卵巢肿瘤保守性手术后IVF助孕的安全性和有效性

随着卵巢肿瘤筛查的普及和诊治水平的提高,早期诊断和治疗提高了该类患者的生存期以及生活质量,同时也让更多年轻的卵巢肿瘤患者保留了生育的机会。然而,由于手术及放、化疗等原因,部分卵巢肿瘤患者术后常常出现不孕,需要寻求辅助生殖技术助孕治疗。本文结合国内外相关文献及病例报道,对卵巢肿瘤患者术后体外受精(IVF)的时机、方案及安全性和有效性等方面进行总结和综述。     

无糖型半夏泻心颗粒制备工艺的研究

目的：优选无糖型半夏泻心颗粒最佳制备工艺。方法以黄芩苷、小檗碱含量和出膏率为指标,应用L 9(34)正交设计和多指标综合评分法优选无糖型半夏泻心颗粒最佳水提取工艺;以成型性、制粒情况为指标,考察辅料、矫味剂的种类和配比。结果最佳提取工艺为黄连用70%乙醇提取后,药渣与处方中其他6味药混合,提取3次,第一次加9倍量水,煎煮1 h,第二次加8倍量水,煎煮1 h,第三次加6倍量水,煎煮0.5 h;最佳的辅料种类和比例为浸膏粉∶糊精∶可溶性淀粉∶甜味素=1∶0.6∶0.2∶0.015,85%乙醇为润湿剂。结论该工艺合理可行,适宜做无糖型半夏泻心颗粒的制备工艺。     

正交试验法优化珠子参总皂苷提取工艺

目的优选珠子参总皂苷的提取工艺,为珠子参中皂苷类化合物的开发利用提供理论依据。方法采用紫外分光光度法建立珠子参中总皂苷含量的测定方法,检测波长540 nm,并通过正交试验考察乙醇浓度、溶剂倍量、提取时间及提取次数对珠子参总皂苷提取工艺的影响。结果珠子参总皂苷的线性范围为0.052~0.182 mg,平均加样回收率为98.64%。珠子参总皂苷最佳提取工艺为加入70%的乙醇10倍量,提取3次,每次提取1 h,平均收率12.32%。结论建立的紫外分光光度法检测珠子参总皂苷含量方法准确可靠,优选的珠子参总皂苷提取工艺简便、稳定可行。     

不同层次医务人员对抑郁症和老年期痴呆诊治技术了解情况的调查

目的调查医务人员对抑郁症和老年期痴呆诊治技术了解情况。方法选择浙江省10个地市的医务人员进行《抑郁症和老年期痴呆诊治问卷》调查,共发放问卷527份,回收521份,其中有效问卷512份。结果随着医院等级的提高,两种疾病技术的了解程度逐渐提高,但街道与社区卫生服务的基层医务人员对两种疾病的诊疗技术的了解程度较低（P＜0.01）。在社区卫生服务中心的医务人员不了解的人群远远高于了解的人群,除精神专科医务人员,其他专业的医务人员对抑郁症的精神访谈技术及心理测试技术（包括量表自评及他评）,不了解的人群基本上多于了解的人群（P＜0.01）。老年期痴呆的诊断、评估、治疗、康复管理等技术的医务人员不了解超过了解（P＜0.01）。综合医院和精神专科医院的医务人员对两种疾病的技术了解的人群高于不了解的人群,而在社区卫生服务中心的医务人员不了解的人群远远高于了解的人群（P＜0.01）。随着工作年限的增加,抑郁症识别技术、精神访谈技术、药物治疗、心理治疗技术及康复技术了解的人群要高于不了解的人群（P＜0.05或0.01）。结论基层医务人员作为精神疾病防控、康复的第一线,对相关知识的了解程度令人担忧,应该通过各种方式,把专业知识向基层进行传播。     

Practitioner reporting of birth defects in children born following assisted reproductive technology: Does it still have a role in surveillance of birth defects?

BACKGROUND: National assisted reproductive technology (ART) data collections that rely on practitioners' reports of birth defects have consistently reported lower proportions of children with birth defects than record linkage studies that link ART infants to birth and malformation registers. METHODS: We compared the birth defect data reported to the national Australian Assisted Conception Data Collection (ACDC) by practitioners at three Western Australian ART clinics with the birth defect data identified on the Western Australian Birth Defects Registry (WABDR) through record linkage of all the pregnancies conceived at these clinics to the WABDR. Cases are reported to the WABDR by multiple statutory and voluntary sources. RESULTS: We found that the national ACDC significantly underestimated the prevalence of birth defects in WA-born ART infants. Less than one-third of ART children identified with a major birth defect on the WABDR were reported to the ACDC. CONCLUSIONS: Although national ART data collections provide valuable information on pregnancy rates and short-term pregnancy outcomes such as multiple birth and birth weight, we strongly recommend that birth defect information used for patient counselling is preferentially drawn from large studies that have used record linkage to high-quality birth defect registers.     

