人绒毛膜促性腺激素诱发排卵不同状态对自然周期冻融胚胎移植临床结局的影响

目的分析人绒毛膜促性腺激素(h CG)诱发排卵不同状态对自然周期冻融胚胎移植临床结局的影响。方法选择2015年1-12月在河北医科大学第二医院生殖医学中心行自然周期冻融胚胎移植的162例患者为研究对象,给予人绒毛膜促性腺激素(h CG)诱发排卵,24 h和48 h后复查B超,自然排卵者为A组,根据未破裂卵泡黄素化综合征(LUFS)的超声诊断标准,A组中出现黄素化征象者(25例)出组,其余未自然排卵者随机分为B组及C组,B组经阴道穿刺优势卵泡。比较3组患者妊娠结局。结果 3组临床妊娠率、多胎率、异位妊娠率、流产率、活产率比较,差异均无统计学意义(均P0.05)。结论是否排卵不影响自然周期冻融胚胎移植妊娠结局。     

排卵时间对自然周期冻融胚胎移植妊娠结局的影响

目的了解不同排卵时间对自然周期冻融胚胎移植患者临床妊娠结局的影响,分析准确定位排卵时间是否更有利于妊娠结局。方法回顾性分析2015年10月-2017年3月在该院行自然周期冻融胚胎移植的98个周期。按照h CG注射后B超监测到的卵泡破裂时间分为3组:D1组即h CG注射后1d排卵(44个周期),D2组即h CG注射后2d排卵(40个周期),D3组即h CG注射后2d仍未排卵(14个周期)。按照h CG注射后B超监测到的卵泡破裂时间,结合患者排卵痛和血孕酮(P)值,分为两组,传统组以B超监测到的排卵日定为第0天,当天给予黄体酮转化内膜,黄体酮第4日移植(58个周期);优化组当B超监测到排卵时,如满足当日血P值2ng/ml+患者诉前1日10点前出现排卵痛,将前1日定为排卵日即第0天,当天给予黄体酮转化内膜,黄体酮第3日移植(40个周期)。观察并比较各组临床妊娠率、异位妊娠率、早期流产率及胚胎着床率的差异。结果 D1组、D2组和D3组临床妊娠率、异位妊娠率、早期流产率和胚胎着床率比较,差异无统计学意义(P0. 05)。优化组的临床妊娠率明显高于传统组,差异有统计学意义(P0. 05)。结论在行自然周期冻融胚胎移植时,准确定位排卵时间有助于提高临床妊娠率。     

GnRHa在冻融周期胚胎反复种植失败患者中的应用

目的:探讨促性腺激素释放激素激动剂(gonadotrophin releasing hormone agonist,Gn RHa)降调节后对冻融周期胚胎反复种植失败患者子宫内膜容受性及临床结局的影响。方法:回顾性分析2014年1月—2015年8月在广西医科大学第一附属医院生殖医学中心及柳州市人民医院生殖医学中心行131例冻融周期胚胎反复种植失败(≥2次)患者的临床资料,按子宫内膜准备方案分组,其中69例行单纯激素替代疗法(HRT)周期者为HRT组,62例Gn RHa降调节联合HRT周期者为降调节组,从降调节组选取48例既往行HRT周期患者,与本周期进行自身配对比较。结果:HRT组与降调节组患者的年龄、不孕时间、基础性激素水平、体质量指数、子宫内膜厚度、移植胚胎数、移植优质胚胎数、优质胚胎率、早期流产率比较差异均无统计学意义(P>0.05)。降调节组的临床妊娠率、胚胎着床率、子宫内膜A型血流者比例均高于HRT组(P<0.05)。自身对照分析显示,不同内膜准备患者的子宫内膜厚度、优质胚胎率差异均无统计学意义(P>0.05),但降调节者子宫内膜A型血流者比例显著高于单纯HRT周期(P<0.05)。结论:Gn RHa降调节联合HRT方案可以显著提高冻融周期胚胎反复种植失败患者的子宫内膜容受性和临床妊娠率。     

