Propiedades psicométricas del cuestionario de gratitud (gq-6) para Brasil / Psychometric Properties of the Gratitude Questionnaire (gq-6) to Brazil / Propriedades psicométricas do questionário de gratidão (gq-6) para o Brasi

Este estudio tuvo como objetivo adaptar el Cuestio-nario de Gratitud (gq-6) a la población brasileña. La muestra estuvo constituida por 1 850 participantes con una edad media de 25.13 años (dt = 5.36), 50 % mujeres y 50 % hombres, con representación de todos los estados brasileños. Se realizó análisis factorial exploratorio (afe) y análisis factorial confirmatorio (afc), y correlaciones entre gratitud (gq-6) y satisfac-ción con la vida (swls), optimismo (lot-r), esperanza (ahs), felicidad (shs), afectos positivos y negativos (panas), y personalidad (bfi). Los resultados de efay cfa indicaron una solución unidimensional con los elementos que soportan cargas (λ > 0.39) en el factor y un ajuste aceptable para la solución de un factor (χ2(9) = 59, p < 0.001; cfi= 0.956, rmsea= 0.078). Las correlaciones indican una asociación con variables externas relevantes. Se concluye que el cuestionario presenta evidencia de validez y confiabilidad para su uso en investigación en el contexto brasileño

This study aimed to evaluate the psychometric properties of the Gratitude Questionnaire (gq-6) to the Brazilian population. The sample consisted of 1 850 participants with a mean age of 25.13 years (sd = 5.36), 50 % female and 50 % male and the sample represents all Brazilian states. Exploratory factor analysis (efa) and confirmato-ry factor analysis (cfa) were run, along with correlations between gratitude (gq-6) and life satisfaction (swls), optimism (lot-r), hope (ahs), happiness (shs), positive and negative affects (panas), and personality (bfi). The efa and cfa results indicated a one-dimensional solu-tion with the items loading satisfactorily (λ > 0.39) in the factor and acceptable fit for the one-factor solution (χ2 (9) = 59, p < 0.001; cfi= 0.956, rmsea= 0.078). Correlations indicate relevant relationships with exter-nal variables. In conclusion, the questionnaire shows evidence of validity and reliability for research use in the Brazilian context

Este estudo investigou as propriedades psicométricas do Questionário de Gratidão (gq-6) na população bra-sileira. Participaram 1 850 respondentes com média de idade de 25.13 anos (dp= 5.36), sendo 50 % do sexo feminino e 50 % do sexo masculino e com representação de todos os estados brasileiros. Foram rodadas análi-ses fatoriais exploratória (efa) e fatorial confirmatória (cfa), e correlações entre gratidão (gq-6) e satisfação com a vida (swls), otimismo (lo-r), esperança (ahs), felicidade subjetiva (shs), afetos positivos e negativos (panas) e personalidade (bfi). Os resultados da efa e da cfa indicaram uma solução unidimensional com os itens carregando com cargas adequadas (λ > 0.39) no fator e ajuste aceitável para a solução unifatorial (χ2 (9) = 59, p < 0.001; cfi= 0.956, rmsea = 0.078). As correlações indicaram relações com variáveis externas relevantes. Conclui-se que a escala apresenta evidências de validade e fidedignidade para uso em pesquisa no Brasil.

Estudio de Validez y Confiabilidad del Cuestionario de Gratitud-6 (GQ-6) en México / Validity and Reliability Study of the Gratitude Questionnaire-6 (GQ-6) in Mexico

Resumen Las investigaciones han sugerido que las personas agradecidas son más felices, enérgicas y tienen mayor esperanza de tener experiencias positivas. A pesar de que el GQ-6 es un instrumento ampliamente utilizado para evaluar la gratitud, su estructura factorial no ha sido explorada en población mexicana. El objetivo del presente estudio fue evaluar las propiedades psicométricas del GQ-6 en una muestra mexicana. Participaron 566 personas de población general de 18 a 67 años. El GQ-6 fue administrado junto con la Escala de Afecto Positivo y Afecto Negativo (PANAS) y el Test de Orientación Vital (LOT-R). Los resultados indicaron una estructura unifactorial con seis indicadores la cual mostró una buena bondad de ajuste y confiabilidad aceptable (α = .79); estos resultados se mantuvieron independientemente del sexo. Puede concluirse que el GQ-6 es un instrumento con buenas propiedades psicométricas para evaluar la disposición para experimentar gratitud en población mexicana.

