碩士 / 國立政治大學 / 語言學研究所 / 103 / This thesis is aimed analyzes tone sandhi domain of “e structure” in Taiwan Southern Min from the perspective of Optimality theory. The discussion is divided into two parts. First, this thesis explores the tonal domain in terms of the interface of syntax and phonology. The analysis indicates that the tonal domain of “e structure” is a phonological phrase. Furthermore, this thesis also investigates different types of “e structure” such as pronoun, V-complement structure, and focus words. The analysis indicates pronoun is cliticized rightward to a following phonological phrase; verb is a focus word and has a base tone in V-complement structure, however, complement is neutralized;, and the focus word has a base tone unless it is an adjunct. Secondly, Optimality Theory is adopted to analyze the data after exploring the tonal domain. Prosodic constraints and tonal constraints are proposed in this thesis. The tonal constraints are responsible for explaining the delimitation of tonal domains. The interaction between *ADJUNCT]PhP, ALIGN-R(FOC, PhP) and other markedness constriant determines that a focus word has a base tone, except when it is an adjunct. Besides, IDENT-T(FOC) and UNPARSED-N predict that a word which is not parsed by phonological phrase is neutralized.

碩士 / 國立暨南國際大學 / 中國語文學系 / 96 / This thesis is accepted Akitani Hiroyuki（秋谷裕幸） to the discussion of Cangnan Manhun, and probed into the synchronic and diachronic phonology of Cangnan Manhun. At probing into the features of Cangnan Manhun , is different from other people:Cangnan Manhun tone sandhi of trisyllable, the law of tone sandhi of trisyllable specially; tone sandhi of trisyllable ' exception ' and initial devoicing on tone sandhi of disyllable that produce, this prove tone sandhi of disyllable tone sandhi of trisyllable is it belong to different system in Cangnan Manhun. In historical phonology part, research into devoicing condition in completely voiced of Ancient Chinese and a narrow distribution of the nasalizd finalal.Chapter 5 is discussed how to dialect division for Cangnan Manhun.

碩士 / 國立政治大學 / 語言學研究所 / 88 / The present thesis is mainly devoted to the research issue of tone sandhi in Mandarin-Taiwanese code-mixing using an Optimality Theoretic (OT) Approach. Since the study of this code-mixed tone sandhi necessarily involves the tone sandhi rules of Mandarin and of Taiwanese, the tone sandhi phenomena in Mandarin and in Taiwanese are carefully discussed under OT as well. Tone sandhi in Mandarin has been widely studied by many Chinese linguistics under the derivational approach. This thesis argues that the previous analyses to Mandarin tone sandhi are inadequate and that an Optimality Theoretic approach is needed to account for tone sandhi in Mandarin. The inadequacy of the previous analyses comes from the common failure of offering a uniform solution to account for non-PP and PP word stings in Mandarin. Based on the Optimality Theory, this thesis proposes two sets of constraints to account for Mandarin tone sandhi; one is the prosodic constraints set and the other is the tonal constraints set. This thesis proves that these two constraints can successfully get rid of the problem left by the derivational tradition. Tone sandhi in Taiwanese is also widely studied by many Chinese linguistics under the derivational approach. This thesis argues that the previous analyses to Taiwanese tone sandhi are inadequate and that an Optimality Theoretic approach is needed to account for tone sandhi in Taiwanese. The inadequacy of the previous analyses comes from the fact that Taiwanese word strings with non-adjunct and adjunct structures as well as with non-clitic and clitic structures fail to be accounted for using a uniform solution. Based on the Optimality Theory, this thesis proposes two sets of constraints to account for Taiwanese tone sandhi; one is the prosodic constraints set and the other is the tonal constraints set. This thesis proves that these two constraints can successfully get rid of the problem left by the derivational tradition. Tone sandhi in Mandarin-Taiwanese code-mixing is a phenomenon that is very interesting but has not been studied before. This thesis thus offers a derivational analysis to this tone sandhi phenomenon first, where it is found that (1) in Mandarin-Taiwanese code-mixing, a Mandarin base tone can trigger Taiwanese tone sandhi and a Taiwanese low tone can trigger Mandarin tone sandhi, (2) in Mandarin-Taiwanese code-mixing, the Mandarin tone sandhi rule is sensitive to all and only the Mandarin tone sandhi domain and the Taiwanese tone sandhi rule is sensitive to all and only the Taiwanese tone sandhi domain, and (3) in Mandarin-Taiwanese code-mixing, the Taiwanese tone sandhi rule must apply before the Mandarin tone sandhi rule to derive the tonal output. However, since the demand for an extrinsic rule order between the tone sandhi rules of Mandarin and Taiwanese is inadequate, the tone sandhi phenomenon is reanalyzed under the framework of the Optimality Theory. A set of tonal constraints is proposed. According to the tonal constraints set, the inadequacy left by the derivational approach is successfully avoided.

