目的 本文旨在了解就业认知和生育观念对安徽省高校女性毕业生生育意愿的影响,为生育政策的制定和完善提供理论参考。方法 通过问卷调查的方法,对438名2022届高校女性毕业生的就业认知和生育观念进行调查,分析生育意愿相关的影响因素。结果 期望未来不生育、生育1个孩子、生育2个及以上孩子的占比分别是12.8%、16.6%、46.6%。分析结果显示因担忧职场歧视而不敢结婚生育的女性选择不生育的概率是生2个及以上孩子者的2.23倍(OR=2.23,95%CI:1.00~4.96);生育观现代化得分高的女性选择不生育(OR=4.18,95%CI:2.63~6.64)和生育1个孩子(OR=1.35,95%CI:1.00~1.80)的概率更大。结论 安徽省女性毕业生的就业认知和生育观念已发生重要转变,而传统性别观念的淡化是导致生育意愿降低的潜在原因。以政策手段推动家庭和社会范围的性别平等,创造生育友好的社会环境,有助于提高生育率。

卵巢储备功能减退(DOR)是指卵巢内卵母细胞的数量减少和/或质量下降,同时伴有抗苗勒氏激素水平降低、窦卵泡计数减少、促卵泡激素水平升高。DOR患者常伴有月经不调、生育能力减退、骨质疏松、认知功能障碍等,还会伴随肥胖、肠道菌群失衡、免疫失调、血液与卵泡液中代谢物含量改变等代谢异常,其中卵泡液中氨基酸、蛋白质、脂质、酯类等代谢物的异常变化与卵泡细胞异常氧化应激、线粒体功能缺失等可为DOR的诊断及治疗提供新的思路。辅酶Q10、烟酰胺单核苷酸、脱氢表雄酮、白藜芦醇、褪黑素、激素、中药、自噬激活剂、免疫调节剂等可从不同程度改善DOR患者的代谢异常及卵巢功能,同时也有一些新型非药物治疗方法包括干细胞疗法、线粒体替代疗法、线粒体基因编辑技术等,未来,基于代谢靶点的开发可能为DOR患者带来福音。

Objective To evaluate the clinical efficacy of methylprednisolone sodium succinate(MSS) as adjuvant therapy in the treatment of severe mycoplasma pneumoniae pneumonia in pediatric patients, and its impact on serum lactate dehydrogenase(LDH), C-reactive protein(CRP), and T lymphocyte subsets. Methods A total of 120 children with severe mycoplasma pneumonia admitted to the Department of Pediatrics at the Second Hospital of Hebei Medical University from January 2023 to January 2024 were selected. Three groups are divided, treatment group(conventional treatment and MSC) with 80 patients, including 40 patients treated with MSC for 3 days(Short-course group) and 40 patients for 5 days(extended group). The control group consisted of 40 cases receiving conventional treatment. Pairwise comparisons were conducted by comparing the time for body temperature to return to normal, resolution of cough and rales, as well as improvements in C-reactive protein(CRP) and lactate dehydrogenase(LDH) before and after treatment. Results Compared with the control group, the treatment group had a significantly shorter time for body temperature to return to normal, resolution of rales, and disappearance of cough(P<0.05), while there were no statistically significant differences for the parameters between the short-course and extended groups. In terms of inflammatory markers(CRP and LDH), there were no statistically significant differences between the two groups before treatment. After treatment, the improvement in the treatment group was better than that in the control group, with statistically significant differences. There were no statistically significant differences in the improvement of CRP and LDH before and after treatment within the treatment group. In the comparison of T lymphocyte subsets, the improvement of CD4⁺ and CD8⁺ in the treatment group was more significant compared to the control group, with statistically significant differences. There were no statistically significant differences in the improvement of CD4⁺ and CD8⁺ between the short-course and extended groups in the treatment group. Conclusion MSC as adjuvant therapy for children with severe mycoplasma pneumonia demonstrates significant clinical efficacy, which can shorten the the time for body temperature to return to normal, cough and rale to disappear, and can significantly improve the recovery of inflammatory indicators(CRP and LDH), thereby alleviating pain in children and shortening hospital stay.

Objective To explore the causal relationship between circulating inflammatory proteins and premature ovarian insufficiency (POI) using Mendelian randomization method. Methods Based on the data collected from the genome-wide association studies (GWAS), inflammatory proteins were used as exposure factors, single nucleotide polymorphisms (SNPs) associated with inflammatory proteins were selected as instrumental variables, and POI was used as the outcome factor. We used IVW, MR Egger, simple mode, weighted media, and weighted mode methods to analyze and evaluate the sensitivity of the results. Results Glial cell-derived neurotrophic factor (OR=1.558, 95% CI:1.078-22.52), leukemia inhibitory factor (OR=1.580, 95% CI:1.027-2.429) showed a positive correlation with the occurrence of POI, while interleukin-10 (OR=0.653, 95% CI:0.462-0.922 showed a negative correlation with the occurrence of POI. Sensitivity assessment showed no horizontal pleiotropy, heterogeneity, or reverse causality. Conclusion Glial cell-derived neurotrophic factor and leukemia inhibitory factor are risk factors for POI, while interleukin-10 is a protective factor for POI occurrence.

目的 探索妊娠期糖尿病(GDM)发病的危险因素,以期对GDM高危孕妇早期管理提供依据。方法 选取2021年1月到2023年4月在本院建档并产检的孕妇,于建档时记录孕妇年龄、身高、孕前体重等信息,于孕早期采集孕妇静脉血,检测血脂血糖水平,记录孕早期体重,于口服葡萄糖糖耐量试验(OGTT)记录空腹体重,OGTT前孕中期每周体重增长为以上两个体重之差除以间隔孕周。采用巢式病例对照方法,以年龄、孕前体质量指数(BMI)为匹配因素进行1∶1配对选择对照组。分析GDM发病的影响因素。结果 与对照组相比,GDM组孕前BMI较高、糖尿病家族史比例较高、妊娠期糖尿病史比例较高、孕中期每周体重增长较多,孕早期TG、FPG水平较高,以上差异均具有统计学意义。多因素logistic回归分析结果显示,家族史(OR=3.09)、GDM史(OR=3.58)、孕早期FBG升高(OR=3.00)、孕早期TG升高(OR=2.63)、孕中期每周体重增长过多(OR=1.85)是GDM发病的危险因素,孕中期每周体重增长不足(OR=0.56)是GDM发病的保护因素。结论 家族史、GDM史、孕早期FBG升高、孕早期TG升高为GDM发病的高危人群,应予早期管理,使孕中期每周体重增长在适宜范围内。

