BACKGROUND & AIMS: STUDY OBJECTIVE:To assess the prognostic performance of general severity systems (APACHE II [acute physiology and chronic health evaluation], simplified acute physiology score [SAPS II], and mortality probability models [MPM II]) in coronary patients and to derive new customized indexes for coronary patients using a reduced number of variables.

DESIGN:Inception cohort.

SETTING:Adult medical and surgical ICUs in 17 hospitals in Catalonia and the Balearic Islands.

PATIENTS:Four hundred fifty-six patients with acute myocardial infarction.

MEASUREMENTS AND RESULTS:The APACHE II, SAPS II, and MPM II variables and survival status at hospital discharge have been collected. Performance of the severity systems was assessed by evaluating calibration and discrimination. Logistic regression was used to customize the MPM II(24) and SAPS II indexes. Discrimination was high enough for all of the models. However, calibration of the MPM II(24) was not as satisfactory as for the other models. The MPM II(24) and SAPS II were both reduced to five variables (MPM II(24 cor:) age, PaO2, continuous vasoactive drugs, urinary output, and mechanical ventilation; SAPS II(cor:) age, PaO2/FI(O2) ratio, systolic BP, Glasgow coma score, and urinary output). Both models showed better calibration and discrimination than the original ones.

CONCLUSIONS:Prognostic indexes developed for multidisciplinary patients show good performance when applied to patients with acute myocardial infarction, but customization can reduce the number of variables necessary to compute them without a loss of, and a possible improvement in, prognostic accuracy.

背景与目标： 研究目标 : 评估一般严重程度系统 (APACHE II [急性生理学和慢性健康评估]，简化的急性生理学评分 [SAPS II]，和冠心病患者的死亡率概率模型 [MPM II])，并使用减少的变量数量为冠心病患者推导新的定制指标。
设计 : 初始队列。
设置 : 加泰罗尼亚和巴利阿里群岛17家医院的成人医疗和外科重症监护医师。
患者 : 456例急性心肌梗死患者。
测量和结果 : 已收集APACHE II，SAPS II和MPM II变量以及出院时的生存状态。通过评估校准和判别来评估严重性系统的性能。Logistic回归用于定制MPM II(24) 和SAPS II指数。歧视对于所有模型来说都足够高。但是，MPM II(24) 的校准不如其他模型令人满意。MPM II(24) 和SAPS II均降低为五个变量 (MPM II(24 cor :) 年龄，PaO2，持续血管活性药物，尿量和机械通气; SAPS II(cor :) 年龄，PaO2/FI(O2) 比，收缩压，格拉斯哥昏迷评分，和尿量)。两种模型均显示出比原始模型更好的校准和区分度。
结论 : 为多学科患者开发的预后指标在应用于急性心肌梗死患者时显示出良好的表现，但是，自定义可以减少计算它们所需的变量数量，而不会损失预后准确性，并可能提高预后准确性。

BACKGROUND & AIMS: Visual optics is taking on new clinical significance. Given that current refractive procedures can and do induce large amounts of higher order ocular aberration that often affects the patient's daily visual function and quality of life, we can no longer relegate the considerations of ocular aberrations to academic discussions. Instead, we need to move toward minimizing (not increasing) the eye's aberrations at the same time we are correcting the eye's spherical and cylindrical refractive error. These are exciting times in refractive surgery, which need to be tempered by the fact that after all the research, clinical, and marketing dust settles, the level to which we improve the quality of the retinal image will be guided by the trade-off between cost and the improvement in the quality of life that refractive surgery offers.

