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Pathogenesis, diagnosis, and treatment of recurrent spontaneous abortion with immune type

Qi-De LIN, Li-Hua QIU

《医学前沿（英文）》 2010年第4卷第3期页码 275-279 doi: 10.1007/s11684-010-0101-y

摘要： Recurrent spontaneous abortion (RSA), defined as three or more consecutive pregnancy losses before 20 weeks of gestation, is difficult to treat in the clinical setting. It affects 1%–5% of women of reproductive age. In the investigations of immunopathogenesis, diagnosis, and treatment of RSA since the late 1980s, it was found that RSA was associated with abnormal maternal local or systemic immune response. The pathogenesis of autoimmune RSA was mainly associated with antiphospholipid antibody (APA), while that of alloimmune RSA was due to the disturbance of maternofetal immunological tolerance. Systemic etiological screening process and diagnosis systems of RSA with immune type were developed, and anticardiolipin (ACL or ACA) + anti-β2-GP1 antibody combining multiple assays for effective diagnosis of RSA with autoimmune type was first established. According to the dynamic monitoring of clinical parameters before and during gestation, low-dose, short-course, and individual immunosuppressive therapy and lymphocyte immunotherapy for RSA with immune type were carried out. The outcomes of the offsprings of patients with RSA were followed up, and the safety and validity of the therapies were confirmed. The research achievement leads to great progress in the diagnosis and treatment of RSA in China.

关键词： spontaneous abortion recurrent autoimmune alloimmune pathogenesis diagnosis immunotherapy

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自然流产的细胞遗传学研究进展

罗岚蓉,李坚

《中国工程科学》 2015年第17卷第6期页码 65-69

摘要：

自然流产是妊娠并发症，指妊娠在28周之前自然终止，其发病率在15 %～40 %。近年来在辅助生育技术的使用中，同样面临着较高的自然流产率的问题。自然流产的病因十分复杂，除了遗传因素以外，还包括解剖因素、内分泌因素、感染因素、环境因素、免疫因素、血栓前状态以及母体的全身性疾病等等。自然流产的细胞遗传学研究，主要在两个方面，一是胚胎染色体的异常，包括染色体数量异常和结构异常；二是夫妇染色体的异常。在自然流产中胚胎染色体异常的检出率在60 %左右，且随着流产次数的增加，染色体异常的比例下降。其中大部分为胚胎染色体数目异常如三体、三倍体及X单体等，较少为染色体结构异常，包括染色体断裂、倒置、缺失和易位等。在自然流产的夫妇中，尤其是反复自然流产的夫妇，其染色体异常的检出率在8 %左右，且随着流产次数的增加异常的比例升高。成人染色体的异常多为染色体的平衡易位。随着细胞遗传学的检测技术的发展，从传统染色体核型分析和荧光原位杂交技术到染色体微阵列芯片分析、第二代测序技术即高通量测序技术的相继应用，使得自然流产的遗传学方面的研究更加深入。自然流产的细胞遗传学的研究进展，对于自然流产的病因研究以及生育指导有着非常重要的意义。

关键词：自然流产细胞遗传学染色体异常

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Association between history of abortion and metabolic syndrome in middle-aged and elderly Chinese women

null

《医学前沿（英文）》 2013年第7卷第1期页码 132-137 doi: 10.1007/s11684-013-0250-x

摘要：

Epidemiologic studies have suggested that abortion may cause long term health consequences such as cardiovascular disease. Until recently, studies focusing on the association between history of abortion and metabolic diseases were limited. In the present study, we aimed to investigate the association between history of abortion and metabolic syndrome (MetS) in middle-aged and elderly Chinese women. A cross-sectional survey was performed in 6302 women (age≥40 years) in Shanghai. Standardized questionnaire was used to obtain the information about reproductive histories. Overall, we observed a positive association between history of induced abortion and the prevalence of MetS, independent of potential confounding factors. A multivariable-adjusted logistic regression analysis revealed that compared to those without a history of induced abortion, women with a history of induced abortion remained at 1.25 times more likely to have MetS (OR=1.25, 95% CI=1.06–1.47, P<0.05), and the association was number-dependent. However, no significant association between history of spontaneous abortion and the prevalence of MetS was observed. Compared to those without a history of spontaneous abortion, the multivariate-adjusted odds ratio associated with a history of spontaneous abortion for MetS was 0.88 (95% CI=0.65–1.19, P >0.05).

