重复经颅磁刺激在孤独症谱系障碍中的应用进展

孤独症谱系障碍是一种患病率日益增长的神经发育综合征，可出现多种行为障碍。近年来，重复经颅磁刺激在孤独症谱系障碍治疗中取得了一些研究成果，但关于刺激参数选择、安全性及可行性评估方面仍存在一定争议。本文就其关于诱导长时程增强/抑制、调节皮质抑制的治疗机制、低频和高频经颅磁刺激的临床应用及目前涉及的安全性、道德伦理问题等局限性进行综述，从而为今后的研究与临床应用提供一定的参考依据。     

Cerebrovascular events during pregnancy and puerperium

Though cerebrovascular complications of pregnancy remain relatively rare, they represent a potentially devastating event that necessitates prompt identification and treatment. Eighteen percent of strokes occurring in young women are linked to pregnancy. They occur mostly in the third trimester or during the post-partum period. Their biggest risk factors are hypertension, preeclampsia/eclampsia and migraine. Cerebrovascular events occurring during this period may involve specific pathophysiological processes that include embolic phenomena or endothelial dysfunction, but can also have common etiologies that are simply favored by the context of pregnancy. Thus, posterior encephalopathy and vasoconstriction cerebral syndrome are relatively frequently involved in cerebrovascular complications of pregnancy. Other very specific causes like amniotic fluid embolism or postpartum cardiomyopathy can also be responsible for such events. The management of stroke during pregnancy must be multidisciplinary and include a neurovascular expertise. Some conditions can lead to a long-life follow-up and modify the management of a future pregnancy.     

Changes and significance of plasma fibrinogen gamma‐chain concentration in preeclampsia patients

ObjectiveTo investigate the plasma fibrinogen gamma‐chain concentration in preeclampsia patients and explore its value in preeclampsia prediction and auxiliary diagnosis.MethodsFollow‐up of pregnant women who regularly attended perinatal care at two hospitals in China was performed, and clinical data and plasma samples were collected at each examination until delivery. The gamma‐chain concentration was detected by Western blotting, and Quantity One Software was used for gamma‐chain grayscale value measurements.ResultsForty‐two patients with preeclampsia and 42 control patients completed the follow‐up. In the control group, the gamma‐chain concentration at 32 weeks of gestation was higher than that at 20 weeks of gestation, but the difference was not statistically significant (p > 0.05). In the experimental group, the gamma‐chain concentration at preeclampsia diagnosis was significantly higher than that at 20 weeks of gestation (p < 0.05). Compared with the control group, the gamma‐chain concentration was higher at 20 weeks of gestation in the experimental group, but the difference was not statistically significant. However, at 32 weeks of gestation and at the time of diagnosis, the gamma‐chain concentration in the experimental group was significantly higher than that in the control group (p < 0.05). At 32 weeks of gestation and at the time of diagnosis, the AUCs from ROC curve analysis of plasma fibrinogen gamma‐chain concentrations were 0.64 and 0.71, respectively.ConclusionPlasma fibrinogen synthesis and degradation were disrupted in preeclampsia patients before and after diagnosis, and gamma‐chain concentration was significantly increased. Plasma fibrinogen gamma chain may be of some value in preeclampsia prediction and auxiliary diagnosis.     

基于交叉对比神经网络的心音分类

目的:通过交叉对比神经网络（CCNN）实现心音信号的自动分类，从而对心血管疾病进行早期诊断。方法:实验基于PhysioNet/Cinc 2016心音数据库。训练集和测试集数据来自互斥的健康受试者/病理患者，并以4:1的比例进行划分，输入CCNN。CCNN利用深度卷积神经网络进行特征提取，结合基于信息的相似度度量理论（IBS），对特征向量间的相似性进行度量并分类。结果:实验结果得出灵敏度为0.834 6，特异性为0.962 3，最终大赛综合得分为0.898 5。结论:CCNN使用交叉对比的输入模式扩充数据量，引入信号间的对比信息，同时在神经网络的训练过程中应用统计学思想，使网络具备良好的泛化性，更加适应医学数据量较少的场景，在心音分类中取得较好的结果。     

