The Bologna criteria for poor ovarian response: a contemporary critical appraisal

Postponement of child bearing and maternal age at first pregnancy are on the rise, contributing considerably to an increase in age-related infertility and the demand for assisted reproductive technologies (ART) treatment. This brings to the infertility clinics many women with low ovarian reserve and poor ovarian response (POR) to conventional stimulation. The Bologna criteria were released to standardize the definition of POR and pave the way for the formulation of evidence-based, efficient modalities of treatment for women undergoing IVF-ET. More than four years have passed since the introduction of these criteria and the debate is still ongoing whether a revision is due. Women with POR comprise several sub-groups with diverse baseline distinctiveness, a major issue that has fueled the discussion. Although antral follicle count (AFC) and anti-Müllerian hormone (AMH), are considered good predictors of ovarian reserve, their threshold values are still not universally standardized. Different definitions for sonographic AFC and diverse assays for AMH are held responsible for this delay in standardization. Adding established risk factors to the criteria will lead to more reliable and reproducible definition of a POR, especially in young women. The original criteria did not address the issue of oocyte quality, and the addition of risk factors may yield specific associations with quality vs. quantity. Patient’s age is the best available criterion, although limited, to predict live-birth and presumably oocyte quality. High scale studies to validate these criteria are still missing while recent evidence raises concern regarding over diagnosis.     

当前我国几种医务社会工作实务模式比较

医务社会工作在我国尚处于起步阶段,分析我国现行的医务社会工作实务模式,总结具有中国特色的医务社会工作实务模式,对促进医务社会工作本土化发展具有重要意义。     

深圳市劳务工医疗保险制度满意度调查

目的：了解深圳市劳务工对劳务工医疗保险制度的满意度。方法：按照分层随机抽样的方法抽取深圳市289名参保劳务工进行问卷调查和小组座谈,就他们对劳务工医疗保险的满意度进行分析。结果：参保者对劳务工医疗保险的筹资水平、保障范围、风险分担作用表示认可,满意度分别为88．78％、57．29％、94．29％;对报销比例、定点医疗机构的满意度（就医便利性、医疗质量、医疗费用）均低于50％。结论：劳务工认可现行“低水平、广覆盖”、“既保门诊、又保住院”的模式;可通过适当提高报销比例,合理选择定点医疗机构,加强对定点医疗机构规范管理和费用控制等措施,完善劳务工医疗保险制度。     

感到不适你就拍拍手

儿时，和小伙伴围坐在一起。举起稚嫩的小手，唱着：“如果感到幸福你就拍拍手……”而今。我们拍手不仅仅是为了幸福，还有防病治病的功效呢!那么，如果——     

An automated,broad-based,near real-time public health surveillance system using presentations to hospital Emergency Departments in New South Wales,Australia

Background  

In a climate of concern over bioterrorism threats and emergent diseases, public health authorities are trialling more timely surveillance systems. The 2003 Rugby World Cup (RWC) provided an opportunity to test the viability of a near real-time syndromic surveillance system in metropolitan Sydney, Australia. We describe the development and early results of this largely automated system that used data routinely collected in Emergency Departments (EDs).     

Erroneous identification in a mixed population: simulation using Israeli STR data

Allele distributions of 10 short tandem repeat (STR) polymorphic DNA loci used in forensic and paternity testing were determined for a cohort comprising 163 individuals representing a mixed Jewish Caucasian population. Typing was carried out by the commercial AmpFlSTR SGM Plus kit. The polymorphism and the utility of three of these markers for forensic studies in Israel were established for the first time. Results were compared with data for U.S. Caucasians and African Americans. The probability of identity of two persons of different ethnic origins for identification purposes is discussed. A lemma is presented to show that the chance of erroneous identification of an innocent person who belongs to a population that had not committed a crime will, in most cases, be smaller than for those who belong to a population that had truly committed the crime.Drs. Korostishevsky and Loewenthal are joint first co-authors.     

