The peripartum human brain: Current understanding and future perspectives

The peripartum period offers a unique opportunity to improve our understanding of how dramatic fluctuations in endogenous ovarian hormones affect the human brain and behavior. This notwithstanding, peripartum depression remains an underdiagnosed and undertreated disorder. Here, we review recent neuroimaging findings with respect to the neuroplastic changes in the maternal brain during pregnancy and the postpartum period. We seek to provide an overview of multimodal neuroimaging designs of current peripartum depression models of hormone withdrawal, changes in monoaminergic signaling, and maladaptive neuroplasticity, which likely lead to the development of a condition that puts the lives of mother and infant at risk. We discuss the need to effectively integrate the available information on psychosocial and neurobiological risk factors contributing to individual vulnerability. Finally, we propose a systematic approach to neuroimaging the peripartum brain that acknowledges important co-morbidities and variation in disease onset.     

Best Practices for Counseling Adolescents about the Etonogestrel Implant

Among young persons, ease of use, high efficacy, and high acceptability makes the etonogestrel contraceptive implant an important choice for this age group. Adolescent-friendly, patient-centered counseling considers the patient's cognitive development, the influence of friends and family, as well as their own preferences and values. Age-appropriate language, graphics, and models are useful to explain contraceptive options and relevant side effects. Effectiveness, reversibility, safety, noncontraceptive benefits, and side effects are important attributes and should be discussed when teens are choosing a contraceptive method. In this review we describe suggested best practices for counseling adolescents about the etonogestrel implant so they can make informed, prudent decisions about using this contraceptive method.     

上皮-间质转化与女性生殖系统发育、功能及疾病

上皮-间质转化（epithelial-mesenchymal transition，EMT）是指上皮细胞在形态学上发生向成纤维细胞或间质细胞表型转化的过程，在胚胎发育、组织再生、肿瘤转移和器官纤维化疾病中发挥重要作用。随着EMT在生殖领域不断被发现，EMT作为女性生殖系统的重要调控机制越来越受到关注。本文综述了EMT在女性生殖系统形成、发育及正常功能中的重要性，并讨论EMT在病理状态如子宫内膜异位症、宫腔粘连和生殖系统恶性肿瘤等疾病发生中的作用，以期为女性生殖系统的研究及疾病治疗提供新思路。     

The indicators associated with increasing suicide trends: Need for harmony in discussing suicide in legal medicine and other fields

Each year in Japan from 1990 to 1997, approx. 21,000–24,000 individuals committed suicide. In 1998, the number of suicides increased to >30,000, and a trend of high suicide numbers then persisted for >10 years. Although Japan’s annual number of suicides has recently been decreasing, it remains among the highest worldwide. Herein, we assessed the annual suicide data (numbers and rates) related to three economic and life indicators: (1) the difference between actual income and consumer spending of one average month per year in one household, (2) the annual difference between exports and imports, and (3) the annual total debt determined by statistical analyses for both sexes/males/females during the 40-year period from 1979 to 2018 in Japan. Our findings indicated that [1] total debt may be associated with both the number of suicides and the suicide rate for both sexes, for males, and for females, and [2] the difference between actual income and consumer spending may be associated with both the number of suicides and the suicide rate only in females. These findings revealed factors that are clearly suicide-related, and it is necessary to design suicide prevention strategies based on the factors. Relevant public and private entities should become aware of the involvement of both debt and the difference between income and spending in suicide trends as they plan suicide prevention measures. Further analyses of suicide data should be performed in a wide range of fields including legal medicine, toward a greater understanding of suicide risk factors.     

The Relationship Between Female Reproductive Functions and Vitamin D

Nonclassical target organs recently defined for vitamin D, a major regulator of calcium phosphorus homeostasis and bone health, include reproductive ones. This compilation study focuses on the potential effects of vitamin D on female reproductive functions. Vitamin D receptor enzymes that metabolize vitamin D are expressed in both central and peripheral reproductive organs. Most studies suggest that vitamin D may be directly or indirectly related to gonadal functions. Vitamin D's effects on reproductive functions may be indirectly related to diseases such as polycystic ovary syndrome (PCOS), uterine leiomyomas, and endometriosis. In case of vitamin D deficiency during infertility treatment, vitamin D supplementation can be recommended especially for women who have PCOS, insulin resistance, or low anti-Mullerian hormone levels. Supplementation, however, should take into account possible toxic effects of high-dose vitamin D. To be able to recommend measuring vitamin D as a routine screening test and to better understand the effects of vitamin D and its supplementation on female reproductive functions, larger randomized controlled prospective studies are needed.     

