卵巢反应性指标的临床研究进展

卵巢反应性是指在控制性卵巢刺激（controlled ovarian stimulation,COS）过程中卵泡对外源性促性腺激素的反应。在辅助生殖技术中,COS是重点亦是难点,因此临床上可以借助一些卵巢反应性评估指标来评估患者在COS过程中的反应性,并选择适合患者的最佳个体化方案,从而在体外受精/胞浆内单精子注射-胚胎移植（in-vitro fertilization/intra-cytoplasmic sperm injection -embryo transfer,IVF/ICSI-ET）中获得理想的妊娠结局。现选取年龄、基础卵泡刺激素、基础卵泡刺激素/基础黄体生成素比值、基础雌二醇、抑制素B、抗苗勒管激素、卵泡输出率和基础窦卵泡数这些常见的卵巢反应性评估指标,就目前国内外的研究现状,总结其评估卵巢反应性及IVF结局的能力,分析不同指标在临床中应用的优越性及局限性,并对评估卵巢反应性的指标进行展望。     

Predictors of Symptom-Specific Treatment Response to Dietary Interventions in Irritable Bowel Syndrome

(1) Background: Predictors of dietary treatment response in irritable bowel syndrome (IBS) remain understudied. We aimed to investigate predictors of symptom improvement during the low FODMAP and the traditional IBS diet for four weeks. (2) Methods: Baseline measures included faecal Dysbiosis Index, food diaries with daily energy and FODMAP intake, non-gastrointestinal (GI) somatic symptoms, GI-specific anxiety, and psychological distress. Outcomes were bloating, constipation, diarrhea, and pain symptom scores treated as continuous variables in linear mixed models. (3) Results: We included 33 and 34 patients on the low FODMAP and traditional IBS diet, respectively. Less severe dysbiosis and higher energy intake predicted better pain response to both diets. Less severe dysbiosis also predicted better constipation response to both diets. More severe psychological distress predicted worse bloating response to both diets. For the different outcomes, several differential predictors were identified, indicating that baseline factors could predict better improvement in one treatment arm, but worse improvement in the other treatment arm. (4) Conclusions: Psychological, nutritional, and microbial factors predict symptom improvement when following the low FODMAP and traditional IBS diet. Findings may help individualize dietary treatment in IBS.     

The view of experts on initiatives to be undertaken to promote equity in the access to orphan drugs and specialised care for rare diseases in Spain: A Delphi consensus

ObjectivesTo reach a consensus amongst experts on the most feasible actions to be undertaken to facilitate patient access to specialised care and orphan drugs (OD) in the public health sector in Spain.MethodsTwo Delphi rounds were completed. The questionnaire was based on a literature review and 2 focus groups. Agreement was sought on the desire (D) and prognosis (P) for the implementation within the next 5 years, on a 5-point Likert scale. Consensus was reached when ≥75% participants chose agreement (1–2) or disagreement options (4–5).Results82 experts on rare disease (RD) participated. Agreement on the D and P was reached in 66.07% statements: OD pricing review [absence of clinical effectiveness (D:85.37%; P:85.90%), target population increase (D:79.27%; P:91.03%)]; reference team definition of referral protocols and clinical practice guidelines (D: 97.56%; P: 89.74%); and a unified, usable, etiology-based registry (D:97.56%; P:84.62%). D and P assessment diverged in 32.14% items: creation of a specific funding system for OD (D: 97.56%; P: 60.25%); and a network of medical teams to coordinate the care of RD patients (D: 99%; P: 62%).ConclusionsThe results have shown the need to promote dialogue between stakeholders, introduce European recommendation to national and regional Spanish policies and set up priorities and undertake actions to drive relevant changes in current medical practice in managing RD patients.     