逐瘀止血汤加减治疗慢性子宫内膜炎气虚血瘀证的疗效观察

目的 评价逐瘀止血汤加减对慢性子宫内膜炎（CE）气虚血瘀证患者妊娠结局的影响及对免疫炎症因子的调节作用。方法 将144例患者随机按数字表法分为观察组和对照组各72例。观察组脱落、失访4例，剔除2例，完成66例；对照组脱落、失访3例，剔除5例，完成65例。两组均给予抗感染治疗14 d。对照组口服妇科千金片，6片/次，3次/d。观察组内服逐瘀止血汤加减，1剂/d。两组疗程均为3个月，并随访6个月。记录治疗前后月经经量、经期和周期变化情况；进行治疗前后宫腔镜和阴道彩色多普勒超声检查，评价子宫内膜形态、子宫内膜容受性（CP）［子宫内膜厚度、阻力指数（RI），搏动指数（PI）和血流指数（FI）］等，并进行子宫内膜病理检查；进行治疗前后气虚血瘀证评分；检测治疗前后月经血白细胞介素-1β（IL-1β），IL-6和肿瘤坏死因子-α（TNF-α）水平和外周血测T淋巴亚群（CD3⁺，CD4⁺，CD8⁺）水平；随访记录妊娠情况和流产情况。进行安全性评价。结果 治疗后观察组经量、经期、周期和月经完全正常率均高于对照组（P<0.05）；观察组子宫内膜厚度和FI均高于对照组（P<0.01），RI和PI均低于对照组（P<0.01）；观察组月经血IL-1β，IL-6和TNF-α水平均低于对照组（P<0.01）；观察组CD3⁺，CD4⁺水平和CD4⁺/ CD8⁺均高于对照组（P<0.01），CD8⁺水平低于对照组（P<0.01）；在6个月随访期间，观察组妊娠率46.97%（31/66），高于对照组的27.69%（18/65）（χ²=5.197，P<0.05）；观察组子宫内膜形态疗效总有效率为96.97%（64/66），高于对照组的86.15%（56/65）（χ²=4.981，P<0.05）；观察组子宫内膜病理组织疗效总有效率为95.45%（63/66），高于对照组的84.62%（55/65）（χ²=4.304，P<0.05）；观察组综合临床疗效总有效率为93.94%（62/66），高于对照组的81.54%（55/65）（χ²=4.696，P<0.05）；两组治疗期间均未发现与中药相关不良反应。结论 逐瘀止血汤加减治疗CE气虚血瘀证患者，可调经月经、减轻临床症状，改善宫腔镜下内膜形态，调节全身和局部的免疫炎症反应，提高了CP，从而改善了妊娠结局，有着较好的综合疗效，且安全。     

三维超声自由解剖成像技术对早期宫角与间质部妊娠的诊断价值

【摘要】 目的 探讨三维经阴道超声自由解剖成像技术(3DTVUOT)对早期宫角妊娠(CP)与间质部妊娠(ITP)的定性诊断价值。 方法 回顾性分析35例CP和36例ITP患者的临床资料。均因临床疑诊早期CP或ITP被序贯予以二维经阴道超声(2DTVU)和3DTVUOT检查，对妊娠病灶与宫腔的相通情况、病灶周围肌层完整性和厚度情况等进行比较分析；以手术 病理结果作为诊断金标准，对两种检查方法应用于CP和ITP定性诊断中的敏感性、特异性及准确性进行比较。 结果 CP患者的妊娠病灶与宫腔相通率(9143％)高于ITP(833％),病灶周围包绕肌层的厚度(608±135） mm高于ITP (195±058）mm,完整性(100％)亦高于ITP的(7222％)，组间比较差异均有统计学意义（P＜005）。2DTVU定性诊断CP和ITP的敏感性(8611％)、特异性(7714％)及准确性(8168％)均明显低于3DTVUOT（分别9444％、8571％、9014％），组间差异具有统计学意义（P＜005）。 结论 3DTVUOT对CP和ITP的早期定性诊断，具有较高的可靠性，优于2DTVU，可在临床推广应用。