Clinical Efficacy of TCM Multi-channel Intervention Plus Antagonist Regimen on Ovarian Function，TCM Syndromes and Natural Conception in Poor Ovarian Responders Undergoing IVF-ET / 中国实验方剂学杂志

ObjectiveTo objectively analyze the effects of traditional Chinese Medicine （TCM） multi-channel intervention on the ovarian function，TCM syndromes and natural conception of poor ovarian responders（kidney-Yin deficiency，liver depression and blood stasis pattern） who planned to receive another in vitro fertilization embryo transfer（IVF-ET）antagonist regimen. MethodThe 128 low-prognosis patients （kidney Yin deficiency，liver depression and blood stasis pattern） who attended the West China Second University Hospital， Sichuan University and the Hospital of Chengdu University of Traditional Chinese Medicine from August 2020 to February 2023 and met the inclusion criteria were selected，and then divided into the treatment group and the control group according to the random number table，with 64 patients in each group. The control group was treated with oral dehydroepiandrosterone（DHEA），while the treatment group was treated with multi-channel TCM（oral TCM decoction + auricular point sticking + Bushen Huoxue prescription through retention enema）. After 3 menstrual cycles，the relevant indicators for ovarian function evaluation，TCM syndrome scores and natural conception were collected from both groups. ResultCompared with the situation before treatment，the basal follicle stimulating hormone（bFSH），bFSH/basal luteinizing hormone（bLH），basal estradiol（bE2），antral follicle count（AFC），the number of oocytes obtained，the number of normal fertilization，the number of superior embryos and TCM syndrome scores in the treatment group were improved after treatment（P<0.05，P<0.01）. For the control group， the bFSH/bLH and TCM syndrome scores were increased after treatment（P<0.05）， while the bFSH，bFSH/bLH，bE2，AFC，the number of oocytes obtained，the number of normal fertilization，and the number of superior embryos showed no significant difference after treatment. Compared with the control group after treatment，bFSH，bFSH/bLH，bE2，AFC，the number of normal fertilization，the number of superior embryos and TCM syndrome scores in the treatment group were better （P<0.05，P<0.01），while there was no significant difference in the number of oocytes obtained. After treatment，there were 3 cases of natural conception in the treatment group，while there were no natural conception in the control group. ConclusionFor patients with poor ovarian response and kidney Yin deficiency，liver depression and blood stasis pattern，multi-channel intervention of TCM plus the antagonist regimen can reduce bFSH，bFSH/bLH values，improve the levels of bE2，increase AFC，the number of oocytes obtained，the number of normal fertilization and the number of superior embryos，improve ovarian function，menstruation and TCM syndromes，improve their quality of life，and even enable some patients to get pregnant naturally before re-progression and improve their pregnancy outcome.

The Ethical Value of Hospice Narrative Doulas in the Context of Great Health / 中国医学伦理学

Death is the last transitional rite in the life process. Whether for the life state, family ethics or social relations of both the dead or the living, death indicates a major change and hides a certain crisis. The bio-health narrative concept puts forward that any transitional rite of life process requires narrative intervention and narrative care, as does death. Under the guidance of the concept, the profession of narrative death-doula came into being. Using the narrative concept as a framework, hospice narrative doulas provide emotional, physical, mental support to the terminal stage subjects and their families by accompanying the dying at close range, listening to their life stories, helping them record and dictate their autobiographies, reconstructing and repairing interpersonal narrative connections, and even planning funeral details with the dying. The death narrative doulas will create a personalized and humanized ritual and process around death, restore the spirituality and humanity which has been lost in the modern medical context to death itself.

Design and baseline characteristics of a population-based birth cohort in Shanghai / 上海预防医学

ObjectiveTo introduce the basic design， development plan and objectives of a population-based birth cohort in Shanghai， and further present the main data and baseline characteristics of enrolled participants in the cohort， and to provide key information for reproductive health-related studies. MethodsThe Shanghai population-based birth cohort initiated on January 1， 2005， included newborns born in Shanghai every year and their parents， and collected information on reproductive health， reproductive treatment， birth characteristics， growth and development status， as well as the incidence， treatment and death of diseases by employing data linkage technology and investigations. This formed a birth cohort spanning the entire life cycle. ResultsAs of October 2022， a total of 2 978 538 newborns and their parents were included in the cohort. Among them， 2 905 135 （97.54%） were naturally conceived （NC）， and 73 403 （2.46%） were born through assisted reproductive technologies （ART）. The average age of parents was （32.56±4.12） years old for females and （34.62±5.34） years old for males in the ART group， which was higher than （28.02±4.71） years and （30.07±5.54） years for parents in the NC group. Among parents， females and males aged 30 and above accounted for 77.12% and 85.08%， respectively， which were higher than that of parents （35.28% for females and 49.66% for males） in the NC group. Furthermore， the percentage of parents with a college degree or above in the ART group was 73.23% for females and 73.66% for males， which were higher than those in the NC group （49.98% and 50.91%， respectively）. The multiple births rate in the ART group was 33.81%， which was higher than that in the NC group （1.88%）. The incidence of premature birth and low birth weight in the ART group were 24.47% and 19.08%， respectively， which was higher than that in the NC group （5.47% and 3.73%）. ConclusionThe comprehensive collection of reproductive health-related information in the birth cohort in Shanghai can provide essential resources to determine the influence of genetics， environment， reproductive treatment and other related factors on the health of offspring after birth.

SUCCESSFUL HYSTEROSCOPY GUIDED SUCTION & EVACUATION OF PRODUCT OF CONCEPTION ALONG WITH REMOVAL OF UTERINE SEPTUM IN SAME SITTING

Objective To report a case of early pregnancy loss with septate uterus, successfully managed by hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum in same sitting. Case report. Tertiary care hospital. One woman with early pregnancy loss with septate Design Setting Patient uterus. Hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum Intervention in same sitting. Hysteroscopy guided suction & evacuation of product of conception followed by septum removal with Result hysteroscopic scissor was performed, with minimal blood loss, in same sitting. Products of conception were sent for pathologic examination. There were no intra-operative or postoperative complications. Even though the role of septum as a Conclusion contributing factor to miscarriage in not certain, early pregnancy loss may be seen in patients with septate uterus. Blind removal of POCs with dilatation & curettage, may be complicated with retained products of conception (RPOC) or intrauterine adhesion formation, which can lead to adverse fertility outcomes in the future. Also removal of septum, which may or may not be the cause, is often performed before further pregnancy. This requires another admission & exposure to anaesthesia, along with added cost. Hysteroscopy guided resection of POC with septum removal in same sitting has been associated with complete tissue removal under vision, less damage to surrounding endometrium, cost effective combination of two surgical procedures & earlier time to conception compared with 2 sitting procedure (dilation and curettage than septum removal). Thus, hysteroscopy guided suction & evacuation of POC & septum removal in same sitting can be considered as an alternative surgical technique for management of early pregnancy loss in patients diagnosed with septate uterus. This case report demonstrates the successful application of hysteroscopic procedure in a case of early pregnancy loss with septate uterus.

