Objective To carry out the intrauterine growth evaluation of neonates, and establish intrauterine growth curves of singleton neonates in different gestational age (GA) among primiparity and multiparity. Methods We evaluated and classified the intrauterine growth of 324 521 multiparous, primiparous, and mixed neonates from Shenzhen, Chongqing, Haikou, Guangzhou, Changsha, Chengdu, Quanzhou, Liuzhou, and Guilin cities in China from 2017 to 2020. We also revealed the characteristics of intrauterine growth higher level in multiparity than that that in primiparity. A total of 16 852 live singleton neonates in 28~42 weeks of GA among primiparity and multiparity from Shenzhen City were measured at birth by cluster sampling from April 2013 to September 2015 in this cross sectional study. We established intrauterine growth curves of singleton neonates among primiparity and multiparity. Results The classification and evaluation results of intrauterine growth grade for 324 521 neonates in 9 maternal and child health care hospitals of China showed the orders in the characteristics were multiparous neonates, mixed neonates, and primiparous neonates. We created the intrauterine growth 3rd~97th percentile curves of body weight, body length, crown-rump length, head circumference, and chest circumference of 16 852 singleton neonates in 28~42 weeks of GA among primiparity and multiparity in Shenzhen, China. The level of above 5 indexes of multiparous neonates was higher than that of primiparous neonates. The 10th, 50th and 90th curves of body weight for multiparous singleton neonates were higher than those of Shenzhen singleton neonates in 2015, while the 10th, 50th and 90th curves of body weight for primiparous singleton neonates were lower than those of Shenzhen singleton neonates in 2015. Conclusion The level of intrauterine growth evaluation of neonates in multiparity was higher than that in primiparity in Chinese nine cities. We created the intrauterine growth 3rd~97th percentile curves of body weight, body length, crown-rump length, head circumference, and chest circumference of singleton neonates in 28~42 weeks of GA among primiparity and multiparity in Shenzhen, China. It provided the standard about above 5 indexes of intrauterine growth evaluation for multiparous neonates and primiparous neonates. The curve level of above 5 indexes of multiparous neonates was higher than that of primiparous neonates.

Objective To investigate the level of hepatitis B serological testing in the free pre-pregnancy health examination laboratories from 2012 to 2021 in Jiangsu province.Methods The external quality assessment of hepatitis B serological testing in free pre-pregnancy health examination laboratories was carried out twice a year and each laboratory participating in the external quality assessment, filled in the report and uploaded for statistical analysis.Results From 2012 to 2021, the full mark rate of HBsAg, HBsAb, HBeAg, HBeAb and HBcAb external quality assessment increased from 72.6%、73.7%、94.2%、82.1% and 13.7% to 100%, respectively. The qualified rate of HBsAg, HBsAb, HBeAg, HBeAb and HBcAb external quality assessment increased from 94.2%, 94.2%, 94.2%, 90.9% and 67.4% to 100%, respectively. The qualified rate and full mark rate of the external quality assessment from 2017 to 2021 were significantly higher than those from 2012 to 2016, and the differences were statistically significant(P<0.05). The total positive missed rate of HBsAg, HBsAb, HBeAg, HBeAb and HBcAb external quality assessment decreased from 9.8%, 13.2%, 5.8%, 16.8% and 47.4% to 0%, respectively.Conclusion From 2012 to 2021, the overall serological detection capacity of hepatitis B in grassootsmedical laboratories of free pre-pregnancy health examination in Jiangsu province has been improved.

Objective To describe the changes of IGF-Ⅱ concentration in breast milk during lactation and investigate the association between breast milk IGF-Ⅱ and physical growth index of infants, and to explore the influencing factors of breast milk IGF-Ⅱ during lactation. Methods 32 women who met the inclusion and exclusion criteria were recruited From October 2020 to September 2021 in Peking University People′s Hospital. Breast milk samples were collected at 48 hours after delivery, 15 days after delivery, 42 days after delivery, 6 months, 9 months and 12 months after delivery, and growth indicators including body length and body weight were collected. Breast milk IGF-Ⅱ was detected by enzyme-linked immunosorbent assay. Generalized Estimation Equations (GEE) were used to analyze the association between maternal IGF-Ⅱ and infant physical growth indexes, factors that may affect breast milk IGF-Ⅱ were estimated. Results The median concentration of IGF-Ⅱ in breast milk was the highest (82.5 ng/mL) in 12-month mature milk and the lowest (55.3 ng/mL) in 6-month mature milk, which showed a trend of first decreasing and then increasing, but there was no significant difference between the median concentration in each stage. After adjusting for maternal age, pre-pregnancy BMI, gestational age, maternal nationality, maternal history, pregnancy complications (gestational diabetes mellitus, gestational hypertension, gestational thyroid disease), infant feeding pattern and infant sex, the results showed that IGF-Ⅱ content in colostrum was positively correlated with infant body length (β=0.9, P ＜0.01). IGF-Ⅱ content in colostrum, 42-day-old milk and 12-month-old milk was positively correlated with infant body weight (P=0.02, P＜0.01 and P=0.01). The Dietary Inflammation Index (DII) was divided into three groups by its tertiles (Q1:the most anti-inflammatory group, Q2:the middle group, Q3:the most pro-inflammatory group) into GEE model, and the results showed that Q3 was positively correlated with the content of IGF-Ⅱ in breast milk (β=28.6, P=0.01). Conclusion Breast milk IGF-Ⅱ has a certain promoting effect on infant length and weight. Pro-inflammatory diet during pregnancy was associated with breast milk IGF-Ⅱ concentration.

出血性疾病所致青春期异常子宫出血,可导致月经过多、经期延长及经间期出血等问题,严重影响青春期少女身心健康,降低生活质量,急性大出血时甚至危及生命。中医药协同西药治疗本病具有优势,急性期快速有效止血,可减少西药用量及副作用;长期调控月经阶段,采用健脾益肾填精等方法调整脏腑功能,同时兼顾血液病的治疗和异常子宫出血的防治。本文根据国内外研究结果,结合临床实践经验,探析中西医结合诊治本病的临证思路。

新生儿缺氧缺血性脑病(HIE)是神经系统受损的重要原因,发病率高达13‰,其中25-30%的婴儿患有永久性神经损伤,包括脑瘫、癫痫、精神障碍、视力和听力障碍以及认知和学习障碍,给家庭带来了巨大的精神和经济负担,也给全球公共卫生事业带来了挑战。亚低温治疗是支持治疗外,唯一公认有效的神经保护治疗措施,在一定程度上降低了HIE的死亡率和残疾率。研究者们致力于探索新的治疗方法,作为亚低温治疗的辅助治疗或独立应用于HIE。本文综述了新生儿缺氧缺血性脑病的治疗研究进展,着重于足月儿及晚期早产儿,以期进一步降低HIE的死亡率、致残率和改善神经发育预后。

目的 分析不同浓度的己酮可可碱对体外精液中精子的活力、活率、运动功能等的影响,为体外受精技术提供依据。方法 将30例精液标本进行分组,添加不同浓度的己酮可可碱,终浓度分别为0、0.6、1.2、2.4、3.6 mmol/L,通过程序降温仪冷冻精子后转移到液氮中保存24 h,然后进行复苏操作。用计算机辅助精子分析仪检测精子冷冻前和复苏后的各项参数。结果 添加己酮可可碱后不会对精液的浓度产生影响,能够显著提高精子复苏率、精子活力、活率、运动功能,并且各项的增幅随着己酮可可碱浓度的增加而逐渐提高。这种提高作用在精子冷冻前后均有体现。结论 己酮可可碱的终浓度为3.6 mmol/L时,改善精液各项参数作用效果最好,临床应用时可以此浓度作为参考依据。

