BACKGROUND & AIMS: OBJECTIVE:To examine the neuropsychologic profile of MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes) and relate it to neuropathologic findings. BACKGROUND:MELAS is one of over 40 mitochondrial disorders. Symptoms include seizures, strokelike episodes, headaches, memory impairment, hemianopsia, hearing loss, short stature, diffuse limb weakness, exercise intolerance, nausea, and vomiting. Age of onset ranges from 2 to 40 years. A hallmark of MELAS is normal development until the first symptoms appear. METHOD:Because information regarding the neuropsychologic functioning of these individuals is sparse, we report findings from detailed neuropsychologic evaluations for a 13-year-old white male and a 33-year-old African-American male with MELAS. RESULTS:Results revealed global patterns of deterioration in executive function, attention, language, memory, visuospatial, and motor functioning. In both patients, brain scans revealed posterior pathology in the absence of frontal pathology. CONCLUSIONS:We compared our findings with other documented cases and concluded that MELAS is characterized by a pattern of global deterioration. This pattern differs from that observed in other mitochondrial disorders. The absence of identifiable frontal lobe pathology despite the presence of deficits in executive functioning may be related to the distribution patterns of deficient mitochondria and neuronal projection patterns.

背景与目标： 目的：研究MELAS的神经心理学特征（线粒体肌病，脑病，乳酸性酸中毒和中风样发作），并将其与神经病理学发现相关联。
背景：MELAS是40多种线粒体疾病之一。症状包括癫痫发作，中风样发作，头痛，记忆力减退，偏瘫，听力下降，身材矮小，肢体弥漫无力，运动不耐受，恶心和呕吐。发病年龄为2至40岁。 MELAS的标志是正常发展，直到出现第一个症状。
方法：由于有关这些人的神经心理功能的信息稀少，因此我们报告了详细的神经心理学评估结果，这些评估是针对一名13岁的白人男性和33岁的非洲裔美国男性与MELAS进行的。
结果：结果揭示了执行功能，注意力，语言，记忆，视觉空间和运动功能下降的整体模式。在这两名患者中，脑部扫描显示在没有额叶病理的情况下为后部病理。
结论：我们将我们的发现与其他已记录的病例进行了比较，得出的结论是，MELAS的特征在于全球恶化的模式。这种模式不同于其他线粒体疾病中观察到的模式。尽管执行功能存在缺陷，但缺乏可识别的额叶病理可能与线粒体缺乏和神经元投射模式的分布模式有关。

BACKGROUND & AIMS: :Cerebrovascular disease (CVD) and amyloid burden are the most frequent pathologies in subjects with cognitive impairment. However, the relationship between CVD, amyloid burden, and cognition are largely unknown. We aimed to evaluate whether CVD (lacunes, white matter hyperintensities, and microbleeds) and amyloid burden (Pittsburgh compound B [PiB] retention ratio) contribute to cognitive impairment independently or interactively. We recruited 136 patients with subcortical vascular cognitive impairment who underwent magnetic resonance imaging, PiB-positron emission tomography, and neuropsychological testing. The number of lacunes was associated with memory, frontal dysfunctions, and disease severity. The volume of white matter hyperintensities and the PiB retention ratio were associated only with memory dysfunction. There was no direct correlation between CVD markers and PiB retention ratio except that the number of lacunes was negatively correlated with the PiB retention ratio. In addition, there were no interactive effects of CVD and PiB retention ratio on cognition. Our findings suggest that CVD and amyloid burden contribute independently and not interactively to specific patterns of cognitive dysfunction in patients with subcortical vascular cognitive impairment.

背景与目标： ：脑血管疾病（CVD）和淀粉样蛋白负荷是认知障碍受试者中最常见的病理。然而，CVD，淀粉样蛋白负荷和认知之间的关系在很大程度上尚不清楚。我们旨在评估CVD（内毒素，白质高信号和微出血）和淀粉样蛋白负荷（匹兹堡化合物B [PiB]保留率）是否是导致认知障碍的独立或交互作用。我们招募了136位皮层下血管性认知障碍患者，他们接受了磁共振成像，PiB-正电子发射断层扫描和神经心理学测试。腔隙的数量与记忆力，额叶功能障碍和疾病严重程度有关。白质过高的体积和PiB保留率仅与记忆功能障碍有关。 CVD标记与PiB保留率之间没有直接相关性，只是内腔数量与PiB保留率负相关。此外，CVD和PiB保留率对认知没有交互作用。我们的研究结果表明，CVD和淀粉样蛋白负荷是皮层下血管性认知障碍患者认知功能障碍特定模式的独立影响因素，而不是交互作用。

