坤泰胶囊联合来曲唑在PCOS不孕症患者中的应用效果

目的：探究坤泰胶囊联合来曲唑治疗多囊卵巢综合征（PCOS）不孕症患者的效果。方法：采用随机数字表法将2020年6月至2022年3月收治的100例PCOS不孕症患者分为对照组和观察组各50例。对照组服用来曲唑片治疗，观察组采用坤泰胶囊联合来曲唑片治疗。比较两组性激素水平、成熟卵泡数、子宫内膜厚度、子宫容受性、排卵率和妊娠率及不良反应发生情况。结果：两组治疗后促黄体生成激素（LH）、促卵泡生成激素（FSH）、睾酮（T）、雌二醇（E2）、泌乳素（PRL）水平均降低，且观察组水平均低于对照组（P＜0.05）；两组治疗后孕酮（P）均升高，且观察组水平高于对照组（P＜0.05）；观察组治疗后直径≥18 mm的成熟卵泡数、子宫内膜厚度及子宫容受性均大于对照组（P＜0.05）；观察组治疗后排卵率、妊娠率均高于对照组（P＜0.05）；两组不良反应发生率对比，差异无统计学意义（P＞0.05）。结论：坤泰胶囊与来曲唑联合治疗能够发挥中西药结合的优势，获得更好的治疗效果，临床应用安全性较高，利于改善患者性激素水平、子宫内膜厚度及子宫容受性，保护卵巢功能，促进卵泡发育，提高排卵率和妊娠率。     

益肾舒肝汤治疗无排卵性不孕症对患者超声动态多参数的影响评价

目的：评价益肾舒肝汤治疗无排卵性不孕症对患者超声动态多参数的影响。方法：回顾性分析2019年5月~2020年5月妇产科收治的62例无排卵性不孕症患者临床资料，按照随机数字表法分为观察组和对照组各31例。对照组患者接受不孕症常规治疗，观察组患者接受益肾舒肝汤治疗。比较两组患者卵泡发育（卵泡数目）、子宫动脉血流灌注[搏动指数（PI）、阻力指数（RI）]、子宫内膜容受性（子宫内膜厚度）变化情况。结果：观察组患者治疗后卵泡数目多于对照组，PI指数、RI指数、子宫内膜厚度大于对照组，差异有统计学意义（P＜0.05）。结论：益肾舒肝汤治疗无排卵性不孕症对患者超声动态多参数的影响十分积极，可促进卵泡发育，增加子宫内膜厚度。     

二甲双胍联合炔雌醇环丙孕酮治疗多囊卵巢综合征不孕症的临床研究

目的：探讨二甲双胍联合炔雌醇环丙孕酮治疗多囊卵巢综合征（PCOS）不孕症的疗效,及对患者多种性激素水平与妊娠结局的影响。方法：选取2018年5月至2021年5月收治的PCOS不孕症患者90例,按数字奇偶法分为两组,各45例。对照组予以炔雌醇环丙孕酮治疗,研究组采用二甲双胍联合炔雌醇环丙孕酮治疗。治疗3个月经周期后评定两组治疗优良率,治疗前后睾酮（T）、雌二醇（E2）、卵泡生成激素（FSH）、黄体生成素（LH）水平,治疗后成熟卵泡个数、促排卵天数、排卵率、妊娠率及不良反应发生情况。结果：研究组治疗优良率95.56%,高于对照组的77.78%（P＜0.05）。两组治疗后血清T、LH、FSH水平均低于治疗前,且研究组治疗后低于对照组（P＜0.05）;两组治疗后血清E2水平高于治疗前,而研究组治疗后高于对照组（P＜0.05）。治疗后研究组成熟卵泡个数（2.15±0.37）个,多于对照组的（1.03±0.29）个;研究组排卵天数（9.34±1.15） d,少于对照组的（12.17±1.68） d（P＜0.05）。研究组排卵率91.11%、妊娠率53.33%,分别高于对照组的66.67%、28.89%（P＜0.05）。两组不良反应发生率比较,差异无统计学意义（P＞0.05）。结论：PCOS不孕症患者采用二甲双胍联合炔雌醇环丙孕酮治疗,可调节机体性激素,促进卵泡成熟,提高排卵率及妊娠率,疗效较好,且安全性较高。     