不同黄体支持方案在人绒毛膜促性腺激素诱发排卵自然周期冻融胚胎移植中的临床结局分析

目的:分析不同黄体支持方案在人绒毛膜促性腺激素(hCG)诱发排卵自然周期(NC)方案冻融胚胎移植(FET)过程中的不同临床结局。方法:选择2015年1月—2016年1月采用hCG诱发排卵NC方案FET的35岁以下患者,随机分组,最终入组286例。根据黄体支持方案分为:Ⅰ组(n=81)无黄体支持;Ⅱ组(n=104)口服地屈孕酮20 mg,2次/d;Ⅲ组(n=101)肌内注射黄体酮20 mg/d,同时口服地屈孕酮10 mg,2次/d。比较3组患者一般资料、临床特征、治疗结局。结果:3组患者年龄、不孕年限、不孕类型、不孕原因、基础卵泡刺激素(FSH)水平,体质量指数(BMI)比较差异均无统计学意义(均P0.05)。3组患者的控制性超促排卵方案、受精方式、新鲜周期治疗结局、hCG日激素水平和移植日子宫内膜厚度比较差异均无统计学意义(均P0.05)。3组患者的移植胚胎数、胚胎种植率、临床妊娠率、异位妊娠率、继续妊娠率比较差异均无统计学意义(均P0.05)。结论:对于年轻患者hCG诱发排卵自然周期冻融胚胎移植,不进行黄体支持是可行的。但是临床中需要与患者进行深入的沟通交流。对于有顾虑的患者,口服地屈孕酮方案满意度高、用药方便,可以选择应用。     

多次胚胎移植失败患者采用冻融胚胎移植3种内膜准备方案结局分析

目的:探讨多次移植失败患者不同内膜准备方案对冻融胚胎移植结局的影响。方法:回顾分析多次胚胎移植失败者行冻融胚胎移植资料,其中采用自然周期45例(A组);采用激素替代周期33例(B组);采用降调节后激素替代周期40例(C组)。结果:3组对象的年龄、体重指数、不孕年限、解冻胚胎数、移植胚胎数、转化日雌二醇水平、转化日子宫内膜厚度、自然周期排卵前内膜厚度、早期流产率差异均无统计学意义(P0.05);自然周期中排卵前内膜形态A组和B组优于C组,差异有统计学意义(P0.05);B组、C组的胚胎种植率、临床妊娠率高于A组,差别有统计学意义(P0.05),B组与C组之间差别无统计学意义(P0.05);B组的移植优胚数高于C组(P0.05),A组与C组、A组与B组差别均无统计学意义(P0.05)。冻融胚胎移植周期中A组和B组转化日内膜形态优于C组,差异有统计学意义(P0.05)。结论:对于多次移植失败者采用激素替代和降调节后激素替代子宫内膜准备法行冷冻胚胎解冻移植可获得较好的妊娠结局,对于子宫内膜形态欠佳者,建议行降调后激素替代方案。     

3种内膜准备方案对多次胚胎移植失败患者冻融胚胎移植结局的影响

目的 分析自然周期、激素替代周期与降调节后激素替代周期内膜准备方案对多次胚胎移植失败患者冻融胚胎移植结局的影响.方法 选取海南省妇幼保健院生殖医学中心与南京医科大学附属苏州医院生殖与遗传中心在2015年12月至2016年12月期间收治的、符合纳入标准的多次胚胎移植失败患者130例,根据内膜准备方案的不同,分为自然组(n=51)、替代组(n=32)、降调节组(n=47).对样本做回顾性分析并对比患者年龄、解冻胚胎数、不孕年限、移植胚胎数、转化日内膜厚度、雌二醇水平等一般临床资料.在自然周期以及冻融胚胎移植中,对比三组转化日子宫内膜形态,记录并比较三组胚胎着床、早期流产等妊娠结局情况.结果 三组患者年龄、解冻胚胎数、不孕年限、移植胚胎数、转化日内膜厚度、雌二醇水平差异均无统计学意义(均P>0.05).自然组在自然周期以及冻融胚胎移植中,子宫内膜形态均优于替代组和降调节组(χ2值分别为11.99、14.88,均P<0.05).降调节组的妊娠率、胚胎着床率达53.19%(25/47)、61.70%(29/47),均显著高于替代组和自然组(χ2值分别为9.80、11.80,均P<0.05),但三组早期流产率无明显差异(χ2=3.51,P>0.05).结论 降调节后激素替代周期能够有效提高多次胚胎移植失败患者的妊娠率和胚胎着床率.对于子宫内膜形态有缺陷或状态欠佳的患者,选择降调节后激素替代周期为佳.     