目的 探讨血清中补体因子B、Toll样受体4(TLR4)对妊娠期糖尿病患者发生子痫前期风险的预测价值。方法 2022年5月至2023年5月,从本院就诊的妊娠期糖尿病患者中选取100例作为研究组,另选同期就诊的100例健康妊娠的患者作为对照组,对照组年龄为21～38岁,孕周为21～36周;研究组年龄为22～39岁,孕周为22～37周;研究组按照有无子痫前期分为无子痫前期组68例,有子痫前期组32例;按照子痫前期不同程度分为轻度组12例,中度组11例,重度组9例;检测血清补体因子B、TLR4水平,分析其与妊娠期糖尿病患者发生子痫前期的关系及其风险预测价值。结果 与对照组相比,研究组血清中补体因子B、TLR4水平明显升高,组间差异有统计学意义;与无子痫前期组相比,有子痫前期组血清中补体因子B、TLR4水平明显升高,组间差异有统计学意义;与轻度组相比,中度组、重度组血清中补体因子B、TLR4水平明显升高,且重度组明显高于中度组,组间差异有统计学意义。二元Logistic回归分析显示,血清中补体因子B、TLR4均为妊娠期糖尿病患者发生子痫前期的风险因素;血清补体因子B检测的AUC为0.736,血清TLR4为0.697,联合为0.845。结论 血清中补体因子B、TLR4是妊娠期糖尿病患者发生子痫前期的风险因素,对妊娠期糖尿病患者发生子痫前期具有预测价值。

滤泡性淋巴瘤(FL)是除弥漫大B细胞淋巴瘤(DLBCL)之外在成年人中最常见的非霍奇金淋巴瘤(NHL)之一,临床上表现为无症状性淋巴结肿大,病程进程缓慢,是一种低度恶性淋巴细胞增生性疾病。FL主要侵犯淋巴结,也可侵犯结外组织,如胃肠道、血液系统等。组织病理学是诊断FL的金标准。关于治疗方面,无化疗方案是近年来研究热点,新型靶向药物的开展和研究的不断深入,为FL患者的治疗带来新的希望。不同患者临床异质性明显,预后差异较大。本文回顾分析1例妊娠期间意外发现的FL患者,并复习相关文献,提高临床医生对该病的认识,真正使患者得到有效诊治。

复发性妊娠丢失病因复杂,目前仍有相当一部分原因不明。免疫、微生物等因素是不明原因复发性妊娠丢失的潜在病因之一。NK细胞是女性生殖道中的重要免疫细胞,参与妊娠抗感染免疫、滋养层侵袭和子宫螺旋动脉重塑,维持正常妊娠。在感染、内分泌异常、生殖道菌群失调等病理状态下,NK细胞可能通过破坏母胎界面免疫稳态和影响滋养层侵袭与子宫螺旋动脉重塑介导妊娠丢失发生。本文综述了人体NK细胞亚群及其作用,提出了NK细胞在复发性妊娠丢失发病中的可能参与机制,以期为复发性妊娠丢失的病因诊断和治疗提供参考。

Objective To discuss the effect of serum estradiol(E2) and progesterone(P) levels on transplantation day that are in natural cycle frozen embryo transfer(NT-FET) on pregnancy outcomes.Methods A total of 503 NT-FET cycles from May 2019 to May 2021 in the reproductive center of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine were analyzed retrospectively. Based on the pregnancy outcomes, these cycles were divided into the live birth group(140 cycles)and no live birth group(363 cycles).The serum hormone levels on transplantation day and other relevant information were compared between the two groups. In addition, 503 cycles were divided into four subgroups according to the quartile of serum progesterone levels on transplantation day and the quartile of serum estradiol levels on transplantation day, respectively. The live birth rate and clinical pregnancy rate between the four groups and between the two groups were compared. The effects of serum estradiol and progesterone levels on transplantation day, and other related variables on the outcome of live birth were analyzed.Results There was significant difference in serum estradiol levels, serum progesterone levels, number of transferred embryos, number of high-quality transferred embryos, female age, and intimal thickness between the live birth group and no live birth group(P<0.05). There was no significant difference in body weight and body mass index(P>0.05).There was no significant difference in live birth rate and clinical pregnancy rate across the four subgroups of serum progesterone levels on transplantation day or the four subgroups of serum estradiol levels on transplantation day. Through the comparison between the two groups, the live birth rate of the 16.4 ng/mL<P≤21.6 ng/mL group was significantly higher than that of the P≤12.7 ng/mL group(P=0.008). The levels of serum progesterone on transplantation day(OR=0.84, 95%CI=0.73-0.97; P=0.021) and the number of high-quality embryos transferred(OR=0.71, 95%CI=0.51-1.00; P=0.048) were positive factors affecting the outcome of live birth; female age(OR=1.35, 95%CI=1.05-1.75; P=0.020) and serum estradiol levels on transplantation day(OR=1.21, 95%CI=1.04-1.42; P=0.017) were negative factors affecting the outcome of live birth.Conclusion The levels of serum estradiol and progesterone on NT-FET transplantation day are the influencing factors of pregnancy outcome.

胎儿先天性结构异常作为出生缺陷的重要组成部分,是引起新生儿残疾甚至死亡的重要原因之一。产前诊断是预防出生缺陷的重要举措。通过染色体核型分析、拷贝数变异检测技术等产前诊断技术,部分超声异常胎儿能得到明确诊断,但仍有60%以上病因尚未明确。全外显子组测序技术能在上述检测未见异常时,进一步识别出部分致病基因变异,目前已逐步应用于胎儿多系统异常、骨骼发育异常、中枢神经系统畸形、先天性心脏发育畸形及先天性泌尿系统发育异常等的遗传学病因检测。本文对WES在产前胎儿超声异常中的应用进展作一综述。

Objective To investigate the feasibility of single embryo transfer-based IVF-ET treatment strategy outcomes and applications. Methods A total of 1 096 infertile patients who received IVF-ET treatment in the reproductive center of our hospital from October 2015 to December 2020 were retrospectively analyzed. Ovulation induction fresh embryo transfer treatment was used by antagonist regimen, which was divided into 3 groups according to the number of embryos transferred and the time of embryo development:group A, the next day embryo single embryo transfer (n=566); group B, second day embryo double embryo transfer (n=410); and group C, fifth day embryo single embryo transfer (n=120). Pregnancy outcomes and complications were compared across the three groups. Results There were no significant differences in the clinical pregnancy rate (30.0% vs. 33.1%) and live birth rate (23.6% vs. 23.6%) between group A and group B. There was no significant difference in the clinical pregnancy rate between group C and group B (40.0% vs. 33.1%). There was a statistically significant difference in live birth rate between group C and group B (33.3% vs. 23.6%). There were significant differences in the clinical pregnancy rate (30.0% vs. 40.0%) and live birth rate (23.6% vs. 33.3%) between group A and group C. Conclusion The single embryo transfer as the main antagonist regimen is a safe and effective strategy, and twin transfer does not significantly improve the clinical pregnancy rate and live birth pregnancy rate of transplantation.

