复发性流产的内分泌因素

复发性流产是一种常见妊娠并发症，病因复杂多样，其中内分泌因素占8%～12%，文章主要就甲状腺功能异常、高催乳素血症、多囊卵巢综合征及代谢异常、糖尿病、黄体功能不全等内分泌因素进行综述，旨在为复发性流产的预防及治疗方面带来新的思考。     

Parada cardiorrespiratoria intrahospitalaria: incidencia,factores pronósticos y resultados

Background and aimsIn-hospital cardiac arrest (CA) is a clinical entity with high morbidity and mortality that occurs in up to 2% of hospitalized patients. It is a public health problem with important economic, social, and medical repercussions, and as such its incidence needs to be reviewed and improved. The aim of this study was to determine the incidence of in-hospital CA, return of spontaneous circulation (ROSC), and survival rates at Hospital de la Princesa, and to define the clinical and demographic characteristics of patients with in-hospital CA.Material and methodsRetrospective observational chart review of patients presenting in-hospital CA and treated by anaesthesiologists from the hospital's rapid intervention team. Data were collected over 1 year.ResultsForty-four patients were included in the study, of which 22 (50%) were women. Mean age was 75.70 years (± 15.78 years), and incidence of in-hospital CA was 2.88 per 100,000 hospital admissions. Twenty-two patients (50%) achieved ROSC and 11 patients (25%) survived until discharge home. The most prevalent comorbidity was arterial hypertension (63.64%); 66.7% of cases were not witnessed, and only 15.9% presented a shockable rhythm.ConclusionsThese results are similar to those reported in other larger studies. We recommend introducing immediate intervention teams and devoting time to training hospital staff in in-hospital CA.     

基于动脉自旋标记技术的麻痹性痴呆患者脑血流量特点及其与认知障碍相关性

目的探讨麻痹性痴呆（GPI）患者脑血流量（CBF）特点及其与认知障碍的相关性。 方法纳入2018年1月至2019年12月于首都医科大学附属北京地坛医院就诊的GPI患者18例和健康体检者18例（健康对照组），采用蒙特利尔认知评估量表评定认知功能。采用磁共振动脉自旋标记技术扫描评估其各个脑区CBF，并进一步应用Spearman相关分析CBF异常区域与认知功能的相关性。 结果GPI患者蒙特利尔认知评估量表评分低于健康对照组[（16.00 ± 7.19）vs. （27.90 ± 1.21）：t =－7.853、P < 0.001）]。18例GPI患者中，头颅MRI正常5例，脑白质病变1例，脑萎缩9例，3例患者同时存在脑萎缩和脑白质病变。健康对照组头颅MRI均未见异常。GPI患者脑13、14、28、37、38、41、42、43、44、46、48、49、50、51、52、69、70、77、78、83、84、88、109、117、165、166、167、168、169、177、178、179、187、188、211、212、213、214、215、216、219、223、227、237和238区CBF显著高于健康对照组（P均< 0.001）。GPI患者认知障碍中的注意力障碍与脑69、70、77、78、166和168区CBF异常有一定的负相关性（r =－0.476、P = 0.046，r =－0.487、P = 0.034，r =－0.604、P = 0.008，r = －0.545、P = 0.019，r =－0.544、P = 0.02，r =－0.522、P = 0.026）。 结论GPI患者存在全脑血流量升高。GPI患者认知功能障碍中的注意力障碍可能与局部脑区血流量升高有一定相关性。局部CBF越高，注意力障碍越严重。这可能也是GPI发病机制之一。     

Trends in Risk of Pregnancy Loss Among US Women, 1990–2011

Background

Pregnancy loss can have physical and psychological consequences for women and their families. Though a previous study described an increase in the risk of self‐reported pregnancy loss from 1970 to 2000, more recent examinations from population‐based data of US women are lacking.

Methods

We used data from the 1995, 2002, 2006–2010, 2011–2015 National Survey of Family Growth on self‐reported pregnancy loss (miscarriage, stillbirth, ectopic pregnancy) among US women (15–44 years) who reported at least one pregnancy conceived during 1990–2011 that did not result in induced termination (n = 20 012 women; n = 42 526 pregnancies). Trends in the risk of self‐reported pregnancy loss and early pregnancy loss (<12 weeks) were estimated, separately, by year of pregnancy conception (limited to 1990–2011 to ensure a sufficient sample of pregnancies for each year and maternal age group) using log‐Binomial and Poisson models, adjusted for maternal‐ and pregnancy‐related factors.

Results

Among all self‐reported pregnancies, excluding induced terminations, the risk of pregnancy loss was 19.7% and early pregnancy loss was 13.5% during 1990–2011. Risk of pregnancy loss increased by a relative 2% (rate ratio [RR] 1.02, 95% confidence interval [CI] 1.01, 1.02) per year in unadjusted models and 1% per year (RR 1.01, 95% CI 1.00, 1.02) during 1990–2011, after adjustment for maternal characteristics and pregnancy‐related factors. In general, trends were similar for early pregnancy loss.

Conclusion

From 1990 to 2011, risk of self‐reported pregnancy loss increased among US women. Further work is needed to better understand the drivers of this increase in reported pregnancy loss in the US.     

生物钟基因Bmal1对早期自然流产的影响

Bmal1（Brain and muscle arnt-like 1）作为生物钟基因的核心基因之一,在女性生殖系统中均有表达,其昼夜节律性表达参与了发情周期的产生、排卵、着床及妊娠的维持。Bmal1表达改变与流产的发生有关联,可通过多种机制引起妊娠丢失,其表达下调可通过SP1-DNMT1/DAB2IP途径引起基质金属蛋白酶2/9表达降低,从而抑制滋养细胞迁移和侵袭;Bmal1基因缺失干扰了卵巢颗粒细胞类固醇合成相关基因的转录和翻译,从而影响妊娠相关激素的分泌,并通过磷脂酰肌醇3激酶（PI3K）/蛋白激酶B（Akt）/哺乳动物雷帕霉素靶蛋白（mTOR）信号通路促进颗粒细胞凋亡;Bmal1表达下降可引起卵巢和输卵管中活性氧增加从而降低卵母细胞受精、早期胚胎发育和着床潜能,最终导致胚胎丢失。本文就生物钟基因Bmal1对早期自然流产的影响进行综述。     

深刺久留针法结合火针治疗周围性面瘫体会

针灸治疗周围性面瘫是公认行之有效的方法,尤其采取分期多种方法联合治疗周围性面瘫效果会更加显著。急性期初起较轻,采用针刺配合刺血疗法;静止期采用火针点刺后再行刺血和毫针刺法;恢复期采用火针点刺,毫针深刺久留,同时配合刺血疗法。周围性面瘫采用针灸择期治疗能取得更好的治疗效果,从针刺治疗面瘫病的时机到穴位的选取都有其科学性和规律性。