Personal Digital Assistants are Comparable to Traditional Diaries for Dietary Self-Monitoring During a Weight Loss Program

Dietary self-monitoring is considered the core of behavioral weight control programs. As software for personal digital assistants (PDA) has become more available, this study investigated whether the use of a PDA would improve dietary self-monitoring frequency and subsequent weight loss over the use of traditional paper diaries. One-hundred-seventy-six adults (BMI 25–39.9) participated in a 6-month behavioral weight control program. Treatment subjects (n = 61) were provided with a PalmZire 21 with Calorie King’s Diet Diary software installed. Their self-monitoring habits and weight loss were compared with the results from a previous program (n = 115) which followed the same protocol using paper diaries for self-monitoring. No significant differences in weight loss or dietary self-monitoring were found. More frequent self-monitoring correlated with weight loss in both groups (p<.001). People seeking to lose weight should be encouraged to self-monitor and be matched with a mode of self-monitoring that is fitting to their lifestyle and skills.     

Visuomotor learning in immersive 3D virtual reality in Parkinson’s disease and in aging

Successful adaptation to novel sensorimotor contexts critically depends on efficient sensory processing and integration mechanisms, particularly those required to combine visual and proprioceptive inputs. If the basal ganglia are a critical part of specialized circuits that adapt motor behavior to new sensorimotor contexts, then patients who are suffering from basal ganglia dysfunction, as in Parkinson's disease should show sensorimotor learning impairments. However, this issue has been under-explored. We tested the ability of 8 patients with Parkinson's disease (PD), off medication, ten healthy elderly subjects and ten healthy young adults to reach to a remembered 3D location presented in an immersive virtual environment. A multi-phase learning paradigm was used having four conditions: baseline, initial learning, reversal learning and aftereffect. In initial learning, the computer altered the position of a simulated arm endpoint used for movement feedback by shifting its apparent location diagonally, requiring thereby both horizontal and vertical compensations. This visual distortion forced subjects to learn new coordinations between what they saw in the virtual environment and the actual position of their limbs, which they had to derive from proprioceptive information (or efference copy). In reversal learning, the sign of the distortion was reversed. Both elderly subjects and PD patients showed learning phase-dependent difficulties. First, elderly controls were slower than young subjects when learning both dimensions of the initial biaxial discordance. However, their performance improved during reversal learning and as a result elderly and young controls showed similar adaptation rates during reversal learning. Second, in striking contrast to healthy elderly subjects, PD patients were more profoundly impaired during the reversal phase of learning. PD patients were able to learn the initial biaxial discordance but were on average slower than age-matched controls in adapting to the horizontal component of the biaxial discordance. More importantly, when the biaxial discordance was reversed, PD patients were unable to make appropriate movement corrections. Therefore, they showed significantly degraded learning indices relative to age-matched controls for both dimensions of the biaxial discordance. Together, these results suggest that the ability to adapt to a sudden biaxial visuomotor discordance applied in three-dimensional space declines in normal aging and Parkinson disease. Furthermore, the presence of learning rate differences in the PD patients relative to age-matched controls supports an important contribution of basal ganglia-related circuits in learning novel visuomotor coordinations, particularly those in which subjects must learn to adapt to sensorimotor contingencies that were reversed from those just learned.     

A real-time dynamic 3D model of the human inguinal region for surgical education

A suitable dynamic 3D model that allows the simulation of the inguinal region with real-time performance on a personal computer was developed. A geometric model adjusted to real data was created by means of semiautomatic contour segmentation of anatomic units from the visible human project and data generated from classical anatomic information. A dynamic model included converting muscular units from their continuous geometric representation into a set of voxels and then real-time interaction and performance. The current implementation enables deformation of the realistic model associated with pushing and stretching interaction, allowing immersion in the anatomy of the inguinal structures. The model does not allow simulation of surgical interventions.     

Cleavage-stage embryo micromanipulation in the clinical setting

Embryo micromanipulation was developed after introduction of microinjection to overcome infertility. Embryo micromanipulation may be performed at any embryo stage from pronuclear to blastocyst. The technique started out as basic and turned out to be increasingly more complex. Embryo micromanipulation at the cleavage-stage includes a wide range of techniques, from opening the zona pellucida in order to improve the chance of implantation, to removing detrimental components from the embryo to enhance embryo development or blastomeres for preimplantation genetic diagnosis and embryo splitting. Evaluating the impact(s) of different micromanipulation techniques on epigenetics of the embryo and considering quality control during these techniques are important issues in this regard. This review aims to discuss the micromanipulation of cleavage-stage embryos in clinical assisted reproductive technology (ART).

Abbreviations: ART: assisted reproductive technology; ICSI: intracytoplasmic sperm injection; IVF: in vitro fertilization; PGD: preimplantation genetic diagnosis; PZD: partial zona dissection; ZP: zona pellucida; SUZI: subzonal insemination; PVS: perivitelline space; AH: assisted hatching; LAH: laserassisted hatching; ZT: zona thinning; UV: ultraviolet; IR: infrared; PCR: polymerase chain reaction; FISH: fluorescent in situ hybridization; NGS: next generation sequencing; QC: quality control; QA: quality assurance     

Acceptance of evidence based medicine (EBM) databases by Iranian medical residents using unified theory of acceptance and use of technology (UTAUT)

Objective

Physicians often need uptodate, reliable and with easy access information for clinical decisions evidence based medicine (EBM) databases can be a suitable approach to meet this need. The aim of this study was to assess the knowledge, use and factors affecting the acceptance of EBM and its databases by Iranian medical residents using UTAUT model.