Progress of Integrative Chinese and Western Medicine in Treating Polycystic Ovarian Syndrome Caused Infertility

Polycystic ovarian syndrome （PCOS） is one of the most popular diseases that cause menstrual dysfunction and infertility in women. The present paper is a brief retrospection on the progress in treatment of PCOS caused infertility with integrative Chinese and Western medicine （ICWM）. It can be seen from these materials that using traditional Chinese medicine （TCM） recipes formulated by Shen-replenishing herbs or acupuncture to reinforce Gan-Shen, regulate Chong-Ren Channels in treating PCOS, stable clinical efficacy could be obtained, with less adverse reaction, though the effect initiated somewhat late. Whereas, when Shen-replenishing recipe and acupuncture are combined with hormone or ovulation promoting drugs of Western medicine, the above-mentioned shortcomings would be overcome. So, this combined therapy is frequently used in clinical practice.     

BONE MASS, RATES OF OSTEOPOROTIC FRACTURES, AND PREVENTION OF FRACTURES： ARE THERE DIFFERENCES BETWEEN CHINA AND WESTERN COUNTRIES？

Fractures are one of the most common causes of disability in older women.The quantity and density of bone decrease with age.Most types of fractures increase as bone density declines.But most of the knowledge about causes and prevention of fractures comes from studies performed in Western countries.Asian women appear to have similar or slightly lower bone density that may be a result of their smaller size.The appear to have a lower risk of hip fracture than Whites.which may be a result of their shorter hip axis.The risks of other types of fractures in Chinese women is less well defined and reasons for differences in the rates of osteoporotic fractures between China and Western countries remain to be expolored.A study is underway in Beijing to describe the risks and potential causes of fractures among older women in urban China.Randomized trials in Western countries have demonstrated that calcium and vitamin D,estrogen,calcitonin,or bisphosphonates can reduce the rate of fractures.Increased intake of calcium and vitamin D may be the most effective approach to preventing fractures in China,but this should be tested be tested in a randomized trial.     

Application of immunosuppressant facilitates the therapy of optic neuritis combined with Sj（o）gren＇s syndrome

Background Optic neuritis （ON） is often the first symptom of multiple sclerosis （MS） and neuromyelitis optica （NMO） while there has been very little research reported on ON combined with Sj（o）gren＇s syndrome （SS）.The aim of this study is to provide different treatments and services for and NMO patients combined with SS.Methods Twenty-seven patients with ON combined SS were divided into two groups：corticosteroid group （C group,methylprednisolone sodium succinate,14 patients） and corticosteroid＋ immunosuppressant group （C＋I group,leflunomide,13 patients）.ON relapse times in 1 year after treatment,number of patients who relapsed to NMO/MS in 1 years,visual acuity and retina nerve fiber layer （RNFL） thickness were measured.Mann Whitney-Wilcoxon test was used to compare continuous variables and Chi-square test or Fisher＇s exact test was to compare proportions.Results ON combined with SS patients had higher incidence rates in middle-aged women who have binocular damage and heavier visual function damage or when there is an easy relapse,and the patients are often hormone dependent.The patients are more likely anti-aquaporin-4 IgG seropositive （70.4％）.They are liable to form a centrocecal scotoma and tubular vision.The times of relapse decreased in patients who used immunosuppressant,and a significant difference was found between immunosuppressant and non-immunosuppressant groups in visual acuity recovery during 6-month followup period （P ＜0.05）; however,the RNFL thickness at the four quadrants was not significantly different.Conclusions The effect of immunosuppressant plus corticosteroid on the early onset of ON combined with SS was to provide ON remedy and to prevent recurrence in clinics.This study provides a significant reference for the prevention and treatment of ON on the basis of immunosuppressant and corticosteroid.     

Doubling over ten years of central obesity in Hong Kong Chinese working men

Obesity is now an epidemic in most parts of the world. In this cross sectional study, we report the most recent data on obesity in Hong Kong Chinese working population and compare the changes over 10 years. Methods Between July 2000 and March 2002, 5882 adult subjects from the working class in Hong Kong were recruited （2716 men （46.2%） and 3166 women （53.8%））. They were randomly selected using computer generated codes according to the distribution of occupational groups. Results of this study were compared with the data collected from a prevalence survey for cardiovascular risk factors in a Hong Kong Chinese working population conducted in 1990 （1513 subjects, 910 men （60.1%） and 603 women （39.9%））. Results Standardized percentages of overweight, obesity, and central obesity, in Hong Kong Chinese working population were 59.7%, 35.0%, 26.7% in men and 32.0%, 21.7%, 26.7% in women. Compared to the data collected in 1990, the percentage of obesity increased by 5% in men and reduced by 6% in women. The percentage of central obesity doubled in men （from 12.2% to 26.7%） but remained stable in women. Conclusions There is a doubling of the percentage of central obesity in Hong Kong Chinese working men over previous decade. Education and proper lifestyle modification program to tackle this social health issue are urgently indicated.     