目的 通过分析不同严重程度子痫前期患者的临床资料及母儿结局,探讨影响发病程度及妊娠结局的高危因素。方法 回顾性分析2007年1月1日—2021年12月31日于山西医科大学第一医院住院分娩的775例产妇的临床资料,分为无严重表现子痫前期组(MPE组,228例)和伴严重表现子痫前期组(SPE组,547例),对两组患者的一般资料、妊娠并发症及母儿结局进行分析。结果 SPE组分娩中位孕周为35周,MPE组为38周,差异有统计学意义(P＜0.05)。SPE组糖尿病、胰岛素释放延迟、甲状腺功能减退症、亚临床甲状腺功能减退症、低钙血症等妊娠期并发症比例分别为38.2%、11%、12.4%、32.9%,显著高于MPE组(分别为26.8%、4.4%、4.8%、18.4%,P＜0.01)。SPE组孕产妇心功能不全、低蛋白血症、胎盘早剥、HELLP综合征等母体不良妊娠结局比例分别为5.9%、25.4%、16.6%、13.3%、显著高于MPE组(分别为2.2%、6.6%、6.6%、1.8%,P＜0.05)。SPE组围产儿新生儿窒息、死胎比例分别为4.9%、9.3%,高于MPE组(分别为0.4%、1.3%,P＜0.01)。合并糖尿病、胰岛素释放延迟、甲状腺功能减退症、亚临床甲状腺功能减退症、低钙血症以及孕期不规律产检是影响子痫前期严重程度的风险因素,ROC曲线下面积为0.718。结论 合并有糖尿病、胰岛素释放延迟、甲状腺功能减退症、亚临床甲状腺功能减退症、低钙血症以及孕期不规律产检的患者更易发展为重度子痫前期,且更易导致母体及围产儿不良妊娠结局的发生。

Objective To investigate the concentration and related factors of organophosphorus pesticides(OPs) exposure among pregnant women in their first trimester in Beijing. Methods Pregnant women in their first trimester were recruited at Beijing Obstetrics and Gynecology Hospital from July 2018 to October 2020. Questionnaires were used to collect the general demographic information of pregnant women and ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) was used to determine the concentrations of six non-specific metabolites of OPs—dialkyl phosphates(DAPs) in the urine of pregnant women. Results A total of 232 pregnant women were included in the study. Detection rates of urinary DAPs ranged from 19.4% to 95.3%, with the detection rate of diethylphosphate(DEP) being the highest(95.3%). DEP and dimethylphosphate(DMP) were the major components of the six DAPs measured. The geometric mean(GM) concentration range of six DAPs was 0.07-17.28 ng/mg Cre after adjusted for creatinine, DEP and DMP were 17.28 ng/mg Cre and 6.46 ng/mg Cre, respectively. The results of multivariate linear regression analysis revealed that pre-pregnancy BMI was an influencing factor on the concentration of maternal organophosphorus exposure in early pregnancy, and the pregnant women with low pre-pregnancy BMI have higher concentrations of DAPs in their urine(P<0.05). Conclusion Pregnant women in their first trimester are widely exposed to organophosphorus pesticide in Beijing, and the overall exposure level was at a moderate level. The exposure was related to pre-pregnancy BMI, and attention needs to be paid to the impact of organophosphorus pesticide exposure during pregnancy on the health of mothers and infants.

Objective The aim of this study is to investigate the BRCA gene mutations and clinical characteristics of ovarian cancer patients in eastern China, and to analyze the differences with other regions. Methods BRCA1/2 gene detection was performed on 310 patients with ovarian cancer. Information on patient age, pathological type, and preoperative tumor markers CA125 and HE4 was collected. Information on mutation rates and common mutations of the BRCA1/2 gene in ovarian cancer from different countries was also collected. Results A total of 310 patients with nonselective ovarian cancer were selected for this study, of which 87(28.1%) had BRCA1/2 mutations, including 64(20.1%) BRCA1 mutations and 23(8.0%) BRCA2 mutations. A total of 45 mutations were found in patients with BRCA1 mutations, with c.5470-5477del and c.981-982del mutations being the most common. A total of 22 mutations were found in patients with BRCA2 mutations, with c.6373-6374insA mutations being the most common. BRCA gene mutations were not significantly related to age, pathologic type, serum CA125, or HE4(P>0.005). Conclusion There are significant differences in BRCA gene mutations among different countries and regions.

Objective To investigate the relationship between immune response and human papilloma virus (HPV) outcome in patients with high-grade cervical intraepithelial neoplasia (HSIL). Methods 213 patients with HSIL admitted to our hospital from September 2020 to March 2022 were selected as the research subjects. They aged 28-63 years with an average age of (39.0 ± 4.8) years. We compared the changes in various serum immune indicators of HSIL patients before surgery, 3 months after surgery, 6 months after surgery, and 12 months after surgery. According to the HPV conversion status of HSIL patients 12 months after surgery, they were divided into a negative conversion group (n=162) and a non-negative conversion group (n=51). We compared the general and clinical data of the two groups, and used multiple logistic regression analysis to screen independent influencing factors of HPV conversion in HSIL patients. We also compared the predictive efficacy of each factor for HPV conversion, and analyzed the correlation between each factor and HPV conversion. Results The levels of CD3⁺, CD4⁺, Th/Ts, immunoglobulin A (IgA), immunoglobulin G (IgG) and immunoglobulin M (IgM) were significantly increased in patients with HSIL 12 months after surgery, while the levels of CD8⁺ were significantly decreased (P<0.05). The age of patients and the proportion of patients with abortion history in the non-negative conversion group were significantly higher than those in the negative conversion group (P<0.05). The levels of CD4⁺ and Th/Ts in patients with negative conversion were significantly higher than those in patients without negative conversion, and the levels of IL-6 and TNF-α in patients with negative conversion were significantly lower than those in patients without negative conversion. There were significant differences in the number of sialidase (SIA) positive, H₂O₂ positive and abnormal vaginal cleanliness (CLE) patients between the two groups (P<0.05). Multivariate logistic regression analysis showed that older age and higher TNF-α level were risk factors for postoperative HPV non-negative conversion in patients with HSIL, and more CD4⁺ cell counts and higher Th/Ts level were protective factors for postoperative HPV non-negative conversion in patients with HSIL (P<0.05). The area under curve (AUC) of postoperative HPV outcome in HSIL patients tested by age+CD4⁺+Th/Ts+TNF-α was 0.881, the Yoden index was 0.695, and the accuracy was 0.848, which were all higher than other prediction models. After establishing logistic model through gradually excluding the confounding factors, we stratified by age, CD4⁺, Th/Ts and TNF-α levels, and found that age, CD4⁺, Th/Ts and TNF-α levels were still independent influencing factors for postoperative HPV outcome in patients with HSIL. The association effect values increased with the increment of age and TNF-α, and the decrease of CD4⁺ and Th/Ts levels (P trend <0.05). Conclusion The cellular and humoral immune responses of HSIL patients were significantly improved 12 months after surgery compared with those before surgery. Age and TNF-α level were risk factors for non-negative HPV conversion in HSIL patients, and CD4⁺ and Th/Ts were protective factors for non-negative HPV conversion in HSIL patients. The combined detection of postoperative HPV outcomes in HSIL patients by age+CD4⁺+ Th/Ts+TNF-α showed good predictive performance. After the elimination of confounding factors, the associated effect sizes with HPV outcomes increased with the decreased levels of CD4⁺ and Th/Ts and the increment of age and TNF-α.

