北京市1～3月龄婴儿睡眠现状及影响因素研究

目的 了解北京市1～3月龄婴儿的睡眠现状并分析睡眠问题的影响因素。方法 采用整群抽样的方法,选取2015年12月15日-2016年1月15日在北京城区、近郊、远郊各选取的两家妇幼保健机构进行健康体检的1~3月龄婴儿1 152例,对家长进行调查,内容包括一般情况、养育及家庭环境、睡眠环境、睡眠问题等。用χ²检验和Logistic回归分析进行分析。结果 1 152名婴儿中,与大人同床睡的比例为73.8%,摇晃/拍抱哄睡和含奶头入睡的比例分别为72.9%和59.8%,晚上睡觉开小夜灯的比例为52.0%。入睡困难、睡眠节律紊乱的比例分别是50.3%和60.4%。张口呼吸、打鼾、呼吸暂停的比例分别是33.0%、26.5%、3.5%。婴儿年龄(d)增加(OR=1.013,95%CI:1.002~1.023)、剖宫产(OR=1.509,95%CI:1.101~2.068)、混合喂养(OR=1.401,95%CI:1.036~1.894)、不良睡眠环境(OR=1.602,2.587,2.278,95%CI:1.177~2.180,1.113~6.011,1.217~4.263)、缺乏睡眠仪式(OR=1.611,95%CI:1.198~2.168)、摇晃/拍抱哄睡(OR=3.397,95%CI:2.419~4.768)会增加婴儿入睡困难的风险。结论 北京地区小婴儿不良睡眠行为及睡眠问题较多,亟待改善看护人的睡眠知识。     

Secrets and disclosure in donor conception

This article considers the disclosure, sharing and exchange of information on being donor conceived within families, drawing on data from a study undertaken with donor‐conceived adults registered with UK Donor Link (a voluntary DNA‐linking register). This paper considers the narratives of how respondents found out they were donor‐conceived and what events triggered disclosure of this information. This paper then goes on to examine the role secrecy played in their family life and uses the concept of ‘display’ to explore how secrecy affected their relationships with their immediate and extended family. Secrets are notoriously ‘leaky’ and we found complex patterns of knowing and uncertainty about whom in the family knew that the person was donor‐conceived. We argue that what is kept secret and from whom provides insights into the multifaceted web of social relationships that can be created by donor‐conception, and how knowledge can be managed and controlled in attempts to display and maintain family narratives of biogenetic connection.     

¿Quién decide qué datos deben constar en la historia clínica en relación con el origen biológico?

There is an increasing request by patients or their representatives not to have some data registered in their clinical history or if such data exists to be deleted. Without doubt, this is so because such clinical data is accessed by various professionals who in most cases are not directly involved in caring for such patients. On the other hand, such data is copied and iteratively and unnecessary reproduced in various discharge reports and others forms. The problem arises when such controversial data refer to particularly sensitive clinical aspects such as assisted reproduction techniques, which invades personal and family privacy. Therefore, the question is who determines what data should be recorded in the medical records and according to what criteria should be taken that decision?     

Preventing syndemic Zika virus,HIV/STIs and unintended pregnancy: dual method use and consistent condom use among Brazilian women in marital and civil unions

Syndemic Zika virus, HIV and unintended pregnancy call for an urgent understanding of dual method (condoms with another modern non-barrier contraceptive) and consistent condom use. Multinomial and logistic regression analysis using data from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS), a nationally representative household survey of reproductive-aged women in Brazil, identified the socio-demographic, fertility and relationship context correlates of exclusive non-barrier contraception, dual method use and condom use consistency. Among women in marital and civil unions, half reported dual protection (30% condoms, 20% dual methods). In adjusted models, condom use was associated with older age and living in the northern region of Brazil or in urban areas, whereas dual method use (versus condom use) was associated with younger age, living in the southern region of Brazil, living in non-urban areas and relationship age homogamy. Among condom users, consistent condom use was associated with reporting Afro-religion or other religion, not wanting (more) children and using condoms only (versus dual methods). Findings highlight that integrated STI prevention and family planning services should target young married/in union women, couples not wanting (more) children and heterogamous relationships to increase dual method use and consistent condom use.     

