Objective: To investigate the possible pathogenesis and possible risk factors of tinnitus related to female menopause. Methods: From April 2016 to October 2016, 59 female patients with menopausal syndrome were diagnosed in the menopause comprehensive management clinic. Tinnitus and menopause questionnaires were conducted, based on whether having tinnitus, those patients were divided into two groups: tinnitus group and no tinnitus group. Age, body mass index (BMI), Kupperman menopausal index (KMI) score, follicle-stimulating hormone (FSH) level of patients in the two groups were analyzed. Menopausal symptoms, related medical history and possible related factors of tinnitus were statistically analyzed. Results: A total of 59 cases were collected, 22 of which were accompanied by tinnitus. The incidence of idiopathic tinnitus was 35.1% (20/57) because 2 cases of thyroid related tinnitus with clear etiology were removed. Complete data were obtained from 17 of 20 patients with idiopathic tinnitus and 26 of 37 patients without tinnitus. Age, BMI, menopause KMI score, hormone level, menopause symptoms and possible factors related to tinnitus were statistically analyzed between the two groups, and the incidence of headache was statistically different between the two groups (χ2=9.098, P=0.003), but no other factors were statistically significant(P>0.05). The severity of insomnia and tinnitus were further analyzed (χ2=2.841, P=0.417), and there was no significant difference between the two groups. Conclusion: Headache history may be one of the high risk factors for the occurrence of menopausal tinnitus.

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. The ketogenic diet (KD), a diet high in fat and low in carbohydrates, has been applied clinically for the treatment of obese women with PCOS. We have previously demonstrated that KD improved the reproductive phenotype in an androgen-induced PCOS mouse model, yet the underlying molecular mechanisms remain largely unclear. The aim of the present study was to investigate the effect of KD on the reproductive phenotype of a letrozole-induced PCOS mouse model. Female C57BL/6N mice were divided into three groups, designated control, letrozole, and letrozole + KD groups. Mice of control and letrozole groups were fed the control diet, whereas letrozole + KD mice were fed a KD with 89.9

Background Overweight/obese women are a growing population with high incidence of depression, anxiety and psychological abnormalities. Due to lack of effective responsive measures to emotions and behaviors, weight loss outcomes are often unsatisfactory in overweight/obese women with anxiety and depression. And less attention has been paid to weight loss outcomes and emotions in this group.Objective To explore the effect of daily self-weighing supported by online supervision on body composition and emotions in overweight/obese women with anxiety and depression.Methods A prospective, randomized, controlled study was conducted with 92 overweight/obese women with mild to moderate anxiety and depression voluntarily recruited from Beijing's Haidian District from October to December 2019. The subjects were randomized into an experimental group (n=46) and a control group (n=46) at a ratio of 1∶1, and treated with weight control interventions for three months: besides eating the appropriate food combinations with scientific and individualized guidance and excising rationally, the experimental group measured their body weight daily with online supervision from the special member of our research group and reported the data to the group, while the control group measured their body weight per month, which was collected by our research group through monthly telephone follow-up. Body composition measurement result, anxiety assessed using Self-Rating Anxiety Scale (SAS) and depression assessed using Self-Rating Depression Scale (SDS) were compared at baseline and three months after the intervention.Results All the participants completed the questionnaire assessment and follow-up. After the intervention, the control group had higher average body weight, BMI, body fat percentage and body fat as well as larger average visceral fat area than the experimental group （P<0.05） . Reduced body weight, BMI, body fat percentage, body fat and visceral fat area were seen in the experimental group after intervention （P<0.05） . The SAS score and SDS score in the experimental group were also lowered after intervention （P<0.05） . The average post-intervention scores of SAS and SDS in the experimental group were lower than those in the control group （P<0.05） .Conclusion In overweight/obese women with anxiety and depression, daily self-weighing with online supervision contributes to weight and fat loss and the improvement of anxiety and depression symptoms, which is a simple, effective and safe intervention measure.