BACKGROUND & AIMS: OBJECTIVE:To determine diagnostic overlap of depression, anxiety and somatization as well as their unique and overlapping contribution to functional impairment. METHOD:Two thousand ninety-one consecutive primary care clinic patients participated in a multicenter cross-sectional survey in 15 primary care clinics in the United States (participation rate, 92%). Depression, anxiety, somatization and functional impairment were assessed using validated scales from the Patient Health Questionnaire (PHQ) (PHQ-8, eight-item depression module; GAD-7, seven-item Generalized Anxiety Disorder Scale; and PHQ-15, 15-item somatic symptom scale) and the Short-Form General Health Survey (SF-20). Multiple linear regression analyses were used to investigate unique and overlapping associations of depression, anxiety and somatization with functional impairment. RESULTS:In over 50% of cases, comorbidities existed between depression, anxiety and somatization. The contribution of the commonalities of depression, anxiety and somatization to functional impairment substantially exceeded the contribution of their independent parts. Nevertheless, depression, anxiety and somatization did have important and individual effects (i.e., separate from their overlap effect) on certain areas of functional impairment. CONCLUSIONS:Given the large syndrome overlap, a potential consideration for future diagnostic classification would be to describe basic diagnostic criteria for a single overarching disorder and to optionally code additional diagnostic features that allow a more detailed classification into specific depressive, anxiety and somatoform subtypes.

背景与目标： 目的：确定抑郁症，焦虑症和躯体化的诊断重叠，以及它们对功能障碍的独特和重叠的贡献。
方法：在美国的15家初级保健诊所中，有291名连续的初级保健诊所患者参加了多中心横断面调查（参与率92％）。使用来自患者健康问卷（PHQ）的有效量表（PHQ-8，八项抑郁量表； GAD-7，七项广义焦虑症量表）和PHQ-15，15评估抑郁，焦虑，躯体化和功能障碍。项目躯体症状量表）和简短的一般健康状况调查表（SF-20）。多元线性回归分析用于研究抑郁，焦虑和躯体化与功能障碍的独特和重叠联系。
结果：在50％以上的病例中，抑郁，焦虑和躯体化之间存在合并症。抑郁，焦虑和躯体化的共性对功能障碍的贡献大大超过了其独立部位的贡献。然而，抑郁，焦虑和躯体化对于功能障碍的某些区域确实具有重要的个体作用（即，与它们的重叠作用分开）。
结论：鉴于大型综合症的重叠，未来诊断分类的潜在考虑因素是描述单个总体疾病的基本诊断标准，并可选地编码其他诊断特征，以更详细地分类为特定的抑郁症，焦虑症和体型亚型。

BACKGROUND & AIMS: :In the present study, we investigated the effects of repeated morphine pre-treatment on impairment of spatial memory acquisition induced by intra dorsal hippocampus (intra-CA1) administration of the non-selective cannabinoid CB1/CB2 receptor agonist, WIN55,212-2 in adult male rats. 2-day version of Morris water maze task has been used for the assessment of spatial memory. On the training day, rats were trained by a single training session of eight trials and 24 h later a probe trial test consist of 60s free swim period without a platform and the visible test was administered. Animals received pre-treatment subcutaneous (s.c.) injections of morphine, once daily for three days followed by five days drug-free treatment before training trials. The results indicated that bilateral pre-training intra-CA1 infusions of WIN55,212-2 (0.25 and 0.5 μg/rat) impaired acquisition of spatial memory on the training and test day. The amnesic effect of WIN55, 212-2 (0.5 μg/rat) was prevented in rats previously injected with morphine (20 mg/kg/day × 3 days, s.c.). Improvement in spatial memory acquisition in morphine-pretreated rats was inhibited by once daily administration of naloxone (1 and 2 mg/kg, s.c.) 15 min prior to injection of morphine for three days. The results suggest that sub-chronic morphine treatment may produced sensitization to cannabinoids, which in turn reversed the impairment of spatial memory acquisition induced by WIN55,212-2 and mu- opioid receptors may play an important role in this effect.

背景与目标： ：在本研究中，我们研究了重复吗啡预处理对非选择性大麻素CB1 / CB2受体激动剂WIN55,212-2背侧海马内（intra-CA1）给药引起的空间记忆获得障碍的影响在成年雄性大鼠中。莫里斯水迷宫任务的2天版本已用于评估空间记忆。在训练当天，通过八次试验的单次训练对大鼠进行了训练，并且在24小时后，探针试验测试包括无平台的60秒钟自由游泳期，并进行了可见测试。在训练试验前，动物每天接受一次皮下（s.c.）皮下注射吗啡治疗，连续三天，然后进行五天的无毒治疗。结果表明，WIN55,212-2（0.25和0.5μg/大鼠）的双训练前CA1内输注在训练和测试当天损害了空间记忆的获取。在事先注射吗啡（20 mg / kg /天×3天，s.c.）的大鼠中，WIN55，212-2（0.5μg/大鼠）的记忆消除得到了预防。在吗啡注射3天前每天15分钟每天一次给予纳洛酮（1和2 mg / kg，皮下注射），抑制了吗啡预处理大鼠的空间记忆获得性改善。结果表明，亚慢性吗啡治疗可能对大麻素产生敏感性，从而逆转了由WIN55,212-2引起的空间记忆获得障碍，而多阿片受体可能在这种作用中起重要作用。

