重庆市孕前生殖健康与出生结局队列：设计简介与建设概况

出生队列是研究生命早期暴露对健康结局影响的重要工具, 但目前缺乏有力支撑孕前暴露特别是父系暴露对生殖健康和妊娠结局影响研究的大型队列平台。重庆市孕前生殖健康与出生结局队列研究是起始于孕前阶段, 同等关注男女双方的环境、心理、行为等暴露因素对生殖健康和不良妊娠结局影响的前瞻性队列研究。项目于2019年正式启动, 计划招募有生育意愿的育龄夫妇20 800人。通过随访, 调查志愿者2年内是否自然受孕。对进入妊娠期的女性志愿者, 在孕早、中、晚期进一步随访, 并对分娩的子代随访至2岁, 监测早产、低出生体重、出生缺陷、神经功能发育障碍等结局发生情况。各阶段分别采集相应的数据信息和生物样本, 包括精液、外周血、尿液、胎盘、脐带、脐带血、口腔拭子等。截至2022年1月, 已纳入志愿者8 698人, 分布于重庆市所有38个区/县。本队列建设目标是成为涵盖父母双方的前瞻性大样本孕前出生队列, 将以独特的设计和更加全面的视角阐明全生育周期特别是孕前期暴露因素对生殖健康和不良出生结局的影响及机制。     

Hemifacial spasm caused by a tortuous recurrent perforating artery: A case report

IntroductionWhen the culprit vessel in hemifacial spasm (HFS) is hard to determine, this is a challenge in microvascular decompression (MVD) surgery. In such a situation, small arteries such as perforators to the brainstem might be suspected. But small arteries are omnipresent near the facial nerve root exit/entry zone (fREZ). How to decide whether a given small artery is responsible for HFS is unclear.MethodWe report a case with a previously unreported form of neurovascular impingement, in which the culprit was found to be the recurrent perforating artery (RPA) from the anterior inferior cerebellar artery (AICA). An aberrant anatomic configuration of the RPA was found intraoperatively, which we thought was responsible for generating focal pressure on the facial nerve.Case reportA 62-year-old woman presented with a 1-year history of paroxysmal but increasingly frequent twitching in her right face. MRI showed tortuosity of the vertebral artery and apparently marked neurovascular impingement on the asymptomatic left side, while only the right AICA could be implicated as the possible culprit. Hemifacial spasm was diagnosed based on the typical clinical manifestation, and MVD was performed. The pre-meatal segment of the AICA was found not to be impinging the facial nerve at any susceptible portion near the fREZ: root exit point, attached segment, or root detachment point. The real culprit was in fact the RPA. This occult culprit vessel was tortuous, forming a coil-shaped twist which was interposed between the facial nerve and the intermediate nerve near the root detachment point. Focal pressure atrophy of the nerve was clearly observed at the compressing site. The patient achieved total spasm relief immediately after surgery, and remained spasm-free at 1-year follow-up, without any postoperative complications.ConclusionMVD is the only curative treatment for hemifacial spasm, but with a failure rate of around 10%. Mistaking the real culprit has been reported to be the most likely reason for surgical failure. Therefore, intraoperative identification of atypical occult forms of vascular compression is of importance to improve surgical outcome. In the present case, the RPA formed a coil-shaped twist, which inflicted focal vascular compression causing hemifacial spasm. We recommend careful inspection of the recurrent perforating artery during MVD for HFS, and decompressing any such neurovascular impingement.     

重庆地区艾滋病病毒感染孕产妇接受预防艾滋病母婴传播干预现状及对策分析

目的通过对艾滋病病毒(HIV)感染孕产妇及所生婴儿采取预防艾滋病母婴传播措施的现状分析,探讨重庆地区预防艾滋病母婴传播干预措施实施的相关影响因素及对策。方法采用统一问卷及个案表,对68例HIV感染孕产妇进行有关检测时间、感染原因、妊娠结局、影响各种预防传播措施的实施情况的回顾性调查。结果在调查的68例HIV感染孕产妇中,22例在孕期终止了妊娠,占32.4%。28.3%的分娩产妇和68.6%的新生儿服用了抗逆转录病毒药物,100%婴儿采用了人工喂养方式。结论现行的预防艾滋病母婴传播措施是可行的。孕产妇初次产检的时间影响了孕产妇的服药比例,应该提高孕早期检测率。     