面肌痉挛面神经的组织学变化和超氧化物歧化酶变化

目的：通过建立面肌痉挛动物模型来研究面肌痉挛面神经的组织学变化和超氧化物歧化酶（SOD）值的变化,为临床治疗面肌痉挛提供理论支持。方法：将18只成年兔随机分为正常对照组与4周模型组和6周模型组,对模型组成年兔于左侧颞外面神经主干施以人工压迫建立面肌痉挛模型,分别于4周和6周后取材。通过观察显微结构及相应的组织学变化,比较正常对照组和4周模型组及6周模型组之间的组织学差异。在取材前抽取3~5ml血液离心分离血清做SOD检测。结果：模型组与正常对照组比较观察发现面神经有脱髓鞘等多种组织变化。4周模型组较正常对照组,SOD明显降低（P〈0.05）,6周模型组较4周模型组,SOD明显升高（P〈0.05）。结论：面肌痉挛正常对照组与4周模型组及6周模型组之间有明显的组织学变化,SOD的检测显示机体自身SOD检测值有明显的变化。     

宁波市织纹螺毒素检测与毒性消长

目的检测织纹螺毒素,分析其毒性消长情况,为预防和控制织纹螺中毒提供科学依据.方法用小鼠生物测试法对市场样品、中毒样品、新产螺点和监测点等来源的257份织纹螺样品进行PSP测定,按出口贝类麻痹性贝类毒素和美国FDA的贝类麻痹性毒素标准判断,以100g织纹螺肉中PSP≥400 MU判为有毒,反之则无毒,以此来判定本市织纹螺毒性的强弱.结果从257份织纹螺样品中检出有毒织纹螺100份,占总数的38.9%,除象山外,其余织纹螺栖息地均能检出有毒织纹螺,其毒性的高低分别为中毒样品最高,监测点样品其次,市场样品最低.长期观察结果显示织纹螺毒性具有消长性,其产生的消除是动态性的,消长曲线呈锯齿状,毒素的产生有高峰年份,也有回落的情况,无规律性和可预测性.结论检测发现本市的织纹螺毒性较强,分布地域广泛,毒性强弱与织纹螺的来源、品种和地域有关,应充分认识其对人们的危害,提示我们本市的织纹螺不能食用.     

Dietary Predictors of 5-Year Changes in Waist Circumference

Background

Previous studies on the association between macronutrient intake and the development of abdominal obesity, which carries an increased health risk, have not shown a consistent pattern, possibly due to mixed effects of other aspects of the food intake.

Objective

This study investigated the association between intake from 21 food and beverage groups and the subsequent 5-year difference in waist circumference.

Methods

The study population consisted of 22,570 women and 20,126 men, aged 50 to 64 years at baseline, with complete data on baseline and follow-up waist circumference, baseline diet (192 items food frequency questionnaire), body mass index, and selected potential confounders (eg, smoking status, sport activities, and intake of alcoholic beverages). Multiple linear regression analyses were performed.

Results

For women, 5-year difference in waist circumference was inversely related to intake from red meat, vegetables, fruit, butter, and high-fat dairy products, whereas intake from potatoes, processed meat, poultry, and snack foods was positively associated. For men, red meat and fruit intakes were inversely associated with 5-year difference in waist circumference, whereas snack foods intake was positively associated. Sex differences occurred for vegetables, high-fat dairy products, and processed meat.

Conclusions

The results suggest that a diet low in fruits and red meat and high in snack foods was associated with larger waist circumference gains in both sexes. Furthermore, in women a diet low in vegetables, butter, and high-fat dairy products, and high in poultry, potatoes, and processed meat were likely determinants of subsequent gain at the waist.     

What does it mean to involve consumers successfully in NHS research? A consensus study

OBJECTIVE: To obtain consensus on the principles and indicators of successful consumer involvement in NHS research. DESIGN: Consensus methods were used. An expert workshop, employing the nominal group technique was used to generate potential principles and indicators. A two-round postal Delphi process was used to obtain consensus on the principles and indicators. SETTING AND PARTICIPANTS: Participants were drawn from health, social care, universities and consumer organizations. A purposive sampling strategy was used to identify people who had experience and/or knowledge of consumer involvement in NHS research. Six researchers and seven consumers participated in an expert workshop. Ninety-six people completed both rounds of the Delphi process. MAIN OUTCOME MEASURES: Consensus on principles and indicators of successful consumer involvement in NHS research. RESULTS: Eight principles were developed through an expert workshop and Delphi process, and rated as both clear and valid. Consensus was reached on at least one clear and valid indicator by which to measure each principle. CONCLUSIONS: Consensus has been obtained on eight principles of successful consumer involvement in NHS research. They may help commissioners, researchers and consumers to deepen their understanding of this issue, and can be used to guide good practice.     