Abstract Studies suggest that gratitude contributes to the development of prosocial behaviors and strengthens interpersonal relationships. Research has suggested that grateful people are happier, more energetic, and have a higher hope of having positive experiences. There are currently several instruments available to measure gratitude, with the Gratitude Questionnaire-6 (GQ-6) being the most widely used. The GQ-6 is a self-report questionnaire with the objective of evaluating the willingness to experience gratitude, which is available in several languages and has been validated in different countries around the world. Its original six-item unifactorial structure has been replicated in several countries; however, a five-item unifactorial solution was more appropriate in some studies in the adult population. Despite the above, the factorial structure of the GQ-6 has not been explored in the Mexican population, so the objective of this study was to evaluate the psychometric properties of the GQ-6 in a Mexican sample. It was an instrumental study through non-probability sampling. The sample consisted of men and women aged 18 to 67 years. Participants were 566 adults of the general population (64.6% women and 35.5% men) from different states of Mexico. The GQ-6 was administered together with the Positive Affect and Negative Affect Scale (PANAS) and the Life Orientation Test (LOT-R). For the performance of EFA, the sample was divided in half randomly (N = 280). The analysis indicated a unifactorial structure with six indicators which explained 48.58% of the variance, which was maintained according to the sex of the participants (46.47% women and 46.66% men). Using the other half of the participants (N = 286), the CFA and the multigroup analysis were performed in relation to sex. The GQ-6 showed good fit and adequate internal consistency (α = .79) for both women (α = .77) and men (α = .76). Data on the convergent and divergent validity of GQ-6 showed a positive association with LOT-R (rs = .456, p < .001), Positive Affect (rs = .253, p < .001), and Negative Affect (rs = - .186, p < .001). Therefore, it can be concluded that GQ-6 is an instrument with good psychometric properties to evaluate the willingness to experience gratitude in the Mexican population.

Histamine/H1 receptor signaling in the parafacial region increases activity of chemosensitive neurons and respiratory activity in rats.

Histaminergic neurons of the tuberomammillary nucleus (TMN) are pH sensitive and contribute to CO2/H+-dependent behaviors including arousal and respiratory activity. TMN neurons project to several respiratory centers including the ventral parafacial region (pF), where the chemosensitive retrotrapezoid (RTN) neurons are located, and since RTN neurons are an important source of CO2/H+-dependent respiratory drive, we wondered whether histamine contributes to RTN chemoreception. To test this, we characterized effects of histamine on mean arterial pressure (MAP) and diaphragm muscle activity (DIAEMG) in urethane-anesthetized, vagotomized, and artificially ventilated male Wistar rats. Unilateral injection of histamine in the pF (25 mM) increased DIAEMG amplitude without changing DIAEMG frequency and MAP. Bilateral injections of the H1 receptor antagonist diphenhydramine hydrochloride (DPH; 0.5 mM) into the pF decreased baseline DIAEMG amplitude and frequency and MAP. Despite the strong inhibitory effect of DPH on baseline breathing, the hypercapnic ventilatory response was preserved under these experimental conditions. At the cellular level, chemosensitive RTN neurons showed a dose-dependent excitatory response to histamine that was blunted by DPH and mimicked by H1 receptor agonist 2-pyridylethylamine dihydrochloride (2PYEA) both under control conditions and when fast neurotransmitter receptors were blocked. We also tested effects of 2PYEA in the presence of serotonin, another wake-on neurotransmitter that activates RTN chemoreceptors partly by activation of Gq-coupled receptors. We found that the response to 2PYEA was diminished in serotonin, suggesting that RTN neurons have a limited capacity to respond to multiple Gq-coupled modulators. These results suggest that histamine can modulate breathing at the pF level by a mechanism involving H1 receptors.NEW & NOTEWORTHY Histamine/H1 receptor signaling activates retrotrapezoid (RTN) neurons under control conditions and to a lesser extent in the presence of serotonin. These results suggest that RTN neurons have a limited capacity to respond to simultaneous activation of multiple Gq-coupled receptors.

Modulation of Gq/PLC-Mediated Signaling by Acute Lithium Exposure.

