锻炼心理学中动机理论：自我决定理论的新进展

目的:对锻炼心理学中的自我决定理论进行简要概述与分析。资料来源:检索中国期刊网、EBSCO和UMI资料库1997-01/2006-10有关自我决定理论的文献,检索词(限制为标题)为“self-determination theory,sport and exercise”,限定语言种类为英文。资料选择:对所获得的文献进行仔细研读,从中选择有关自我决定理论在锻炼心理学中实证研究的文章,排除重复研究类文章。资料提炼:在53篇文献中,删除7篇内容重复的文献;对46篇文献进行分类整理,其中30篇选为参考文献。资料综合:自我决定论是新近发展起来的一种认知动机理论,代表着当下动机理论研究的趋向。它把人类的动机看成是一个从外在调节到内在动机之间的动态的连续体,并依据自主的程度对动机的类型进行了详细的划分,同时从满足人们基本心理需要的角度对促进外在动机内化的条件进行了探讨。结论:自我决定理论还有许多待以完善的地方,关于自我决定理论的一些假设还有待于进一步的验证。     

大鼠海马注射β-淀粉样蛋白1-40后β位淀粉样前体蛋白裂解酶1mRNA表达及加减地黄饮子提取物的干预烛

目的：观察SD大鼠海马立体定向注射β-淀粉样蛋白1-40后β位淀粉样前体蛋白裂解酶1mRNA表达的变化及加减地黄饮子对其的干预作用。方法：①实验于2005-09／2006-09在齐齐哈尔医学院医药科学研究所完成。②选用100只SD大鼠随机分为空白对照组、假手术对照组、模型对照组、盐酸多奈哌齐组、加减地黄饮子组共5组，每组20只。通过海马立体定向注射β-淀粉样蛋白，40诱导老年性痴呆动物模型。③盐酸多奈哌齐按0.33mg，（kg·d）给药，加减地黄饮子组按1.0g，（kg·d）给药，共给药28d。空白对照组和假手术对照组给予等量生理盐水。④第5周处死大鼠，应用实时定量PCR法检测大脑海马组织13位淀粉样前体蛋白裂解酶1mRNA表达（用2^-△△ct表示，Ct为阈循环值，△Ct=Ctbace1CtGAPDH，△△Ct=△Ct各干预组-△Ct空白对照组）。⑤多组间差异的显著性分析用单因素方差分析，组间两两比较运用LSD-f检验。结果：实验选用100只大鼠，每组随机选5只用于抽提大脑海马组织总RNA，因此共有25只大鼠纳入结果分析。β位淀粉样前体蛋白裂解酶12^-△△ct值模型组（4.67±0.52）显著高于假手术对照组（1.07±0.08）（P〈0.01），表明模型组B位淀粉样前体蛋白裂解酶1mRNA表达上调。盐酸多奈哌齐组（1.80±0.23）和加减地黄饮子组（1.26±0.20）显著低于模型对照组，表明13位淀粉样前体蛋白裂解酶1mRNA表达下调。结论：大鼠大脑海马注射β-淀粉样蛋白，40后海马组织β位淀粉样前体蛋白裂解酶1mRNA表达水平明显增高，加减地黄饮子提取物可以抑制海马组织β位淀粉样前体蛋白裂解酶1mRNA的表达，从而发挥抗老年性痴呆的作用。     

Predictors of One Year Outcome in Lupus Nephritis: The Importance of Renal Biopsy

The short-term prognosis of lupus nephritis was evaluated byassessing serum creatinine 12 months after renal biopsy in 87patients with lupus nephritis. On univariate analysis, significantclinical and laboratory predictors of this outcome includedclinical signs of renal injury (serum creatinine, 24-hour urinaryprotein, prolonged renal disease, nephrotic syndrome, serumalbumin), as well as thrombocytopenia, older age, and coexistingillness or hypertension at the time of biopsy. On renal biopsy,diffuse proliferative nephritis, higher activity, chronicity,or tubulointerstitial scores, or subendothelial or subepithelialelectron dense deposits predicted a higher serum creatinine12 months after biopsy. A clinical predictive model was developed which included asindependent predictors serum creatinine, age, platelet countand 24-hour urinary protein. Any one of three biopsy variablesadded information to the clinical prediction model: a markedquantity of subendothelial deposits (p=0.02), a higher activityindex score (p=0.02), or the presence of diffuse proliferativelupus nephritis (p=0.05). However, the relative predictive accuracyof the clinical model did not improve with the addition of anyof the biopsy variables. The value of renal biopsy in lupus nephritis is discussed basedon the ability of biopsy information to confirm the prognosis,to add new predictive information for a group of subjects, andto improve predictive accuracy for individual patients.     