目的 探讨降调节替代方案复苏周期中雌二醇/雌二醇地屈孕酮片(商品名:芬吗通)联合金凤丸对子宫内膜容受性及临床结局的影响。方法 将2020年7月至2021年8月于本科生殖中心接受降调节替代方案复苏周期移植的155个周期,按经醋酸亮丙瑞林3.75 mg降调节后内膜准备过程中是否使用雌二醇/雌二醇地屈孕酮片+金凤丸分为两组,A组采用戊酸雌二醇片(商品名:补佳乐)＋雌二醇/雌二醇地屈孕酮片＋金凤丸(79个周期),B组采用戊酸雌二醇片(76个周期)。回顾性分析比较两组患者的年龄、不孕年限、体重指数(BMI)、移植优质胚胎数,转化日子宫内膜厚度、分型比率、子宫内膜血流,血雌二醇E₂、孕酮P值,胚胎种植率、临床妊娠率的差异。结果 两组患者的年龄、不孕年限、移植优质胚胎数无明显差异(P>0.05);A组转化日子宫内膜厚度及B型子宫内膜比率显著高于B组(P<0.05),子宫内膜血流参数:搏动指数(PI)、阻力指数(RI)均显著低于B组(P<0.05);血E₂值显著高于B组(P<0.05),血P值无明显差异(P>0.05);A组胚胎种植率、临床妊娠率均高于B组,但差异无统计学意义。结论 降调节替代方案复苏移植周期中雌二醇/雌二醇地屈孕酮片联合金凤丸可显著提高转化日子宫内膜厚度、B型子宫内膜的比例及血E₂值,降低PI、RI,改善内膜血流,增加子宫内膜容受性,并在一定程度上提高胚胎种植率和临床妊娠率,优化周期结局。

Objective To explore and analyze the differences in clinical features, outcomes and perinatal outcomes between delayed and timely treatment of pregnant women with tuberculosis, so as to provide empirical ideas for improving the prognosis of pregnant women with tuberculosis. Methods The medical records of pregnant women with tuberculosis admitted to the Tuberculosis Institute of the Eighth Medical Center of the PLA General Hospital from January 2017 to January 2022 were retrospectively analyzed. They were divided into the delayed treatment group and the timely treatment group. The clinical symptoms, tuberculosis outcomes and perinatal outcomes of the two groups were analyzed. Results In the delayed treatment group,7 patients (16.2%)with consciousness disorder were significantly more than 1 patient (5.5%) in the timely treatment group, the difference was statistically significant (P<0.05),but there was no statistically significant difference in the symptoms of headache, chest tightness and choking, cough and sputum and weight loss(P>0.05).In the delayed and timely treatment groups, 38 cases (82.6%) and 5 cases(27.7%) of patients with hematogenous disseminated tuberculosis/tuberculous meningitis,27 cases (58.6%) and 3 cases (16.6%) of patients with severe disease (neurological sequelae, coma),3 cases (6.5%) and 0 cases (0.0%) of patients died,and 6 cases (13) of patients with stable disease. 0%) and 10 cases (55.5%), there were statistical differences in the above indexes between the two groups (P<0.05). In perinatal outcomes, there were no significant differences in age, pre-pregnancy weight, method of termination of pregnancy, tuberculosis type, neonatal weight and live birth rate between the delayed and timely treatment groups (P>0.05).The weeks of diagnosis(22.2±6.5 vs 15.4±7.3) and termination of pregnancy(28.6±9.3 vs 23.7±14.6)in the delayed treatment group were larger than those in the timely treatment group,the difference was statistically significant (P<0.05). Conclusion Pregnancy with tuberculosis is prone to delay diagnosis and treatment; It is necessary to strengthen the education and awareness of pregnant women with tuberculosis and improve doctors′ awareness of pregnancy complicated with tuberculosis.Early treatment, diagnosis and treatment are helpful to improve the prognosis and perinatal outcome of pregnant women with tuberculosis.

Objective To evaluate the fetal growth pattern and perinatal outcome after selective feticide of monochorionic diamniotic (MCDA) twin pregnancy. Methods A case-control study was conducted during January 2016 to December 2020 in Peking University Third Hospital. 85 MCDA twin pregnant women with selective feticide were selected as MCDA twin pregnancy with intervention group, 171 singleton pregnant women and 165 MCDA twin pregnant women who did not undergo intervention (MCDA twin pregnancy without intervention group) were matched by general characteristics. The fetal intrauterine development and perinatal outcome of the three groups were analyzed. Results The estimated fetal weight (EFW), abdominal circumstance (AC), femur length(FL), biparietal diameter(BPD) and head circumference(HC) in the singleton control group were higher than those of MCDA groups, only AC in MCDA twin pregnancy with intervention is higher than those without intervention, and there was no significant difference in the other indicators between the twin groups. The cesarean section rate of MCDA twin pregnancy with intervention group was significantly lower (52.9%) than MCDA twin pregnancy without intervention group (86.1%), and there was no statistical difference compared with the singleton control group (39.2%). The gestational week of delivery of t MCDA twin pregnancy with intervention group (37.1±2.7) was earlier than that of the singleton control group (38.84±2.20) and later than that of MCDA twin pregnancy without intervention group (34.0±2.8). The preterm birth rate before 32 weeks and 34 weeks (5.9% and 11.8%) was lower than that of MCDA twin pregnancy without intervention group (21.8% and 46.7%), but there was no statistical difference compared with the singleton control group. The preterm birth rate before 37 weeks (30.6%) was lower than that of MCDA twin pregnancy without intervention group (78.8%) and higher than that of the singleton control group (7.6%). Conclusion There is no significant difference in the growth trend of the remaining fetus after selective feticide from those the MCDA twins without selective feticide, and its perinatal outcome is mainly related to whether there is premature rupture of membranes and premature delivery. Compared with MCDA twin pregnant women without selective feticide, the preterm birth, low birth weight, small for gestational age and NICU transfer rates of surviving newborns after selective feticide decreased to a certain extent, but they are still higher than those of normal singletons.

