目的 观察养精种玉汤对卵巢储备功能下降(diminished ovarian reserve,DOR)模型大鼠性激素水平的影响,探讨养精种玉汤通过PI3K/AKT信号通路治疗DOR的作用与机制.方法 纳入动情周期正常的雌性SD大鼠50只,随机选取其中10只作为正常对照组(等剂量生理盐水),其余SD大鼠采用首次腹腔注射环磷酰胺50mg/kg,以每天8mg/kg的剂量连续腹腔注射14d诱导DOR模型.按随机数字表法将造模成功40只大鼠分为模型对照组(等剂量生理盐水,灌胃给予)、垂体促卵泡素阳性对照组(7.5 IU/kg,皮下注射,1次/日,连续7d)、养精种玉汤低剂量(16.5g/kg,灌胃给予,2次/日,连续7d)组和养精种玉汤高剂量(66g/kg,灌胃给予,2次/日,连续7d)组,每组10只.HE染色观察卵巢组织病理学变化,并计算各组大鼠生长卵泡数量,ELISA测定血清卵泡刺激素(follicle stimulating hormone,FSH)、黄体生成素(luteini-zing hormone,LH)、雌二醇(estradiol,E2)、抗苗勒管激素(anti-Mullerian hormone,AMH)水平,Western Blot 检测大鼠卵巢组织磷脂酰肌醇3-激酶(phosphoinositide 3-kinase,PI3K)、蛋白激酶B(protein kinase B,AKT)蛋白表达.结果 养精种玉汤高剂量组可提高模型大鼠体重、子宫与左侧卵巢的湿重、子宫系数(P＜0.05),促进生长卵泡生长发育(P＜0.05),下调FSH、LH蛋白表达(P＜0.05)、上调E2、AMH蛋白表达(P＜0.05),同时使PI3K、AKT蛋白表达升高.结论 养精种玉汤高剂量组能改善DOR大鼠卵巢储备功能,其机制与激活PI3K/AKT信号通路密切相关.

目的 研究肾虚血瘀型多囊卵巢综合征经针药联合治疗的疗效及对患者中医证候积分、彩超检查结果、性激素水平、卵巢动脉血流动力学的影响.方法 选取海南医学院第一附属医院于2016年8月—2019年8月收治的肾虚血瘀型多囊卵巢综合征患者60例为研究对象,通过随机数字表法分为对照组和研究组,各30例.对照组使用阿司匹林肠溶片、枸橼酸氯米芬片、注射用绒促性素进行治疗;在对照组的基础上,研究组联合应用针灸和补肾活血方进行治疗,2组均治疗3个月经周期,随访2年.对比对照组、研究组治疗3个月经周期后的疗效;治疗前、治疗3个月经周期后的中医证候积分、彩超检查结果、性激素水平、卵巢动脉血流动力学.结果 随访期间,研究组妊娠率(66.67％)高于对照组(40.00％)(P<0.05);与治疗前比,治疗3个月经周期后2组面部痤疮、胸肋胀痛、崩漏、月经稀发、婚久不孕评分、血清促黄体激素(LH)、睾酮(T)、胰岛素(INS)、垂体泌乳素(PRL)水平、双侧子宫动脉搏动指数、阻力指数降低,研究组低于对照组(P<0.05);2组卵巢体积减小,研究组小于对照组,2组卵泡数减少,研究组少于对照组,2组子宫内膜加厚,研究组厚于对照组(P<0.05);2组血清雌二醇(E2)、促卵泡激素(FSH)水平升高,研究组高于对照组(P<0.05).结论 针药联合治疗能改善肾虚血瘀型多囊卵巢综合征患者子宫、卵巢情况及性激素分泌,减轻患者中医证候,改善患者卵巢动脉血流动力学,提高妊娠率.