Infection or suspected infection after hip replacement surgery with autologous or homologous blood transfusions

Homologous blood transfusions have been associated in both animals and humans with an increased risk of acute postoperative infectious complications. Eighty-four patients who underwent hip replacement surgery and were transfused with 2 or 3 units of blood were analyzed to determine whether those receiving homologous transfusions had different outcomes than those receiving autologous blood only. Only patients free of other risks for postoperative infection were studied. Those receiving homologous blood had a 32 percent (16/50) rate of proven or suspected infections, which was significantly higher than the 3 percent (1/34) rate in patients receiving autologous blood (p = 0.0029). Wound infections accounted for only a minority (6/17) of the proven or suspected infections, which suggests that nonsurgical factors contributed to these complications. The patients identified as being infected required significantly more antibiotic therapy (mean, 7.6 days) and lengthier hospital stays (mean, 15.5 days) than the patients who remained free of evidence of infection (means: 2.3 days of antibiotics and 12.3 days in the hospital) (p = 0.0001 for each variable). Other potential risk factors for infection, such as duration of surgical procedure, advanced patient age, amount of blood loss, type of anesthesia, surgeon performing the operation, use of a cemented versus porous-coat prosthesis, leukocytopenia, anemia, and underlying medical diagnosis, did not account for the differences in infection rates seen in those receiving homologous and autologous transfusions. These results confirm previous reports of an increased risk of postoperative infection in patients receiving homologous transfusions. Homologous transfusion may contribute to an increased risk of infection by immunologic modulation of the recipient.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mycobacterial Infections After Renal Transplantation

Mycobacterial infections occurred in 11 of 633 (1.7 per cent)recipients of successful renal transplants. There were no casesof tuberculosis in patients receiving chemoprophylaxis, butamongst those who did not receive prophylaxis disease occurredin six of the 27 (22 per cent) high-risk patients. The majorcause of morbidity during treatment was renal allograft rejection,largely due to reduction in immunosuppressive drug therapy.     

Hepatitis C virus among blood donors: follow-up study

BACKGROUND: The exact significance of antibodies to hepatitis C virus (HCV) in blood donors remains unknown. Confirmatory tests of anti-HCV- reactive serum and HCV RNA by polymerase chain reaction (PCR) are used to refute a large proportion of false-positive results. STUDY DESIGN AND METHODS: Ninety-two blood donors who were anti-HCV reactive in a first-generation enzyme-linked immunosorbent assay (ELISA) were reevaluated 10 months later with a second-generation ELISA (ELISA-2) as well as with second-generation recombinant immunoblot assay (RIBA-2) and by PCR. RESULTS: Twenty-five (43.9%) of the 57 ELISA-2-positive donors were confirmed as positive by RIBA-2; of these, 84 percent were HCV RNA positive in PCR. Of the 57 who were still anti-HCV positive, 46 were followed up and tested again in the same manner 2 years after the first screening. At that time, the pattern was little changed: 94 percent of RIBA-2- and PCR-positive donors remained positive. Of RIBA-2- and PCR-positive blood donors, 62 percent had abnormal alanine aminotransferase levels in at least one of the three evaluations. Among the anti-HCV-positive donors confirmed by RIBA-2, 60 percent, versus 12.6 percent in the control group, had a significantly (p < 0.001) more frequent risk factor for HCV infection, due to parenteral exposure to blood. CONCLUSION: These data confirm a good correlation between RIBA-2 reactivity and the detection of HCV RNA in a population of anti-HCV- positive blood donors.     

Fluoxetine in orthostatic hypotension of Parkinson's disease: A clinical and experimental pilot study

Summary— Recent clinical studies have reported a beneficial effect of fluoxetine, a serotonin reuptake inhibitor, in patients with severe refractory orthostatic hypotension. The present study was undertaken to investigate the effect of fluoxetine in orthostatic hypotension occurring during Parkinson's disease on both blood pressure values and number of clinical symptoms during orthostatic procedure evaluated using a validated clinical rating scale. In a pilot study performed in fourteen patients with idiopathic Parkinson's disease plus orthostatic hypotension, fluoxetine hydrochloride (20 mg orally daily during one month) significantly reduced the fall in systolic blood pressure [-33 ± 21 (SD) mmHg before fluoxetine vs -22 ± 19 mmHg after fluoxetine, P = 0.03] elicited by standing without modifying heart rate. The drug also significantly reduced the number of postural symptoms occurring during the orthostatic procedure [2.9 ± 1.5 (SD) before fluoxetine vs 1.2 ± 1.3 after fluoxetine, P = 0.006]. A similar pattern of response was obtained in an experimental model of neurogenic orthostatic hypotension obtained in chronically sino-aortic denervated dogs submitted to an 80° head-up tilt test procedure under chloralose anaesthesia. Fluoxetine did not change plasma noradrenaline levels. This pilot study suggests a slight but clinically significant effect of fluoxetine on both hemodynamic parameters and clinical symptoms in parkinsonian patients suffering from orthostatic hypotension.     