Objective To study the effect of gestational diabetes mellitus (GDM) on fasting blood glucose in offspring, and to explore the ability of 2'-fucosyllactose(2'-FL) to improve impaired fasting blood glucose in offspring with GDM and the appropriate dose. Methods Healthy SD rats were randomly divided into control group and GDM model group. The GDM model was established by high-fat diet combined with low-dose streptozotocin intraperitoneal injection. The GDM model group was randomly divided into GDM model group (GDM group), GDM+2'-FL low-dose intervention group (GLF group), GDM+2'-FL medium-dose intervention group (GMF group), GDM+2'-FL high-dose intervention group (GHF group). There were 8 pregnant mice in each group. The offspring rats in the control group and GDM group were given distilled water by gavage, and the rats in the 2'-FL intervention groups were given 2'-FL at 0.2 g/kg, 0.6 g/kg and 1.8 g/kg, respectively. Fasting blood glucose(FPG) and body weight of maternal rats during pregnancy and lactation were recorded. Breast milk samples were collected on postnatal days 3, 11 and 21 for analysis of 2'-FL content. The body weight of offspring rats during lactation was recorded, and FPG was measured on the 21st day after delivery. On the 7th and 21st day after delivery, one male and one female offspring of each litter were sacrificed to weigh the main organs and calculate the organ coefficient. Results The content of 2'-FL in breast milk of the GDM model group was significantly lower than that of the control group on postnatal days 3 and 21 (P<0.05), and the content of 2'-FL in breast milk of the two groups decreased over time during lactation. The FPG of female and male offspring in the GDM group was significantly higher than that in the control group on postnatal day 21 (P<0.05), and the FPG of female and male offspring in the low-dose 2'-FL intervention group was significantly lower than that in the GDM group (P<0.05). The FPG of male offspring in the medium-and high-dose 2'-FL intervention groups was significantly lower than that in the control group (P<0.05). The liver coefficients of female and male offspring on postnatal day 7 were significantly lower than those of the blank control group (P<0.05). The liver coefficients of female offspring in the high-dose 2'-FL intervention group were significantly higher than those in the GDM group (P<0.05). The liver coefficient of male and kidney coefficient of female offspring in the GDM group were significantly higher than those in the control group on postnatal day 21 (P<0.05), and the kidney coefficient of female offspring in the high-dose 2'-FL intervention group was significantly lower than that in the GDM group (P<0.05). Conclusion The FBG of offspring rats affected by gestational diabetes mellitus is impaired, and 2'-FL intervention can improve FBG to a certain extent.

本文报道首都医科大学附属北京友谊医院收治的8例脐血管血栓患者资料及文献复习妊娠晚期分娩的98例脐血管血栓临床资料。本院8例脐血管血栓病例中孕妇年龄为(32.5±3.1)岁,脐静脉血栓2例,脐动脉血栓4例,脐血管混合血栓2例。超声产前诊断脐血管血栓6例。超声发现孕周(37.0±3.7)周,期待时间0~17 d,分娩孕周为(37.3±3.6)周。6例剖宫产,2例自然分娩。8例中胎儿生长受限2例(25%);围产儿死亡2例(25%),其中1例胎死宫内,1例足月新生儿重度窒息死亡;新生儿活产6例(75%),预后均良好。胎盘脐带病理:脐带螺旋过密3例,其中1例合并脐带扭转38周,表面华通胶缺失,并合并边缘性前置胎盘及前置血管。98例文献资料中有脐动脉血栓91例(92.9%),脐静脉血栓5例(5.1%),混合血栓2例(2.0%)。胎儿生长受限22例(22.4%),胎死宫内9例(9.2%),死产1例(1.0%),重度窒息5例(5.1%),预后良好的活产71例(72.4%)。脐带异常(真结、脐带缠绕、扭转、过长、脐带脱垂)、产科并发症如妊娠期糖尿病、妊娠期高血压或免疫性疾病等是脐血管血栓的高危因素。产科超声提示脐动脉数量改变,脐带螺旋过密、脐动脉血流异常时应警惕脐血管栓塞。早期超声筛查,早期诊断,制定合适的分娩计划有可能获得较好的结局。分娩时机应综合患者孕周、胎动、胎心监护情况做出及时处理,若短时间内不能经阴道分娩或胎心监护异常,建议急诊剖宫产终止妊娠。