Obstetric outcome of women with uterine anomalies in China

Background Congenital uterine anomalies are associated with the highest incidence of reproductive failure and obstetric complications. This study aimed to summarize the clinical characteristics and prenatal outcome of pregnancy in women with congenital uterine malformations. Methods This retrospective study evaluated the fertility and obstetric outcome of 116 inpatients with uterine malformations with pregnancy in Peking University Third Hospital from June 1998 to June 2009. A total of 270 randomly selected pregnant women with a previously confirmed normally shaped uterus as a control group. Student＇s t test and analysis of variance （ANOVA） were used to compare means for normally distributed variables. The analysis was carried out using the SPSS. Results Among 21 961 deliveries in Peking University Third Hospital, 116 （0.45%） were in women with uterine anomalies. A septate uterus was present in 43 （37.1%） and the uterus didelphys in 28 （24.2%） of the 116 women identified. Bicornuate uterus, arcuate and unicomate uterus were observed in 12 （10.3%）, 18 （15.5%） and 15 （12.9%） patients, respectively. Patients with uterine anomalies had significantly higher rates of malpresentation （38.8%）, preterm delivery （19.8%）, and cesarean section （78.5%） compared with the group of women with a normal uterus. Patients with uterine anomalies had significantly lower mean birth-weight neonates and a significantly higher incidence of small for gestationalage （SGA） neonates; women with uterus didelphys more frequently required infertility treatment than patients with other uterine anomalies （P 〈0.001）. The rate of malpresentation was significantly higher in patients with septated uterus in comparison with patients with uterus unicorns （P 〈0.05）. Conclusions Women with congenital uterinemal formation usually have higher incidence of complications during pregnancy and delivery. A septate uterus appears to be associated with poorer obstetric outcomes.     

Metformin for adolescents with polycystic ovary syndrome

Polycystic ovary syndrome(PCOS) is a common endocrine disorder in women of reproductive age characterized by chronic anovulation, hyperhandrogenism, and is increasingly recognized as a disease developed in adolescent period. The management of adolescents with PCOS is a difficult challenge. The objective of the review was to provide an overview on the effects of metformin for adolescents with PCOS.     

Analysis of pathogenesis and risk factors associated with retinopathy of prematurity

Retinopathy of prematurity （ROP）is a disease associated with na and in particular, in preterm newborns. The long term visual outcome blindness and visual disabilities. The increasing prevalence of ROP, the 1 the vasculogenesis of the developing reti- of this disease includes increased risk of eading cause of blindness in infants, necessitates the implementation of preventive measures to halt this trend, and this, most certainly, calls for the thorough understanding of the pathogenesis and various risk factors associated with the disease. Risk factors for ROP are among the main targets for improving health outcomes. Angiogenic factors including VEGF and IGF- 1, maternal factors, oxidative stress and others （erythropoietin and inflammatory cytokines） are among the few of the most important risk factors that need to be addressed. A growing body of evidence suggests that subjects with ROP who have prenatal or postnatal risk factors are at increased risk of more severe ROP. These consistent observations have given rise to hopes of identifying the potential new risk factors and coming up with more efficient prevention and therapeutic strategies. However, studies focusing on incidence rates of ROP over time have painted an inconsistent picture. Individual studies have unequivocally demonstrated an association with the aforementioned risk factors, whereas epidemio-logical data however, is at best inconclusive. We have tried to integrate the studies, past and present, to identify the pathogenesis and novel risk factors.     

Individual Patient Data Meta-Analysis Is Needed in Chinese Medical Research

Publication biases and collection limitations are the main disadvantages of a traditional meta-analysis based on aggregate patient data（APD）from published articles.Individual patient data（IPD）meta-analysis,as the gold standard of systematic review,is a possible alternative in this context.However,the publications relative to IPD meta-analyses are still rare compared with the traditional ones,especially in the research oriented to Chinese medicine（CM）.In this article,the strengths and detailed functioning of IPD meta-analysis are described.Furthermore,the need for IPD meta-analysis to assess the treatments based on CM was also discussed.Compared with the traditional APD meta-analysis,the IPD meta-analysis might give a more accurate and unbiased assessment and is worth to be recommended to CM researchers.     

