转化生长因子β(TGF-β)是一种分泌型同源蛋白,调节众多的细胞反应,如增殖、分化、迁移和凋亡。在体内,TGF-β/Smads细胞信号转导通路受到多种机制的时空特异性调控,包括配体、受体、Smads及转录水平的调控等,其信号转导异常则与多种疾病相联系,如胚胎发育异常、肿瘤、组织纤维化等疾病。本文将着重介绍近年来TGF-β1/Smads信号转导通路在人类多种疾病中的作用机制的研究进展。

合理的喂养行为对婴幼儿的健康成长非常重要,母亲的焦虑情绪是影响婴幼儿喂养实践的一个重要因素,直接影响婴幼儿的营养与健康。国内外学者就母亲焦虑情绪与婴幼儿喂养行为之间的关系开展了大量的研究。本文从焦虑情绪对母乳喂养、辅食添加和喂养习惯的影响出发,对近年来国内外针对二者关系的研究进行综述。

Objective To explore the effect of improved kangaroo mother care (KMC) on growth and development of premature infants and anxiety of mothers. Methods A total of 60 premature infants hospitalized in our hospital were recruited from June 2017 to June 2018 by convenience sampling method, with 30 infants classified into the KMC group and 30 into the control group. The control group received routine nursing, while the KMC group received kangaroo care when premature infants conditions were stable. KMC was provided five times a week, one hour each time, until the premature infants were discharged from the hospital. The differences in growth and development of premature infants and mothers' anxiety were compared between the two groups. Results No adverse events occurred in the KMC groups. The hospitalization time, body weight growth rate, oral feeding time, feeding mode, oxygen usage time, et al. were comparable between the KMC group and the control groups (P>0.05). The mothers' anxiety in the KMC group was significantly alleviated at discharge (P<0.05), while that for mothers in the control group remained unchanged (P>0.05). Conclusion Implementing improved kangaroo nursing for premature infants can alleviate the mothers' anxiety, but its effect on infants growth and development needs to be further explored.

近年来,肥胖已成为备受全世界关注的健康问题,也是作为大多数常见肿瘤的一个重要危险因素。脂肪酸结合蛋白家族4( FABP4) 是一种脂肪细胞型脂肪酸结合蛋白,主要在脂肪细胞及巨噬细胞中呈高表达,是细胞内游离脂肪酸在转运过程中的伴侣分子,FABP4能够与游离脂肪酸结合,将其运输到细胞内,同时FABP4参与调控基因表达、细胞增殖、分化及肿瘤转移的信号转导,参与了脂肪与肿瘤组织之间的交互作用,包括脂肪细胞与肿瘤细胞之间的脂质转移,提供肿瘤生长所需的脂肪酸,被看作为关联肥胖与肿瘤的潜在因子。肥胖相关重要脂肪因子FABP4在肿瘤发病风险的分子机制尚不明确,本文就FABP4与肿瘤的发生发展进行综述。

卵巢癌是女性生殖系统中复发率最高、预后最差的恶性肿瘤。化疗耐药性及肿瘤复发是卵巢癌患者存活率低的主要原因。尽管在卵巢癌化疗方面取得了进展,人们对其特点有了更多的认识,但化疗耐药仍然是一项巨大的临床挑战。肿瘤干细胞是具有自我更新能力和分化能力的未分化肿瘤细胞群,可以导致癌症发生、晚期转移、耐药和复发,存在于卵巢癌等数种肿瘤中。目前的研究表明在卵巢癌化疗耐药的发生过程中卵巢癌干细胞发挥至关重要的作用。因此,从卵巢癌干细胞这一新的角度研究卵巢癌的治疗方法 ,为提高卵巢癌的治愈率、降低复发耐药提供新思路。

产后抑郁症(PPD)因其严重危害产妇身心健康和婴儿发育而成为学者们的研究热点。本文对产后抑郁症对母儿的影响、研究工具、相关危险因素和预防、治疗及护理措施进行了回顾,并对今后的发展方向做出了预测,旨在使临床工作者更好的了解产后抑郁症,以便开展预防保健工作。