Non-malignant FDG uptake in infradiaphragmatic adipose tissue: a new site of physiological tracer biodistribution characterised by PET/CT

The purpose of this study was to characterise a benign pattern of infradiaphragmatic ¹⁸F-fluorodeoxyglucose (FDG) uptake in cancer patients using PET/CT. Infradiaphragmatic foci of FDG uptake, localised by PET/CT in regions of normal fat tissues, were demonstrated, in conjunction with fatty uptake in the neck and shoulders, in 9 of 1,241 (0.7%) patients. The imaging and clinical characteristics of this pattern and its possible clinical significance were assessed. PET/CT precisely localised infradiaphragmatic fat uptake (IDFU) within normal retroperitoneal fatty tissue of the perirenal space (nine patients) and in the paracolic or parahepatic space (four patients). Perirenal uptake was bilateral in five patients and focal in six. Paracolic and parahepatic uptake was bilateral in three patients and linear in all four patients. There was no evidence of malignancy at any of the sites during a follow-up period of 9–21 months. IDFU was significantly more prevalent in young patients assessed for monitoring response to therapy, and was always associated with the benign supradiaphragmatic uptake pattern, although its prevalence was significantly lower. There were no significant differences between the clinical characteristics of these two patterns of benign fatty FDG uptake. It is concluded that PET/CT allows for precise identification of increased FDG uptake in abdominal fatty tissue and further exclusion of disease at such sites. This benign uptake may represent increased glucose consumption in activated brown adipose tissue, similar to the mechanism suggested for supradiaphragmatic uptake. Recognition of this benign IDFU pattern is important for correct interpretation of abdominal PET findings in cancer patients.     

中国艾滋病健康教育与行为干预综述

艾滋病是一种由HIV感染引起的疾病,已经流行了20多年,而且目前还没有办法对它进行根本性的治疗。预防和控制艾滋病,健康教育和行为干预是最有效的方法之一。中国是HIV检测阳性率增长最快的国家之一,正面临着全国范围内的艾滋病流行。通常情况下,多性伴者和静脉吸毒者是高危人群,他们也是健康教育和行为干预的主要人群,在多种形式的健康教育和行为干预中已经取得了明显的效果,健康教育和行为干预必须从科学事实出发,遵循一系列策略从各个方面进行执行,并要求全社会的人都来参与。     

Cardiac Manifestations in Thiamine-Responsive Megaloblastic Anemia Syndrome

Thiamine-responsive megaloblastic anemia (TRMA) syndrome is a rare autosomal recessive disorder defined by the occurrence of megaloblastic anemia, diabetes mellitus, and sensorineural deafness, responding in varying degrees to thiamine treatment. Other features of this syndrome gradually develop. We describe three TRMA patients with heart rhythm abnormalities and structural cardiac anomalies. Eight other reported TRMA patients also had cardiac anomalies. Recently, the TRMA gene, SLC19A2, was identified, encoding a functional thiamine transporter. Characterization of the metabolic defect of TRMA may shed light on the role of thiamine in common cardiac abnormalities.     

Percutaneous Transaortic Occlusion of Patent Ductus Arteriosus Using a New Versatile Angiographic and Delivery Catheter

We evaluated the usefulness of patent ductus arteriosus (PDA) occlusion using a new catheter that combines good angiographic properties, easy manipulation across the duct, documentation of aortic and pulmonary artery pressure, and coil delivery for percutaneous transaortic ductal occlusion. Thirty patients (13 females and 17 males) who met the clinical and echocardiographic criteria for the percutaneous closure of PDA were catheterized. The patients selected for this study had a small to moderate PDA with a conal or tubular shape, adequate aortic ampula, and normal or mildly elevated pulmonary artery pressure. The median age was 4.8 years (range, 10 months–20 years). Patients were catheterized by the transaortic approach using the new angiographic and coil delivery catheter specially designed for this procedure. A PDA was closed in every case. A single DuctOcclud pfm coil was delivered in 28 patients, and 2 patients had NitOcclud pfm coils for ductal occlusion. The screening time was measured and found to be 50% less than the measured screening time using other catheters in our laboratory. Only one catheter and one guidewire were used per procedure, with no need for exchange wires or the establishment of an arteriovenous loop. The procedure time was also reduced by 50%. A minimal residual shunt, demonstrated by color-flow Doppler mapping, was present in 2 patients. The new combined angiographic and coil delivery catheter is most suitable for transaortic PDA coil occlusion, significantly decreasing the procedure and screening time.