Concepción didáctica del proceso formativo interdisciplinar de la habilidad diagnosticar enfermedades para residentes de Dermatología / Didactic Concept of the Interdisciplinary Formation Process of the Diagnostic Ability of Dermatology Residents

Fundamento: El estudio teórico, el diagnóstico realizado y la experiencia de los investigadores, posibilitan formular como problema de la presente investigación: limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología del Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila. Objetivo: Elaborar una concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología, a partir de la caracterización del estado actual de esta habilidad. Metodología: Se realizó una investigación educativa con un componente descriptivo en el Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila, en los cursos escolares desde 2016 al 2020. La población de estudio fueron los 16 residentes de 1.er año que matricularon la especialidad de Dermatología en el período de estudio. Se emplearon métodos del nivel teórico y empírico. Resultados: La caracterización realizada reveló limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los laboratorios de Anatomía Patológica, Microbiología y Parasitología Médica, por los residentes (100 %). La concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar orienta el proceso desde las actividades docentes-atencionales y prácticas de laboratorio en una consecutividad lógica y sistematización desde las diferentes formas de enseñanza y tipologías de clase. Integra la interdisciplinariedad y la utilización del método investigativo establecido en las ideas rectoras. Conclusiones: La concepción didáctica como aporte de la investigación resuelve la contradicción dialéctica entre la aplicación del método clínico y los procedimientos en la práctica de laboratorio que se da en ese proceso formativo y constituye un soporte didáctico que respalda las actividades prácticas en los laboratorios para cumplir con los objetivos del Plan de estudio de la especialidad.

Background: The theoretical study, the diagnosis conducted and the experience of the researchers make possible to formulate the problem of the present research: limitations in the development of the ability to diagnose dermatological diseases in residents of the Specialty of Dermatology of the General Provincial Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila. Objective: To elaborate a didactic conception of the interdisciplinary training process of the ability to diagnose dermatological diseases in residents of the specialty of Dermatology, based on the characterization of the current state of that ability. Methodology: An educational research with a descriptive component was conducted at the Provincial General Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila, in the 2016-2020 school years. The study population consisted of the 16 first-year dermatology residents who enrolled in the specialty during the study period. Results: The characterization conducted showed limitations in the development of the ability to diagnose dermatological diseases in anatomic pathology laboratories, Microbiology and Medical Parasitology, by residents (100%). The didactic conception of the interdisciplinary training process of diagnostic ability focuses on teaching and learning activities and laboratory practices in a logical consecutiveness and systematization from the different forms of teaching and class typologies. It integrates the interdisciplinary and the use of the research method that is established in the guiding ideas. Conclusions: The didactic conception, as a research contribution, resolves the dialectic contradiction between the application of the clinical method and the procedures in laboratory practice that occurs in this formative process which is a didactic support that backs up the practical activities in the laboratories in order to achieve the objectives of the study plan of the specialty.

Concepción teórica para favorecer la transferencia de la rapidez de movimientos técnicos en el lanzamiento del martillo

El presente artículo se realizó a partir de detectar insuficiencias teórico-metodológicas y prácticas en el proceso de preparación técnica del lanzador de martillo categoría escolar; por tal razón, se propuso como objetivo general elaborar una concepción teórica para favorecer el entrenamiento en la transferencia de la rapidez de movimientos técnicos de los giros al instante final del lanzamiento del martillo, en atletas categoría escolar de la Eide "Pedro Batista Fonseca" de la provincia de Granma. Para el logro del objetivo antes expuesto se emplearon métodos de la investigación científica como los teóricos, el análisis y síntesis, el hipotético-deductivo y el sistémico estructural funcional; dentro de los empíricos, el análisis de documentos, la observación y la medición y como método matemático-estadístico la estadística descriptiva, además, se utilizó como técnica de investigación la entrevista. La propuesta permitió la sistematización de aquellos elementos relacionados directamente con la transferencia en el deporte y el proceso de entrenamiento del lanzador de martillo; de tal manera se previó, con su aplicación, el perfeccionamiento técnico de los atletas implicados en la investigación, así como un incremento en su rendimiento y resultados deportivos.

O presente artigo foi realizado a partir da detecção de insuficiências teórico-metodológicas e práticas no processo de preparação técnica do arremessador de martelos da categoria escola; por esta razão, foi proposto como objetivo geral elaborar uma concepção teórica para favorecer o treinamento na transferência da velocidade dos movimentos técnicos das voltas para o instante final do arremesso do martelo, na categoria escola atletas do Eide "Pedro Batista Fonseca" da província de Granma. Para alcançar o objetivo acima mencionado, foram utilizados métodos de pesquisa científica, tais como métodos teóricos, de análise e síntese, hipotéticos-dedutivos e estruturais-funcionais sistêmicos; dentro dos métodos empíricos, análise de documentos, observação e medição, e estatística descritiva como método matemático-estatístico; além disso, a entrevista foi utilizada como técnica de pesquisa. A proposta permitiu a sistematização daqueles elementos diretamente relacionados com a transferência no esporte e o processo de treinamento do martelo lançador; de tal forma que, com sua aplicação, foi previsto o aperfeiçoamento técnico dos atletas envolvidos na pesquisa, bem como um aumento de seu desempenho e resultados esportivos.

The present article was carried out from the detection of theoretical-methodological and practical insufficiencies in the process of technical preparation of the school category hammer thrower; For this reason, it was proposed as a general objective to develop a theoretical conception to favor training in the transfer of the speed of technical movements of the turns to the final moment of the hammer throw, in school category athletes of the Eide" Pedro Batista Fonseca" of Granma province. To achieve the aforementioned objective, scientific research methods such as theoretical, analysis and synthesis, hypothetical-deductive and structural-functional systemic were used; within the empirical, the analysis of documents, observation and measurement and as a mathematical-statistical method descriptive statistics, in addition, the interview was used as a research technique. The proposal allowed the systematization of those elements directly related to the transfer in sport and the training process of the hammer thrower; In this way, with its application, the technical improvement of the athletes involved in the research was foreseen, as well as an increase in their performance and sports results.