Characteristics of pathological findings in women with chronic pelvic pain using conscious mini-laparoscopic pain mapping

Chronic pelvic pain （CPP） is a common and disabling disorder of women that may have a significant impact on a woman＇s personal health and quality of life.Data have shown an annual prevalence of 3.8% in women 15 to 73 years of age, making its prevalence comparable to that of asthma （3.7%）, back pain （4.1%）, and migraines （2.1%）. CPP in women is described as ＂intermittent or constant pain in the lower abdomen or pelvis of at least six months duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy＂. In addition, the condition is considered as a symptom, not a diagnosis. CPP is estimated to account for 10% of all referrals to gynecologists, 12% of all hysterectomies, and more than 40% of gynecologic diagnostic laparoscopies. The etiology is complex and may involve disorders of the reproductive tract,gastrointestinal tract, urinary tract, musculoskeletal system, and psychoneurological system. The diagnosis is often difficult, especially when nothing positive is found on physical examimation and imaging studies. The optimal management is usually difficult due to the unknown etiology.     

Reticulocyte hemoglobin content in the diagnosis of iron deficiency in Chinese pre-menopausal women

Pre-menopausal women are at risk for iron deficiency due to menstrual blood losses. The prevalence rates （PR） of iron depletion, iron deficiency anemia （IDA）, and iron deficiency were 34.4%, 15.1% and 49.5% in pre-menopausal non-pregnant women respectively in China.1 Traditionally, the diagnosis of iron deficiency relies on the hematological markers （hemoglobin （HGB）, mean corpuscular volume （MCV）, mean corpuscular hemoglobin （MCH）, red cell distribution width （RDW）） and biochemical markers （serum ferritin （SF）, serum iron （SI）, transferrin saturation （TS）, total iron-binding capacity （TIBC））. Recently, the reticulocyte hemoglobin content （CHr） is considered to be used as a marker of iron deficiency.2 The aim of this study was to compare the diagnostic efficiency of CHr with the old markers in diagnosis of iron deficiency in Chinese pre-menopausal women.     

Plummer-Vinson syndrome associated with solid- pseudopapillary tumor of the pancreas

Plummer-Vinson syndrome （PVS）, also known as Paterson-Kelly syndrome or sideropenic dysphagia1 is characterized by dysphagia, iron deficiency anemia and esophageal webs. This syndrome is known to be associated with an increased risk of hypopharyngeal and/or cervical esophageal cancer. Three to 15 percent of the patients with PVS, mostly women between 15 and 50 years of age, have been reported to develop esophageal or pharyngeal cancer. There is a decreasing trend in the overall incidence of hypopharyngeal cancer in women, probably due to the diminished prevalence of PVS. There are few reports of gastric cancer in association with PVS.2[第一段]     

Profile of the levonorgestrel-releasing intrauterine system users in China

The widespread usage of modem contraceptive methods has predominantly been driven by government family planning policies in efforts to mandate reduced total fertility rates.1 In particular,the high prevalence of long-acting contraception usage can be attributed to the mandatory requirement in the early 1980s for women with one child to have a copper intrauterine device （IUD） fitted and for sterilization for those with two or more children,2and more recently through financial incentives for married couples to use long-acting contraceptive methods.1 The levonorgestrel-releasing intrauterine system （LNG-IUS） has been available in China since 2000 for contraception and treatment of heavy menstrual bleeding.Little is known about the profile of the Chinese women opting to use the LNG-IUS and the type of information they received before intrauterine system placement.We undertook this survey to profile the Chinese women choosing to use the LNG-IUS in clinical practice.     

Expression of TWEAK on the Ectopic and Eutopic Endometrium from Women with Endometriosis

Objective To investigate the relationship between Tumor necrosis factor （TNF）-like weak inducer of apoptosis（TWEAK） and endometriosis.
Methods TWEAK mRNA and protein concentrations in paired samples of eutopic endometrial tissue from women with and without endometriosis, and also of ectopic endometrial tissue from women with endometriosis were measured by Real-time PCR, immunohistochemistry and Western blotting, respectively.
Results Compared with control endometrium from women without endometriosis and eutopic endometrium from women with endometriosis, TWEAK expressions were reduced on the ectopic endometrium （P〈O.05）. Moreover, the expressions of TWEAK mRNA on eutopic endometrium and control endometrium in proliferative phase were much lower than those in secretory phase. TWEAK protein was expressed in the cytoplasm of glandular cells and stromal cells of endometrium.
Conclusion TWEAK is expressed on the endometrium of reproductive women, and its concentration rises in secretory phase, compared with that in proliferative phase. Patients with endometriosis had a lower expression of TWEAK on ectopic endometrium, which may lead to a decreased level of apoptosis on endometrial cells. Consequently, endometrial cells were able to survive outside uterus helping the development of endometriosis.     