BACKGROUND & AIMS: :We studied expressive and receptive language, oral motor ability, attention, memory, and intelligence in 20 6-year-old children with epilepsy (14 females, six males; mean age 6y 5mo, range 6y-6y 11mo) without learning disability, cerebral palsy (CP), and/or autism, and in 30 reference children without epilepsy (18 females, 12 males; mean age 6y 5mo, range 6y-6y 11mo). Ten children had partial, six primarily generalized, and four unclassified epilepsy. Fourteen were having monotherapy and six were taking two or more antiepileptic drugs; 13 children were free from seizures 3 months before the assessment. Results show no statistically significant difference between the groups concerning Verbal IQ, expressive and receptive grammar, and receptive vocabulary. The children with epilepsy had a significantly lower Performance IQ and lower scores in tests of oral motor ability, articulation, emerging literacy, auditory attention, short-term memory, and rapid word retrieval. Parent ratings revealed no significant difference in communicative ability. Polytherapy and early onset of epilepsy influenced some results. Preschool children with epilepsy without learning disability, CP, and/or autism may have receptive verbal ability within the normal range but visuoperceptual, auditory attentional, and speech-language difficulties that could affect school achievement. Careful testing of children with epilepsy who appear to be functioning within the normal range is needed because this may reveal specific impairments that require appropriate professional input.

背景与目标： ：我们研究了20名没有学习障碍的6岁癫痫儿童（14名女性，男6名；平均年龄6y 5mo，范围6y-6y 11mo）的表达和接受语言，口述运动能力，注意力，记忆力和智力，脑瘫（CP）和/或自闭症，以及30例没有癫痫的参考儿童（女性18例，男性12例；平均年龄6y 5mo，范围6y-6y 11mo）。十名儿童患有部分性癫痫，六名主要为全身性癫痫和四名未分类癫痫。十四名接受单一疗法，六名正在服用两种或更多种抗癫痫药；评估前3个月，有13名儿童没有癫痫发作。结果显示，在语言智商，表达和接受语法以及接受词汇方面，两组之间在统计学上没有显着差异。患有癫痫病的儿童在口语运动能力，清晰度，新兴素养，听觉注意，短期记忆和快速单词检索方面的测试中，智商显着降低，得分较低。父母的等级显示沟通能力没有显着差异。多种疗法和癫痫的早期发作影响了一些结果。患有癫痫病且没有学习障碍，CP和/或自闭症的学龄前儿童，其言语接受能力可能在正常范围内，但视觉，听觉，听觉和言语方面的困难可能会影响学习成绩。需要对似乎在正常范围内运行的癫痫患儿进行仔细检查，因为这可能会发现需要适当专业投入的特定障碍。

BACKGROUND & AIMS: OBJECTIVE:The objective of this study was to compare functional impairments in dementia with Lewy bodies (DLB) and Alzheimer disease (AD) and their relationship with motor and neuropsychiatric symptoms. METHODS:The authors conducted a cross-sectional study of 84 patients with DLB or AD in a secondary care setting. Patients were diagnosed according to published criteria for DLB and AD. The Bristol Activities of Daily Living Scale (BADLS) was used to assess functional impairments. Participants were also assessed using the Unified Parkinson's Disease Rating Scale (motor section), the Neuropsychiatric Inventory, and the Mini-Mental Status Examination. RESULTS:Patients with DLB were more functionally impaired and had more motor and neuropsychiatric difficulties than patients with AD with similar cognitive scores. In both AD and DLB, there were correlations between total BADLS scores and motor and neuropsychiatric deficits. There was more impairment in the mobility and self-care components of the BADLS in DLB than in AD, and in DLB, these were highly correlated with UPDRS score. In AD, orientation and instrumental BADLS components were most affected. CONCLUSION:The nature of functional disability differs between AD and DLB with additional impairments in mobility and self-care in DLB being mainly attributable to extrapyramidal motor symptoms. Consideration of these is important in assessment and management. Activities of daily living scales for use in this population should attribute the extent to which functional disabilities are related to cognitive, psychiatric, or motor dysfunction.

背景与目标： 目的：本研究的目的是比较路易体（DLB）和阿尔茨海默氏病（AD）痴呆患者的功能障碍及其与运动和神经精神症状的关系。
方法：作者进行了横断面研究，对84名患有DLB或AD的二级保健患者进行了横断面研究。根据公布的DLB和AD标准诊断出患者。布里斯托尔日常生活活动量表（BADLS）用于评估功能障碍。还使用统一帕金森氏病评分量表（运动部分），神经精神病学量表和小精神状况检查对参与者进行了评估。
结果：与认知评分相似的AD患者相比，DLB患者的功能障碍更严重，运动和神经精神障碍更大。在AD和DLB中，总BADLS评分与运动和神经精神病学缺陷之间存在相关性。与AD相比，DLB中BADLS的活动性和自我护理成分受损更多，而在DLB中，这些与UPDRS评分高度相关。在AD中，定向和工具BADLS组件受到的影响最大。
结论：AD和DLB之间功能性残疾的性质不同，DLB的活动性和自我护理方面的其他损伤主要归因于锥体外系运动症状。在评估和管理中，考虑这些因素很重要。在该人群中使用的日常生活量表的活动应归因于功能障碍与认知，精神病或运动功能障碍相关的程度。

