Serum anti-Mullerian hormone levels during controlled ovarian hyperstimulation in women with polycystic ovaries with and without hyperandrogenism

BACKGROUND: Anti-Mullerian hormone (AMH) is expressed in pre- and small-antral follicles. High serum levels are found in women with polycystic ovaries (PCO), accordant with their increased content of small follicles. To evaluate the relationship between AMH, folliculogenesis and hyperandrogenism, we compared serum AMH levels between women with PCO with and without hyperandrogenism and normal controls during controlled ovarian hyperstimulation (COH). METHODS: Nineteen women with PCO and hyperandrogenism (group A), 10 women with PCO but no hyperandrogenism (group B) and 23 ovulatory women with normal ovarian morphology (group C, controls) underwent COH with the long protocol. Serum levels of AMH, estradiol, androstenedione and follicular tracking were determined before gonadotropins treatment (day 0) and every 2-4 days up to the day of HCG administration. RESULTS: AMH levels declined gradually throughout COH in the three groups, but remained higher in groups A and B compared with the controls. Significantly higher levels were found in group A compared with group B, despite comparable numbers of small follicles. Multiple regression analysis revealed that both the number of small follicles and serum androgens were correlated to AMH. CONCLUSIONS: Women with PCO have higher serum AMH levels during COH than controls. Hyperandrogenism is associated with an additional increase in AMH. It is conceivable that hyperandrogenism may reflect more severe disruption of folliculogenesis in women with PCO or may affect AMH secretion.     

Vasectomy techniques for male sterilization: systematic Cochrane review of randomized controlled trials and controlled clinical trials

BACKGROUND: The review aimed to compare the effectiveness, safety and acceptability of vasectomy techniques for male sterilization. METHODS: We searched five computerized databases and reference lists of relevant articles and book chapters for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing vasectomy techniques. Two reviewers independently extracted data from eligible articles. RESULTS: Two poor-quality trials compared vas occlusion with clips versus a conventional technique, and four poor-quality trials examined vas irrigation with water versus no irrigation or irrigation with euflavine. No significant differences regarding the primary outcome of time to azoospermia were found. However, one trial reported fewer median number of ejaculations to azoospermia with euflavine rather than water irrigation. An interim report of a high-quality trial comparing vasectomy with and without fascial interposition found more azoospermia with fascial interposition but also more surgical difficulties. CONCLUSIONS: No conclusions can be reached regarding the effectiveness, safety and acceptability of vas occlusion techniques or vas irrigation since only low-quality, underpowered studies were available. Fascial interposition had improved vasectomy success but also increased surgical difficulty. High-quality, adequately reported RCTs are required. More work is also needed in the standardization of follow-up protocols, evaluation of vasectomy success and failure, recanalization and analytical methods.     

Electronic patient-provider communication: will it offset office visits and telephone consultations in primary care?

BACKGROUND AND AIM: Electronic patient-provider communication promises to improve efficiency and effectiveness of clinical care. This study aims to explore whether a secure web-based messaging system is an effective way of providing patient care in general practices. METHOD: We conducted a randomised controlled trail and recruited 200 patients from the waiting area in one primary clinic in Norway. Participants were randomised to either the intervention group, which received access to a secure messaging system, or the control group receiving standard care without such access. Primary outcome measures were number of online consultations, telephone consultations and office visits in the two groups. Data were derived from patient records and collected 1 year prior to (baseline), and 1 year after the intervention. RESULTS: Forty-six percent of the patients who were given access to the messaging system (n=99) used the online communication system on at least one occasion (ranging from 1 to 17 messages per patient per year). A total of 147 electronic messages were sent to six general practitioners during a 1-year trial period. Eleven percent of the messages were to schedule an appointment. In 10% of the messages, the GP was unable to respond adequately and recommended an office visit. The reduction in office visits over time was greater for the intervention group than for the control group (P=0.034). There was however no significant difference in the number of telephone consultations between the groups during the study (P=0.258). CONCLUSION: The use of a secure electronic messaging system reduced the number of office visits at the general practice, but not phone consultations.     

