HtrA系丝氨酸蛋白酶家族,参与许多生理病理过程。HtrA4相对局限表达于胎盘组织,大量研究证明HtrA4在子痫前期(PE)的胎盘或是血液循环中都存在差异,近年通过生物信息学分析出的PE与正常妊娠之间的差异基因也涉及到HtrA4。PE严重影响母儿安全,早期发现和及时治疗至关重要,HtrA4参与PE生理病理的全部机制仍有待研究,深入探讨其与子痫前期的关系有可能为子痫前期的治疗与诊断提供依据。随着国内外对HtrA4参与子痫前期的深入研究,近年的研究结果发现其通过多种机制参与PE,包括抑制血管生成、破坏血管内皮屏障、影响滋养细胞合胞浸润等。本文就HtrA4的结构功能及与子痫前期发病的关系综述。

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。

回顾性分析1例经新生儿筛查确诊的肉碱棕榈酰转移酶1A缺乏症患儿诊断随访资料,患儿男,生后4天新生儿筛查示游离肉碱升高伴长链酰基肉碱下降,基因检测示CPT1A基因复合杂合突变,给予喂养指导,随访至24月龄未出现临床症状。肉碱棕榈酰转移酶1A缺乏症可筛可治,经早期诊断及合理随访干预总体预后较好,但该病的长期管理及远期预后仍待深入研究。

子宫内膜异位症(EMs)是一种雌激素依赖性慢性炎症性疾病,与不孕症密切相关。然而,EMs影响生育能力的机制尚未完全阐明。有研究证实,细胞焦亡可能在导致EMs女性生殖能力降低方面起着关键作用。细胞焦亡是一种新型的非凋亡程序性细胞坏死形式,其特征在于快速的质膜破裂和促炎内容物的释放。本文综述了细胞焦亡的主要分子机制和最新研究进展,探讨了细胞焦亡与炎症、类固醇激素的关系及其在EMs进展中的作用,分析了细胞焦亡可能通过降低子宫内膜容受性和卵巢储备功能导致EMs相关不孕症。

Objective To explore the association between 15 current used pesticides (CUPs) in maternal placenta and the risk of fetal neural tube defects (NTDs). Methods A case-control study was conducted among mothers of 308 controls and 150 NTD cases. Concentrations of 15 CUPs in placental tissues were measured by liquid chromatography-mass spectrometry. Multivariate logistic regression and weighted quantile sum (WQS) regression were used to explore the association between placental CUPs and the risk of NTDs. Questionnaire survey was used to collect information on maternal pesticide active exposure history and dietary habits during pregnancy. Results The overall detection rate of 15 CUPs was 89.7% in this study. Multivariate logistic regression showed that high level of flumorph (OR=2.58, 95%CI[1.10-5.90]) was significantly associated with a higher risk of NTDs, and high levels of pyraclostrobin (OR=0.28, 95%CI[0.08-0.86]) and imidacloprid (OR=0.38, 95%CI[0.15-0.90]) were significantly associated with lower risk of NTDs, but the associations were no longer significant after Bonferroni correction. WQS regression did not show any significant combined exposure effect of CUP mixtures on the risk of fetal NTDs (OR=0.69, 95%CI[0.14-3.45]). Conclusion Exposure to CUPs during pregnancy was quite common in this study, but no statistical association was found between placental CUPs and the risk of fetal NTDs.