Objective To describe the current status of visual disorders among children aged 3-6 years in the study area, so as to provide reference for the prevention and control of eye diseases and visual disorders in children. Methods The study was carried out based on the vision screening project of a county in Shandong province in 2021, and the data included children′s demographic information, kindergarten characteristics, and vision screening results. Visual disorders included poor visual acuity, myopia, and suspected insufficient hyperopia reserve. The prevalences of visual disorders were described and age-related trends were examined by the trend chi-square test. Results This study included a total of 14,198 children aged 3-6 years old. Among the 14,198 subjects, the prevalences of poor visual acuity, myopia, suspected insufficient hyperopia reserve were 19.6%, 3.1%, 42.5%, respectively. The prevalences of poor visual acuity in children aged 3, 4, 5 and 6 years were 9.4%, 16.4%, 24.5% and 22.8%, and the prevalences of myopia were 1.9%, 1.3%, 3.6% and 9.0%, respectively, both of which showed an increasing trend with age. The prevalences of suspected insufficient hyperopia reserve were 54.6%, 42.3%, 39.2% and 46.0%, respectively, which had no increasing trend with age. The differences of the three measurements between male and female children were less than 2.0 percentage points. The prevalence of poor visual acuity in rural children was 8.9 percentage points higher than that in urban children, the prevalence of myopia was 5.3 percentage points higher, and the prevalence of suspected insufficient hyperopia reserve was 9.6 percentage points higher. In urban area, the prevalence of poor visual acuity in private kindergartens was 9.1 percentage points higher than that in public kindergartens, and the prevalence of suspected insufficient hyperopia reserve was 17.3 percentage points higher. However, in rural area, the prevalence of myopia in private kindergartens was 2.4 percentage points lower than that in public kindergartens and the prevalence of suspected insufficient hyperopia reserve was 8.0 percentage points lower. Conclusion In the study area, the prevalences of poor visual acuity, myopia, suspected insufficient hyperopia reserve in children aged 3-6 were close to 20%, slightly higher than 3% and more than 40%, respectively. The prevalence of poor visual acuity and myopia increased with age, but the prevalence of suspected insufficient hyperopia reserve didn′t show increasing trend with age. There were obvious differences in visual disorders between children in the urban area and rural area, so it is advisable to explore the potential causes of the difference to improve prevention and control of eye diseases.

目的 分析2015—2022年间北京市青少年中艾滋病病毒感染者和艾滋病病人(HIV/AIDS)的疫情特征,为科学防控艾滋病提供依据。方法 从“中国疾病监测信息报告管理系统”中选择2015—2022年期间年龄在13~22岁,疾病诊断为HIV/AIDS的报告病例,对校内和校外青少年中的流行情况进行趋势分析。结果 共报告HIV/AIDS病例2 417例,13~22岁青少年的HIV/AIDS报告发病率从2015年的21.4/10万下降到2022年的9.5/10万(P_趋势=0.007)。其中校内青少年的HIV/AIDS报告发病率从2015年的14.2/10万下降到2022年的2.8/10万(P_趋势=0.008);校外青少年的HIV/AIDS报告发病率在24.0/10万~50.0/10万之间波动,无明显趋势性变化(P_趋势=0.8);男性HIV/AIDS报告发病率远高于女性;中学、大学阶段,校外青少年的HIV/AIDS报告发病率分别是校内青少年的4.1倍、1.6倍;传播途径以同性传播为主,占86.9%(2 100/2 417)。结论 近年来北京市青少年中艾滋病报告发病率呈下降趋势,校内青少年中报告发病率下降明显,校外青少年无明显趋势性变化,应重点针对校外青少年中男男性行为者开展干预工作。

Objective To explore the influence of fetal heart monitoring pattern, delivery mode and perinatal prognosis in women with excessive umbilical cord torsion. Methods A retrospective case-control study was used in this study. The observation group was used to select a total of 122 women with a single fetus during delivery in a third class Hospital Obstetrics Department from January 2012 to December 2021 with excessive umbilical cord torsion. In the same period, 136 of the puerperae without excessive torsion of the umbilical cord were selected as the control group. The general condition, mode of delivery, perinatal outcomes, and the influences of fetal heart monitoring characteristics with different umbilical coiling index on fetal and neonatal outcomes were retrospectively analyzed between two groups. Results Compared with the control group, there was statistically significant differences in mean gestational age in the observation group (P<0.05). Also statistically significant differences in delivery mode (cesarean section or natural delivery), newborn birth weight, body length, umbilical cord length and fetal distress incidence rate (P<0.05). The type Ⅱ and type Ⅲ fetal heart monitoring in the observation group were significantly higher than that in the control group (P<0.05). Compared with the UCL-H and UCL-L, there were statistical significance in fetal distress, type Ⅱ monitoring and type Ⅲ monitoring (P<0.05) Conclusion Excessive torsion of umbilical cord have certain risk factors during pregnancy, which increase the chance of cesarean section and vaginal midwifery, and increase the incidence of fetal distress. In fetal heart monitoring, the patterns of type Ⅱ and tpye Ⅲ are significantly increased.

Objective To investigate the prevalence of anemia in first trimester of gestational period among women in Tongzhou district of Beijing and evaluate the association between pure folic acid (PFA) or multiple micronutrients containing folic acid (MMFA) supplementation and the prevalence of anemia in first trimester. Methods The study was based on the information of 37 034 pregnant women in pregnancy health care system and the first-trimester laboratory system of Tongzhou Maternal and Child Health Hospital of Beijing during 2013 to 2018. Logistic regression model was used to analyze the relationship between status of PFA or MMFA consumption during periconceptional period and the risk of anemia in early pregnancy. Results The overall prevalence of anemia among the participants in first trimester of gestational period was 1.8%. Mild and microcytic hypochromic anemia were the predominant cases. Compared with women taking PFA, women taking MMFA had lower risk of overall anemia (aOR=0.79, 95% CI:0.66-0.95) and microcytic hypochromic anemia (aOR=0.69, 95% CI:0.53-0.91) in first trimester of gestational period. Among women who took MMFA, the women who started taking MMFA before pregnancy had lower risk of overall anemia (aOR=0.69, 95% CI:0.53-0.90) and microcytic hypochromic anemia (aOR=0.47, 95% CI:0.30-0.75) than those who started taking MMFA after pregnancy. Women who took MMFA frequently had lower risk of overall anemia (aOR=0.59, 95% CI:0.41-0.86) and microcytic hypochromic anemia (aOR=0.42, 95% CI:0.23-0.76) in first trimester of gestational period than those who did not take it. Among women taking MMFA, those who started taking it before pregnancy had higher serum iron levels (aβ=4.25, 95% CI:1.70-6.80). Conclusion The prevalence of anemia among pregnant women in first trimester of gestational period in Tongzhou district of Beijing was lower from 2013 to 2018. Periconceptional MMFA supplementation could reduce the risk of anemia in first trimester of gestational period, especially microcytic hypochromic anemia.

Objective To understand the dietary intake and metabolic status of folic acid and vitamin B₁₂ in pregnant women, and their relations with gestational diabetes mellitus(GDM).Methods This study was a cross-sectional study based on a mother-child nutrition and health cohort, and selected Beijing and Shandong as the study sites, relying on local maternal and child health care and medical institutions, and followed the principle of voluntary recruitment of pregnant women at 24 to 30 weeks of pregnancy to enter the study. Dietary survey was conducted by 3-day 24-hour dietary retrospective method to calculate the daily intake of folic acid, vitamin B₁₂ and related nutrients of pregnant women. The fasting venous blood of pregnant women was collected, Serum and red blood cell folate were detected using microparticle chemiluminescence method, serum homocysteine was detected using enzyme circulation method, and serum vitamin B12 was detected using chemiluminescence method. Oral glucose tolerance test was used to diagnose GDM at the same time.Results A total of 368 pregnant women were included in this study, and the prevalence of GDM was 39.9%. The median dietary folic acid intake and vitamin B₁₂ intake were 543.00 μgDFE and 3.01μg in the non-GDM group, and 360.90 μg DFE and 2.58 μg in the GDM group, respectively. The mean value of erythrocyte folate in the non-GDM group(969.64±288.57 ng/mL) was higher than that in the GDM group(962.86±280.28 ng/mL). The median values of serum folate, vitamin B₁₂ and homocysteine in the non-GDM group were 14.26ng/mL, 223.00 pmol/L and 4.72 μmol/L, and those in the GDM group were 12.93 ng/mL, 233.00 pmol/L and 4.89 μmol/L. Multivariate logistic analysis showed that inadequate carbohydrate intake during pregnancy was a risk factor for GDM(OR=2.19, 95%CI:1.17~4.09) and serum folate(>20 ng/mL)was associated with a low risk of GDM(OR=0.53, 95%CI:0.30~1.00).Conclusion Pregnant women with higher serum folate content were less likely to develop GDM.

