Ｒelationship between theory of mind and local brain functional connectivity children with autism spectrum disorder

目的:探讨孤独症谱系障碍(ASD)儿童心理推理能力(ToM)与局部脑功能连接的关系。方法:选取符合DSM-5诊断标准的6～18岁ASD儿童39例和年龄、性别及智商相匹配的正常儿童43例,进行ToM任务测查和静息态磁共振成像扫描,比较两组ToM通过率/得分和全脑局部一致性(ReHo)缺陷的脑机制值,并采用偏相关方法分析两组间存在差异的ToM通过率/得分和ReHo值之间的关系。结果:ASD组显性错误信念、一级错误信念通过率和表情识别任务得分低于正常对照组(均P&lt;0.05);右额上回局部ReHo值高于正常对照组,右距状沟、左内侧额叶皮层区域ReHo值低于正常对照组(GRF校正,体素P&lt;0.001,团块P&lt;0.05)。结论:ASD患者存在ToM缺陷和局部一致性异常,其中显性错误信念与左内侧额叶皮层局部功能连接相关。</p

Functional connectivity characteristics of executive control network in patients with high-functioning autism aged 6 - 18 years

目的:探讨6~18岁高功能孤独症患者执行网络功能连接特点、年龄组差别及与孤独症症状的相关。方法:纳入44例6~18岁符合DSM-IV孤独症诊断标准的高功能患者及年龄、性别、智商组间匹配的31例正常对照,根据年龄将每组被试分为儿童期(6~12岁)和青春期(12~18岁)两组。选取左右侧后顶叶皮层及背外侧前额叶4个执行网络的核心脑区为种子点,计算其与全脑的功能连接。采用偏相关分析计算异常脑区功能连接与孤独症谱系障碍筛查问卷评分的相关。结果:孤独症组rdl PFC与左侧额上回/额中回/前扣带回的功能连接高于正常对照组(P <0. 05),该脑区功能连接同时呈现组别-年龄交互效应,在儿童期孤独症组高于正常对照组,在青春期低于正常对照组(均P <0. 05)。且该异常功能连接与重复刻板行为及交流问题呈负相关(r=-0. 50~-0. 45)(均P <0. 05)。结论:6~18岁高功能孤独症患者的执行网络存在过度连接特点及年龄组别差异,与重复刻板及交流症状相关

Functional connectivity difference of theory of mind related brain regions in different age groups of individuals with autism aged 6-18 years old

目的:分析社会认知中心理推理能力(ToM)相关重要脑区与其他脑区功能连接的随年龄发育模式,探讨孤独症核心症状社会交往障碍的脑机制。方法:43例6～18岁符合美国精神障碍诊断与统计手册第4版孤独症诊断标准的患者及年龄、性别组间匹配的39例正常对照,选取背内侧前额叶(dMPFC)、左侧颞顶联合(1TPJ)、右侧颞顶联合(rTPJ)和右侧颞上沟(rSTS) 4个ToM相关的重要脑区,计算其与全脑体素之间的功能连接,通过单变量方差分析探索感兴趣区域的功能连接在被试中的组别及年龄交互作用;并将被试根据年龄分为儿童期(6.0～11. 9岁)和青春期(12.0～18.0岁),探讨不同年龄段的组间差异。结果:rTPJ与右侧缘上回及左侧顶下小叶的功能连接、rSTS与双侧额上/中回的功能连接均呈现出组别与年龄的交互作用(校正后P <0.05);而青春期,rTPJ和rSTS存在显著交互效应的功能连接均小于正常对照组(均

First 24 Japanese cases of robotic-assisted laparoscopic radical prostatectomy using the da Vinci surgical system

手術用ロボットを使用した腹腔鏡下根治的前立腺全摘除術(RALP)24例の手術成績について検討した。その結果, 1例を除く23例でRALPを完遂しえた。平均console timeは223.0分, 平均setup timeは47.0分, 平均術中尿込み出血量は313.0mlであった。全例で術後早期合併症は認めず, 術後経過は良好であった。術後疼痛は鎮痛剤の使用回数で評価したが, 21例は2POD以降鎮痛剤を使用しなかった。術後平均カテーテル留置日数は平均10.5日, 平均在院日数は16.6日であった。病理結果での断端陽性率はpT2で7.6%(1/13), pT3で56%(5/9), 全体で30%(7/23)であった。術後3, 6, 12ヵ月での尿禁制回復率はそれぞれ65, 78, 100%であった。片側神経温存症例6例中1例, 両側神経温存例3例中2例は術後の性交可能であった。In Japan, as of September 2007, prostatectomy is conducted with open surgical procedures in more than 90% of the cases. Following the first reported robotic prostatectomy by Binder, et al. in 2000, a robotic-assisted laparoscopic radical prostatectomy (RALP) using the daVinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA) has been extensively used as a standard procedure with gratifying results in the United States. In the Asian region, in contrast, RALP is still in an introductory phase. Recently, we introduced RALP in Japan. A total of 24 patients received robotic surgery within a year since August 2006. RALP was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-hour operation had been imposed by the Ethical Committee. The mean operative time using the daVinci device and the mean estimated blood loss were 232.0 (range; 136-405) minutes and 313.0 (range; 10-1, 000) ml, respectively. The training program we recently developed proved remarkably effective in reducing the learning curve of robotic surgery in Japan, where there is no person with expertise in this operating procedure. In particular, the intraoperative guidance given by the expert was useful after relevant problematic points were delineated by operators who received comprehensive video-based image training and actually performed robot surgery in several cases. With direct intraoperative guidance by the mentor during cases 13 and 14, both the operation time and estimated blood loss was markedly reduced