Clinical study of treating somatoform pain disorder with the combination of electroacupuncture and duloxetine / 针灸推拿医学（英文版）

Objective:To observe the clinical efficacy of treating somatoform pain disorder(SPD)with electroacupuncture(EA)at the Governor and Conception Vessel points plus duloxetine.Methods:Eighty-two SPD patients were randomly allocated to an observation group and a control group,with 41 cases in each group.The control group was intervened by oral administration of duloxetine hydrochloride enteric capsules at a dose of 60 mg per time once a day;based on the medication,the observation group received additional EA treatment by selecting points from the Governor and Conception Vessels.Clinical efficacy was evaluated after 8 weeks of treatments;changes in the scores of the short-form McGill pain questionnaire(SF-MPQ),self-report symptom inventory,symptom check list-90(SCL-90),Pittsburgh sleep quality index(PSQI),and generic quality of life inventory-74(GQOLI-74)were also compared.Results:After the intervention,the observation group surpassed the control group in comparing the total effective rate(P＜0.05).The SF-MPQ score,SCL-90 somatization score,and PSQI score dropped notably in both groups after treatment,and the intra-group differences were statistically significant(P＜0.05);the three scores were significantly lower in the observation group than in the control group(P＜0.05).The GQOLI-74 score got an increase in each dimension in both groups after treatment,and the intra-group differences were also statistically significant(P＜0.05);the GQOLI-74 dimension scores were all significantly higher in the observation group than in the control group(P＜0.05).Conclusion:For patients with SPD,combining EA at the Governor and Conception Vessel points and duloxetine hydrochloride enteric capsules can markedly improve their clinical symptoms and quality of life.

The skin surface microcirculation of conception vessel, governor vessel and thoroughfare vessel in patients with primary dysmenorrhea / 中国针灸

OBJECTIVE@#To observe the skin surface microcirculation of acupoints of conception vessel, governor vessel and thoroughfare vessel in patients with primary dysmenorrhea using laser speckle contrast imaging (LSCI), and provide acupoint selection basis of acupuncture-moxibustion for primary dysmenorrhea.@*METHODS@#Ninety-nine healthy female college students with regular menstrual cycles (normal group) and 94 female college students with primary dysmenorrhea (dysmenorrhea group) were recruited. Before menstrual period, on the first day of menstruation, and on the third day after menstruation, LSCI was used to observe the surface microcirculation at the abdominal acupoints of conception vessel, i. e. Yinjiao (CV 7), Qihai (CV 6), Shimen (CV 5), Guanyuan (CV 4), Zhongji (CV 3) and Qugou (CV 2), acupoints of thoroughfare vessel, i. e. Huangshu (KI 16), Zhongzhu (KI 15), Siman (KI 14), Qixue (KI 13), Dahe (KI 12), Henggu (KI 11) and acupoints of lumbosacral region of governor vessel, i. e. Xuanshu (GV 5), Mingmen (GV 4), Yaoyangguan (GV 3), Yaoshu (GV 2) as well as two non-acupoints.@*RESULTS@#Before menstrual period, there was no significant difference in the surface blood perfusion of the acupoints between the dysmenorrhea group and the normal group (P>0.05). On the first day of menstruation, the surface blood perfusion of Xuanshu (GV 5), Mingmen (GV 4), Yaoyangguan (GV 3) and right Huangshu (KI 16) in the dysmenorrhea group was higher than that in the normal group (P<0.05, P<0.01). On the third day after menstruation, the surface blood perfusion of the right Henggu (KI 11) in the dysmenorrhea group was lower than that in the normal group (P<0.05).@*CONCLUSION@#In patients with primary dysmenorrhea, on the first day of menstruation, the surface blood perfusion of Xuanshu (GV 5), Mingmen (GV 4), Yaoyangguan (GV 3) of governor vessel, and the right Huangshu (KI 16) of thoroughfare vessel is increased, while on the third day after menstruation, the surface blood perfusion of the right Henggu (KI 11) of thoroughfare vessel is decreased. These findings might provide a basis for acupoint selection in the acupuncture-moxibustion treatment of primary dysmenorrhea.

A Preliminary Framework for Syndrome Differentiation of Prostate Meridian， Qi And Blood Based on the “Conception Vessel， Governor Vessel and Thorough Vessel Sharing the Same Origin” Theory / 中医杂志

The “conception vessel， governor vessel and thorough vessel sharing the same origin” theory refers to the concept that the conception vessel， governor vessel and thorough vessel all originate from the same source within the uterus and emerge from the perineum. Based on the modern research of McNeal's prostate zonal anatomy theory， it is believed that the conception vessel， governor vessel and thorough vessel have the closest relationship with the prostate in terms of their origin and running course. It is proposed that the essential meaning of the ‘conception vessel， governor vessel and thorough vessel sharing the same origin’ theory in relation to the prostate is that the conception vessel， governor vessel and thorough vessel respectively connect to the transition zone， peripheral zone， and central zone of the prostate. Moreover， the differences in the yin-yang attributes of the conception vessel， governor vessel and thorough vessel exhibit distinct functional characteristics in different zones of the prostate， which serve as an important basis for the physiological and pathological differences in various prostate zones. Based on this premise， a prostate meridian， qi and blood syndrome differentiation method is further proposed， wherein the differences in the meridian characteristics of the conception vessel， governor vessel and thorough vessel determine the differences in the yin-yang aspects of qi and blood in different prostate zones. When clinical diagnosis is conducted， the inherent physiological differences of the different prostate zones should be fully taken into account， as well as the pathological characteristics of the disease， in order to guide the diagnosis and treatment of related clinical conditions.

Reproductive Traits for Identifying Prolific Black Bengal Goat (Capra hircus bengalensis)

The present investigation recorded that the average litter size was 2.03 per doe and the prolificacy rate being 202.92%. The result indicates that the litter size proportion for single, twin and triplet were 28.3%, 40.4% and 31.3% respectively. There was a tendency of increasing body weight with higher litter size and such variation was highly significant (P<0.01). The result revealed that the overall mean age of first estrus was 209.08±2.06 days. Maximum age of first conception was 226.18±5.39 days when the animal gave single birth and the minimum AC was 216.65±4.9 days when it produced triplet indicating that failure of conception was more in single bearing does. Service period were recorded to very significantly (P<0.01) among different litter bearing groups, the highest value was observed in triplet producing does (80.88±4.68 days). This is an important finding to understand that, less Age of Puberty (AP), Age at 1stConception (AC), Days Open (DO) & Kidding Interval (KI) has prominent benefit for multiple foetuses and thus achieving economic benefit.