关键词： induced abortion spontaneous abortion metabolic syndrome

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流产后避孕咨询与教育对人工流产后妇女避孕行为的影响初探

袁钦钦,许良智,宿宓,聂颖

《中国工程科学》 2014年第16卷第5期页码 34-38

摘要：

探讨对人工流产术后女性加强流产后避孕咨询与教育对其避孕行为的影响。选择2011年8月1 日—2011 年9 月30 日在四川大学华西第二医院妇产科门诊自愿行人工流产术的女性200 人，进行术后常规处理（常规处理组）。选择2011 年10 月25 日—2012 年4 月10 日在四川大学华西第二医院妇产科门诊自愿行人工流产术的女性200 人，流产后常规处理并加强避孕咨询与教育（加强干预组），两组均于术后1 个月、3 个月、6 个月进行随访调查。常规处理组和加强干预组半年后随访率分别为46 %，71.5 %（P<0.01）。常规处理组和加强干预组流产后4 周内性生活的恢复率分别为10.8 %，3.5 %（P<0.05）；半年内加强干预组避孕行为的正确率高于常规处理组(P<0.01)，而且其避孕套、复方口服避孕药（COC）和节育环等现代避孕措施的使用率高于常规处理组(P<0.01)，安全期和体外排精等传统避孕方法使用率低于常规处理组（P<0.01）；常规处理组和加强干预组非意愿妊娠率分别为7.0 %，1.5 %（P>0.05）。研究表明，及时通过加强流产后避孕咨询与教育，能提高人工流产后女性的避孕意识，增加避孕知识，提高正确避孕措施的使用率，更好地促进了女性的生殖健康。

关键词：人工流产流产后咨询与教育避孕行为

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PAC在人工流产术后计划生育关爱中的应用

钟慧玲

《中国工程科学》 2014年第16卷第5期页码 31-33

摘要：

文本研究人流后关爱（PAC）在人工流产术后计划生育关爱中的应用。选择2011年1月—2013年1月，武汉市蔡甸区计划生育服务站门诊进行人工流产的260 名病例为分析对象，根据其先后序号按照奇偶顺序分为关爱PAC组和对照组，每组130 例，对PAC组进行流产后关爱指导，而对照组只进行常规处理。一年后，共收回有效问卷248 份，其中关爱组126 份，对照组122 份。PAC组避孕知识和人流后保健知识掌握优良率均高于对照组，生活质量评分有明显优势，而重复流产率明显较低，育龄妇女满意率较高。其差异均有统计学意义（P<0.05）。高价值的PAC关爱，对于减少重复流产的概率和提高生活质量有着积极重要的意义。