多囊卵巢综合征(PCOS)是育龄期女性最常见的妇科内分泌疾病之一.生酮饮食(KD)是一种以低碳水化合物、高脂肪、适量蛋白质为特点的饮食结构.2019年专家组组织了妇科专家和营养专家共同制定并发布了《生酮饮食干预多囊卵巢综合征中国专家共识(2018年版)》.鉴于近5年KD治疗在安全性和应用范围方面出现了大量新的临床数据,专家组决定对《生酮饮食干预多囊卵巢综合征中国专家共识(2018年版)》进行修订和数据更新.主要更新内容有:①更新中国PCOS患病率研究数据;②增加PCOS中的代谢综合征与饮食干预临床证据;③增加KD改善PCOS的循证证据及中国临床研究证据;④增加KD对与PCOS相关代谢综合征影响的循证医学证据;⑤提供短期和长期KD有效性和安全性证据;⑥增加低能量生酮饮食(LCKD)在PCOS中的应用及安全性证据;⑦增加PCOS治疗常用药物联合KD干预效果的证据;⑧完善KD干预PCOS的适应证、禁忌证、不良反应及对策;⑨完善KD中食物种类的选择及操作方法建议.

目的 评价富血小板纤维蛋白(platelet-rich fibrin,PRF)对宫腔粘连创面修复的形态学影响.方法 将经宫腔镜证实为宫腔粘连的患者68例按1:1随机分为PRF组与对照组,均行宫腔镜宫腔粘连分离术(TCRA)并留取子宫内膜组织,PRF组在TCRA后即刻、4周后宫腔置入PRF,对照组宫腔内未置入药物.8周后两组均行宫腔镜二探术评估粘连情况并再次留取子宫内膜组织.评估治疗前与治疗后8周子宫内膜形态学变化.结果 形态学研究显示PRF组治疗后腺体数量、Ki67、细胞角蛋白18(Cytokeratin 18,CK-18)、波形蛋白(Vimentin)平均荧光强度均增加,纤维化面积比例减小.PRF组子宫内膜腺体数量、Ki67平均荧光强度均显著高于对照组(P<0.05);纤维化面积比例小于对照组(P<0.01).结论 应用PRF治疗宫腔粘连,可以显著促进创面修复.

Research question: Do overweight/obese women with PCOS with different uric acid concentrations show different effects after a ketogenic diet intervention? Design: The study involved women with PCOS with a body mass index (BMI) of >= 24 kg/m(2). Groups showing different uric acid concentrations were given ketogenic diet guidance for 12 weeks. Weight, BMI, body fat percentage, fasting blood glucose, triacylglyerols, total cholesterol, uric acid and other metabolism-related indexes were measured. Results: After 12 weeks of the ketogenic diet intervention, body weight (hyperuricaemia group: P=0.001; non-hyperuricaemia group: P<0.001), BMI (hyperuricaemia group: P = 0.025; non-hyperuricaemia group: P<0.001) and body fat percentage (hyperuricaemia group: P<0.001; non-hyperuricaemia group: P<0.001) were decreased in both groups. There was greater weight loss in the non-hyperuricaemia group (hyperuricaemia group 11.2 +/- 4.6 kg versus non-hyperuricaemia group 14.7 +/- 4.8 kg; P < 0.05). In the non-hyperuricaemia group, uric acid concentrations increased significantly after 6 weeks of the ketogenic diet intervention (week 0: 5.69 +/- 0.84 mg/dl versus week 6: 8.41 +/- 2.33 mg/dl; P < 0.001) and reached the concentrations of the hyperuricaemia group (week 6: 9.37 +/- 2.43 mg/dl; P > 0.05). Conclusions: A ketogenic diet intervention is beneficial for overweight/obese women with PCOS with different serum uric acid concentrations. Participants with normal basal uric acid concentrations showed a greater fluctuation of serum uric acid concentrations during the ketogenic diet intervention and had a greater weight loss.