冻融胚胎移植中子宫内膜不同转化时间对妊娠结局的影响

目的探讨冻融胚胎移植中不同内膜转化时间对妊娠结局的影响。方法回顾性分析2017年山西医科大学第一医院生殖医学中心采用激素替代周期准备子宫内膜进行冻融胚胎移植的895个周期的妊娠结局。根据孕酮转化子宫内膜时间的不同分为两组,A组:600个周期随机抽样300个周期,孕酮转化子宫内膜后3 d移植D 3胚胎;B组:295个周期,孕酮转化子宫内膜后4 d移植D 3胚胎。比较两组种植率、临床妊娠率、异位妊娠率、多胎妊娠率、早期流产率、活产率。结果两组患者的不孕原因、不孕类型、年龄、不孕年限、移植日子宫内膜厚度、体质量指数、解冻胚胎数、移植胚胎数、优质胚胎率、种植率、临床妊娠率、异位妊娠率、多胎妊娠率、早期流产率、活产率比较,差异均无统计学意义(P0.05)。结论冻融胚胎移植中孕酮转化内膜后3 d、4 d移植胚胎均可获得满意的妊娠结局。     

移植日注射人绒毛膜促性腺激素对冻融胚胎移植妊娠结局的影响

目的:探讨移植日注射人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)是否影响冻融胚胎移植(frozen-thawed embryo transfer,FET)的妊娠结局。方法:回顾性分析第二军医大学附属长海医院生殖医学中心2015年5月—2017年8月1 636例FET周期不孕症患者临床资料,根据胚胎移植日是否注射h CG分为hCG组(1 084例)和对照组(552例),分析2组患者胚胎移植后临床妊娠结局。结果:2组患者年龄、体质量指数、不孕时间、基础卵泡刺激素水平和子宫内膜准备方案、移植日子宫内膜厚度、移植胚胎数差异均无统计学意义(P0.05)。2组的临床妊娠率、胚胎着床率、异位妊娠率、流产率、活产率差异均无统计学意义(P0.05)。根据移植胚胎期别进行卵裂期、桑葚胚期、囊胚期胚胎移植亚组分析后,2组的妊娠结局差异无统计学意义(P0.05)。Logistic多因素回归分析结果提示年龄、移植胚胎数以及移植优质胚胎数是影响临床妊娠的因素;而年龄是影响活产率的独立影响因素:年龄越大,活产率越低。结论:FET移植日注射h CG对妊娠结局没有显著的影响,年龄是影响妊娠结局的主要因素。     

玻璃化冻融胚胎移植妊娠结局的影响因素分析

目的:探讨玻璃化冻融胚胎移植妊娠结局的影响因素。方法:对接受玻璃化冻融胚胎移植患者的247个周期进行回顾性分析,根据患者的临床结局分为妊娠组(112例)和非妊娠组(135例)。对年龄、不孕原因、受精方式、冻融胚胎移植次数、移植胚胎数目、胚胎质量、子宫内膜厚度、子宫内膜准备方案、冻胚时间等9个可能影响因素进行分析。结果:妊娠组与非妊娠组的冻胚时间和子宫内膜厚度均有统计学差异(χ2=8.703,P=0.003;χ2=2.838,P=0.009),logistic多因素回归分析结果显示冻胚时间和子宫内膜厚度与妊娠结局有关。结论:玻璃化冻融胚胎移植受精后第3天冻胚比第2天冻胚的胚胎临床妊娠率更高;在一定范围内,移植日子宫内膜厚度11.0mm比≤11.0mm患者的妊娠率更高。     

单囊胚移植在冻融周期中的3种内膜准备方案的临床比较

目的 比较冻融周期3种不同内膜准备方式单囊胚移植的临床结局. 方法 对681个单囊胚冻融胚胎移植周期的临床资料进行回顾性分析.按内膜准备的方案分为3组,激素替代周期495例(激素替代组),自然周期142例(自然周期组),微刺激周期44例(微刺激组),均移植1个解冻优质囊胚.比较3组生化妊娠率、临床妊娠率和早期流产率. 结果 激素替代组、自然周期组和微刺激组临床妊娠率分别为63.0％、59.2％、61.4％,流产率分别为11.2％、11.9％、11.1％,生化妊娠率分别为69.5％、63.4％、65.9％,3组比较差异均无统计学意义. 结论 在单囊胚冻融移植中,3种子宫内膜准备方案均能获得较高的临床妊娠率.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.