目的 研究补肾活血调冲汤序贯针灸对多囊卵巢综合征(PCOS)患者促排卵效果及妊娠的影响,为临床提供参考.方法 选取2020年8月至2021年9月海南医学院第一附属医院收治的120例PCOS患者为研究对象,按照随机数字表法分为联合组、针灸组、中药组和西药组,每组30例.联合组患者采用补肾活血调冲汤联合序贯针灸治疗,针灸组患者仅采用序贯针灸治疗,中药组患者仅采用补肾活血调冲汤治疗,西药组患者行炔雌醇环丙孕酮片治疗.比较各组患者临床疗效,比较各组患者治疗前后子宫内膜厚度、宫颈黏液评分,比较4组患者治疗前后血清内分泌生殖激素[黄体生成素(LH)、雌二醇(E2)、睾酮(T)、促卵泡生成素(FSH)]变化,观察各组排卵率.结果 联合组患者总有效率高于针灸组、中药组、西药组(P<0.05);4组患者治疗后子宫内膜厚度、宫颈黏液评分均高于治疗前,且联合组患者子宫内膜厚度、宫颈黏液评分均高于针灸组、中药组、西药组(P<0.05);4组患者治疗后LH、T水平低于治疗前,E2、FSH水平高于治疗前(P<0.05);联合组患者治疗后LH、T水平低于针灸组、中药组、西药组,E2、FSH水平高于针灸组、中药组、西药组(P<0.05);联合组患者排卵率高于针灸组、中药组、西药组(P<0.05).结论 补肾活血调冲汤序贯针灸用于PCOS的疗效显著,可改善内分泌生殖激素,增高子宫内膜厚度,促进排卵,提升妊娠率,值得临床应用.

目的 研究中药联合序贯针灸疗法治疗多囊卵巢综合征(PCOS)对患者排卵、性激素和妊娠结局的影响.方法 将2021年2—10月海南医学院第一附属医院收治的120例PCOS患者作为研究对象,按照随机数表法均分为联合组(补肾活血调冲汤联合序贯针灸疗法治疗)、针灸组(序贯针灸疗法治疗)、中药组(补肾活血调冲汤治疗)、西药组(达英-35治疗)各30例,治疗3个月经周期后,比较4组子宫内膜厚度和排卵情况、性激素[黄体生成素(LH)、促卵泡激素(FSH)、睾酮(T)、雌二醇(E2)]水平及临床疗效,记录月经情况、妊娠结局及不良反应发生情况.结果 治疗3个月经周期后,4组成熟卵泡径线与治疗前比较及治疗后组间比较差异均无统计学意义(P均>0.05);4组子宫内膜厚度、成熟卵泡个数及血清E2水平均明显高于治疗前(P均<0.05),且联合组均明显高于其他组(P均<0.05);4组卵巢体积及血清LH、FSH、T水平均明显低于治疗前(P均<0.05),且联合组明显低于其他组(P均<0.05);4组总有效率、月经来潮时间、月经量、不良反应发生情况、排卵率比较差异均无统计学意义(P均>0.05),联合组临床妊娠率明显高于其他组(P均<0.05).结论 补肾活血调冲汤联合序贯针灸疗法能够有效改善PCOS患者排卵和性激素水平,提高临床妊娠率.

目的 探讨"双主教学模式"的多元整合教学法在中西结合妇产科学中的应用教学效果.方法 将海南医学院中医学院中西医结合专业2015级本科班设为对照组,采用传统教学模式;2016级本科班设为研究组,采用"双主教学模式"的多元整合教学法,最终通过期末成绩、综合成绩和学生满意度调查进行教学评价.结果 研究组的期末成绩和综合成绩均高于对照组(P<0.05),调查问卷显示绝大部分学生对该教学法的满意度较高,研究组在提高课程学习效果、加强师生交流、提高分析归纳与总结问题能力、提高团队合作能力、增强对理论知识的掌握、培养临床思维能力、提高中西医妇产科知识的结合能力7个方面的调查满意度均高于对照组(P<0.05).结论 "双主教学模式"的多元整合教学法通过多种教学法之间整合优劣、互相渗透和叠加优势,显著优化了教学过程,提高了教学质量,从而增强了学生解决问题的能力.