Although lithium has long been one of the most widely used pharmacological agents in psychiatry, its mechanisms of action at the cellular and molecular levels remain poorly understood. One of the targets of Li+ is the phosphoinositide pathway, but whereas the impact of Li+ on inositol lipid metabolism is well documented, information on physiological effects at the cellular level is lacking. We examined in two mammalian cell lines the effect of acute Li+ exposure on the mobilization of internal Ca2+ and phospholipase C (PLC)-dependent membrane conductances. We first corroborated by Western blots and immunofluorescence in HEK293 cells the presence of key signaling elements of a muscarinic PLC pathway (M1AchR, Gq, PLC-ß1, and IP3Rs). Stimulation with carbachol evoked a dose-dependent mobilization of Ca, as determined with fluorescent indicators. This was due to release from internal stores and proved susceptible to the PLC antagonist U73122. Li+ exposure reproducibly potentiated the Ca response in a concentration-dependent manner extending to the low millimolar range. To broaden those observations to a neuronal context and probe potential Li modulation of electrical signaling, we next examined the cell line SHsy5y. We replicated the potentiating effects of Li on the mobilization of internal Ca, and, after characterizing the basic properties of the electrical response to cholinergic stimulation, we also demonstrated an equally robust upregulation of muscarinic membrane currents. Finally, by directly stimulating the signaling pathway at different links downstream of the receptor, the site of action of the observed Li effects could be narrowed down to the G protein and its interaction with PLC-ß. These observations document a modulation of Gq/PLC/IP3-mediated signaling by acute exposure to lithium, reflected in distinct physiological changes in cellular responses.

Síndrome anti-GQ1b en un niño con síndrome de Miller-Fisher-Bickerstaff / Anti-GQ1b syndrome. A child with Miller-Fisher-Bickerstaff syndrome

El síndrome anti-GQ1b reúne el síndrome de Miller-Fisher y la encefalitis del tronco cerebral de Bickerstaff, entre otras entidades. Tienen etiopatogenia común, constituida por la presencia de anticuerpos anti-GQ1b que reaccionan contra los sitios GQ1b del sistema nervioso según sea su accesibilidad. La prevalencia anual del síndrome de Miller-Fisher es de 0,09 casos por 100 000 habitantes por año y no existen estudios epidemiológicos sobre la encefalitis del tronco cerebral de Bickerstaff, que sería menos frecuente. De evolución natural hacia la mejoría, se beneficia del tratamiento con gammaglobulina endovenosa.Se presenta a un paciente de 12 años con síndrome de Miller-Fisher­Bickerstaff tras un episodio de diarrea aguda por Campylobacter jejuni en el que los anticuerpos anti-GQ1b resultaron positivos. Es nuestro objetivo comunicar sobre un síndrome de presentación poco habitual en pediatría a fin de advertir acerca de la necesidad de su sospecha precoz y solicitud de estudios de laboratorio específico

Miller-Fisher syndrome and Bickerstaff brainstem encephalitis, among others, constitute the anti-GQ1b syndrome, with a common immune pathophysiologic pathway characterized by the presence of anti-GQ1b antibodies, which react against the different nervous system GQ1b sites according to their different accessibility. The Miller-Fisher syndrome has a prevalence of 0.09 cases per 100 000 people-year but there are not epidemiological studies about Bickerstaff brainstem encephalitis, that it seems to be less frequent. In spite of having a good natural outcome, the immunoglobulin administration has been established as efficacious at improving it. A twelve-year-old boy suffering from Miller-Fisher-Bickerstaff syndrome after an acute Campylobacter jejuni diarrhea with positive titers of anti-GQ1b and anti-QGT1a antibodies is presented. We communicate a very uncommon pediatric disease with the aim of warning about the importance of its early suspicion and the need of specific laboratory determination

[Anti-GQ1b syndrome. A child with Miller-Fisher-Bickerstaff syndrome]. / Síndrome anti-GQ1b en un niño con síndrome de Miller-Fisher-Bickerstaff.

