Laparoscopic correction of perforated peptic ulcer: first choice? A review of literature

Background Perforated peptic ulcer (PPU), despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Outcome might be improved by performing this procedure laparoscopically, but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense. Methods An electronic literature search was done by using PubMed and EMBASE databases. Relevant papers written between January 1989 and May 2009 were selected and scored according to Effective Public Health Practice Project guidelines. Results Data were extracted from 56 papers, as summarized in Tables 1-7. The overall conversion rate for laparoscopic correction of perforated peptic ulcer was 12.4%, with main reason for conversion being the diameter of perforation. Patients presenting with PPU were predominantly men (79%), with an average age of 48 years. Onethird had a history of peptic ulcer disease, and one-fifth took nonsteroidal anti-inflammatory drugs (NSAIDs). Only 7% presented with shock at admission. There seems to be no consensus on the perfect setup for surgery and/or operating technique. In the laparoscopic groups, operating time was significant longer and incidence of recurrent leakage at the repair site was higher. Nonetheless there was significant less postoperative pain, lower morbidity, less mortality, and shorter hospital stay. Conclusion There are good arguments that laparoscopic correction of PPU should be first treatment of choice. A Boey score of 3, age over 70 years, and symptoms persisting longer than 24 h are associated with higher morbidity and mortality and should be considered contraindications for laparoscopic intervention

Anticipation of difficult tasks: neural correlates of negative emotions and emotion regulation

Abstract Background Difficult cognitive tasks are often associated with negative feelings. This can be already the case for the mere anticipation of having to do a difficult task. For the case of difficult math tasks, it was recently suggested that such a negative emotional response may be exclusive to highly math-anxious individuals. However, it is also conceivable that negative emotional responses simply reflect that math is perceived as difficult. Here we investigated whether non-math-anxious individuals also experience negative emotional responses when anticipating to do difficult math tasks. Methods We compared brain activation following the presentation of a numerical cue indicating either difficult or easy upcoming proportion magnitude comparison tasks. Results Comparable to previous results for highly math-anxious individuals we observed a network associated with negative emotions to be activated in non-math-anxious individuals when facing cues indicating a difficult upcoming task. Importantly, however, math anxiety scores did not predict the neural response. Furthermore, we observed activation in areas associated with processes of cognitive control areas such as anterior cingulate cortex, which were suggested to play a key role in emotion regulation. Conclusion Activation in the emotion processing network was observed when anticipating an upcoming difficult (math) task. However, this activation was not predicted by individual’ degree of math anxiety. Therefore, we suggest that negative emotional responses to difficult math tasks might be a rather common reaction not specific to math-anxious individuals. Whether or not this initial negative response impairs math performance, however, might depend on the ability to regulate those emotions effectively

Neurofunctional plasticity in fraction learning : An fMRI training study

Background: Fractions are known to be difficult for children and adults. Behavioral studies suggest that magnitude processing of fractions can be improved via number line estimation (NLE) trainings, but little is known about the neural correlates of fraction learning. Method: To examine the neuro-cognitive foundations of fraction learning, behavioral performance and neural correlates were measured before and after a five-day NLE training. Results: In all evaluation tasks behavioral performance increased after training. We observed a fronto-parietal network associated with number magnitude processing to be recruited in all tasks as indicated by a numerical distance effect. For symbolic fractions, the distance effect on intraparietal activation was only observed after training. Conclusion: The absence of a distance effect of symbolic fractions before the training could indicate an initially less automatic access to their overall magnitude. NLE training facilitates processing of overall fraction magnitude as indicated by the distance effect in neural activation.acceptedVersionPeer reviewe

When the brain comes into play : Neurofunctional correlates of emotions and reward in game-based learning

Accumulating evidence identifies emotions as drivers of effective learning. In parallel, game-based learning was found to emotionally engage learners, allegedly harnessing the fundamental tie between emotions and cognition. Questioning further whether and how game-based learning elicit emotional processes, the current fMRI study examined the neurofunctional correlates of game-based learning by directly comparing a game-based and a non-game-based version of a digital learning task. We evaluated neurofunctional activation patterns within a comprehensive set of brain areas involved in emotional and reward processes (e.g. amygdala or ventral tegmental area) when participants received feedback. With only a few exceptions, decoding of these brain areas’ activation patterns indicated predominantly stronger relative activation in the game-based task version. As such, our results substantiate on a neurofunctional level that game-based learning leads to an invigoration of learning processes through processes of reward and emotional engagement.publishedVersionPeer reviewe

Neurofunctional plasticity in fraction learning: An fMRI training study

© 2020 Elsevier GmbH Background: Fractions are known to be difficult for children and adults. Behavioral studies suggest that magnitude processing of fractions can be improved via number line estimation (NLE) trainings, but little is known about the neural correlates of fraction learning. Method: To examine the neuro-cognitive foundations of fraction learning, behavioral performance and neural correlates were measured before and after a five-day NLE training. Results: In all evaluation tasks behavioral performance increased after training. We observed a fronto-parietal network associated with number magnitude processing to be recruited in all tasks as indicated by a numerical distance effect. For symbolic fractions, the distance effect on intraparietal activation was only observed after training. Conclusion: The absence of a distance effect of symbolic fractions before the training could indicate an initially less automatic access to their overall magnitude. NLE training facilitates processing of overall fraction magnitude as indicated by the distance effect in neural activation