形成性评价能够在教学过程中动态、多次、及时对学生进行评价,从而能客观、全面地对学生学习过程进行整体考察与评估,并对其学习状态进行反馈.有效的形成性评价有利于教学相长,促进教学目标的达成,是整体提升学生综合能力与素质的重要途径.本教研室经过反复实践,初步形成适用于自身的一套中医妇科学形成性评价体系,并将在今后的实践中实时改进与完善.

通过以问题为导向的教学法(Problem-based learning,PBL)、以团队为中心教学法(Team-based Learning,TBL)和传统教学法(Lecture-based learning,LBL)三联融合教学模式在中西结合妇产科学教学中的应用分析,结果证明PBL+TBL+LBL三联融合多元化教学模式优于任何其中单一的形势,提高了教学质量,从而优化了中西结合妇产科学的教学效果,推进了教学改革,值得教师深入探讨研究,进一步推广.

目的:观察针刺配合艾灸治疗肾阴虚型卵巢储备功能不足(DOR)的影响.方法:选取2017年4月至2019年8月海南医学院第一附属医院收治的DOR患者65例作为研究对象,按照随机数字表法随机分为针灸组(n=17)、中药组(n=21)和西药组(n=20),3组均治疗3个月经周期后,观察临床疗效、中医症状积分,血清卵泡刺激素(FSH)、雌二醇(E2)、FSH/LH及抗缪勒管激素(AMH)水平.结果:在改善中医症状积分、血清FSH、FSH/LH方面,针灸组及中药组均优于西药组;E23组治疗前后有统计学意义,但组间比较无明显差异;AMH3组治疗前后比较差异无统计学意义,组间比较无统计学意义.3组中医症候疗效3组治疗前后差异有统计学意义,针灸组和中药组优于西药组.结论:针灸和中药一样能改善卵巢功能,改善临床症状,也是治疗卵巢储备功能不足的好的治疗手段.

阿尔茨海默病(Alzheimer's disease,AD)是一种神经退行性疾病,β淀粉样蛋白(β-amyloid,Aβ)沉积形成老年斑、Tau蛋白过度磷酸化造成神经纤维缠结及神经元丢失是其主要病理特征.经方当归芍药散出自《金匮要略》,是体现仲景“肝脾同调-血水同治”思想的代表方剂,本为疗妇人之疾而设,但自二十世纪八十年代末被广泛用于治疗AD,且临床疗效确切,具有抗炎、抗氧化、神经保护、神经营养、调节神经递质及调控中枢神经系统等活性.泛素-蛋白酶体途径(ubiquitin-proteasome pathway,UPP)是目前已知最精细的蛋白降解途径,为真核细胞内蛋白质降解的主要途径,能有效清除多余的和错误折叠的蛋白.近年来,研究证实UPP功能出现障碍,不能及时有效地清除Aβ沉积和过度磷酸化Tau蛋白,在AD的发生发展进程中扮演了极其重要的角色,为科学阐释当归芍药散治疗AD的分子生物学机制提供了新视角.本文在总结当归芍药散“肝脾同调-血水同治”治疗AD的临床疗效及其作用机制研究基础上,从UPP角度提出新的假说,以期“古为今用”,秉承古方为现代临床治疗服务;“今为古用”,进一步开展相关实验研究积极阐释古方的科学内涵.

沈大成的《花园单位》属于那一类小说:它不以编织跌宕起伏的情节为己任,让读者在故事中获得某种想像中的安慰;它也不着力塑造人物,人物的性格、命运等并不是它真正关心的问题.我猜测,作者一定是被她头脑中的某个景象、某个画面所征服了,她必须要把这幅画面用文字记录下来,继而繁衍出意义和隐喻.这一类小说,或许可以称之为场景小说吧,在读者心中,留下长久印象的,也是曾经打动过作者的那幅景象——现在,经由文字的渲染,它仿佛被一层神圣的光晕所环绕,散发出欲言又止的光泽,被不同的读者赋予了更多的意义,怎么说呢,就像一个人遭遇天启时刻.