University of Macau / Faculty of Arts and Humanities. / Department of Chinese

本篇論文旨在從優選理論（Optimality Theory）之框架背景來探討國、台語夾碼（Mandarin-Taiwanese Code-Mixing）時的連讀變調現象。由於此現象之探討涉及國語及台語之變調，本篇論文亦從優選理論之觀點來探討國語三聲變調（Mandarin Tone Sandhi）以及台語的變調（Taiwanese Tone Sandhi）。 在國語三聲變調方面，由於傳統派生（derivational）模式在處理國語三聲變調時，仍遺留了些許的問題。例如，無法以一致的方式來處理non-PP和PP的變調現象。本文主要針對這個問題，重新以優選理論的角度提出解決之道。文中分別提出了一組韻律制約（Prosodic Constraint）及一組聲調制約（Tonal Constraint）；根據這兩組制約，傳統派生模式所遺留下的缺失則得以獲得妥善的處理。 在台語變調方面，台語變調在傳統派生模式的探討中亦遺留下些許問題。例如，無法以一致的方式來處理non-adjunct和adjunct以及non-clitic和clitic的變調問題。本文根據優選理論，重新分析台語變調。文中分別提出了一組韻律制約及一組聲調制約；根據此兩組制約，則可以成功的免除傳統派生分析模式下的缺失。 國、台語夾碼時的變調是未曾被探討過的問題。本文先就國、台語夾碼時的變調，提出一個派生模式的分析。不過，以派生模式來處理國、台語夾碼變調時，遺留下必須限定國語變調規則和台語變調規則的運作次序這項缺點。因此，本文根據優選理論，重新分析了這個變調現象，並提出了一組聲調制約；這組聲調制約，配合國語及台語的韻律制約，得以成功的處理傳統派生模式所遺留下的問題。 / The present thesis is mainly devoted to the research issue of tone sandhi in Mandarin-Taiwanese code-mixing using an Optimality Theoretic (OT) Approach. Since the study of this code-mixed tone sandhi necessarily involves the tone sandhi rules of Mandarin and of Taiwanese, the tone sandhi phenomena in Mandarin and in Taiwanese are carefully discussed under OT as well. Tone sandhi in Mandarin has been widely studied by many Chinese linguistics under the derivational approach. This thesis argues that the previous analyses to Mandarin tone sandhi are inadequate and that an Optimality Theoretic approach is needed to account for tone sandhi in Mandarin. The inadequacy of the previous analyses comes from the common failure of offering a uniform solution to account for non-PP and PP word stings in Mandarin. Based on the Optimality Theory, this thesis proposes two sets of constraints to account for Mandarin tone sandhi; one is the prosodic constraints set and the other is the tonal constraints set. This thesis proves that these two constraints can successfully get rid of the problem left by the derivational tradition. Tone sandhi in Taiwanese is also widely studied by many Chinese linguistics under the derivational approach. This thesis argues that the previous analyses to Taiwanese tone sandhi are inadequate and that an Optimality Theoretic approach is needed to account for tone sandhi in Taiwanese. The inadequacy of the previous analyses comes from the fact that Taiwanese word strings with non-adjunct and adjunct structures as well as with non-clitic and clitic structures fail to be accounted for using a uniform solution. Based on the Optimality Theory, this thesis proposes two sets of constraints to account for Taiwanese tone sandhi; one is the prosodic constraints set and the other is the tonal constraints set. This thesis proves that these two constraints can successfully get rid of the problem left by the derivational tradition. Tone sandhi in Mandarin-Taiwanese code-mixing is a phenomenon that is very interesting but has not been studied before. This thesis thus offers a derivational analysis to this tone sandhi phenomenon first, where it is found that (1) in Mandarin-Taiwanese code-mixing, a Mandarin base tone can trigger Taiwanese tone sandhi and a Taiwanese low tone can trigger Mandarin tone sandhi, (2) in Mandarin-Taiwanese code-mixing, the Mandarin tone sandhi rule is sensitive to all and only the Mandarin tone sandhi domain and the Taiwanese tone sandhi rule is sensitive to all and only the Taiwanese tone sandhi domain, and (3) in Mandarin-Taiwanese code-mixing, the Taiwanese tone sandhi rule must apply before the Mandarin tone sandhi rule to derive the tonal output. However, since the demand for an extrinsic rule order between the tone sandhi rules of Mandarin and Taiwanese is inadequate, the tone sandhi phenomenon is reanalyzed under the framework of the Optimality Theory. A set of tonal constraints is proposed. According to the tonal constraints set, the inadequacy left by the derivational approach is successfully avoided.

