妊娠期糖尿病妇女产后糖代谢转归调查及糖代谢异常的危险因素分析

摘要 目的：研究妊娠期糖尿病(GDM)妇女产后糖代谢转归情况及糖代谢异常的危险因素。方法：选取2018年6月~2020年6月期间本院收治的GDM患者119例为研究对象,对患者产后进行随访观察,调查患者的糖代谢转归情况。根据患者的糖代谢转归情况将患者分为糖代谢正常组(64例)和糖代谢异常组(55例),采用单因素分析的方法对两组患者的人口学资料、临床检测数据等进行统计比较,并采用多因素Logistic回归分析影响GDM患者产后糖代谢异常的危险因素。结果：119例GDM患者中产后12周内糖代谢异常患者55例,糖代谢异常发生率为46.22%。经单因素分析显示：糖代谢异常组年龄、孕前体质指数(BMI)、糖尿病家族史患者占比均高于糖代谢正常组,产后每天运动时间少于糖代谢正常组(P<0.05)。经多因素Logistic回归分析显示：年龄≥35岁、孕前BMI≥25 kg/m²、糖尿病家族史、产后每天运动时间<1 h是GDM患者产后糖代谢异常的危险因素。结论：GDM患者产后有较高的糖代谢异常发生率,患者产后糖代谢异常受多种因素影响,临床工作中应尽早根据相关因素制定干预方案。     

Emergence and selection of the dominant follicle and gonadotropin dynamics in postpartum lactating versus non-postpartum cycling mares

Among female livestock, the mare has the shortest interval from parturition to first ovulation. Due to the scarcity of research on postpartum mares, little progress has been made on the characterization of the resumption of ovarian cyclicity after parturition. This study compared follicular and gonadotropin dynamics during follicle emergence and deviation in postpartum lactating (PP Lactating) versus non-postpartum cycling (N-PP Cycling) mares. On the day of parturition, every PP Lactating mare was paired with a N-PP Cycling mare. Comparisons were made by considering the partum-ovulation interval and the postpartum interovulatory interval for the PP Lactating mares, and two interovulatory intervals for the N-PP Cycling mares. The results presented herein demonstrate that during the postpartum period, lactating mares have some similarities in follicular and hormonal profiles around emergence and deviation when compared with non-postpartum cycling mares. However, some peculiar and important characteristics were noticed during the postpartum period in lactating mares: (1) The emergence of the DF occurs around the day of parturition; (2) follicle deviation in the ovulatory wave occurs earlier during the foal heat than in other intervals; (3) lower FSH and LH systemic concentrations were not detrimental enough to prevent the rapid resumption of ovarian activity just after parturition; and (4) the association between parturition and season can have an additional and confounding effect during postpartum ovarian activity in mares. The novel findings of this study provide better knowledge of the resumption of ovarian activity after parturition and may help provide insight into the reproductive management of this species.     

Rockall危险性积分对急性上消化道出血患者临床预后的预测价值

目的:探讨Rockall危险性积分对急性上消化道出血(AUGIH)患者临床预后的预测价值。方法:选择2012年1月至2014年1月我院收治的120例AUGIH患者,依据Rockall评分标准对患者相关临床资料进行收集,并计算其Rockall危险性积分评分,记录患者再出血率及死亡率。结果:120例AUGIH患者中,低危组39例(32.5%)、中危组72例(60.0%)、高危组9例(7.5%)。高危组患者再出血率及死亡率分别为33.3%和22.2%,均明显高于中危组16.7%和15.3%,比较差异具有统计学意义(P0.05)。结论:Rockall评分系统可作为AUGIH患者预后预测的重要指标,对急诊AUGIH预后的判断具有重要临床意义。     

