目的 利用血清铁蛋白预测妊娠期糖尿病(GDM)的发病风险,为孕期妇女合理补铁和预防妊娠期糖尿病的发生提供参考.方法 选取2017-2021年在重庆医科大学附属永川医院规范产检并分娩的孕妇630例,根据是否患有妊娠期糖尿病分为妊娠期糖尿病组(病例组)129例和未患妊娠期糖尿病组(对照组)501例.收集年龄、身高、体重等信息.在妊娠14～27+6周检测血清铁蛋白浓度;在妊娠24～28周规范进行75 g 口服糖耐量试验(OGTT),按国家标准诊断妊娠期糖尿病.用单因素分析法筛选妊娠期糖尿病发病的影响因素,将有统计学意义的因素进一步进行多因素logistic回归分析;将有统计学意义的单因素作受试者工作特征曲线下面积(ROC-AUC)拟合,预测妊娠期糖尿病发病风险.结果 共观察孕妇630例,血清铁蛋白中位数为26.66 μg/L,诊断妊娠期糖尿病129例,发病率为20.48％.单因素分析血清铁蛋白、年龄、孕次、产次、孕前BMI和学历6个因素,病例组与对照组有统计学意义的有:血清铁蛋白分别为 49.24(15.95～155.93)μg/L和 22.00(8.00～71.85)μg/L(Z=-14.379,P＜0.001),年龄分别为(30.83±4.80)岁和(29.05±4.44)岁(t=-4.00,P＜0.001),孕次分别为(2.92±1.59)次和(2.47±1.48)次(t=-3.03,P＜0.005),孕前BMI分别为(22.79±3.35)kg/m2和(21.90±3.35)kg/m2(t=-2.70,P＜0.01).多因素分析结果显示,血清铁蛋白和年龄是妊娠期糖尿病发生的风险因素,OR(95％CI)分别为1.042(1.033～1.052)(P＜0.001)和1.081(1.027～1.134)(P=0.002).血清铁蛋白预测妊娠期糖尿病的AUC(95％CI)为0.790(0.75～0.83);发生妊娠期糖尿病的阈值为 30.28 μg/L,其敏感性为 78.29％(101/129),特异性为64.87％(325/501),阳性预测值为 36.46％(101/277),阴性预测值为92.07％(325/353),超过该阈值发生妊娠期糖尿病的风险为6.66倍(Kappa=0.303,P＜0.001),调整年龄风险因素后为1.45倍,仍显示妊娠期糖尿病发生的风险显著增加.结论 血清铁蛋白可作为预测妊娠期糖尿病的独立风险因素,预测阈值30.28 μg/L,可为重庆地区孕期妇女预防妊娠期糖尿病和监测血清铁蛋白及缺铁性贫血补铁提供参考.

Objective To explore the characteristics and significance of functional connectivity (FC) of affective network (AN) in patients with postpartum depression (PPD) under resting state. Methods A total of 23 patients with PPD (PPD group) and 28 healthy postpartum women (control group) were examined using resting-state fMRI. As two critical nodes of AN, amygdala (AMYG) and subgenual anterior cingulate cortex (sgACC) were selected as the regions of interest (ROI) to analyze the differences of functional connectivity strength (FCS) of two regions from other brain regions between two groups, followed by Pearson correlation analysis on the abnormal FCS and the Edinburgh postnatal depression scale (EPDS) score in PPD group. Results Compared to the control group, the patients in PPD group showed the extensively reduced FCS (P<0.05, Alphasim correction) between AMYG and frontal cortex, temporal cortex, hippocampus, cerebellum and orbitofrontal cortex, while there were enhanced FCS (P<0.05, Alphasim correction) between sgACC and parietal cortex, occipital cortex, thalamus, superior temporal gyrus and cingulate cortex. Moreover, in PPD group, the reduced FCS between left AMYG and left medial orbitofrontal cortex was negatively correlated with EPDS scores (r=-0.62, P=0.02). Conclusion Patients with PPD have dysfunctional connectivity of AN in multiple brain regions. The weaker FCS between left amygdala and left medial orbitofrontal cortex is, the more severe depression. The dysfunctional connectivity of AN may provide an effective mechanism-based biomarker underlying PPD.

情境教学法在医科大学妇产科教学中的运用,是一个值得深入研究的课题.教师要灵活运用情境教学法,注重创设讨论情境、多媒体情境、角色扮演情境等,以营造良好的教学氛围,激发学生的学习兴趣,提高课堂教学效果.

翻转课堂教学模式在医科大学妇产科教学中的应用是一个新颖的课题.文章分析翻转课堂教学模式的内涵及翻转课堂教学模式在妇产科教学中的具体应用策略,指出翻转课堂教学模式的应用需要把握好教学视频的设计与制作、上传与观看、回顾与提问等一系列问题.

目的:验证对分课堂教学模式在妇产科临床教学中的应用成效.方法:进行对分课堂教学模式在妇产科临床教学中应用的实验研究.结果:除病史的询问、外阴检查的操作考核成绩无显著性差异外,其它方面均呈现出显著性差异.研究对象认为对分课堂教学模式的应用不同程度上有效.结论:在妇产科临床教学中应用对分课堂教学模式可行且有效.

<正>微小RNA(miRNA)是一类内源性的小分子非编码单链RNA,通过与mRNA的3′非编码区(3′UTR)完全或不完全互补配对结合,引起靶mRNA的降解或翻译抑制,从而在转录后水平对靶基因进行负调控。miRNA参与细胞的分化、发育、增殖、死亡等生命活动中的一系列重要进程,因此,miRNA被应用于许多疾病发病机制探讨的研究。早期的学者们主要集中

Objective To analyze the results of the 75g oral glucose tolerance test(OGTT)in gestational diabetes mellitus(GDM)at six weeks after delivering to investigate the relationship between the leptin and 6 weeks postpartum glucose metabolism in gestational diabetes.Methods A retrospective study was conducted on the clinical data of 36 women with GDM,who delivered and underwent a 2 hours 75g OGTT at 42 days postpartum from April to November in 2011 in our hospital.On the basis of the results of OGTT,they were reclassified into two groups(normal group(I group)and abnormal group(II group)to test leptin and fasting insulin levels.Results In theⅠgroup,the mean fasting blood-glucose level was much lower than that of theⅡgroup(P<0.05),and the mean leptin concentration was significantly higher than that of the Ⅱgroup(P<0.05).There was not significant differences in age,BMI,fasting blood-insulin and HOMA-IR between two groups.The multiple logistic regression model showed that the leptin concentratiodn was significantly negatively correlated with fasting blood-glucose(R=-0.51,P=0.02),and was significantly positively correlated with HOMA-IR(R=0.7,P=0.003).There was no significant correlation between BMI and age with fasting blood-glucose,so did BMI and age with HOMA-IR.The linear regression model showed that the fasting blood-glucose was significantly negatively correlated(R=-0.56,P=0.01)with HOMA-IR,the leptin concentratiodn was significantly positively correlated with fasting blood-insulin concentration(R=0.73,P=0.001).Conclusion In theⅠgroup,the mean fasting blood-glucose is much lower than that of the Ⅱgroup,the mean leptin concentration is significantly higher than that of theⅡgroup.The leptin concentratiodn is significantly negatively correlated with fasting blood-glucose,and is significantly positively correlated with HOMA-IR.There is no significant correlation between BMI and age with fasting blood-glucose,so do BMI and age with HOMA-IR.