Undergraduate medical education in obstetrics and gynaecology in the USA and Canada, 1985

Many factors have led to a movement from the emphasis of the 1960s and 1970s on departmental expansion towards an emphasis on cost-effective undergraduate medical education emphasizing the 'art' as well as the 'science' of medicine. In January 1985 a questionnaire was sent under the auspices of the Undergraduate Education Committee of the Association of Professors of Obstetrics and Gynecology to all chairmen of departments of obstetrics and gynecology in the USA and Canada seeking their opinions about these trends and information about the educational programmes in their departments. The information from this study indicates that the chairmen are aware of and responding to this new direction in medical education. A stabilization of teaching staff and clerkship sizes and the emphasis on clinical as well as cognitive evaluation, despite recognition of the cost of the former, shows active interventions towards these ends. An emphasis on education in 'basic' as compared to 'subspecialty' areas which is independent of the subspecialty of the academic chairman also supports this trend.     

Economic consequences of occupational disorders in women with repetitive industrial work

Background: In a previous study, we found a three to four timesincrease in sick listing and disability pensioning among 269women in industrial repetitive work, as compared to 290 referentwomen in varied work. Methods: Here, by using an economic model,we estimated the costs for society of the work-environment dysfunctionsin the industrial group. Results: The costs for disability pensionsin the exposed group were 38.8 kSEK per person year at riskand for sick-leave 27.2 kSEK per person year, while the directcosts for health care were 2.2 kSEK per person year. Among referents,the sums were much lower: 5.6 kSEK per person year for disabilitypensions and 7.9 kSEK per person year for sick-leave and costsfor health care were 0.9 kSEK per person year. The costs (lossesin production) per person year of employment were 4.7 timeshigher for the exposed women than for the referents. The differencewas 53, 800 SEK (1 ECU = 8.74 SEK), of which disability pensioningwas 62%, sick-leave 35% and healthcare 3%. The actual transfersin the social insurance system corresponded to 45.1 MSEK amongthe exposed workers, as compared to 9.1 MSEK for the referents.Conclusions: Repetitive industrial work results in huge costs.Hence, preventive and other measures are needed.     

INSULIN-LIKE GROWTH FACTOR BINDING PROTEINS IN FOLLICULAR FLUID FROM NORMAL DOMINANT AND COHORT FOLLICLES, POLYCYSTIC AND MULTICYSTIC OVARIES

There is now considerable evidence that the insulin-like growth factors (IGFs) play an important role in the human ovary. It has also recently become apparent that the physiological activity of the IGFs is modulated by a number of specific binding proteins (IGFBPs). In order to understand the role of the IGFs in ovarian physiology, the presence and functions of these IGFBPs will need to be characterized. As an initial step towards this we have investigated the presence of the various binding proteins by Western ligand blotting and have measured the levels of one of them, IGFBP-1, in follicular fluid (FF) obtained from unstimulated dominant and cohort follicles in 19 normal women and in eight patients with polycystic and one with multicystic ovaries. In normal women, IGFBP-1 levels in dominant follicles were similar to matched serum levels but were significantly lower in cohort follicles. IGFBP-1 levels correlated with FF-volume (r = 0.58, P less than 0.001) and with paired serum levels (r = 0.63, P less than 0.001). In post-LH surge dominant follicles this relationship with serum levels no longer held and in three out of nine subjects FF levels were higher than in serum. Thus IGFBP-1 in normal human FF appears to be partly derived from the circulation but with additional local production in the larger developing dominant follicles. Western ligand blotting revealed five IGF-binding proteins in FF running parallel with those identified in serum, suggesting that the IGFBP species previously identified in serum may also be present in FF. The two bands in positions corresponding to the components of the large (150kDa) binding complex were, as in serum, the predominant forms and in most FF samples these were even more prominent than in the accompanying serum sample. This contrasts with previous studies in lymph which suggested that the 150kDa complex was largely retained in the circulation. All three small IGFBPs varied considerably between FF samples even within an individual; each IGFBP varied independently of the other IGFBPs. Our results demonstrate that at least four discrete IGFBPs are present in FF and suggest that each may be produced independently within the ovary.     

阿司匹林抵抗的研究

本文对阿司匹林抵抗的定义、临床意义、诊断、发生机理及对策研究作了较祥细的综述。对临床医生运用阿司匹林及如何处置阿司匹林抵抗有一定参考价值。     

Presence of Streptococcus mutans and lactobacilli in saliva and on enamel, glass ionomer cement, and composite resin surfaces

Abstract— The quantity of S. mutans , total streptococci, and lactobacilli on sound enamel surfaces and 1-yr-old glass ionomer cement and composite resin fillings with the cervical margins placed subgingivally was compared intraindividually. The amount of bacteria was compared to their number in saliva. The evaluation was done in a cross sectional study, where the patients continued to use their customary oral hygiene procedures and during a 14-day period of experimental plaque formation. The number of lactobacilli and S. mutans recovered from the test surfaces indicated that the critical salivary concentrations necessary for the isolation of S. mutans and lactobacilli from glass ionomer cement and composite resin surfaces are the same as for the enamel surfaces. The fluoride levels in plaque adjacent to glass ionomer cement will not become high enough to inhibit the accumulation of the investigated bacteria.     

One-year Sequential Follow-up of Venous Emptying Rate and Leg Temperature Profiles after Acute Deep Vein Thrombosis

Abstract. In order to study the natural course of venous flow and temperature reaction in the legs after symptomatic first episode of deep vein thrombosis (DVT), 65 patients (57 with proximal DVT) without further thromboembolic complications during the observation period were followed for 1 year by repeated plethysmography (PG) and thermography (TG). Regarding the non-invasive parameters substantial individual variations were observed during the observation period. After 1 year pathologic PG and TG were still demonstrated in 39% (I_μ (95%) = /0.43±0.05/) and 65% (I_μ (95%) = /1.18±0.11/), respectively, of the patients after proximal DVT. Only a minority of the patients were normalized permanently in both PG and TG during the first year. The high frequency of remaining venous obstruction and especially, persistent thermoactivity is notable and may be of clinical importance.