执行功能与儿童流行性肥胖的关系

流行性肥胖被认为是由于能量摄入和能量消耗间长期的不平衡导致的一种反常的、脂肪堆积过多的状态, 近期研究发现执行功能与儿童流行性肥胖关系密切。与正常体重儿童相比, 肥胖儿童执行功能差主要体现在抑制控制上, 他们难以抑制对食物线索的注意, 并且更容易对其做出冲动反应, 表明他们干扰抑制中的注意抑制以及反应抑制存在不足。脑机制研究发现, 前额皮质(PFC)与肥胖关系密切, 肥胖被试对食物线索表现出较低的眼窝前额皮质(OFC)激活水平与较高的背外侧前额皮质(DLPFC)激活水平; 奖励回路也与肥胖密切相关, 肥胖或许是由PFC与奖励回路间复杂的相互作用引起的。执行功能与流行性肥胖之间可能是双向作用关系, 执行功能差可能是个体BMI增加的潜在因素, 而肥胖个体的体重减少在一定程度上则有助于其执行功能改善。少量对儿童肥胖的干预研究表明执行功能训练或许在减肥效果保持上有一定优势, 未来研究应当关注对执行功能, 尤其是抑制控制进行有效训练的方法, 并将其与其他干预方式结合, 更好地解决儿童流行性肥胖问题。     

Adult Chronic Kidney Disease: Neurocognition in Chronic Renal Failure

In recent years there has been a keen interest in the neurocognitive sequelae of renal failure and subsequent end-stage renal disease given its increasing prevalence and incidence. This review article summarizes the relevant information on cognitive functioning in chronic kidney disease in adults before the initiation of dialysis, after the initiation of dialysis, and after renal transplantation. In general, compared to pre-dialysis, there is an improvement in cognitive function after the institution of dialysis and further improvement after renal transplantation. Throughout the paper an attempt is made to highlight the importance of considering disease related variables in the neuropsychological assessment of individuals with chronic kidney disease. The paper concludes with a discussion of future avenues of research.     

慢性肾病、慢性肾功能衰竭全方位审视

慢性肾病（CKD）、慢性肾功能衰竭（CRF）是全身性疾病在肾脏的表现、特别与血管性免疫性和代谢性疾病相关。肾脏又是一个排泄器官,中西药的过度应用,尤其是具有毒性药物如雷公藤类、抗生素类累积性损伤肾脏。所以,根本性控制在于预防和少用药物。近年来因为应用了肾替代疗法、包括肾移植带来一些社会、经济、生活质量、移植肾来源等问题。本文以全新的理念提出质疑且对其共性治疗重新评估替代疗法,并重视个案分析对某些肾病的病名提出它的概念的非合理性,对其共性治疗的误导应予以反思。最后,建议逐步改变单纯生物医学模式的替代疗法,重视整体全方位地发挥自身潜在调节力量缓解或治愈或延长寿命,这样可以大大地减少CKD、CRF、ESRD的发病率。     

慢性肾病、慢性肾功能衰竭全方位审视

慢性肾痛(CKD)、慢性肾功能衰竭(CRF)是全身性疾病在肾脏的表现、特别与血管性免疫性和代谢性疾病相关.肾脏又是一个排泄器官,中西药的过度应用,尤其是具有毒性药物如雷公藤类、抗生素类累积性损伤肾脏.所以,根本性控制在于预防和少用药物.近年来因为应用了肾替代疗法、包括肾移植带来一些社会、经济、生活质量、移植肾来源等问题.本文以全新的理念提出质疑且对其共性治疗重新评估替代疗法,并重视个案分析对某些肾病的病名提出它的概念的非合理性,对其共性治疗的误导应予以反思.最后,建议逐步改变单纯生物医学模式的替代疗法,重视整体全方位地发挥自身潜在调节力量缓解或治愈或延长寿命,这样可以大大地减少CKD、CRF、ESRD的发病率.     