目的 总结某院妇科实施临床药师主导的围手术期抗菌药管理模式的经验与成效.方法 建立临床药师主导的抗菌药管理模式,点评妇科病区围手术期预防用抗菌药医嘱,比较干预前和干预后的住院患者抗菌药物使用率、抗菌药物使用强度以及二者的达标率等相关指标.结果 通过多种管理措施,妇科病区住院患者抗菌药物使用率由管理前的61.65％±8.27％降至干预后的54.31％±4.04％,抗菌药物使用强度由管理前的抗菌药物累计数(DDDs)54.42±8.99降至干预后的42.61±7.27,管理前后的两组数据经t检验,P<0.05,差异有统计学意义.抗菌药物使用率的达标率由12.5％提高至50％,抗菌药物使用强度的达标率由37.5％提高至75％.结论 临床药师参与妇科围手术期抗菌药预防性应用管理,有助于规范妇科抗菌药物的合理使用.

目的 探讨晚期卵巢癌及复发性卵巢癌患者经肿瘤细胞减灭术(CRS)和腹腔热灌注化疗(HIPEC)治疗后围手术期的不良事件情况.方法 回顾性分析2015年4月至2019年7月收治的95例经CRS+HIPEC治疗的晚期卵巢癌或复发性卵巢癌患者的临床病理资料.结果 原发性卵巢癌患者44例,复发性卵巢癌患者51例,死亡率和3～4级不良事件发生率分别为2.11％和29.5％.Logistic多因素分析显示直肠切除手术(OR=3.70,95％CI:1.29～10.59,P<0.05)是影响患者CRS+HIPEC术后严重不良事件的危险因素,而原发性卵巢癌、病理组织学类型和淋巴结转移非危险因素.结论 CRS+HIPEC术后患者严重不良事件发生率低,围手术期安全性可接受.

目的 探讨生酮饮食对超重/肥胖多囊卵巢综合征(PCOS)患者血清维生素D及糖脂代谢的影响.方法 选取2021年6-12月在首都医科大学附属北京世纪坛医院妇科门诊就诊的超重/肥胖PCOS患者51例,给予生酮饮食干预4周.比较患者干预前后体质量、维生素D以及糖脂代谢指标的变化.结果 生酮饮食干预4周后,患者维生素D水平从(16.37±5.67)ng/mL升高至(21.72±6.64)ng/mL,维生素D 水平不足或缺乏比率由82.35％降至45.10％,差异有统计学意义(P＜0.01);体成分分析显示,体质量[(81.11±11.23)kg 与(75.32±10.58)kg]、体质量指数[(29.87±3.79)kg/m2与(27.75±3.68)kg/m2]、体脂率[(40.77±4.70)％与(37.88±5.14)％]、内脏脂肪面积[(163.25±38.76)cm2与(142.56±39.53)cm2]、腰臀比[(0.96±0.05)与(0.94±0.06)]均下降,差异有统计学意义(P＜0.01);糖脂代谢指标显示,空腹胰岛素[(18.59±8.86)μIU/mL 与(11.43±4.90)μIU/mL]、空腹血糖[(5.57±1.90)mmol/L 与(4.90±0.78)mmol/L]、胰岛素抵抗指数[(4.62±2.55)与(2.52±1.20)]、糖化血红蛋白[(5.70±1.06)％与(5.24±0.63)％]、甘油三酯[(1.68±0.86)mmol/L 与(1.07±0.33)mmol/L]、高密度脂蛋白[(1.22±0.25)mmol/L与(1.07±0.21)mmol/L]均下降,差异有统计学意义(P＜0.01),总胆固醇[(4.98±1.09)mmol/L 与(4.80±0.91)mmol/L]、低密度脂蛋白[(3.42±1.02)mmol/L 与(3.27±0.91)mmol/L]下降,但差异无统计学意义(P＞0.05).干预前,患者维生素D水平与腰臀比呈显著负相关(r=-0.289,P=0.039);干预后,患者维生素D水平与腰臀比、内脏脂肪面积、空腹胰岛素、胰岛素抵抗指数均呈显著负相关(r=-0.361、-0.279、-0.329、-0.309,P＜0.05).结论 生酮饮食可以在有效减重的同时提高患者维生素D水平,改善糖脂代谢,维生素D与糖代谢之间有相互协同作用.