Objective To explore the impact of changes in prenatal depressive symptoms on delivery methods and to reveal the relationship between prenatal depressive symptoms and cesarean section. Methods Pregnant women who received the Mother and Child Health Handbook in Beijing underwent mental health assessments using the Patient Health Questionnaire-9 (PHQ-9) via the “Beijing Maternal and Child Health Service” WeChat public account during early pregnancy and mid-to-late pregnancy. The assessment results were uploaded in real-time to the Beijing Maternal and Child Health Information System. Data were obtained from pregnant women who gave birth between January 1, 2023, and December 31, 2023. Based on changes in prenatal depressive symptoms (defined as a PHQ-9 total score ≥ 5 with a non-zero score on the last item indicating abnormal results), pregnant women were divided into a normal group and an abnormal group. The normal group included those whose assessment results were normal in both early pregnancy and mid-to-late pregnancy (consistently normal group), as well as those who had abnormal results in early pregnancy but returned to normal in mid-to-late pregnancy (recovered to normal group). The abnormal group included those with normal results in early pregnancy but abnormal results in mid-to-late pregnancy (developed abnormalities group) and those with abnormal results in both early pregnancy and mid-to-late pregnancy (consistently abnormal group). Univariate and multivariate statistical analyses were conducted to examine the relationship between changes in prenatal depressive symptoms and delivery methods. Results A total of 100,258 pregnant women were included, with 84,386 (84.2%) in the normal group and 15,872 (15.8%) in the abnormal group. Among the normal group, 67,575 (80.1%) were in the consistently normal group, and 16,811 (19.9%) were in the recovered to normal group. In the abnormal group, 9,053 (57.0%) were in the consistently abnormal group, and 6,819 (43.0%) were in the developed abnormalities group. Comparisons of delivery methods showed that the cesarean section rate was highest in the developed abnormalities group (43.0%). Univariate analysis indicated that factors such as maternal age, household registration, BMI, parity, history of cesarean section, hypertension, and placenta previa were significantly associated with changes in prenatal depressive symptoms. The proportion of abnormal changes in prenatal depressive symptoms was slightly higher among women who had vaginal deliveries compared to those who had cesarean sections (15.9% vs. 15.2%). Multivariate analysis revealed a significant association between abnormal changes in prenatal depressive symptoms and the choice of cesarean section (OR=1.06, 95%CI:1.01-1.11). Stratified analysis showed that this association was more pronounced among women with higher education levels, primiparas, and those without a history of cesarean section, placenta previa, or placental abruption. Conclusion There is a certain association between changes in prenatal depressive symptoms and delivery methods, with women experiencing abnormal changes in prenatal depressive symptoms being more likely to opt for cesarean sections. This suggests that attention should be paid to the mental health of pregnant women during prenatal care.

目的 分析2010—2021年无锡市5岁以下儿童意外死亡发生情况及潜在寿命损失,为意外死亡的防控工作和有限卫生资源的合理分配提供依据。方法 收集无锡市2010—2021年5岁以下儿童死亡监测资料,描述意外伤害死亡率及性别、年龄、季节分布特征,并计算意外死亡所导致的潜在寿命损失。结果 无锡市2010—2021年5岁以下儿童意外死亡共682例(男童432例,女童250例),占5岁以下儿童总死亡数的25.78%,年均意外死亡率为96.87/10万;男童占比高于女童。意外窒息是0岁～组意外死亡的首位死因占79.35％,其余各年龄组儿童意外死亡的首位死因均为溺水(溺水死亡占比在44.04％～64.29％),交通意外则分别为各年龄组儿童意外死亡的第二位死因。意外窒息主要发生在冬春季,其他意外死亡的发生无明显季节性;意外死亡导致儿童平均潜在寿命损失77.63年,平均潜在寿命损失率为15.08‰。结论 意外伤害严重危害无锡市5岁以下儿童生命健康,应采取措施对意外窒息、溺水、交通意外等意外伤害重点干预。

目的 评估中重度新生儿缺氧缺血性脑病(HIE)亚低温(TH)治疗现状并探讨影响TH实施的因素。方法 回顾性分析2018年1月至2023年6月华中科技大学同济医学院附属湖北妇幼保健院新生儿重症监护病房收治的诊断中重度HIE且符合TH纳入标准的新生儿,收集母婴资料、医疗组织转运及TH治疗情况进行分析,采用单因素和多因素Logistic回归分析影响TH使用的因素。结果 54.1% 中重度HIE患儿未进行TH治疗,主要原因为超过TH治疗时间窗(55.6%),其次分别是患儿胎龄较小(16.0%)、实验室指标未达治疗标准(8.3%)、存在TH治疗禁忌症(14.6%)、家属放弃治疗(5.5%)。多因素分析显示,35~36周、中度HIE、市外转运患儿TH使用率较低,OR(95%CI)值分别为0.41(0.17~0.96)、0.27(0.14~0.52)、0.28(0.13~0.57)。结论 本研究中重度HIE患儿TH使用率偏低。胎龄35周 ~ 36周、中度HIE、市外转运的患儿TH使用率较低,需采取持续质量改进措施,加强HIE诊断与评估,提高TH使用率。

早期不利的胎儿环境会显著干扰中枢神经系统发育并随后改变大脑成熟度,甚至造成胎儿脑损伤,依程度不同而造成各种远期发育障碍。肌酸是人体重要的能量代谢物质,由于脑组织的能量代谢旺盛,所以肌酸代谢障碍与多种脑损伤疾病有关,但目前相关的孕期研究较少。本文旨在探索肌酸在胎儿脑发育和损伤中的神经保护作用,希望通过早期宫内干预来预防胎儿脑损伤的发生。

目的 探究低度鳞状上皮内病变(LSIL)患者血清25羟基维生素D[25(OH)D]水平、阴道微生态变化与人乳头瘤病毒(HPV)感染的相关性。方法 选取本院2020年1月—2022年12月诊断为LSIL患者60例作为LSIL组,同期60例慢性宫颈炎患者作为慢性宫颈炎组及无宫颈病变的健康育龄女性60例作为对照组,检测各组血清25(OH)D水平、阴道微生态指标,并行HPV-DNA载量及亚型检测,分析血清25(OH)D水平、阴道微生态与LSIL及HPV持续感染的相关性。结果 对照组、慢性宫颈炎组、LSIL组血清25(OH)D水平呈逐渐降低趋势(P<0.05)。对照组、慢性宫颈炎组、LSIL组三组间菌群密度、菌群多样性、滴虫、乳酸杆菌、加德纳菌、pH值、孢子、唾液酸苷酶(SNA)阳性、白细胞酯酶(LE)阳性、阴道清洁度、Nugent评分、Donders评分异常情况比较差异显著(P<0.05),异常率呈上升趋势。对照组、慢性宫颈炎组、LSIL组HPV低危型感染率差异无统计学意义。LSIL组HPV高危型HPV-16、18等11个亚型的感染率与慢性宫颈炎组比较,差异具有(临界)统计学意义。根据HPV感染情况分为HPV阴性组和HPV阳性组,HPV阳性组慢性宫颈炎及LSIL患者较阴性组血清25(OH)D均出现不同程度下降,差异具有统计学意义。LSIL患者HPV阴性组和HPV阳性组菌群密度、菌群多样性、滴虫、乳酸杆菌、加德纳菌、pH值、孢子、唾液酸苷酶(SNA)阳性、白细胞酯酶(LE)阳性、阴道清洁度、Nugent评分、Donders评分异常比较,差异均具有统计学意义。Logistic回归分析结果表明阴道微生态异常、高危型HPV感染和25(OH)D降低为LSIL的风险因素(P<0.05)。结论 血清25(OH)D降低、阴道微生态变化及HPV感染与宫颈病变关系密切,并可能是LSIL患者HPV持续感染的发生发展的危险因素。