目的 观察补肾活血中药联合针灸治疗肾阴虚型卵巢储备功能下降(DOR)的临床疗效.方法 将60例符合纳入标准的卵巢储备功能下降患者随机分成2组,每组30例,治疗组患者给予补肾活血方联合针灸治疗,对照组患者给予单纯补肾活血方治疗,2组均治疗3个月经周期后,观察临床疗效、中医症状积分,血清卵泡刺激素(FSH)、雌二醇(E2)、FSH/LH及抗苗勒氏管激素(AMH)水平.结果 2组治疗后上述指标都有显著改善,在改善中医症状积分、血清FSH、FSH/LH、AMH水平方面治疗组优于对照组(P<0.05).结论 补肾活血中药联合针灸比单纯中药更能改善临床症状及卵巢储备功能.

夏烁的《让这夜晚继续》清澈、明媚,有一股天真之气,仿佛一条小溪,潺潺流过这人世,映照出人世的种种混沌与混浊,也让人,比如已不再年轻的我,陷入对青春的缅怀之中.在我看来,这篇小说是不那么像青春文学的青春文学,也是非典型的成长小说.它呈现的是一个年轻人,突然发现人生复杂面貌的时刻,万念俱在,而万念各行其是.

This paper aimed at evaluating the therapeutic effects of acupuncture and moxibustion in treatment of heart-spleen deficiency and observing the improvement effect for insomnia patients′ sleep quality. A total of 70 cases of heart-spleen deficiency were selected as the research data, to the all cases were divided into acupuncture group and controlgroup. Acupuncture group were treated with acupuncture and moxibustion in many acupoints, the control group weretreated with estazolampo. After 3 courses of treatment, the PSQI and TESS of the two groups were observed. The totaleffective rate of the acupuncture group was 94.3％, the total effective rate of the control group was 77.1％ (P ＜ 0.05), andthe acupuncture group was more ideal than the control group (P ＜ 0.05) . After treatment the PSQI score and TESS scorein acupuncture group were decreased compared with control group (P ＜ 0.05) . Acupuncture and moxibustion in thetreatment of heart-spleen deficiency insomnia curative effect is ideal and reliable, can effectively decrease the PSQI andTESS score, and has lower auxiliary work compared with taken estazolam.

OBJECTIVE To study the clinical effect of gatifloxacin capsule combined with modified fuling pi decoction on patients with U.urealyticum infection.METHODS A total of 80 cases of female patients with U.urealyticum infection from May 2015 to May 2016 were selected,and were randomly divided into experimental group and control group,with 40 cases in each group.Patients in control group were treated with gatifloxacin capsules for more than 6 weeks of medication,and in experimental group were treated with modified fuling pi decoction based on control group for 2 weeks a course of treatment and a total of three courses.After each course,U.urealyticum DNA were qualitatively detected,and patients with positive results continued to receive treatment.The main symptoms of traditional Chinese medicine clinical score of the two groups of patients before and after treatment were recorded,and the clinical therapeutic effects were evaluated.RESULTS After treatment,the clinical symptom scores of the two groups were reduced,and the clinical symptom score of the experimental group was (0.49±0.18) points,lower than (4.45±1.56) points of the control group (P＜0.05).After three courses of treatment,the negative rate of U.urealyticum DNA in experimental group was 95.00％,which was significantly higher than 62.50％ in control group (P＜0.05).After treatment,the total effective rate of experimental group was 100.00％,which was higher than 80.00％ of control group (P＜0.05).CONCLUSION The clinical effect of gatifloxacin capsule combined with modified fuling pi decoction on U.urealyticum infection is better than that of gatifloxacin capsules.

中药调周法是在中西医结合研究的基础上发展起来的新疗法之一.通过研究中药调周法的理论基础,探讨该法概念的提出、产生及发展的背景,以冀优化该法的概念及产生的背景,对其的运用及发展有所裨益,以便更好指导临床,提供参考.

四逆散是疏肝理气,调理气机的基本方,广泛应用于治疗女性由于肝气郁结,气血不和,冲任带脉功能异常而引起的经、带、胎、产、杂等疾病.总结了近年来四逆散治疗妇科疾病的临床应用,发现四逆散治疗肝郁气滞导致的各种妇科疾病疗效良好,尤其是盆腔炎性疾病后遗症.但是对其应用于妇科临床的药理作用研究不足,今后应加强这一方面.