超声在新生儿肺炎诊断中的应用

新生儿肺炎作为新生儿常见疾病,严重危害新生儿健康,是导致其死亡的重要原因。目前临床诊断新生儿肺炎的主要方法为X线摄片。随着超声技术的发展,其在肺部疾病诊断中的应用也越来越多。本文就超声在新生儿肺炎的辅助诊断及治疗随访中的应用现状与进展进行综述。     

SARS-CoV-2病毒载量及其临床意义

在应对全球大流行的2019年冠状病毒病(COVID-19)疫情过程中,对患者、疑似感染者或接触者进行SARS-CoV-2病毒核酸检测是确认感染、管理感染者、预防病毒扩散的重要措施。核酸检测不仅反映了检测对象的病毒感染状态,大部分检测结果还能够对阳性样品进行定量。理论上多种病毒疾病中,病毒载量与患者潜在感染性、疾病转归等密切相关。本文拟简要介绍实时荧光RT-PCR和数字PCR测定SARS-CoV-2病毒载量的原理及特点,探讨病毒载量在宿主体内分布及其动态变化,分析病毒载量与疾病严重程度、患者感染性以及与疾病预后的相关性,以便深入认识COVID-19特征,指导感染控制、患者治疗与管理,更加精准地抗击大流行疫情。     

Impact of hepatitis B virus infection on maternal and infant outcomes of women with gestational diabetes mellitus: A three-year retrospective study

AimsTo explore the impact of HBV infection on maternal and infant outcomes of GDM women.MethodsWe retrospectively identified 8126 women with GDM in China from July 2017 to June 2020, and divided them into GDM with HBV infection group (n = 483) and GDM with non-HBV infection group (n = 7643). Two sample t-test and Chi-square test were used to compare differences between groups. Logistic regression models were used to explore the association between HBV infection and maternal and infant outcomes.ResultsPlacental abruption (PA), (2.3% vs. 1.0%, P = 0.008), placenta previa (4.3% vs. 2.8% p = 0.044), intrahepatic cholestasis of pregnancy (ICP), (6.4% vs. 3.0%, P < 0.001), cesarean section (52.0% vs. 46.0%, P = 0.011), fetal chromosomal abnormalities (1.2% vs. 0.4%, P = 0.021), and neonatal hyperglycemia (1.9% vs. 3.6%, P = 0.047) were more likely to occur in GDM with HBV infection group. After adjusting for the covariates, HBV infection was found to be associated with ICP (aOR, 2.35; 95% CI: [1.58–3.50]), PA (aOR, 2.34; 95% CI: 1.22–4.47), and fetal chromosomal abnormalities (aOR, 2.88; 95% CI: 1.18–7.03).ConclusionsHBV infection was associated with part of maternal and infant outcomes in the GDM population.     

基因重组促卵泡激素(FSH)与尿源性FSH用于体外受精-胚胎移植的Meta分析

目的:比较体外受精(IVF)或卵胞质内单精子注射(ICSI)治疗周期基因重组促卵泡激素(rFSH)与尿源性促卵泡激素(uFSH)在控制性促排卵(COS)中的有效性。方法:检索Pub Med、EMBASE、Cochrane,CNKI及万方数据库中自rFSH上市至2013.09前发表的文章,收集rFSH与uFSH在IVF或ICSI中应用的随机对照研究,对纳入的研究进行质量评价,提取数据,采用Rev Man5.2软件对IVF或ICSI治疗周期的获卵数、FSH总用量、周期出生率、临床妊娠率、持续妊娠率、卵巢过度刺激综合征(OHSS)的相对有效性进行Meta分析。结果:共纳入21篇研究,6 496个周期。总体上,rFSH较uFSH获卵数更多,FSH总用药量更少,差异有显著统计学意义;周期出生率和临床妊娠率r FSH和u FSH之间无显著性差异。结论:rFSH较uFSH在辅助生殖中具有更好的COS有效性。     

Alterations in Gut Vitamin and Amino Acid Metabolism are Associated with Symptoms and Neurodevelopment in Children with Autism Spectrum Disorder

Journal of Autism and Developmental Disorders - Metabolic disturbance may be implicated in the pathogenesis of autism. This study aimed to investigate the gut metabolomic profiles of autistic...