BACKGROUND & AIMS: :Diabetes mellitus (DM) may give rise to cognitive impairment, but the pathological mechanism involved was still unknown. We employed streptozotocin (STZ)-induced diabetic rats and test their capacity for learning and memory by three-arm radial maze. We determined the expression level of growth-associated protein-43 (GAP-43) and mitogen activated protein kinase phosphatase-1 (MKP-1) in the hippocampus by immunohistochemistry. MKP-1 mRNA level in the CA1 and dentate gyrus (DG) Hippocampal area is further determined by RT-PCR method. We also observed the ultrastructures of Hippocampal neurons by transmission electron microscopy (TEM). All data were analyzed by the independent samples t-test. Four weeks after STZ induction, the diabetic rats showed decreased capacity for learning and memory as indicated by the increase in the error number and reaction time in three-arm radial maze test. TEM results showed the ultrastructures of diabetic hippocampus, including area CA1 and DG, neurons were characterized by swollen mitochondria, increased heterochromatin accumulation and reduced synaptic contacts. The optical density as well as the positive neuron number for GAP-43 and MKP-1 decreased significantly in the CA1 and DG Hippocampal area in diabetic rats (P<0.01). RT-PCR results also showed MKP-1 mRNA in the CA1 and DG Hippocampal area was decreased in the diabetic rats. These results indicated that DM could down-regulate GAP-43 and MKP-1 expression in Hippocampal area that is in charge of memory and cognition. As indicated by our study, the changes in GAP-43 and MKP-1 expression in hippocampus may play a role in the pathogenesis of diabetic dementia.

背景与目标： ：糖尿病（DM）可能引起认知障碍，但涉及的病理机制仍不清楚。我们采用了链脲佐菌素（STZ）诱导的糖尿病大鼠，并通过三臂radial骨迷宫测试了它们的学习和记忆能力。我们通过免疫组织化学测定了海马中的生长相关蛋白43（GAP-43）和有丝分裂原活化蛋白激酶磷酸酶1（MKP-1）的表达水平。通过RT-PCR方法进一步测定CA1和齿状回（DG）海马区中的MKP-1 mRNA水平。我们还通过透射电子显微镜（TEM）观察了海马神经元的超微结构。所有数据均通过独立样本t检验进行分析。诱导STZ后四周，糖尿病大鼠的学习和记忆能力下降，这是通过三臂放射状迷宫测试中错误数和反应时间的增加来表明的。 TEM结果显示，糖尿病海马的超微结构包括CA1区和DG区，神经元的特征在于线粒体肿胀，异染色质积累增加和突触接触减少。糖尿病大鼠CA1区和DG海马区的GAP-43和MKP-1的光密度以及阳性神经元数量均显着下降（P <0.01）。 RT-PCR结果还显示，糖尿病大鼠CA1和DG海马区的MKP-1 mRNA降低。这些结果表明DM可以下调负责记忆和认知的海马区GAP-43和MKP-1的表达。正如我们的研究所表明的，海马区GAP-43和MKP-1表达的变化可能在糖尿病性痴呆的发病机理中起作用。

BACKGROUND & AIMS: :We compared rates of neurocognitive impairment (NCI) among 93 Thai adults failing non-nucleoside reverse transcriptase inhibitor (NNRTI)-based combination antiretroviral therapy (cART) before and after switching to lopinavir/ritonavir monotherapy (mLPV/r) vs. tenofovir/lamivudine/LPV/r (TDF/3TC/LPV/r). Participants completed the Color Trails 1 and 2, Digit Symbol, and Grooved Pegboard at weeks 0, 24, and 48. We calculated z-scores using normative data from 451 healthy HIV-negative Thais. We defined NCI as performance of <-1 SD on ≥2 tests. The Thai depression inventory was used to capture depressive symptoms. Lumbar puncture was optional at week 0 and 48. At baseline, median (IQR) age was 36.9 (32.8-40.5) years, and 46 % had primary school education or lower. The median CD4 count was 196 (107-292) cells/mm(3), and plasma HIV RNA was 4.1 (3.6-4.5) log(10) copies/ml. Almost all (97 %) had circulating recombinant CRF01_AE. At baseline, 20 (47 %) of the mLPV/r vs. 22 (44 %) of TDF/3TC/LPV/r arms met NCI criteria (p = 0.89). The frequency of NCI at week 48 was 30 vs. 32 % (p = 0.85) with 6 vs. 7 % (p = 0.85) developing NCI in the mLPV/r vs. TDF/3TC/LPV/r arms, respectively. Having NCI at baseline and lower education each predicted NCI at week 48. Depression scores at week 48 did not differ between arms (p = 0.47). Cerebrospinal fluid HIV RNA of <50 copies/ml at 48 weeks was observed in five out of seven in mLPV/r vs. three out of four in TDF/3TC/LPV/r arm. The rates of NCI and depression did not differ among cases failing NNRTI-based cART who received mLPV/r compared to LPV/r triple therapy.