Background Female railway workers are a high-risk group for obesity. Information technology is increasingly used in interventions for weight loss in overweight and obese populations. Daily self-weighing is a cognitive-behavioral strategy for self-monitoring of weight, but its effect on weight loss remains still controversial. Objective To investigate the effect of daily self-weighing plus online group interaction on weight loss and development of healthy lifestyle in overweight and obese female workers in Beijing Railway Bureau. Methods A prospective randomized controlled study was conducted. Participants were 72 overweight or obese female workers of Beijing Railway Bureau voluntarily recruited from June 1 to September1, 2019. They were equally randomized into an experimental group and a control group, receiving different weight loss interventions for 3 months (intervention scheme for the experimental group: individualized diet and exercise recommendations, daily self-weighing plus online group-based cognitive-behavioral therapy for weight loss, and that for the control group: individualized diet and exercise recommendations, and self-measurement of body weight with weight management counseling during the telephone or hospital follow-up once a month). Baseline and post-intervention data of both groups were collected, including composition indices (body weight, BMI, body fat percentage, fat content, waist circumference, hip circumference, waist-to-hip ratio), blood lipid indices〔total cholesterol (TC), triacylglyceride (TG), high-density liptein cholesterol (HDL-C), low-density liptein cholesterol (LDL-C) 〕and total score and dimension scores of the Health Promoting Lifestyle Profile-Ⅱ (HPLP-Ⅱ). Univariate and multivariate Logistic regression was used to explore factors associated with a 5% or more weight loss from baseline. Results Seventy-one participants (35 cases and 36 controls) who completed the study were finally included for analysis. The each body composition index, each blood lipid index, and total score and dimension scores of the HPLP-Ⅱ were similar in both groups at baseline (P>0.05). After the intervention, the experimental group showed a significant decrease in the body composition indices (except the waist-to-hip ratio), blood lipid indices (except the HDL-C), and a significant increase in the total score and dimension scores of the HPLP-Ⅱ (P<0.05). However, no significant differences were found in each observation index in the control group before and after the intervention (P>0.05). Compared with the control group, the experimental group showed lower post-intervention body composition indices (except the waist-to-hip ratio) and blood lipid indices (except the HDL-C), and higher post-intervention total score and dimension scores of the HPLP-Ⅱ (P<0.05). A total of 22 participants (31.0%) had a weight loss of ≥5% from the baseline, including 16 cases (72.7%), and 6 controls (27.3%). Both univariate and multivariate Logistic regression analyses showed that intervention scheme and baseline nutrition status were the influencing factors of a 5% or more weight loss from baseline. Conclusion Daily self-weighing and online group-based cognitive-behavioral interventions contributed to weight loss, formation of a healthy lifestyle, and improvement in quality of life in overweight and obese female workers in Beijing Railway Bureau.

目的 探讨慢性子宫内膜炎与输卵管通畅性的关系.方法 分析2015年6月至2019年12月在北京世纪坛医院因可疑输卵管性不孕同时接受腹腔镜和宫腔镜检查的育龄妇女363例,所有患者术中均进行宫腔镜检查并留取子宫内膜组织进行C跨膜硫酸已酰肝素蛋白聚糖合癸聚糖-1(CD138)的检测确定是否存在慢性子宫内膜炎,同时进行腹腔镜下输卵管的美兰通液,判断输卵管的通畅性,根据美兰通液的结果分为:输卵管通畅组与输卵管梗阻组.比较2组患者慢性子宫内膜炎的患病率.结果 输卵管梗阻组患者既往盆腔炎性疾病患病率要明显高于输卵管通畅组(52/177与22/186),且差异具有统计学意义(P=0.007).慢性子宫内膜炎在输卵管通畅组患病率为(22/186,11.8％),慢性子宫内膜炎在输卵管梗阻组患病率为(53/177,29.9％),2组相比差异具有统计学意义(P<0.01).双侧输卵管阻塞组经过输卵管疏通治疗后1个月行输卵管超声造影评价输卵管通畅性,9例(5.1％)提示双侧输卵管梗阻,其中3例受试者子宫内膜病理活检提示存在慢性子宫内膜炎.二元Logistic回归分析的结果表明:慢性子宫内膜炎是输卵管阻塞发生的高危因素[OR值(95％CI):3.388(1.831,6.269),P<0.05].结论 慢性子宫内膜炎是输卵管阻塞发生的危险因素,慢性子宫内膜炎的存在与双侧输卵管阻塞疏通术后患者的预后密切相关.