目的 探讨妊娠期高血压(HDP)患者剖宫产后产褥期感染病原菌分布情况及感染可能因素。方法 按照是否发生感染将2020年1月—2022年1月在西北妇女儿童医院行剖宫产手术的140例HDP剖宫产妇分为感染组(13例)和未感染组(127例);产妇入组后建立档案,由培训通过的研究人员调查产妇的情况(采用专用调查表),首先确定无菌条件,然后专业人员采集感染患者阴道或宫颈分泌物、血液、痰液及尿液,采用全自动微生物鉴定仪分析HDP产妇感染类型及其感染病原菌分布特点;多因素分析HDP患者剖宫产后发生产褥期感染的可能影响因素。结果 共检出16株,革兰阴性菌:大肠埃希菌占比最高,达37.5%(6/16),铜绿假单胞菌次之,占比12.5%(2/16),阴沟杆菌占6.3%(1/16);革兰氏阳性菌:金黄色葡萄糖球菌占25.0%(4/16),表皮葡萄球菌占6.3%(1/16)。感染组与未感染组在产前BMI、妇科炎症、产前胎膜早破、生殖道感染史、手术季节、手术时间、是否接台手术及围术期抗生素使用方面有差异,且有统计学意义(P<0.05);多因素提示,产前BMI、妇科炎症、产前胎膜早破、手术季节、手术时间均是HDP患者剖宫产后发生产褥期感染的影响因素(P＜0.05)。结论 HDP患者产褥感染以大肠埃希菌为主,金黄色葡萄糖球菌次之,产前BMI、妇科炎症、产前胎膜早破、手术季节、手术时间均是HDP患者剖宫产后发生产褥期感染的影响因素。

目的 探讨经阴道超声联合盆底肌功能性电刺激治疗在不同孕期增重初产妇盆底功能障碍诊断及康复治疗效果评价中的作用。方法 2020年9月——2022年3月在本院产检分娩且产后早期行盆底肌电刺激治疗的170例初产妇资料,根据孕期增重情况分三组:增重11.5~16 kg组(对照组),增重小于11.5 kg组,增重大于16 kg组。所有产妇在产后首次复诊时及盆底肌电刺激治疗后均行经阴道三维盆底超声检查,比较治疗前后盆底肌电指标及盆底超声指标变化。结果 三组产妇在年龄、孕前BMI等方面比较无统计学差异;产后首次行盆底超声提示,增重大于16 kg产妇组膀胱颈移动度、尿道旋转角、尿道倾斜角、肛提肌裂孔及膀胱后角大于增重小于11.5 kg组及对照组,差异具有统计学意义(P＜0.05),增重大于16 kg组在Valsalva状态下肛提肌裂孔及膀胱后角较增重小于11.5 kg组和对照组,组间差异有统计学意义(P＜0.05);盆底肌电评估提示,三组产妇在快肌阶段得分(F=16.88,P＜0.05)、慢肌阶段得分(F=25.21,P＜0.05)、总得分(F=23.33,P＜0.05)上比较具有统计学差异;治疗后,产妇的膀胱颈移动度、尿道旋转角、Valsalva动作时的肛提肌裂孔面积及膀胱后角均较治疗前小,且盆底肌电评估的总得分较治疗前明显升高,差异均具有统计学意义(P＜0.05)。结论 经阴道分娩初产妇孕期增重过多对其盆底功能影响较大,盆底超声联合盆底肌电刺激治疗对盆底功能评价及恢复具有较好的价值,适当的孕期体重管理对初产妇盆底功能有益。

Objective To explore the effect of circadian rhythm disruption on the expression of rhythm gene CLOCK in endometrial cancer and its possible promoting mechanism during the disease progression. Methods According to the patient's age, gravidity and parity, occupational history, educational background, environmental factors, and other background matching, 6 cases of endometrioid adenocarcinoma with a history of night shift work were selected as the abnormal rhythm group, and 6 cases without a history of night shift work were selected as the normal rhythm group. qPCR and Western blot were used to detect the expression of CLOCK mRNA and protein in the two groups. Immunohistochemistry was used to detect the expression of CLOCK and epithelial-mesenchymal transformation related phenotypic proteins(E-cadherin and vimentin) in 32 cases of endometrioid adenocarcinoma, than analyzed the relationship between the expression and clinicopathological features, and the correlation between CLOCK expression and epithelial-mesenchymal transformation related phenotypic protein. Results The results of qPCR and Western blot showed that the relative expression levels of CLOCK mRNA and protein in abnormal rhythm group were significantly lower than those in normal rhythm group(P<0.05). Immunohistochemistry indicated that the negative rate of E-cadherin and CLOCK, the positive rate of vimentin were higher in the tumors with night shift work history, FIGO stage II-III and deep muscle infiltration, and the difference was statistically significant (P<0.05).The correlation between CLOCK expression and E-cadherin, vimentin in endometrioid adenocarcinoma tissue specimens was statistically significant, (P<0.05). Conclusion The disruption of circadian rhythm caused by night shift down-regulates the expression of CLOCK gene in endometrioid adenocarcinoma tissues. The involvement of CLOCK gene in epithelial-mesenchymal transformation process of tumor tissues is a possible mechanism of endometrioid adenocarcinoma progression and may be an important factor affecting prognosis.