背景与目标： ：我们比较了在使用洛匹那韦/利托那韦单药治疗（mLPV / r）与替诺福韦/拉米夫定/ LPV / r（TDF / 3TC / LPV / r）。参与者分别在第0、24和48周完成了色标1和2，数字符号和凹槽钉板。我们使用了451名健康的HIV阴性泰国人的标准数据计算了z得分。我们将NCI定义为在≥2次测试中<-1 SD的性能。泰国抑郁症调查表用来记录抑郁症状。在第0周和第48周时可以选择穿刺腰椎。在基线时，中位（IQR）年龄为36.9（32.8-40.5）岁，46％的儿童具有小学或以下学历。 CD4计数中位数为196（107-292）细胞/ mm（3），血浆HIV RNA为4.1（3.6-4.5）log（10）拷贝/ ml。几乎所有（97％）都具有循环重组CRF01_AE。在基线时，满足PV的NDF标准为20（47％）mLPV / r，而TDF / 3TC / LPV / r组为22（44％）（p = 0.89）。在第48周时，NCI的发生频率分别为30％vs. 32％（p = 0.85），其中在mLPV / r与TDF / 3TC / LPV / r组中分别有6％vs. 7％（p = 0.85）。在基线时接受NCI和接受低等教育时，每位都在第48周时预测了NCI。两组之间在48周时的抑郁评分没有差异（p = 0.47）。在48周时，mLPV / r中七分之五的脑脊液HIV RNA小于50拷贝/ ml，而TDF / 3TC / LPV / r组中四分之三。与LPV / r三联疗法相比，在接受mLPV / r的基于NNRTI的cART失败的病例中，NCI和抑郁的发生率没有差异。

BACKGROUND & AIMS: Schizophrenic illnesses occur with approximately the same incidence in all human populations with a characteristic distribution (slightly earlier in males) of ages of onset. Given that the predisposition (which presumably is genetic) is associated with a procreative disadvantage why do such illnesses persist? Here it is suggested that these conditions are a manifestation of genetic diversity in the evolution of the specifically human characteristic of language, an innovation that has occurred by a process of progressive hemispheric specialization-the establishment of dominance for some critical component of language in one or the other hemisphere. Individuals who develop schizophrenic symptoms show lesser anatomical and functional asymmetries than the population as a whole; such symptoms may reflect 'dominance failure' for language.

背景与目标： 在所有人群中，精神分裂症疾病的发病率几乎相同，并且发病年龄具有特征性分布（男性稍早）。鉴于这种易感性（可能是遗传性的）与生产性劣势有关，为什么这种疾病持续存在？在此建议这些条件是语言的特定人类特征演变过程中遗传多样性的体现，这种创新是通过逐步半球专业化的过程（在一个或多个语言中确定语言的某些关键成分的主导地位）而发生的。另一个半球。与整个人群相比，出现精神分裂症症状的个体在解剖学和功能上的不对称性较小。这样的症状可能反映了语言的“统治失败”。

BACKGROUND & AIMS: 1. Studies have reported various neuropsychological abnormalities in people with excessive drinking patterns and associated problems with the assessment and treatment of this group. 2. The aim of this study was to assess the potential of a screening instrument to help detect the presence of cognitive impairment in excessive alcohol users undergoing detoxification. 3. The Memory Screening Test has potential as a screening instrument to assess clients' cognitive ability to benefit from psychoeducational material.

背景与目标： 1.研究报告了过度饮酒的人的各种神经心理异常情况，以及与该人群的评估和治疗有关的问题。 2.这项研究的目的是评估筛查仪器的潜力，以帮助检测正在接受排毒的过量酒精使用者中认知障碍的存在。 3.记忆筛查测试有潜力作为一种筛查工具，用于评估客户从心理教育材料中受益的认知能力。

BACKGROUND & AIMS: OBJECTIVES:To longitudinally assess the receptive and expressive language functioning of children with symptomatic HIV disease and to explore the relationship between immune status, computed tomography (CT) brain scan abnormalities, and language dysfunction over time. METHODS:Children with symptomatic HIV infection were administered an age-appropriate standardized comprehensive language test and general cognitive measure prior to starting antiretroviral therapy (n = 44) and again after 6 months (n = 29) and 24 months (n = 17). CD4 percentage and CT brain scans were also obtained at each evaluation. RESULTS:Expressive language was significantly more impaired than receptive language at the baseline, 6- and 24-month evaluations. No significant changes over time were found in receptive or expressive language from baseline to after 6 months of antiretroviral therapy, but despite treatment, language scores declined significantly between 6 and 24 months. Overall cognitive function, however, remained stable from baseline to 24 months. Age-adjusted CD4 percentage increased significantly over the initial 6 months, then remained stable. Overall CT brain scan severity ratings did not change significantly over 24 months. CONCLUSION:Expressive language was consistently more impaired than receptive language over 24 months, further supporting an earlier finding that expressive language was differentially affected by HIV in children with symptomatic disease. Both receptive and expressive language declined significantly after 24 months despite antiretroviral therapy, although overall cognitive function remained stable. Thus, functioning in some domains may be more vulnerable to the effects of HIV and global measures of cognitive ability may mask such differential changes in specific brain functions.

