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141.
Dohle GR; Ramos L; Pieters MH; Braat DD; Weber RF 《Human reproduction (Oxford, England)》1998,13(3):620-623
Male genital tract obstructions may result from infections, previous
inguinal and scrotal surgery (vasectomy) and congenital bilateral absence
of the vas deferens (CBAVD). Microsurgery can sometimes be successful in
treating the obstruction. In other cases and in cases of failed surgical
intervention, the patient can be treated by microsurgical or percutaneous
epididymal sperm aspiration (MESA, PESA) or testicular sperm extraction
(TESE) and intracytoplasmic sperm injection (ICSI). We present the results
of 39 ICSI procedures for obstructive azoospermia in 24 couples. The
aetiology of the obstruction was failed microsurgery in 11 patients, CBAVD
in nine and genital infections in four. Sperm retrieval was accomplished
via MESA in four cases, PESA in 18 cases and via TESE in 11 cases. TESE was
only applied when PESA failed to produce enough spermatozoa for
simultaneous ICSI. In six patients, the ICSI procedure was performed with
cryopreserved spermatozoa after an initial PESA procedure. Fertilization
occurred in 47% of the metaphase II oocytes; embryo transfer was performed
in 92% of procedures and resulted in a clinical pregnancy in 13/39
procedures. Ongoing pregnancy was achieved in 10/39 procedures. One
pregnancy was terminated early after prenatal investigation showed a
cytogenetic abnormality (47,XX+18, Edwards syndrome). The other nine
pregnancies resulted in the live birth of 10 children, without any
congenital abnormalities. Epididymal and testicular retrieved spermatozoa
were successfully used for ICSI to treat obstructive azoospermia, and
resulted in an ongoing pregnancy in 10 of 24 couples (41.6%) after 39 ICSI
procedures, a success rate of 25.6% per treatment cycle and of 27.7% per
embryo transfer.
相似文献
142.
Bersinger NA; Brandenberger A; Berger E; Baumann CK; Birkhauser MH 《Human reproduction (Oxford, England)》1998,13(7):1962-1967
We have previously observed the repeated presence of low but detectable
amounts of the trophoblast marker pregnancy-specific beta1-glycoprotein
(SP1) in the serum of some women undergoing in-vitro fertilization (IVF)
treatment around the time of oocyte retrieval. The occurrence of these
signals seemed to be restricted to a defined group of patients which also
showed a lower pregnancy success rate in a preliminary study. To test our
hypothesis we have analysed 173 consecutive cycles leading to an embryo
transfer. Fifty-four cycles (31%) had a serum SP1 level of at least 0.1
ng/ml between days embryo transfer -5 and embryo transfer (group A). Five
pregnancies were obtained in this group (pregnancy rate = 9.3%), while in
group B, defined by the absence of detectable SP1 before embryo transfer
(119 cycles), 36 ongoing pregnancies were achieved (30.3%). Ten of the 41
pregnancies were achieved in 33 first-time non-pregnant patients undergoing
further attempts during the study period. Again the pregnancy rate was
higher in the first-time group B women (9/23 versus 1/10 for group A).
Patients tended to remain in their groups A or B, the latter being
associated with a better immediate as well as subsequent chance for
pregnancy. Group A cycles had a significantly lower endometrial thickness
two days before oocyte retrieval than group B (P = 0.0011). We postulate
that the presence of an unknown, maternal and progesterone- or follicle
stimulating hormone-independent factor in some patients could stimulate
tonic ectopic SP1 synthesis and at the same time negatively influence
endometrial development.
相似文献
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146.
Genetic and non‐genetic factors that increase the risk of non‐syndromic cleft lip and/or palate development 下载免费PDF全文
147.
P53 gene mutations in acute myeloid leukemia with 17p monosomy 总被引:4,自引:2,他引:4
Fenaux P; Jonveaux P; Quiquandon I; Lai JL; Pignon JM; Loucheux-Lefebvre MH; Bauters F; Berger R; Kerckaert JP 《Blood》1991,78(7):1652-1657
We looked for mutations of exons 5 to 8 of the P53 gene in 10 patients with acute myeloid leukemia (AML) and 17p monosomy, and 36 patients with AML and no cytogenetic abnormalities of 17p. DNA was analyzed by polymerase chain reaction, single-strand conformation polymorphism analysis, and nucleotide sequencing. Four of the 10 patients with 17p monosomy showed point mutation, single-nucleotide deletion, or insertion in exons 7 or 8. By contrast, only 1 of the 36 patients with AML and no cytogenetic abnormalities of 17p showed a mutation of the P53 gene in exons 5 to 8 (P less than .01). These results suggest that alterations of the P53 gene may have a role in leukemogenesis in some cases of AML. The fact that P53 gene mutations occurred more often in patients with 17p monosomy seems to support the "recessive" model of tumor suppressive activity of the P53 gene rather than the "dominant" model, in which alteration of only one allele is sufficient for the development of malignancy. 相似文献
148.