针刺疗法联合补肾活血中药治疗多囊卵巢综合征导致不孕症的临床观察

目的：探究针刺疗法联合补肾活血中药治疗多囊卵巢综合征导致不孕症患者的效果。方法：选取2018年5月至2022年5月收治的多囊卵巢综合征患者60例，按照随机数字表法分为对照组和观察组各30例。两组均采用炔雌醇环丙孕酮片治疗，对照组再服用枸橼酸氯米芬片，观察组在对照组的基础上加用针刺疗法联合补肾活血中药治疗。对比两组临床疗效、中医证候积分、性激素水平、卵巢功能、排卵及妊娠情况。结果：观察组治疗总有效率高于对照组（P＜0.05）；治疗后，观察组中医证候积分低于对照组（P＜0.05）；观察组卵泡刺激素（FSH）、睾酮（T）、黄体生成素（LH）水平低于对照组（P＜0.05）；观察组子宫内膜厚度、最大卵泡直径、优势卵泡数均优于对照组（P＜0.05）；观察组排卵率、妊娠率均高于对照组（P＜0.05）。结论：针刺疗法联合补肾活血中药治疗多囊卵巢综合征导致不孕症患者效果显著，利于改善其性激素水平，优化卵巢功能，提高排卵率及妊娠率。     

自拟补肾健脾方联合暖宫孕子胶囊治疗多囊卵巢综合征的临床疗效

目的：分析自拟补肾健脾方联合暖宫孕子胶囊对多囊卵巢综合征（PCOS）的影响。方法：选取2018年4月至2020年4月收治的PCOS患者104例,按照随机数字表法分为常规组与观察组,各52例。常规组采用暖宫孕子胶囊,观察组采用自拟补肾健脾方联合暖宫孕子胶囊。对比两组疗效、治疗前后卵泡数目及卵巢大小、血清脂联素（Visfatin）及血清超敏C反应蛋白（hs-CRP）、性激素[黄体生成素（LH）、睾酮（T）、卵泡刺激素（FSH）、雌二醇（E2）、LH/FSH]水平及不良反应。结果：观察组总有效率94.23%（49/52）高于常规组80.77%（42/52）（P＜0.05）;观察组治疗后卵泡数目、卵巢大小均低于常规组（P＜0.05）;观察组治疗后Visfatin、hs-CRP水平均低于常规组（P＜0.05）;治疗后,两组LH、T、LH/FSH水平均降低,且观察组降低幅度大于常规组,E2水平升高,观察组升高幅度高于常规组（P＜0.05）;治疗后,FSH水平组间比较,差异无统计学意义（P＞0.05）;观察组不良反应发生率7.69%（4/52）与常规组3.85%（2/52）比较,差异无统计学意义（P＞0.05）。结论：自拟补肾健脾方联合暖宫孕子胶囊治疗PCOS临床效果显著,可有效降低患者机体内卵泡数目及卵巢大小,减轻炎症反应,改善患者性激素水平,安全性高。     

持续生脉注射液静脉注射治疗急性冠脉综合征合并心源性休克的疗效观察

目的探讨生脉注射液持续静脉泵入治疗急性冠脉综合征（ACS）合并心源性休克的临床疗效。方法选择2005年1月至2011年3月本院收治的ACS 合并心源性休克患者33例为治疗组,同期住院ACS 患者32例为对照组,将治疗组再按不同中医证型分为阴虚型（15例）、气虚型（11例）、血瘀型（7例）。两组均给予西医常规治疗,对照组在西医常规治疗基础上给予生脉注射液30～60 mL 静脉滴注（静滴）,每日1次;治疗组给予生脉注射液10～100 mL/h 微量泵持续静滴,血压恢复正常后生脉注射液5 mL/h 微量泵持续静脉注射,连续5～7 d。观察两组患者治疗后的临床疗效、血压、心率、临床症状改善情况及治疗组不同中医证型患者平均动脉压（MAP）的变化。结果治疗组显效率〔69.7%（23例）比46.9%（15例）〕、总有效率〔90.9%（30例）比62.5%（20例）〕均明显高于对照组（均P＜0.05）。两组治疗前后血压和心率比较差异均无统计学意义（均 P＞0.05）。治疗后48 h 治疗组临床症状较对照组明显改善〔胸痛：2例（6.1%）比10例（31.3%）,汗出：3例（9.1%）比13例（40.6%）,气短：4例（12.1%）比12例（37.5%）,均P＜0.05;心悸：5例（15.2%）比9例（28.1%）,恶心：3例（9.1%）比4例（12.5%）,但P＞0.05〕,治疗组阴虚型患者的MAP（mm Hg,1 mm Hg＝0.133 kPa）升高较气虚型、血瘀型明显（105.00±8.53比91.00±9.53和89.00±3.53,均P＜0.05）。结论持续生脉注射液静脉注射治疗ACS 合并心源性休克患者疗效显著。     