Objective To explore the relationship between maternal serum homocysteine (Hcy) during second trimester and cognitive-motor development of infants. Methods 594 pregnant women (aged 20~35 years) in their second trimester (15-20⁺⁶ weeks) in Hefei city were enrolled from April to May 2020. Infants′ cognitive-motor development at 6 and 12 months were evaluated through the Age and Developmental Progress Questionnaire (ASQ-3) which five main developmental areas were included, i.e., communication, gross motor, fine motor, problem-solving, and personal-social skills. Pregnancy outcomes and cognitive-motor assessments were collected, and Pearson correlation was used to analyze the correlation between maternal serum Hcy and infants′ cognitive-motor development; linear regression was used to analyze the relationship between maternal serum Hcy and infants′ cognitive-motor development levels. Results There is no statistically significant differences for ASQ-3 score at 6 months by birth weight, preterm birth, and serum Hcy. There was no statistically significant differences for ASQ-3 scores at 12 months by birth weight, preterm birth. The difference in infant fine motor development scores at 12 months was statistically significant when comparing infants with serum Hcy. The results of correlation analysis showed that serum Hcy during pregnancy was statistically negatively correlated with infant fine motor development score at 12 months (r=-0.123, P<0.05). Linear regression analysis showed a statistically significant difference between serum Hcy during pregnancy and infants′ fine motor development score at 12 months of age (β=-0.996, 95% CI:-1.83 to -0.16, P<0.05). Conclusion Maternal serum Hcy was negatively correlated with fine motor development scores of infants at 12 months, and elevated serum Hcy during pregnancy may affect cognitive-motor development of infants.

Objective In order to find the risk factors of recurrent implantation failure and to reduce the incidence of recurrent implantation failure by retrospective analysis of the clinical data of the patients with recurrent implantation failure.Methods 196 cases who were diagnosed as recurrent implantation failure during 2015-2016, and 392 patients with successful pregnancy of their first IVF cycle which was preformed at the same month with recurrent implantation failure patients were selected as the control group. The clinical data of the two groups were analyzed, including basic information, the cause of infertility and the first IVF cycle-related information. Besides, according to patients' age, we analyze the clinical data in each group.Results Patients' husband age and endometriosis are risk factors for recurrent implantation failure, while the 2PN rate, the rate of good quality embryo and A pattern of the endometrium are protective factors for recurrent implantation failure. Analysis on Stratification of Age revealed that the age of the husband and ISCI-2PN rate had statistical significance in Group A, and anovulatory infertility, male factors, high quality embryos, total 2PN rate, IVF-2PN rate, ICSI-2PN rate and high quality embryo rate were significantly different in Group B, and there were significant differences in androgen levels, endometrial thickness, total oocytes count and 2PN numbers in Group C.Conclusion The higher the age of the husband, the higher the risk of recurrent implantation failure, and the infertile patients combined with endometriosis are prone to recurrent implantation failure. While the success rate of IVF assisted pregnancy was high in patients with high fertilization rate, good embryo quality and A pattern endometrium. In addition, stratification management according to the patients' age should be used.

Objective To explore influencing factors of anxiety and depression in pregnant women and their pathways, which can provide evidence for improving the level of anxiety and depression in pregnant women.Methods A random sampling method was used to investigate the general characteristics, perceived social support, anxiety and depression of pregnant women who were registered in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from April 2020 to November 2021.Results In 282 valid questionnaires, the percentage of pregnant women who were suffering from anxiety and depression were 9.2% and 9.9%, respectively, and the average score of perceived social support was (70.8±11.5). Negative life events(anxiety:r=0.48, P<0.05; Depression:r=0.51, P<0.05), and perceived social support(anxiety:r=-0.38, P<0.05; Depression:r=-0.39, P<0.05) were significantly correlated with anxiety and depression in pregnant women. For pregnant women, the mediating effects of perceived social support between negative life events and anxiety, depression accounted for 12.3% and 12.0% of the total effects, respectively.Conclusions Perceived social support played mediating roles between negative life events and anxiety, depression in pregnant women. In order to reduce the level of anxiety and depression in pregnant women, it was necessary to improve their social support and avoid them to suffer from negative life events.

目的 分析尿微量白蛋白肌酐比值(UACR)与子痫前期孕妇及围产儿发生不良预后的相关性并探讨其作为不良预后预测指标的临床价值。方法 回顾性分析2018年1月～2020年6月于中国医科大学附属盛京医院产科分娩的符合入选标准的孕妇共420例,其中子痫前期组130例,正常组290例,比较两组UACR水平。分析子痫前期组UACR与24 h尿蛋白定量水平之间的相关性。采用受试者工作曲线(ROC)分析UACR作为子痫前期组母儿不良预后的诊断价值。结果 (1)子痫前期组UACR水平高于正常组,差异有统计学意义。(2)与未发生不良预后人群相比,子痫前期组发生胎盘早剥,HELLP综合征,低蛋白血症导致的心包积液、胸腔积液、腹腔积液,胎儿生长受限,医源性早产、引产,新生儿窘迫时UACR水平升高,24 h尿蛋白定量水平升高,两者差异均有统计学意义。(3)子痫前期组UACR水平与24 h尿蛋白定量呈正相关(r=0.83),与不良预后的发生之间呈正相关(r=0.53),两者差异均有统计学意义。(4)UACR作为预测子痫前期孕妇发生母儿不良预后情况的ROC曲线下面积为0.85,UACR的最佳诊断界值为584.8 mg/g。结论 子痫前期孕妇UACR水平升高,且与24 h尿蛋白定量水平显著相关,孕期监测UACR对于防范母儿不良预后有积极指导意义。

目的 基于生物信息学分析铜死亡相关基因在子宫内膜癌中的预后价值。方法 从癌症基因组图谱数据集官网和UCSC Xena数据库下载子宫内膜癌患者的RNA-seq表达数据及相应的临床数据,筛选出肿瘤组织与正常组织之间差异表达的铜死亡相关基因。用LASSO回归构建风险评分,分析风险评分与子宫内膜癌患者临床病理参数和预后的关系,利用风险评分和其他临床特征构建预后模型。通过DAVID网站对铜死亡相关基因进行GO注释和KEGG分析。结果 构建了由3个铜死亡相关基因形成的风险评分,该评分可较准确区分高、低风险病人,是子宫内膜癌患者总生存率的独立不良预后因素。GO和KEGG富集显示,铜死亡相关基因主要参与柠檬酸循环、丙酮酸代谢、糖酵解等信号通路,风险评分和其他临床特征构建的预测模型列线图可较准确预测子宫内膜癌患者1年、3年、5年生存率。结论 本文研究构建了铜死亡相关基因预后模型,可为子宫内膜癌患者预后的评估提供临床指导。

Objective To explore the extensive effects of hyperandrogen on granulosa cell gene expression, and to provide reference for the molecular mechanism and intervention targets of local hyperandrogen in polycystic ovary syndrome (PCOS). Methods Mouse granulosa cells were obtained and cultured with DHEA or equivalent amount of DMSO in vitro. Gene differential expression in DHEA group and control group were compared by transcriptome sequencing technology, and GO, KEGG and GSEA enrichment analysis was conducted. Results Compared with the control group, 355 genes were significantly down-regulated and 577 genes were significantly up-regulated in the granulosa cells treated with DHEA, showing significant differences between two groups. PPAR signaling pathway, glutathione metabolism, arginine biosynthesis, monobactam biosynthesis, cAMP signaling pathway, mTORC1 signaling, unfolded protein response, reactive oxygen pathways, oxidative phosphorylation and epithelial interstitial transformation were significantly enriched. Conclusion This study suggests that DHEA treatment activated oxidative stress and inflammatory pathways in mouse granulosa cells to induce apoptosis, but the degree of influence and mechanism of each pathway on PCOS still need further experimental verification.