Objective The purpose of this study was to examine the trajectories of body mass index-for-age z-score (Z-BMI) in 3-year-old infants and their determining factors. Methods In this prospective cohort study, pregnant women were recruited based on convenience sampling method at the third trimester from 5 counties in China and their offspring were followed up to 3-year old during Sept 2015 to June 2019. Group-based trajectory model was used to identify distinct Z-BMI trajectories. Group lasso regression analysis and multinomial logistic regression were utilized identify prenatal and early life determinants of the identified trajectories. Results Among a total of 2330 individuals (1253 males and 1077 females), we identified four distinct Z-BMI trajectories:"low-stable" (25.4%), "catch-up" (18.8%), "intermediate-stable" (38.4%) and "rising" (17.4%) trajectories. Multinomial logistic regression showed that, paternal underweight (OR=1.80, 95%CI:1.08-3.01), maternal underweight before pregnancy(OR=1.30, 95%CI:1.04-1.63), time for outdoor activity in the third trimester < 1h (OR=1.30, 95%CI:1.04-1.63), no iron supplementation during pregnancy (OR=1.47, 95%CI:1.17-1.85), and time for outdoor activity of 6-month-old infants < 3h (OR=1.36, 95%CI:1.06-1.75) were associated with significantly increased risk of being at the "low-stable" group compared with the “intermediate-stable” group, while infants whose sleep quality at 1-month-old was assessed as high-quality (OR=0.74, 95%CI:0.58-0.94) had decreased risk of being at the "low-stable" group. Maternal obesity (OR=1.69, 95%CI:1.07-2.66), cesarean delivery (OR=1.43, 95%CI:1.12-1.83), the duration of exclusive breastfeeding < 6 months (OR=1.39, 95%CI:1.07-1.7) were associated with significantly increased risk of being at the "rising" group compared with the "intermediate-stable" group. Conclusion Distinct BMI trajectories exist during the infancy period. Paternal underweight, maternal underweight, no iron supplementation during pregnancy, and inadequate outdoor activity in the third trimester for pregnant women and at 6 months of age for infants are associated with increased the risk of "low-stable" growth, while high-quality of sleep at 1 month of age is associated with decreased risk of "low-stable" growth. Maternal obesity, cesarean delivery, shorter duration of exclusive breastfeeding are associated with increased risk of "rising” growth.

自闭症(Autism)是一种神经发育障碍类疾病,给家庭和社会带来了巨大的经济负担。目前,自闭症的发病原因尚未完全阐明。随着对自闭症发病原因研究的不断深入,发现环境因素在自闭症的发生中起了非常重要的作用,父母亲生育年龄、环境中化学物质暴露、母亲孕期药物使用史以及饮食因素等都被认为与自闭症的发生有关。本文从自闭症发生的环境影响因素角度对其发生的病因予以综述,以期为自闭症的相关研究提供参考。

目的 了解北京市高校女大学生对宫颈癌及HPV疫苗的认知情况,分析相关影响因素,为大学生宫颈癌及HPV相关健康教育、HPV疫苗推广提供参考依据。方法 采用横断面调查的研究方法,通过方便取样,应用自设问卷对北京市高校的1 267名全日制本科女大学生进行问卷调查。结果 女大学生听说过宫颈癌的比例为94.2%,宫颈癌认知足够的比例为52.4%;听说过HPV疫苗的比例为88.7%,HPV疫苗认知足够的比例为53.9%。多因素Logistic回归分析显示,低年级、非医学类是女大学生对宫颈癌认知不足的影响因素,低年级、非医学类、父母受教育程度低是女大学生对HPV疫苗认知不足的影响因素。结论 女大学生知晓宫颈癌及HPV疫苗的比例较高但认知不足;医学生与非医学生对宫颈癌及HPV疫苗的认知存在差异;女大学生对HPV疫苗的接种意愿较强但期望价格较低。建议在非医学高校开展健康教育课程,举办宫颈癌及HPV疫苗相关知识讲座,通过网络媒体进行宣传,以提高女大学生对宫颈癌及HPV疫苗的认知。