烹调油烟所致大鼠肺部病变的时相分析

利用吸入烹调油烟（ 浓度为４３ ±４ｍｇ／ ｍ３） 持续染毒２０ 、４０ 、６０ 天制备动物模型，通过常规 Ｈ Ｅ 染色，光学显微镜观察肺部病理形态改变。结果表明， Ｃ Ｏ Ｆ 染毒组肺组织病理形态改变以炎症改变为主，尚有肺泡上皮腺样化生，不典型腺样增生病变形成。以第三时相病变更为明显。阴性对照组有轻度间质性肺炎及轻度的上皮增生。 Ｂ（ａ） Ｐ 组肺组织炎症病变少，以鳞状上皮化生较多见。     

医师职业紧张和紧张反应的研究

[目的]评价医师职业紧张和紧张反应强度。[方法]应用职业紧张量表修订版(OSI-R)(1998修订版)对 342名医师(医师组)和362名非卫生部门脑力劳动者(对照组)进行了测试。[结果]医师职业任务得分高于对照组, 差异有非常显著性(P<0．01)。医师的主要紧张源为任务过重、任务不适和责任感。医师仅人际关系紧张反应因子得分显著高于对照组(P<0．01)。医师的职业紧张水平和紧张反应强度随年龄增长而增高,不同年龄段之间差异呈非常显著性(P<0．01);男医师的职业紧张水平和紧张反应显著高于女医师(P<0．01)。[结论]医师职业是个紧张的职业,加强医师业务和医德学习,缓解医患矛盾,减少工作压力可保护和促进他们的健康。     

Decision Thresholds and Changes in Risk for Preventive Treatment

This paper investigates the notion of treatment threshold for preventive treatment with potential side effects in the context of changes in risk. Changes in risk are defined by the concept of nth‐order stochastic dominance and concern the effectiveness of preventive treatment, side effects, severity of the potential disease, and comorbidity risk. The impact of a riskier environment on the probability of disease threshold above which the preferable decision is to undergo preventive treatment is shown to depend on both mixed risk averse individual preferences and the configuration of increase in risk considered. These results suggest that neglecting differences between risks when evaluating the treatment threshold is likely to lead to substantial errors in most cost‐benefit applications for preventive treatment. Copyright © 2014 John Wiley & Sons, Ltd.     

洪灾地区县级疾病预防控制机构救灾防病应急能力的综合评价

目的建立洪灾地区县级疾病预防控制机构救灾防病应急能力的综合评价方法.方法应用层次分析法建立洪灾地区县级疾病预防控制机构救灾防病应急能力的初评指标体系,德尔菲法确定指标及其权重,综合评分法建立综合评价模型;通过方差分析、相关性分析对综合评价模型等级分类的可行性和所包含指标的独立性进行验证.结果建立了包含20个一级指标和57个二级指标的综合评价模型;运用该模型评价的应急能力较强的县级疾病预防控制机构5个,中等的10个,较差的5个;综合评价模型等级分类具有较好的区分度,且包含指标的独立性较好.结论建立的综合评价模型,可以较好区分洪灾地区县级疾病预防控制机构救灾防病应急能力的强弱,具有较好的适用性和较高的可信度.     

林州食管癌流行动态与居民膳食结构变化调查报告

目的 为了解林州居民膳食结构变化,分析与食管癌发病率和死亡率流行动态的关系;方法 采用食管癌发病率和死亡率动态变化及膳食结构变化动态数列比较法;结果 近20年来,林州居民的主食、副食、蔬菜、水果特别是低年龄组都发生了明显改善;近10多年来,居民食管癌发病率和死亡率均呈下降趋势,也以低年龄组显。结论 研究提示林州食管癌发病率和死亡率的下降与居民的膳食结构和营养状况的改善有密切关系。     

