominal pain discomfort in Hepatolithasis-associated intrahepatic cholangiocarcinoma showed multiple symptoms.Three typical Charcot syndromes were rare.On the gender distribution,intrahepatic bile duct stones was frequently found in women,on the contrary,Hepatolithasis-associated intrahepatic cholangiocarcinoma was frequently more found in men (P ＜0.05) Abdominal pain and fever in patients of Hepatolithasis-associated intrahepatic cholangiocarcinoma was more than that of patients with Intrahepatic bile duct stone (P＜0.05) When alkaline phosphatase (ALP) was more than 169 U/L,significant difference was seen between two groups (P＜ 0.05) According to the diagnosis of HICC,the accuracy of CA199,CEA,CA50 combined with ALP was 88.6％,the accuracy of magnetic resonance examination alone was 90.2％,and the accuracy of multiple serological markers and magnetic resonance was 95.5％.Conclusion MRI combined with serum CA199,CEA,CA50 and ALP can effectively improve the HICC preoperative diagnosis rate.

Objective To investigate the relationship between the characteristics of psychological defense style and clinical symptoms of eating attitude in patients with anorexia nervosa patients. Methods Totally 92 ca?ses ( 46 cases of restricting type,46 cases of binge?eating/purging type,48 cases of early onset before 16 years old, 44 cases of late onset after 16 years old) meeting the Diagnostic and Statistical Manual of Mental Disorders,Forth Edition ( DSM?4) for anorexia nervosa (AN) were collected.92 gender?marriage?and education?matched normal cases in a psychiatric hospital were selected as the healthy control group(HC) .All were assessed with defensive style questionnaire(DSQ) and eating attitude test?26(EAT?26).DSQ and EAT?26 were compared between AN and HC,between early onset of AN( before 16 old years) and late onset of AN( after 16 old years) ,and between AN?R and AN?P.Then correlation study was done for the AN. Results Compared with HC,AN showed higher scores in the immature defense,neurotic defense ((4.49±1.13)vs (3.55±0.93),(4.33±0.76)vs (3.88±0.69), P<0.001), and higher EAT?26 median total and factor scores of dieting scale items,bulimia&food preoccupation scale items, oral control subscale items (P<0.01).Compared with AN?R,AN?P showed higher scores in the immature defense ((4.49±1.03)vs (4.79±1.13), P=0.01),and higher EAT?26 median total and factor score of bulimia&food pre?occupation scale items (P<0.05, P<0.01).The correlations between immature defense and EAT?26 total score,be?tween neurotic defense and EAT?26 total score were significant( r=0.472, P<0.001;r=0.315, P=0.002). The correlations between immature defense and EAT?26 dieting score, between neurotic defense and EAT?26 dieting score were significant( r=0.343, P<0.001, r=0.257, P=0.014).The correlations between immature defense and EAT?26 bulimia & food preoccupation score,between neurotic defense and EAT?26 bulimia & food preoccupation score were significant( r=0.523, P<0.001, r=0.267, P=0.010).The correlations between immature defense and duration were significant( r=0.375, P<0.001).The correlations between all defense factors and BMI were not sig?nificant( r=-0.15?0.25, P>0.05) . Conclusion AN patients tend to use more immature defense and neurotic de?fense compared with HC,and AN?P patients use more immature defense compared with AN?R. Immature defense and neurotic defense are related to the eating attitude,and the immature defense is related the duration.

BACKGROUNDNicotine may improve schizophrenia patient's cognitive deficit symptoms. This study was to explore the chronic effects of smoking on prepulse inhibition of the startle reflex (PPI) and P50 in the patients with first-episode schizophrenia (FES).

METHODSThe event-related potentials (ERP) recording and analysis instrument made by Brain Products, Germany, was used to detect PPI and P50 in 49 male FES patients (FES group, n = 21 for smokers and n = 28 for non-smokers) and 43 normal male controls (control group, n = 19 for smokers and n = 24 for non-smokers).

RESULTSCompared with normal controls, the FES group had prolonged PPI latency when elicited by single stronger stimulus (P < 0.05); the FES group had prolonged PPI latency and increased PPI amplitude (P < 0.05, 0.01) when elicited by weak and strong stimuli. The FES group had lower PPI inhibition rate than normal controls (P < 0.05). Compared with normal controls, the FES group had increased P50-S2 amplitude and increased amplitude ratio S2/S1 (both P <0.05). In the control group, the smokers had a tendency of increase in P50-S2 amplitude (P > 0.05) and shorter P50-S2 latency (P < 0.05) than the non-smokers. The smokers had higher PPI amplitude than the non-smokers (P < 0.05). In the FES group, the smokers had higher P50-S1 amplitude, shorter P50-S2 latency, and higher amplitude ratio S2/S1 than the non-smokers (P < 0.05, 0.01). The smokers had higher PPI amplitude than the non-smokers (P < 0.05).