Miller-Fisher syndrome and Bickerstaff brainstem encephalitis, among others, constitute the anti-GQ1b syndrome, with a common immune pathophysiologic pathway characterized by the presence of anti-GQ1b antibodies, which react against the different nervous system GQ1b sites according to their different accessibility. The Miller-Fisher syndrome has a prevalence of 0.09 cases per 100 000 people-year but there are not epidemiological studies about Bickerstaff brainstem encephalitis, that it seems to be less frequent. In spite of having a good natural outcome, the immunoglobulin administration has been established as efficacious at improving it. A twelveyear- old boy suffering from Miller-Fisher-Bickerstaff syndrome after an acute Campylobacter jejuni diarrhea with positive titers of anti-GQ1b and anti-QGT1a antibodies is presented. We communicate a very uncommon pediatric disease with the aim of warning about the importance of its early suspicion and the need of specific laboratory determinations.

El síndrome anti-GQ1b reúne el síndrome de Miller-Fisher y la encefalitis del tronco cerebral de Bickerstaff, entre otras entidades. Tienen etiopatogenia común, constituida por la presencia de anticuerpos anti-GQ1b que reaccionan contra los sitios GQ1b del sistema nervioso según sea su accesibilidad. La prevalencia anual del síndrome de Miller-Fisher es de 0,09 casos por 100 000 habitantes por año y no existen estudios epidemiológicos sobre la encefalitis del tronco cerebral de Bickerstaff, que sería menos frecuente. De evolución natural hacia la mejoría, se beneficia del tratamiento con gammaglobulina endovenosa. Se presenta a un paciente de 12 años con síndrome de Miller- Fisher­Bickerstaff tras un episodio de diarrea aguda por Campylobacter jejuni en el que los anticuerpos anti-GQ1b resultaron positivos. Es nuestro objetivo comunicar sobre un síndrome de presentación poco habitual en pediatría a fin de advertir acerca de la necesidad de su sospecha precoz y solicitud de estudios de laboratorio específicos.

GQ-130, a novel analogue of thiazolidinedione, improves obesity-induced metabolic alterations in rats: Evidence for the involvement of PPARß/δ pathway.

The present investigation aimed to characterize the effect of a short-time treatment with a new thiazolidinedione (TZD) derivative, GQ-130, on metabolic alterations in rats fed a high-fat diet (HFD). We investigated whether metabolic alterations induced by GQ-130 were mediated though a mechanism that involves PPARß/δ transactivation. Potential binding and transactivation of PPARα, PPARß/δ or PPARγ by GQ-130 were examined through cell transactivation, 8-anilino-1-naphthalenesulfonic acid (ANS) fluorescence quenching assays and thermal shift assay. For in vivo experiments, male 8-week-old Wistar rats were divided into three groups fed for 6 weeks with: (a) a standard rat chow (14% fat) (control group), (b) a HFD (57.8% fat) alone (HFD group), or (c) a HFD associated with an oral treatment with GQ-130 (10 mg/kg/d) during the last week (HFD-GQ group). In 293T cells, unlike rosiglitazone, GQ-130 did not cause significant transactivation of PPARγ but was able to activate PPARß/δ by 153.9 folds in comparison with control values (DMSO). Surprisingly, ANS fluorescence quenching assay reveals that GQ-130 does not bind directly to PPARß/δ binding site, a finding that was further corroborated by thermal shift assay which evaluates the thermal stability of PPARß/δ in the presence of GQ-130. Compared to the control group, rats of the HFD group showed obesity, increased systolic blood pressure (SBP), insulin resistance, impaired glucose intolerance, hyperglycaemia, and dyslipidaemia. GQ-130 treatment abolished the increased SBP and improved all metabolic dysfunctions observed in the HFD group. Oral treatment with GQ-130 was effective in improving HFD-induced metabolic alterations probably through a mechanism that involves PPARß/δ activation.

Sobreposición del síndrome de Miller Fisher y encefalitis de Bickerstaff en pediatría: reporte de caso / Overlap of Miller Fisher syndrome and Bickerstaff encephalitis in pediatrics: Case report

RESUMEN Se describe el caso en pediatría de la sobreposición del síndrome de Miller Fisher y la encefalitis de Bickerstaff en presencia de perfil de anticuerpos positivos para anti-GQ1b en un niño de 6 años, quien presenta un compromiso tronco-encefálico y luego entra en una encefalopatía con compromiso de nervio periférico. El presente caso es relevante en relación con los escases de artículos semejantes en la literatura pediátrica, con pocos precedentes en la literatura publicada hasta la fecha.

