Neuropsychological Functioning in Chronic Lyme Disease

Lyme disease is currently the most common vector-borne illness in the United States. The disease is multisystemic, and chronic disease, in particular, may be associated with neuropsychological deficits. However, to date, only a few empirical studies exist, which examine the neuropsychological sequelae associated with chronic Lyme disease. A review of the literature shows that the deficits observed in adults with chronic Lyme disease are generally consistent with the deficits that can be seen in processes with primarily frontal systems involvement. These observations are generally consistent with neuroradiologic findings. The clinical presentation in chronic Lyme disease and the nature of the neuropsychological deficits are discussed, as are several central issues in understanding neuropsychological functioning in chronic Lyme disease, such as the impact of chronic illness, response to treatment, and the relationship between neuropsychological performance and depression, fatigue, and neurological indicators of disease.     

The Infectious Diseases Society of America Lyme guidelines: a cautionary tale about the development of clinical practice guidelines

Flawed clinical practice guidelines may compromise patient care. Commercial conflicts of interest on panels that write treatment guidelines are particularly problematic, because panelists may have conflicting agendas that influence guideline recommendations. Historically, there has been no legal remedy for conflicts of interest on guidelines panels. However, in May 2008, the Attorney General of Connecticut concluded a ground-breaking antitrust investigation into the development of Lyme disease treatment guidelines by one of the largest medical societies in the United States, the Infectious Diseases Society of America (IDSA). Although the investigation found significant flaws in the IDSA guidelines development process, the subsequent review of the guidelines mandated by the settlement was compromised by a lack of impartiality at various stages of the IDSA review process. This article will examine the interplay between the recent calls for guidelines reform, the ethical canons of medicine, and due process considerations under antitrust laws as they apply to the formulation of the IDSA Lyme disease treatment guidelines. The article will also discuss pitfalls in the implementation of the IDSA antitrust settlement that should be avoided in the future.     

Normative data for the selective reminding test: a random digit dialing sample

Healthy control participants (46 women, M age=44.3 yr., SD=7.6; 29 men) were recruited to undergo a comprehensive neuropsychological battery and serve as a comparison group in a study of cognitive functioning in patients with Lyme isease. Participants were selected using Mitofsky-Waksberg random digit dialing. The Buschke 12-word, six-trial Selective Reminding Test was administered as part of the neuropsychological battery and normative data are presented stratified by age and sex. Performance on alternate forms of this measure were examined. Mean education, intelligence quotient, and Wide Range Achievement Test-3 Reading scores are reported.     

Calling Science Pseudoscience: Fleck's Archaeologies of Fact and Latour's ‘Biography of an Investigation’ in AIDS Denialism and Homeopathy

Fleck's Genesis and Development of a Scientific Fact foregrounds claims traditionally excluded from reception, often regarded as opposed to fact, scientific claims that are increasingly seldom discussed in connection with philosophy of science save as examples of pseudoscience. I am especially concerned with scientists who question the epidemiological link between HIV and AIDS and who are thereby discounted—no matter their credentials, no matter the cogency of their arguments, no matter the sobriety of their statistics—but also with other classic examples of so-called pseudoscience including homeopathy and other sciences, such as cold fusion. The pseudoscience version of the demarcation problem turns out to include some of the details that Latour articulates multifariously under a variety of species or kinds in his essay/interactive research project/monograph, ‘Biography of an Investigation’. Given the economic constraints of the current day, especially in the academy, the growing trend in almost all disciplines is that of suppression by threat: say what everyone else says or you won't be hired (tenured/published/cited). In this way, non-citation of outlier views generates what Kuhn called normal science. Finally, a review of Lewontin's discussion of biology shows the continuing role of ideology by bringing in some of the complex issues associated with the resistant bacteria (tuberculosis, Lyme disease, syphilis) and AIDS.     

