成人和婴儿麻疹临床特点和治疗

麻疹是一种急性呼吸道传染病,常见于6月～5岁儿童。近年来婴儿和成人麻疹患者在总患者数中所占比率表现出上升的趋势,容易造成误诊、漏诊。作为临床工作者,我们认为临床医生应充分认识到麻疹发病人群及年龄的改变,在临床工作中减少误诊,并为患者提供及时有效的治疗,对高危人群的有计划干预对于减低成人麻疹发病率有着重要作用。本文针对婴儿和成人麻疹的诊断和治疗进行了综述,试图提供参考。     

The efficacy of progressive relaxation in systematic desensitization and a proposal for an alternative competitive response--the relaxation response.

The theoretical basis of systematic desensitization is reciprocal inhibition in which an alternative, competitive response to anxiety is conditioned to arousal-producing, phobic stimuli. Abbreviated training in progressive relaxation is believed to serve as a competitive response to anxiety by decreasing autonomic nervous system activity. However, physiologic studies of progressive relaxation have not substantiated that its practice is associated with such decreased autonomic activity. Consequently, the use of progressive relaxation has been a confounding factor in the determination of the function of reciprocal inhibition in systematic desensitization. To confirm and refine the theoretical constructs of reciprocal inhibition, it is necessary to test the effects of a response which is competitive to the anxiety response. Such a response may be the relaxation response which is characterized by physiologic changes consistent with decreased autonomic nervous system activity. Derived from meditational practices, techniques which ehcit the relaxation response incorporate the element of focused attention which has been implicated as a critical factor in systematic desensitization. Thus, the use of the relaxation response should be a more appropriate method than progressive relaxation if the therapeutic usefulness of systematic desensitization is indeed due to reciprocal inhibition.     

Lost forever or temporarily misplaced? The long debate about the nature of memory impairment

Studies of memory impairment in humans and experimental animals have been fundamental to learning about the organization of memory and its cellular and molecular substrates. When memory impairment occurs, especially after perturbations of the nervous system, the question inevitably arises whether the impairment reflects impaired information storage or impaired accessibility. This topic has been the subject of considerable commentary and experimental work over the years. In this reappraisal, I first consider four broad areas of behavioral study from the 1970s and 1980s that led to a dominant and compelling view of memory impairment as a deficit of information storage. Second, I identify some ambiguities that arise about how the terms "storage" and "retrieval" are applied, especially when the evidence is somewhat indirect and based on a behavioral-psychological level of analysis. I then review neurobiological findings that have been largely overlooked in these discussions. The relevant studies are ones where it has been possible to monitor neurons and synapses in direct relation to behavioral memory, for example, in animals with simple nervous systems and in single cell recordings from behaving monkeys. This work provides a straightforward and illuminating perspective on the question and confirms the view that first emerged from less direct evidence.     

Central Nervous System Opportunistic Infections in HIV-1 Infection

Neurologic disease is commonly encountered in the population infected with human immunodeficiency virus type 1 (HIV-1). Although HIV-1 is responsible for many of these neurologic complications, other organisms will affect the nervous system as the immune deficiency state progresses. With the wide use of potent antiretroviral therapy, the mortality from and incidence of opportunistic infections (OIs) among persons with advanced HIV-1 infection has decreased. Nevertheless, these diseases are still seen frequently, especially among those with limited access to new antiretroviral therapies. Therefore, it remains important to recognize the most common OIs of the central nervous system (CNS) as well as primary CNS lymphoma, which will be the focus of this review.     

Both odor identification and ApoE-ε4 contribute to normative cognitive aging

Research indicates that apoliprotein E (ApoE) plays a role in the development of Alzheimer's disease (AD) and possibly in the cognitive decline associated with normative aging. More recently, researchers have shown that ApoE is expressed in olfactory brain structures, and a relationship among ApoE, AD, and olfactory function has been proposed. In the current analyses, we investigated the contribution of ApoE and odor identification in decline trajectories associated with normative cognitive aging in various domains, using longitudinal data on cognitive performance available from the Swedish Adoption/Twin Study of Aging. Data on both ApoE status and olfactory functioning were available from 455 individuals ranging in age from 50 to 88 years at the first measurement occasion. Odor identification was measured via a mailed survey. Cognitive performance was assessed in up to 5 waves of in-person testing covering a period of 16 years. Latent growth curve analyses incorporating odor identification and ApoE status indicated a main effect of odor identification on the performance level in three cognitive domains: verbal, memory, and speed. A main effect of ApoE on rates of decline after age 65 was found for verbal, spatial, and speed factors. The consistency of results across cognitive domains provides support for theories that posit central nervous system-wide origins of the olfaction-cognition-ApoE relationship; however, olfactory errors and APOE ε4 show unique and differential effects on cognitive trajectory features.     