Self-Regulation and Other Executive Functions Relationship to Pediatric OCD Severity and Treatment Outcome

The intersection of obsessive-compulsive disorder (OCD) and executive functioning (EF) in children and adolescents is an emerging topic in the current literature. Spurred by the consistent association between increased EF deficits and higher adult obsessive-compulsive severity, a few initial studies have replicated this relationship in pediatric OCD samples and also have found preliminary evidence that EF deficits are associated with worse response to first-line psychotherapeutic or psychopharmacological treatments for pediatric OCD. This study aimed to extend the literature by providing the first comprehensive investigation of how multiple EF domains, measured repeatedly over the course of treatment, impact pediatric obsessive-compulsive severity and response to multimodal treatment. Multi-level modeling results found that deficits in shifting, inhibition, emotional control, planning/organizing, monitoring and initiating all predicted higher average obsessive compulsive severity across treatment. Interestingly, out of the eight domains of EF investigated, only emotional control moderated treatment outcome such that those with worse emotional control experienced less of a reduction in obsessive-compulsive severity during treatment. The findings generally align with previous theories for the link between EF and OCD and indicate that emotional control has important implications in the treatment of pediatric OCD. In fact, emotional control may provide one explanation for why factors such as disgust sensitivity, oppositional behavior, and third-wave behavioral treatment techniques have all been linked to pediatric OCD treatment outcome. Future research should investigate augmentation strategies that target emotional control in children and adolescents.     

Executive Functions in Dyslexia

This study focused on executive functions in dyslexia. A group of 43 heavily-affected young dyslexics, divided into two groups based on the results of a receptive language test, and 20 non-dyslexic controls, were tested with a Dichotic Listening Test, the Stroop Color Word Test and the Wisconsin Card Sorting Test. The dyslexic subjects demonstrated significant impairment on all tasks, but with different patterns of impairment according to the subgrouping. The subgroups were equally impaired on the Dichotic Listening Test, but differed on the Stroop and the Wisconsin Tests. The data support a hypothesis suggesting executive problems in dyslexia, depending on receptive language skills.     

慢性肾脏病治疗的临床决策

慢性肾脏病(CKD)的治疗以前主要集中在终末期肾病(ESRD),但ESRD仅仅是CKD患者群体中的一小部分,因此CKD患者应根据不同阶段采取不同的治疗:早期治疗强调预防为主,中期治疗在于延缓肾病进展,晚期治疗应选择一体化肾替代治疗.慢性肾脏病需肾科医师与患者及家属共同参与,以期达到最佳的治疗目标.     

慢性肾脏病患者心理状态研究进展

慢性肾脏病是一种很难治愈的一种疾病,绝大多数的患者需要中西医结合治疗。患有慢性肾脏病的患者最终需要肾脏替代疗法来缓解症状,如透析治疗或选择肾脏移植。巨大花费同疾病本身使患者身心均受到很大的压力,CKD患者抑郁、焦虑情况普遍存在,影响患者生存质量、营养状态和治疗配合性及疾病的预后,因此解决其心理问题至关重要。     

Executive Functions and Mental Attentional Capacity in Preschoolers

ABSTRACT

The structure of executive functions in preschoolers is controversial. Miyake and colleagues found that, in adults, inhibition, shifting, and updating are correlated but distinguishable processes; this finding was sometimes replicated with schoolchildren. Based on schoolchildren data, Im-Bolter, Johnson, and Pascual-Leone proposed a four-component model, with mental attentional capacity and inhibition as basic resources, and shifting and updating as executive processes that partly rely on those resources. Studies on preschoolers propose either a single factor or two factors. We tested 118 children (36 to 73 months old) using measures of mental attentional capacity (Mr. Cucumber, Direction Following Task, and Backward Word Span), inhibition (Bear/Dragon and Day-Night Stroop), shifting (Dimensional Change Card Sort) and updating (Magic House). Confirmatory factor analyzes showed that the best-fitting model comprises two highly correlated factors – one loading the mental attentional capacity measures, the other loading inhibition, shifting, and updating measures. Performance in inhibition, shifting, and updating tasks showed qualitative changes with increasing attentional capacity. In preschoolers, shifting and updating seem to emerge tied to inhibition – but only when sufficient capacity enables children to perform executive control tasks. This seems consistent with Im-Bolter’s et al.’s proposal of two basic resources.     