关键词：人工流产流产后关爱计划生育关爱效果分析

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人流不全的临床特点分析及生育情况调查

罗岚蓉,李坚

《中国工程科学》 2015年第17卷第6期页码 70-76

摘要：

目的：分析人流不全的临床特点，探讨其发生的高危因素，同时调查患者术后的生育及避孕情况。方法：对首都医科大学附属北京妇产医院2007年10月—2012年10月收治的55例人流不全病历进行回顾性病例分析以及电话随访了解其生育情况及避孕情况。结果：人流不全的主要临床表现为人流术后的异常阴道出血42例（42/55，76.4 %）以及月经异常13例（13/55，23.6 %），超声检查可以发现人流不全造成的宫腔内异常，但需要结合人绒毛膜促性腺激素（HCG）水平的测定以及术后的病理来诊断人流不全。B超下的清宫手术能有效地清除残留的妊娠组织，术后均未再发现宫腔残留。人流不全的高危因素中主要的客观因素为子宫过度屈曲，占23.6 %（13/55），主要的主观因素为宫颈扩张不够，占25.5 %（14/55）。二次清宫术后主要并发症为宫腔粘连，发生率为5.5 %（3/55）。55例患者术后共随访到29例患者，有17例再次妊娠，其中11例妊娠分娩，6例选择人工流产终止妊娠，未发现人流不全二次清宫对生育的明显不良影响。无生育要求的妇女均有意识采取避孕方法来避免意外妊娠。结论：人流不全的主要临床表现为手术后异常的阴道出血，通过结合尿或血的HCG检查以及B超检查，可以及时地发现人流不全。超声指导下清宫是治疗的有效办法。人流不全发生的高危因素，主要客观因素为子宫过度屈曲，主要主观因素为宫颈扩张不够。对于存在高危因素的手术采取超声指示下手术，能够有效地降低人流不全的发生率。人流不全二次清宫术后主要手术并发症为宫腔粘连，无手术并发症发生的患者，未发现明显生育能力的受损。但是对于避孕方法的选择，还需要更多的计划生育服务来帮助她们采取高效的避孕方法。

关键词：人流不全并发症宫腔粘连生育避孕

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Comparison of CT-guided aspiration to key hole craniotomy in the surgical treatment of spontaneous putaminal

ZHAO Jizong, WANG Dejiang, WANG Shuo, YUAN Ge, KANG Shuai, JI Nan, ZHAO Yuanli, YE Xun, ZHOU Liangfu, ZHOU Dingbiao, WANG Renzhi, WANG Mei

《医学前沿（英文）》 2007年第1卷第2期页码 142-146 doi: 10.1007/s11684-007-0027-1

摘要： This study was designed to compare the approaches and efficacies of two different ways of neurosurgical management for spontaneous putaminal hemorrhage (SPH): computed tomographic-guided aspiration (CTGA) and the key-hole approach (KHA). The indications of the two approaches are also explored. From September 2001 to 2003, a total of 1077 cases of SPH distributed in 135 hospitals all over the mainland of China were included for analysis. All cases had three-month follow-up data. The study was designed in a single-blinded manner to compare the efficacies of the different approaches. There were 563 cases in the CTGA group, 165 in the KHA group, and 217 cases in the conventional open craniotomy (COC) group. In the CTGA and KHA groups, the mortalities at one month after operation (M1m) were 17.9% and 18.3%, respectively, while the mortalities at three months after operation (M3m) were 19.4% and 19.4%, respectively (>0.05). The postoperative complications due to CTGA (23.7%) were not significantly different from those due to KHA (25.7%) ( = 0.420). The M3m of patients with Glasgow coma scale (GCS) "d8 was 3.45 and 4.0 times as much as those with GCS>8, respectively. The M3m of patients with complications was 3.92 times as much as those without complications. The M3m of patients with hemorrhage volume "e70 mL was 2.67 times as much as those <70 mL. The CTGA is not better than KHA in the treatment of SPH in terms of a more favorable outcome or less mor tality and morbidity, but CTGA could be the first choice for those with bleeding volumes "d50mL, while KHA is the first choice for those with bleeding volumes >50 mL.

关键词： tomographic-guided aspiration single-blinded manner favorable outcome operation Glasgow

