Mode of delivery and pelvic floor muscle strength and sexual function after childbirth.

OBJECTIVE: To investigate the respective roles of the mode of delivery and strength of pelvic floor muscles in the sexual function of women. METHOD: Thirty-two women who were delivered vaginally and 21 women who underwent cesarean delivery at the Celal Bayar University School of Medicine Obstetrics Department were enrolled in the study, and 15 nulliparas were recruited as controls. Sexual function was assessed in all women by a validated questionnaire (the Female Sexual Function Index). Desire, arousal, lubrication, orgasm, satisfaction, and pain were measured separately, and pelvic floor muscle strength was assessed by a perineometer. Sexual function was compared among the 3 groups. The correlation between pelvic floor muscle strength and sexual function was also investigated. RESULTS: Pelvic floor muscle strength was significantly lower in the group vaginally delivered compared with the group delivered by cesarean section and the nulliparous group (P<0.05). There was no difference between the groups regarding sexual function (P>0.05), and there was also no correlation between sexual function and pelvic muscle strength. CONCLUSION: Pelvic floor muscle strength and mode of delivery did not affect sexual function in our study participants. The muscular component of female sexual function should be further investigated.     

医疗器材智能管理系统的开发研究

设计开发了一个医疗器材智能管理系统,改善了医疗器材采购与管理流程,降低了库存量。此系统具有智能、稳定、易用的特点,克服了现有的一些医院M IS的通病。本系统的开发实施,为日益复杂的医院医疗器材的采购与管理事务提供了一个有效的解决方案。     

影响臀位妊娠结局的因素分析

目的 探讨臀位妊娠情况下．影响母儿结局的因素及合理分娩方式的选择原则。方法 对单胎臀位妊娠369例的临床资料进行单因素及多因素分析，找出影响单胎臀位妊娠结局的因素。结果 剖宫产组新生儿需转NICU率、新生儿并发症率、围产儿死亡率均较阴道分娩组低（P〈0．05）。剖宫产组产妇产后出血率及产后并发症发生率均较阴道分娩组高（P〈0．01），足月妊娠度剖宫产对臀住妊娠的新生儿有利．而剖宫产对母亲来说则是不利因素。结论 臀位妊娠分娩方式的选择应全面考虑围产儿及母亲因素，结合产妇及家属的意愿来决定。     

流行性出血热病毒在宿主动物间传播方式及其流行病学意义的研究

应用血清学检测技术在驻地进行了流行性出血热病毒在宿主动物间传播方式及其流行病学意义的研究。结果表明在自然条件下主要宿主间存在水平传播的垂直传播等方式，其中以密切接触传播为主，经破损皮肤感染为主要途径，并且多发生在成年，这对ＥＨＦ疫源地的扩散和演变起着重要作用。而垂直传播对ＥＨＦ疫源地保存与延续具有重要意义。     