碩士 / 國立陽明大學 / 神經科學研究所 / 104 / The goal of this study was to test the psychological reality of tone sandhi rules of the tone language by observing the differences of the mismatch negativity response (MMN), which is an automatic differences detection response in the brain, between two tone language groups, Mandarin Chinese and Taiwanese. An instance of tone sandhi in Mandarin Chinese is called “tone three sandhi,” meaning that when two mandarin characters with the third tone are read consecutively, the tone of the first word is changed into the second tone of Mandarin. The phenomenon of the tone three sandhi includes two points, the first one is “Sandhi pair tones or not.”, when two tone-three words are put together to read, the tone of the first word being changed into the second tone, but not changed into the first or the fourth tone of Mandarin. The second point of tone sandhi is “Specific sandhi position.” The sandhi happens only when two tone three words are put together to read, the tone changed from tone 3 tone 3 into tone 2 tone 3, but the sandhi does not apply to the second tone three word (for instance tone3 tone 3 into tone3 tone2) nor when two tone two words are put together to read (for instance tone 2 tone 2 into tone 2 tone 3). Research in the past that investigated how the experience of tone sandhi in a tone language affected the phonological processing in the brain found that only tone language speakers (like Mandarin) had differences in MMN responses between different tone pairs, for instance tone 3 with tone 2 verses tone 3 with tone 1, but not in non-tone language speakers (like English). Why is the MMN response different in native tone language speakers? They reasoned that 1st, the sensitivity of tone contour of the participants whose mother tone was a tone language was higher than the participants whose mother tongue was a non-tone language. 2nd, there is a tone three sandhi rule in Mandarin Chinese which makes tone two frequently come with tone three, so for the participants who are familiar with this rule the differences between tone two and tone three is reduced compared to differences between tone one and tone three cognitively and psychologically. Does the experience of tone sandhi affect the MMN response? There was only comparison between tone and non-tone language speakers the evidence was not convincing enough. To investigate this question in a more delicate way, the present study applied word tones in Taiwanese and Mandarin as experiment stimuli. There were two experiments in this study, and odd-ball paradigm with EEG recording for both experiment were applied, the with-in group variables were “The sandhi pair and non-sandhi pair” and “The changing position of a sandhi pair”, and in experiment 2 we added a between group variable “ high/low Taiwanese tone sandhi ability”. The statistical results showed that participants with a native language of Taiwanese or Mandarin, the MMN peak latency were earlier in non-sandhi pair conditions compared to sandhi pair conditions, supporting the hypothesis that the experience of tone sandhi can affect the phonological process of the brain in the category of sandhi pair or not. When the stimuli were tones in Taiwanese, the main effect of the changing position of a sandhi pair was significant, no matter if there was high or low Taiwanese tone sandhi ability, under a 100 millisecond observation time window, the mean amplitude of standard 3 deviant 7 tone pair was smaller than standard 7 deviant 3 tone pair, not supporting the hypothesis that the experience of the changing position of a sandhi pair can be shown by MMN responses.

