“调任通督”法针刺治疗围绝经期潮热的随机对照研究＊

目的 观察“调任通督法”针刺治疗围绝经期潮热的临床疗效和安全性。方法 将符合纳入标准的72例围绝经期潮热患者，按照1∶1的比例随机分为治疗组（针刺组）和对照组（等待组）。治疗组取穴百会、印堂、神庭、关元、气海、中脘、阴郄、太溪、复溜、三阴交。针刺治疗每次持续30 min，每周2次，连续治疗6周。对照组为等待组，试验期间仅给予同针刺组相同的健康宣教，两组分别于治疗前、治疗第3周、治疗第6周以及第10周随访评估其潮热频率和程度，以及更年期生活质量量表（Menopause-specific quality of life questionnaire，Men-QoL）的变化情况，同时记录针刺不良事件的发生。结果 ①潮热频率及潮热程度：在治疗后及随访时，针刺组较等待组有明显改善，差异具有统计学意义（P < 0.01）。与治疗前相比，针刺组第3周即出现了潮热频率明显下降的趋势（P < 0.01），治疗后以及随访期针刺组潮热频率及潮热程度均较治疗前有明显统计学差异（P < 0.01）。而等待组在各时间点潮热频率及潮热程度均无统计学差异（均P > 0.05）。②围绝经期生活质量量表：治疗后针刺组在Men-QoL总分、血管舒缩功能评分、社会心理、体能状况较等待组比较均有统计学差异（均P < 0.01）。在随访期，针刺组在Men-QoL社会心理以及体能方面明显改善，差异均具有统计学意义（P < 0.01，P < 0.05）。两组Men-QoL性功能在治疗后及随访期均无统计学差异（P > 0.05）。与治疗前相比，在治疗后及随访期，针刺组Men-QoL总分、血管舒缩功能、社会心理、体能状况均有统计学差异（均P < 0.05），在Men-QoL性功能方面无统计学差异（P > 0.05）。等待组在Men-QoL总分及四个域方面均无明显改善，无统计学意义（均P > 0.05）。结论 调任通督法针刺治疗围绝经期潮热安全有效，且对围绝经期生活质量有所改善。     

Recurrent pregnancy loss due to familial and non-familial habitual molar pregnancy.

OBJECTIVES: To present a series of women with recurrent molar pregnancies, including rare familial cases, and discuss etiology and treatment options. METHODS: We performed a detailed clinical evaluation and pedigree analysis of five Egyptian women with recurrent pregnancy loss due to molar pregnancy. RESULTS: The women had a history of four to nine consecutive hydatidiform moles but of no viable pregnancies. Two of the women had molar pregnancies with different husbands who themselves had viable offspring from previous wives; and three of them, who belonged to a family with extensive intermarriage, had a pedigree consistent with an autosomal recessive maternal-effect mutation. CONCLUSIONS: Recurrent pregnancy loss due to habitual molar pregnancy is uncommon and familial cases are extremely rare. The etiology of this disorder is not well understood but likely results from a maternal-effect mutation. Management options are limited, especially for couples who desire to have their own genetic offspring.     

卵巢低反应患者大剂量超排卵的助孕结局

在辅助生殖助孕中通常采用控制性卵巢刺激(controlled ovarian hyperstimulation, COS),以获得适当数量的卵子用于体外受精,既希望获得理想的辅助生殖助孕成功率,又能降低卵巢过度刺激并发症.COS中约有9%~24%[1,2]的卵巢低反应发生率.卵巢低反应者获得有效卵子数少、可移植胚胎数少或无胚胎移植、取消治疗周期率高,累计成功率更低等,导致较差的治疗结局,是辅助生殖助孕中面临的棘手问题.针对卵巢低反应者,大多数辅助生殖中心仍会采用增加促性腺激素(Gn)的起始和(或)总用量以期获得提高助孕结局的目的.而大剂量Gn是否为改善低反应患者助孕结局的有效策略却仍存在争议.     

Paternal and Maternal Smoking Habits before Conception and During the First Trimester: Relation to Spontaneous Abortion

PURPOSE: This study examined the association between maternal smoking before and during the first trimester of pregnancy and spontaneous abortion.

METHODS: We have been conducting a hospital-based case-control study on risk factors for spontaneous abortion in the greater Milan area. We collected information from 782 cases of spontaneous abortions and 1543 controls (women who delivered at term healthy infants).

RESULTS: With respect to never smokers, the odds ratio (OR) were 0.7 (95%, confidence interval (CI), 0.5–1.0) for women who quit smoking and 1.3 (95% CI, 1.0–1.6) for those who continued during pregnancy. Women who smoked more than 10 cigarettes/day in the first trimester were at increased risk of miscarriage, with an OR of 1.4 (95% CI, 1.0–2.1). No relationship was evident between the number of cigarettes smoked before conception and the risk of abortion. Likewise, no association emerged between paternal smoking and miscarriage. Moreover, no significant interaction or modification effect was obtained when strata of age and other major characteristics were investigated.

CONCLUSIONS: The risk of abortion associated with cigarette smoking during the first trimester of pregnancy was measurable and noticeable in this population, and accounted for 9% (95% CI, 6–13%) of all cases. The increased risk of spontaneous abortion in women smoking during pregnancy is a further reason to encourage pregnant women to quit.     

