Return of fertility following discontinuation of an injectable contraceptive — Norethisterone oenanthate (NET EN) 200mg dose

The return of fertility following discontinuation of norethisterone oenanthate (NET EN) 200 mg injectable contraceptive after use for a minimum period of six months or more was studied in 69 women who discontinued the method for planning pregnancy. Former users of copper intra-uterine device (CuT 200) were enrolled as a control group. Another 161 women who had discontinued NET EN due to other reasons (e.g. amenorrhoea, excessive bleeding or personal reasons) were also studied for return of fertility after ensuring that they were not using any other method of contraception and were exposed to the risk of pregnancy. The subjects from both groups were followed for a period of one year. The cumulative conception rates at one year were 72.5 and 83.6 per 100 subjects for ex-NET EN and ex-CuT 200 users who had discontinued the method for planning pregnancy and this difference was not statistically significant (P > 0.05). The median time for conception for ex-NET EN users was 7.8 months as compared to 3.7 months in ex-CuT 200 users but the cumulative conception rates at the end of one year show that future return of fertility in NET EN users does not appear to be adversely affected.

In 51 subjects who had discontinued NET EN due to amenorrhoea, the return of fertility was predictably slower and less. The return of fertility in subjects who discontinued NET EN for other reasons (e.g. excessive bleeding and other personal reasons) was similar to ex-NET EN and ex-CuT 200 users.     

Measuring clinical outcome

At the present time, there are many fundamental issues coming from the Department of Health or from other national organizations, which will have an effect on the future development of the dietetic profession. The British Diatetic Association (BDA) Professional Development Committee will consider these issues, as and when appropriate, and will publish the information in the form of Briefing Papers.
The first Briefing Paper on 'Quality Assurance' was published by the BDA in November 1989. The second on 'Measuring clinical outcome' is published below. In each case the opinion of BDA members and specialist groups has been sought and the Professional Development Committee wishes to thank individuals and the specialist groups for their comments.
The Briefing Papers are intended to provide information and promote discussion among the membership. I would welcome further comments from readers, which may be directed to the British Dietetic Association Office.     

Randomised trial comparing the upright and supine positions for the second stage of labour

Objective To assess the maternal and neonatal effects of upright compared with recumbent positions during delivery, in terms of defined outcome variables.
Design A randomised controlled trial.
Setting St Monica's Nursing Home, a midwife based maternity unit in Cape Town, South Africa.
Participants Five hundred and seventeen women of low obstetrical risk assigned to deliver at the nursing home.
Results The trial showed that women who adopted the upright posture for delivery experienced less pain, perineal trauma and fewer episiotomies than those who delivered in the supine position.
Conclusion The data suggest that in women of low obstetrical risk, choice of posture during delivery may be encouraged.     

中国儿童维生素A、维生素D临床应用专家共识

维生素A和维生素D是与儿童健康密切相关的两种脂溶性维生素,充足的维生素A、维生素D营养对儿童早期发展及疾病的防治具有积极的作用,缺乏和不足均会影响儿童健康。针对儿童保健医生和儿童家长对维生素A、维生素D的营养现状、缺乏原因及危害、防治措施、安全性等方面所存在的一些疑虑,中华预防医学会儿童保健分会组织国内相关专家,就上述问题结合国内外相关研究展开了充分讨论,基于现有研究成果,达成如下共识,希望对我国儿童维生素A、维生素D的临床应用提供参考.     