背景与目标： 视觉光学具有新的临床意义。鉴于当前的屈光手术可以并且确实会引起大量的高阶眼像差，这些像差通常会影响患者的日常视觉功能和生活质量，因此我们不能再将眼像差的考虑因素置于学术讨论中。相反，我们需要在校正眼睛的球形和圆柱形屈光不正的同时，朝着最小化 (不增加) 眼睛的像差的方向发展。在屈光手术中，这是激动人心的时刻，需要通过以下事实来缓解: 在所有研究，临床和营销尘埃落定之后，我们提高视网膜图像质量的水平将取决于成本与屈光手术提供的生活质量之间的权衡。

BACKGROUND & AIMS: :Cognitive and learning styles research is limited by the lack of evidence supporting valid interpretations of style assessment scores. We sought evidence to support the validity of scores from 4 instruments: the Index of Learning Styles (ILS); the Learning Style Inventory (LSI); the Cognitive Styles Analysis (CSA), and the Learning Style Type Indicator (LSTI). The ILS assesses 4 domains: sensing-intuitive (SensInt), active-reflective (ActRefl), sequential-global (SeqGlob) and visual-verbal (VisVerb), each of which parallel a similar domain in at least 1 of the other instruments. We administered the ILS, LSI and CSA to family medicine and internal medicine residents and Year 1 and 3 medical students and applied the multitrait-multimethod matrix to evaluate convergence and discrimination. After 3 months participants repeated the ILS and completed the LSTI. A total of 89 residents and medical students participated. Multitrait-multimethod analysis showed evidence of both convergence and discrimination for ActRefl (ILS, LSI and LSTI) and SensInt (ILS and LSTI) scores. ILS SeqGlob and SensInt scores showed unanticipated correlation. No other domains met the criteria for convergence or discrimination. Test-retest reliabilities for ILS scores were 0.856 for SensInt, 0.809 for ActRefl, 0.703 for SeqGlob and 0.684 for VisVerb. Cronbach's alpha values were > or = 0.810 for LSI and 0.237-0.758 for LSTI. At least 9 participants misinterpreted the LSI instructions. These data support the validity of ILS active-reflective and sensing-intuitive scores, LSI active-reflective scores and LSTI sensing-intuitive scores for determining learning styles in this population. Cognitive style and learning style scores may not be interchangeable, even for constructs with similar definitions.

背景与目标： : 认知和学习风格研究受到缺乏支持风格评估分数有效解释的证据的限制。我们从4种工具中寻找证据来支持分数的有效性: 学习风格指数 (ILS); 学习风格清单 (LSI); 认知风格分析 (CSA) 和学习风格类型指标 (LSTI)。ILS评估4个域: 感知-直觉 (SensInt)，主动-反射 (ActRefl)，顺序-全局 (SeqGlob) 和视觉-言语 (VisVerb)，每个域在至少1个其他工具中都平行于一个相似的域。我们对家庭医学和内科住院医师以及1年级和3年级的医学生进行了ILS，LSI和CSA的管理，并应用了多性状-多方法矩阵来评估收敛和歧视。3个月后，参与者重复ILS并完成LSTI。共有89名居民和医学生参加。多性状-多方法分析显示了ActRefl (ILS，LSI和LSTI) 和SensInt (ILS和LSTI) 得分的收敛性和区分性。ILS SeqGlob和SensInt评分显示出意想不到的相关性。没有其他领域符合趋同或歧视的标准。对SensInt，ActRefl，SeqGlob，0.703和VisVerb，对0.809 0.856 ILS分数的重测可靠性。LSI的Cronbach α 值> 或 = 0.810，LSTI的0.237-0.758。至少有9名参与者误解了LSI指令。这些数据支持ILS主动反射和感知直觉分数，LSI主动反射分数和LSTI感知直觉分数用于确定该人群的学习方式的有效性。认知风格和学习风格得分可能不可互换，即使对于具有相似定义的结构也是如此。

BACKGROUND & AIMS: The relationship between preferred objects associated with stereotypy, stereotypic behavior, and accuracy of responding during a counting task by a child with autism was analyzed. Object preference was determined by presenting the child with different sets of objects and asking him to choose one. His choices were then rank ordered into three groupslow, medium, and high preference objects. Counting performance within each of the three object groups was then analyzed in a multi-element design, alternating preference groups. Teaching with high-preference objects occasioned more stereotypic behavior and less accurate counting than teaching with medium- and low-preference objects. Thus, there exists the possibility that teaching may be less successful with certain teaching materials, especially if those materials evoke high rates of incompatible behaviors.