Evaluation of Current Termination of Pregnancy and Related Services at Grimsby （UK） and Recommendations for Service Improvement

Objective To develop local termination of pregnancy （TOP） dataset and to identify ＂hotspots＂ for highest activity and gaps in our fertility control services. Methods This was a retrospective analysis of 305 women who received TOP under section C of the Abortion Act 1967 over a period of 9 consecutive months from 1st March through to 31st October 2012. Results There were 275 （90.2%） British White （BW） and 30 non-BW women. Among 30 non-BW women, 10 （3.3%） were British Asian, 8 （2.6%） were Polish, 6 （2.0%） were British Black or Black, 5 （1.6%） were Chinese and i （0.3%） was White Latvian. The TOP rate was 8.9% in the under 18 years old and 27.9% in the over 30 years old. Totally 240 TOPs （78. 7%） occurred in 〈10 weeks and 276 TOPs （90.5%） occurred under 13 weeks of gestation. Eight-five women who received TOP-service have had one or more previous termination（s） in the last 3 years. The contraception use was low pre-TOP and none of the women were on long-acting reversible contraception （LARCs） pre- TOP, including those who had repeat terminations. Conclusion There are inequalities and gaps in the TOP and related services in Grimsby which must be addressed to reduce the rate of TOP. This is a major challenge involving multiple agencies. Provision of contraception across all age and ethnic groups, improving sex education, engaging with parents and women to improve their negotiation skills for safer sex, supporting vulnerable women, reducing risk factors e.g. alcohol and substance misuse and raising aspirations across the region will contribute to a reduction in termination rate.     

Endovascular treatment of wide-necked intracranial aneurysms using of ＂remodeling technique＂ with the HyperForm balloon

Background Aneurysms with wide-necked or a large neck/fundus ratio, especially located on an arterial bifurcation or a small artery, are challenges for interventional neuroradiologist because of the risk of coil migration or coil protrusion into the parent vessels. Our study was designed to improve the efficacy and safety of the ＂remodeling technique＂ with the HyperForm balloon for these difficult aneurysms and was confirmed by a follow-up result.
Methods From June 2004 to September 2006, forty-two patients （20 men, 22 women） with wide-necked or large neck/fundus ratio aneurysms were treated by using the ＂remodeling technique＂ with the HyperForm balloon.
Results Forty wide-necked aneurysms were successfully treated with the HyperForm balloon remodeling technique with only two failed cases. Final results consisted of total occlusion in 34 cases （80.9%）, subtotal in 4 （9.5%） and incomplete in 2 （4.8%）. One aneurysmal rupture occurred, but no clinical consequence was shown. No thromboembolic events were observed during treatment. Final angiographic follow-up time ranged from 3 to 18 months.
Conclusions The ＂remodeling technique＂ with the HyperForm balloon is a very useful tool in the treatment of wide-necked or unfavorable neck/fundus ratio intracranial aneurysms - located on an arterial bifurcation or a small artery and, especially, located on the bifurcation of a large artery and a small one. In our experience, this technique provided a safe and efficient treatment for difficult aneurvsms when the standard remodelina techniaue miaht have failed.     

设计适合传统东亚医学系统和方法的临床研究-聚焦模式辨识

ABSTRACT This article is based on two presentations held at Chinese medicine conference in Rothenburg （2013）, Germany and at the 19th Anniversary of Korean Institute of Oriental Medicine （KIOM） International Symposium of Current Research Trends in Traditional Medicine - Pattern of Identification （2013）. In designing clinical studies, it is a research question that leads to appropriate study design. However, they are mostly diagnostic procedures and techniques that are the key points to reflect the application of systems and methods in all forms of medicine - traditional East Asian medicine （TEAM） is no exception. The challenges within TEAM based on research reflect in different systems of medicine/theories such as traditional Japanese acupuncture, traditional Korean acupuncture and traditional Chinese acupuncture. This diversitv of medical svstems and methods applied in East Asia seems to have beenfruitful within the different countries and traditional medicines have found their places within the respective countries health systems. The existing diversity, from a clinician＇s point of view, may be viewed as a treasure when dealing with patients in the ＇real world＇. On the other hand, this diversity seems to challenge the scientific mind worldwide, esoeciallv when it comes to research. Hence. there is a and between clinical practice and research.     

