单胎妊娠早产胎膜早破呼吸窘迫综合征的危险因素分析

目的:探讨单胎妊娠早产胎膜早破发生新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的危险因素。方法:选择2017年5月至2019年5月在我院产科分娩的2810例产妇为研究对象,其中97例(3.45%)符合未足月胎膜早破(Preterm premature rupture of membranes,pPROM)标准,包括53例RDS。收集以下信息:PROM潜伏期、出生时胎龄、脐动脉搏动指数(Umbilical artery pulsatility index,UAPI)、大脑中动脉搏动指数(Middle cerebral artery pulsation index,MCAPI)、胎儿窘迫、产前使用类固醇、新生儿实验室参数、性别、体重、Apgar评分、分娩类型、妊娠高血压疾病、妊娠期糖耐量异常或糖尿病等信息,通过Logistic回归分析研究变量对RDS的影响。结果:Logistic回归分析结果显示,以下变量与RDS密切相关:新生儿性别女性(OR=0.517;95%CI:0.312-0.107;P=0.042),产前使用类固醇(OR=0.467;95%CI:0.355-0.698;P0.001),异常UAPI(OR=2.830;95%CI:1.783-6.234;P=0.002),异常MCA PI(OR=2.136;95%CI:1.120-4.017;P=0.032),胎儿窘迫(OR=2.420;95%CI:1.287-4.824;P=0.017),母体HGB(OR=0.689;95%CI:0.511-1.013;P=0.221),新生儿HGB(OR=0.752;95%CI:0.645-0.891;P0.001),新生儿RBC(OR=0.311;95%CI:0.201-0.565;P0.001)。结论:单胎妊娠早产胎膜早破发生RDS危险因素主要是性别、胎儿胎盘循环异常和胎儿窘迫。     

未足月胎膜早破合并绒毛膜羊膜炎孕妇血清淀粉样蛋白A、血小板激活因子水平的表达及临床意义

目的:检测未足月胎膜早破合并绒毛膜羊膜炎(HCA)孕妇血清淀粉样蛋白A(SAA)、血小板激活因子(PAF)水平,并探讨其临床意义。方法:选择从2013年7月到2017年7月,在我院接受治疗的165例胎膜早破孕产妇作为研究对象。165例患者中,未足月胎膜早破者80例(未足月胎膜早破组),足月胎膜早破者85例(足月胎膜早破组),再根据是否合并HCA分为合并HCA胎膜早破组43例和未合并HCA胎膜早破组122例。另选取同期在我院体检的80例健康孕产妇志愿者作为正常组,对比各组血清SAA和PAF水平,分析合并与未合并HCA胎膜早破组的妊娠结局,利用受试者工作特征(ROC)曲线分析血清SAA和PAF对未足月胎膜早破是否合并HCA的诊断价值。结果:未足月胎膜早破组及足月胎膜早破组的血清SAA和PAF水平均明显高于正常组,且未足月胎膜早破组又高于足月胎膜早破组,差异有统计学意义(P0.05)。未足月胎膜早破组80例患者中HCA发生率为35.00%(28/80),明显高于足月胎膜早破组的17.65%(15/85),差异有统计学意义(P0.05)。合并HCA胎膜早破组的血清SAA和PAF水平均明显高于未合并HCA胎膜早破组,差异有统计学意义(P0.05)。合并HCA的未足月胎膜早破患者血清SAA和PAF水平高于未合并HCA的未足月胎膜早破患者(P0.05)。合并HCA的胎膜早破组的产后大出血、剖宫产以及新生儿肺炎的发生率均明显高于未合并HCA胎膜早破组,差异有统计学意义(P0.05)。根据ROC曲线分析可知,血清SAA和PAF对未足月胎膜早破是否合并HCA的诊断价值较高。结论:血清SAA、PAF水平在未足月胎膜早破合并HCA孕妇中明显升高,二者对此种合并症具有较高的诊断价值。临床诊疗过程中可将SAA及PAF纳入到指标监测体系中,从而为临床治疗提供指导。     