医学院女大学生自主神经系统功能状况及其影响因素分析

目的通过对医学院女大学生心率变异性的测量,了解其自主神经系统功能状况,分析其影响因素,为改善女大学生自主神经功能,促进其身心健康提供科学依据。方法 2015年6-10月选取422名吉林省某综合大学医学院女大学生为研究对象,采取自填式问卷方法,对其心率变异性进行测查。结果医学院女大学生自主神经系统活性偏低的检出率为37.0%,自主神经系统均衡性异常的检出率为71.1%;多因素Logistic回归结果显示,压力大和睡眠质量差分别是医学院女大学生自主神经系统活性和自主神经系统均衡性的独立影响因素(P<0.05)。结论医学院女大学生自主神经功能异常问题突出,应及时采取缓解压力、改善睡眠质量、加强体育锻炼等措施提高自主神经功能,促进女大学生身心健康。     

A diagnostic evaluation of a molecular assay used for testing and treating anorectal chlamydia and gonorrhoea infections at the point-of-care in Papua New Guinea

ObjectivesPapua New Guinea has among the highest prevalences of sexually transmissible infections (STIs) globally with no services able to accurately test for anorectal Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections. Here we prospectively evaluated the diagnostic performance of a molecular CT/NG assay used at the point-of-care (POC) with the aim of enhancing anorectal STI screening and same-day treatment.MethodsMen who have sex with men, transgender women and female sex workers taking part in Papua New Guinea's first large-scale biobehavioural study were enrolled and asked to provide a self-collected anorectal swab for POC GeneXpert CT/NG testing. Same-day treatment was offered if positive. A convenience sample of 396 unique and randomly selected samples were transported to Australia for comparison using the Cobas 4800 CT/NG test (Roche Molecular Diagnostics, Pleasanton, CA, USA).ResultsA total of 326 samples provided valid results by Cobas whereas 70 samples provided invalid results suggesting inhibition. The positive, negative and overall percentage agreements of GeneXpert CT/NG for the detection of C. trachomatis were 96.7% (95% CI 92.3%–98.9%), 95.5% (95% CI 91.3%–98.0%) and 96.0% (95% CI 93.3%–97.8%), and for N. gonorrhoeae were 93.0% (95% CI 86.1%–97.1%), 100.0% (95% CI 98.3%–100.0%) and 97.8% (95% CI 95.6%–99.1%), respectively.ConclusionsThe overall rate of agreement between the GeneXpert and Cobas CT/NG assays was high with 96.0% for C. trachomatis and 97.8% for N. gonorrhoeae. Results from this study data suggest that the GeneXpert CT/NG assay is suitable for testing self-collected anorectal specimens at the POC and that same-day treatment was feasible.     

迷走神经途径的L-谷氨酸与十二指肠运动的量效关系

目的 构建经迷走神经背核（DMV）注射L-谷氨酸(L-Glu)的剂量与雌性家兔十二指肠肌电活动指数的数学模型,为探讨激素、细胞因子等影响迷走神经活动的作用机制提供实验依据。 方法 采用DMV显微注射技术,分别按0 mol/L、0.05 mol/L、0.10 mol/L、0.15 mol/L和0.20 mol/L剂量经DMV注射L-Glu,每剂量组样本数为5只,监测卵巢摘除家兔的十二指肠肌电活动;并构建L-Glu的剂量与十二指肠肌电活动指数之间的数学模型。 结果 经t检验分析,相邻剂量组之间,肌电活动的振幅逐渐增强,且差异极显著（P＜0.01）;频率逐渐加强,其中0 mol/L与0.05 mol/L、0.10 mol/L与0.15 mol/L组间差异有显著性（P＜0.05）;肌电活动指数逐渐增强,且组间差异极显著（P＜0.01）。以L Glu浓度为自变量 x,十二指肠肌电活动指数为因变量 y,构建的数学模型的函数关系式为：y=13.71/1 + exp ［-22.35 × (x -0.082)］,函数拟合精度：R²=0.9948,P<0.01,属于增长型S型逻辑函数。函数分析表明,0.082 mol/L L-Glu剂量为该逻辑函数的拐点值;在L-Glu剂量范围为0 mol/L～0.082 mol/L时,十二指肠肌电活动指数成指数型增长模式;当L-Glu剂量大于0.082 mol/L时,十二指肠肌电活动指数呈对数型增长模式,且其理论极限值为13.71。 结论 L-Glu通过DMV对家兔十二指肠肌电活动的促进作用具有显著的量效关系,且具有区间作用的特点。     

Stigma as a barrier to health care utilization among female sex workers and men who have sex with men in Burkina Faso

Purpose

The aim of this study is to examine the prevalence and correlates of perceived health care stigma among female sex workers (FSWs) and men who have sex with men (MSM), including other stigma types, suicidal ideation, and participation in social activities.