Introduction: Lesions of vocal folds predispose to voice disorder related to work; however, high prevalence of dysphonia is confirmed regardless of the presence or degree of this kind of lesion. Related clinical controversies have been attenuated in face of recent epidemiologic studies that indicate context elements as possible triggering and aggravating factors of voice disorder, bringing clarification to hygienistic conducts in the field of speech Therapy. Having set the object of study that regards the chronicity of vocal disease and the barriers for keeping educational function on schools, the results of the survey on Belo Horizonte's municipal schools brought about questions that justified addressing the social representation on voice disorder. Objectives: 1) To identify the factors associated with the search of assistance to deal with vocal problems among elementary school teachers; 2) To investigate the prevalence and factors associated with recent absenteeism due to voice disorders among teachers; 3) investigate the existence of links between the social representations of teachers on the voice disorder and deal with the problem. Materials and methods: A study of social representation on dysphonia was coordinated with an epidemiological survey that involved 1,980 teachers of the Municipal School System of Belo Horizonte. Data were collected from a self-administered, unidentified, structured questionnaire, with questions about sociodemographic aspects, health and lifestyle habits, occupational history as well as questions related to labor and voice. A multiple logistic regression was performed to analyze two events: 1) the recent search for medical and/or speech Therapy assistance to address voice issues; 2) recent absenteeism due to vocal problems. The qualitative study employed the technique of focal groups and discourse analysis for the interpretation of the results obtained from interviews with a total of 18 teachers referred by medical expertise for speech therapy. Results: Both the search for assistance (event 1) and the absenteeism due to vocal problem (event 2) were associated with upper airways problems. Perception of worsening vocal quality, report of high or unbearable levels of noise in the classroom and recent absenteeism were related to event 1. Teachers who reported exposure to violence (by students and/or parents of students) in the previous year, emotional problems, and sick leave due to voice 12 problem in the last 6 months were more susceptible to recent absenteeism (event 2) due to voice problems when compared to those who did not report absenteeism. The underestimation of voice symptoms (event 3) also emerged from the subjects discourse. Two lines of analysis allowed to build on the results achieved: 1) despite the dominant biological paradigm, macrostructural factors indicate the social nature of the teachers' illness process, 2) the institutional recognition of the disease and the environmental and organizational conditions of the workplace interfered in the declaration of voice disorder by the teacher. Conclusion: It arose from the subjects' discourse explanatory elements around the behavior of postponing the search for vocal assistance and for the absence from work due to vocal problems. A paradox was identified between the presence of vocal symptoms and inability to work and the denial or avoidance declaration of voice disorder. Fear, guilt and frustration before the diagnosis of dysphonia are (re)produced on the subjects' discourse. The statement vocal symptom is not immediate to its clinical expression, or in spite of stated and assumed such symptoms are relegated to the background by the teachers themselves. Multiple factors show to be related to coping with the voice disorder: health related factors (decrease of vocal quality, emotional and upper airways problems); contextual factors (report of high or unbearable levels of noise in the classroom and the testimony of abuse by students or parents at the school) associated to the search for vocal assistance and/or recent absenteeism. There is little influence of anchoring representations of voice disorder in the biomedical model on the coping strategies of teachers, compared to the weight of the representations of the voice problem as losses. Thus, it is reasonable to conclude that the identified behaviors are grounded in logic that prioritizes the goals of education, the students and the classroom at the expense of health. / Introdução: As lesões de pregas vocais são predisponentes