Aims and objectives. Explore effectiveness of 11 collaboratives focusing on 11 different topics, as perceived by local improvement teams and to explore associations with collaborative‐, organisational‐ and team‐level factors. Background. Evidence underlying the effectiveness of quality improvement collaboratives is inconclusive and few studies investigated determinants of implementation success. Moreover, most evaluation studies on quality improvement collaboratives are based on one specific topic or quality problem, making it hard to compare across collaboratives addressing different topics. Design. A multiple‐case cross‐sectional study. Methods. Quality improvement teams in 11 quality improvement collaboratives focusing on 11 different topics. Team members received a postal questionnaire at the end of each collaborative. Of the 283 improvement teams, 151 project leaders and 362 team members returned the questionnaire. Results. Analysis of variance revealed that teams varied widely on perceived effectiveness. Especially, members in the Prevention of Malnutrition and Prevention of Medication Errors collaboratives perceived a higher effectiveness than other groups. Multilevel regression analyses showed that educational level of professionals, innovation attributes, organisational support, innovative culture and commitment to change were all significant predictors of perceived effectiveness. In total, 27·9% of the individual‐level variance, 57·6% of the team‐level variance and 80% of the collaborative‐level variance could be explained. Conclusion. The innovation’s attributes, organisational support, an innovative team culture and professionals’ commitment to change are instrumental to perceived effectiveness. The results support the notion that a layered approach is necessary to achieve improvements in quality of care and provides further insight in the determinants of success of quality improvement collaboratives. Relevance to clinical practice. Understanding which factors enhance the impact of quality improvement initiatives can help professionals to achieve breakthrough improvement in care delivery to patients on a wide variety of quality problems. 相似文献
149.
Jean MH Lee Nina Laxmikantha Marcus E H Ong Evelyn Wong Jeremy CP Wee 《世界急诊医学杂志(英文)》2013,4(4):281-284
BACKGROUND:
This study aimed to compare the topical anesthetic lignocaine, adrenaline, and tetracaine (LAT) (4% lignocaine, 1:2 000 adrenaline, 1% tetracaine) with the conventional lignocaine infiltration(LI) for repair of minor lacerations, for the comfort of anesthetic administration, efficacy, adverse effects and cost.METHODS:
This was a prospective randomized clinical trial. Forty Asian patients who required toilet and suture for minor lacerations in the emergency department of the Singapore General Hospital over a 4-month period. The patients were assigned randomly to 2 arms of treatment. The first was the LAT gel group who had LAT gel applied to the laceration prior to suturing. The second was the control group in whom the anesthetic administered was lignocaine infiltration (LI) via a syringe. The pain of the process of administering anesthetic and efficacy of anesthesia were scored using the visual pain scale included within. The efficacy of LAT vs. lignocaine infiltration as an anesthetic prior to the toilet and suture of minor lacerations and complications of therapy.RESULTS:
Twenty patients were randomized to LAT gel and 16 to LI on an intention to treat analysis. The mean pain score by patients in the LAT gel group was 2.5 (0.52 SE), and 2.5 (0.58 SE) in the LI group. The pain score for pain during application of the anesthetic was 1.5 (0.40) in the LAT gel group, and 3.5 (0.46) in the LI group. There was no difference in complications between the LAT and LI groupsCONCLUSION:
LAT gel prior to the toilet and suture of minor lacerations is proven to be as efficacious as LI in terms of patient comfort and effectiveness of anesthesia. The complications are also comparable to those treated with LI.KEY WORDS: Lignocaine infiltration, Lacerations, Emergency department, Pain score 相似文献150.
The chasm of care: Where does the mental health nursing responsibility lie for the physical health care of people with severe mental illness? 下载免费PDF全文
Dianne Wynaden RN MHN PhD Brett Heslop RN MNursing Karen Heslop RN PhD Lesley Barr RN Grad Cert MH Eric Lim RN MNurSt PhD Candidate Gin‐Liang Chee RN MNurs; PhD Candidate James Porter RN Jane Murdock 《International journal of mental health nursing》2016,25(6):516-525
The poor physical health of people with a severe mental illness is well documented and health professionals' attitudes, knowledge and skills are identified factors that impact on clients' access to care for their physical health needs. An evaluation was conducted to determine: (i) mental health nurses' attitudes and beliefs about providing physical health care; and, (ii) the effect that participant demographics may have on attitudes to providing physical health care. It was hypothesized that workplace culture would have the largest effect on attitudes. Nurses at three health services completed the “Mental health nurses' attitude towards the physical health care of people with severe and enduring mental illness survey” developed by Robson and Haddad (2012). The 28‐item survey measured: nurses' attitudes, confidence, identified barriers to providing care and attitudes towards clients smoking cigarettes. The findings demonstrated that workplace culture did influence the level of physical health care provided to clients. However, at the individual level, nurses remain divided and uncertain where their responsibilities lie. Nursing leadership can have a significant impact on improving clients' physical health outcomes. Education is required to raise awareness of the need to reduce cigarette smoking in this client population. 相似文献