背景与目标： 分析了与自闭症儿童在计数任务中与刻板印象相关的首选对象，刻板行为和响应准确性之间的关系。对象偏好是通过向孩子展示不同的对象集并要求他选择一个来确定的。然后将他的选择排序为三个慢，中和高偏好对象。然后，在多元素设计 (交替的偏好组) 中分析了三个对象组中每个对象组的计数性能。与中低偏好对象的教学相比，高偏好对象的教学产生了更多的刻板行为和更不准确的计数。因此，存在使用某些教材进行教学可能不太成功的可能性，尤其是如果这些教材引起高度的不相容行为。

BACKGROUND & AIMS: BACKGROUND:Choline is essential for fetal brain development, and it is not known whether a typical American diet contains enough choline to ensure optimal brain development. OBJECTIVE:The study was undertaken to determine whether supplementing pregnant women with phosphatidylcholine (the main dietary source of choline) improves the cognitive abilities of their offspring. DESIGN:In a double-blind, randomized controlled trial, 140 pregnant women were randomly assigned to receive supplemental phosphatidylcholine (750 mg) or a placebo (corn oil) from 18 wk gestation through 90 d postpartum. Their infants (n = 99) were tested for short-term visuospatial memory, long-term episodic memory, language development, and global development at 10 and 12 mo of age. RESULTS:The women studied ate diets that delivered ∼360 mg choline/d in foods (∼80% of the recommended intake for pregnant women, 65% of the recommended intake for lactating women). The phosphatidylcholine supplements were well tolerated. Groups did not differ significantly in global development, language development, short-term visuospatial memory, or long-term episodic memory. CONCLUSIONS:Phosphatidylcholine supplementation of pregnant women eating diets containing moderate amounts of choline did not enhance their infants' brain function. It is possible that a longer follow-up period would reveal late-emerging effects. Moreover, future studies should determine whether supplementing mothers eating diets much lower in choline content, such as those consumed in several low-income countries, would enhance infant brain development.

背景与目标：

BACKGROUND & AIMS: :Cognitive dysfunction syndrome is a major disease affecting old cats and is the consequence of severe and irreversible loss of brain cells and brain atrophy. The present study focused on the hypothesis that the optimal strategy for promoting successful brain ageing is to target risk factors associated with brain ageing and dementia. We used a nutritional strategy involving supplementation with a blend of nutrients (antioxidants, arginine, B vitamins and fish oil) to test this hypothesis. Middle-aged and old cats between 5·5 and 8·7 years of age were assigned to cognitively equivalent control or treatment groups based on prior cognitive experience and performance on baseline cognitive tests. The cats in the treatment group were maintained on a diet supplemented with the nutrient blend and the cats in the control group were maintained on the identical base diet without the additional supplementation. After an initial wash-in period, all cats were tested on a battery of cognitive test protocols. The cats fed the test diet showed significantly better performance on three of four test protocols: a protocol assessing egocentric learning, a protocol assessing discrimination and reversal learning and a protocol focused on acquisition of a spatial memory task. The results support the hypothesis that brain function of middle-aged and old cats can be improved by the nutrient blend that was selected to minimise or eliminate the risk factors associated with brain ageing and dementia.