Involvement of Executive Functions in Children's Metamemory

This experiment examined how knowledge of memory strategies and of memory functioning improves during childhood and what variables are involved in this development. Three main aspects of metamemory were assessed based on the performance of a group of 100 children (aged 4, 6, 9 and 11 years) on a battery of executive tasks. At the same time, the influence of variables such as intelligence, vocabulary and parental education level was also investigated. Results of mediation analyses reveal that the relation between children's age and internal strategy knowledge was partially mediated by working memory skills but that executive functions did not mediate the impact of chronological age on children's knowledge of external strategies or of memory functioning. Additionally, verbal fluency predicted internal and external strategy knowledge. Implications for general learning theories in childhood are discussed.Copyright © 2015 John Wiley & Sons, Ltd.     

Working Memory Capacity as Executive Attention

Performance on measures of working memory (WM) capacity predicts performance on a wide range of real-world cognitive tasks. I review the idea that WM capacity (a) is separable from short-term memory, (b) is an important component of general fluid intelligence, and (c) represents a domain-free limitation in ability to control attention. Studies show that individual differences in WM capacity are reflected in performance on antisaccade, Stroop, and dichotic-listening tasks. WM capacity, or executive attention, is most important under conditions in which interference leads to retrieval of response tendencies that conflict with the current task.     

Wellness and Religious Coping Among Thai Individuals Living with Chronic Kidney Disease in Southern California

This qualitative research is based on eight Thai participants living with chronic kidney disease living in Southern California. Four emerging themes are (a) wellness, (b) self-care, (c) impact of illness on life, and (d) religious coping. Family relations, social support, and religious coping affected self-care and how they managed their everyday activities. Knowledge about the disease and its mechanism were crucial to the decision-making process in relation to self-care. Good self-care and appropriate self-management led to wellness and improved quality of life. Religion provided a belief system focusing on the place of acceptance that was essential for coping with emotional stressors.     

Motivational Interviewing Promotes Adherence and Improves Wellbeing in Pre-Dialysis Patients with Advanced Chronic Kidney Disease

Low rates of adherence to medical treatments and adverse emotional states are a widespread problem in advanced chronic kidney disease (ACKD). Motivational interviewing using the stages of change model is an effective combination in promoting behavior modifications. The objective of the present study was to determine the effectiveness of an individual, pre-dialysis intervention program (monthly sessions of 90 min over a 6-month period) in terms of adherence, emotional state and health-related quality of life (HRQL). Forty-two patients were evaluated for adherence, depression, anxiety and HRQL with standardized self-report questionnaires. Biochemical markers were also registered. The results show that after the intervention, patients reported significantly higher levels of adherence, lower depression and anxiety levels, and better HRQL (i.e., general health and emotional role domains). Biochemical parameters were controlled significantly better after the intervention, except for iPTH. These findings highlight the potential benefit of applying individual psycho-educational intervention programs based on motivational interviewing and using the stages of change model to promote adherence and wellbeing in ACKD patients.     

Theory of Mind and Executive Functions in Young Bilingual Children

Few studies have explored the relationship between theory of mind (ToM), executive function (EF), and bilingualism at the same time. In this study 14 young bilingual children were compared with monolingual children on a test battery composed of 5 ToM tests, 5 EF tests, and 1 test of general language ability. The result showed that despite significantly lower verbal ability, the bilingual children outperformed the monolingual ones on tests of EF. There were no differences in ToM performance. The authors argue that there is a strong relationship between bilingualism and EF, but, contrary to results from earlier studies, they could not find any relationship between bilingualism and ToM. EF did not predict ToM performance. Lack of a significant relationship could be due to the children's young age and consequently their low scores on the ToM tasks.     