do distúrbio de voz relacionado ao trabalho, contudo, estão confirmadas elevadas prevalências independentemente da presença e do grau desse tipo de lesão. Controvérsias clínicas a esse respeito têm sido atenuadas diante das contribuições dos estudos epidemiológicos recentes que indicaram fatores contextuais como possíveis desencadeadores e agravadores do distúrbio vocal, trazendo aclarações às condutas higienistas no campo da fonoaudiologia. Assim constituído o objeto do estudo, que diz respeito à cronicidade do adoecimento vocal e às barreiras para a manutenção da função docente nas escolas, os resultados do inquérito nas escolas municipais de Belo Horizonte suscitaram questões que justificaram abordar as representações sociais sobre o distúrbio vocal. Objetivos: 1) conhecer os fatores associados à busca de assistência devido a problemas na voz entre professoras do ensino fundamental; 2) investigar a prevalência e os fatores associados ao absenteísmo recente relacionado ao distúrbio vocal em professoras; 3) investigar a existência de nexos entre as representações sociais de professores sobre o distúrbio vocal e o enfrentamento do problema. Material e métodos: Articulou-se um estudo das representações sociais sobre o distúrbio vocal ao inquérito epidemiológico que focalizou 1.980 professoras municipais de Belo Horizonte por meio de questionário estruturado, não identificado, autopreenchido, contendo questões sociodemográficas, sobre hábitos de vida e saúde, história profissional e questões relacionadas ao trabalho e à voz. A regressão logística múltipla foi utilizada para analisar dois eventos: 1) procura recente por médico e/ou fonoaudiólogo por causa da voz; 2) absenteísmo recente devido ao distúrbio vocal. O estudo qualitativo utilizou a técnica de grupos focais e análise do discurso para a interpretação dos resultados obtidos das entrevistas de um total de 18 professores encaminhados pela perícia médica para tratamento de voz. Resultados: Tanto a procura pela assistência vocal (evento 1) quanto o afastamento do trabalho por problema de voz (evento 2) foram associados aos problemas de vias aéreas superiores. Percepção de piora na qualidade vocal, relato de ruído elevado ou insuportável na sala de aula e absenteísmo recente foram associados ao evento 1. Docentes que informaram ter vivenciado agressões no ano anterior (alunos e/ou pais de alunos), terem tido problemas emocionais e terem se ausentado do trabalho por problema de voz nos últimos 6 meses apresentaram mais chance de se afastar recentemente do trabalho (evento 2) por problema de voz quando comparados àqueles que não relataram o absenteísmo. A subvalorização dos sintomas vocais (evento 3) emergiu do discurso dos sujeitos. Dois eixos de análise permitiram aprofundar os resultados obtidos: 1) apesar do paradigma biológico dominante, fatores macroestruturais indicaram no discurso dos sujeitos o caráter social do processo de adoecimento dos docentes; 2) o reconhecimento institucional da doença e as condições ambientais e organizacionais do trabalho interferiram na declaração do distúrbio vocal pelo professor. Conclusões: Emergiram dos discursos dos sujeitos elementos explicativos para o comportamento de adiamento da busca da assistência vocal e para o absenteísmo por distúrbio vocal. Identificou-se um paradoxo entre a vigência de sintomas vocais e de incapacidade para o trabalho e a negação ou evitação de declaração do problema de voz. Medo, culpa e frustração diante do diagnóstico de distúrbio vocal se (re)produziram no discurso dos sujeitos. A declaração do sintoma vocal não é imediata à sua expressão clínica, ou apesar de declarado e assumido, tais sintomas são relegados ao segundo plano pelos próprios professores. Vários fatores se mostraram relacionados ao enfrentamento do distúrbio vocal: fatores relacionados à saúde (piora da qualidade vocal, problemas emocionais e de vias aéreas superiores); fatores contextuais (relato de ruído elevado à insuportável na sala de aula e de testemunho de violência por alunos e/ou seus pais na escola) associados à procura pela assistência vocal e/ou ao absenteísmo recente. Há pouca influência da ancoragem das representações do distúrbio vocal no modelo biomédico sobre as estratégias de enfrentamento dos professores, comparada ao peso das representações do problema de voz como prejuízo. Assim, torna-se plausível concluir que os comportamentos identificados estejam embasados na lógica que prioriza os objetivos do ensino, dos alunos e da sala de aula em detrimento da saúde.