本研究采用文献综述法,以中国学术期刊(CNKI)和 Springer online journals为资料库,对近5年370篇国内外妇女更年期综合征的文献资料进行探讨分析,了解妇女更年期综合征的流行现状及研究进展。研究发现,中国近年来妇女更年期综合征的防治研究主要集中在激素替代疗法、心理治疗和健康教育、中医药辩证论治,而运动锻炼或运动结合其他疗法防预更年期综合征的研究以及对农村更年期妇女体质健康状况的研究颇显空白,应将其列为体育、医学领域的研究重点。

Objective To describe sonographic features of abnormal fetal foramen and foramen ovale and to correlate with prognosis.Methods When fetal foramen was found large, small, (nearly) closed, foramen ovale long, and aneurysm, foramen diameter was calculated and the distance from vertices of arc foramen oval to foramen was measured. Blood flow direction and spectrum form and velocity were recorded by color Doppler ultrasonography. All cases were followed up to 12 months of live.Results Twenty-five fetuses with abnormal foramen or foramen ovale were identified. One case was delivered by emergency cesarean section, and two cases by oxytocin induction. The remaining two cases were diagnosed with secundum atrial septal defects after term birth.Conclusion It is valuable to screen abnormal foramen and foramen oval during fetal cardiac ultrasonography, which can offer important information to delivery opportunity, modes, and clinical prognosis.

子宫内膜异位症是一种常见的妇科疾病,是育龄期女性痛经和不孕的主要原因之一。目前主要的治疗方式包括手术治疗和激素治疗,但都存在一些局限性,包括反复发作、副作用多、产生避孕作用、费用高等。新型的治疗药物有芳香化酶抑制剂、促性腺激素释放激素拮抗剂、抗氧化剂、免疫调节剂、抗血管生成药物等。但仅仅以上这些药物是远远不够的,仍然还需要对子宫内膜异位症进行更深层次的研究,以便发现新的潜在的治疗靶点,从而实现子宫内膜异位症患者的精准治疗和个体化治疗。

Objective To analyze the characteristics of the belief that children born in the Sheep year are unlucky and its effects on the births in Beijing. Methods We analyzed the secular trends in births and in proportions of people whose names contained Chinese characters with "艹" according to Chinese calendar years, using the birth registration data of Chaoyang District, Beijing during 2009 and 2017. Results From 2009 to 2017, the registered number of births in the study area was generally on the rise, but there was significant decline in the Sheep year. The number of births in the Sheep year was 38,351, which was 34.1% and 39.0% lower than the neighboring year of the Horse and the Monkey, respectively. The births in all the lunar months of the Sheep year were significantly lower than those in the corresponding months of the Horse year and the Monkey year. The proportion of babies whose mother or father had registered residence in Northern provinces of China was lower in the Sheep year (91.7%) than that in the Horse year (93.2%) and the Monkey year (94.0 %). Babies born in the Sheep year had the highest proportion (16.3%) of having a name containing Chinese characters with "艹"; this phenomenon existed in both male and female babies, with the females being particularly significant. For babies whose father or mother had registered residence in Northern provinces of China, those born in the Sheep year were more likely to have a name containing Chinese characters with "艹" than those born in the Horse year (risk difference 2.3%; 95%CI, 1.8% to 2.8%; P<0.001); this difference, however, was not significant in infants whose parents neither had registered residence in Northern provinces of China (risk difference 0.5%; 95%CI, -1.1% to 2.2%; P<0.52). Further analyses concerning the names of babies′ parents, the proportions of those containing Chinese characters with "艹" were 3.3%, 8.5% and 9.4% in people born in the Sheep years of 1967, 1979 and 1991, respectively, much lower than that in people born in the Sheep year of 2015. Conclusion In 2015, the belief that children born in the Sheep year are unlucky primarily exists in the Northern provinces of China and this belief has significant impacts on births at the population level. However, such a belief is not evident in previous Sheep years.

