關於 screening committee ，我們在網路上蒐集到這些相關的討論、資訊與評價

<七夕情人節特別篇：輸卵管問題的評估方法，披衣菌抗體vs.輸卵管攝影 >

各位好

我是威廉氏後人 – 李毅評醫師

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這是一位34歲的患者，小司

備孕已經超過5年了

卵巢功能正常、AMH 4.6

精子正常

子宮腔正常

唯一的問題是披衣菌抗體陽性

雙側輸卵管也確實是有阻塞

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由於小司是今年疫情爆發前取卵的

所以當時還沒有試管嬰兒補助專案

當時取卵20顆，共有18顆受精

得到13顆囊胚

品質都不錯。

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由於疫情關係

小司等到七月下旬重新開放後才來植入

因為從取卵起就沒有申請補助案

小司選擇直接植入兩顆

昨天驗孕順利懷孕

看起來應該是雙胞胎

真是可喜可賀、可喜可賀。

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今天是七夕情人節

先祝各位情人節快樂

有情人終成父母

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既然是七夕

我想最適合再來說說輸卵管

女生的輸卵管

是精卵結合所必經的鵲橋

這個鵲橋

並不需要一年才出現一次

而是應該時時刻刻保持暢通

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要評估輸卵管的問題

傳統上我們一直以輸卵管攝影為標準檢查項目

然而，

也有許多醫師選擇檢測披衣菌抗體

披衣菌抗體是否能夠代表輸卵管的暢通性呢？

今天我們來討論一下這個問題。

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我們知道

輸卵管不通最常見的原因

就是披衣菌感染造成的骨盆腔發炎。

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根據統計

如果發生1次骨盆腔發炎，

12%可能造成輸卵管問題

如果發生2次骨盆腔發炎，

23%可能造成輸卵管問題

如果發生3次以上的骨盆腔發炎

則有53%會出現輸卵管問題。

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也就是說

披衣菌感染引起的骨盆腔發炎

確實是最常見的輸卵管阻塞的原因

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然而

還有許多其他可能的原因會造成輸卵管問題

如子宮內膜異位症、盲腸炎、手術引起的沾黏等等

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如果我們單純以披衣菌抗體檢測

對於輸卵管暢通性的檢查效果究竟是如何呢？

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根據2006年人類生殖期刊的一篇回顧論文

他分析了各種披衣菌抗體的檢測方法

並同時進行其他輸卵管的檢查

結果發現

披衣菌抗體的陰性運測值很好，

有85-90%

也就是說

如果你從來沒有感染過披衣菌

身上的披衣菌抗體是陰性的

你的輸卵管有大概率是沒問題的

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而披衣菌抗體檢測的陽性預測值則偏低

陽性預測值是30-65%

也就是說

若披衣菌抗體陽性

你是否真的有輸卵管問題呢？

其實也還是很難說

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當然啦

大家聞之色變的輸卵管攝影準確率也沒高多少

陽性預測值約38%

陰性預測值則是94%

這是因為有些人在輸卵管攝影時發生劇烈地宮縮

導致顯影劑完全無法流過去

造成輸卵管出現雙側近端阻塞的假象

所以如果是輸卵管攝影出現雙側近端阻塞的結果

就會建議接受更進一步的腹腔鏡檢查才能確定。

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不過

根據2015年美國生殖醫學會的專家會議結論

輸卵管攝影推薦度還是比披衣菌抗體檢測高一些

因為輸卵管攝影同時還有子宮腔的檢查、輸卵管水腫的診斷

以及一些治療效果

這裡的治療效果是指輕度的輸卵管阻塞或沾黏

在輸卵管攝影的同時被沖開了的可能性。

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參考資料：
1. Hum Reprod Update. Nov-Dec 2006;12(6):719-30.
Chlamydia trachomatis-associated tubal factor subfertility: Immunogenetic aspects and serological screening.
2. Fertil Steril . 2015 Jun;103(6):e44-50.
Diagnostic evaluation of the infertile female: a committee opinion
Practice Committee of the American Society for Reproductive Medicine

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“今年七月份的出生率果然慘不忍睹，今年7月出生人數共11,809人，年減6.38%”

“幸好，政府終於正視這個問題，自今年7/1起提供試管嬰兒補助專案”

“我相信明年的夏天開始，我們會看到台灣試管嬰兒潮的出現。”

“而這個試管嬰兒潮，每個月大概都有幾十個是我貢獻的喔！”

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~ 威廉氏後人 – 李毅評醫師 ~

試管嬰兒懷孕成功率計算器 : https://haveababy.tw/predict/

粉絲專頁 : https://www.facebook.com/mrwilliams999

個人網站 : https://haveababy.tw/

Instagram： https://www.instagram.com/mr_williams_li/......