目的 探讨卵巢癌患者接受肿瘤细胞减灭术(CRS)联合腹腔热灌注化疗(HIPEC)术后发生胸腔积液的危险因素.方法 分析首都医科大学附属北京世纪坛医院卵巢癌数据库中接受CRS+HIPEC的初治或复发卵巢癌临床病例数据.术后发生胸腔积液者纳入胸腔积液组,其余纳入非胸腔积液组.利用单因素和多因素Logistic回归对数据进行分析.结果 共纳入病例106例,年龄为(56.08±9.96)岁.研究对象术后胸腔积液发生率为51.89％(55/106),其中双侧胸腔积液占比63.64％(35/55),左侧胸腔积液占比25.45％(14/55),右侧胸腔积液占比10.91％(6/55).单因素分析显示初治/复发、手术时间、术中输液量、谷丙转氨酶、膈肌累及、腹水、低白蛋白血症比较差异有统计学意义(P＜0.05),多因素Logistic回归分析结果 表明:右侧膈肌累及(OR=5.66,95％CI:1.10～29.39)、腹水(OR=4.21,95％CI:1.05～16.83)、复发(OR=4.66,95％CI:1.32～16.42)是术后发生胸腔积液的独立危险因素.结论 右侧膈肌累及、腹水和复发是卵巢癌行CRS+HIPEC术后发生胸腔积液的独立危险因素,术后应加强对复发卵巢癌患者,尤其是存在右侧膈肌受累患者的关注,及时引流腹水,防止胸腔积液的发生发展.

Perimenopausal syndrome is a common uncomfortable symptom in women during the perimenopausal period, with a high incidence, a long duration, and adverse effects on physical and psychological, patients bear a heavy burden of symptoms, and increase the risk of adverse events in the elderly stage, increase the social medical burden. With the development of sports rehabilitation research, more and more attention has been paid to the effect of exercise on human health. This paper reviews the studies on exercise rehabilitation in women with perimenopausal syndrome, including exercise forms, exercise intensity, exercise time and exercise effect, in order to provide basis for the relevant research and practice.

多囊卵巢综合征(PCOs)是常见的妇科内分泌疾病,以高雄激素表现、持续无排卵、卵巢多囊样改变为特征,易导致育龄妇女不孕.PCOS病因尚不清楚,肥胖等代谢相关性疾病与PCOS关系密切.生活方式干预是PCOS的首选基础治疗,减重是有效的治疗措施.与传统饮食相比,生酮饮食能够较快降低体质量.基于《生酮饮食干预多囊卵巢综合征中国专家共识(2018年版)》及既往相关研究成果,本研究制订《多囊卵巢综合征的生酮治疗临床路径》,为PCOS的生酮治疗提供临床标准.

目的 分析1991-2019年中国女性围绝经期睡眠障碍相关研究文献特征和研究热点.方法 采用文献计量学的方法,通过检索CNKI和万方数据库中1991-2019年公开发表的中国女性围绝经期睡眠障碍相关主题中文文献,采用VOSviewer软件进行文献可视化分析.结果 2014年以后围绝经期睡眠障碍发文量稳步持续增加;发文期刊以中医药杂志为主;广东省论文数量最多,为105篇;研究主题主要为女性围绝经期睡眠障碍的证候诊断与证素分布,针灸针刺与中医辅助疗法配合中成药的临床疗效、影响因素及治疗有效性的Meta分析.结论 围绝经期女性睡眠障碍主要强调中西医结合诊治、身心诊疗及人文关怀护理.

我是一名妇产科医生,见过形形色色的患者,生产的、流产的…… 我一直以为体重秤上限只是个理论值,直到遇见本故事的主角——文文,她告诉我体重秤的上限是130kg.她还给我出了一个难题:一个达到体重称上限的伴有子宫内膜重度不典型增生的多囊卵巢综合征患者,不仅要治疗、治愈,还要生孩子.