从古典医籍看古代医德观

中国古代医学典籍中有大量篇章论述了中国传统医德伦理思想,本文试图从中发掘出它对医德思想的创立,发展及促进作用,探讨其对社会主义医德的借鉴作用。     

恶性肿瘤患者甲床紫晕与舌下络脉变化的对比观察

甲床紫晕指甲半月远侧甲床上的紫色晕带,宽约2mm以上。伴指压反应延迟者,多见于肺癌、肺转移癌、肝癌、全身转移癌等重症肿瘤及肺心病、支气管哮喘及慢性支气管炎等阻塞性肺疾患,辨证均属血瘀证。铸型标本显示甲床有三级血管弓,第一级弓发出直行血管,血流为瀑布样直流,不易瘀滞;第二级弓发出的微血管互相交叉吻合形成网眼,血流变缓,其弓正当甲半月远侧,在气滞血瘀微循环障碍时易形成甲床紫晕。通过与吉下络脉同步观察,认为两者均可作血瘀证体征。     

2型糖尿病一级亲属非糖尿病患者胰岛素抵抗与胰岛β-细胞功能状态的研究

目的　研究 2型糖尿病 (DM)一级亲属非糖尿病患者胰岛素抵抗与胰岛β-细胞功能 ,探讨其在糖尿病发生发展中的作用。方法　选取 2型 DM一级亲属非糖尿病患者 6 0例为实验组 ,6 0例无糖尿病家族史的正常人为对照组 ,计算并比较两组的稳态模型胰岛素抵抗指数 (HOMAIR)、β-细胞功能指数 (HOMAβ)及胰岛素敏感性指数 (ISI)。结果　在年龄、体质指数 (BMI)及性别构成比可比的情况下 ,实验组 HOMAIR(0 .80 2 7± 0 .4 6 74 )、HOMAβ(5 .12 39± 1.0 86 3)显著高于对照组 (分别为 0 .6 0 11± 0 .5 4 6 2 ,4 .735 6± 0 .5 6 77) (P<0 .0 5 ) ,而 ISI(- 3.92 31± 0 .5 0 11)显著低于对照组(- 3.6 5 4 4± 0 .4 0 981) (P<0 .0 1)。结论　 2型 DM非 DM一级亲属具有高β-细胞分泌功能 ,低胰岛素敏感性 ,提示非DM一级亲属存在胰岛素抵抗。     

Training and certifying gastroenterologists as physician nutrition specialists

Because nutrition is an integral aspect of the science and practice of gastroenterology, all gastroenterology fellows should receive training in core aspects of nutrition (level 1 training). Some gastroenterologists also wish to train more extensively in nutrition (level 2) and become physician nutrition specialists. The Intersociety Professional Nutrition Education Consortium, composed of representatives from eight national societies with significant nutrition interests, including the American Gastroenterological Association, and three credentialing bodies, has developed a paradigm and training requirements for physician-nutrition specialists that recognizes their varied backgrounds and areas of interest. Opportunities exist for gastroenterology fellows to obtain physician nutrition specialist training within their gastroenterology fellowships and to be eligible to take the Certification Examination for Physician Nutrition Specialists offered by the new American Board of Physician Nutrition Specialists.* This article reviews the development of consensus on subspecialty training for physicians in nutrition; it also encourages directors of gastroenterology fellowships to develop training opportunities and gastroenterology fellows to consider identifying nutrition as an area of emphasis for their careers.     

中国恶性肿瘤整合诊治指南-肛管癌部分

目的探讨肿瘤细胞减灭术（CRS）及腹腔热灌注化疗（HIPEC）联合肝切除治疗结直肠癌腹膜转移（CRPM）合并肝转移（LM）的安全性及有效性。 方法回顾性收集中国医学科学院肿瘤医院结直肠外科自2017年6月至2019年6月采用CRS+HIPEC联合肝切除治疗的16例CRPM合并孤立LM患者的临床病理资料。 结果男性6例，女性10例，中位年龄62岁。全组患者接受CRS+HIPEC联合同步肝切除，肝脏转移瘤均获得完整切除。中位总生存期25个月，中位无病生存期9个月。1年及3年总生存率分别为75.0%及37.0%，1年及3年无病生存率分别为50.0%及9.4%。6例（37.5%）出现轻度并发症（Clavien-Dindo Ⅰ~Ⅱ），4例（25.0%）出现严重并发症（Ⅲ~Ⅳ）。 结论CRPM合并孤立的、能完整切除的LM的患者接受CRS+HIPEC联合同期肝切除是安全可行的，同时可为患者带来一定生存获益。