The HTLV (Human T cell lymphotropic virus) type 1 does not necessarily cause a pathological process in their carriers. Different factors between the virus and the patient will determine the disease if as an inflammatory or hematologic manifestation. While myelopathy associated with HTLV-1 (HAM/TSP) is the most common and wellknown neurological manifestation, few studies have examined the possibility of cognitive disorders in HTLV-1. Apparently, there are white matter lesions similar to HIV-infected patients, suggesting chronic perivascular involvement. The histological characteristic finding is a perivascular lymphocytic infiltrate in the central nervous system, suggesting vasculitis. The pathogenesis of HAM/TSP is not yet fully understood. The current understanding is that the infected T lymphocytes migrate to the central nervous system, interect with CD8 + T cells resulting in the production of cytokines such as TNF-, IL- 1 , IL-2 and IL-6 with consequent destruction of glial cells, fibroblast proliferation and lipohialinose of small arteries and veins. Understanding the diseases impact on cognition and immune disorders in central nervous system may help to determine the prognostic factors for the development of neurological damage associated with HTLV-1, and provides subsidies for future treatments that are not yet established. In endemic areas for HTLV-1, the differential diagnosis with other causes of myelopathy can be difficult, particularly if the patient has signs and symptoms of brain involvement, as seropositive for HTLV-1 can be detected in patients with other neurological diseases. In this study, we report a case of a patient diagnosed with Multiple Sclerosis and upon further investigation, was found to be HTLV-1 seropositive. We performed a cross-sectional study with 114 patients with HAM/TSP who underwent a comprehensive neuropsychological assessment through cognitive function tests (Mattis Dementia Rating Scale, Span of digits forward and backward, Trail Making Test A and B, Stroop Test, Verbal fluency tests included semantic and phonemic fluency, Auditory Learning Test Rey). We investigated the association between lowered cognitive function and clinical, epidemiological and sociodemographic, immunological, viral factors and findings on magnetic resonance imaging of the brain. Patients were stratified into three age groups and three education groups and neuropsychological tests were standardized so that was given a mean of zero and a standard deviation of 1 and 1,35 (z-scores). Participants with lower score less than or equal to 1 for your stratum of age and education were considered with lowered cognitive function. The chi-square (X2) and the t test were used for univariate analysis to association between variables. All independent variables with a significance level of 0.80 (p <0.20) were tested for the logistic regression and the level of statistical significance was set at p <0.05. We found 15 patients (13.1%) has lowered cognition function. In univariate and multivariate analysis, inflammatory factors - high levels of IgA, IgG, IL-6 and TNF- - lifestyle - tobacco - severity of the disease - use of wheelchair - and presence of brain white matter lesions and brain atrophy were associated with poor cognition. The results suggest that lowered cognitive function in patients with HAM / TSP appears to have a multifactorial association with persistent inflammation, disease severity, lifestyle and a real brain injury. There is also a possibility that disability is a factor by it self for poor cognition in these patients. Subpopulations of patients with HAM / TSP and these characteristics should receive special attention from a multidisciplinary professionals for investigation of cognitive function. In conclusion, we suggest that the brain lesions in HTLV- I infection may be secondary a worse severity of disease associated with persistent inflammation, which may hinder worse cognitive performance in the course of developing of the myelophaty / A infecção pelo HTLV (Human T cell Lymphotropic virus) do tipo 1 não necessariamente gera um processo patológico em seus portadores. Diferentes fatores na interação vírus/hospedeiro determinarão se ocorrerá a doença e de que forma