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屈螺酮炔雌醇片预防稽留流产清宫术后宫腔粘连初步研究

赵现立,刘朝阳,谭宏伟,张恩娣

《中国工程科学》 2015年第17卷第6期页码 13-15

摘要：

目的：观察稽留流产清宫术后服用屈螺酮炔雌醇片对减轻宫腔粘连发生的效果。方法：选择2013年6月至2014年6月在西北妇女儿童医院（陕西省妇幼保健院）诊断为稽留流产并实施清宫术的患者220例，随机分成观察组和对照组，每组110例。两组患者均在清宫术前服用米非司酮片150 mg和米索前列醇片600 μg治疗，术后常规应用抗生素3天。观察组：清宫术后给予屈螺酮炔雌醇片，每天服用一片，连续3个周期，对照组：患者实施清宫术后不给予屈螺酮炔雌醇片治疗。观察手术时间、胚胎绒毛大小、患者阴道流血持续时间、月经复潮时间、术后2周超声检查子宫内膜以及宫腔镜检查宫腔粘连情况。结果：观察组术后阴道流血天数（（4.98±0.80）天）及月经复潮时间（（28.41±1.61）天）显著少于对照组（P＜0.05）。观察组患者术后子宫内膜厚度（（9.12±1.12） mm）明显高于对照组子宫内膜厚度（（6.23±1.16）mm），两组比较差异有统计学意义（P＜0.05）。观察组的宫腔粘连率显著低于对照组（x2=4.67，P=0.031）。结论：清宫术后口服屈螺酮炔雌醇片是减少稽留流产术后发生宫腔粘连的一种安全有效的方法。

关键词：稽留流产宫腔粘连屈螺酮炔雌醇片

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Spontaneous polarization enhanced bismuth ferrate photoelectrode: fabrication and boosted photoelectrochemical

《能源前沿（英文）》 2021年第15卷第3期页码 781-790 doi: 10.1007/s11708-021-0782-8

摘要： In this paper, the fabrication of a highly orientated Bi₂Fe₄O₉ (BFO) photoelectrode in the presence of two-dimensional (2D) graphene oxide (GO) was reported. It was found that the GO can be used as a template for controlling the growth of BFO, and the nanoplate composites of BFO/reduced graphene oxide (RGO) with a high orientation can be fabricated. The thickness of the nanoplates became thinner as the ratio of GO increased. As a result, the ferroelectric spontaneous polarization unit arranges itself in the space in a periodic manner, leading to the formation of a polarization field along a special direction. Therefore, the created built-in electric field of the nanoplate composites of BFO/RGO is improved upon the increase of the amount of RGO. As expected, carrier separation is enhanced by the built-in electric field, therefore substantially enhancing the photoelectrochemical (PEC) activity of water splitting compared to pure BFO under the irradiation of visible-light.

关键词： bismuth ferrate ferroelectric polarisation photoelectrochemical (PEC) water splitting graphene oxide (GO) high orientation

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一项关于药物和补充剂对改善男性不育症患者的自然妊娠和精液参数影响的系统综述和网状荟萃分析 Article

李建, 吴奇, Ernest Hung Yu Ng, Ben Willem J. Mol, 吴效科, Chi Chiu Wang

《工程（英文）》 2022年第16卷第9期页码 198-209 doi: 10.1016/j.eng.2021.07.009

摘要：

本研究采用网状荟萃分析对药物和补充剂治疗特发性男性不育症的疗效进行比较，以获得最佳治疗方法。对Medline、EMBASE、OVID和CNKI等数据库中发表于1990年1月至2021年6月的文献进行检索，检索关键词包括“男性不育”“药物疗法”“补充/营养疗法”及其相关术语等。将研究药物[主要包括促卵泡激素（FSH）、雄激素、克罗米芬/他莫昔芬（SERM）]或补充剂[主要是锌、硒、维生素C/E、卡尼丁、辅酶Q₁₀（CoQ₁₀）或联合治疗]治疗特发性不育男性的随机对照试验（RCT）纳入meta分析。按PRISMA声明中的报告规范提取数据，并使用偏倚风险工具和适用于网状meta分析的GRADE系统评估证据质量。研究的主要结局是活产率和自然妊娠率（SPR），次要结局是精子参数（包括精子浓度、前向运动百分比和形态）和不良反应。65项RCT被纳入分析，共包括7541名精子参数异常但激素水平正常的育龄男性。36项研究报道SPR，但仅三项研究报道活产率。纳入研究的质量评价为中、高级。与安慰剂或未治疗相比，卡尼汀联合维生素治疗显著增加SPR（RR = 3.7, 95% CI为1.6 ~ 8.5），脂肪酸补充剂显著增加精子浓度（MD = 12.5 × 10⁶ mL^–1, 95% CI为3.1 × 10⁶ ~ 22.0 × 10⁶）。SERM联合辅酶Q₁₀显著提升前向活力精子（MD = 11.0%, 95% CI为0.1% ~ 21.9%）和正常形态精子（MD = 11.0%, 95% CI为4.6% ~ 17.4%）。对改善SPR和精子浓度的最佳治疗方案分别是卡尼汀联合维生素和脂肪酸补充剂，即便排除具有高偏倚风险的研究，结果仍保持一致。对于少弱精子症男性，与安慰剂或未治疗相比，FSH（RR = 4.9, 95% CI为1.1 ~ 21.3）显著增加SPR，而SERM联合激肽酶可显著增加精子浓度（MD = 16.5 × 10⁶ mL^–1, 95% CI为1.6 × 10⁶ ~ 31.4 × 10⁶)，SERM联合辅酶Q₁₀则显著改善前向活力精子（MD = 11.3%, 95% CI为7.3% ~ 15.4%）和正常形态精子（MD = 11.2%, 95% CI为 5.4% ~ 16.9%）。在不良反应方面，脂肪酸补充剂和己酮可可碱分别与口臭或味觉差（RR = 8.1, 95% CI为1.0 ~ 63.5）和呕吐（RR = 8.0, 95% CI为1.0 ~ 63.0）相关。综上所述，对于改善不育男性配偶活产率的最佳治疗方案仍然不清楚。对于所有不孕夫妇和男性少弱精症不孕夫妇，卡尼汀联合维生素和FSH方案在成功实现自然妊娠方面分别优于其他方案。其他治疗方法对妊娠结局的疗效仍需要进一步验证。