目的 通过总结14例孤独症谱系疾病(ASD)合并癫痫患者的临床表现及遗传学特点,探讨孤独症和癫痫之间的关系。方法 回顾性分析2019年9月至2022年8月四川省妇幼保健院门诊及住院部收治的ASD合并癫痫14例患者的临床资料及基因检查结果。结果 14例ASD合并癫痫患者均有不同程度的智力障碍,癫痫首发年龄从出生10 d到3岁7月不等。发作类型包括局灶性发作、癫痫性痉挛发作、全面性强直-阵挛发作、肌阵挛发作和不典型失神发作,其中5例存在多种发作形式。孤独症诊断年龄范围为1岁8月至6岁。头颅影像学异常6例。药物难治性癫痫6例,死亡1例。基因检测结果显示:拷贝数变异(CNVs)8例,单基因突变5例,DNA甲基化异常1例。结论 ASD合并癫痫患者中,ASD症状迟于癫痫发作年龄,基因检测结果揭示了孤独症和癫痫相关的基因重叠,CNVs最常见,建议对ASD合并癫痫的患儿及时完成智力/全面发育评估、头颅影像学及基因测序检查。

Objective To describe the gestational weight gain (GWG) of women with advanced maternal age (AMA) in urban areas of China and to explore the characteristics of GWG of AMA women, so as to provide reference for the clinical weight management for AMA women. Methods Based on the University Hospital Advanced Age Pregnant Cohort, a total of 13 567 pregnant women were enrolled from July 2017 to June 2021 in 8 tertiary hospitals in 7 cities. Among them, 10 972 were AMA women (maternal age at delivery ≥35 years), and 2 595 were non-AMA women. The general demographic characteristics and follow-up data during pregnancy were collected. Total GWG and GWG in different trimesters were calculated and divided into three groups:insufficient GWG, appropriate GWG, and excessive GWG, according to the GWG recommendations. The mean difference (MD) between AMA and non-AMA women was estimated by mixed effects linear model, and the odds ratio (OR) between AMA and non-AMA women was estimated by mixed effects multinomial logistic model. Piecewise mixed effects linear model was used to fit the GWG trajectories. Results The average total GWG was (12.7±4.9) kg, and the proportion of insufficient total GWG and excessive total GWG were 12.1% and 45.8%, respectively, for AMA women. There was no statistically significant difference in total GWG between AMA and non-AMA women (adjusted MD [aMD]=-0.2 kg, 95% CI:-0.5 to 0.1 kg), nor was there any statistically significant difference in risk of insufficient total GWG and excessive total GWG (insufficient GWG:adjusted OR [aOR]=0.99, 95% CI:0.81 to 1.20; excessive GWG:aOR=0.92, 95% CI:0.81 to 1.04). AMA women had higher GWG (aMD= 0.3 kg, 95% CI:0.1 to 0.4 kg) in the first trimester and lower GWG (aMD=-0.4 kg, 95% CI:-0.7 to -0.2 kg) in the second and third trimester. AMA women had higher risk of insufficient GWG and excessive GWG (insufficient GWG:aOR=1.28, 95% CI:1.02-1.60; excessive GWG:aOR=1.32, 95% CI:1.16-1.51) in the first trimester and higher risk of insufficient GWG (aOR=1.21, 95% CI:1.02-1.43) in the second and third trimester. The GWG trajectory also showed that AMA women gained more weight in the first trimester and less weight in the second and third trimesters than non-AMA women. Conclusion The average GWG of AMA women in urban areas was (12.7±4.9) kg, and the proportions of insufficient and excessive GWG were 12.1% and 45.8%, respectively, indicating that more than half of AMA women have inappropriate GWG. Compared with non-AMA women, AMA women had a higher risk of insufficient and excessive GWG in the first trimester, and a higher risk of insufficient GWG in the second and third trimester. There is a need to refine and standardize weight management according to the characteristics of GWG of AMA women.

目的 了解河北省新生儿中小于胎龄儿(SGA)的发生率,并分析其危险因素,为制定妇幼健康工作政策和规划提供可靠依据。方法 采用回顾性分析方法,分析2017—2021年河北省21所危重孕产妇监测医院中出院且妊娠满28周的所有单胎活产儿的孕产妇及新生儿相关数据,分析SGA发生率及其危险因素。结果 本研究共纳入单胎活产儿205 707例,SGA发生率为15.93%。多因素Logistic 回归分析显示:产妇年龄＜20岁或≥40岁、产妇受教育程度高中及中专、前置胎盘、胎盘早剥、子痫前期、早产是SGA发生的危险因素;经产妇、妊娠期糖尿病、产前贫血是新生儿发生SGA的保护因素。结论 建议适龄怀孕,对于受教育程度低及高危因素的人群,进行早期规范管理,切实降低SGA的发生率。

Objective This study aims to determine the prevalence of intimate partner violence (IPV) against pregnant women and the risk of adverse birth outcomes (ABO) in pregnant women in Wuhan, China. Methods The survey was conducted among 806 pregnant women at Tongji Hospital, Qiaokou District Maternity and child care hospital and Dongxihu District People′s Hospital in Wuhan from April 2013 to March 2014. Face-to-face standardized interviews were performed prior to woman′s antenatal care. IPV and depressive symptoms were assessed through the Abuse Assessment Screen (AAS) and the Center for Epidemiologic Studies-Depression scale (CES-D). Birth outcomes were collected after delivery. Chi-square test was applied to compare the differences of prevalence rate of various ABO between IPV and non-IPV groups, Path analysis was used to determine the risk for ABO in women experienced IPV during pregnancy. Results 18.3% of 797 participants reported experiencing IPV during pregnancy. Husband′s personality, pregnancy complications, depression and IPV had direct effects on ABO, the influence coefficient were 0.107, 0.084, 0.095, and 0.099, respectively. Conclusion The findings revealed IPV and depression in the antenatal significantly predicted adverse birth outcomes, and assist prenatal care providers in prioritizing and screening for IPV and depression during pregnancy that are associated with ABO.