背景与目标： : 认知功能障碍综合征是影响老猫的主要疾病，是严重且不可逆转的脑细胞丧失和脑萎缩的后果。本研究的重点是以下假设: 促进成功的大脑衰老的最佳策略是针对与大脑衰老和痴呆症相关的危险因素。我们使用了一种营养策略，包括补充营养素 (抗氧化剂，精氨酸，b族维生素和鱼油)，以检验这一假设。根据先前的认知经验和基线认知测试的表现，将5·5至8·7岁的中年和老年猫分配到认知上等效的对照组或治疗组。治疗组中的猫维持在补充营养混合物的饮食中，而对照组中的猫维持在相同的基础饮食中，而无需额外补充。在最初的冲洗期后，所有猫都接受了一系列认知测试协议的测试。喂养测试饮食的猫在四个测试协议中的三个协议中表现出明显更好的性能: 评估以自我为中心的学习的协议，评估歧视和逆转学习的协议以及专注于获取空间记忆任务的协议。结果支持以下假设: 可以通过选择营养混合物来改善中老年猫的脑功能，以最大程度地减少或消除与脑衰老和痴呆症相关的危险因素。

BACKGROUND & AIMS: :The effects of temporal variation in the quality of short-lived annual plants on oviposition preference and larval performance of insect herbivores has thus far received little attention. This study examines the effects of plant age on female oviposition preference and offspring performance in the large cabbage white butterfly Pieris brassicae. Adult female butterflies lay variable clusters of eggs on the underside of short-lived annual species in the family Brassicaceae, including the short-lived annuals Brassica nigra and Sinapis arvensis, which are important food plants for P. brassicae in The Netherlands. Here, we compared oviposition preference and larval performance of P. brassicae on three age classes (young, mature, and pre-senescing) of B. nigra and S. arvensis plants. Oviposition preference of P. brassicae declined with plant age in both plant species. Whereas larvae performed similarly on all three age classes in B. nigra, preference and performance were weakly correlated in S. arvensis. Analysis of primary (sugars and amino acids) and secondary (glucosinolates) chemistry in the plant shoots revealed that differences in their quality and quantity were more pronounced with respect to tissue type (leaves vs. flowers) than among different developmental stages of both plant species. Butterflies of P. brassicae may prefer younger and smaller plants for oviposition anticipating that future plant growth and size is optimally synchronized with the final larval instar, which contributes >80% of larval growth before pupation.

背景与目标： : 到目前为止，短命一年生植物质量的时间变化对昆虫食草动物的产卵偏好和幼虫表现的影响很少受到关注。这项研究研究了植物年龄对大型白菜白蝴蝶粉蝶的雌性产卵偏好和后代表现的影响。成年雌蝶在十字花科的短寿命一年生物种的下侧产下可变的卵簇，包括短寿命的一年生芸苔和Sinapis arvensis，它们是荷兰十字花科的重要食用植物。在这里，我们比较了三个年龄类别 (年轻，成熟和衰老前) 的芸苔属植物的产卵偏好和幼虫表现。在两种植物中，芸苔属的产卵偏好均随植物年龄而下降。尽管幼虫在黑质B. nigra的所有三个年龄段的表现相似，但在S. arvensis中，偏好和表现之间的相关性较弱。对植物芽中初级 (糖和氨基酸) 和次级 (硫代葡萄糖苷) 化学的分析表明，在组织类型 (叶与花) 方面，其质量和数量的差异比在不同发育阶段之间更为明显。两种植物物种。芸苔属的蝴蝶可能更喜欢年轻和较小的植物进行产卵，以预期未来的植物生长和大小与最终的幼虫最佳地同步，这在化P之前有助于幼虫生长的80%。

