胃脘痛是指近心窝处及上脘处疼痛,程度逐渐加剧,频次逐渐增多,临床上多见于慢性萎缩性胃炎、胃溃疡、胆囊炎、胰腺炎等相关疾病.本病病因复杂,难以根治,易反复发作,迁延日久.脾胃为元气之本,精神压力大、饮食作息无度、嗜食寒凉辛辣油腻之品,均可致气机转枢不利、运化失司,致脾胃虚损,百病由生[1].中医采用辨证论治,标本兼顾,在治疗胃脘痛方面疗效显著.卢俊明主任医师运用经方治疗胃脘痛,疗效较好,现择其验案4则介绍如下.

子宫内膜容受性降低是导致胚胎着床失败的重要原因之一.目前,子宫内膜容受性降低的具体机制尚未明确,缺乏长期有效的治疗方法.越来越多的学者发现了宫腔菌群与子宫内膜容受性存在着一定关系,菌群或能通过影响免疫应答、炎症反应及酶的活性来影响子宫内膜容受性.本文主要总结了宫腔菌群的基本特征、宫腔菌群对子宫内膜容受性的影响,并分析了宫腔菌群失调影响子宫内膜容受性的潜在作用机制,以期为临床子宫内膜容受性的诊疗提供参考.

梳理《儒门事亲》中胎产病,分析和总结胎产病的防治方法,认为胎产病不免多有实证,因实而发病.在胎产疾病的治疗中,张从正不避吐下,反对滥用温补之时弊,对于部分胎产病的治疗采用食疗为主针药为辅的策略.通过分析此特殊时期的治疗,不仅可窥探"攻邪派"中"攻"的核心要义和本质,亦可了解张从正对"补"的理解,以深度指导临床.此外,张从正举误诊以警示、处理医患关系灵活,提出难产需预防等理念和方法,对现代临床仍有借鉴作用.现结合现代胎产病的发病特点及临床运用,更好地展现张从正学术思想对现代胎产疾病的治疗发挥的启示作用.

Background This study aimed at determining the predictive value of human chorionic gonadotropin and progesterone levels on pregnancy outcomes in patients receiving in vitro fertilization due to fallopian tube associated infertility. Methods We retrospectively analyzed the clinical data of 854 cycles due to fallopian tube associated infertility in vitro fertilization fresh embryo transfer. The clinical data had been collected from January 2010 to December 2018 and was divided into 7 groups depending on the progesterone level on human chorionic gonadotropin administration day. Live birth rates and observation trends were calculated. The receiver operating characteristic curve was established to determine the optimal cutoff value for progesterone, which was used to further divide the data into 3 groups; Group 1 (progesterone ≦ 1.0 ng/ml), Group 2 (1.0 ng/ml ≤ progesterone ≤ 1.25 ng/ml), and Group 3 (progesterone ≥ 1.25 ng/ml). We then compared the ovulation results and clinical outcomes among the 3 groups. Results There were no significant differences in age, infertility years, gonadotropin dosage, gonadotropin days, Luteinizing hormone level on human chorionic gonadotropin day, 2 pronuclear fertilization rates, clinical pregnancy rates, live birth rates, full-term birth rate, and preterm birth rates among the three groups. However body mass index ( p = 0.001), basal luteinizing hormone ( p = 0.034), estrogen peak ( p < 0.001), number of oocytes obtained ( P < 0.001) were significantly different. Conclusions Progesterone level on human chorionic gonadotropin day does not affect the clinical pregnancy rate and live birth rates after in vitro fertilization. However, progesterone levels between 1.0 and 1.25 ng/ml may lead to good clinical pregnancy outcomes.