CONCLUSIONSThere is obvious PPI and P50 deficits in schizophrenic patients. However, these deficits are relatively preserved in the smokers compared with the non-smokers, which suggests that long-term smoking might partially improve the sensory gating in schizophrenic patients. Whether this conclusion can be deduced to female patients requires further follow-ups.

Adult ; Case-Control Studies ; Evoked Potentials ; drug effects ; physiology ; Humans ; Male ; Reflex, Startle ; physiology ; Schizophrenia ; physiopathology ; Smoking ; adverse effects ; Young Adult

Objective To explore the rationality of pancreaticojejunostomy and double purse embedded pancreaticogastrostomy in pancreaticoduodenectomy through comparing the short-term effects between pancreaticojejunostomy and double purse embedded pancreaticogastrostomy in pancreaticoduodenectomy.Methods A retrospective review was performed for 38 patients who were underwent pancreaticoduodenectomy at the second affiliated hospital of Kunming Medical University from January 2010 to December 2012.Results All 38 pancreaticoduodenectomy were performed successfully.The pancreatic fistula (0％),operationtime [(327.50±32.56) min],postoperative hospital days [(10.31 ±2.44) d] were found to be significantly lower in double purse embedded pancreaticogastrostomy group than those of pancreaticojejunostomy group [3/12,(425.83 ± 33.77) min,(14.33 ± 4.14) d],which has statistical significance(P＜0.05).Although the incidence of bile leakage,postoperative abdominal bleeding,delayed gastric emptying,infection of incision,infection of lung,intraoperative amount of bleeding are also lower than that of pancreaticojejunostomy group,which has no statistical significance.Conclusions Double purse embedded pancreaticogastrostomy is a digestive tract reconstruction which is safer and more reasonable than pancreaticojejunostomy.The former one is operated simply and the operation time is shorter.There are great advantages in the prevention of complications such as pancreatic fistula after pancreaticoduodenectomy.

Objective To investigate the current status of type 2 diabetic patients who failed to achieve the glycemic control target, and provide theoretic evidences for making corresponding strategies. Methods The 2 diabetic patients who failed to reach the glycemic target were recruited from 181 hospitals in 26 cities and received a standard questionnaire, the conditions of their blood glucose level, lifestyle intervention, blood sugar monitoring, and drug therapy were recorded. Totally 3 861 questionnaires with complete information were collected. And the causes which account for glycemic control status were analyzed. Results Among these patients, the mean HbA1c was 7.9%, the mean fasting plasma glucose was 8.2 mmol/L, and the mean postprandial plasma glucose was 11.5 mmol/L. Only 25.6% of patients take their diet control strictly as prescribed and 44. 5% of patients have little exercise. 35. 8% and 47.8% of patients did not monitor their fasting and postprandial plasma glucose,respectively. Glycemic control in the patients aged ＞ 60 years was similar to the younger patients, but the hypoglycemia incidence in the elder group reached 35.5%, which was higher than those in the other 2 groups (20.8% and 21.4%, both P＜0. 05 ). The proportion of patients with mono-therapy and combination therapy was 46. 1% and 51.7%, while the proportion with combination therapy rose in the patients aged ＞60 years (58.7%;Compared with the other age-groups, all P＜0.05 ). 75 % of patients have adjusted their drug administration regimen since initial treatment. Conclusions Inadequate or inappropriate drug therapy regimen is a major cause responsible for this poor glycemic control status. In addition, the unhealthy life styles, insufficient blood sugar monitoring, and poor compliance were also important causes. Thus, for these patients, it is necessary to further enhance patients' education, to improve life style intervention, as well as to select more effective, safer, and compliant drug therapy regimens. Finally, the glycemic control target for the elder patients should be more flexible.