Objective To explore the effects of hypnotherapy combined with health education on menopausal symptoms Methods. Methods This study used prospective randomized controlled studies, 70 patients with mild to moderate menopause-related symptoms were selected as study participants from May 2019 to February 2022, and randomly divided into joint group and health education group according to a random number table 1∶1. Both groups were given perimenopausal health care related knowledge and health education, and the joint group was additionally given hypnotherapy to the patients twice a week for 4 weeks for a total of 8 sessions. The health education group was in a natural state after receiving health education. The modified Kupperman Rating Scale, Anxiety Self-rating Scale, Depression Self-rating Scale and Pittsburgh Sleep Quality Index Scale were used before the intervention and one month after the intervention to evaluate the two groups of patients. Results The median menopausal symptom score was 12.0(10.2, 15.2) in the joint group and 24.5(23.0, 30.0) in the health education group after 1 month of intervention, and the difference between the groups was statistically significant(P<0.05). One month after the intervention, the median scores of the anxiety self-assessment scale, depression self-assessment scale and Pittsburgh sleep scale in the joint group were 46.0(40.5, 50.0), 41.5(37.2, 43.0), 6.5(5.0, 11.0), which were significantly lower than the health education group of 51.0(48.0, 52.5), 50.0(45.7, 52.0), 12.5(11.0, 15.0), respectively(P<0.05). Conclusion Hypnotherapy combined with health education can effectively relieve menopausal symptoms, anxiety and depression, and improve sleep quality in perimenopausal patients.

塑料因其轻便、耐用、防水防潮、易于加工和成本低廉等优点,在现代社会被广泛使用。然而,这些优点也使塑料成为“隐形的杀手”。大量塑料分解产生数量更为庞大的微塑料,对人类健康产生了潜移默化的影响。本文结合了近年来国内外研究文献,系统综述了微塑料的来源及分类、对雌性哺乳动物生殖功能毒性的研究进展以及其作用机制,并对未来研究方向进行了展望。

妊娠期高血压疾病(HDP)是一种妊娠期女性特有的疾病,以高血压、蛋白尿、心肝肾功能损害,甚至发生母儿死亡为临床特点。HDP对孕产妇和胎儿的危害不仅发生在妊娠时,与正常妊娠的女性相比,曾患有HDP的女性多年后罹患心血管疾病的风险增加。产后良好的自我管理可以有效减少远期心血管疾病的发病率、延迟发病时间。本综述总结目前慢性高血压患者的自我管理方案和妊娠高血压疾病患者产后的管理现状,并分析其优点及不足,为建立合理、全面的HDP自我管理方案,对患有HDP的女性产后进行健康指导及干预,改善远期健康提供支持帮助。

Objective To explore the effect and mechanism of SSBP1 gene on autophagy and apoptosis of ovarian cancer cells. Methods The subjects of the study selected drug-resistant ovarian cancer cell line SKOV3 cell line and were divided into 39 samples after culture, 13 of which were used as the control group for routine culture, and the other 26 were used as the study group, which were respectively given SSBP1 inhibitor(13 strains) and SSBP1 active(13 strains) intervention. Cell viability, cell proliferation rate, cell apoptosis rate, autophagy related proteins, apoptosis related proteins, CHOP, DCR, Caspase8 proteins were observed in each group. Results Cell viability, cell proliferation rate, LC3I and Bcl-2 protein relative expression in SSBP1 inhibitor 1 were lower than those in control group. Apoptosis rate, p62, LC3II, Bax, CHOP, DCR, Caspase8, active-Caspase8, cleaved-Caspase8 protein and relative expression of SSBP1 gene were higher than those in the control group. Cell viability, cell proliferation rate, LC3I and Bcl-2 protein relative expression in SSBP1 inhibitor 2 were significantly higher than those in control group. Apoptosis rate, p62, LC3II, Bax, CHOP, DCR, Caspase8, active-Caspase8, cleaved-Caspase8 protein and relative expression of SSBP1 gene were lower than those in control group(P<0.05). Conclusion SSBP1 gene can regulate the expression of apoptosis-related proteins in ovarian cancer cells, and its low expression can promote the apoptosis of ovarian cancer cells, inhibit the autophagy and cell viability of ovarian cancer cells. The mechanism of SSBP1 gene may be related to the CHOP/DCR/Caspase8 signaling pathway, and it is expected to become a new drug target for ovarian cancer treatment.