BACKGROUND & AIMS: :Cognitive decline is a feared aspect of growing old. It is a major contributor to lower quality of life and loss of independence in old age. We investigated the genetic contribution to individual differences in nonpathological cognitive ageing in five cohorts of older adults. We undertook a genome-wide association analysis using 549 692 single-nucleotide polymorphisms (SNPs) in 3511 unrelated adults in the Cognitive Ageing Genetics in England and Scotland (CAGES) project. These individuals have detailed longitudinal cognitive data from which phenotypes measuring each individual's cognitive changes were constructed. One SNP--rs2075650, located in TOMM40 (translocase of the outer mitochondrial membrane 40 homolog)--had a genome-wide significant association with cognitive ageing (P=2.5 × 10(-8)). This result was replicated in a meta-analysis of three independent Swedish cohorts (P=2.41 × 10(-6)). An Apolipoprotein E (APOE) haplotype (adjacent to TOMM40), previously associated with cognitive ageing, had a significant effect on cognitive ageing in the CAGES sample (P=2.18 × 10(-8); females, P=1.66 × 10(-11); males, P=0.01). Fine SNP mapping of the TOMM40/APOE region identified both APOE (rs429358; P=3.66 × 10(-11)) and TOMM40 (rs11556505; P=2.45 × 10(-8)) as loci that were associated with cognitive ageing. Imputation and conditional analyses in the discovery and replication cohorts strongly suggest that this effect is due to APOE (rs429358). Functional genomic analysis indicated that SNPs in the TOMM40/APOE region have a functional, regulatory non-protein-coding effect. The APOE region is significantly associated with nonpathological cognitive ageing. The identity and mechanism of one or multiple causal variants remain unclear.

背景与目标： : 认知能力下降是变老的一个令人恐惧的方面。这是导致老年生活质量下降和失去独立性的主要原因。我们调查了五个老年人群对非病理性认知衰老个体差异的遗传贡献。在英格兰和苏格兰的认知老化遗传学 (CAGES) 项目中，我们使用549   692单核苷酸多态性 (snp) 对3511无关的成年人进行了全基因组关联分析。这些个体具有详细的纵向认知数据，从中构建了用于测量每个人的认知变化的表型。位于tom40 (线粒体外膜40同源物的转位酶) 中的一个SNP-rs2075650与认知老化具有全基因组显着关联 (P = 2.5 × 10(-8))。该结果在三个独立的瑞典队列的荟萃分析中被复制 (P = 2.41 × 10(-6))。先前与认知衰老相关的载脂蛋白E (APOE) 单倍型 (与tom40相邻) 对笼子样本中的认知衰老具有显着影响 (P = 2.18 × 10(-8); 女性，P = 1.66 × 10(-11); 男性，P = 0.01)。Tom40/APOE区域的精细SNP图谱将APOE (rs429358; P = 3.66 × 10(-11)) 和tom40 (rs11556505; P = 2.45 × 10(-8)) 识别为与认知衰老相关的基因座。发现和复制队列中的插补和条件分析强烈表明，这种效应是由于APOE引起的 (rs429358)。功能基因组分析表明，tom40/APOE区域的snp具有功能性，调节的非蛋白质编码作用。APOE区域与非病理性认知老化显着相关。一种或多种因果变异的身份和机制仍不清楚。

BACKGROUND & AIMS: :A specific form of family therapy (family-based treatment) is the leading treatment for adolescents with anorexia nervosa. As this treatment has certain limitations, alternative approaches are needed. "Enhanced" cognitive behaviour therapy (CBT-E) is a potential candidate given its utility as a treatment for adults with eating disorder psychopathology. The aim of the present study was to establish, in a representative cohort of patients with marked anorexia nervosa, the immediate and longer term outcome following CBT-E. Forty-nine adolescent patients were recruited from consecutive referrals to a community-based eating disorder clinic. Each was offered 40 sessions of CBT-E over 40 weeks from a single therapist. Two-thirds completed the full treatment with no additional input. In these patients there was a substantial increase in weight together with a marked decrease in eating disorder psychopathology. Over the 60-week post-treatment follow-up period there was little change despite minimal subsequent treatment. These findings suggest that CBT-E may prove to be a cost-effective alternative to family-based treatment.