胃肠道的肠神经系统、黏膜免疫系统和肠道菌群之间存在相互作用,在生理情况下可以维持胃肠道生理稳态;在感染和炎症期间,各系统之间相互诱导发生变化,参与胃肠道病理进程。本文旨在通过文献综述回顾近年来关于胃肠道的肠神经系统 、黏膜免疫系统、肠道菌群在生命早期中的发展,三者之间的动态联系和相互作用,及对胃肠道功能的影响的研究新进展。

目的 研究多种遗传代谢病新生儿筛查初筛可疑阳性的早产儿转归及远期心理行为发育情况。方法 2020年12月1日至2021年11月30日出生的早产儿186例,通过干血斑检测氨基酸、酯酰肉碱谱,筛查多种遗传代谢病,并在高危儿门诊系统随访,在矫正月龄6月龄和12～18月龄分别进行盖塞尔(Gesell)法神经心理评估。根据氨基酸、酯酰肉碱谱检测结果分为初筛可疑阳性组和阴性组。结果 早产儿186例中初筛可疑阳性75例,阴性111例。初筛可疑阳性的早产儿中氨基酸代谢异常占50.0%,脂肪酸代谢异常占43.4%,有机酸代谢异常占6.6%。其中前五位可疑阳性异常的指标有精氨酸升高(占25.5%)、游离肉碱升高(占15.1%)、蛋氨酸升高(占12.3%)、十八碳酰肉碱降低(占11.3%),异戊酰肉碱升高(占7.6%)。与多种遗传代谢病初筛阴性组比较,初筛可疑阳性组早产儿矫正月龄6月龄时大运动发育商和个人社会发育商落后,差异有统计学意义(P＜0.05),母亲孕32~36周早产儿中初筛可疑阳性的早产儿在矫正月龄6～18月龄Gesell神经心理评估无差异性(P>0.05)。母亲孕25~31周早产儿中初筛可疑阳性组矫正6～18月龄Gesell评估结果在精细发育商、适应性发育商和语言发育商方面落后,差异有统计学意义(P＜0.05)。结论 血液氨基酸、酯酰基肉碱谱初筛可疑阳性的早产儿半岁内大运动和个人社会发育落后,母亲孕25~31周早产儿矫正6～18月龄在适应性发育商和语言发育商方面落后。

胆汁淤积性黄疸是脑腱黄瘤病的罕见首发表现之一,报道宁夏地区首例以胆汁淤积性黄疸为首发表现的新生儿脑腱黄瘤病,总结患儿的临床特征、实验室检查和基因检测结果,并结合文献进行复习,旨在提高临床医师对本病的认识。患儿男,46天,主因“皮肤黄染1个月余”入院。血生化示TBil 205.3μmol/L,DBil 154.1 μmol/L,ALT 126 U/L,AST 177 U/L,ALP 613 U/L,GGT 146 U/L,TBA 85.32 μmol/L,提示胆汁淤积性黄疸。超声、核磁、胆道造影检查均未见胆道系统明显异常。基因检测示CYP27A1 c.1184+1G>A、大片段缺失复合杂合变异,确诊为脑腱黄瘤病,给予鹅去氧胆酸治疗,随访近3年,患儿胆红素、肝功能恢复正常,无其他系统异常表现。