Objective To introduce the basic principle and operation process of minimization, and compile a customized SAS macro program. Methods Through literature review, the basic principle and operation process of minimization were summarized. By using a simulation example, we introduced a customized SAS macro program of minimization, and the results of allocation for the simulation example were provided. Results As a dynamic randomization method, minimization assigned the next patient into treatment groups with dynamic probability which depended on the balance of some prognostic factors, in order to achieve well-balanced groups. The assignment depended on three functions: the factor level imbalance function, the total imbalance function, and the optimal allocation probabilities. Although the method of minimization has advantages compared with other methods of randomization, its application has been limited probably because of the relatively complicated implementation procedure. As demonstrated by the simulated example, the utilization of minimization could be simplified by using the customized SAS macro. Conclusion Minimization was a method suitable for clinical trials with small sample and complex baseline characteristics. The SAS macro program could simplify the implementation process and facilitate the application of minimization.

妊娠期子宫的蜕膜螺旋动脉重铸是胚胎种植和正常发育所必需的生理变化,这一过程异常将导致病理性妊娠,甚至对母胎未来疾病的发生产生影响。本综述重点详细描述妊娠期子宫蜕膜螺旋动脉重铸的机制及其影响因素,尤其是孕早期,并列举目前国内外文献有关影响子宫蜕膜螺旋动脉重铸的相关因素及其临床相关性的报道,为临床基础研究提供理论依据。

目的 分析稽留流产患者绒毛染色体核型,探讨稽留流产与染色体异常的关系。方法 选取124例因胚胎停止发育稽留流产而行人工流产的绒毛组织,经培养法制备染色体,常规制片后经过G显带,分析染色体核型并对结果进行统计。结果 124例患者稽留流产胚胎绒毛取材顺利,其中122例培养成功,成功率为98.4%。染色体核型分析检出异常核型69例,异常率为56.6％。数目异常中以染色体三体居多,占异常核型率的53.1%,其次为三倍体(21.9%)、性染色体单体(15.6%)、四倍体(6.3%)、常染色体单体(3.1%)。结论 染色体异常是导致稽留流产的因素之一,绒毛染色体检查会为临床流产原因筛查、优生优育的指导提供可靠的参考依据。

Objective To identify the hotspots and frontiers of studies about the Developmental Origins of Health and Disease(DOHaD) hypothesis, and to provide reference for further researches in the future. Methods Data of publications from 2005 to 2020 were retrieved from the Web of Science Core Collection database. CiteSpace software was used to analyze the hotspots and frontiers of DOHaD studies by identifying co-occurrences in the aspects of countries/regions, institutions and keywords and burst detection. Results A total of 1008 publications on DOHaD hypothesis were included. The annual number of the published articles has been rising. Most of the studies were from the United States, followed by England. The current research hotspots focused on adverse health outcomes associated to early-life malnutrition, biological mechanisms and fetal exposure. Meanwhile, in vitro fertilization, oxidative stress and endocrine disruptor were identified as three frontier topics. Conclusion Adverse health outcomes, biological mechanisms, fetal exposure, in vitro fertilization, oxidative stress and endocrine disruptor are the hotspots and frontiers of the current studies about DOHaD hypothesis.

目的 探讨1 044例早产儿动脉导管未闭(PDA)的发生率、危险因素及相关并发症的发生情况。方法 选择2016年5月-2019年4月华中科技大学同济医学院附属同济医院新生儿科收治的早产儿(胎龄<34周)作为研究对象,根据生后一周内超声心动图结果分为PDA组(249例)和对照组(795例),收集两组早产儿的临床资料进行病例对照研究,对PDA发生的相关因素进行单因素分析,并建立二元Logistic回归模型,分析PDA的危险因素及相关并发症的发生情况。结果 胎龄小于34周早产儿PDA发生率为23.9%。且胎龄和出生体重越小,PDA发生率越高。单因素分析结果显示,胎龄、出生体重、窒息、妊娠高血压、产前糖皮质激素使用、胎膜早破与PDA的发生有关(P<0.05)。多因素二元Logistic回归分析显示,胎龄小(OR=1.40,95% CI:1.24～1.59)、窒息(OR=1.82,95% CI:1.21～2.75)是PDA发生的独立危险因素;胎膜早破(OR=0.63,95% CI:0.45～0.88)、产前糖皮质激素使用(OR=0.52,95% CI:0.36～0.76)是PDA的独立保护因素。PDA组患儿有创及无创呼吸机应用、肺炎、早产儿支气管肺发育不良(BPD)、喂养不耐受、Bell分期II期以上坏死性小肠结肠炎(NEC)、颅内出血(IVH)、早产儿视网膜病变(ROP)及肾损伤的发生率高于对照组,差异有统计学意义,两组患儿在脑室周围白质软化(PVL)的发生率之间的差异无统计学意义。结论 早产儿胎龄和出生体重越小,PDA发生率越高;胎龄小和窒息是早产儿PDA的高危因素之一,而产前激素使用和胎膜早破是其保护因素。早产儿PDA可引起呼吸机应用时间延长,增加肺炎、BPD、喂养不耐受、NEC、IVH、ROP及肾损伤的发生率。