背景与目标： : 一种特殊形式的家庭治疗 (基于家庭的治疗) 是青少年神经性厌食症的主要治疗方法。由于这种治疗有一定的局限性，因此需要其他方法。“增强” 认知行为疗法 (cbt-e) 是一种潜在的候选药物，因为它可用于饮食失调精神病理学的成年人。本研究的目的是在具有明显神经性厌食症的代表性队列中，建立cbt-e后的近期和长期结果。从连续转诊到社区饮食失调诊所招募了49名青少年患者。每位治疗师在40周内接受了40次cbt-e治疗。三分之二的人完成了完整的治疗，没有额外的投入。在这些患者中，体重显着增加，进食障碍心理病理学显着减少。在治疗后60周的随访期内，尽管后续治疗很少，但变化不大。这些发现表明，cbt-e可能被证明是基于家庭的治疗的一种经济有效的替代方法。

BACKGROUND & AIMS: OBJECTIVES:To evaluate and assess the impact of pharmacy students' electronic device (e-device) use during a lecture-based pharmacotherapeutics sequence. METHODS:A validated survey instrument to assess e-device use was e-mailed to 238 second- (P2) and third-year (P3) pharmacy students. Grades were reviewed retrospectively and correlated with e-device use to determine its impact on academic performance. RESULTS:Of 140 responding students (59% response rate), 106 reported using e-devices during class for course-related (91.5%) and non-course-related (81.1%) activities. When P2 and P3 students were combined, e-device use was not associated with academic performance (p = 0.70). Academic performance was not impacted among P3 students (p = 0.86), but P2 students performed better academically if they refrained from using e-devices during class (mean grade = 88.5% vs. 83.3%; p=0.019). CONCLUSIONS:The impact of e-device use on overall academic performance was negligible. Use of e-devices by students enrolled in their first pharmacotherapeutics course may negatively impact academics.

背景与目标：

BACKGROUND & AIMS: :Cognitive insight refers to awareness of one's own thinking. Research has found deficits in cognitive insight in schizophrenia but studies of its links with positive symptoms and delusions have been equivocal. One possibility is that the association of cognitive insight with positive symptoms and delusions is moderated by other factors. To explore this issue this study examined whether level of socially naive self-appraisal moderated the relationship of two forms of cognitive insight, self-reflectivity and self-certainty with delusions and positive symptoms. Participants were 92 adults, with diagnoses of schizophrenia or schizoaffective disorder, who were administered the Positive and Negative Syndrome Scale, self-deceptive subscale from the Marlowe-Crowne Social Desirability Scale and the Beck Cognitive Insight Scale. Stepwise multiple regressions with the interaction term of the predictive and moderator variables suggested that social naiveté moderates the relationship between self-reflectivity and self-certainty with positive symptoms in general. Moreover, association between self-certainty and delusions was also moderated by social naiveté self-appraisal. All models were significant after controlling for willful impression management as well as a measure of executive function. Results suggest that higher levels of self-certainty are a risk factor for having greater positive symptoms including more severe levels of delusions, when one has a view of oneself that is not tempered by the perceptions of others. Concerning lower levels of self-reflectivity it may be that this combined with a socially naïve view of oneself leaves persons less inhibited when they are tempted to accept unusual thoughts and perceptions as accurate. Implications for treatment are discussed.

背景与目标： : 认知洞察力是指对自己思维的认识。研究发现精神分裂症的认知能力不足，但对其与阳性症状和妄想的联系的研究却模棱两可。一种可能性是，认知洞察力与积极症状和妄想的关联受到其他因素的调节。为了探讨这个问题，本研究检查了社交天真的自我评估水平是否调节了两种认知洞察力，自我反射和自我确定性与妄想和积极症状之间的关系。参与者为92名诊断为精神分裂症或分裂情感障碍的成年人，他们接受了阳性和阴性综合征量表，Marlowe-Crowne社会期望量表和Beck认知洞察力量表的自我欺骗性量表。具有预测变量和调节变量相互作用项的逐步多元回归表明，社会天真通常会缓和自我反射性和自我确定性与积极症状之间的关系。此外，社会天真的自我评估也减轻了自我确定性和妄想之间的联系。在控制了故意的印象管理以及执行功能的度量之后，所有模型都很重要。结果表明，当一个人对自己的看法不受他人的看法影响时，较高的自我确定性水平是出现更大积极症状 (包括更严重的妄想) 的危险因素。关于较低的自我反射率，这可能与对自己的社会天真的看法相结合，使人们在试图接受不寻常的想法和看法准确时受到的抑制较小。讨论了对治疗的影响。

