No evidence for decreasing semen quality in four birth cohorts of 1,055 Danish men born between 1950 and 1970

Objective: To compare the quality of semen in 1,055 Danish men born between 1950 and 1970 who are assumed to represent a random sample of the Danish male population of fertile age.Design: Retrospective review of data on semen quality at the time of the female partner's first IVF treatment.Setting: The Fertility Clinic, Odense University Hospital, Odense, Denmark.Patient(s): One thousand fifty-five male partners of women with tubal infertility who were referred for IVF treatment consecutively during the period 1990–1996.Intervention(s): Analysis of the semen samples delivered and used in connection with the couples' first IVF treatment.Main Outcome Measure(s): Year of birth, age at time of sample collection, sperm concentration, and semen volume.Result(s): The mean sperm concentration (±SD) was 183.7 x 10⁶ mL and the mean semen volume (±SD) was 3.9 mL. A considerable variation in both parameters was found from year to year, but no significant change occurred in either parameter throughout the entire period. When four birth cohorts were compared, a later year of birth was not associated with any change in sperm concentration or semen volume.Conclusion(s): Sperm concentration and semen volume were not related to year of birth, indicating that sperm quality has not changed in the Danish male population during the last 20–30 years.     

Oocyte quality in polycystic ovaries revisited: Identification of a particular subgroup of women

Purpose: Our purpose was to assess the endocrine status of women with polycystic ovaries (PCO) undergoing IVF, and to compare oocyte quality with endocrine markers of the syndrome, in an attempt to define a subpopulation with poor quality oocytes. Methods: This was a retrospective study. Patients were first endocrinologically analyzed: serum levels of androgens (T, androstenedione, DHEAS), FSH, and LH as well as glucose and insulin after an oral glucose tolerance test (OGTT) were recorded and are expressed as absolute values and area under the curve (AUC). Subsequently, they were followed over a 2-year period in which patients underwent several attempts of IVF as well as serving as oocyte donors. Patients were divided into three groups: group I (n=4) was women who displayed embryos unable to implant in 15 IVF cycles and 10 ovum donation cycles in which they served as donors; group II (n=16) was PCO patients in whom IVF (n=38) and/or oocyte donation cycles (n=42) resulted in pregnancies; and group III (n=13) was IVF patients with normal appearance of the ovaries by ultrasound. The endocrine status was compared with the IVF results. Results: There was no difference among groups in the endocrinological parameters tested, except for the OGTT which identified women in group I as having higher serum glucose and insulin levels than patients in groups II and III. Similarly, the OGTT showed higher serum glucose values in group II compared to group III. Women in group I were also obese. Patients in group III were older than PCO patients and needed more gonadotropins to reach an ovarian response which resulted in a reduced number of oocytes retrieved. Fertilization was also impaired in group I, in which no pregnancy was recorded. Conclusions: This study shows that there is a particular subgroup of PCO patients with lower fertilization rates and embryos unable to implant. These patients are obese and nonhyperandrogenic and show derangements of insulin secretion.     

Embryo developmental stage at transfer influences outcome of treatment with intracytoplasmic sperm injection

Purpose: Our purpose was to determine if embryo cell stage at the time of intrauterine transfer correlates with pregnancy rate in patients treated with intracytoplasmic sperm injection (ICSI). Methods: We conducted a retrospective analysis of 455 embryo transfer cycles following ICSI and 304 conventional in vitro fertilization (IVF) and embryo transfer cycles in women aged 40 years or less. Abstracted information included grading of the embryo cell stage and quality at the time of transfer. Results: The overall ICSI pregnancy rate was 30.8%, while that of conventional IVF was 29.3%. However, the ICSI pregnancy rate fell to 9.3% for embryo transfers taking place at the two-cell stage but increased to 35.8% when at least one embryo had more than two cells, and this difference was statistically significant (P≤0.0001). The pregnancy rate following conventional IVF was 22.0% when only two-cell embryos were transferred and 32.0% when at least one of the embryos had more than two cells, but this difference in pregnancy rates was not significant (P>0.05). Conclusions: The stage of embryo development at transfer appears to exert a powerful influence on the successful establishment of pregnancy after ICSI.     

Evaluation of sexual misconduct complaints: The Oregon Board of Medical Examiners, 1991 to 1995