Biological markers of cognition in prodromal Huntington's disease: a review

Huntington’s disease (HD), an autosomal-dominant genetic disorder, has historically been viewed as a degenerative movement disorder but it also includes psychiatric symptoms and progressive cognitive decline. There has been a lack of consensus in the literature about whether or not cognitive signs can be detected in carriers before clinical (motor) onset of the disease, i.e., prodromal HD. However, recently validated mathematical formulas to estimate age of clinical onset, refined over the past 5–7 years, have allowed researchers to overcome the methodological limitation of treating all prodromal carriers as a homogenous high-risk group (i.e., whether they may be 2 or 15 years from diagnosis). Here we review 23 articles on the HD prodrome, all of which related cognition to a biological marker of disease burden (i.e., genetic load, neuroimaging). All studies found at least one cognitive domain was associated with disease burden in prodromal HD participants. There was greater variability in both the detection and cognitive domain affected in those farther from onset (or those with less pathology) while most studies reliably found declines in visuomotor performance and working memory in those closer to onset. These findings indicate that cognitive signs can be reliably detected in the HD prodrome when comparing cognition to additional disease markers, however, there continues to be significant variability on cognitive findings among large and methodologically rigorous studies. This may reflect true heterogeneity in the prodromal HD phenotype which must be further explored by analyzing intra-individual variance, determining demographic risk factors associated with decline/protection, and examining if particular HD families exhibit distinct cognitive profiles. These and additional future directions are discussed.     

Alcoholism, aging, and functional cerebral asymmetries

Reviews research concerning the possible relationship between cognitive decline and abnormal hemispheric asymmetries in alcoholic and aging individuals. Because the deteriorative effects of alcoholism on the central nervous system have suggested greater visuospatial than language-related functional impairments, numerous investigators had hypothesized that right-hemisphere integrity may be selectively disrupted (rather than the left hemisphere). Furthermore, performance on diverse perceptual and cognitive tests used to measure right-hemisphere functions in alcoholics had been observed to decline with normal chronological aging as well, thereby raising the possibility that certain neuropsychological deficits associated with alcoholism (presumably related to right-hemispheric decline) are identical to those associated with aging. However, an extensive review of empirical research findings on cerebral asymmetries both in alcoholics and in aging individuals suggested that their patterns of functional laterality are similar to those of normal controls.     

Neuroscience and learning: lessons from studying the involvement of a region of cerebellar cortex in eyeblink classical conditioning

How the nervous system encodes learning and memory processes has interested researchers for 100 years. Over this span of time, a number of basic neuroscience methods has been developed to explore the relationship between learning and the brain, including brain lesion, stimulation, pharmacology, anatomy, imaging, and recording techniques. In this paper, we summarize how different research approaches can be employed to generate converging data that speak to how structures and systems in the brain are involved in simple associative learning. To accomplish this, we review data regarding the involvement of a particular region of cerebellar cortex (Larsell's lobule HVI) in the widely used paradigm of classical eyeblink conditioning. We also present new data on the role of lobule HVI in eyeblink conditioning generated by combining temporary brain inactivation and single-cell recording methods, an approach that looks promising for further advancing our understanding of relationships between brain and behavior.     

Has the cataphasic form of schizophrenia increased in modern times?

According to our investigations the incidence of cataphasia, which is a subtype of schizophrenia, has become more common in the last years and on average, has started earlier in life. As the central disorder of this illness concerns thinking perhaps there exists a relation of our finding to the rapid modern development of techniques, insofar as the cognitive function is overstrained in childhood and adolescence, when the nervous system has not matured yet. Introverted individuals seem to be at a particular risk. However, it must not be disregarded that cataphasia is an inherited illness which cannot be caused by external influences, but can only be promoted in its manifestation.     

Reflexology,schizokinesis and autokinesis

A resume of the history and concepts culminating in the work of Pavlov shows that there has been a gradual and slow elaboration toward a science of behavior. The past work has been oriented since the time of Locke increasingly toward the external environment. Pavlov’s theories, however, were directed toward forceswithin the nervous system. Further work from the Pavlovian Laboratories at Johns Hopkins and the V.A. (and elsewhere) indicate that the various physiological systems do not always work harmoniously, but that there is often a split in function (Schizokinesis)—changes occurring over a period of time—which do not seem to be referable to the external environment but to elaborations occurringwithin the organism (Autokinesis). These may tend toward improvement of function or, on the other hand, toward deterioration. The time has come when the progressive changes and the interrelationships of active fociwithin the organism should be considered as well as the reactivity of the individual toward the external environment.     