The diagnosis of male infertility--prospective time-specific study of conception rates related to seminal analysis and post-coital sperm--mucus penetration and survival in otherwise unexplained infertility

Infertile women without any inherent female infertility factorsand able to secrete normal cervical mucus were studied prospectivelyin relation to post-coital sperm—mucus penetration (PCT)and their partner's seminal analysis, excluding men with azoospermia.Time-specific cumulative conception rates calculated as forlife-table analysis were related to each measured seminal variableon routine analysis of 2–3 samples (volume, density, proportionwith progressive motility, and proportion with normal morphology);to various derivatives from combinations of these variables;to seminal findings after vital staining; and to the PCT results.The best seminal predictor of fertility was the motile normalsperm density (MNSD), the 18 month conception rates being 57.4%+ 4.6 (SE) and 30.2% + 5.9 (ratio 1.9, P < 0.001) above andbelow a derived threshold value of 4 x 10⁶/ml. The PCT led torates of 55.6% ± 4.3 and 14.9% ± 5.1 (ratio 3.73,P < 0.001) for positive and negative results, respectively.The PCT also gave rise to a significantly distinct intermediatepoor-psitive sub-group (conception rate 30.6% ± 9.0).Seminal analysis (the MNSD) did not affect the conception rateassociated with a positive PCT but helped to discriminate furtherwith a negative PCT (conception rates 22.5% ± 8.7 withan MNSD above 4 x 10⁶/ml versus 5.6% ± 4.8 below, P <0.05). The PCT was the single best predictor of fertility butseminal analysis (the MNSD) was of additional value after anegative PCT.     

Children conceived using ICSI do not have an increased risk of delayed mental development at 5 years of age

BACKGROUND: Concerns about possible adverse outcomes for children conceived using ICSI were highlighted in 1998 when 1-year-old ICSI children were found to be at increased risk (relative risk = 9.2) of delayed mental development compared with children conceived naturally or using IVF. As the findings were biologically plausible, it was considered important to reassess child development when a more accurate measure of long-term cognitive ability could be obtained. METHODS: The mental development of 97 ICSI, 80 IVF and 110 naturally conceived (NC) children at 5 years of age was assessed using intelligence quotients (IQ) obtained from the Wechsler Preschool and Primary Scales of Intelligence. RESULTS: The mean full-scale IQ was 110 +/- 18 for ICSI, 111 +/- 13 for IVF and 114 +/- 13 for NC children (P = 0.21, non-significant). ICSI children were not at increased risk for delayed (full-scale IQ <85) cognitive development (ICSI 5.2%, IVF 2.5%, NC 0.9%; P = 0.18, non-significant). The only significant independent predictor of below-average full-scale IQ on multivariate analysis was lower maternal education level. CONCLUSIONS: These findings suggest that the genetic influence of parental cognitive ability is more important than the mode of conception in determining the long-term intellectual ability of children conceived using ICSI.     

高校师资队伍建设的构想

师资是一所高校最重要的资源 ,是高校实现人才培养、科学研究和社会服务三大功能的主体力量 ,也是一所高校在人才培养、科学创造与学术成就以及社会影响力等方面获得竞争优势的决定性因素。在新的历史时期 ,高等院校师资队伍建设的总体目标 ,是建设一支素质良好、结构优化、富有活力、具有创新能力的师资队伍。其具体措施是完善选人机制 ,优化教师资源配置 ;采取得力措施 ,优化教师队伍成才环境 ;建立激励机制 ,加强学科带头人和骨干教师队伍建设 ;强化竞争机制 ,实施和完善教师聘任制 ;强化教师培训 ,全面提高教师素质 ;加大投入 ,确保教师队伍建设落到实处     

Fertility and digital technology: narratives of using smartphone app ‘Natural Cycles’ while trying to conceive

Fertility awareness apps, which help to identify the ‘fertile window’ when conception is most likely, have been hailed as ‘revolutionising’ women’s reproductive health. Despite rapidly growing popularity, little research has explored how people use these apps when trying to conceive and what these apps mean to them. We draw on in‐depth, qualitative interviews, adopting a critical digital health studies lens (a sub‐field of science and technology studies), to explore the experiences of cisgender women and partners with one such app, Natural Cycles, in the context of their daily lives. We found that many women valued the technology as a ‘natural’, inobtrusive alternative to biomedical intervention, and a means of controlling and knowing their bodies, amid a dearth of fertility‐related education and care. Yet this technology also intervened materially and affectively into the spaces of their lives and relationships and privileged disembodied metrics (temperature) over embodied knowledge. Meanwhile, app language, advertising and cost have contributed to characterising ‘typical’ users as white, heterosexual, affluent, cisgender women without disabilities. In the context of neoliberal shifts towards bodily self‐tracking, technologies appealing as novel, liberating and ‘natural’ to individuals who can access them may nevertheless reproduce highly gendered reproductive responsibilities, anxieties and broader health and social inequalities.     

公立医院和民营医院营销理念的分析

目的比较上海地区公立医院和民营医院营销理念引入和运用的差异。方法采用问卷调查和实地采访相结合的方式进行调查,内容主要包括对营销理念的理解、对医院广告的看法、医院品牌和顾客满意度等。结果公立医院的营销理念和意识较民营医院淡薄,营销投入和营销管理尚不及民营医院。结论公立医院要转变观念,正确认识营销,提高营销管理的能力。民营医院要掌握营销的适度性,正确处理营销、盈利和发展的关系。     

邓小平理论的时代观纵横谈

邓小平理论的时代观，始于战争和平观念的转变，成于时代基本特征的高度概括，终于和平与发展两大问题总体对策——建设中国特色社会主义的确立。因此，邓小平理论的时代观是马列主义时代观的新阶段，与时俱进是邓小平理论时代观发展的历史必然性。