será, podendo comportar-se como manifestação hematológica ou inflamatória. Enquanto a mielopatia associada ao HTLV1 (HAM/TSP) é a manifestação neurológica mais frequente e já bem caracterizada na literatura, ainda são poucos os estudos que examinam a possibilidade de ocorrência de transtornos cognitivos na infecção pelo HTLV-I. Aparentemente, ocorrem lesões de substância branca que são similares àquelas encontradas em pacientes infectados pelo HIV, sugestivas de acometimento perivascular crônico. O achado anatomopatológico característico consiste na presença de infiltrado perivascular linfocitário no sistema nervoso central, sugestivo de vasculite. A patogênese da HAM/TSP ainda não está totalmente esclarecida. O entendimento atual é que os linfócitos T infectados migram para o sistema nervoso central, onde ocorre a interação com os linfócitos T CD8+, resultando na produção de citocinas como TNF- , IL-1, IL-2 e IL-6, com consequente destruição das células gliais, proliferação de fibroblastos e lipohialinose de pequenas artérias e veias. Entender melhor a repercussão da doença, já manifesta como mielopatia, sobre a cognição, assim como as alterações imunológicas e o acometimento do sistema nervoso central pode auxiliar a determinar os fatores prognósticos de desenvolvimento da lesão neurológica associada ao HTLV-I, além de fornecer subsídios para futuros tratamentos, que até o momento não estão estabelecidos. Em áreas endêmicas para o HTLV-1, o diagnóstico diferencial com outras causas de mielopatias pode ser difícil, particularmente se o paciente tem sinais e sintomas de acometimento encefálico, já que a sorologia positiva para o HTLV-I pode ser detectada em pacientes com outras doenças neurológicas. Nesta tese, relata-se o caso de uma paciente inicalmente diagnosticada com Esclerose Múltipla e que, na investigação posterior, foi encontrado soropositividade para este vírus. Foi realizado estudo transversal com 114 pacientes com HAM/TSP, que foram submetidos à uma detalhada avaliação neuropsicológica através de testes da função cognitiva (Mattis Dementia Rating Scale, Span de dígitos ordem direta e inversa, Teste de Trilhas A e B, Teste de Stroop, Fluência Verbal Semântica e Fonêmica, Teste de Aprendizado Auditivo de Rey). Foi investigada a associação entre o rebaixamento cognitivo e fatores clínicos epidemiológicos, imunológicos e virais, além dos achados da ressonância nuclear magnética de encéfalo. Os pacientes foram estratificados em três grupos de idade e três grupos de escolaridade e os testes neuropsicológicos foram padronizados por média igual a zero e desvio-padrão de 1 e 1,35 (z-scores). O rebaixamento cognitivo foi definido por escores menores que 1/1,35 desvio-padrão da média, para cada estrato de idade e escolaridade. O Qui Quadrado (X2) e o test t foram usados para análise univaridada da associação entre as variáveis. Todas as variáveis independentes com nível de significância de 0,80 (p<0,20) foram testadas para a regressão logística e o nível de significância foi considerado com p<0,05. Foi evidenciado que 15 pacientes (13,1%) apresentavam rebaixamento da cognição. Na análise univariada e multivariada, fatores inflamatórios - níveis elevados de IgA, IgG, Il-6 e TNF- - hábitos de vida tabagismo - , gravidade da doença uso de cadeira de rodas e presença de lesões de substância branca e atrofia cerebral foram associadas à baixa cognição. Os resultados apontam que o rebaixamento cognitivo em pacientes com HAM/TSP parece ter uma associação multifatorial com a inflamação persistente, gravidade da doença, hábitos de vida e um real acometimento cerebral. Também existe a possibilidade de que a incapacidade física seja um fator por si só relacionado ao rebaixamento da cognição nestes pacientes. As subpopulações de pacientes com HAM/TSP e essas características, devem receber atenção especial da equipe multidisciplinar de profissionais com o objetivo de investigação das funções cognitivas. Como conclusão, nós sugerimos que as lesões encefálicas em infecção pelo HTLV-1 podem ser secundárias à maior gravidade da doença associada à uma inflamação persistente, o que pode prejudicar a performance cognitiva ao longo do curso do desenvolvimento da doença manifesta como mielopatia.