女性盆底承托和支持子宫、阴道、直肠、膀胱等器官,并参与控制排尿、排便,影响性快感及阴道紧缩度。女性盆底功能障碍性疾病,多见于产后及中老年女性。产后是预防和治疗PFD的最佳有利时机,本文综述产后PFD患者的最新康复治疗研究成果,包括产后盆底康复锻炼、物理治疗、中医传统康复治疗等内容。

双酚-A(BPA)等环境内分泌干扰物是一类普遍存在于日常生活中的外源性化学物质,可以结合人体内不同的激素受体,通过多种机制干扰内源激素的功能,导致诸多疾病发生。本文就非持久性环境内分泌干扰物-BPA对女性生殖系统的作用及生殖健康的影响进行了分析和总结,并提出了对今后研究的启示。

Objective To study the level of dietary inflammation index of women in Beijing during pregnancy, and to explore the correlation between dietary inflammation index and pregnancy outcome. Methods From April 2018 to April 2019, pregnant women who underwent prenatal examination in a Maternal and Child Health Hospital in Beijing were selected. Questionnaire surveys were conducted to collect the basic information, birth history, dietary information, the serum inflammatory factors (CRP and TNF) were detected by enzyme-linked immunosorbent assay- α、 IL-1 β、 IL-4, IL-6 and IL-10), and the dietary inflammation index during pregnancy was calculated. Multiple linear regression was used to analyze the relationship between dietary inflammation index and pregnancy outcomes such as pregnancy weight gain, neonatal birth weight, preterm birth and fetal distress. Results the average dietary inflammatory index of 113 pregnant women during pregnancy was normally distributed. Compared with those with lower dietary inflammatory index, the serum CRP and TNF of pregnant women with higher dietary inflammatory index- α And IL-6 concentrations increased significantly. The level of dietary inflammatory index during pregnancy will significantly affect the weight gain during pregnancy (P=0.009), and the increase of dietary inflammatory index during pregnancy and early pregnancy will lead to insufficient weight gain in early pregnancy (P=0.031); The increase of dietary inflammatory index in the third trimester of pregnancy significantly increased the risk of low birth weight (P=0.020) and preterm birth (P=0.024); Increased mean dietary inflammatory index during pregnancy increased the risk of fetal distress (P=0.048). Conclusion Dietary inflammatory index during pregnancy affects weight gain during pregnancy and increases the risks of neonatal birth weight, premature delivery and fetal distress. It is suggested that pregnant women should pay attention to scientific diet during pregnancy and reduce the risk of adverse pregnancy outcome caused by dietary inflammatory factors.

目的 探究间苯三酚对冻融胚胎移植(FET)患者妊娠结局的影响。方法 对2017年1月—2018年12月在武汉大学人民医院生殖中心行FET治疗的1 305个周期患者的临床资料进行回顾性分析。根据患者胚胎移植后是否行间苯三酚治疗分为对照组(n=860)和间苯三酚治疗组(n=445)。比较两组患者的生化妊娠率、临床妊娠率、胚胎着床率、早期自然流产率以及异位妊娠率。结果 间苯三酚治疗组患者早期自然流产率(7.4%)显著低于对照组患者(13.2%,P＜0.05)。两组患者生化妊娠率、临床妊娠率、胚胎着床率及异位妊娠率无显著差异。此外,间苯三酚可以显著降低卵裂球期胚胎移植患者的早期自然流产率(P＜0.05)。对移植囊胚的患者,观察组与对照组妊娠结局无显著差异。结论 间苯三酚应用于FET周期可以改善患者妊娠结局,能显著降低患者早期自然流产率。