Inseminação artificial homóloga póstuma: análise bioética do planejamento familiar / Posthumous homologous artificial insemination: a bioethical analysis of family planning / Inseminación artificial homóloga póstuma: un análisis bioético de la planificación familiar

Resumo Este artigo trata de questões relacionadas à inseminação artificial homóloga post mortem. Tomando como referência normas éticas que asseguram a livre escolha do casal no planejamento familiar, objetivou-se descobrir de que forma tais regulamentações influenciariam na concretização desse projeto parental. A partir do método hipotético-dedutivo, realizou-se revisão de literatura em bioética e biodireito, além de pesquisa documental no sítio eletrônico do Conselho Federal de Medicina. Refletiu-se, então, sobre o princípio de autonomia dos pacientes submetidos às técnicas de reprodução assistida, levando em conta algumas das repercussões dessa técnica sobre o direito de família e sucessões. Por fim, descreveu-se o método de casuística clínica, utilizado pelas clínicas como parâmetro para tomar decisões e aconselhar o cônjuge sobrevivente acerca da problemática da concepção póstuma.

Abstract This article discusses issues related to post mortem homologous artificial insemination. Taking as reference ethical norms that ensure the couple's free choice in family planning, the objective was to understand how such regulations would influence the accomplishment of this parental project. Using the hypothetical-deductive method, a literature review on bioethics and biolaw was carried out, in addition to a documentary research on the website of the Federal Council of Medicine. Then, reflections on the principle of autonomy of patients undergoing assisted reproduction techniques were made, considering some of the repercussions of this technique on family and succession law. Finally, a description of the method of clinical casuistry is presented, being used by clinics as a parameter to make decisions and advise the surviving spouse about the problem of posthumous conception.

Resumen Este artículo trata aspectos relacionados a la inseminación artificial homóloga post mortem. Con base en la normativa ética que garantiza la libre elección de la pareja en la planificación familiar, el objetivo fue identificar la influencia de la legislación en la realización de este proyecto parental. A partir del método hipotético-deductivo, se realizó una revisión bibliográfica sobre bioética y bioderecho, además de una búsqueda documental en el sitio web del Consejo Federal de Medicina. Con esto, se reflexionó sobre el principio de autonomía de los pacientes sometidos a técnicas de reproducción asistida, teniendo en cuenta algunas de las repercusiones de esta técnica en el derecho de familia y de sucesiones. Por último, se describió el método de la casuística clínica utilizado por las clínicas como parámetro en la toma de decisiones y asesoramiento al cónyuge sobreviviente en el tema de la concepción póstuma.

Pautas para la delimitación y empleo de los resultados científicos en la investigación educativa / Guidelines for the delimitation and use of scientific results in educational research

RESUMEN Las investigaciones educativas ofrecen diversos productos de valor para la ciencia, que incluyen contribuciones de carácter teórico y práctico. A menudo resulta difícil para los investigadores rotular los aportes, diferenciarlos y establecer su tipicidad. Tales resultados involucran modelos, concepciones, sistemas, estrategias, metodologías y programas de intervención, entre los más comunes. Dada la importancia que ello reviste para maestrandos y doctorandos a la luz de las tesis que elaboran y por las exigencias que deben cumplir los investigadores y coordinadores de proyectos al redactar sus informes de investigación; el presente trabajo se propone caracterizar las principales contribuciones científicas derivadas de la investigación educativa, en función de la determinación de la naturaleza que identifica cada resultado y el establecimiento de sus particularidades. Se efectuó un muestreo de tesis doctorales en Ciencias Pedagógicas y Ciencias de la Educación predefendidas y defendidas en la provincia de Camagüey entre 2016 y 2021.

ABSTRACT Educational research offers various products of value for science, including contributions of a theoretical and practical nature. It is often difficult for researchers to label such contributions, differentiate them and establish their typicity. Such results involve models, conceptions, systems, strategies, methodologies and intervention programs, among the most common. Due to the importance that this has for master's and doctoral students in light of the theses they prepare and because of the requirements that researchers and project coordinators must meet when writing their research reports; The present work intends to characterize the main scientific contributions derived from educational research, based on the determination of the nature that identifies each result and the establishment of its particularities. A sampling of doctoral theses in Pedagogical Sciences and Educational Sciences pre-defended and defended in the province of Camagüey between 2016 and 2021 was carried out.

The Pathway of Female Couples in a Fertility Clinic / O percurso de casais homossexuais femininos em uma clínica de fertilidade

Abstract Objective The present study aims to describe the main characteristics of female couples resorting to a fertility clinic, to understand whether these patients have clear previous plans concerning procreation and how they end up completing their family planning, and to briefly describe the main outcomes of the recepción de ovocitos de pareja (ROPA, in the Spanish acronym: in English, reception of partner's oocytes) method. Methods This is a descriptive retrospective study of the pathway and outcomes of female couples in a fertility clinic during a 2-year period. Results A total of 129 couples were treated. Only one third of the couples had no condition potentially affecting fertility or advanced age. Most couples were decided to undergo artificial insemination or in vitro fertilization and the majority kept their plans, as opposed to 38% of the couples who decided to the ROPA method (lesbian shared in vitro fertilization) who changed plans. Live birth rates per treatment (including frozen embryo transfers) for artificial insemination, 58% for in vitro fertilization, 80% for treatments with donated oocytes or embryos, and 79% for ROPA. Four in five couples achieved live births. Conclusion The present study highlights the importance of a thorough medical workup in same-sex couples resorting to assisted reproduction. Despite the higher-than-expected rates of fertility disorders, the outcomes were good. Most couples end up in a single parented method. Furthermore, the results of the ROPA method are reassuring.