SUMMARY To describe the pediatric case of the overlap of Miller Fisher syndrome and Bickerstaff encephalitis in the presence of an anti-GQ1b positive antibody profile in a 6-year-old boy who presents with a brainstem compromise and progress to encephalopathy with peripheral nerve compromise, the present case is relevant in relation to the scarcity of similar articles in pediatric literature with few precedents in the literature published to date.

Síndrome de Miller Fisher en un niño de 12 años / Miller Fisher Syndrome in a 12 year old boy

El Síndrome de Miller Fisher (SMF) es una variante del Síndrome de Guillain Barré (SGB), caracterizado por la tríada clínica de oftalmoplejía, ataxia y areflexia. Se presenta el caso de un niño de 12 años de edad, examinado con un tiempo de enfermedad de 4 días y con una variedad de síntomas que incluían ptosis palpebral, somnolencia, marcha tambaleante y debilidad muscular, asociados a antecedente de infección respiratoria de vías altas. El examen clínico demostró paresia del III, IV, y VI nervios craneales de ambos ojos, arreflexia y debilidad distal en extremidades. Se instaló tratamiento con Inmunoglobulina intravenosa que condujo a una evolución clínica satisfactoria.

The Miller Fisher Syndrome (MFS) is a variant of the Guillain Barre Syndrome (GBS), characterized by the clinical trial of ophthalmoplegia, ataxia and areflexia. The case of a 12 year old boy is examined with a 4-day long history characterized by symptoms such as palpebral ptosis, somnolence, ataxia and muscle weakness, associated with a history of upper respiratory infection. Clinical examination showed paresis of III, IV, and VI cranial nerves of both eyes, areflexia, and distal weakness in the extremities. Treatment with intravenous immunoglobulin was established, leading to a satisfactory clinical evolution.

CHARMM Force Field Parameterization of Peroxisome Proliferator-Activated Receptor γ Ligands.

The peroxisome proliferator-activated receptor γ (PPARγ) ligands are important therapeutic drugs for the treatment of type 2 diabetes, obesity and cardiovascular diseases. In particular, partial agonists and non-agonists are interesting targets to reduce glucose levels, presenting few side effects in comparison to full agonists. In this work, we present a set of CHARMM-based parameters of a molecular mechanics force field for two PPARγ ligands, GQ16 and SR1664. GQ16 belongs to the thiazolidinedione class of drugs and it is a PPARγ partial agonist that has been shown to promote the "browning" of white adipose tissue. SR1664 is the precursor of the PPARγ non-agonist class of ligands that activates PPARγ in a non-classical manner. Here, we use quantum chemical calculations consistent with the CHARMM protocol to obtain bonded and non-bonded parameters, including partial atomic charges and effective torsion potentials for both molecules. The newly parameterized models were evaluated by examining the behavior of GQ16 and SR1664 free in water and bound to the ligand binding pocket of PPARγ using molecular dynamics simulations. The potential parameters derived here are readily transferable to a variety of pharmaceutical compounds and similar PPARγ ligands.

Chronic LPSF/GQ-02 treatment attenuates inflammation and atherosclerosis development in LDLr-/- mice.

BACKGROUND: Atherosclerosis is a complex disorder with a multifactorial pathogenesis. We previously indicated that the new TZD LPSF/GQ-02 inhibits hepatic steatosis and inflammation, which are reported as risk factors for atherosclerosis development. Here, we explored the effects of LPSF/GQ-02 on atherosclerosis in LDLr-/- mice comparing two treatment periods. METHODS AND RESULTS: LDLr-/- mice were fed a high-fat diet for 10 and 12 weeks and received oral treatment with LPSF/GQ-02 (30mg/kg/day) or pioglitazone (20mg/kg/day) for 15 and 30 days, respectively. Both treatment protocols with LPSF/GQ-02 resulted in lower collagen density in the atherosclerotic lesions. In addition, the treatment for 15 days also decreased mRNA levels of CD40, MCP-1, ABCG1 and upregulated PPARα, whereas the 30-days treatment reduced the protein levels of LOX-1, p-IκBα and p-NFκB. CONCLUSION: This study provides evidence that LPSF/GQ-02 affects the composition and growth of atherosclerotic lesions in LDLr-/- mice. Moreover, our data also support previous findings showing anti-inflammatory properties of LPSF/GQ-02 and reinforce the therapeutic potential of this TZD for treating atherosclerosis and inflammation-related disorders.

Clinical presentation and management of uveal melanoma.