滋肾促卵汤治疗脾肾亏虚证卵巢早衰的临床研究

目的：研究滋肾促卵汤治疗脾肾亏虚证卵巢早衰的临床疗效。方法：选取郑州市中医院妇科2021年10月至2022年6月收治的脾肾亏虚证卵巢早衰患者170例，按照随机数字表法分为两组。对照组85例采用激素替代治疗，研究组85例在激素替代治疗的基础上联合滋肾促卵汤治疗，两组均治疗3个周期。比较两组临床疗效，治疗前后中医证候积分、卵巢形态结构（窦卵泡数、窦卵泡直径、卵巢体积）、激素水平[（促黄体生成素（LH）、雌二醇（E2）、卵泡刺激素（FSH）、卵巢抗苗勒氏管激素（AMH）]及不良反应发生情况。结果：研究组总有效率（96.47%）较对照组（85.88%）高，差异有统计学意义（P＜0.05）；两组治疗后四肢倦怠、闭经、腰骶酸痛积分与LH、FSH水平均较治疗前降低，且研究组低于对照组；窦卵泡数、窦卵泡直径、卵巢体积与E2、AMH水平均较治疗前提高，且研究组高于对照组，差异有统计学意义（P＜0.05）；研究组不良反应发生率2.35%，与对照组的3.53%相比，差异无统计学意义（P＞0.05）。结论：采用滋肾促卵汤治疗脾肾亏虚证卵巢早衰的疗效确切，可有效促进患者卵巢功能恢复，缓解症状，调节激素水平，且安全性较好。     

补肾填精助孕汤联合西药治疗排卵障碍性不孕症的疗效观察

目的 探讨补肾填精助孕汤联合西药治疗排卵障碍性不孕症的疗效。方法 选取100例排卵障碍性不孕患者随机分为治疗组和对照组各50例,对照组给予克罗米芬治疗,治疗组在对照组基础上联合补肾填精助孕汤治疗。比较两组临床疗效、治疗前后子宫内膜厚度、最大卵泡直径、排卵及妊娠情况。结果 治疗组临床治疗有效率88.00%高于对照组72.00%(P0.05);治疗组治疗后子宫内膜厚度、最大卵泡直径均大于对照组(P0.05);治疗组排卵率、妊娠率分别为84.00%、58.00%均高于对照组66.00%、38.00%(P0.05)。结论 补肾填精助孕汤联合西药治疗排卵障碍性不孕具有较好的疗效,能够增加子宫内膜厚度、最大卵泡直径,提升排卵率及妊娠率。     

腹腔镜穿刺术治疗多囊卵巢临床分析

多囊卵巢（PCO）患者非排卵性不孕可用抗雌激素药物诱导排卵，但部分患者无效、本文介绍腹腔镜卵巢穿刺术对PCO不同型的疗效。1资料与方法1．1一般资料1993年10月～1997年5月，我院共收治PCO患者361例，术前均给予数种促排卵药物治疗无效。年龄20～35岁，平均26岁。不孕年限1～8年，平均3．5年。1．2诊断结合病史，内分泌和阴道彩色多普勒超声检查。其诊断标准如下：不孕1年以上和无排卵型月经周期；闭经、月经稀发和多毛，LH／FSH＞2；阴道彩色多普勒超声示卵巢中央反射增强，卵泡数目＞10个，且卵泪直径wtgmm［’j。1．3手术方法所…     

二甲双胍联合来曲唑对多囊卵巢综合征合并不孕患者内分泌代谢的影响

目的：评价多囊卵巢综合征合并不孕患者采用二甲双胍联合来曲唑治疗对其内分泌代谢的影响。方法：按照随机数字表法将2019年1月至2020年11月就诊于洛阳市妇幼保健院的202例多囊卵巢综合征合并不孕患者分为对照组与实验组，各101例。对照组接受来曲唑治疗，实验组接受来曲唑联合二甲双胍治疗，均治疗3个月经周期。对比两组宫颈黏液评分、成熟卵泡数、诱排日子宫内膜厚度、药物副作用，并观察治疗前、治疗3个月经周期后性激素水平、糖脂代谢、卵巢功能的变化。结果：实验组宫颈黏液评分、成熟卵泡数、诱排日子宫内膜厚度均优于对照组高（P＜0.05）；治疗后，实验组血清促卵泡刺激素（FSH）、促黄体生成激素（LH）、睾酮（T）、雌二醇（E2）水平均低于对照组（P＜0.05）；治疗后，实验组总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）与对照组相比，差异无统计学意义（P＞0.05）；治疗后，实验组甘油三酯（TG）、胰岛素抵抗指数（HOMA-IR）、切面卵泡数目（FN）、卵巢体积（V）均优于对照组（P＜0.05）；实验组妊娠率（57.43%）、月经改善率（72.28%）均高于对照组（28.71%、43.56%）（P＜0.05）；实验组不良反应发生率（8.91%）与对照组（12.87%）相比，差异无统计学意义（P＞0.05）。结论：多囊卵巢综合征合并不孕患者采用二甲双胍联合来曲唑治疗的效果明显，可改善月经情况、性激素水平与卵巢功能，调节胰岛素抵抗，提高成熟卵泡数与妊娠成功率，且未明显增加不良反应。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.