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。     

老年人前后牙牙髓感觉功能昼夜节律性的比较研究

目的：比较老年人前、后牙牙髓感觉昼夜节律的差异，以指导选择老年人缺失牙修复最佳就医时间。方法：在24h内7个等距间隔时间点，测定20名受试老年人上颌中切牙（切牙组）和下颌第一恒磨牙（磨牙组）牙髓活力的阈值，运用Halberg余弦法分析切牙组和磨牙组牙髓感觉功能的生物节律，并比较二者的差异。结果：两者整体变化趋势一致，感觉阈值的最高峰和最低谷分别出现在0：00与12：00。磨牙牙髓感觉闽值的振幅、振幅比中值大干切牙，整体水平和中值略高于切牙。结论：老年人切牙与磨牙的牙髓感觉功能均具有昼夜节律性，感觉最迟钝和最敏感的时间分别在0：00与12：00。     

谷氨酸钠的安全性研究进展

谷氨酸钠是一种氨基酸的钠盐,大量摄入时,会导致血液谷氨酸浓度显著上升,可引起一系列有害影响.谷氨酸钠高暴露可干扰下丘脑的信号传导和瘦素功能,引起机体出现代谢综合征症状,母体高暴露可致新生儿出现代谢紊乱,新生儿期高暴露可致成年代谢综合征.谷氨酸钠还可诱导神经兴奋毒性,引起化学性脑损伤;以剂量依赖的方式损害男性生殖系统,通过损伤卵巢和子宫的功能来抑制雌性生殖功能;通过改变肾脏抗氧化系统损伤肾细胞和肾功能.本文对谷氨酸钠的安全性研究进展进行综述.     

高龄女性促排卵长方案与拮抗剂方案临床分析

目的 分析高龄女性体外受精-胚胎移植（IVF-ET）助孕治疗中两种促排卵方案（长方案与拮抗剂方案）的临床结局。方法回顾性分析郑州大学第三附属医院2016年3月至2018年3月收治的年龄≥35周岁、采用两种不同促排卵方案行体IVF-ET/体外单精子胞内注射-胚胎移植（ICSI-ET）助孕的2 515个周期患者,分为长方案组（1 545周期）与拮抗剂方案组（970周期）。结合两组患者的年龄、不孕年限、月经周期天数、体质指数（BMI）、基础内分泌水平、抗苗勒管激素（AMH）、基础窦卵泡数（AFC）等相关指标,比较两组患者促性腺激素（Gn）天数、Gn用量、获卵数、受精率、可移植胚胎数、子宫内膜厚度、周期取消率、妊娠率、卵巢过度刺激综合征（OHSS）发生率和流产率等结局相关指标。结果（1）在不同促排卵方案中不孕年限、月经周期天数、BMI、基础内分泌水平、AMH、AFC均差异无统计学意义(P>0.05);（2）拮抗剂方案组患者治疗中Gn使用量及使用时间,统计均低于长方案患者,差异有统计学意义（P<0.001）;（3）两组在获卵数、受精率、流产率、有效胚胎数、子宫内膜厚度差异无统计学意义(P>0.05);统计拮抗剂方案组患者OHSS发生率明显低于长方案组患者,而有效胚胎数、妊娠率高于长方案组,差异有统计学意义（P<0.05）。结论拮抗剂方案促排卵在高龄女性IVF助孕治疗中,可明显降低Gn用量和Gn使用时间的前提下获得更多可移植有效胚胎,提高妊娠率降低OHSS发生率,在条件相当的前提下,为高龄患者推荐选择的促排卵方案。