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. The majority of the patients are Caucasian (97.8%) and aged 50-80 years. Choroidal melanoma is the predominant type (86.3%). The clinical presentation may range from no symptoms over various types of visual disturbances to visual loss. Examination includes slit-lamp biomicroscopy, indirect ophthalmoscopy and diagnostic testing, such as B-scan ultrasonography. A number of patients with posterior UM are treated with plaque radiation therapy or enucleation. At present, targeted therapy includes inhibitors of the mitogen-activated protein kinase/mitogen-activated protein kinase kinase signaling pathway. UM disseminates hematogenously, with a high propensity for metastasis to the liver, which the most common site (93% of the cases). While UM is uncommon, a significant proportion of affected patients succumb to this disease and new treatment options to improve patient survival are required.

Miller Fisher syndrome: a rare variant of Guillain-Barré syndrome.

This report describes the case of a 39-year-old male patient who presented to the emergency room with complaints of impaired balance, diplopia, and nasal voice. The patient had a history of upper respiratory tract infection. The initial physical examination revealed ataxia, ophthalmoplegia, and areflexia, which are consistent with the classic triad of Miller Fisher syndrome, considered a benign variant of Guillain-Barré syndrome. The patient developed peripheral facial paralysis during hospitalization. He underwent a treatment with immunoglobulin for five days, resulting in near complete resolution of the ataxia. However, the ophthalmoplegia and areflexia persisted. He was discharged to outpatient follow-up.

Oftalmoplejia aguda sin ataxia de carácter recurrente / Recurrent acute ophthalmoplegia without ataxia

Pueden mostrar aumento de anticuerpos anti-GQ1b los síndromes de Miller Fisher, Guillain-Barré con Oftalmoplegia, Rombencefalitis de Bickerstaff y Oftalmoplejia Aguda sin Ataxia, llamadas síndromes anti-GQ1b. Presentamos hombre de 72 años que ingresa por diplopía, oftalmoplejia de instalación aguda y dolor retro-ocular. Tuvo un episodio semejante hace cinco años, recuperado. Al ingreso mostraba oftalmoplejia completa bilateral sin ptosis, miosis y leve enoftalmo del ojo derecho. Potencia muscular conservada, arreflexia osteotendinea, sin compromiso cerebeloso ni sensitivo. LCR y electromiografía normales. RM de cerebro mostraba captación e hiperintensidad (T2) de los pares tercero y sexto. RM de medula espinal no mostró cambio de las raíces espinales. Aumento de GQ1b de 46.2/ 25 en el suero. Mejoró sin tratamiento. Treinta días después, quedaba solo paresia de los sextos pares. El anti-GQ1b es un marcador que identifica las neuropatías con compromiso oculomotor. Las oftalmoplejias agudas sin ataxia tienen reflejos conservados, el 30 por ciento tiene arreflexia. Sólo existen reportes de Síndrome de Guillain-Barré y Miller-Fisher recurrentes con anti-GQ1b. Sería el primer caso descrito de Oftalmoplejia aguda sin ataxia anti-GQ1b, recurrente.

They may exhibit increased anti-GQ1b antibodies in Miller Fisher syndrome, Guillain-Barre syndrome with ophthalmoplegia, Bickerstaff Rhombencephalitis, and Acute Ophthalmoplegia without ataxia , the so called anti-GQ1b syndromes. We report a 72 years old man who was admitted because of diplopia, acute onset ophthalmoplegia and retro-ocular pain. He had a similar episode five years ago, fully recovered. At admission he showed complete bilateral ophthalmoplegia without ptosis, miosis and slight enophthalmos of the right eye. Preserved muscle strength, deep tendon areflexia, without sensory or cerebellar commitment. CSF and electromyography were normal. Brain MRI showed uptake and T2 hyperintensity of the third and sixth cranial nerves. Spinal cord MRI showed no change in the spinal roots. Serum anti-GQ1b increase of 46.2 / 25. He improved without treatment. Thirty days later, paresis was only the sixth pair. The anti-GQ1b is a marker that identifies neuropathies with oculomotor commitment. The acute ophthalmoplegia without ataxia have normal reflex, 30 percent had areflexia. There are only Guillain-Barré and Miller-Fisher syndromes recurrent case reports with anti-GQ1b. It would be the first case of recurrent anti-GQ1b-positive acute ophthalmoplegia without ataxia.