Fluoxetine: an update of its use in major depressive disorder in adults

The selective serotonin reuptake inhibitors (SSRIs) have emerged as a major therapeutic advance in psychiatry. They have emphasized the pathophysiological role of serotonin (5-HT) in affective disorders. Indeed, SSRIs were developed for inhibition of the neuronal uptake for serotonin (5-HT), a property shared with the TCAs (tricyclic anti-depressants), but without affecting the other various central neuroreceptors (ie, histamine, acetylcholine and adrenergic receptors) that are responsible for many of the safety and tolerability problems with TCAs. In this way, fluoxetine and other SSRIs represent a major advance over tricyclics, because of their lower toxicity. While the position of fluoxetine relative to other selective serotoninergic antidepressants requires further investigation, fluoxetine has a more favorable tolerability profile for a similar efficacy in comparison to tricyclic antidepressants. The pharmacokinetic and pharmacodynamic properties of fluoxetine are well described. After oral administration, fluoxetine is almost completely absorbed. Due to hepatic first-pass metabolism, the oral bioavailability is < 90%. Fluoxetine has a half-life of 2-7 days, whereas the half-life of norfluoxetine ranges between 4 and 15 days. This long half-life of fluoxetine may be advantageous when the patient omits a dose since drug concentrations decrease slightly. On the other hand, in the case of fluoxetine non-response, long washout periods are necessary before switching the patient to a TCA or a MAO inhibitor to avoid drug interactions or the development of a 5-HT syndrome. As a class, SSRIs are considerably more selective in comparison to TCAs in terms of their central nervous system mechanisms, but differ in other clinically relevant aspects. This action affects several specific 5-HT receptors, which, in turn, effects a multitude of neural systems and signalization pathways. However, despite the facilitating serotoninergic neurotransmission, the direct mechanism by which a SSRI exerts its anti-depressant activity remains uncertain. The therapeutic response in major depression for SSRIs (ie 15-20 days) maybe due to a progressive desensitization of somatodendritic 5-HT autoreceptors in the midbrain raphe nucleus. On the other hand, it has also been postulated that 5-HT is a modulator of several neurophysiological pathways, including dopamine, noradrenaline, but also neurotrophic factors, intra-cytoplasmic phosphorylations and nuclear genes expression. Therapeutic activity of SSRIs may finally results in a complex modulation and homeostasis between monoaminergic neurotransmisson and neuronal plasticity. In term of health-care, the introduction of fluoxetine and other SSRIs in the 1980s has radically changed the treatment of depressive disorder worldwide and they have emerged as the first line of treatment for depressive disorders. The efficacy of fluoxetine is now well established in the treatment of major depressive disorder. Indeed, this efficacy has been assessed in numerous clinical controlled trials involving patients with major depressive disorders. Meta-analysis were carried out and confirmed that fluoxetine was as effective as the tricyclic antidepressants, and appeared more effective than placebo in improving the symptoms of depression. However, there is no scientific evidence to suggest that any one SSRI is more effective than another, but not all patients respond to the same agent. Looking to the future, we need further comparative studies of the SSRIs with the next generation of antidepressants such as 5-HT noradrenaline reuptake inhibitors (SNRIs, Venlafaxine). Actually, it is interesting to note that, whereas the emphasis with the SSRIs has been on their selectivity, recent developments have tended to move towards less selective agents, and now to other neurobiological pathways (ie neurotrophic factors). Finally, fluoxetine, in common with other SSRIs, remains today a first-line treatment option for major depressive disorder.     

原位再生医学教育人才培养模式的思考

目的：为了适应教育服务与复合型人才培养要求,探讨原位再生医学教育人才培养策略。方法：试从原位再生医学教育面临的问题、再生医学教育背景、教育模式、培养目标和再生医学精神方面论述原位再生医学教育人才培养模式思考。通过科学和艺术双重特点教育手段．再生医学基础理论突出实用性;再生医学专业理论突出针对性、再生医学人文知识突出应用性、淡化烧伤外科意识和学科意识。通过教学培育再生医学精神,如平等的多元化意识,理性的批判态度、自由的个性特征和非功利的超现实追求。使之成为毕生昂然进取、发奋建树、渴望勤勉之后的荣誉和荣誉之后淡泊的超越前人的一代“再生医学人”．通过教学培育人文精神．如“经验、体察、认知为特征的利学主体精种．以仁爱、克己、敬业为特征的伦理主体精神,以激情、想象、形象为特征的审美主体精神。将烧伤新例分析救治过程引入课堂,构建学习再生医学知识、培养能力、提高素质融为一体的课程体系．以再生医学技术应用能力和基本知识为主线的理论教学体系和实践教学体系,即课堂教学-临床见习教学-实习教学一体的培养模式。结果：经过十余年的艰苦探索和实践．再生医学教育的教学成果不仅使我们拥有了3届专业思想稳定,深受用人单位欢迎的毕业生,更重要是锻炼了以烧伤科为基础的一支具有一定专业知识和教学能力的教师队伍。结论：构建我国原位再生医学教育人才培养模式,对于培养质量高的、具有创新和竞争力的高级原位再生医学专门人才有着重要意义。     