O tromboembolismo venoso (TEV) é uma doença crônica e constitui um problema de saúde pública (1;2). A definição do tempo de duração do tratamento com anticoagulante após um primeiro episódio de TEV depende de dois fatores: do risco estimado de recorrência do TEV e risco de hemorragia relacionada com a anticoagulação (3). A anticoagulação por tempo indeterminado é reservada para aqueles pacientes com fatores de risco sabidamente pró-trombóticos e permanentes para recorrência da trombose. Pacientes que apresentam um episódio de TEV com fator de risco transitório bem documentado podem fazer tratamento por apenas três a seis meses (4). Em muitos pacientes com TEV a definição da duração da anticoagulação é uma decisão difícil (5). Nos últimos anos um grande esforço tem sido feito na busca de marcadores ou fatores de risco que possam predizer o risco de recorrência de trombose. Alguns deles são relacionados a aspectos clínicos como o sexo, idade no primeiro evento, a localização do TEV, presença ou não de fatores desencadeantes, tais como cirurgias ou uso de contraceptivos orais a história familiar de TEV (6;7). Outros estão relacionados com os testes laboratoriais ou exames de imagem, como a presença de dímero-D elevado um mês após a suspensão da anticoagulação, presença de determinadas trombofilias, o teste de geração da trombina alterado e a presença de trombo residual na ultra-sonografia após o período de tratamento (8-10). No entanto, muitas questões sobre a utilidade desses possíveis marcadores ou fatores de risco permanecem não esclarecidas (11).

A disfunção vascular é uma manifestação precoce da aterosclerose, está relacionada a fatores de risco e prediz eventos cardiovasculares. A tonometria arterial periférica (PAT) avalia, nos vasos digitais, a amplitude do pulso basal, a função endotelial (PAT ratio) e a reflexão da onda de pulso (PAT-AIx). Neste estudo, investigamos, em adultos brasileiros, a associação das respostas obtidas pela PAT com fatores de risco cardiovascular e com a velocidade da onda de pulso carótida-femoral (VOP), medida de rigidez arterial. Trata-se de um estudo transversal, onde 1535 participantes da coorte Estudo Longitudinal da Sáude do Adulto foram submetidos à PAT (52 ± 9 anos; 35-74 anos; 44% mulheres). Os coeficientes de correlação parciais ajustados para sexo e idade foram calculados e modelos de regressão linear múltipla foram utilizados nas análises multivariadas, as quais evidenciaram que a amplitude do pulso basal maior e o PAT ratio menor, portanto compatíveis com função vascular mais prejudicada, correlacionaram-se com sexo masculino, além de IMC e colesterol total/HDL mais elevados. Adicionalmente, triglicérides elevados, PAS reduzida e a presença de doença CV prevalente correlacionaram-se com valores mais baixos do PAT ratio. O PATAIx associou-se diretamente a sexo feminino, idade, PAS, PAD e tabagismo e inversamente a frequência cardíaca, altura, IMC e doença CV prevalente. Indivíduos com raça/cor da pele preta apresentaram BPA mais baixos e PAT ratio e PAT-AIx mais elevados, quando comparados a indivíduos brancos e pardos. Quanto à relação entre as medidas de função vascular, não houve associação entre a amplitude do pulso basal ou o PAT ratio com rigidez arterial. O PAT-AIx correlacionou-se diretamente à VOP e à amplitude do pulso basal e inversamente ao PAT ratio, sugerindo que a reflexão da onda de pulso é influenciada por múltiplos componentes e fornece informações distintas em relação à rigidez arterial. Em adultos brasileiros, as medidas de função vascular digitais correlacionaram-se com fatores de risco cardiovascular metabólicos, assim como descrito em outras populações. Entretanto, a associação da raça/cor da pele preta com uma resposta vascular mais favorável para o BPA e PAT ratio é contrastante com o que foi descrito em estudos norte-americanos, levantando a hipótese que os padrões de função vascular podem diferir entre populações.