关键词：男性不育症药物补充剂自然妊娠率精子参数

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天津滨海新区产后妇女对避孕相关问题的认知现状分析

秦丽艳

《中国工程科学》 2015年第17卷第6期页码 53-56

摘要：

通过对天津滨海新区产后妇女对避孕相关问题的认知现状的调查分析，以期认识到提高产后妇女的整体避孕意识的必要性。采用自行设计问卷，由固定医师进行询问并填写问卷。产后妇女中81.9 %的人知道产后应该避孕，但只有46.9 %知道产后高危人工流产的危害，48.8 %的产后妇女没有避孕计划或打算3个月后再采取避孕措施，47.2 %的产后妇女计划或已于首次性生活采取避孕措施，其中学历高、职业为干部组、剖宫产的产后妇女避孕意识较好，258人（80.6 %）通过住院分娩或产后访视得知产后应避孕，207人（64.7 %）在产后避孕方法上首选避孕套。产后妇女选择长效可靠避孕措施的少，医护工作者应提高对产后妇女有关产后避孕的指导和宣传，提高产后妇女对避孕效果可靠措施的使用率，提高产后妇女的生活质量。

关键词：产后妇女；避孕；人工流产

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Spontaneous firing properties of rat medial vestibular nucleus neurons in brain slices by infrared visual

XIA Jiao, KONG Weijia, ZHU Yun, ZHOU Yan, ZHANG Yu, GUO Changkai

《医学前沿（英文）》 2008年第2卷第3期页码 264-268 doi: 10.1007/s11684-008-0050-x

摘要： Domestic application of infrared patch clamp techniques on brain slices is limited. The key of the technique is to prepare high-quality brain slices. The present paper describes the preparation procedure of brainstem slices and the spontaneous firing properties of rat medial vestibular nucleus (MVN) neurons. By infrared differential interference contrast technique, neurons of rat MVN were visualized directly at the depth of 50–100 ?m underneath the surface of slices. Firing activities of MVN neurons were recorded by the whole-cell patch clamp technique in artificial cerebrospinal fluid (ACSF) and low Ca - high Mg fluid. The firing mode was more irregular and depressive in low Ca - high Mg fluid than in ACSF. According to the averaged waveform of action potentials, cells were classified as the neurons with monophasic after-hyperpolarization potential (AHP), and the neurons with biphasic AHP. The resting membrane potential (RMP), input resistance (Rin) and membrane capacitance (Cm) of neurons were recorded and compared between groups. With infrared videomicroscopy, patch clamp recordings could be made under direct observation in freshly prepared brainstem slices. The discharge activities of MVN neurons were spontaneous and the firing mode was modulated by extracellular calcium concentration. The basic membrane properties of two types of neurons were not significantly different, while the differences in waveform might play a role in the segregation between tonic and kinetic cells.