目的 探究孕妇中高危人类乳头瘤病毒(HR-HPV)的感染情况及其相关因素。方法 回顾性分析2022年6月—2023年10月在宁夏医科大学总医院妇科进行诊疗的382例女性病例资料,共纳入191例孕妇和191例非孕妇。收集宫颈脱落细胞进行HR-HPV(AptimaE6,E7mRNA)和BD PrepstainTM细胞学检测,并对所有孕妇的阴道分泌物进行pH水平和常规病原微生物检测。比较病例资料并分析影响孕妇 HR- HPV 感染的危险因素。结果 不同年龄组间的孕妇HPV-16(+)阳性率和HPV-16/18/45(+)阳性率比较差异具有统计学意义(P<0.05)。第一孕期、第二孕期和第三孕期HR-HPV阳性率和非HPV-16/18/45阳性率差异比较具有统计学意义(P<0.05)。阴道合并感染孕妇的HR-HPV阳性率、HPV-16阳性率、HPV-18/45阳性率和非HPV-16/18/45阳性率高于未发生合并感染的孕妇(P<0.05)。孕妇HR-HPV阳性率和HPV-16/18/45阳性率与细胞学检查结果显著相关(P<0.05)。结论 孕妇的HR-HPV-16和HR-HPV-18/45的总体感染率高于非孕妇。妊娠期是女性HR-HPV的易感时期,建议在孕期进行HR-HPV筛查为针对性预防和治疗提供临床依据。

目的 本研究旨在通过病例回顾研究,评估袋鼠式护理对新生儿高胆红素血症的治疗效果,关注其对光疗时间、峰值胆红素含量、住院时间及出院前24 h纯母乳喂养率的影响。方法 本研究回顾了2022年1月至2024年5月在火箭军特色医学中心儿科住院的112例胎龄≥35周的高胆红素血症新生儿,其中50例接受了袋鼠式护理作为袋鼠式护理组,62例未接受该护理者作为对照组。以光疗时间、峰值胆红素含量、住院时间及出院前24 h纯母乳喂养率为结局指标。结果 袋鼠式护理组新生儿的平均光疗时间[(23.4±8.2)h]显著短于对照组[(35.5±13.5)h,P<0.001],新生儿的平均住院时间[(4.2±2.1)d]也明显短于对照组[(6.2±3.9)d,P<0.001],但两组胆红素峰值[(15.8±1.9) vs.(15.7±1.9)mg/dL]和出院前24 h纯母乳喂养率(64.0% vs.46.8%)均无明显差异(P＞0.05)。结论 袋鼠式护理可以有效缩短高胆红素血症新生儿光疗时间以及住院时间,因此建议在临床实践中积极推广袋鼠式护理,以优化新生儿高胆红素血症的治疗效果。

Objective The aim of this study was to quantify the contribution of different variables to the live birth outcome of In Vitro Fertilization and Embryo Transfer(IVF-ET) treatment and to identify the sensitive ranges of key variables, providing scientific decision-making references for clinicians and patients. Methods This retrospective cohort study was conducted based on an existing cohort, including a total of 5 859 fresh treatment cycles from the Reproductive Medicine Department of Yuhuangding Hospital in Yantai. A combination of univariate logistic regression analysis, multivariate Lasso regression analysis and random forest(RF) importance coefficient analysis was used for preliminary variable selection. Additionally, a literature search was conducted to supplement the preliminary variable set based on the correlation results of previous studies. The random forest algorithm was applied to construct a machine learning model with the selected variables, and the importance coefficients of the variables were calculated. Finally, partial dependence plots were used for quantitative analysis of key variables to determine their sensitive ranges. Results The live birth rate of fresh embryo transfer cycles included in this study was approximately 43%. Twenty-eight important variables were identified, with female age and the total number of high-quality embryos being the most important variables affecting the live birth outcome of embryo transfer. The success rate of live birth gradually decreased with increasing female age, and the decreasing trend became more pronounced when the female age was ≥37 years. When the total number of high-quality embryos reached 2, the probability of live birth increased to a peak and then leveled off. Conclusion Female patients undergoing IVF-ET fresh cycle treatment before the age of 37 and having a total of 2 high-quality embryos cultured are likely to achieve better live birth outcomes.

Objective To explore the genes associated with oxidative stress response in the pathogenesis of type 1 diabetes mellitus(T1DM) in children. Methods The Genecards database was used to obtain the genes related to "oxidative stress (OS)", and the GEO dataset was used to GSE33440, which analyzed the gene expression of peripheral blood mononuclear cells of 16 children with type 1 diabetes mellitus (T1DM group) and 6 adult healthy controls (healthy subjects group) to determine the gene expression changes related to T1DM, and the molecular function and biological pathways of OS-related differential genes were explored by GO and KEGG enrichment analysis. Furthermore, combined with the single-cell transcriptome GSE141784 dataset, the dynamic changes of mRNA expression of candidate genes, the specificity of cell types and the biological processes involved in them were discussed. Results Compared with the healthy subjects, the expression of 250 genes in the T1DM group was increased and the expression of 296 genes decreased. GO and KEGG analyses showed that OS-DEGs were significantly enriched in C-type lectin receptor signaling pathway, lipid and atherosclerotic pathway, Salmonella infection pathway and toxoplasmosis pathway. Combined with PPI network analysis, 10 core differential genes were screened, including TLR4, PTGS2, IKBKG, etc. Single-cell data analysis showed that TLR4 and IKBKG were uniformly and highly expressed in all groups of cells during the pathogenesis of T1DM, while PTGS2 was mainly highly expressed in classical dendritic cells and macrophages. Conclusion TLR4, PTGS2 and IKBKG may be involved in the pathogenesis of T1DM by regulating oxidative stress, and TLR4 and PTGS2 may interact with each other.

Objective To investigate the pregnancy stress status of low-risk pregnant women in early pregnancy and explore its related factors. Methods In this study, we enrolled 416 pregnant women, aged 19-45 years, with gestational age <14 weeks, who attended the obstetrics outpatient clinic of Peking University Third Hospital during April 2022-December 2023 and were evaluated to be in the low-risk category by their doctors. The Pregnancy Stress Rating Scale(PSRS) was used to assess the pregnancy stress status of the pregnant women. The socio-demographic information, basic health condition and pregnancy status of the pregnant women were extracted from a self-administered questionnaire and medical records. Results The quartile distribution of total pregnancy stress in early pregnancy among low-risk pregnant women was 36.0(20.0, 57.0), and the dimension with the highest mean scores being "pressure to seek maternal and child safety services"; the number of births and a history of adverse maternal outcomes were influencing factors of the pregnancy stress status in early pregnancy. Conclusion Low-risk pregnant women have mild pregnancy stress in early period. Maternal adverse maternal history and number of deliveries were associated with maternal stress.