室性早搏患者射频消融术预后与起源部位的相关性

目的:探讨室性早搏(PVCs)患者射频消融术(RFCA)预后与起源部位的相关性。方法:回顾性分析2016年12月～2017年12月第二军医大学第一附属医院长海医院心血管内科收治并接受RFCA治疗的PVCs患者的临床资料,根据起源部位分为右心室组(n=58),左心室组(n=24)。记录两组RFCA手术时间、X线曝光时间及手术成功率等指标,术后随访6个月,比较两组术后心功能指标的改善情况,记录24h PVCs总数及复发情况。结果:与左心室组比较,右心室组手术时间、X线曝光时间明显延长,手术成功率明显下降(P0.05)。术后3个月,右心室组LVESD、LVEDD均明显减小,LVEF明显升高(P0.05);术后6个月,两组24h PVCs数均较术前显著降低,且右心室组下降幅度更为显著(P0.05)。术后6个月,两组各心功能指标均较术前明显改善,右心室组较术后3个月进一步改善,且明显优于左心室组(P0.05)。结论:射频消融术治疗PVCs的预后与起源部位存在一定相关性,右心室起源相对左心室起源的PVCs手术成功率更高,更有利于抑制心室重构、改善心功能。     

Flirtation reduces males’ fecundity but not longevity

Theory predicts that due to limited resources males should strategically adjust their investment in reproduction and survival. Based on different conceptual framework, experimental designs, and study species, many studies support while others contradict this general prediction. Using a moth Ephestia kuehniella whose adults do not feed and thus have fixed resources for their lifetime fitness, we investigated whether males adjusted their investment in various life activities under dynamic socio‐sexual environment. We allowed focal males to perceive rivals or additional females without physical contact. We show that males do not adjust the number of sperm they transfer to mates in a given copulation at different immediate or both immediate and mean sperm competition levels. Contradictory to general predictions, our results demonstrate that cues from additional females increase males’ investment in courtship and reduce their lifetime number of copulations and sperm ejaculated, whereas cues from rivals have no effect on these parameters. Males have similar longevity in all treatments. We suggest that the sex pheromone produced by multiple females overstimulate males, increasing males’ costly flirtations, and reducing their lifetime copulation frequency and fecundity. This finding offers a novel explanation for the success of mating disruption strategy using sex pheromones in pest management.     

Rictor/mTORC2 Pathway in Oocytes Regulates Folliculogenesis,and Its Inactivation Causes Premature Ovarian Failure

Molecular basis of ovarian folliculogenesis and etiopathogenesis of premature ovarian failure (POF), a common cause of infertility in women, are not fully understood. Mechanistic target of rapamycin complex 2 (mTORC2) is emerging as a central regulator of cell metabolism, proliferation, and survival. However, its role in folliculogenesis and POF has not been reported. Here, we showed that the signaling activity of mTORC2 is inhibited in a 4-vinylcyclohexene diepoxide (VCD)-induced POF mouse model. Notably, mice with oocyte-specific ablation of Rictor, a key component of mTORC2, demonstrated POF phenotypes, including massive follicular death, excessive loss of functional ovarian follicles, abnormal gonadal hormone secretion, and consequently, secondary subfertility in conditional knock-out (cKO) mice. Furthermore, reduced levels of Ser-473-phosphorylated Akt and Ser-253-phosphorylated Foxo3a and elevated pro-apoptotic proteins, Bad, Bax, and cleaved poly ADP-ribose polymerase (PARP), were observed in cKO mice, replicating the signaling alterations in 4-VCD-treated ovaries. These results indicate a critical role of the Rictor/mTORC2/Akt/Foxo3a pro-survival signaling axis in folliculogenesis. Interestingly, loss of maternal Rictor did not cause obvious developmental defects in embryos or placentas from cKO mice, suggesting that maternal Rictor is dispensable for preimplantation embryonic development. Our results collectively indicate key roles of Rictor/mTORC2 in folliculogenesis, follicle survival, and female fertility and support the utility of oocyte-specific Rictor knock-out mice as a novel model for POF.     