关键词： resistance infrared infrared videomicroscopy depressive after-hyperpolarization potential

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Role of chemerin/CMKLR1 in the maintenance of early pregnancy

Xuezhou Yang, Junning Yao, Qipeng Wei, Jinhai Ye, Xiaofang Yin, Xiaozhen Quan, Yanli Lan, Hui Xing

《医学前沿（英文）》 2018年第12卷第5期页码 525-532 doi: 10.1007/s11684-017-0577-9

摘要：

Chemerin is a cytokine that attracts much attention in the reproductive process. This study aimed to explore the effects of chemerin and its receptor chemokine-like receptor 1 (CMKLR1) on the maintenance of early pregnancy. The expression levels of chemerin and CMKLR1 in the decidua tissues of 20 early normal pregnant women and 20 early spontaneous abortion women were examined by Western blot and real-time polymerase chain reaction analyses. CMKLR1 receptor antagonist (α-NETA) was then intrauterinely injected into normal pregnant mice model to assess its effect on the outcome of pregnancy and the phosphorylation rate of ERK1/2 in decidua tissues. We found that the expression level of chemerin in women who had experienced early spontaneous abortion was lower than in those who had experienced normal early pregnancy (P<0.01); conversely, CMKLR1 expression was higher in the former than in the latter (P<0.01). In a pregnant-mouse model, the embryo resorption rate of α-NETA group was higher than that in the negative control group (61.5% vs. 10.8%) (P<0.001). Compared with the control group, ERK1/2 phosphorylation in decidua tissues decreased in the α-NETA-treated group (P<0.01). These results suggested that the inhibition of the chemerin/CMKLR1 signaling pathway can lead to the abortion of mouse embryos, and that chemerin/CMKLR1 may play an important role in the maintenance of early pregnancy possibly by regulating ERK1/2 phosphorylation.

关键词： chemerin CMKLR1 early abortion

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中央企业应该也能够率先成为自主创新的主体

顾大钊

《中国工程科学》 2008年第10卷第10期页码 9-13

摘要：

系统分析了中央企业在我国经济中的地位和作用、中央企业本身技术需求、经济实力、科技资源和成果转化特点，指出中央企业应该也能够率先成为自主创新的主体。而要实现这一目标，必须充分调动企业、企业科技管理人员和企业研发人员技术创新的积极性，结合神华的成功经验，提出了企业基于技术资源整合成为自主创新主体的新模式。

关键词：中央企业技术创新资源整合

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Numerical study and control method of interaction of nucleation and boundary layer separation in condensing flow

Liansuo AN , Zhi WANG , Zhonghe HAN ,

《能源前沿（英文）》 2009年第3卷第3期页码 254-261 doi: 10.1007/s11708-009-0047-4

摘要： The spontaneous nucleation flow in turbine cascade was numerically studied. The model was implemented within a full Navier–Stokes viscous flow solution procedure and the process of condensation was calculated by the quadrature method of moments that shows good accuracy with very broad size distributions. Results were presented for viscous and inviscous flow, showing the influence of boundary layer separation and wake vortices on spontaneous nucleation. The results show that the degree of flow separation in wet steam flow is greater than that in superheated steam flow due to condensation shock and that the loss cannot be neglected. Furthermore, the impact of boundary layer separation and wake vortices on velocity profiles and its implications for profile loss were considered. The calculations showed that layer separation and wake vortices influence nucleation rate, leading to different droplet distributions. A method for controlling homogeneous nucleation and for reducing degree of flow separation in high-speed transonic wet steam flow was presented. The liquid phase parameter distribution is sensitive to the suction side profile of turbine cascade, which impacts the nucleation rate distribution leading to different droplet distributions and affects the degree of flow separation. The numerical study provides a practical design method for turbine blade to reduce wetness losses.

关键词： wet steam two-phase flow spontaneous condensation numerical simulation flow separation profile loss