背景与目标： 目的：纵向评估有症状的艾滋病毒儿童的接受和表达语言功能，并探讨免疫状态，计算机断层扫描（CT）脑部扫描异常和语言功能障碍之间的关系。
方法：在开始抗逆转录病毒治疗之前（n = 44），在6个月（n = 29）和24个月（n = 17）之后，对有症状HIV感染的儿童进行适合年龄的标准化综合语言测试和一般认知测量。在每次评估中也获得了CD4百分比和CT脑部扫描。
结果：在基线，6个月和24个月评估中，表达语言比接受语言明显受损。从基线到抗逆转录病毒治疗6个月后，在接受性或表达性语言上均未发现随时间的显着变化，但尽管进行了治疗，但语言评分在6到24个月之间显着下降。然而，从基线到24个月，总体认知功能保持稳定。年龄调整后的CD4百分比在最初的6个月中显着增加，然后保持稳定。整个CT脑部扫描的严重程度等级在24个月内没有显着变化。
结论：在过去的24个月中，表达语言始终比接受语言受到的损害更大，这进一步支持了较早的发现，即对有症状疾病的儿童而言，表达语言受HIV的影响不同。尽管进行了整​​体抗逆治疗，尽管接受了抗逆转录病毒治疗，但接受性和表达性语言在24个月后均显着下降。因此，某些领域的功能可能更容易受到HIV的影响，而认知能力的整体衡量标准可能掩盖了特定大脑功能的这种差异性变化。

BACKGROUND & AIMS: OBJECTIVE:The objective of this study was to examine if patients with migraine who responded sufficiently to acute treatment were significantly different from those who did not in terms of patient characteristics, treatment patterns, and patient level of impairment, and to identify characteristics associated with insufficient response. BACKGROUND:Migraine is highly prevalent and impacts functional ability substantially. Current treatment approaches are not sufficiently meeting the needs of patients, and inadequate response to acute treatment is reported by at least 56% of patients with migraine in the United States. METHODS:Data were obtained from the 2014 Adelphi Migraine Disease-Specific Program, a cross-sectional survey. Using logistic regression, we assessed the association between patient factors and insufficient response. Responders were defined as patients with migraine who achieved pain freedom within 2 hours of acute treatment in ≥4 of 5 attacks, while insufficient responders achieved it in ≤3 of 5 attacks. RESULTS:Of 583 patients included, insufficient responders to acute treatment constituted 34.3% (200/583) of the study population. A statistically significantly larger proportion of insufficient responders vs responders had ≥4 migraine headache days/month (46.3% [88/190] vs 31% [114/368]), had ever been prescribed ≥3 unique preventive treatment regimens (11.7% [21/179] vs 6.3% [22/347]), and had chronic migraine, medication-overuse headaches, and comorbid depression (all P values ≤.05). Patient level of impairment was statistically significantly greater among insufficient responders vs responders. Factors associated with insufficient response after adjusting for covariates included Migraine Disability Assessment total score (odds ratio [OR] = 1.04, 95% CI [1.02, 1.05]), time of administration of acute treatment (OR = 1.83, 95% CI [1.15, 2.92]), depression (OR = 1.98, 95% CI [1.21, 3.23]), sensitivity to light not listed as current most troublesome symptom (OR = 2.30, 95% CI [1.21, 4.37]), and change in the average headache days per month before being prescribed an acute treatment vs now (OR = 1.75, 95% CI [1.05, 2.90]). CONCLUSIONS:Clinical characteristics, treatment patterns, and health-related quality of life measures are statistically significantly different between insufficient responders and responders to acute treatment in patients with migraine.

背景与目标： 目的：本研究的目的是检查对急性治疗有充分反应的偏头痛患者在患者特征，治疗模式和患者损伤水平方面是否与未偏头痛患者显着不同，并确定与不足的患者相关的特征回复。
背景：偏头痛非常普遍，并且会严重影响功能能力。当前的治疗方法不能充分满足患者的需求，在美国，至少有56％的偏头痛患者报告对急性治疗的反应不足。
方法：数据来自2014年Adelphi偏头痛疾病专项计划横断面调查。使用逻辑回归，我们评估了患者因素与反应不足之间的关联。响应者被定义为偏头痛患者，在急性发作后2小时内在5次发作中≥4次达到了疼痛自由度，而响应不足的患者在5次发作中≤3次发作中实现了疼痛自由度。
结果：在583例患者中，对急性治疗的反应不足，占研究人群的34.3％（200/583）。统计学上显着更大的反应不足者与反应者相比，≥4个偏头痛天/月（46.3％[88/190] vs 31％[114/368]），曾被处方≥3种独特的预防性治疗方案（11.7％[ [21/179]比6.3％[22/347]），并患有慢性偏头痛，药物滥用性头痛和合并性抑郁症（所有P值均≤.05）。在反应不足者与反应者之间，患者的损伤水平在统计学上显着更大。校正协变量后与反应不足相关的因素包括偏头痛残疾评估总分（赔率[OR] = 1.04，95％CI [1.02，1.05]），急性治疗的给药时间（OR = 1.83，95％CI [1.15] ，2.92]），抑郁（OR = 1.98、95％CI [1.21、3.23]），对光的敏感性未列为当前最麻烦的症状（OR = 2.30，95％CI [1.21、4.37]），并且相对于现在而言，在接受紧急治疗之前每月平均头痛天数（OR = 1.75，95％CI [1.05，2.90]）。
结论：对于偏头痛患者，反应不足和对急性治疗的反应者之间，临床特征，治疗方式和与健康相关的生活质量测量在统计学上有显着差异。