BACKGROUND & AIMS: :This study aimed to investigate the prevalence of oral health impact on daily performance in Brazilian adults. 276 civil servants 35 to 44 years of age from the Public Works and Waste Disposal Department of Porto Alegre, in southern Brazil, were interviewed and clinically examined. Oral Impacts on Daily Performance (OIDP) was used to evaluate the impact of oral health status on daily performance. 73.6% of all subjects had at least one daily performance affected by an oral impact in the previous six months. The most commonly affected performance was eating (48.6%), while the most common symptoms were discomfort (40.6%) and dissatisfaction with one's appearance (31.5%). Missing teeth (21.7%) and toothache (20.7%) were recognized as the main causes of oral impacts on daily performance. OIDP was useful for measuring (physically, psychologically, and socially) the oral impacts on daily performance.

背景与目标： : 这项研究旨在调查巴西成年人口腔健康对日常表现的影响。来自巴西南部阿雷格里港公共工程和废物处理部门的276名35至44岁的公务员接受了采访和临床检查。口腔对日常表现的影响 (OIDP) 用于评估口腔健康状况对日常表现的影响。在过去的六个月中，所有受试者的73.6% 至少有一个每日表现受到口腔影响的影响。最常见的影响表现是进食 (48.6%)，而最常见的症状是不适 (40.6%) 和对自己的外表不满意 (31.5%)。牙齿缺失 (21.7%) 和牙痛 (20.7%) 被认为是口腔影响日常表现的主要原因。OIDP可用于测量 (身体，心理和社交) 口头对日常表现的影响。

BACKGROUND & AIMS: :The efficacy of cognitive behavioral treatments (CBT) for anxiety in adults has been supported by multiple meta-analyses. However, most have focused on only 1 diagnosis, thereby disallowing diagnostic comparisons. This study examined the efficacy of CBT across the anxiety disorders. One hundred eight trials of CBT for an anxiety disorder met study criteria. Cognitive therapy and exposure therapy alone, in combination, or combined with relaxation training, were efficacious across the anxiety disorders, with no differential efficacy for any treatment components for any specific diagnoses. However, when comparing across diagnoses, outcomes for generalized anxiety disorder and posttraumatic stress disorder were superior to those for social anxiety disorder, but no other differences emerged. CBT effects were superior to those for no-treatment and expectancy control treatments, although tentative evidence suggested equal effects of CBT when compared with relaxation-only treatments.

背景与目标： : 认知行为治疗 (CBT) 对成年人焦虑的功效已得到多项荟萃分析的支持。然而，大多数只关注1个诊断，因此不允许进行诊断比较。这项研究检查了CBT在焦虑症中的功效。针对焦虑症的CBT试验达到了研究标准。单独使用认知疗法和暴露疗法，或与放松训练相结合，在焦虑症中是有效的，对于任何特定诊断的任何治疗成分都没有不同的功效。然而，当比较各种诊断时，广泛焦虑症和创伤后应激障碍的结果优于社交焦虑症，但没有其他差异。CBT效果优于无治疗和预期对照治疗，尽管初步证据表明CBT与仅松弛治疗相比具有相同的效果。