OBJECTIVE: In 1991 the Oregon Board of Medical Examiners initiated a separate category for the complaint of sexual misconduct. Investigated complaints of sexual misconduct brought to the Oregon Board of Medical Examiners were analyzed for the years 1991 to 1995 to serve as a baseline. Comparison was made to the Federation of State Medical Boards sexual misconduct data for 1991 and 1992.STUDY DESIGN: One hundred complaints brought against 80 licensees were evaluated by practitioner's degree, age group, sex, specialty, and disposition of complaints for the years 1991 to 1995. The allegations were classified into behavior categories of sexual impropriety, sexual transgression, and sexual violations.RESULTS: Sexual misconduct was the allegation in 5.9% of the complaints investigated for the study period. Oregon had more sexual misconduct complaints than the average reported to the Federation of State Medical Boards for the years 1991 and 1992. Most (72%) complaints came from the patients or their families. Two female physicians (2.4%) had sexual boundary complaints. Sexual misconduct complaints increased by a risk ratio of 1.44 with advancing age by decades. Allegations classified into behavior categories according to severity revealed 39% sexual impropriety, 31% sexual transgression, and 30% sexual violation. Reportable disciplinary actions occurred only with multiple allegations of sexual impropriety (6.5%) and for sexual transgression (27%) whereas sexual violation allegations often had one complainant but there were 54% reportable disciplinary actions. Family practice, obstetrics and gynecology, and psychiatry had the highest incidence of sexual misconduct complaints whereas psychiatry and obstetrics and gynecology had the highest incidence of reportable disciplinary actions. Twenty-five percent of the closed cases resulted in reportable disciplinary actions. This analysis is discussed in relationship to legal and ethical issues and the goal of zero tolerance.CONCLUSIONS: Oregon has a higher percentage of sexual misconduct complaints than the average for 42 states reporting to the Federation of State Medical Boards for the years 1991 and 1992. Analysis of the Oregon Board's experience for the study years will provide a baseline for future evaluation and as an educational resource for the Oregon Board of Medical Examiners and professional and specialty societies. Ethical standards, the reporting and investigative processes, and the legal framework are in place and lessen the incidence of sexual misconduct and work toward zero tolerance. (Am J Obstet Gynecol 1997;176:1340-8.)     

An obstetric and gynecologic clerkship''s influence on a medical community: The Washington, Alaska, Montana, and Idaho Anchorage obstetric and gynecologic clerkship

OBJECTIVES: Our purpose was to explore the influences of an obstetric and gynecologic medical student clerkship on a remote medical community. Return of physicians to Alaska and faculty perceptions of their experience were central foci.STUDY DESIGN: Data were obtained on former clerks to determine choice of speciality and location of practice. Data regarding all physicians new to Alaska was correlated with the University of Washington Medical School graduate data. Additionally, a questionnaire with a Likert-type scale evaluated the 10 clinical faculty members participating in the clerkship.RESULTS: Between 1978 and 1991 we trained 266 clerks. A total of 77 of 374 (21%) new physicians in Alaska (1978 to 1991) were graduates of the University of Washington; 26 of those 77 (34%) were our former Anchorage obstetrics and gynecology clerks. The clinical faculty reported both positive and negative effects of their participation in the clerkship.CONCLUSION: The desired benefit, the return of new physicians to Alaska, seemed supported. Questionnaire results hinted at additional benefits for the supervising faculty physicians in this isolated community. The formal affiliation effected by the clerkship seemed to have a positive impact on patient care, communication, consultation, and shared action among the participating physicians. (Am J Obstet Gynecol 1997;176:1363-7.)     

卫生技术干部全面量化考核方法的研究

在卫生技术干部人才管理过程中,研究制定出一套全面量化考核标准和考核方法。考核内容分学历、任职年限、政治思想表现、业务技术水平、创新能力、科研(医疗)成果、专业论文发表和外语水平八大项。对每项内容制定了考核标准的隶属度,并根据考核内容的权重大小,定出每项内容的分配系数。采取述职、考查、测评、答辩等形式进行考核,然后运用综合分析方法,对卫生技术干部作出“优秀、称职、基本职称、不称职”的评价。     

医疗法学在医务人员再教育中的地位

随着社会的文明进步,特别是在法制越来越健全的社会,作为医务人员在培养业务技能的同时,接受医疗法学再教育有着非常重要的意义。文章论述了医疗法学的概念及其存在、发展的客观事实;医疗法学在医疗实践中的作用;医疗法学在医务人员继续教育体系中的地位和意义。     

抗癌宝口服液治疗中晚期恶性肿瘤103例临床观察

目的：观察中药抗癌宝口服液治疗中晚期恶性肿瘤临床效果。方法：１０３例患者随机分为抗癌宝观察组与化疗对照组，对两组疗效作比较。结果：观察组患者免疫功能，近期有效率（ＣＲ＋ＰＲ），生存质量，１、２、３年生存期及中位生存时间，癌胚抗原下降水平，明显高于对照组，且有显著性差异。结论：抗癌宝具有抑制肿瘤生长，延长生存时间，提高生存质量之效。     

世界中西医结合大会在京召开──交流中西医结合在理论、临床、教育及政策管理方面经验

世界中西医结合大会在京召开──交流中西医结合在理论、临床、教育及政策管理方面经验人民日报北京１０月２７日讯世界中西医结合大会今天在北京国际会议中心开幕。大会以“继承、发扬、结合、创新”为主题，交流重点是中西医结合在理论、临床、教育及政策管理等各方面的...     

洛阳龙门石窟药方与敦煌卷子《备急单验药方卷》同源

刻于唐初高宗时期的洛阳龙门石窟药方，并未标注文献来源，千余年来龙门药方的文献来源一直是个谜。本文作者通过对宋以前各类医书的探寻，在敦煌医学卷子中找到线索，最终发现龙门药方与敦煌医学卷子Ｓ９９８７、Ｓ３３４７、Ｓ３３９５有明显的同源关系，亦即它们同样来源于《备急单验药方》一书。