Resumo Objetivo O presente estudo tem como objetivo descrever as principais características dos casais femininos que recorrem a uma clínica de fertilidade, perceber se estas pacientes têm planos prévios claros sobre a procriação, como acabam por completar o seu planejamento familiar e descrever sucintamente os principais resultados do método fertilização in vitro compartilhada lésbica (ROPA, na sigla em espanhol). Métodos Trata-se de um estudo retrospectivo descritivo da trajetória e dos resultados de casais femininos em uma clínica de fertilidade durante um período de 2 anos. Resultados Um total de 129 casais foram tratados. Apenas um terço dos casais não apresentava nenhuma condição que afetasse potencialmente a fertilidade ou idade avançada. A maioria dos casais optou pela inseminação artificial ou fertilização in vitro e a maioria manteve seus planos, ao contrário dos 38% dos casais que decidiram se submeter ao método ROPA que mudaram de planos. As taxas de nascidos vivos por tratamento (incluindo transferências de embriões congelados) - 22% para inseminação artificial, 58% para fertilização in vitro, 80% para tratamentos com oócitos ou embriões doados e 79% para ROPA. Quatro em cada cinco casais conseguiram nascidos vivos. Conclusão O presente estudo destaca a importância de um acompanhamento médico em casais femininos que recorrem à reprodução assistida. Apesar das taxas mais altas do que o esperado de distúrbios de fertilidade, os resultados foram bons. A maioria dos casais acaba em um método monoparental. Além disso, os resultados do método ROPA são tranquilizadores.

Effect of the percentage of Bos taurus inheritance on the fertility of Holstein×Zebu and Brown Swiss×Zebu cows in the Mexican tropics

Background: No dairy breed or crossbreed has superior overall performance in all environments; therefore, it is necessary to determine which crossbreed is the most suitable for the Mexican tropic and what proportion of European breed is optimum for reproduction. Objective: To assess the effect of the proportion of Bos taurus (Bt) genes on reproductive performance of Holstein×Zebu (HZ) and Brown Swiss×Zebu (BZ) cows, and compare reproductive performance of these genotypes in a dual- purpose production system. Methods: Cows were maintained in a rotational grazing system on African star grass (Cynodon plectostachyus) in Veracruz, Mexico. Cows were milked twice daily. Calves were kept tied to the side of their dams while the cows were milked. Results: The percentage of Bt genes did not affect (p>0.05) fertility traits (age at first calving, days to first service after calving, services per conception, conception rate at first service, days open until conception, gestation length, and calving interval) of BZ cows. In contrast, HZ cows with less than 75% Holstein (H) genes were 0.3 years younger (p<0.05) at first calving and had 39.8 fewer days open (p<0.05) than HZ cows with 75% H genes or more. In addition, the calving interval of HZ cows with less than 75% H genes was 44.8 days shorter (p<0.05) than that of HZ cows with 75% H genes or more. The HZ cows had five fewer days pregnant and were 22.8 kg heavier at calving (p<0.05) than BZ cows. Conclusions: The effect of the percentage of Bt genes on cow fertility depends on the dairy breed used. In general, BZ and HZ cows present similar reproductive performance.

Antecedentes: Ninguna raza lechera o cruce tiene un desempeño general superior en todos los ambientes; por lo tanto, es necesario determinar cuál cruce lechero es más apropiado en el trópico mexicano y qué proporción de raza europea es óptima para la reproducción. Objetivo: Evaluar el efecto de la proporción de genes Bos taurus (Bt) en el desempeño reproductivo de vacas cruzadas Holstein×Cebú (HC) y Pardo Suizo×Cebú (PC), y comparar el desempeño reproductivo de estos dos genotipos en un sistema de producción doble propósito. Métodos: Las vacas se mantuvieron en un sistema de pastoreo rotacional en zacate Estrella de África (Cynodon plectostachyus) en Veracruz, México. Las vacas se ordeñaron dos veces al día. Los becerros se mantuvieron atados, a un costado de sus madres mientras éstas se ordeñaron. Resultados: El porcentaje de genes Bt no afectó (p>0,05) ninguna característica de fertilidad (edad a primer parto, días a primer servicio después del parto, servicios por concepción, tasa de preñez a primer servicio, días abiertos a la concepción, duración de la gestación, e intervalo entre partos) de las vacas PC. En contraste, las vacas HC con menos de 75% de genes Holstein (H) fueron 0,3 años más jóvenes (p<0,05) al primer parto y tuvieron 39,8 días abiertos menos (p<0,05) que las vacas HC con 75% de genes H o más. Además, el intervalo entre partos de las vacas HC con menos de 75% de genes H fue 44,8 días más corto (p<0,05) que el de las vacas HC con 75% de genes H o más. Las vacas HC tuvieron cinco días de gestación menos y fueron 22,8 kg más pesadas al parto (p<0,05) que las PC. Conclusiones: El efecto del porcentaje de genes Bt sobre la fertilidad de la vaca depende de la raza lechera usada. En general, las vacas PC y HC tienen similar desempeño reproductivo.

Antecedentes: Nenhuma raça ou cruza leiteira tem desempenho geral superior em todos os ambientes; portanto, é necessário determinar qual cruza leiteira é mais apropriada no trópico mexicano e qual proporção da raça europeia é ideal para a reprodução das vacas. Objetivo: Avaliar o efeito da proporção de genes Bos taurus (Bt) no desempenho reprodutivo de vacas Holandês×Zebu (HZ) e Pardo Suíço×Zebu (PZ), e comparar o desempenho reprodutivo desses dois genótipos em sistema de produção de dupla aptidão. Métodos: As vacas foram mantidas em sistema de pastoreio rotacional em capim Estrela de África (Cynodon plectostachyus) em Veracruz, México. As vacas foram ordenhadas duas vezes por dia. Os bezerros foram mantidos ao lado de suas mães enquanto eram ordenhadas. Resultados: A porcentagem dos genes Bt não afetou (p>0,05) nenhuma característica de fertilidade (idade ao primeiro parto, número de dias para o primeiro serviço pós-parto, serviços por concepção, taxa de prenhes no primeiro serviço, dias abertos, período de gestação e intervalo entre partos) das vacas PZ. Em contraste, vacas HC com menos de 75% dos genes Holandês (H) eram 0,3 anos mais jovens (p<0,05) no primeiro parto e tiveram 39,8 dias abertos a menos (p<0,05) do que as vacas HZ com 75% ou mais dos genes H. Além disso, o intervalo de parto das vacas HZ com menos de 75% dos genes H foram 44,8 dias mais curtos (p<0,05) do que as vacas HZ com 75% ou mais de genes H. As vacas HZ tiveram cinco dias de gestação a menos e foram 22,8 kg mais pesadas no parto (p<0,05) do que as PZ. Conclusões: O efeito da porcentagem de genes Bt na fertilidade da vaca dependeu da raça leiteira utilizada. Em geral, as vacas PZ e HZ tiveram desempenho reprodutivo semelhante.