子痫前期(pre-eclampsia,PE)是一种特有的多系统损害性疾病,严重时可造成孕产妇和围生儿死亡。目前研究认为子痫前期的发病机制与胎盘滋养细胞侵袭能力受损导致螺旋动脉重铸不足、炎症免疫反应过度激活和血管内皮细胞损伤等有关。近年研究发现,间充质干细胞(Mesenchymal stem cells,MSCs)可以通过线粒体途径等多种调控手段改善滋养细胞和内皮细胞功能,缓解内皮损伤和炎症免疫反应而发挥治疗作用。间充质干细胞来源的外泌体(Mesenchymal stem cell extracellular vesicles,MSC-EVs)也可以通过分泌细胞因子改变细胞的行为,增加滋养细胞增殖和迁移,促进血管生成,改善螺旋动脉重铸不足,在PE治疗中发挥重要作用。本文综述MSCs与PE治疗相关研究进展。

目的 了解恶性肿瘤患者生育力的研究热点、趋势及前沿动态,为国内相关研究提供参考。方法 在Web of science数据库核心合集中,以恶性肿瘤与生育力为主题检索相关文献,利用Cite Space软件对发文量、国家、期刊共被引、关键词进行检索,查找相关文献,然后对纳入文献进行分析。结果 共纳入1 626篇文献。发文量呈整体上升趋势,发文量最多的国家是美国,机构是美国和哈佛大学医学院及其附属医院(布列根和妇女医院);发表该领域研究最多的期刊为Journal of Clinical Oncology;通过关键词聚类得到该领域的研究热点主要为成年早期或年轻女性及癌症幸存者生育力研究,生育力危险因素研究,生育力保存与管理研究3个方面。结论 恶性肿瘤生育力研究逐渐受到研究者重视,国内可多关注该领域研究热点,加强国际间交流和合作,继续提升在该领域的学术影响力。

目的 探讨剖宫产产妇唾液、血浆中催产素水平与产后抑郁的关系。方法 选取2020年5月至2021年10月在本院327名剖宫产产妇为研究对象。根据术后42 d爱丁堡产后抑郁量表(EPDS)评分分为抑郁组(EPDS评分≥13分)、非抑郁组(EPDS评分<13分),比较两组临床资料及产前1 d的唾液、血浆催产素水平;分析唾液、血浆催产素水平对产后抑郁的影响及其预测价值。结果 最终随访到322名产妇,其中43例(13.3%)发生产后抑郁,产后抑郁产妇EPDS评分13~23分,平均(16.3±2.6)分。Logistic回归显示:唾液催产素(OR=0.768,95% CI=0.687~0.859)、血浆催产素(OR=0.984,95% CI=0.976~0.992)是剖宫产产妇产后抑郁的保护因素(P<0.05)。ROC曲线显示:唾液水平预测产后抑郁的AUC为0.745(95%CI=0.666~0.825)、敏感度74.4%、特异度65.9%;血浆催产素水平预测产后抑郁的AUC为0.764(95%CI=0.694~0.833),敏感度为72.1%,特异度为73.8%。Pearson相关性显示:产后抑郁产妇唾液、血浆催产素水平与EPDS评分均呈负相关(r=-0.550、r=-0.518,P<0.05)。结论 产前唾液、血浆催产素水平与剖宫产产妇产后抑郁EPDS评分相关,是产后抑郁的保护因素,且对产后抑郁具有预测价值。

Objective To understand the prevalence of suspected development delay of left-behind children under 3 years old in rural areas and the impact of home environment. Methods Five national poverty-stricken counties were selected to conduct the cross-sectional study in 2018. The modified Infant-Toddler Home Observation for Measurement of the Environment inventory (IT-HOME) was used to assess the home environment of left-behind family. Ages and Stages Questionnaires-Chinese, Third Edition (ASQ-3) were used to detect the suspected development delay of left-behind children. The chi-square test was used to compare the differences in the rates of suspected development delay among left-behind children with different characteristics, and multivariate logistic regression was applied to analyze the effects of home environment on the early development of rural left-behind children aged 0-3 years. Results A total of 878 pairs of left-behind children under the age of 3 and their caregivers were included. The overall suspected development delay rate for left-behind children aged 0-3 years was 31.8%. After controlling for children′s gender, age, low birth weight, left-behind type and caregivers′ gender, age, ethnicity, education level, depression and the number of vehicles and appliances owned by the family, lack of a stimulating home environment was a risk factor for the communication, gross motor, fine motor, problem solving, and personal-social competence zones, as well as for overall suspected developmental delay, with ORs of 2.53 (95% CI: 1.51-4.24), 2.00 (95% CI: 1.12-3.57), 2.17 (95% CI: 1.31-3.61), 3.94 (95% CI: 2.42-6.42), 2.52 (95% CI: 1.47 -4.32), and 2.97 (95% CI: 1.95-4.51), respectively. Conclusion The early development status of left-behind children aged 0-3 years in the survey areas is not optimistic, and the lack of a stimulating home environment increases the risk of suspected early development delays in left-behind children.

Objective To detect the expression levels of serum histone deacetylase 4 (HDAC4) and histone deacetylase 6 (HDAC6) in patients with preeclampsia, and analyze the correlation between the two and the severity of the disease. Methods Eighty preeclampsia patients (study group) hospitalized in Northwest Women and Children′s Hospital from January 2020 to June 2021 were selected, the patients were grouped into mild group (n=48) and severe group (n=32) according to the severity of their illness, in addition, 80 healthy pregnant women who gave birth in hospital during the same period were regarded as the control group. The general data of the study group and the control group were compared; Pearson correlation analysis was applied to analyze the correlation between serum HDAC4 level, HDAC6 level and the severity of preeclampsia, and the correlation between serum HDAC4 level and serum HDAC6 level; multivariate Logistic regression analysis was applied to analyze the factors influencing the occurrence of preeclampsia in pregnant women; the evaluation value of serum HDAC4 and HDAC6 levels on the occurrence of preeclampsia was analyzed by receiver operating characteristic (ROC) curve. Results Systolic blood pressure, diastolic blood pressure, 24h urine protein content, total cholesterol, triglyceride, HDAC4, and HDAC6 in preeclampsia patients were obviously higher than those in the control group (P<0.05); the expression levels of HDAC4 and HDAC6 in severe group were obviously higher than those in mild group (P<0.05). Correlation analysis showed that serum HDAC4 and HDAC6 were obviously positively correlated with the severity of the disease (r=0.536, 0.614, P<0.001); there was a obvious positive correlation between serum HDAC4 level and HDAC6 level in patients with preeclampsia (r=0.412, P<0.001). Multivariate Logistic regression analysis showed that serum HDAC4, HDAC6, systolic blood pressure, diastolic blood pressure, 24h urine protein content, total cholesterol, and triglyceride, were the influencing factors of preeclampsia (P<0.05). The AUC of combined prediction of serum HDAC4 and HDAC6 for the occurrence of preeclampsia was 0.886, the sensitivity was 87.50%, and the specificity was 78.75%, which was superior to their respective independent prediction (Z_{combined detection-HDAC4}=2.564, Z_{combined detection-HDAC6}=4.083, P<0.05). Conclusion The serum HDAC4 and HDAC6 levels in patients with preeclampsia are closely related to the occurrence and severity of the disease, and the combination of the two has a good reference value for pregnant women with preeclampsia.