Perinatal inflammation results in decreased oligodendrocyte numbers in adulthood

Aims

Maternal inflammation is a risk factor for preterm birth, and premature infants are often exposed to supplemental oxygen as a life-sustaining therapy. While more immature neonates are surviving, rates of neurodevelopmental impairment are not improving. We developed a novel mouse model with clinically relevant exposures to test the hypothesis that systemic maternal inflammation with transient neonatal hyperoxia exposure will induce a phenotype similar to diffuse periventricular leukomalacia (PVL) like that observed in premature human infants.

Main methods

Timed-pregnant C3H/HeN mice received intraperitoneal injections of lipopolysaccharide (LPS) or saline on embryonic day 16. Newborn pups were placed in room air (RA) or 85% oxygen (O₂) for 14 days, followed by 14 days in RA recovery. Oligodendroglial and microglial populations were evaluated at 14 and 28 days.

Key findings

Brain weight to body weight ratios were lower in mice exposed to LPS. Oligodendrocyte numbers were decreased significantly in the cerebral cortex and hippocampus in groups exposed to LPS or LPS/O₂ at 14 days, and persisted in the cerebral cortex at 28 days for LPS/O₂ mice. At day 14, cleaved caspase 3 was increased and numbers of microglia were elevated in the cerebral cortex and hippocampus of LPS/O₂ animals.

Significance

These data indicate that combining systemic maternal LPS and neonatal hyperoxic exposure impairs myelination, and suggests that this novel mouse model may represent a subtle, diffuse form of periventricular white matter injury that could provide a clinically relevant platform for further study of perinatal brain injury.     

逆行射精精子冷冻保存在宫腔内人工授精技术中的应用

目的:探讨逆行射精患者尿液中回收精子的冷冻保存及其在宫腔内人工授精(IUI)周期中的应用效果。方法:2008年12月至2011年1月逆行射精患者共计7例,嘱其按要求留取射精后的尿液,充分洗涤后实施液氮蒸汽法超低温精子冷冻,共冻存精液标本14人份。IUI周期时将冻存精子解冻、优化后行宫腔内人工授精。结果:冷冻前、解冻后前向运动精子总数分别为(19.9±10.4)×106和(6.9±4.2)×106,存在显著性差异(P<0.05),解冻优化后前向运动精子总数为(2.6±1.7)×106,实施IUI 8个周期,临床妊娠1例。结论:超低温冷冻会明显降低前向运动精子总数,但多次冷冻后一次复苏行IUI可能是治疗逆行射精所致不育的一种较为理想的方法。     

胎膜早破与分娩方式的关系及产程观察

目的:探讨胎膜早破对分娩方式与结果的影响,提高对产程观察的重视。方法:统计分析249例孕足月胎膜早破者的分娩方式、产程及母儿并发症,并与249例随机抽取同期孕足月无胎膜早破的产妇进行对照。结果:胎膜早破组自然分娩率明显低于对照组(P<0.05),产褥感染、新生儿窒息发生率明显高于对照组(P<0.05)。结论:胎膜早破易感染,并导致胎儿宫内窘迫和新生儿窒息,与难产、剖宫产有相关性,应合理选择分娩方式,积极处理产程,以确保母婴安全。     

C- 反应蛋白检测在胎膜早破孕妇中的临床意义

目的:探讨C反应蛋白(CRP)检测在足月胎膜早破(PROM)孕妇中的临床意义。方法:选取足月胎膜早破(PROM)孕妇50例为实验组,并根据破膜时间将足月破膜孕妇分为3个亚组;并选取同期住院的正常孕妇30例为对照,采用高敏CRP试剂盒,测定不同组别孕妇中CRP水平。结果:入院时,胎膜早破各亚组中CRP水平明显高于对照组,具有显著统计学意义(P<0.05);同时随着破膜时间的增加,各亚组中的CRP水平及WBC计数也逐渐升高,且3个亚组之间也分别存在统计学差异(P<0.05)。在应用抗生素3d后,CRP出现显著下降,与正常组相比未见明显差异(P>0.05);WBC计数在应用抗生素后的3d时间出现下降,但与入院前相比未见明显统计学差异。结论:CRP检测在判断孕妇胎膜早破、指导临床用药方面具有较高的临床价值,可作为常规检查项目。