痛血康胶囊对早孕大鼠不完全流产模型的治疗作用

目的：探讨痛血康胶囊治疗早孕SD大鼠不完全流产模型产后出血的疗效及作用机制。方法：1）受孕7 d予米非司酮和米索前列醇,造成早孕不完全流产模型,痛血康治疗7 d观察并记录SD大鼠离体子宫平滑肌活动情况及病理组织学改变。2）用小鼠尾尖取血法,观察痛血康对小鼠出凝血时间的影响。3）用小鼠耳廓肿胀和SD大鼠棉球肉芽肿两个模型,观察痛血康的抗炎作用。4）用皮下注射肾上腺素加冰水刺激所致SD大鼠血瘀模型,观察痛血康的活血化瘀作用。结果：痛血康能增强早孕不完全流产SD大鼠子宫平滑肌收缩强度,促进残存的胚囊组织排出;能降低血瘀模型SD大鼠全血和血浆黏度,缩短小鼠出凝血时间;对二甲苯所致小鼠耳廓肿胀和SD大鼠棉球肉芽肿有明显抑制作用。结论：痛血康在早孕SD大鼠中具有治疗产后出血的作用,可能与增强流产SD大鼠的子宫收缩强度、促进残留在宫腔的绒毛或蜕膜组织排出、缩短出凝血时间、抑制炎症等有关。     

Hemopexin decreases hemin accumulation and catabolism by neural cells

Hemopexin is a serum, CSF, and neuronal protein that is protective after experimental stroke. Its efficacy in the latter has been linked to increased expression and activity of heme oxygenase (HO)-1, suggesting that it facilitates heme degradation and subsequent release of cytoprotective biliverdin and carbon monoxide. In this study, the effect of hemopexin on the rate of hemin breakdown by CNS cells was investigated in established in vitro models. Equimolar hemopexin decreased hemin breakdown, as assessed by gas chromatography, by 60–75% in primary cultures of murine neurons and glia. Extracellular hemopexin reduced cell accumulation of ⁵⁵Fe-hemin by over 90%, while increasing hemin export or extraction from membranes by fourfold. This was associated with significant reduction in HO-1 expression and neuroprotection. In a cell-free system, hemin breakdown by recombinant HO-1 was reduced over 80% by hemopexin; in contrast, albumin and two other heme-binding proteins had no effect. Although hemopexin was detected on immunoblots of cortical lysates from adult mice, hemopexin knockout per se did not alter HO activity in cortical cells treated with hemin. These results demonstrate that hemopexin decreases the accumulation and catabolism of exogenous hemin by neural cells. Its beneficial effect in stroke models is unlikely to be mediated by increased production of cytoprotective heme breakdown products.     

烙铁头蛇咬伤后迟发性出血的临床分析

目的探讨烙铁头蛇咬伤后迟发性出血的临床特点及治疗方法。方法对我院11例烙铁头蛇咬伤后出现迟发性出血的患者进行回顾性分析,总结其临床特点及治疗方法,并分析其病因。结果迟发性出血通常发生在烙铁头蛇咬伤后的第5～6天,发病率约16.42%;11例患者均出现伤口流血不止、皮下淤斑、牙龈出血及鼻衄,其中1例伴有便血及血尿,同时凝血酶原时间、活化部分凝血活酶时间及凝血酶时间均显著延长。经及时给予抗蛇毒血清、补充血容量等治疗,11例患者均痊愈。结论烙铁头蛇咬伤后迟发性出血并不少见,及早发现、积极处理是治愈的保证。     

大鼠产后压力性尿失禁模型的建立与探讨

目的 应用在大鼠阴道内放置水囊模拟产伤破坏大鼠盆底组织的方法建立产后压力性尿失禁( postpartum urinary incontinence,PPUI)的动物模型,并对此模型进行初步研究.方法 对40只SD雌性大鼠进行持续8h水囊扩张阴道,随机选取PPUI模型建立成功的大鼠25只并与对照同龄大鼠5只分别于模型建立后1d、1周、2周、4周、8周进行喷嚏实验以及尿动力学测定,张力换能器测定盆底肌肉肌力强度,采用JSCC标准化对应法测定血清生化指标(LDH,CK),应用逆转录-聚合酶链反应检测caspase-3基因表达,胆碱酯酶染色法计数盆底肌肉乙酰胆碱受体数量.结果 建模后喷嚏实验阳性率明显升高,阳性率为72.5％(29/40),尿动力学检测最大膀胱容量及漏尿点压力均降低,盆底肌肉收缩力下降,血清LDH、CK水平上升,盆底耻尾肌乙酰胆碱受体数量减少,与对照组比较均差异有显著性(P＜0.05).耻尾肌组织中caspase-3基因表达在建立模型当日达到最高,与对照组差异有显著性(P＜0.05),之后逐渐下降.结论 大鼠阴道内放置8h水囊的方法可以成功模拟产后压力性尿失禁,引起尿动力以及盆底肌肉的相关损伤指标发生改变.     