Objective To investigate the correlation between sperm DNA fragmentation index(DFI), serum 25-hydroxy-vitamin D[25(OH)VD] and semen routine parameters in male infertility patients. Methods The examination data of 627 male infertility patients in the Reproductive Medicine Center of the First Affiliated Hospital of Air Force Military Medical University from November 2021 to July 2022 were retrospectively analyzed. The routine parameters of semen were analyzed by computer assisted sperm analysis system, the percentage of sperm with normal morphology was detected by manual method, the sperm DFI was analyzed by flow cytometry, and the total amount of 25(OH)VD in serum was detected by liquid chromatography-tandem mass spectrometry detection system. SPSS 25.0 software was used to analyze the correlation between sperm DFI and total sperm count, sperm concentration, percentage of forward motile sperm (PR), total sperm motility and percentage of normal morphology sperm, as well as the correlation between total amount of serum 25(OH)VD and total sperm count, concentration, PR, total sperm motility, percentage of normal morphology sperm and sperm DFI. Results Sperm DFI was negatively correlated with total sperm count and concentration (r=-0.082, -0.094, P<0.05), but r<0.1, with limited clinical value. Sperm DFI was negatively correlated with PR, total sperm motility and percentage of normal morphology sperm (r =-0.519, -0.534, -0.327, P<0.001). Serum 25(OH)VD was not correlated with total sperm count, concentration, PR and total sperm motility (r =-0.009, -0.020, 0.059, 0.054, P>0.05), but was positively correlated with the percentage of normal morphology sperm (r =0.147, P<0.001), and was negatively correlated with sperm DFI (r =-0.294, P<0.001). Conclusion Sperm DFI was negatively correlated with the PR, total sperm motility and percentage of normal morphology sperm, which could reflect sperm quality to a certain extent. Sperm DFI detection and semen routine parameters could complement each other, providing effective information for a comprehensive and objective assessment of male fertility. The total amount of serum 25(OH)VD was positively correlated with the percentage of normal morphology sperm and negatively correlated with sperm DFI, which could be used as a reference index to evaluate male fertility.

目的 探讨产前强化饮食联合体力活动干预对妊娠期糖尿病(GDM)孕妇脂代谢、血清内脂素(Visfatin)和丝氨酸蛋白酶抑制因子(Vaspin)水平及母婴结局的影响。方法 选取2020年5月至2021年12月120例GDM孕妇,年龄20~35岁,孕周24~28周,简单随机分为联合组和对照组各60例。对照组孕妇进行常规健康教育,联合组孕妇在常规健康教育的基础上进行产前强化饮食联合体力活动干预。比较两组孕妇的血糖、血脂、血清Visfatin、Vaspin、母婴结局。结果 干预后,联合组的空腹血糖、餐后2 h血糖低于对照组(P＜0.05)。联合组的血浆TC、TG、LDL-C水平低于对照组,血浆HDL-C水平高于对照组(P＜0.05)。联合组的血清Visfatin、Vaspin水平低于对照组(P＜0.05)。联合组剖宫产、羊水过多、早产、胎儿宫内窘迫、巨大儿的比例低于对照组(P＜0.05)。结论 产前强化饮食联合体力活动干预有利于调节GDM孕妇的脂代谢,降低血清Visfatin、Vaspin水平,血糖控制效果良好,显著改善母婴结局。

目的 通过回顾性分析罕见常染色体非整倍体(RAAs)病例的胚胎/胎儿结局,探讨RAAs对胚胎/胎儿发育的影响,旨为染色体异常孕妇提供进一步的生育指导。方法 选取2018年8月至2021年9月于内蒙古自治区妇幼保健院经羊水染色体核型分析、染色体微阵列(CMA)分析或荧光原位杂交(FISH)诊断为RAAs的胎儿193例,其中经CMA发现126例,FISH发现65例,染色体核型分析发现2例。跟踪胎儿结局,并对不同染色体异常及胎儿结局进行统计分析。结果 193例RAAs胎儿中,190例结局为流产,其中一般流产2例,稽留流产188例;3例未发生流产,其中2例引产,1例成功分娩。(1)RAAs妊娠结局中97.4%为稽留流产;少数不发生流产(1.6%),妊娠结局为引产和足月分娩;极少数发生一般流产(1.0%)。(2)在193例RAAs病例中,16号、22号和15号染色体异常检出率较高,分别为43.0%、24.4%和9.3%。未发现1、17、19号染色体异常。(3)RAAs流产的孕周范围为6~18周,完全型RAAs胎儿最大发育孕周为18周,3例嵌合型RAAs胎儿可发育到较大孕周,其中2例发育到19周时,孕妇要求终止妊娠,另一例胎儿足月出生(37周+),新生儿生长发育正常。结论 RAAs是导致孕妇发生流产的重要原因,不同RAAs发育孕周不同,染色体的嵌合比例与部位对胎儿发育和孕妇妊娠结局均会产生重要影响。

目的 探讨宫内刨削系统(IBS)对育龄期子宫内膜息肉患者治疗效果及术后复发情况,探讨其影响因素。方法 回顾性分析2020年1月—2021年12月本科室治疗的106例育龄期子宫内膜息肉患者的临床信息,根据术式不同分为电切组和IBS组,比较两组患者的手术疗效、并发症发生率、妊娠率及复发率,并分析复发相关因素。结果 IBS组的病理平滑肌组织报告率4.9%低于电切组患者的27.7%(P=0.003);IBS组较电切组手术时间、膨宫液用量相对更少,但差异无统计学意义;两组患者术后复潮时间和卵泡后期内膜厚度之间差异无统计学意义;IBS组术后妊娠率较电切组高,复发率较电切组低(P均<0.05);术后联合药物辅助治疗组与未用药组复发率存在统计学差异。多因素Logistics回归分析显示:体质指数、术后内膜厚度、多发息肉、剖宫产史、PCOS史均是患者术后复发的危险因素(P均＜0.05)。结论 宫内刨削系统能提高妊娠率,更安全有效地治疗育龄期妇女子宫内膜息肉。联合术后药物辅助疗法可降低复发率。在术后随访管理中,建议肥胖、有剖宫产史、PCOS史、多发息肉、术后内膜较厚的患者加强随诊,降低复发风险。

目的 探讨阴道超声下输卵管积水的量对体外受精胚胎移植临床结局的影响。方法 回顾性分析2015年9月—2020年12月在本院首次进行体外受精胚胎移植的患者,根据HCG日阴道超声下输卵管积水的直径分为4组,≤20 mm组(n=155),20 mm＜积水≤40 mm组(n=215),40 mm＜积水≤60 mm(n=200),＞60 mm(n=197),对照组为促排卵过程中超声均未发现输卵管积水组(n=200)。分别比较各研究组和对照组一般情况、治疗过程及临床结局。结果 各组一般情况、治疗过程与对照组比较差异无统计学意义(P ＞ 0.05)。与无积水组相比,生化妊娠率、临产妊娠率、胚胎着床率、活产率随着积水增加程逐渐下降趋势,＞60 mm 组与无积水组比较差异均有统计学意义(P=0.001、0.002、0.007、0.004)。生化妊娠流产率各组均较无积水组高,＞60 mm 组与无积水组比较差异有统计学意义(P=0.049)。结论 阴道超声下可见输卵管积水未经处理对妊娠结局产生不良影响,输卵管积水的直径越大对胚胎移植临床结果的影响就越大,当积水直径大于40 mm应该高度关注,当积水直径大于60 mm 时强烈建议先行预处理后再行胚胎移植术。