透皮给药研究的新进展

透皮给药安全可控，是无创给药的新途径，有着广阔的市场前景。现有的透皮药物限于小分子和低浓度，角质层屏障使大多数药物难以通过或难以达到有效浓度和有效速率。透皮给药的关键在于促进药物渗透，使药物透皮吸收进毛细血管。促渗手段有：使用化学促渗剂；对药物进行化学修饰制成前体药物；使用物理方法；将药物载入载体。这些方法的原理大致分为三种：改变角质层结构；外力驱动药物；将药物进行修饰或包裹。简要地介绍了增强药物透皮的物理方法和载体方法研究的新进展。     

睡眠信念与态度量表在失眠患者健康教育中的应用

目的: 采用睡眠个人信念与态度量表探索患者睡眠障碍与哪些歪曲的信念有关,针对歪曲的信念进行睡眠实践教育,达到促进睡眠的目的.方法: 连续收集62例以失眠为主诉的患者,随机分成试验组与对照组,各31例,两组均在药物治疗及心理治疗基础上进行睡眠健康教育.试验组针对患者自身存在的歪曲信念态度进行健康教育,而对照组只进行常规的健康宣教.入组前及入组后每周,应用睡眠个人信念与态度量表(Dysfunctional Beliefs and Attitudes about Sleep Scale,DBAS)、匹茨堡睡眠指数量表(Pittsburgh Sleep Quality Index,PSQI)对两组进行测评,同时让患者评价睡眠时间、睡眠质量、睡眠效果和对健康教育接受程度.结果: 健康教育4周后试验组和对照组DBAS得分均高于人组时[(111.0±8.7)vs.(88.9±12.3)、(93.5±17.2)vs.(81.3±19.2),P:0.001、0.010],而PSQI得分均低于入组时[(5.5±2.1)vs.(10.9±4.4)、(9.0 ±2.1)vs.(11.5±3.6),均P=0.001];健康教育4周后对照组的DBAS得分低于实验组,而PSQI得分高于实验组.健康教育后试验组对睡眠时间、睡眠质量、睡眠效果满意的比例均明显提高,睡眠时间满意的比例由18/31到30/31,对睡眠质量满意比例由8/31变为23/31,对睡眠效果满意比例由8/31到21/31(均P＜0.05).试验组对睡眠时间满意的比例明显高于对照组(30/31 vs.14/31,P＜0.01),对健康教育的接受程度也明显高于对照组(18/31 vs.5/31,P＜0.05).结论: 试验组健康教育后患者的睡眠信念有了明显的改善,睡眠质量有了提高.     

孤独症患儿脑干听觉诱发电位研究

目的 :探讨孤独症患儿脑干听觉诱发电位 (BAEP)的表现。方法 :将研究对象分 3组 :(I)孤独症组 (AD ;2 2例 ) ;(II)单纯智力低下组 (MR ,2 0例 ) ;(III)正常对照组 (NG ,30例 )。智商测验采用 0 - 4岁小儿神经心理发育量表及韦氏智力量表 ;研究对象给予脑干听觉诱发电位测试。结果 :(1 )ADBAEP之III、V波潜伏期及I-III,I-V波峰间期 (IPL)较NG延长 (P <0 0 0 1 )。(2 )ADBAEP之III波潜伏期及I-III波IPL较MR组延长 (P <0 0 0 5)。 (3) :MRV波潜伏期及III-V、I-V波IPL较NG延长 (P <0 0 0 1 )。结论 :(1 )孤独症患儿的脑干听觉诱发电位异常 ,尤其是脑干传导时间 (BTT)的延长 ,提示脑干机能障碍导致信息向大脑传递通路的损害可能是造成孤独症患儿在认知、社会及语言能力等方面异常发育的原因之一。 (2 )孤独症患儿BAEP异常原因可能与孤独症本病特性有关而非伴随智力低下所致。     

Direct infant UV light exposure is associated with eczema and immune development

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Intravenous and intracoronary fibrinolytic therapy in acute myocardial infarction: Overview of results on mortality, reinfarction and side-effects from 33 randomized controlled trials