Objective To investigate the clinical efficacy of Bushen Huoxue Culuan Prescriptionin in the treatment of regional kidney and blood stasis due to polycystic ovary syndrome (POS).Methods Forty patients with infertility due to POS with regional kidney deficiency and blood stasis syndrome were randomly selected 40 cases as the treatment group and 40 as the control group.From the fifth day of menstruation,patients in the treatment group began taking Bushen Huoxue and promoting the ovulation,each taking 200 mL,daily one,sooner or later twice,even for 14 days;the control group began taking clomiphene once daily,times 50 ～ 100 mg,even for 5 days.Treatment of 3 to 6 months.In the course of treatment,color Doppler ultrasonography was used to detect the development of endometrium and follicles.The levels of serum sex hormones,such as insulin (INS),luteinizing hormone (LH),follicle stimulating hormone (FSH),pituitary prolactin (PRL),testosterone (T),estradiol (E2) were measured by chemiluminescence immunoassay.The ovulation rate and pregnancy rate of the patients were calculated by using self-defined diagnostic criteria.The ovulation rate,pregnancy rate,follicle number,serum sex hormone,endometrial thickness and ovarian volume change were compared between the two groups.Results The pregnancy rate were 30％,55％ in control and treatment groups,the difference between the two groups was significant (P ＜ 0.05).The ovulation rate were 73％,59.4％ in control and treatment groups,the difference between the two groups was significant(P ＜ 0.05).Compared with before treatment,the FSH,E2 in control group were statistically significant (P ＜ 0.05);the FSH,T,PRL,LH,INS and E2 in treatment group were statistically significant (P ＜ 0.05).Before treatment,the number of follicles with bilateral ovary diameters of 2 ～ 9 mm in control and treatment groups were 15.8 ± 1.9,16.6 ±2.1;the thickness of endometrium were (6.9 ± 1.48),(6.35 ± 1.52)mm in the two groups;the ovarian volume were (11.23 ± 4.12),(10.51 ± 4.51)mL in the two groups.After treatment,follicles with bilateral ovary diameters of 2 ～9 mm in control and treatment groups were 12.9 ± 2.2,9.8 ± 1.0;the thickness of endometrium were (7.96 ± 2.1),(9.82 ± 1.02) mm in the two groups;the ovarian volume were (9.75 ± 3.8),(8.15 ± 2.35) mL in the two groups.Compared with before treatment,the difference of the number of follicles,the thickness of endometrium,the ovarian volume in treatment group was statistically significantly (P ＜ 0.05);while the difference of the three factor in control group were no significant difference (P ＞ 0.05).Conclusion Bushen Huoxue Culuan Prescription can decrease LH level while increase FSH level,improve polycystic ovary,increase the number of follicles is conducive to the development of mature follicles,improve ovulation rates.Meanwhile can invigorating.

中医妇科学中带下病的教学中,采用中西医结合的思路,从带下病中西医病名的对照结合、发病机制的中西互参、中医辨证与西医辨病相结合、中西医内治法和外治法的主次结合等4个方面开展教学,突出特色,取长补短,可以发挥两种医学各自优势,使教学紧密结合临床,增强学生临床能力,激发学生学习兴趣.

目的:探讨形成性评价在中医妇科学教学考核中的应用.方法:根据中医妇科学课程的特点,分析形成性评价在中医妇科学教学考核过程中实施的有效途径.结果:形成性评价考核使学生学习成绩显著提高,调查问卷为85％学生愿意参加形成性评价.结论:形成性评价应用于中医妇科学教学考核中,有助于全面提高学生学习自主性、积极性和创新性,值得推广.

中药调周法吸取了中医传统理法方药的长处,并渗入了现代妇产科理论,临床应用证明对纠正排卵功能失调,恢复正常月经周期疗效较好;治疗范围从最初治疗月经病到不孕症,从功能性月经失调到器质性疾病,可见该法是具有中医特色的治疗方法,优于人工周期疗法及其他单一疗法;但目前的研究仍有一定局限性.