宫颈癌是一种常见的妇科恶性肿瘤,严重威胁女性的生命健康。高危型人乳头瘤病毒(HR-HPV)持续感染是导致宫颈癌的主要原因。已知从HPV感染进展到宫颈癌历时较长,这为宫颈癌的癌前筛查提供了可能。因此,了解HPV自身及其致癌机制十分重要,本文就不同HPV分子的致癌潜能、HPV的生命周期、HPV致宫颈癌变的中心环节及其导致的宿主细胞基因组不稳定性和体细胞基因突变作如下综述。

Objective To analyze the characteristics of the maternal population and the rate of cesarean delivery after universal two child policy in a maternity and child health care hospital in Dalian using the Robson classification method, with the aim to provide a basis for reducing the rate of cesarean delivery for women with different characteristics. Methods This study included a total of 61,691 women who were hospitalized and delivered in a maternity and child health care hospital in Dalian from January 1, 2016 to December 31, 2019. Cesarean deliveries were categorized separately for primiparous and multiparous women according to the Robson classification method. Chi-square trend test was used to examine the trend in the rates and indications of cesarean delivery in different subgroups of women over time, and the subgroups that have greater contributions to the increasing cesarean delivery rate were explored. Results The total cesarean delivery rate of pregnant women in 2016-2019 was 30.7%, and the rate of cesarean delivery among primipara showed an upward trend (P<0.05). Based on the Robson classification, the top 3 contributing groups were R2a, R2b, R6; the proportion of R2a and R9 group showed an upward trend, and that of R10 group showed a downward trend (P<0.05); R1 and R8 (Twin pregnancy primipara) group-specific cesarean delivery rate showed an upward trend (P<0.05). The cesarean delivery rate among multipara was 42.5%, and the cesarean delivery rate showed a downward trend over time (P<0.05). Under the Robson classification, the top 3 contributing groups R5a, R7, and R10; the proportion of R5a showed an upward trend, and that of R10 showed a downward trend (P<0.05); R8 (multiparous twin pregnancy) group-specific cesarean delivery rate showed an upward trend, and R4 (Multiparous women without a previous uterine scar, with single cephalic pregnancy,≥37weeks gestation) group-specific cesarean delivery rate showed a downward trend (P<0.05). Conclusion After implementation of the universal two-child policy, the control of cesarean delivery rate of primipara may need to focus on the groups R2a (Nulliparous women with single cephalic pregnancy ≥37 weeks gestation who had labor induced), R2b (Nulliparous women with single cephalic pregnancy ≥37 weeks gestation who were delivered by caesarean delivery before labor), and R6 (All nulliparous women with a single breech pregnancy); the control of cesarean delivery rate among multipara may need to focus on the groups R5a (One history of cesarean section), R7 (All multiparous women with a single breech pregnancy, including women with previous uterine scars), and R10 (Preterm multiparous women).

产后尿潴留是产科常见的一种并发症,可影响子宫收缩导致阴道出血量多,严重时引起产后大出血、泌尿系感染甚至膀胱破裂、肾衰竭等后果,严重影响产妇的产后康复。因此,临床上对此问题应保持足够重视。本文旨在回顾已发表的文章,总结产后尿潴留的危险因素、治疗及预防,为临床提供有价值的参考资料。

促性腺激素拮抗剂方案由于不需要对垂体进行降调节,促排卵时间短,在体外受精-胚胎移植技术临床上的应用越来越多,女性卵巢储备功能及对超促排卵药物的反应不同,性激素预处理在不同的卵巢反应人群的侧重点不同。高反应人群和正常反应人群通过拮抗剂方案能够很有效地降低卵巢过度刺激综合征发生风险,性激素预处理对于高反应人群是基于改善异常的性激素指标,提高卵子及胚胎的质量;正常反应人群和低反应人群性激素预处理是基于卵泡发育的均一性、增加获得卵子和胚胎的数量和质量;另外就是临床工作时间的安排等,性激素预处理应用的必要性和方法在临床上不统一。