Long-term impact of initial surgical and medical therapy on young patients with papillary thyroid cancer and bilateral cervical metastases

Background There are few reviews on the clinical features and prognosis of young patients with papillary thyroid cancer and bilateral cervical metastases. We have investigated the long-term impact of initial surgical and medical therapy on such patients. Methods A retrospective study was performed on 24 young patients （11 females and 13 males） with papillary thyroid cancer and bilateral cervical lymph node metastases, ranging in age from 11 to 20 years （mean age, 16.6 years）, who were treated in our institution from 1 January 1970 to 31 December 1985. Results All the patients in this group were followed up for 20 years. The survival of the patients at 20 years was 91.7%. The recurrence of local tumor and distant metastases was 20.8% and 12.5%, respectively. Based on analysis of the clinical data, we determined that the completeness of the surgical excision had a significant correlation with tumor recurrence. Conclusion These young patients with papillary thyroid cancer and cervical metastases have a good prognosis after suitable treatment.     

The Aged Organism as a Model of Successful Copping with Tumor Progression-Implications for Therapy

The proportion of aged individuals in the population is constantly rising. Few studies have been dedicated to the effect of aging on tumor biology and even fewer on age-adjusted cancer therapy. Cancer incidence is known to augment with age. However, tumor growth and metastasis often proceed at a slower rate in aged organisms. Mechanisms underlying this reduced tumor aggressiveness in the aged have been demonstrated by our and other groups： （1） Increased apoptosis of tumor cells in old mice; （2） Reduced angiogenesis; （3） Modifications in immune responses. Aged tissues presumably create a microenvironment which favors decreased tumor aggressiveness. We postulated that it may be possible to design age-adjusted treatment modalities based on the mechanism（s） responsible for the reduced tumor progression rate in the aged. Based on these mechanisms, we have shown that three treatment modalities （drugs inducing apoptotic cell death, anti-angiogenic agent and immunomodulators） display an age-related differential effect on two experimental tumors. Very remarkably, the inhibition was generally more pronounced in old than in young mice. The microenvironment of the aged organism appears to cope more successfully with metastatic spread and mice survival than that of young organisms. This might have implications for a novel approach to advanced cancer therapy.     

Characteristics of abnormal menstrual cycle and polycystic ovary syndrome in community and hospital populations

Background Polycystic ovary syndrome （PCOS） is considered to be the most common endocrine disorder in women of reproductive age.The involvement of an abnormal menstrual cycle in the etiology of PCOS remains unclear.We aimed to analyze the characteristics of abnormal menstrual cycles and their association with PCOS in community and hospital patient populations.Methods Women with PCOS identified from 2111 permanent female residents in the community of Beijing and 506 outpatients obtained from the reproductive clinic of Peking University Third Hospital were recruited for this study,comprising the PCOS community group and the PCOS hospital group, respectively.Each group was further divided into four subgroups according to the length of menstrual cycles： 〈21 days; 21-34 days; 35-60 days; and 〉60 days.Women in each group were interviewed using a questionnaire to assess factors including age, age of menarche, menstrual cycle history, related family history, and modified Ferriman-Gallwey （mF-G） score.All women received transvaginal ultrasound scan and had fasting blood samples taken for endocrine evaluation.A two-tailed P value of 〈0.05 was considered significant.Results In the community population, the prevalence of abnormal menstrual cycle was 27.19% （574/2111）.The prevalence of PCOS in the community was 6.11% （129/2111） according to Rotterdam criteria.In the community group,the most common menstrual cycle length was 35-60 days, whereas for the hospital group, it was 〉60 days.In both the community and hospital groups, the most common phenotype of PCOS was that of Oligo/amenorrhea＋PCO＋hyperandrogenism （HA） （O＋P＋H） （P=0.000）.With increasing cycle length of 35-60 days to 〉60 days, the percentages of Oligo/amenorrhea＋PCO （O＋P） and O＋P＋H were found to significantly decrease in the community group and significantly increase in the hospital group （P=0.000 for each）.In the hospital group, as the menstrual cycle length increased from 35-60 days to 〉60 days, the rate of spontaneous abortion increased significantly （P=0.000）, meanwhile the rate of poorly-secreted endometrium and abnormal endometrial hyperplasia increased significantly （P=0.000）.Conclusions The prevalence of PCOS in the Beijing community of women was 6.11%.Oligo/arnenorrhea was the most common type of abnormal menstrual cycle and may be an indicator for PCOS and endometrial lesions.Gynecologists should seek relevant medical information from women in the community to promptly diagnose PCOS and then follow up patients for potential development of subsequent complications.