目的 探讨翻转课堂与传统教学法对妇产科住院医师岗位胜任力的影响效果对比.方法 选取在妇产科进行住院医师规范化培训的50名学员作为研究对象,采用1:1随机对照的方法,将学员分配A、B两组,每组25人.A组前3个月先接受翻转课堂教学模式的培养,后3个月接受传统教学模式;B组前3个月接受传统教学模式,后3个月接受翻转课堂教学模式的培养.分别在研究开始时、3个月、6个月对学员进行以临床胜任力为基础的教学效果评价.结果 两组在接受翻转课堂教学模式期间,其临床胜任力评估结果明显优于于同期接受传统教学模式的学员,差异具有统计学意义(P<0.05).结论 相较于传统教学法,翻转课堂教学应用在妇产科住院医师培养中,可以显著提升学员的临床胜任力.

目的 评估生酮饮食对超重/肥胖多囊卵巢综合征女性月经及生育力的影响.方法 选择2019年1月至2020年1月就诊于首都医科大学附属北京世纪坛医院妇科门诊的超重/肥胖多囊卵巢综合征患者,给予生酮饮食干预12周,随访1年,比较患者干预前后体质量、月经周期、妊娠情况的差异.结果 共纳入52例患者,中位年龄29(23～39)岁,诊断多囊卵巢综合征中位时间5(1～8)年.生酮饮食干预后,体质量明显下降[(75.40±9.74)kg vs(65.48±8.30)kg,P<0.001],月经周期明显缩短[(74.71±45.36)d vs(31.44±4.48)d,P<0.001],月经紊乱率由71.15％降至21.15％.生酮饮食前有生育要求但不孕患者29例,干预后妊娠15例,其中1例胚胎停育,另14例均妊娠至足月,妊娠率为51.72％,活产率为48.28％.妊娠者怀孕时间距离干预结束平均2.4(0.5～10.0)个月,分娩孕周平均(39±1.13)周,分娩方式:阴道分娩占85.71％,剖宫产占21.43％,新生儿出生平均体质量(3.26±0.48)kg,孕期仅有2例合并妊娠期糖尿病,1例合并妊娠期高血压.结论 超重/肥胖多囊卵巢综合征女性经过生酮饮食治疗,可以降低体质量,缩短月经周期,改善不孕症,同时减少孕期合并症.

目的 评估微创减重手术对重度肥胖女性月经周期及生育力的影响.方法 选择2015至2019年在首都医科大学附属北京世纪坛医院减重外科行微创减重手术的肥胖女性患者55名,随访患者术后1、3、6、12个月体质量、月经周期、妊娠等信息,有生育要求者随访至分娩结束,比较患者术前及术后体质量、月经周期、妊娠率的差异.结果 术前平均年龄(27.82±5.16)岁,平均体质量(108.85±20.84)kg,平均体质量指数(39.42±7.39)kg/m2,术前月经紊乱率为70.91％(39/55).术中行袖状胃切除术者占87.27％(48/55),行胃旁路术者占12.73％(7/55).术后随访中位时间为35个月(13～67)个月.术后1个月体质量下降最明显,平均减重(11.21±5.16)kg(-10.18％),术后6个月平均减重(29.79±10.28)kg(-26.94％),术后1年平均减重(34.15±12.72)kg(-30.56％),术后1年体质量指数降至(27.09±4.25)kg/m2.术后月经紊乱改善率为71.79％(28/39),月经恢复中位时间术后1.5(0.5～8.0)个月,总体月经紊乱率降至20％(11/55).不孕症改善率为54.17％(13/24).术后分娩者,妊娠距离手术平均时间(24.06±14.91)个月,分娩距离手术平均时间(33.21±15.17)个月,新生儿出生平均体质量(2.89±1.68)kg.结论 微创减重手术可以明显改善重度肥胖女性的月经周期,提高受孕率,术后2年妊娠不影响新生儿体质量.