Random Generation and the Executive Control of Working Memory

A series of experiments explores the capacity for generating sequences of random responses, relating it to the central executive component of working memory. Experiment 1 shows a broadly similar pattern of redundancy increasing with speed of generation for both the verbal generation of digits and the manual pressing of keys. In both cases deviations from randomness are shown to reflect the increasing use of a limited number of stereotyped response sets. The remaining experiments use keyboard generation. Experiment 2 demonstrates that concurrent immediate serial recall decreases randomness, and that longer recall sequences produce less random output. Experiments 3 and 4 show that whereas simple counting has no effect on randomness, serial recall, semantic category generation, and concurrent digit generation have substantial effects, and a concurrent fluid intelligence test has the greatest influence on the randomness of key pressing. It is suggested that the task of random generation resembles that of category fluency because it requires the subject to switch retrieval plans and inhibit repetition. On this basis it is predicted that a task involving repeated switching of categories will interfere with generation, despite being predictable and having a low memory load. Experiments 5 and 6 confirm this prediction. Strengths and limitations of the switching hypothesis are discussed, as are the implications of our results for the analysis of executive processes.     

Musical Memory in Alzheimer Disease

ABSTRACT

This study examines musical memory in 12 patients with moderate or severe AD and 12 healthy, older adult controls. Participants were asked to distinguish familiar from novel tunes, to identify distortions in melodies, and to sing familiar tunes. Comparison of the AD and control groups showed significant impairment of the AD participants. However, a more complex picture emerged as we compared each individual case to the control group. Five of the AD group performed within the control group range on most tasks. An additional four participants showed partial sparing in that they performed below the range of control participants, but their scores were above the level of chance. The final three participants showed near complete loss of musical memory, as their performance was consistently at or near the level of chance. These results are discussed in terms of the literature on the heterogeneity of cognitive presentation in AD.     

Functions of External Cues in Prospective Memory

Abstract

A simulation of an air traffic control task was the setting for an investigation of the functions of external cues in prospective memory. External cues can support the triggering of an action or memory for the content of the action. We focused on memory for the content, and manipulated the temporal characteristics of the external cue to disentangle two possible functions the cue can support: (1) an external cue visible during a retention interval could support rehearsal of the to-be-performed action; (2) an external cue visible at the end of a retention interval could support retrieval of the to-be-performed action. Two experiments were conducted that converge on the same conclusion: the primary function of an external cue is to support retrieval. Implications for the design of a computer interface to present prospective cues are discussed.     

Attention Problems and Executive Functions in Children With Spina Bifida and Hydrocephalus

This study addressed the incidence of Attention-Deficit/Hyperactivity Disorder (ADHD) subtypes in children with spina bifida meningomyelocele and shunted hydrocephalus (SBH) as well as differences in executive functions among these subtypes. Parent rating scales revealed that 31% of the group with SBH could be identified with AD/HD, mostly the Inattentive type (23%). The group with SBH differed from normal controls on cognitive measures of executive functions, but subtype differences were not significant. Multivariate tests showed that children with SBH were rated with greater difficulties on the Behavior Rating Inventory of Executive Function (BRIEF) compared to controls; those with SBH and any subtype of ADHD differed from those with SBH and no ADHD; and those with ADHD (Combined Type) differed significantly from those with ADHD (Predominantly Inattentive Type). Subtype differences on univariate tests in the latter comparison were significant on the BRIEF Inhibit scale, showing more disinhibition in those with SBH and ADHD (Combined Type), but no significant differences were apparent on the BRIEF Sustain, Shift, and Initiate scales. The results show that the incidence of ADHD in children with SBH exceeds the population rate, is represented by problems with inattention rather than with impulsivity and hyperactivity; and that as with non-brain injured individuals, subtype differences in cognitive function remain to more clearly delineated.     

α-骨化醇对CKD4-5期未透析患者蛋白尿的影响

为了观察α-骨化醇对CKD4-5期未透析患者蛋白尿的影响,对2010年5月～2012年5月在我院就诊的87例CKD4-5期未透析、未肾移植患者进行研究,将其服用α-骨化醇组(S-Alf)和未服用α-骨化醇组(N-Alf),回顾分析α-骨化醇对24小时尿蛋白的影响.结果显示:与治疗前相比,接受α-骨化醇治疗6月后,患者24小时尿蛋白定量减少了13％(P＜0.05),全段甲状旁腺激素(iPTH)下降了11％ (P＜0.05).因此,α-骨化醇能够减少CKD4-5期未透析患者蛋白尿,发挥保护肾脏的作用.