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The new committee for screening election candidates in #HK may be the target of foreign sanctions, a well-known Chinese academic has said, as officials prepare to meet in #Beijing this week to discuss changes to #HK’s electoral system.

Read more: https://bit.ly/2PvPy6R

曾因指北京不要「忠誠的廢物」而與民建聯葉國謙隔空罵戰的田飛龍接受無綫新聞訪問時認為，由委員會審查參選人士資格，較只依靠選舉主任把關更好，可以排除來自香港的極端勢力和外部干預勢力的壓力，認為對「抗擊」外國制裁有幫助，因可能出現整個委員會被制裁情況。
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【給迪士尼CEO的公開信：促披露與新疆政府達成的秘密協議】An Open Letter to Bob Chapek, CEO Walt Disney Company

I call upon Disney to disclose the details of its agreements with Xinjiang authorities, as well as all the subsidies, funding, assistances and instructions that it has received from the authorities.

As the movie is widely considered as an attempt to spread propaganda and whitewash China's cultural genocide, I also urge Disney to suspend the screening of such a controversial movie and clarify its stance on human rights violations regarding re-education camps in the region.

—————————————

[An Open Letter to Bob Chapek, CEO Walt Disney Company]

Dear Mr. Chapek,

Since the release of its teaser trailer last year, Mulan has already been under heavy global criticism. A few days ago, it was reported that Disney offers "special thanks" in its credits to eight government entities in Xinjiang where re-education camps are reportedly located, including the Turpan Municipal Bureau of Public Security. According to the Australian Strategic Policy Institute, the Turpan Municipal Bureau of Public Security is responsible for running at least 14 re-education camps in the area "to extrajudicially detain minorities."

In October 2019, the U.S. Commerce Department already placed the department on its Entry List, for participating in "human rights violations and abuses in the implementation of China's campaign of repression, mass arbitrary detention, and high-technology surveillance against Uighurs, Kazakhs, and other members of Muslim minority groups in the XUAR."

While Disney has been completely remaining silent on the Uyghur issue, its cooperations with the officials responsible for brutal crackdowns on Uighur Muslim minority really sends an alarming signal to the world - what kind of values Disney advocates for, especially when the company's target market is the children worldwide.

Besides, the film also expresses thanks to three CCP's propaganda departments in Xinjiang, from the Publicity Department of CPC Turpan Municipal Committee, the Publicity Department of the CPC Turpan Gaochang District Municipal Committee, to Publicity Department of the CPC Shanshan County Committee. It casts more doubts on whether Mulan is the propaganda masterpiece that Disney works hand in hand with the CCP government to whitewash the cultural genocide and human violations on ethnic minorities in the region.

In fact, Mulan was filmed in 2018, the same year that China staged the hardest suppression on Uyghurs in the region. The film was also shot in locations where all these re-education camps have been documented. As media reports, there are at least seven re-education camps located all along the highway from the Turpan airport to Shanshan desert where the filming took place. Turpan was also the first documented case that political indoctrination was used against Uyghurs by the Chinese authority.

According to the 2019 Report on International Religious Freedom published by the U.S. Department of State, over a million of Uighurs, ethnic Kazakhs, Hui, members of other Muslim groups and some Uighur Christians were detained in internment camps in Xinjiang and subject to "forced disappearance, political indoctrination, torture, psychological and physical and psychological abuse, including forced sterilization and sexual abuse, forced labour, and prolonged detention without trial because of their religion and ethnicity."

As the incident has sparked global concerns, I call upon Disney to disclose the details of its agreements with Xinjiang authorities, as well as all the subsidies, funding, assistances and instructions that it has received from the authorities. As the movie is widely considered as an attempt to spread propaganda and whitewash China's cultural genocide, I also urge Disney to suspend the screening of such a controversial movie and clarify its stance on human rights violations regarding re-education camps in the region.

Regards,
Joshua Wong

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