"Slow virus" infections and degenerative diseases of the central nervous system]

Slow virus infections of the central nervous system are produced by both conventional and unconventional viruses. Diseases of the central nervous system which are produced by unconventional viruses are discussed. They are kuru and the Creutzfeldt-Jacob disease. Mention is also made of the fact that these disease may be transmitted to animals which allows an infectious genesis to be assumed. The author also discusses the clinical symptomatology, the results of anatomical and pathological examinations, and the mechanism of transmission of the disease from one human being to another. Slow virus infection as a cause of other neurological diseases is also dealt with by the author in her present paper.     

外科手术在ⅢA期非小细胞肺癌治疗中的作用

ⅢA期非小细胞肺癌治疗方式存在争议,对于N1期患者,外科手术被广泛接受,对于N2期患者,国内外存在一定的分歧。对于N2期患者,外科手术治疗的效果主要取决于纵隔淋巴结转移情况,微灶转移和单站淋巴结转移患者,外科手术治疗效果比较满意,多站淋巴结转移患者外科手术治疗效果较差,而是需要做行根治性的放化疗。     

Fabry Disease Practice Guidelines: Recommendations of the National Society of Genetic Counselors

Identification and comprehensive care of individuals who have Fabry disease (FD) requires a multidisciplinary approach inclusive of genetic testing, test interpretation, genetic counseling, long term disease symptom monitoring, treatment recommendations, and coordination of therapy. The purpose of this document is to provide health care professionals with guidelines for testing, care coordination, identification of psychosocial issues, and to facilitate a better understanding of disease treatment expert recommendations for patients with Fabry disease. These recommendations are the opinions of a multicenter working group of genetic counselors, medical geneticists, and other health professionals with expertise in Fabry disease counseling, as well as representatives/founders of the two United States based Fabry disease patient advocacy groups who are themselves affected by Fabry disease. The recommendations are U.S. Preventive Task Force Class III, and they are based on clinical experience, a review of pertinent English-language articles, and reports of expert committees. This document reviews the genetics of Fabry disease, the indications for genetic testing, interpretation of results, psychosocial considerations, and references to professional and patient resources.     

Keeping the vermin out: Perceived disease threat and ideological orientations as predictors of exclusionary immigration attitudes

Integrating evolutionary and social representations theories, the current study examines the relationship between perceived disease threat and exclusionary immigration attitudes in the context of a potential avian influenza pandemic. This large‐scale disease provides a realistic context for investigating the link between disease threat and immigration attitudes. The main aim of this cross‐sectional study (N = 412) was to explore mechanisms through which perceived chronic and contextual disease threats operate on immigration attitudes. Structural equation models show that the relationship between chronic disease threat (germ aversion) and exclusionary immigration attitudes (assimilationist immigration criteria, health‐based immigration criteria and desire to reduce the proportion of foreigners) was mediated by ideological and normative beliefs (social dominance orientation, belief in a dangerous world), but not by contextual disease threat (appraisal of avian influenza pandemic threat). Contextual disease threat only predicted support for health‐based immigration criteria. The conditions under which real‐life disease threats influence intergroup attitudes are scrutinized. Convergence and dissimilarity of evolutionary and social representational approaches in accounting for the link between disease threat and immigration attitudes are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Cognitive functions and corticostriatal circuits: insights from Huntington's disease

The basic mechanisms of information processing by corticostriatal circuits are currently a matter of intense debate amongst cognitive scientists. Huntington's disease, an autosomal-dominant neurogenetic disorder characterized clinically by a triad of motor, cognitive, and affective disturbance, is associated with neuronal loss within corticostriatal circuits, and as such provides a valuable model for understanding the role of these circuits in normal behaviour, and their disruption in disease. We review findings from our studies of the breakdown of cognition in Huntington's disease, with a particular emphasis on executive functions and visual recognition memory. We show that Huntington's disease patients exhibit a neuropsychological profile that shows a discernible pattern of progression with advancing disease, and appears to result from a breakdown in the mechanisms of response selection. These findings are consistent with recent computational models that suggest that corticostriatal circuits compute the patterns of sensory input and response output which are of behavioural significance within a particular environmental context.     