Objective To conduct genetic analysis and preimplantation genetic testing for monogenic disorders(PGT-M) in a family with Angelman syndrome. Methods We included a family with Angelman syndrome who visited the Reproductive Department of Zhongshan Hospital Affiliated to Fudan University in April 2023. Methylation-specific multiplex ligation-dependent probe amplification(MS-MLPA) method was used to verify the SNRPN u5 deletion and methylation abnormalities in the 15q11.2-q13 region of the family. The ASA array was used to detect the single nucleotide polymorphism(SNP) sites of the family and construct a haplotype. In vitro fertilization was performed using intracytoplasmic sperm injection technology, followed by embryo biopsy on the third day of cleavage stage. Single cell whole genome amplification, second-generation sequencing, and SNP linked haplotype analysis were used to detect whether the embryo carried SNRPN u5 genetic variations in the 15q11.2-q13 imprinted region and chromosomal copy number variations(CNVs) of 4 Mb or more. Results The results showed that the proband and the younger brother had SNRPN u5 copy number deletion and methylation abnormalities in the 15q11.2-q13 imprinting region. The copy number deletion was inherited from the mother, and the mother had a 15q11.2-q13 SNRPN u5 copy number deletion. However, the mother's methylation status was normal. After successfully constructing a haplotype in the family, one cleavage embryo was obtained through clinical ovulation induction. The PGT-M results showed that the embryo carried pathogenic SNRPN u5 mutations inherited form the mother and had multiple chromosome copy number abnormalities. The embryo transfer is thus not recommended. Conclusion PGT-M technology can assist in reproductive intervention and prevent the birth of Angelman syndrome patients in their families, and is an important way to assist families with monogenic genetic diseases in eugenics.

本文报道1例ADNP基因新发杂合变异Helsmoortel-Van der Aa综合征病例。该患儿为1岁6月男童,存在有特殊面容、智力发育低下、运动、语言发育迟缓、小手等临床表现,基因分析显示患儿ADNP基因有一个新发变异位点C.460_461insAA(p.P154Qfs*7),为移码突变。Helsmoortel-Van der Aa综合征可累及多系统,基因检测有助于诊断。

Objective To explore the effects of the interventions on improving caregivers' family rearing practices of left-behind children(LBC)under 3 years old. Methods The Integrated Early Childhood Development(IECD) project was implemented in 80 villages of four counties in Shanxi and Guizhou provinces from July 2014 to December 2016, which provided integrated interventions of feeding and responsive care for children under 3 years old. A quasi-experimental design was applied in our study to evaluate the effect of intervention on the family rearing attitude and practice of caregivers of left-behind children under three years old.. The baseline and post-intervention survey data of the Integrated Early Childhood Development(IECD) project were used to carry out the study in July-Sep of 2013 and 2016, respectively. The baseline survey included 695 cases in the intervention group, 478 cases in the control group, 740 cases in the post-intervention survey and 514 cases in the control group. Adifference-in-difference model was used to estimate the effects analyze the relationship between intervention dose and nursing practice, and control for confounding factors such as sociodemographic characteristics. Results After two years' intervention, the proportion of undertaking responsive caregiving among caregivers in the intervention group increased from 74.1%(515/695) at baseline to 79.2%(585/739) after intervention with an increase of 5.1%,. The proportion of responsive care in the control group decreased by 29.3% over the same period. After controlling for confounding factors with difference-difference model, the intervention significantly improved the response care received by left-behind children(OR:13.11; 95%CI:7.06-25.35). The proportion of undertaking violent disciplinary practices decreased by 10.9%(baseline:52.7%(366/695); post-intervention:41.8%(309/739) in the intervention group, which was lower than that in the control group(aOR:0.57; 95%CI:0.40-0.82). But no significant improvement was found in the ownership rate of books, toys, experiencing inadequate supervision, and the caregivers' attitude towards physical discipline of left-behind children. Compared to the frequency of intervention less than once a month, the intervention at a frequency of at least once a month but less than once a week was associated with improving responsive care and violent care practices(P<0.05). Conclusion The integrated interventions effectively improved the caregivers' responsive care and violent disciplinary behaviors. Intervention should be at a frequency of no less than once a month, to promote good rearing care practices by caregivers.