Objective To observe the embryo development in vitro during pre-implantation using a time-lapse imaging culture system, and analyze the impact of fertilization methods on early embryo cleavage patterns and implantation outcomes. Methods Patients who entered the in vitro fertilization cycle at the Reproductive Medicine Department of Gulou Hospital in Nanjing from June 2022 to June 2023 were selected. A total of 130 cases of blastocyst culture and single blastocyst transfer cycles were selected from the time-lapse imaging culture system, and were divided into a conventional in vitro fertilization(IVF group, n=99) and an intracytoplasmic sperm injection(ICSI group, n=31) according to the method of fertilization, and a retrospective analysis was conducted. A total of 1422 embryos were obtained from the IVF group(n=1066) and the ICSI group(n=356), and 874 embryos were cultured to the blastocyst stage after 2PN, divided into the IVF group(n=641) and the ICSI group(n=233) according to the method of fertilization. The effects of different fertilization methods on cleavage patterns and blastocyst formation were analyzed, and the pregnancy outcomes of patients undergoing single blastocyst transfer in the IVF group(n=99) and the ICSI group(n=31) were tracked. Results Compared to the ICSI group, the IVF group had a significantly lower proportion of abnormal cleavage in the early embryo stage(P<0.01), and had better embryo development speed and cleavage synchronization; The blastocyst formation rate was significantly higher(P<0.05). In the normal cleavage mode, the rate of embryonic development was comparable between the two fertilization methods, with no significant difference in the blastocyst formation rate(P>0.05). The blastocyst formation rate for embryos with normal cleavage was significantly higher than that of embryos with abnormal cleavage(P<0.01). There was no significant difference in clinical pregnancy rate, miscarriage rate, and live birth rate among blastocysts derived from different fertilization and cleavage methods after transplantation(P>0.05). Conclusion Although the outcome of single blastocyst transfer is not affected by the method of fertilization, the overall blastocyst formation ability in ICSI cycles is lower than that in IVF cycles, which indicated that the fertilization method still has an impact on embryo utilization. In the daily clinical work, the selection of fertilization methods should be cautious, the indications for ICSI should be strictly controlled, ICSI operating procedures should be followed, and damage to oocytes should be minimized as much as possible. At the same time, single blastocyst transfer should be promoted to achieve optimal embryo selection, in order to improve pregnancy rates and reduce multiple pregnancies.

胎儿酒精综合征(FASD)是由于母亲长期大量饮酒所致的胎儿发育异常,包括产前与产后的发育迟缓,出生后特殊的面部形态特征,以及中枢神经系统发育异常。该病的发病机制尚不明确,故缺乏针对性预防和治疗措施。了解FASD的发病机制可以为将来预防、干预及治疗酒精引起的发育障碍提供依据,还可以识别该疾病的生物标记物。本综述对近年来该病的发病机制研究进行回顾,主要包括基因表达、表观遗传、酒精代谢产物、神经免疫等机制。

Objective To screen the items suitable for the specific module of the infertility scale in the patient reported outcome instruments system for chronic disease (PROISCD-IN), and to lay the foundation for the development of a full scale. Methods Items were screened following a structured decision-making approach. Firstly, a topic group and core group were established and a pool of alternative items was proposed. After the first round of discussion, a preliminary scale was formed for pre-investigation. Infertility patients who attended the gynaecology and reproduction departments of Shunde Women′s and Children′s Hospital of Guangdong Medical University and staff working in the infertility clinic were interviewed in September-October 2022.The preliminary screening of items was completed using six methods including coefficient of variation, correlation coefficient, Cronbach′s alpha coefficient, factor analysis, patient importance score and medical importance score. The items were then modified and improved through discussions with experts, medical staffs and patients. Results Based on the six screening methods and the opinions of experts, medical staffs and patients, 14 items were finally selected to form a specific module of the infertility scale (PROISCD-IN). Conclusion The screening of specific module items in the PROISCD-IN outcome measurement scale for infertility patients was strictly adhered to, and the formed specific module has good reliability and validity, which can provide a scientific measurement tool for intergrating patient perspective evidence in the evaluation system of infertility patient.

目的 通过对比接种EV71手足口病疫苗前后的变化,分析东城区手足口病的流行特征。方法 本研究采用了描述性流行病学方法,对接种手足口病疫苗前后手足口病的发病率、年龄、职业和病原学构成等特征进行了对比研究。结果 2008—2022年东城区手足口病发病率在4.11/10万~89.89/10万之间。2008—2016年疫苗接种前,东城区发病率为56.24/10万;2017—2022年疫苗接种后,东城区发病率为35.94/10万。疫苗接种前后东城区手足口病发病率呈现下降趋势(P<0.05)。疫苗接种前后,男性发病数都多于女性,与疫苗接种前相比,疫苗接种后男性构成比上升,女性构成比下降。疫苗接种前六岁以下儿童病例占总数的81.27%,疫苗接种后六岁以下儿童病例占总数的70.48%。与疫苗接种前相比,疫苗接种后幼托儿童和散居儿童构成比下降,学生和其他人群构成比上升。东城区17个街道中,与疫苗接种前相比,10个街道疫苗接种后构成比下降,7个街道构成比上升。东城区肠道病毒EV71构成比逐年下降,而肠道病毒CoxA16和其他肠道病毒构成比逐年上升,三种病毒构成差异有统计学意义(P<0.05)。东城区EV71疫苗接种率在0.13%~31.79%之间,七年平均接种率为16.90%。结论 EV71疫苗在预防手足口病流行方面具有重要作用,如果加大肠道病毒CoxA16和其他肠道病毒等多价疫苗的研发和使用,将会进一步降低手足口病的感染风险。

人类免疫缺陷病毒(HIV)感染伴症状性高乳酸血症的估计发病率为10.8‰~14.8‰,多数为慢性稳定性,少数患者为急性暴发性,死亡率极高。本文对1例以感染、精神症状起病的HIV感染伴乳酸酸中毒婴儿的临床资料、诊治经过、死亡原因结合文献复习进行分析讨论,旨在提高临床医生对症状性高乳酸血症的认识,早期监测及处理。

孕期是胎儿大脑发育的关键时期,也是大脑最容易受到药物影响的时期。随着医学的进步,外科和麻醉技术水平的提高,孕期的非产科手术、宫内胎儿手术在全世界范围内广泛开展。然而,孕期母体暴露于全麻药物对子代大脑发育影响的相关结论主要集中在动物实验,缺乏相关的临床资料,全麻药物对人类胎儿大脑发育的影响尚不完全清楚,孕期非产科手术的全麻用药国内外缺乏一致性的意见或建议。