An historical commentary on the physiological effects of music: Tomatis, Mozart and neuropsychology.

This article provides an overview of the theoretical underpinnings of the Tomatis Method, along with a commentary on other forms of sound/music training and the need for research. A public debate was sparked over the "Mozart Effect." This debate has turned out to be unfortunate because the real story is being missed. The real story starts with Alfred Tomatis, M.D., scientist and innovator. Dr. Tomatis was the first to develop a technique using modified music to stimulate the rich interconnections between the ear and the nervous system to integrate aspects of human development and behavior. The originating theories behind the Tomatis Method are reviewed to describe the ear's clear connection to the brain and the nervous system. The "neuropsychology of sound training" describes how and what the Tomatis Method effects. Since Dr. Tomatis opened this field in the mid 20th century, no fewer than a dozen offshoot and related systems of training have been developed. Though each new system of treatment makes claims of effectiveness, no research exists to substantiate their claims. Rather, each simplified system bases its "right to exist and advertise" on the claimed relationship to Tomatis and his complex Method. Research is desperately needed in this area. The 50 years of clinical experience and anecdotal evidence amassed by Tomatis show that sound stimulation can provide a valuable remediation and developmental training tool for people of all ages. Offshoot systems have watered down the Tomatis Method without research to guide the decisions of simplifying the techniques and equipment.     

Postponed Suicide Death? Suicides around Birthdays and Major Public Holidays

The relationship between suicide and birthdays, and suicide and public holidays has been studied from data on 32,291 Danish suicides by persons ages 15 years and older in the 25-year period 1970-1994. Evidence was found to support the theory of the "broken-promise effect" for major public holidays in that there appears to be a postponement of a significant number of suicides from before a holiday until after. The division of holidays into nonworking and (half-time) working days showed that a "holiday effect" could only be found around major public holidays, particularly Christmas, Easter, and Whitsun. The postponing or transpositioning effect is relevant to prevention, especially because of the availability and accessibility of help at the end of and after major public (nonworking) holidays.     

HIV Infection and the Central Nervous System: A Primer

The purpose of this brief review is to prepare readers who may be unfamiliar with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and the rapidly accumulating changes in the epidemic by providing an introduction to HIV disease and its treatment. The general concepts presented here will facilitate understanding of the papers in this issue on HIV-associated neurocognitive disorders (HAND). Toward that end, we briefly review the biology of HIV and how it causes disease in its human host, its epidemiology, and how antiretroviral treatments are targeted to interfere with the molecular biology that allows the virus to reproduce. Finally, we describe what is known about how HIV injures the nervous system, leading to HAND, and discuss potential strategies for preventing or treating the effects of HIV on the nervous system.     

What Should A “Gibsonian Neuroscience” Look Like? Introduction to the Special Issue

Abstract

Ecological psychology has been criticized for ignoring the brain in its theory formation. In recent years, however, a number of researchers have started asking ecologically-inspired questions about the ways in which not only the embodied activity of the organism in its environment, but also the particulars of the organism's nervous system matter. This work has typically appeared in neuroscience journals, thereby potentially escaping the attention of ecological psychologists. The current article introduces a Special Issue of Ecological Psychology that aims to correct this problem. This issue brings together one empirical and six theoretical articles that develop ideas about the contributions of the nervous system to perception-action. We briefly review each of the articles, identify common themes, and point out the surprising variety in theoretical positions. It is hoped that this Special Issue will help guide discussions amongst ecological psychologists and (ecological) neuroscientists as they confront the question “What should a ‘Gibsonian neuroscience’ look like?”     

Chance, choice, and the future of reproduction

The evolution of reproduction has been characterized by the development of complex biological and behavioral mechanisms that serve to regulate chance events. Human reproduction has been characterized by the increasing importance of individual choice. Some contemporary manifestations of this broad trend are the high incidence of contraceptive and "proceptive" behavior among couples in Western, industrialized nations. The former behavior willingly attempts to prevent conception while the latter actively attempts to induce conception (such as concentrating intercourse around the time of ovulation). Both patterns of behavior indicate that a choice is being made. A 3-year study of 1000 women revealed proceptive behavior as the most important factor predicting occurance of conception among married couples in the United States. The general strategeis people follow while making childbearing decisions: termination, sequencing, and pre-planning form a continuum following the historical trend toward greater reproductive control. In the terminating strategy, a couple makes no decision about child bearing until the number of children they have become enough or too much. In the sequencing strategy, decisions to have children are made 1 child at a time until a satisfactory limit is reached. In the pre-planning strategy, a plan is worked out ahead of time and is subsequently carried out. As new reproductive technology is introduced and as progressive change is made in society's reproductive related values and beliefs, choice will continue to dominate chance as the highly likely trend for the future of reproduction. Surrogate maternity is just 1 example of this trend. However, these new options, which culminate in the theory and practice of "progensis," (still in its infancy), as well as offering a rich opportunity, can also incur psychological burdens on a couple. Thus, as with any kind of freedom, these developments will require care, caution and responsibility.     