Concepção de ser humano na Clínica Ampliada: uma proposta de orientação analítico-existencial / Expanded Clinic conception of human being: an existential-analytical approach / Concepción del ser humano en la Clínica Ampliada: una proposición analítico-existencial

A Clínica Ampliada é uma das diretrizes que a Política Nacional de Huma-nização propõe, a fim de qualificar o modo de se fazer saúde pública. Está fundamentada em ideias que remetem à revisão do entendimento tradicional da saúde, o qual privilegia doença, sintoma e cura, objetivismo positivista e intervenção prioritariamente orgânica. Como alternativa, a Clínica Ampliada propõe a valorização do humano em seu contexto e em sua história de vida. O artigo desenvolve o pensamento de que a essa ampliação da clínica subjaz uma concepção de ser humano, uma vez que a caracterização de qualquer fenômeno humano implica um entendimento a respeito de como é o humano. Argumenta-se que a concepção analítico-existencial de ser humano, elabo-rada pelo filósofo Martin Heidegger, é compatível com a visão de ser humano implícita na abordagem da Clínica Ampliada à saúde, uma vez que também amplia a visão tradicional de ser humano, ao descrevê-lo como ser-no-mundo.

The Expanded Clinic is one of the National Humanization Policy's guidelines, which aims to improve the public healthcare. It is based on ideas that rethink traditional healthcare which is characterized by emphasis on diseases, symp-toms and cure, positivistic objectivity and primarily organic intervention. Alternatively, The Expanded Clinic approach highlights the priority of valuing the human in its context and in its life history. The article unfolds arguing that rethinking traditional healthcare practices implies an underlying conception of human being, since the definition of any human phenomenon is related to an understanding of what it is to be human. It is stated that Martin Heidegger's existential-analytical conception of human being is in line with the implicit vision of human being of the Expanded Clinic's approach, in so far as it broa-dens the long-established conception of the human being by describing it as being-in-the-world.

La Clínica Ampliada es uno de los lineamientos que propone la Política Nacional de Humanización, para calificar la forma de hacer salud pública; se basa en ideas que se refieren a la revisión de la comprensión tradicional de la salud, que privilegia la enfermedad, el síntoma y la cura, el objetivismo positivista y la intervención principalmente orgánica. Como alternativa, la Clínica Ampliada propone valorar al humano en su contexto y en su historia de vida. El artículo desarrolla el pensamiento de que a esta revisión subyace una concepción del ser humano, una vez que la caracterización de cualquier fenómeno humano implica un entendimiento de cómo es el ser humano. Se propone que la concepción analítico-existencial del ser humano, elaborada por el filósofo Martín Heidegger, es compatible con la visión del ser humano implícita en la abordaje de la Clínica Ampliada, ya que también expande la visión tradicional del ser humano, al describirlo como un ser-en-el-mundo.

Capacitación pedagógica en entorno virtual de los entrenadores de Djibouti

Las diferentes formas de capacitación de los entrenadores deportivos están dirigidas a satisfacer las necesidades de movilizar los conocimientos, las técnicas y la reflexión dirigida a la resolución de problemas en la preparación de los atletas. Debido a esto, la investigación se trazó como objetivo diseñar la concepción teórica para la capacitación pedagógica en entorno virtual de los entrenadores de Djibouti sobre la iniciación del niño al futbol. A partir de un enfoque dialéctico materialista de interpretación de los fenómenos, se emplearon como principales métodos de investigación el análisis de documentos, la observación, la encuesta la modelación y la comparación. Fue así, que se constató que eran insuficientes los conocimientos teórico-metodológicos relacionados con la iniciación de los niños al futbol y las limitaciones organizativas y metodológicas en las formas de capacitación. Los elementos epistemológicos modelados fueron comparados con otras propuestas, que demostró la novedad teórica argumentativa de la propuesta.

As diferentes formas de treinamento de treinadores esportivos visam atender às necessidades de mobilização de conhecimentos, técnicas e reflexão voltadas para a solução de problemas na preparação dos atletas. Por isso, a pesquisa teve como objetivo elaborar a concepção teórica para a formação pedagógica dos treinadores djibutianos em um ambiente virtual sobre a iniciação das crianças no futebol. Com base em uma abordagem materialista dialética para a interpretação dos fenômenos, os principais métodos de pesquisa utilizados foram a análise, observação, levantamento, modelagem e comparação de documentos. Assim, verificou-se que os conhecimentos teóricos e metodológicos relacionados com a iniciação das crianças ao futebol e as limitações organizacionais e metodológicas nas formas de treinamento eram insuficientes. Os elementos epistemológicos modelados foram comparados com outras propostas, o que demonstrou a novidade teórica argumentativa da proposta.

The different forms of training of sports coaches are aimed at satisfying the needs of mobilizing knowledge, techniques and reflection aimed at solving problems in the preparation of athletes. Due to this, the research was set as an objective: to design the theoretical conception for the pedagogical training in a virtual environment of the Djiboutian coaches on the initiation of the child to soccer. From a materialist dialectical approach to the interpretation of phenomena, document analysis, observation, survey, modeling and comparison were used as the main research methods. Thus, it was found that the theoretical-methodological knowledge related to the initiation of children to soccer and the organizational and methodological limitations in the forms of training were insufficient. The epistemological elements modeled were compared with other proposals, which demonstrated the argumentative theoretical novelty of the proposal.

Effects of herbal cake-partitioned moxibustion on the expression of thyroid autophagy-related factors LC3B and Beclin-1 in rats with autoimmune thyroiditis / 针灸推拿医学（英文版）