红斑性肢痛症合并周围神经损害1例诊治分析

红斑性肢痛症是一种罕见的临床综合征,以肢端皮肤间歇性皮温升高、发红、肿胀及烧灼样痛为特点,病变主要累及四肢末端,尤以下肢多见,多呈对称分布,较少见于面部和耳部.其症状常因运动和遇热而加重,休息和遇冷而减轻.临床上常分为原发性和继发性两大类,其中原发性红斑性肢痛症,多认为与编码Nav1.7亚单位的SCN9A基因突变有关.目前该病发病机制尚不明确,治疗上缺乏确切有效的治疗方案,临床易误诊误治.本文报道了红斑性肢痛症合并周围神经损害1例,以期提高对该病的认识.     

Scepticism and public health: On the problem of disease for the collective

This paper argues that modern society does not meet the problems posed by the experience of disease in a satisfactory way. It attempts to show this by examining the distinction between disease and plague. Disease is formulated as necesssarily involving the self in unforeseeable ways with what is other to itself: the challenge of disease is treated as the challenge of this involvement. On the other hand, plague as an abstract threat is that towards which the collective shows principled indifference. The strength and the limits of this indifference are explored. Subsequent upon this, the paper examines the consequences of the loss of the distinction between disease and plague, particularly with respect to the implications of that loss for the treatment, management, and control of disease in modern society.     

“病中辨证”是证发展的必然

在疾病的发展过程中,一般存在着病和证的两种演变,相对于病而言,证有着更高层次的组织方式,有自身发展规律,反映的是机体整体状态。这种对证的诠释有利于中西医理论间的接轨,使证研究更容易被现代医学理论所接受,是中医进一步发展的要求,病证二者并不矛盾,而是互补,共同提供了对疾病的完整认识。     

古埃及疾病医治理念透析

疾病医治理念是古埃及文明的重要组成部分。古埃及人针对不同类别疾病有着相应的医治理念：药物、魔法与意志是内科疾病的医治理念;河渠原理是医治外科疾病的理念;对于治疗心理疾病主要是寻求神灵的拯救;预防疾病的理念是保持圣洁。挖掘、梳理这些医治理念,可以加强医学史的学科建设,对某些疾病的治疗有参考价值。     

Schizophrenia: Disease,Syndrome, or Dimensions?

Schizophrenia has the status of a clinical syndrome and may comprise a number of specific disease entities. This construct is similar to dementia, in which several diseases have been defined within the syndrome. Alternatively, schizophrenia may be a single disease entity with quite variable manifestations across cases. Kraepelin proposed dementia praecox as a disease entity, and Bleuler proposed dissociative pathology as fundamental to each case, thus substantiating the single disease entity concept. More recently, the nuclear schizophrenia construct defined the disease entity using specific criteria proposed by Schneider and Langfeldt. This view has been challenged by a series of studies during the past three decades. These investigations are summarized in this report. Implications for clinical work with families are considered.     

Lay Disease Representations and Responses to Victims of Disease

This research extends current understanding of lay disease representations by examining the cognitive organization of disease information and the categories used in thinking about disease. In addition, the implications of these categories for people's responses to disease victims are explored. In the first study, subjects were asked to rate 22 diseases on a series of 18 bipolar scales and then to indicate how willing they would be to interact with a person who had one of 12 diseases. The results indicated that the primary dimensions used to categorize diseases were the extent to which the diseases were perceived to be contagious and serious/life threatening. Further, subjects' responses to disease victims were a direct function of the extent to which the disease was perceived to be contagious. Little apparent distinction was made between different types of contagious diseases. A second study then examined people's understanding of the concept of contagious disease. The results indicated that subjects tended to have a relatively simple and straightforward understanding of contagion. Subjects perceived flu, cold, and chicken pox to be the most typical of their concept of contagious disease as a category. These results are discussed in terms of their implications for understanding disease representations as well as understanding the fear of persons with AIDS.     