Hormones that increase maternal responsiveness affect accumbal dopaminergic responses to pup- and food-stimuli in the female rat

The present study investigated hormonal mediation of maternal behavior and accumbal dopamine (DA) responses to pup-stimuli, as measured in microdialysis samples collected from the nucleus accumbens shell of female rats in non-homecage environment. In Experiment 1, samples were collected before and after continuous homecage pup experience from either intact postpartum or cycling females. In Experiment 2, samples were collected before and after responding maternally in homecage from ovariectomized females given either parturient-like hormone or sham treatments. After baseline sample collection in the dialysis chamber, pup and food stimuli were individually presented to females. Upon sampling completion, all animals were placed back into their homecage with donor pups for several days, and then the sample collection procedure was repeated. Prior to stimulus presentation, postpartum and hormone-treated females had decreased basal DA release compared to their controls. In response to pup stimuli, only postpartum and hormone-treated females had increased DA release compared to basal release (both sampling days). In response to food stimuli, all females had increased DA responses from basal; although there were group differences on the initial day of sampling. Findings suggest that hormones associated with inducing maternal behavior in the postpartum rat play a significant role in modifying accumbal dopaminergic responses on first exposure to pup stimuli in the rat. However, the postpartum experience provides further modifications to this brain region to promote DA responses to pup stimuli.     

Influence of metabolic status on oocyte quality and follicular characteristics at different postpartum periods in primiparous rabbit does

Low reproductive performance of high-yield primiparous animals is closely associated with the metabolic stress caused by a simultaneous gestation and lactation. The aim of this work was (1) to analyze body composition and metabolic environment at three time points along lactation (at parturition time; in the lactation period [Day 11 postpartum]; and in the postweaning period [Day 32 postpartum]) of primiparous rabbit does (Oryctolagus cuniculus) and (2) to investigate the ovarian status at insemination time and the possible link with metabolic environment and with their reproductive performance. To this end, does were either submitted to a semi-intensive reproductive rhythm (Group S, inseminated on Day 11 postpartum) or an extensive rhythm (Group E, inseminated on Day 32 postpartum). Body energy (P < 0.05) and protein content (P < 0.001) as well as serum leptin (P < 0.05) and protein concentrations (P < 0.001) increased significantly along the postpartum period. At parturition, body lipid content was significantly lower and serum nonesterified fatty acids concentrations were significantly higher than that on Days 11 postpartum and 32 postpartum. Concerning ovarian status at insemination time, no significant differences were found in mean follicular stages, serum estradiol, progesterone, and prolactin (PRL) concentrations or in prolactin receptor (PRL-R) immunostaining. However, follicles in Group S showed a significantly higher apoptosis index than that of Group E (P < 0.001). The nuclear and cytoplasmic oocyte maturation rates of Group S were also significantly lower than that in Group E. In addition, conception rate and prolificacy were improved in Group E (P < 0.001 and P < 0.05, respectively). In conclusion, in the early postpartum period, metabolic status seems to impact negatively on ovarian follicle and oocyte quality leading to a poor reproductive outcome in primiparous rabbit does.     

食蟹猴脑出血模型的建立及评价

目的建立稳定的食蟹猴自体股动脉抗凝血脑出血模型。方法健康成年食蟹猴8只,采用新鲜抗凝自体股动脉血1．5mL,立体定向一次性缓慢匀速注入右侧基底节区屏状核内侧,利用MRI、PET、神经功能缺损评分和组织病理学对模型进行评价。结果动物在麻醉苏醒后出现了与血肿部位相对应的神经系统定位体征,影像学检查血肿腔位于右侧基底节,注血部位大片代谢缺损区,中线向左侧移位。组织病理学检查损伤局部周围可见多量泡沫细胞、淋巴细胞及单核巨噬细胞浸润,部分损伤脑组织已被肉芽组织机化。结论自体股动脉抗凝血定向脑内注射法可建立稳定、可靠的食蟹猴脑出血模型,注血量、注血部位和速度是模型成功与否的关键。