Objective: To observe the anti-inflammatory effect, as well as the effect on the expression of microtubule-associated protein light chain 3B (LC3B) and Beclin-1 of herbal cake-partitioned moxibustion in rats with experimental autoimmune thyroiditis (EAT). Methods: Female Sprague-Dawley rats were randomly divided into a normal group and a modeling group. The EAT rat model was prepared by a combination of antigen immunization plus iodine agent induction. After the model was prepared, rats in the modeling group were randomly and equally divided into a model group and a herbal cake-partitioned moxibustion group. In the herbal cake-partitioned moxibustion group, moxibustion was alternately applied to two groups of points [Dazhui (GV14)-Mingmen (GV4) and Tiantu (CV22)-Guanyuan (CV4)], and the treatment continued for 30 d. Rats in the normal and model groups were only fixed identically without intervention. Histopathological manifestations of thyroid glands were observed by hematoxylin-eosin staining; the concentrations of thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TGAb), interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were detected by enzyme-linked immunosorbent assay; real-time fluorescence quantitative polymerase chain reaction and immunohistochemistry were used to detect the mRNA and protein expression of autophagy-related factors LC3B and Beclin-1 in thyroid tissue. Results: There were massive follicular destruction, lymphocytic infiltration, and interstitial fibrous tissue hyperplasia of the thyroid glands in the model group. Some follicles of the thyroid glands were destroyed with few lymphocyte infiltrations and fibrous tissue hyperplasia in the moxibustion group. Compared with the normal group, the concentrations of serum TPOAb, TGAb, IL-1β, IL-6, and TNF-α were increased in the model rats (P<0.05); the mRNA and protein expression levels of LC3B and Beclin-1 in thyroid tissue were reduced in the model group (P<0.05). Compared with the model group, the concentrations of serum TPOAb, TGAb, IL-1β, IL-6, and TNF-α were reduced in the herbal cake-partitioned moxibustion group (P<0.05); the mRNA and protein expression levels of LC3B and Beclin-1 in thyroid tissue were increased in the herbal cake-partitioned moxibustion group (P<0.05). The mRNA and protein expression of LC3B and Beclin-1 in thyroid tissue was negatively correlated with the serum levels of TPOAb and TGAb.Conclusion: Herbal cake-partitioned moxibustion reduces the inflammatory response in the thyroid glands of EAT rats and lowers the levels of serum TPOAb and TGAb. This may be related to the regulation of mRNA and protein expression of the autophagy-associated factors LC3B and Beclin-1 in rat thyroid tissue.

Clinical characteristics of 16 cases of acquired uterine arteriovenous malformation / 中国综合临床

Objective:To analyze the clinical characteristics, diagnosis and treatment of acquired uterine arteriovenous malformation (UAVM).Methods:The clinical data of 16 patients with diagnosis of UAVM from January 2014 to March 2021 in Beijing Friendship Hospital, Capital Medical University were enrolled in this retrospective study. The general data of patients were observed and analyzed: age, pregnancy and childbirth, etc. Auxiliary examinations: human chorionic gonadotropin (hCG), B-ultrasound, CT angiography (CTA), magnetic resonance (MRI), digital subtraction angiography (DSA), lesion diameter, resistance index (RI), peak systolic velocity (PSV), treatment and postoperative pathology.Result:Among the 16 patients, hCG was negative in 10 cases and positive in 6 cases. The first abnormal bleeding time was (43.4±36.4) days and (16.0±9.0) days, respectively. The rehospitalization time was (63.3±54.4) days and (48.3±54.0) days. Six patients with massive bleeding were HCG negative. Ultrasound in 16 cases showed mixed echo light mass with rich blood flow in the uterine cavity, and magnetic resonance examination in 14 cases also showed abnormal signals in the uterine cavity or uterine wall. Mass staining was seen in 6 cases by DSA, vein development in advance, contrast medium overflow was seen in 2 cases, and the conclusion of CTA was consistent with DSA in 5 cases. Uterine artery embolization was performed in 5 cases, including 2 cases of massive bleeding, emergency bilateral uterine artery embolization and 3 cases of preventive embolization. Hysteroscopy was performed in 4 cases after embolization, and balloon compression was performed in 1 case because there was no obvious tissue in the uterine cavity. Hysteroscopy were performed in 10 cases without UAE. Mifepristone combined with misoprostol was used in 1 case. Among the 15 patients treated by surgery, 14 cases showed degenerative trophoblasts or villi. During the follow-up, one patient after uterine artery embolization complained of decreased menstruation, and ultrasound considered the possibility of intrauterine adhesion.Conclusion:After termination of pregnancy, imaging examination should be strengthened to guard against the occurrence of UAVM. Once diagnosed, medical intervention should be started as soon as possible to reduce bleeding. There is no standardized treatment for UAVM related to pregnancy. Comprehensive consideration should be given to the clinical manifestations, bleeding situation, lesion location and fertility requirements of the patients.

Malformación arteriovenosa posterior a la retención de productos de la concepción / Arteriovenous malformation after retention of products of conception

Resumen OBJETIVO: Plantear un procedimiento para pacientes con retención de restos corioplacentarios y riesgo de formación de fístulas arteriovenosas que sea efectivo, seguro y ambulatorio. MATERIALES Y MÉTODOS: Estudio de serie de casos, retrospectivo, de pacientes atendidas en el Hospital Gea González de enero a mayo de 2022. Se empleó un equipo de Bettocchi, de flujo continuo de 5 mm, lente cilíndrico de 2.9 mm y 30°. En casos específicos se programó un procedimiento quirúrgico con resectoscopio Richard Wolf Princess, con diámetro exterior de 7 mm, sistema óptico de 2.7 mm, dirección visual de 30°. RESULTADOS: Se revisaron 642 expedientes de los que se obtuvo una serie de 31 casos que se incluyeron conforme a la clasificación de Gutenberg, con biopsia por protocolo posaborto y resección con Grasper para los tipos 0 y 1; dos pacientes se enviaron a Urgencias por sangrado abundante para aspiración mecánica endouterina inmediata; dos pacientes se catalogaron con tipo 3; en la primera se optó por el tratamiento médico con metotrexato con lo que se consiguió la resolución completa y la segunda finalizó el embarazo con histerectomía laparoscópica. CONCLUSIONES: En pacientes con imágenes ecográficas sugerentes de retención de restos corioplacentarios o malformación arteriovenosa, los procedimientos con visión directa evitan las complicaciones inmediatas y futuras. El diagnóstico mediante la clasificación de Gutenberg permite definir el tipo de acceso con extracción en frío con pinza Grasper para los tipos 0 y 1, o la aplicación de una prueba farmacológica con metotrexato y resección histeroscópica para los tipos 2 y 3 en pacientes hemodinámicamente estables.