Tuberculosis in Patients Infected with Human Immunodeficiency Virus 1. A Retrospective Multicentre Study of 123 Cases in France

SUMMARY In order to study the epidemiological, clinical, and progressivecharacteristics of TB in HIV-infected individuals, a retrospectivestudy was conducted in nine infectious disease centres of universityhospitals located in the southern half of France. Among the5730 HIV-seropositive in- and out-patients, 123 (2.1 per cent)had TB (121 infections caused by M. tuberculosis, 2 by M. bovis).Tuberculosis was pulmonary in 53 patients (43.1 per cent), extrapulmonaryin 36 patients (29.3 per cent), and combined in 34 patients(27.6 per cent). There was no statistically significant differenceamong these three locations as to the mean CD4 count/mm³ (160±17),the type of antituberculosis therapy, the length of treatment(10.8±0.6 months) and the outcome. Fifty-two (45.2 percent) patients received an initial antituberculosis therapeuticregimen of four drugs: isoniazid, rifampicin, ethambutol, pyrazinamide;54 (46.9 per cent) were started on three drugs: isoniazid, rifampicin,ethambutol; and nine (7.8 per cent) received a two-drug combination:isoniazid, rifampicin. Fourteen of 75 patients subsequentlyreceived secondary preventive therapy. The mean follow-up timewas 252±290 days. Clinical healing was obtained in 57.7per cent of patients. Forty-six patients died, 33 during treatment:23 from AIDS and eight from TB (in the first 3 weeks of treatment).Five patients suffered from relapses due to poor treatment compliance.Patients had a good prognosis if tuberculosis was diagnosedearly.     

Opportunistic infections and organ‐specific diseases in HIV‐1‐infected children: a cohort study (1990–2006)

Objectives

Highly active antiretroviral therapy (HAART) has dramatically changed the natural history of HIV infection in children, but there are few studies in the literature about the incidence of clinical manifestations after HAART in this population, compared with adults. The aim of this study was to describe the influence of the widespread use of HAART on the development of opportunistic infections and organ‐specific diseases in HIV‐infected children.

Methods

An observational study of a cohort of 366 vertically HIV‐infected children followed from 1990 to 2006 was carried out. According to the main antiretroviral protocol used, three calendar periods (CPs) were defined and compared: CP1 (1990–1996: no patients on HAART), CP2 (1997–1999: <60% on HAART) and CP3 (2000–2006: >60% on HAART).

Results

Children experienced a progressive increase in CD4 T cell count (P<0.05) and a decrease in HIV viral load from 1996 onwards (P<0.05). Similarly, rates of death, AIDS, opportunistic infections (bacteraemia, candidosis, cryptosporidiosis and bacterial pneumonia) and organ‐specific diseases (wasting syndrome, thrombocytopenia, cardiomyopathy, lymphoid interstitial pneumonia and HIV‐associated encephalopathy) were lower in CP2 and CP3 than in CP1.

Conclusions

This study provides evidence of improved clinical outcomes in HIV‐infected children over time and shows that mortality, AIDS, opportunistic infections and organ‐specific diseases declined as HAART was progressively instituted in this population.

     

Diagnosis of advanced fibrosis in HIV and hepatitis C virus-coinfected patients via a new noninvasive index: the HGM-3 index

Background

Noninvasive tests are increasingly being used for the assessment of liver fibrosis. We aimed to develop a serum index for the identification of advanced fibrosis (F≥3) in HIV/hepatitis C virus (HCV)‐coinfected patients.

Methods

We carried out a cross‐sectional study on a group of 195 patients comprised of an estimation group (EG; n=127) and a validation group (VG; n=68) who all underwent liver biopsy and had not received previous interferon therapy. Liver fibrosis was estimated using the METAVIR score. We developed a new serum index (HGM‐3) dependent on levels of platelets, alkaline phosphatase, hepatic growth factor, tissue inhibitor of metalloproteinase‐1 and hyaluronic acid.

Results

In the EG, the area under the receiver operating characteristic curve (AUC‐ROC) of HGM‐3 for identification of F≥3 was 0.939 [95% confidence interval (CI) 0.899, 0.979] which was significantly higher than the AUC‐ROC of the HGM‐2, FIB‐4, aspartate aminotransferase to platelet ratio (APRI) and Forns' indexes. With HGM‐3 <0.135 for F<3, 57 patients were correctly identified and two patients were misclassified. We found the presence of F<3 with 96.6% certainty. The negative likelihood ratio (LR) was <0.1 and the diagnostic odds ratio (DOR) was >40. With HGM‐3 >0.570 in the EG for F≥3, 31 patients were correctly identified, and five patients were misclassified. We found the presence of F≥3 with 86.1% certainty. The positive LR was >12 and the DOR was >40. For the VG, the diagnostic accuracy values were similar to the values for the EG.

Conclusions

HGM‐3 appears to be an accurate noninvasive method for the diagnosis of bridging fibrosis and cirrhosis in HIV/HCV‐coinfected patients.