下肢深静脉血栓形成的治疗进展

下肢深静脉血栓形成在欧美是一种比较常见的疾病,在我国随着临床医师意识的加强及诊疗水平的提高,其发病率也逐年上升。下肢深静脉血栓形成的危害是其并发症一肺栓塞和血栓形成后综合征,肺栓塞是临床上导致死亡的一个重要原因,而血栓形成后综合征严重影响患者的生活质量及工作能力,故其治疗成为一个热门话题。本文对下肢深静脉血栓形成的治疗...     

Review of Clinical Medicine and Religious Practice

The purpose was to evaluate faith-based studies within the medical literature to determine whether there are ways to help physicians understand how religion affects patients’ lives and diseases. We reviewed articles that assessed the influence of religious practices on medicine as a primary or secondary variable in clinical practice. This review evaluated 49 articles and found that religious faith is important to many patients, particularly those with serious disease, and patients depend on it as a positive coping mechanism. The findings of this review can suggest that patients frequently practice religion and interact with God about their disease state. This spiritual interaction may benefit the patient by providing comfort, increasing knowledge about their disease, greater treatment adherence, and quality of life. The results of prayer on specific disease states appear inconsistent with cardiovascular disease but stronger in other disease states.     

疾病的哲学思考——坦然和平静地对待疾病

面对人类无法改变与疾病共存的命运,本文从健康与疾病的关系、疾病的原因、疾病的话语、对待疾病的态度和利用疾病的契机五个方面来进行哲学追问和反思。以期使我们通过倾听身体的语言,来坦然、自然和平静地对待疾病;利用疾病的契机,获得身心的成长,使人类的生命在亘古的绵延中永远充盈着盎然的生机。     

Quality of Life,Anxiety and Depression in Soft Tissue Sarcomas as Compared to More Common Tumours: An Observational Study

The aim of this study is to compare the quality of life and the levels of anxiety and depression in a relatively large group of subjects undergoing chemotherapy for soft tissue sarcoma and a control group of subjects undergoing chemotherapy for the most common types of cancer. 56 soft tissue sarcoma affected patients and 56 patients with common tumours, homogeneous in regards to stages of disease and sociodemographic characteristics, were enrolled in two oncological centres in Turin, Italy. Quality of life was assessed by Functional Assessment of Cancer Therapy-General and anxiety and depression by Hospital Anxiety and Depression Scale. All patients had ongoing chemotherapy. The comparison between the two groups shows no difference in either quality of life or in anxiety and depression. There are instead gender differences, since females in the group of common tumours show higher levels of anxiety in comparison to those affected by sarcomas, while males show, at a lower degree, the opposite trend. This study suggest that levels of Quality of Life, anxiety and depression are similar in rare and common tumours. The majority of patients are able to cope with the disease in an adaptive manner. However, for some patients the disease poses a threat to their physical and mental integrity; psychological support of these patients may reduce the development of significant morbidity and help patients to better manage the course of the disease and the effects of the treatment.     

Immunizing against prejudice: effects of disease protection on attitudes toward out-groups

Contemporary interpersonal biases are partially derived from psychological mechanisms that evolved to protect people against the threat of contagious disease. This behavioral immune system effectively promotes disease avoidance but also results in an overgeneralized prejudice toward people who are not legitimate carriers of disease. In three studies, we tested whether experiences with two modern forms of disease protection (vaccination and hand washing) attenuate the relationship between concerns about disease and prejudice against out-groups. Study 1 demonstrated that when threatened with disease, vaccinated participants exhibited less prejudice toward immigrants than unvaccinated participants did. In Study 2, we found that framing vaccination messages in terms of immunity eliminated the relationship between chronic germ aversion and prejudice. In Study 3, we directly manipulated participants' protection from disease by having some participants wash their hands and found that this intervention significantly influenced participants' perceptions of out-group members. Our research suggests that public-health interventions can benefit society in areas beyond immediate health-related domains by informing novel, modern remedies for prejudice.