BACKGROUND & AIMS: OBJECTIVES:Nutritional insufficiencies have been associated with cognitive impairment. Understanding whether nutritional biomarker levels are associated with clinical progression could help to design dietary intervention trials. This longitudinal study examined a panel of nutritional biomarkers in relation to clinical progression in patients with subjective cognitive decline (SCD) or mild cognitive impairment (MCI). DESIGN, SETTING AND PARTICIPANTS:We included 299 patients without dementia (n = 149 SCD; age 61 ± 10 years, female 44%, n = 150 MCI; age 66 ± 8 years, female 38%). Median (interquartile range) follow-up was 3 (2-5) years. METHODS:We measured 28 nutritional biomarkers in blood and 5 in cerebrospinal fluid (CSF), associated with 3 Alzheimer's disease pathologic processes: vascular change (lipids), synaptic dysfunction (homocysteine-related metabolites), and oxidative stress (minerals and vitamins). Nutritional biomarker associations with clinical progression to MCI/dementia and cognitive decline based on the Mini-Mental State Examination score were evaluated using Cox proportional hazard models and linear mixed models. We used partial least squares Cox models (PLS-Cox) to examine nutritional biomarker profiles associated with clinical progression. RESULTS:In the total group, high high-density lipoprotein (HDL) levels were associated with clinical progression and cognitive decline. In SCD, high folate and low bilirubin levels were associated with cognitive decline. In MCI, low CSF S-adenosylmethionine (SAM) and high theobromine were associated with clinical progression to dementia and high HDL, cholesterol, iron, and 1,25(OH)2 vitamin D were associated with cognitive decline. PLS-Cox showed 1 profile for SCD, characterized by high betaine and folate and low zinc associated with clinical progression. In MCI, a profile with high theobromine and HDL and low triglycerides and a second profile with high plasma SAM and low cholesterol were associated with risk of dementia. CONCLUSION AND IMPLICATIONS:High HDL was most consistently associated with clinical progression. Moreover, different nutritional biomarker profiles for SCD and MCI showed promising associations with clinical progression. Future dietary (intervention) studies could use nutritional biomarker profiles to select patients, taking into account the disease stage.

背景与目标： 目的：营养不足与认知障碍有关。了解营养生物标志物水平是否与临床进展有关可以帮助设计饮食干预试验。这项纵向研究检查了一组与主观认知下降（SCD）或轻度认知障碍（MCI）患者临床进展相关的营养生物标志物。
设计，地点和参与者：我们纳入了299例无痴呆的患者（n = 149 SCD;年龄61±10岁，女性44％，n = 150 MCI;年龄66±8岁，女性38％）。中位（四分位间距）随访时间为3（2-5）年。
方法：我们测量了血液中的28种营养生物标志物和脑脊液（CSF）中的5种营养生物标志物，这些标志物与3种阿尔茨海默氏病的病理过程相关：血管变化（脂质），突触功能障碍（同型半胱氨酸相关代谢产物）和氧化应激（矿物质和维生素）。使用Cox比例风险模型和线性混合模型评估了基于迷你精神状态检查评分的临床进展到MCI /痴呆和认知能力下降的营养生物标志物关联。我们使用偏最小二乘Cox模型（PLS-Cox）来检查与临床进展相关的营养生物标志物概况。
结果：在整个组中，高密度脂蛋白（HDL）高水平与临床进展和认知能力下降有关。在SCD中，高叶酸和低胆红素水平与认知能力下降有关。在MCI中，低CSF S-腺苷甲硫氨酸（SAM）和高可可碱与临床进展为痴呆症相关，而高HDL，胆固醇，铁和1,25（OH）2维生素D与认知能力下降相关。 PLS-Cox对SCD表现出1种特征，其特征在于高甜菜碱和叶酸以及低锌与临床进展有关。在MCI中，可可碱和HDL含量高，甘油三酯含量低的特征以及血浆SAM高和胆固醇含量低的第二种特征与痴呆症的风险有关。
结论和意义：高HDL与临床进展最一致。此外，SCD和MCI的不同营养生物标志物谱显示出与临床进展相关的有希望的关联。未来的饮食（干预）研究可以使用营养生物标志物概况来选择患者，同时考虑到疾病的阶段。

BACKGROUND & AIMS: :Antiphospholipid syndrome (APS) is a clinical autoimmune disorder characterised by thrombosis, venous or arterial, and recurrent pregnancy morbidity in association with the persistence of antiphospholipid antibodies (aPL). The clinical variety of aPL ranges from asymptomatic individuals to those with multiple organ thromboses and failure developing over a short period, also known as catastrophic APS. An increasing number of phospholipid-binding proteins with crucial functions in the regulation of blood coagulation and fibrinolysis are targeted by APS-related autoantibodies. Disruption of fibrinolysis is one of the proposed pathophysiological mechanisms for the APS. There are some experimental data for an association between impaired overall fibrinolytic activity and autoimmune aPL; however, evidence is still inconclusive and more studies are needed in this area. In this article, we review the evidence by which aPL may disturb fibrinolysis.