天津市成年体检人群血脂动态变化及血脂异常发生率的比较

目的 探讨连续2年健康体检人群血脂水平和血脂异常的动态变化以及血脂异常的发生率.方法 收集2010年和2011年连续2年在天津市某中心医院健康体检中心进行体检的701人的体检结果,包括总胆固醇(TC)、甘油三酯(TG)等数据.对该人群不同组别各年份的血脂水平、血脂异常检出率及发生率进行统计分析.结果 (1)男女血TG和TC含量2年间自身比较,差异均无统计学意义(P＞0.05);各年份50岁以下TG平均水平以及2年差值的平均水平、各年份30岁以下TC平均水平,均显示男性高于女性,差异均有统计学意义(P＜0.01).各年份50～岁以上男女的TC平均水平以及女性的TG平均水平,均高于各自其他年龄组,差异均有统计学意义(P＜0.01).(2)各年份40岁以下男性的TG、TC异常检出率高于女性,而且50岁以上女子TC异常检出率高于其他各年龄组,差异均有统计学意义(P＜0.01).男女各年份TC异常检出率均显示随年龄增长而增高的趋势.(3)男性TG异常发生率(20.2％)高于女性(5.63％),差异有统计学意义(x2=-21.846,P＜0.01),而男女TC异常发生率(分别为7.79％、4.87％)之间差异无统计学意义(x2-1.932,P＞0.05),并且男女50岁及以上组TC异常发生率均高于50岁以下组,差异有统计学意义(P＜0.05,P＜0.01).结论 男女健康查体者各年龄组TC和TG 2年间的平均水平和异常检出率无明显变化,40岁以下成年男子TG和TC异常检出率和发生率高于女性,而50岁以上女子TC异常发生率较高.长期进行血脂监测在健康查体人群中非常必要.     

血分离菌株及其抗生素敏感性变迁

目的了解血分离菌株及其抗生素敏感琏的变化，为预防控制血流感染提供依据。方法收集1999～2003年湖北省15家三级甲等医院临床血分离菌株，用纸片扩散法（K-B）进行药敏试验。结果凝固酶阴性葡萄球菌、肠球菌的检出率分别从1999年的27．0％，1．2％升至2003年的51．9％、4．2％：金黄色葡萄球菌、沙门菌属的检出率分别从1999年的21．1％，11．9％降至2003年的7．8％，3．0％；葡萄球菌对头孢唑啉、环丙沙星，肠球菌对青霉素G，大肠埃希菌和克雷伯菌属对头孢他啶、头抱吡肟以及铜绿假单胞菌对亚胺培南的敏感率均呈逐年下降趋势；肠球菌及大肠埃希菌对氯霉素的敏感率呈逐年上升趋势；耐苯唑西林凝固酶阴性葡萄球菌、产超广谱β内酰胺酶的大肠埃希菌和克雷伯菌属的检出率呈逐年上升趋势。结论动态监测血分离菌株的细菌耐药性非常必要，应根据血流感染菌株监测结果及时调整用药方案。     

母鼠低剂量接触甲基汞所致仔鼠学习能力及脑海马超微结构的变化

[目的]研究ICR母鼠饮水暴露低剂量氯化甲基汞(MeHgCl)后,仔鼠脑组织的病理组织学变化和脑海马超微结构变化,评价低剂量饮水暴露甲基汞的安全性。[方法]ICR孕鼠随机分为对照组、低剂量组和高剂量组,每组各8只,各组于怀孕第6天起,分别自由饮用蒸馏水和氯化甲基汞含量为0.01、0.1mg/L的蒸馏水,直至哺乳期结束。测试各组仔鼠学习能力,观察仔鼠脑组织病理组织学变化及脑海马超微结构变化。[结果]在对仔鼠进行学习能力测试的水迷宫实验中,对照组、低剂量组和高剂量组成功率分别为81.67%、59.09%和70.00%,低剂量组和高剂量组成功率显著低于对照组(P<0.05)。低剂量组和高剂量组仔鼠脑组织有明显的病理学改变,随着甲基汞染毒剂量的增加,海马区大锥体细胞、大脑神经元和小脑浦肯野细胞嗜酸性增强。电镜结果显示,低剂量和高剂量组脑海马神经细胞有变性,严重者呈暗细胞表现。[结论]实验剂量甲基汞可使仔鼠脑组织发生病理组织学改变,脑海马区超微结构改变,实验剂量甲基汞对于仔代是不安全的。     

听性脑干反应检查在新生儿相关疾病诊断中的应用研究进展

近年新生儿听力损失发生率呈增高趋势,听性脑干反应(ABR)作为一种无创检查手段被广泛应用于新生儿临床.本研究就ABR在新生儿相关疾病诊断中的应用及其发展前景,综述如下.