During the past 25 years, 24 randomized trials of intravenous(IV) fibrinolytic treatment have been reported, involving atotal of some 6000 patients in the acute phase of myocardialinfarction. Most tested IV streptokinase (SK), but a few testedIV urokinase (UK). In the past 2 or 3 years numerous small randomizedtrials of intracoronary (IC) SK have been started, 9 of which,involving a total of about 1000 such patients have been reported.Because all of these IV and IC trials were small (the largestincluding only 747 patients), their separate results appearcontradictory and unreliable. But, an overview of the data fromthese trials indicates that IV treatment produces a highly significant(22%±5%, (P<0.001) reduction in the odds of death,an even larger reduction in the odds of reinfarction, and anabsolute frequency of serious adverse effects to set againstthis that is much smaller than the absolute mortality reduction.The apparent size of the mortality reduction in the IV trialswas similar whether anticoagulants were compulsory or optional,whether treatment was in a coronary cure unit or an ordinaryward and, surprisingly, whether treatment began early ( <6h from onset of symptoms) or late (generally 12–24 h).In addition, there was no evidence that UK was more effectivethan the less expensive SK, or that, despite their technicalcomplexity, the new IC regimes were more effective than theold IV regimes. Even the IV schedules that have been studied in randomized trialswere, however, quite complex, and the IC schedules were farmore so. Perhaps partly because of this, none of them is widelyused. If so, then some much simpler, and hence more widely practicable,IV SK regimes should be developed and tested. For example, asimple one hour high-dose IV SK infusion, without anticoagulation,will successfully convert virtually all of the available plasminogeninto plasmin. But, it may be several years before the net effectson mortality of any more widely practicable IV SK regimes canbe agreed unless many of the hospitals that do not wish routinelyto use IC regimes or the complex previous IV regimes will collaboratein multicentre randomized trials that can, if necessary, continuerapid intake until some tens of thousands of patients have beenrandomized, and some thousands of deaths have been observedamong the control and treated patients. The same, of course,may be true for any other fibrinolytic regimes (e.g. infusionof tissue plasminogen activator) if their net effects on mortalityare comparable to those of IV SK.     

角膜塑形镜控制中小学生近视有效性和安全性Meta分析

目的 系统评价角膜塑形镜对中小学生轻中度近视延缓的有效性和安全性。方法 检索The Cochrane Library、PubMed、EMbase、CBM、CNKI、WanFang Data和VIP等数据库,语言限定为中英文。采用Cochrane手册提供的偏倚风险评价工具和改良JADAD评分量表评价纳入文献质量;采用漏斗图检测纳入文献的发表偏倚;采用RevMan5.4软件进行Meta分析。结果 共有12篇文献符合纳入排除标准,包含1 908例研究对象。Meta分析结果显示: 佩戴角膜塑形镜后,裸眼视力有所提高[1年:MD=0.40,95%CI(0.05～0.74),P=0.02];角膜曲率有所下降[1年:MD=-3.21,95%CI=(-3.64～-2.79),P＜0.01];屈光度增长得到了有效控制[1年:MD=-3.19,95%CI=(-4.42～-1.95),P＜0.01;2年:MD=-3.61,95%CI=(-5.78～-1.43),P＜0.01];眼轴增长有所控制[1年:MD=-0.73,95%CI=(-1.43～-0.03),P=0.04;2年:MD=-1.15,95%CI=(-2.25～-0.06),P=0.04];眼轴变化量有所下降[1年:MD=-0.42,95%CI=(-0.64～-0.21),P＜0.01;2年:MD=-0.53,95%CI=(-0.96～-0.11),P=0.01]。结论 角膜塑形镜能够延缓中小学生轻中度近视的进展,且较为安全。     

中医药随机对照试验中采用真实世界数据作为对照组的研究设计及挑战

在设计随机对照试验（RCT）时,如果对照组存在患者招募和入组困难的情况,就会影响试验整体实施。近年来,真实世界数据（RWD）作为除RCT之外的数据来源,在医疗领域中发挥着越来越重要的作用。中医药RCT中可以尝试采用将RWD作为对照组的研究设计,不仅可以有效解决中医药RCT西医对照组患者入组困难的问题,同时能提供有力证据来评价中医药的疗效。倾向评分法目前已广泛应用于真实世界研究中混杂因素的处理,该文对RCT采用RWD作为对照组的这类设计中,基于倾向评分法常见的4种研究设计形式以实例分别进行了介绍,包括不对称随机分配、基于倾向评分分层法的两阶段设计、倾向评分联合复合似然法及倾向评分多种方法的联合。同时,这种设计类型也存在着方法学的挑战,包括RWD数据源必须是高质量且关键信息需要规范收集、RCT和RWD患者基线特征应该具有可比性、协变量选择时需要把所有已知与干预措施和结局相关的协变量都纳入进行分析等。在中医药领域采用这种设计时,还存在着有些RWD中医证型信息缺失、中医结局指标缺失等问题,在使用RWD时,需要根据数据实际情况决定如何分析。该文对以RWD作为RCT对照组的设计类型及面临的方法学挑战进行了介绍,期望能为研究者今后使用这类设计提供方法学借鉴。