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Objective To compare the sedative effect of different regimens of dexmedetomidine in day-case ophthalmic surgery. Methods Fifty patients, ASA Ⅰ-Ⅱ, who underwent elective ophthalmic surgery, were randomly divided into two groups with 25 in each: The dexmedetomidine(group A) and dexmedetomidine midazolam plus sufentanil (group B). In group A, the loading dose of dexmedetomidine was 0.7 μg/kg, followed by 0.5 μg/(kg·h) dexmedetomidine. In group B, the loading dose was midazolam 1.5 mg and sufentanil 5 μg, followed by 0.5 μg/(kg·h) dexmedetomidine. Intra-operative heart rate (HR), mean arterial pressure (MAP), bispectral index (BIS), oxygen saturation (SPO2) and Ramsay scores, Aldrete score, satisfaction score of patient and surgeon were recorded. Results At T2, T4-T6 time points, the Ramsay scores of group B were lower than that of group A (P＜0.05). The MAP was lower in group B than group A at T3-T7 time points; The HR was higher(P＜0.05) in group B than group A at T2 and T3 time points. Patient satisfaction was significant different between the two groups, the IOWA scores of group B was higher than that of group A(P＜0.05).There were no significant differences between the two groups in BIS, SPO2 and surgeon satisfaction. Conclusions The combination of dexmedetomidine midazolam plus sufentanyl appears to have more advantages in day-case ophthalmic surgery regarding hemodynamic stability, sedation effect and patient satisfaction.

To assess the impact of lateral position changes on intraocular pressure and regional cerebral oxygen saturation (rScO2) in patients undergoing surgery.Seventy patients were categorized into the elderly and middle-aged groups, with 35 individuals in each. Apart from collecting physiological data of patients, intraocular pressure was measured using a rebound tonometer, and regional cerebral oxygen saturation levels were assessed with a cerebral oxygen monitor at ten different time points in this study.Intraocular pressure trends in both eyes were similar in both groups, peaking after two hours and then stabilizing. The intraocular pressure of the eye on the compressed side increased after lateral positioning, and this was more notable in the elderly group, indicating a significant difference (P < 0.05). The rScO2 levels did not differ significantly between the groups (P > 0.05); however, patients in the elderly group exhibited higher mean arterial pressure (MAP) fluctuations at post-intubation (T2) and pre-turning (T8) time points compared to those in the middle-aged group, and this difference was significant (P < 0.05). In the middle-aged group, there was no correlation between MAP and changes in cerebral oxygen saturation (P > 0.05), whereas a weak correlation was present in the elderly group (P < 0.05). There was no difference in uncorrected visual acuity between the pre-admission and six hours post-surgery time points (P > 0.05).The results of this study underscores the importance of proper positioning of patients, enhanced intraoperative monitoring, and safe surgical positioning practices. [ABSTRACT FROM AUTHOR]

Objective: To investigate the characteristics of decision-making impairment in Parkinson's disease (PD) patients., Methods: A total of 20 individuals with idiopathic PD were compared with matched health controls on the Iowa Gambling Task, A series of battery including the assessment working memory, visual spatial ability and verbal fluency was also administered. The severity of disease was assessed based on the Hohen and Yahr scale., Results: The results showed that PD group impaired on verbal fluency, working memory and decision-making task. In Iowa gambling task, the PD group selected more disadvantageous cards than health controls (51.6 +/- 5.8, 46.8 +/- 8.2 respectively), the difference between two groups is significant (t((38)) = 2.12, P = 0.04). A 2 (group) x 5 (block) ANOVA (analysis of variance) on the scores of advantageous from the gambling task revealed a significant main effect of group (F((1, 38)) = 6.16, P = 0.01). The ANOVA also revealed a significant main effect of block (F((4, 152)) = 2.43, P = 0.04). The results showed that health controls gradually shifted their selections toward the good decks as the game progresses, but the PD group did not exhibit this stable advantageous shift in decision-making. Meanwhile, the study indicated the total number of disadvantageous cards for PD was positive correlation to the degrees of severity to clinical symptom., Conclusion: The present study suggests that the decision-making impairment might be in early PD. The deficit of decision-making for PD might be attributed to the dysfunction of the orbito-frontal cortex.

Objective: To evaluate the methods of diagnosis and surgical treatment for nonfunctional islet cell tumor (NICT)., Methods: Forty-four patients with non-functional islet cell tumor treated at the First Affiliated Hospital of Nanjing Medical University during January 1968 to June 2008 were analyzed retrospectively. There were 9 males and 35 females, aged from 7- to 70-years-old. Clinical manifestation: 15 cases (34.1%) of abdominal masses, 17 patients (38.6%) with epigastric or back pain, 5 cases of jaundice, 5 cases (11.4%) for upper abdominal fullness or vomiting, 10 cases (22.7%) of pancreatic tumor noticed by routine health checkups or imaging examinations. Imaging examination: CT scan, sonography, ERCP, MRI, upper GI series were performed in 33 (75.0%), 16 (36.4%), 6 (13.6%), 2 (4.5%), and 10 cases (22.7%) respectively. Operation methods: 39 patients (88.6%) underwent surgical resection and the other 5 patients did not., Complications: pancreatic fistula in 7 patients (15.9%), intra-abdominal bleeding in 4 (9.1%), gastrojejunal anastomosis outlet obstruction in 1 (2.3%), biliary fistula in 2 (4.5%) and incisional infection in 3 (6.8%). Surgery related mortality happened in 2 patients (4.5%), both treated before 1999. Twenty-five patients underwent operation between January 1999 and June 2008 were followed up for 6 to 108 months. All survive except one died 75 months after the surgery for unknown reason., Conclusions: No specific clinical manifestation is recognized for non-functional islet cell tumor. Spiral CT is an optimal diagnostic method, while surgery is the first choice for treatment. Middle segmental pancreatectomy has become an alternative surgical protocol for NICT.

Objective: To investigate the influence of injury of prefrontal cortex on the risk-taking decision-making and to test the hypothesis that the orbitofrontal area is involved in the special network of risk-taking decision-making., Methods: 47 patients with lesions in the prefrontal lobe, 21 in the orbitofrontal area (OBF) and 19 in the dorsolateral prefrontal cortex (DLF), and 40 healthy controls (HC group) were administered with a risk-taking task., Results: The risky response rate after punishment of the HC group was 0.54 +/- 0.23, significantly fewer than before punishment (t = -3.82, P < 0.01), and the risky response rate after punishment of the DLF injury group was 0.68 +/- 0.16, significantly fewer than before punishment too (t = -2.32, P < 0.05). The risky response rate after reward of the patients with lesions in OBF areas was 0.79 +/- 0.19, significantly higher than that of the HC group (0.68 +/- 0.16, P < 0.05), and the risky response rate after punishment of the patients with lesions in OBF areas was 0.82 +/- 0.18, significantly higher than that of the HC group (0.54 +/- 0.23, P < 0.05). The risky response rates after reward and after punishment of the DLP group were 0.72 +/- 0.22 and 0.63 +/- 0.25 respectively, both not significantly different from those of the HC group (both P > 0.05)., Conclusion: The patients with lesions in the orbitofrontal area, not in the dorsolateral prefrontal cortex, have a specific deficit in risk-taking decision-making, i.e. an inhibition effect of punishment, reduced sensitivity to punishment but increased sensitivity to reward. The orbitofrontal areas play an important role in risk-taking decision-making processes.