BACKGROUND & AIMS: Importance:Individuals with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for academic problems. Pharmacologic treatment is effective in reducing the core symptoms of ADHD, but it is unclear whether it helps to improve academic outcomes. Objective:To investigate the association between the use of ADHD medication and performance on higher education entrance tests in individuals with ADHD. Design, Setting, and Participants:This cohort study observed 61 640 individuals with a diagnosis of ADHD from January 1, 2006, to December 31, 2013. Records of their pharmacologic treatment were extracted from Swedish national registers along with data from the Swedish Scholastic Aptitude Test. Using a within-patient design, test scores when patients were taking medication for ADHD were compared with scores when they were not taking such medication. Data analysis was performed from November 24, 2015, to November 4, 2016. Exposures:Periods with and without ADHD medication use. Main Outcomes and Measures:Scores from the higher education entrance examination (score range, 1-200 points). Results:Among 930 individuals (493 males and 437 females; mean [SD] age, 22.2 [3.2] years) who had taken multiple entrance tests (n = 2524) and used ADHD medications intermittently, the test scores were a mean of 4.80 points higher (95% CI, 2.26-7.34; P < .001) during periods they were taking medication vs nonmedicated periods, after adjusting for age and practice effects. Similar associations between ADHD medication use and test scores were detected in sensitivity analyses. Conclusions and Relevance:Individuals with ADHD had higher scores on the higher education entrance tests during periods they were taking ADHD medication vs nonmedicated periods. These findings suggest that ADHD medications may help ameliorate educationally relevant outcomes in individuals with ADHD.

背景与目标：

BACKGROUND & AIMS: :Glutamate (GLU) and gamma-amino butyric acid (GABA) are essential amino acids (AA) for brain function serving as excitatory and inhibitory neurotransmitter respectively. Their tablets are available in market for improving gut function and muscle performance. Despite of having a major role during memory formation and processing, effects of these tablets on brain functioning like learning and memory have not been investigated. Therefore, present study is aimed to investigate the effects of orally supplemented GLU and GABA on learning and memory performance and further to monitor related effects of these orally supplemented GLU and GABA on brain levels of these AA. Three groups of rats were supplemented orally with drinking water (control group) or suspension of tablets of GABA and Glutamate, respectively for four weeks. Cognitive performance was determined using behavioral tests (Novel object recognition test, Morris water maze, Passive avoidance test) measuring recognition, spatial reference and aversive memory. Levels of GLU, GABA and acetylcholine (ACh) were estimated in rat hippocampus. Results showed that chronic oral administration of GLU and GABA tablets has a significant impact on brain function and can alter GLU and GABA content in rat hippocampus. Compared to GABA, GLU supplementation specifically enhances memory performance via increasing ACh. Thus, GLU can be suggested as a useful supplement for improving learning and memory performance and neurochemical status of brain and in future could be effective in the treatment of neurological disorders affecting learning and memory performance.

背景与目标： 谷氨酸 (GLU) 和 γ-氨基丁酸 (GABA) 是脑功能必需氨基酸 (AA)，分别作为兴奋性和抑制性神经递质。他们的片剂可用于改善肠道功能和肌肉性能。尽管在记忆形成和处理过程中起着重要作用，但尚未研究这些片剂对大脑功能 (如学习和记忆) 的影响。因此，本研究旨在研究口服补充的GLU和GABA对学习和记忆性能的影响，并进一步监测这些口服补充的GLU和GABA对这些AA的大脑水平的相关影响。三组大鼠分别口服补充饮用水 (对照组) 或GABA和谷氨酸混悬剂，持续4周。使用行为测试 (新颖物体识别测试，莫里斯水迷宫，被动回避测试) 来确定认知能力，以测量识别，空间参考和厌恶记忆。估计大鼠海马中GLU，GABA和乙酰胆碱 (ACh) 的水平。结果表明，长期口服GLU和GABA片对大鼠脑功能有明显影响，可改变大鼠海马GLU和GABA的含量。与GABA相比，补充GLU通过增加ACh来特别增强记忆性能。因此，GLU可以被建议作为改善学习和记忆性能以及大脑神经化学状态的有用补充，并且将来可以有效地治疗影响学习和记忆性能的神经系统疾病。