Objective To study the change of serum metabolite profiles in pregnant mice with embryos occurring neural tube closure failure, and the possible role of histone modification in the development of neural tube defects(NTDs) induced by benzo[a]pyrene(BaP). Methods Pregnant ICR mice were classified into BaP exposure group and control group, which were treated by intraperitoneal injection of BaP or corn oil at gestational day(GD) 7-9. The serum of pregnant mice and embryos were collected at GD 9.5. Based on the phenotype of the embryos, the BaP exposure group was further classified into BaP_NTDs group and BaP_nonNTDs group. Ultra-performance liquid chromatography-mass spectrometry was used to detect serum metabolites, and the differences of metabolites between the two groups were compared. We further annotated metabolic pathways of the different serum metabolites in Kyoto Encyclopedia of Genes and Genomes(KEGG) database. RNA-seq and CUT&Tag were used to assay the genome-wide gene expression and the histone modifications of H3K27me3 and H3K27ac of embryonic neural tissues to explore the possible genes and histone modifications responsible for the NTDs based on the identified metabolic pathways. Results Compared to the control group, 44 differential metabolites were found in BaP_NTDs group. Compared to the BaP_nonNTDs group, 11 differential metabolites were found in BaP_NTDs group. The LysoPC(0:0/18:2(9Z,12Z)) was uniquely up-regulated in BaP_NTDs group. Pentose phosphate pathway was enriched both for the BaP_NTDs/control differential metabolites and BaP_nonNTDs/control differential metabolites. Further, the RNA-seq and CUT&Tag data of embryonic neural tissues revealed that the expression of Aldob in the BaP_NTDs group, one of the key genes involved in the pentose phosphate pathway, was 31.06 fold-change of that in the control group, and 9.68 fold-change of that in the BaP_nonNTDs group. They both had a higher peak of H3K27ac modification in the promoter of the gene. Conclusion LysoPC(0:0/18:2(9Z,12Z)) might be the key differential metabolite in the serum of pregnant mice with NTD embryos induced by BaP, and the histone modifications of Aldob in pentose phosphate pathway might be one of the underlying mechanisms.

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.

Objective To describe the characteristics of pre-hospital emergencies, disease parity, and cause of death parity among children and adolescents aged 3-17 years in Yantai in the past 6 years. Methods All case data of children and adolescents aged 3-17 years from 2016-2021 in the pre-hospital emergency electronic medical record system of Yantai 120 Emergency Command Center were selected for analysis, and the student population data of each year provided by Yantai Education Bureau were used as the denominator to calculate the prevalence and mortality of children's pre-hospital emergencies, and to describe the distribution characteristics of different time(year), different regions(urban and rural), and different populations(gender and school periods). Results The annual prevalence of pre-hospital emergencies was 501.8-600.2/100,000 for boys and 361.7-431.6/100,000 for girls aged 3-17 years in 2016-2021, increasing yearly between 2016-2019, decreasing in 2020 and rebounding in 2021. Among the school periods, senior students had the highest annual prevalence(919.9-1058.6/100,000), while junior students had the lowest annual prevalence(275.5-357.6/100,000). Longkou and the Development Zone had the highest annual prevalence(>500/100,000), while Haiyang and Qixia had lower annual prevalence(304.2-467.3/100,000). The mortality rate for boys showed a decline followed by stabilization, with a fluctuation range of 7.5-10.0/100,000, and for girls showed a rise followed by a decline and stabilization, with a fluctuation range of 3.6-5.6/100,000. Accidental injuries accounted for 56.1% of pre-hospital emergencies, with drowning, traffic injuries and fall injuries as the top three causes of death; roads and homes were the main incident sites. The gender differences, school periods and urban and rural area differences for different injuries and different diseases were statistically significant. Conclusion The overall prevalence of pre-hospital emergencies among children and adolescents aged 3-17 years in Yantai City in 2016-2021 for both genders showed a fluctuating upward trend, and the mortality rate was stable, with increased prevention and control efforts for the types of such as accidental injuries, enhanced school-related health and safety education, and joint efforts of family, school, and community to prevent and reduce the occurrence of emergencies especially injuries.