总结宁夏地区1例川崎病合并面神经麻痹患儿的临床资料和诊治经过,并结合文献进行复习,旨在提高临床医师对本病的认识。患儿,女,5月,主因“发热1周,口角歪斜3 d”入院。患儿临床表现为中度稽留热,右侧面瘫,颈部淋巴结肿大,血常规白细胞及C反应蛋白明显升高,抗感染治疗无效,考虑川崎病并发面神经麻痹,丙种球蛋白和阿司匹林治疗后体温恢复正常,炎症指标下降至正常,面瘫消失。川崎病偶可并发面神经麻痹,原发病治疗好转后,面神经麻痹多可自愈,不需特殊治疗,预后较好。

目的 探究圆柱瘤蛋白(CYLD)介导TRAF6去泛素化调控NF-κB信号通路影响输卵管上皮细胞炎症水平的机制。方法 选取8～10周龄、性成熟但未交配生育的SPF级雌性SD大鼠,以大鼠输卵管上皮细胞为对象,采用LPS干预建立输卵管上皮细胞炎症模型。先设立免疫共沉淀组IP(si-NC组,si-CYLD组)、阳性对照组input(si-NC组,si-CYLD组)检测TRAF6、Ub(泛素分子)灰度;再分为oe-NC组,oe-CYLD组、oe-CYLD+oe-NC组、oe-CYLD+oe-TRAF6组。比较各组CYLD、TRAF6、NF-κBp65、p-p65、IkB-a、p-IkB-a表达、炎症因子含量及细胞活性。结果 oe-CYLD+oe-NC组的TRAF6灰度比oe-NC组浅;过表达各组均检测出NF-κBp65、p-p65、IkB-a、p-IkB-a与炎症因子,其中oe-NC组灰度最深、oe-CYLD组最浅、且oe-CYLD+oe-TRAF6组比oe-CYLD+oe-NC组灰度深;oe-CYLD组细胞活性最高,oe-NC组最低,oe-CYLD+oe-NC组细胞活性优于oe-CYLD+oe-TRAF6组。结论 CYLD高表达可减少TRAF6泛素化抑制NF-κB信号通路,从而降低输卵管炎症水平,改善输卵管炎性不孕。

目的 探讨婴幼儿不同年龄段唇系带形态与上颌正中间隙的关系,为临床实践提供数据支持。方法 选取 2022年就诊于北京大学第一医院宁夏妇女儿童医院儿童保健中心常规体检的患者1 268 例(男 730例,女538例),根据年龄分三组(5~12月、13~24月、25~36月),比较每组唇系带形态。使用卡方检验进行统计学评价。结果 婴幼儿不同年龄段唇系带形态不同。随着年龄组增大,D型穿越牙龈乳头附着型的占比逐渐减小,A型粘膜附着型占比增加,年龄越小上颌正中间隙越大,有统计学差异(P<0.001)。唇系带形态与性别无关。结论 对于婴幼儿家属的上颌正中间隙美学诉求,临床检查时应结合患儿年龄、唇系带形态综合考虑,避免误诊和不必要的治疗。

目的 分析行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)不孕女性TORCH病原体感染对自然流产的影响。方法 选择2017年1月至2020年12月于山东大学附属生殖医院行IVF/ICSI-ET治疗的患者为研究对象,检测TORCH-免疫球蛋白M(IgM)和TORCH-免疫球蛋白G(IgG),随访患者自确立妊娠起至16个月记录妊娠结局,最终筛选出1 265名自然流产患者和4 562名正常分娩患者纳入研究,分析TORCH病原体感染与自然流产的关系。结果 倾向性评分匹配(PSM)前,巨细胞病毒(CMV)-IgM、单纯疱疹病毒(HSV)-IgM、风疹病毒(RV)-IgM会增加自然流产的发生。PSM后,CMV-IgM、HSV-IgM会增加自然流产的发生。CMV-IgM、HSV-IgM是自然流产的独立危险因素。结论 CMV感染、HSV感染与自然流产相关,应加强行IVF/ICSI-ET患者孕前的TORCH筛查并积极干预。

本文回顾性分析2例UBE3A基因突变导致Angelman综合征(AS)家系患者的临床表现及基因检测结果。UBE3A基因突变型变异少见,本文介绍了UBE3A基因两种新发突变,丰富了UBE3A基因突变谱,对于AS家系行遗传咨询和产前诊断具有重要意义。

目的 分析子宫颈鳞癌中 miRNA-145与人乳头瘤病毒(HPV)感染的关系,比较蒙古族与汉族女性子宫颈鳞癌患者中的表达差异及关联性。方法 2013年6月—2021年6月内蒙古医科大学附属医院及内蒙古自治区肿瘤医院妇科子宫颈鳞状细胞癌(癌组),高级别宫颈上皮内瘤变(高CIN组)、低级别上皮内流变(低CIN组),以及因子宫肌瘤切除的正常宫颈(对照组)组织及血清标本各30例。应用荧光定量 RT-PCR技术和原位杂交技术检测各组miRNA-145 的表达情况,并对miRNA-145 与 HPV16,18型感染情况进行相关性分析。结果 蒙古族与汉族宫颈鳞癌患者血清及组织中的miR145相对表达量均呈正相关性。蒙古族与汉族子宫颈鳞状细胞癌组中的组织及血清中miR-145的表达均较高级别上皮内瘤变、低级别宫颈上皮内瘤变和正常宫颈的表达下调;且蒙汉两族无明显差异。正常宫颈组、低CIN组、高CIN Ⅲ组中的 miRNA-145表达无统计学差异。结论 miRNA-145在蒙古族和汉族妇女子宫颈癌前病变以及子宫颈鳞状细胞癌的发生、发展中均起重要作用,并且与高危型 HPV16 感染相关联,但两民族间无明显统计学差异,因此,血清中miRNA-145可被作为子宫颈鳞状细胞癌的早期筛查及早期诊断的分子指标之一。

目的 探讨妊娠期糖尿病(GDM)孕妇脐带血源外泌体LRG1和ECM1表达情况。方法 选取GDM孕妇15例,同期产检的健康孕妇(NGT)15例,收集两组脐带血,分离提取外泌体,利用免疫印迹和ELISA方法检测外泌体LRG1和ECM1含量。结果 GDM组脐带血源外泌体LRG1和ECM1水平均显著高于NGT组(P<0.05)。结论 脐带血源外泌体LRG1和ECM1可能与GDM发生发展有关,值得深入研究。