Physically Transcendent Awareness: A Comparison of the Phenomenology of Consciousness Before Birth and After Death

Veridical evidence of a physically transcendent source of consciousness comes from both extremes of the life span when central nervous system functioning is compromised, suggesting that some form of personhood can exist independently of known cellular processes associated with the body. In pre- and perinatal accounts, veridical memories have surfaced of events in the first two trimesters, long before the central nervous system is fully functional, continuing through the third trimester, when measurable brain activity begins, until just after birth. In the empirically verifiable out-of-body phase of near-death experience (NDE) accounts, a source of consciousness has been shown to record events when measurable metabolic processes, including brain activity, have ceased altogether. These two states have similar phenomenologies, suggesting that a physically transcendent source representing individual consciousness predates physical life at the moment of conception and survives it after death, and that its maturity and functioning do not directly reflect the level of central nervous system functioning in the body.     

Providing a sensory basis for models of visual information acquisition

Our major goal is to account for some simple digit-recall data with a theory that integrates two models from two scientific traditions. Therandom-sampling model, founded in the memory and attention literature, holds that (1) stimulus features are randomly sampled throughout the course of stimulus presence and (2) proportion correct recall is equal to the ratio of sampled features to total features.The linear-filter model, founded in the vision and sensation literature, holds that the initial stages of the visual system act as a low-pass temporal filter on the input stimulus, resulting in a time-varyingsensory response in the nervous system. We report two experiments in which a variable-duration, masked, four-digit string had to be immediately recalled. Experiment 1 was designed principally to replicate past data confirming the basic random-sampling model. Like others, we were able to confirm the model only by endowing it with an additionalprocessing-delay assumption: that feature sampling does not begin until the stimulus has been physically present for some minimal duration. Experiment 2 was an extension of Experiment 1 in which the target stimulus was preceded, 250 msec prior to its onset, by a 50-msec pre-presentation ofthe same stimulus called aprime. The Experiment 2 results allowed the following conclusions. First, the initial processing delay found in Experiment 1 is immutably tied to stimulus onset; that is, if there are two stimulus onsets, separated even briefly in time, there are two associated processing delays. Second, processing rate is essentially unaffected by the prime’s presentation. Third, being presented with a 50-msec prime is equivalent, in terms of memory performance, to increasing unprimed stimulus duration by approximately 30 msec; the prime can thus said to beworth 30 msec of additional exposure duration. This third conclusion seems superficially paradoxical, in the sense that one would expect that having seen a 50-msec prime would be equivalent to increasing exposure duration byat least the same 50 msec. However, both the initial processing delays and the 30-msec prime’s worth are natural consequences of our theory that conjoins the random-sampling model with the linear-filter model.     

Assessment of infant oral sensorimotor and swallowing function

The development of feeding and swallowing is the result of a complex interface between the developing nervous system, various physiological systems, and the environment. The purpose of this article is to review the neurobiology, development, and assessment of feeding and swallowing during early infancy. In recent years, there have been exciting advances in our understanding of the physiology and neurological control of feeding and swallowing. These advances may prove useful in furthering our understanding of the pathophysiology of dysphagia in infancy. Progress in developing standardized, reliable, and valid measures of oral sensorimotor and swallowing function in infancy has been slow. However, there have been significant advances in the instrumental analysis of feeding and swallowing disorders in infancy, including manometric analyses of sucking and swallowing, measures of respiration during feeding, videofluoroscopic swallow evaluations, ultrasonography, and flexible endoscopic examination of swallowing. Further efforts are needed to develop clinical evaluative measures of dysphagia in infancy.     

人乳头瘤病毒在食管癌发病中作用机制研究进展

食管癌的发生涉及到多种因素多个步骤的病理过程,是多种因素相互作用导致正常细胞恶变的结果。人乳头瘤病毒（HPV）在食管癌变过程中起重要作用。现从流行病学、分子生物学、肿瘤学等方面对HPV在食管癌变过程中的作用机制作一综述。