背景与目标： ：抗磷脂综合征（APS）是一种临床自身免疫性疾病，其特征在于血栓形成，静脉或动脉以及反复发作的妊娠发病率以及抗磷脂抗体（aPL）的持续存在。 aPL的临床变化范围广泛，从无症状的个体到具有多器官血栓形成且在短时间内出现衰竭的个体，也称为灾难性APS。 APS相关自身抗体靶向越来越多的在血液凝固和纤维蛋白溶解调节中起关键作用的磷脂结合蛋白。纤维蛋白溶解的破坏是APS的病理生理机制之一。有一些实验数据表明，整体纤溶活性受损和自身免疫性aPL之间存在关联。然而，证据仍然没有定论，在这一领域还需要更多的研究。在本文中，我们回顾了aPL可能干扰纤维蛋白溶解的证据。

BACKGROUND & AIMS: BACKGROUND/OBJECTIVE:Anxiety is common in patients experiencing neurocritical illness and their family caregivers. Resilience factors like mindfulness and coping skills may be protective against symptoms of emotional distress, including anxiety. Less is known about the interplay of anxiety symptoms and resilience factors between patients and caregivers. The purpose of this study is to examine the trajectory of anxiety symptoms among dyads of neurocritical care patients without major cognitive impairment and their family caregivers and to elucidate the relationship between resiliency (e.g., mindfulness and coping) and anxiety in these dyads. METHODS:Prospective, longitudinal study of adults admitted to the neurological intensive care unit (Neuro-ICU) and their caregivers. Dyads of patients (N = 102) and family caregivers (N = 103) completed self-report measures of mindfulness (Cognitive Affective Mindfulness Scale-Revised) and coping (Measure of Current Status-Part A) during Neuro-ICU hospitalization and anxiety symptoms (anxiety subscale of the Hospital Anxiety and Depression Scale) during hospitalization and at 3- and 6-month follow-up. We used actor-partner interdependence modeling to predict the effect of one's own baseline characteristics on one's own and one's partner's future anxiety symptoms. RESULTS:Rates of clinically significant anxiety symptoms were 40% for patients and 42% for caregivers at baseline. Of these, 20% of patients and 23% of caregivers showed moderate and severe symptoms. Approximately, one-third of patients and caregivers reported clinically significant anxiety symptoms at 3- and 6-month follow-ups, with more than 20% endorsing moderate or severe symptoms. Patients' own baseline mindfulness, coping, and anxiety symptoms were associated with lower anxiety symptoms at all time points (ps < 0.001)-this was also true for caregivers. For both patients and caregivers, one's own baseline mindfulness predicted their partner's anxiety symptoms 3 months later (p = 0.008), but not at 6-month follow-up. CONCLUSIONS:Anxiety symptoms in Neuro-ICU patient-caregiver dyads are high through 6 months following admission. Mindfulness is interdependent and protective against anxiety in dyads at 3-month but not 6-month follow-up. Early, dyad-based interventions may prevent the development of chronic anxiety in patients without major cognitive impairment and caregivers.

背景与目标： 背景/目的：焦虑症常见于患有神经危重疾病的患者及其家属。诸如正念和应对技巧等韧性因素可以预防包括焦虑在内的情绪困扰症状。关于患者和护理人员之间的焦虑症状和适应力因素之间相互作用的了解还很少。这项研究的目的是检查没有严重认知障碍的神经重症监护患者的二联症及其家庭护理人员的焦虑症状轨迹，并阐明这些二联症的适应力（例如，正念和应对）与焦虑之间的关系。
方法：对入院神经内科重症监护病房（Neuro-ICU）及其看护者的成年人进行前瞻性纵向研究。患者的病史（N = 102）和家庭照顾者（N = 103）完成了神经ICU住院和焦虑症状期间自我报告的正念（认知情感正念量表修订）和应对（当前状态A部分量度） （住院焦虑和抑郁量表的焦虑量表）在住院期间以及在3个月和6个月的随访中。我们使用演员-伴侣相互依赖模型来预测一个人的基线特征对一个人及其伴侣的未来焦虑症状的影响。
结果：在基线时，临床上显着的焦虑症状发生率分别为患者40％和看护者42％。其中，20％的患者和23％的护理人员表现出中度和重度症状。大约有三分之一的患者和护理人员在3个月和6个月的随访中报告了临床上显着的焦虑症状，其中超过20％的患者认可中度或重度症状。患者在所有时间点的基线正念，应对和焦虑症状与较低的焦虑症状相关（ps <0.001）-护理人员也是如此。对于患者和看护人来说，他们自己的基本正念预言会在3个月后预测其伴侣的焦虑症状（p = 0.008），但在6个月的随访中却没有。
结论：入院后6个月内，Neuro-ICU患者护理组的焦虑症状严重。正念是相互依存的，并且在3个月而不是6个月的随访中可以预防双胞胎的焦虑。在没有重大认知障碍和照顾者的情况下，基于二分法的早期干预措施可能会阻止慢性焦虑症的发生。