Usefulness of Peak-to-Peak Pulsatility Index in Infrainguinal Bypass Graft Surveillance

Purpose. We conducted this study to find out whether the peak-to-peak pulsatility index (PPI) predicted graft failure and which factors affected the PPI.Methods. Color-duplex sonography was used to take 520 scans of 74 infrainguinal bypasses, 62 of which were femoropopliteal bypasses and 12 of which were femorocrural bypasses. Vessel diameter and velocity waveform were measured in the graft as well as in the proximal and distal arteries.Results. There were 13 cases of graft failure. The PPI in the mid-graft was significantly different in the normal group (12.30 ± 8.77) and the graft failure group (4.17 ± 1.79). A PPI of less than 7.0 in the mid-graft was defined as graft failure, with a sensitivity of 96.0% and a specificity of 77.6%. There was no correlation between the graft diameter and the PPI. The average mode frequency was inversely correlated with the PPI (PPI = 44.8 × Mode F^–1 + 3.50, correlation co-efficient: 0.78).Conclusion. One point measurement of the PPI in the mid-graft could be a simple and useful parameter for diagnosing graft failure, based on our finding that the waveform was very similar in the proximal artery, the entire graft, and the distal artery. PPI was inversely correlated with average mode frequency because reverse flow decreased or diminished when a significant stenosis existed.     

内镜中心创新模式的建立

为促进学科间协调发展、优化资源配量,该院将消化科内镜室、普通外科内窥镜室、纤维支气管镜室和膀胱镜检查室整合为内镜中心,实现了内镜检查的中心化、一体化管理。文章通过阐述内镜中心的发展思路、管理模式与主要结构,介绍该院内镜中心的工作模式与管理体会。     

Web环境下统计图表的一种生成方法

利用Windows的图形设备接口GDI+提供的图形工具库(即System.Drawing名称空间的GDI+),将程序代码分布在Web服务器端,用户通过浏览器访问相应的网页并运行服务器端代码,动态地生成图表,然后以GIF或JPG图形的形式发送给客户端提交给用户。最后给出一个生成直条图的例子及程序代码。     

Renal Prognosis in Alport's and Related Syndromes: Influence of the Mode of Inheritance

Progressive hereditary nephritis is subdivided into Alport'ssyndrome (with extrarenal involvement) and hereditary nephritiswithout deafness. Three modes of inheritance have been described:X-linked dominant, autosomal dominant, and autosomal recessive.We reviewed the mode of inheritance in 48 kindred with hereditarynephritis (41 with Alport's syndrome and 7 with hereditary nephritiswithout deafness). It was presumed X-linked dominant in 34 Alport'ssyndrome and 6 hereditary nephritis without deafness, autosomaldominant in five hereditary nephritis and one hereditary nephritiswithout deafness, and autosomal recessive in two Alport's syndrome.We studied the cumulative renal survival of 149 patients, 128(76 males, 52 females) with Alport's syndrome and 21 (10 males,and 11 females) with hereditary nephritis without deafness.Major prognostic factors were the patient's sex (median renalsurvival in males and females being respectively 32 versus 61years in Alport's syndrome and 34 versus 57 years in hereditarynephritis without deafness), and the mode of inheritance (medianrenal survival in males being 25 years in X-linked dominantAlport's syndrome versus 51 years in autosomal dominant Alport'ssyndrome). The presence of hearing loss in the kindred or inthe patient himself did not appear as a significant prognosticfactor. We conclude that Alport's syndrome and hereditary nephritiswithout deafness are predominantly X-linked dominant diseaseswith the same renal outcome, and that in Alport's syndrome thepatient's sex and the mode of inheritance are two independentprognostic factors.