Abstract OBJECTIVE: To propose an effective, safe and outpatient procedure for patients with retained chorioplacental remnants and risk of arteriovenous fistula formation. MATERIALS AND METHODS: Retrospective case series study of patients attended at the Gea González Hospital from January to May 2022. A Bettocchi equipment was used, 5 mm continuous flow, 2.9 mm cylindrical lens and 30°. In specific cases a surgical procedure was scheduled with a Richard Wolf Princess resectoscope, 7 mm outer diameter, 2.7 mm optical system, 30° visual direction. RESULTS: We reviewed 642 files from which we obtained a series of 31 cases that were included according to the Gutenberg classification, with biopsy by postabortion protocol and resection with Grasper for types 0 and 1; two patients were sent to the ER for heavy bleeding for immediate MVA; two patients were categorized as type 3; in the first one we opted for medical treatment with methotrexate with which we achieved complete resolution and the second one ended the pregnancy with laparoscopic hysterectomy. CONCLUSIONS: In patients with ultrasound images suggestive of retained chorioplacental debris or arteriovenous malformation, direct vision procedures avoid immediate and future complications. Diagnosis by Gutenberg classification allows to define the type of access with cold extraction with Grasper forceps for types 0 and 1, or the application of a pharmacological test with methotrexate and hysteroscopic resection for types 2 and 3 in hemodynamically stable patients.

Influence of blood metabolites and body condition score at parturition on fertility and milk yield in Holstein cows / Influencia de metabolitos sanguíneos y condición corporal al parto sobre la fertilidad y producción de leche de vacas Holstein / Influência dos metabólitos sanguíneos e da condição corporal ao nascimento na fertilidade e produção de leite de vacas Holstein

Abstract Background: Variables associated with body tissue mobilization place dairy cows at greater risk of reproductive failure. Objective: To investigate the association between blood metabolites and body condition score (BCS) at the beginning of lactation and the reproductive efficiency and milk yield of Holstein cows in a hot environment. Methods: In total, 165 Holstein cows were selected for the study from which blood samples were taken to determine the concentration of various blood metabolites and their association with the reproductive efficiency and milk yield. Results: Cows with serum β-hydroxybutyrate (BHBA) ≤0.8 mmol/L one week postpartum were 3.3 times more likely to become pregnant at first service, and 2.2 times more likely to become pregnant before 80 d postpartum than cows with higher serum BHBA levels. The odds (OR 2.7; 95% CI 1.3-5.4; p<0.01) of a cow getting pregnant at first service were higher in cows with serum creatinine levels higher than 2.0 mg/dL one week postpartum than cows with lower blood levels of this metabolite. The BCS at 30 and 60 d postpartum that predicted pregnancy at first service and pregnancy to all services was 3.0. Blood urea nitrogen >15 mg/dL, creatinine <1.8 mg/dL, total protein ≤5.0 mg/dL one week postpartum, and >0.40 units of BCS loss during the first 30 d postpartum were critical threshold that predicted the likelihood of 305-d milk yield higher than 10,500 kg. Conclusions: Serum BHBA and creatinine one wk after calving as well as BCS 30 and 60 d post-calving provided reasonably accurate cut-off screening values to discriminate cows with better reproductive performance and higher 305-d milk yield.

Resumen Antecedentes: Las variables asociadas a mayor movilización de tejido corporal en vacas lecheras conducen a un mayor riesgo de falla reproductiva. Objetivo: Investigar la asociación entre los metabolitos sanguíneos y condición corporal (BCS) al comienzo de la lactancia y la eficiencia reproductiva y producción de leche de vacas Holstein en un ambiente caluroso. Métodos: En total, se seleccionaron 165 vacas Holstein de las cual se tomaron muestras de sangre para determinar la concentración de varios matabolitos sanguíneos, los cuales se asociaron con el desempeño reproductivo y producción de leche. Resultados: Las vacas con β-hidroxibutirato (BHBA) en suero ≤0,8 mmol/L una semana postparto tuvieron 3,3 veces más probabilidades de quedar preñadas en los primeros servicios, y 2,2 veces más probabilidades de quedar gestantes antes de los 80 días postparto que las vacas con mayores niveles séricos de BHBA. Las probabilidades (OR 2,7; IC 95% 1,3-5,4; p<0,01) de que una vaca se preñara en el primer servicio fueron mayores en vacas con niveles de creatinina en suero sanguíneo superiores a 2,0 mg/dL una semana postparto que las vacas con niveles más bajos de este metabolito en sangre. Una BCS de 3 a los 30 y 60 días postparto fue un buen predictor de la preñez al primer servicio y la gestación considerando todos los servicios. El nitrógeno ureico en sangre >15 mg/dL, la creatinina <1,8 mg/dL, la proteína total ≤5,0 mg/dL una semana después del parto y >0,40 unidades de pérdida de BCS durante los primeros 30 días postparto fueron los valores críticos para predecir una producción de leche a 305 días superior a 10.500 kg. Conclusiones: El BHBA y la creatinina en suero sanguíneo una semana postparto, así como la BCS 30 y 60 d después del parto, proporcionan valores razonablemente precisos para identificar las vacas que tendrán mejor desempeño reproductivo y mayor producción de leche a 305 días.

Resumo Antecedentes: A maior mobilização do tecido corporal das vacas leiteiras leva a um aumento do risco de falhas reprodutivas. Objetivo: Para investigar a relação entre os metabolitos sanguíneos e condição do corpo (BCS) para o início da lactação e eficiência reprodutiva e produção de leite de vacas Holstein num ambiente quente. Métodos: No total, foram selecionadas 165 vacas da raça Holandesa, das quais foram coletadas amostras de sangue para determinar a concentração de vários metabólitos sanguíneos, associados ao desempenho reprodutivo e à produção de leite das vacas. Resultados: As vacas com β-hidroxibutirato (BHBA) soro ≤0,8 mmol/L de uma semana após o nascimento foram 3,3 vezes mais probabilidade de engravidar nos primeiros serviços, e 2,2 vezes mais provável que seja grávida antes de 80 dias após o parto do que vacas com níveis séricos de BHBA mais elevados. As probabilidades (OR 2,7, IC de 95% 1,3-5,4, p<0,01) que uma vaca preñara primeiros serviços vacas foram maiores com níveis mais elevados de creatinina no soro do sangue >2,0 mg/dL, uma semana pós-parto do que vacas com níveis sanguíneos mais baixos deste metabolito. Um CC de 3 aos 30 e 60 dias pós-parto foi um bom predictor de gravidez no primeiro serviço e gestação, considerando todos os serviços. O azoto de ureia no sangue >15 mg/dL, creatinina <1,8 mg/dL e proteína total, ≤5,0 mg/dL uma semana após o parto e >0,40 unidades perda CC durante os primeiros 30 dias após o nascimento estavam valores críticos que previram produção de leite em 305 dias >10.500 kg. Conclusões: BHBA e creatinina sérica, uma semana após o parto, bem como CC 30 e 60 d após o parto, forneceram valores razoavelmente precisos para discriminar vacas com melhor desempenho reprodutivo e maior produção de leite em 305 dias.