Objective Using murine and cell models to explore the effects of Li₂CO₃ on the cell cycle during mouse embryonic neural development. Methods According to the Li₂CO₃-induced NTDs murine mode which we have established, 350mg/kg Li₂CO₃ was injected intraperitoneally into the C57BL/6J pregnant mice on embryonic day 7.5. The development of the offspring were observed. Li₂CO₃ in different concentrations(0.5,1,1.5, 2, 2.5, 3, 5 and 10mM) were used to treat the NE4Cs and NIH3T3. Cell survival, proliferation and cell cycle were detected by methylthiazolyldiphenyl tetrazolium bromide, 5-ethynyl-2-deoxyuridine labeling and flow cytometry. The quantitative real-time polymerase chain reaction and western blotting used to detect the expressions of cell cycle key genes. Results 350mg/kg Li₂CO₃ affected embryonic development. The incidence of NTDs was 32.7%(18/55). Treatment with the low concentration of Li₂CO₃ in NE4Cs and NIH3T3 cells increased cell survival, reduced the cells in G1 phase, most cells were in S and G2/M phases and promoted cell proliferation. Both in mice and cells models, the expressions of cell cycle key genes cyclin A, cyclin D1, Cdk2 and Cdk4 increased after Li₂CO₃ treatment(P<0.01). Conclusion Li₂CO₃ disturbed the cell cycle to cause abnormal cell proliferation leading to NTDs by up-regulating the expression of cell cycle key genes cyclin A, cyclin D1, Cdk 2 and Cdk 4.

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。

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 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.

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 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.

神经管畸形引起的中枢神经系统发育异常不仅是死产和新生儿死亡的主要原因,也是存活婴儿终身残疾的重要原因。细胞自噬是胞质“更新”的过程,对细胞命运的决定至关重要。自噬可能参与胚胎发生和出生后发育过程中细胞增殖、死亡和分化所需的特定胞质重排。发育中的神经上皮在神经形成期间具有对于神经形成或神经管闭合必不可少的高水平的自噬,自噬异常时可导致神经管畸形。本文关注于细胞自噬在神经管畸形中作用的研究进展,为当前及今后研究发病机制和预防神经管畸形提供参考。

Objective To explore factors that influence the follow-up compliance of high-risk infants and improve the follow-up and management strategy of the high-risk infants. Methods A total of 675 high-risk infants who were under 2 years old and admitted to the outpatient department of the Children`s Health Department of a hospital in Hohhot from 2019 to 2021 were included. Results In total, 49.6%(335/675) of the high-risk infants had high follow-up compliance. Multivariable logistic regression analysis showed that several factors including local residence, multiple high-risk factors, higher mother's education, and multiple caregivers were associated with high follow-up compliance. Conclusion Popularizing parenting knowledge, enhancing parents' health care awareness, strengthening the training of health care providers especially those of primary health care providers, improving child health care capacity, and providing accessible and convenient health care services might improve the follow-up compliance as well as health of high-risk infant.

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 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.

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。

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.

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。

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。

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.

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。

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。

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。

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 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.

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。

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.

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.