Objective To explore the expression of chemerin and chemerin receptor ( chemokine-like receptor 1, CMKLR1) during different periods of non-alcoholic fatty liver disease ( NAFLD) rat model induced by methionine- and choline-deficient ( MCD) diet. Methods Thirty-six Wistar rats were divided into control group and MCD group in random. After one week quarantine and acclimation period, these two groups were fed either normal chow or MCD diet. The animals were respectively sacrificed at the first week, the forth week, and the tenth week. The levels of alanine transaminase (ALT), blood lipid profile, liver function, and the content of triglyceride in liver were detected. HE staining was done to observe the morphologic change of liver. The mRNA expression changes of chemerin and CMKLR1 in liver were measured using real-time PCR, and the change in chemerin mRNA level was further confirmed in liver by Northern blot. Finally, the concentration of chemerin in serum was measured by Western blot. Results The mRNA level of chemerin decreased significantly after four and ten weeks MCD feeding, although no obvious changes were found at first week, similar changes were found in serum chemerin (1.00±0.11 vs 0.96±0.39; 1.00±0.12 vs 0.21 ±0.77; 1.00±0.42 vs 0.21 ±0. 11). Contrasting with the change of chemerin(1.00±0.08 vs 0.72±0.10;1.00±0.24 vs 0.63±0. 31 ;1.00±0.05 vs 0.50±0.13), the mRNA level of CMKLR1 increased after MCD feeding( 1.00±0. 14 vs 0. 84±0. 26; 1.00±0. 38 vs 1. 51 ±0. 33; 1. 01 ±0. 13 vs 1. 84 ± 0. 39 ). Conclusion The change of chemerin and its receptor may participate in the process of the nonalcoholic fatty liver disease.

Objective To investigate the use of component N400 of the event-related potentials (ERPs) elicited by Chinese idioms ending with matching and nonmatching words to explore the cognitive patterns and processing mechanisms elicited by Chinese characters. Methods Sixty-two right-handed healthy adults (age 19-50 years) , were presented with Chinese idioms ending with words with the same pronunciation but different form and meaning, words with similar forms but different pronunciation and meaning, words with same meaning but different pronunciation and form, and words with different pronunciation, form and meaning. A Guangzhou Runjie WJ-1 instrument was used to record component N400 of the potentials evoked. Results N400 showed a midline distribution , and could be detected under electrodes Fz, Cz and Pz. Significant differences were found in N400 latencies and amplitudes between matching and nonmatching ending-words. Compared with idioms with matching ending-words, N400 latencies were prolonged and amplitudes increased in nonmatching cases. The observed changes in N400 latencies and amplitudes were related to stimulus types, and the longest latency and largest amplitude were e-licited by ending-words with different pronunciation, form and meaning. No gender difference in N400 latency or amplitude was observed. Conclusions Compared with Western phonetic words, Chinese ideographic words are more flexible stimuli for N400 research, offering 3 dimensions for change: pronunciation, form and meaning. The N400 features elicited by matching and nonmatching ending words in Chinese idioms are mainly determined by the meaning of the word.

Objective To explore the features and neural generators of the events related potentials ( ERP) component N400, elicited by congruent and incongruent ending sentences, in first episode schizophrenia patients. Methods N400 was elicited by 76 congruent (31) or incongruent (45) ending Chinese sentences paradigm, and recorded by WJ-1 ERP instruments in 56 first episode schizophrenia. The neural generators of N400 different wave in 105 -615 ms time windows were analyzed by Brain Electrical Activity Mapping software. Results① The N400 latencies were significantly longer and amplitudes significantly higher in incongruent conditions than in congruent conditions in first episode schizophrenia (P < 0.05 or P <0.01).② N400 elicited by Chinese sentences distributed on frontal, parietal, occipital and temporal regions, and had a clear waveform. ③ The main brain areas activated by N400 were frontal areas in 345 -405 ms time windows, and central areas in 420 - 570 ms time windows. Conclusion N400 elicited by Chinese sentences are multi-generated in first episode schizophrenia, especially in frontal area.

Objective The purpose of the present study was to examine the reliability and validity of the Chinese version of the impulsive-premeditated aggression scale (IPAS) in a sample of Chinese adolescents with aggression. Methods 126 adolescents completed the IPAS,Barratt impulsive scale and self-report questionnaires. In order to assess test-retest reliability, the IPAS was re-administered to 30 participants 3 weeks later.Results Item analysis showed that IPAS had satisfactory item discrimination, 6 items were excluded in the later analysis. The internal consistency of the IPAS Cronbach alpha was 0.77 and the test-retest reliability was 0.74.Exploratory factor analysis demonstrated two stable factors of aggression with good internal consistency and construct validity, the value of KMO was 0.646, the χ2 value of Bartlett test was 691.93 ( P <0.001). The confirmatory factor analysis showed that the value of χ2/df,GFI,AGFI,RMSEA were 1.42,0.874,0.837 and 0.058 respectively.The whole scale and the two secondly scales all correlated with BIS-11 and MOAS.Conclusion The results of the current study indicate that the Chinese version of the IPAS is a useful tool to subtyping aggressive behavior among adolescents, but it still need to be modified to apply in China.