枸橼酸西地那非对宫腔粘连术后冻融胚胎移植妊娠结局的影响

目的：观察枸橼酸西地那非（万艾可）对宫腔粘连（intrauterine adhesion,IUA）分离术后冻融胚胎移植（frozen embryo transfer,FET）患者妊娠结局的影响。方法：选择2017年1-12月在南京医科大学附属妇产医院行FET的不孕症患者,在进入FET周期前宫腔镜检查确诊IUA,行宫腔镜下IUA分离术,术后复查宫腔镜显示宫腔形态正常行FET,共310例。根据患者是否添加枸橼酸西地那非将患者分为2组,其中A组（对照组）实施激素替代周期FET,共190例;B组（治疗组）为激素替代周期并在患者月经干净后每日阴道给予枸橼酸西地那非50 mg,应用至移植前,共120例。首先比较2组患者的妊娠结局,其次将A组及B组患者进一步分为轻度IUA组和中重度IUA组,比较2组之间的差异。结果：B组临床妊娠率［50.83%（61/120）］高于A组［34.74%（66/190）］,差异有统计学意义（P＜0.05）;B组胚胎种植率［31.17%（72/231）］略高于A组［21.82%（79/362）］,但差异无统计学意义（P＞0.05）。与A组相比,B组轻度IUA患者的临床妊娠率与胚胎种植率差异无统计学意义（P＞0.05）;B组中重度IUA患者的临床妊娠率［44.78%（30/67）］及胚胎种植率［28.46%（37/130）］均高于A组,差异有统计学意义（P＜0.05）。2组间流产率和异位妊娠率比较差异均无统计学意义（P＞0.05）。结论：应用枸橼酸西地那非可提高IUA术后患者子宫内膜容受性,尤其对中重度IUA术后患者可显著提高其FET妊娠率。     

Real world initial palliative treatment patterns and clinical outcomes in premenopausal patients with hormone receptor-positive,HER2-negative metastatic breast cancer: A study of the National Cancer Center,China

BackgroundTo observe whether guideline non-adherence in initial palliative treatment choices for premenopausal hormone receptor-positive (HR+), HER2-negative metastatic breast cancer (MBC) patients result in worse clinical outcomes in the Chinese population.MethodsThe China National Cancer Center database was used to identify 2194 patients diagnosed between 2004 and 2015. A total of 451 premenopausal patients with HR + HER2- MBC were included. Clinicopathological features and survival information were extracted. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared using log-rank test.ResultsThe number of patients receiving initial chemotherapy, endocrine therapy and chemo-endocrine therapy were 222 (49.2%), 80 (17.7%), and 149 (33.0%), respectively. Patients receiving initial chemotherapy were more likely to be luminal B subtype, had more de novo stage IV disease and more liver metastasis, compared with patients receiving initial endocrine therapy. Both PFS and OS were significantly longer for chemo-endocrine therapy group (median PFS 18.9 months and OS 75.0 months), than for endocrine therapy group (median PFS 11.7 months and OS 53.5 months), and chemotherapy group (median PFS 7.1 months and OS 43.9 months). In multivariate analysis, none of the three treatment strategies were independently associated with PFS or OS.ConclusionIn real world, a high percentage of premenopausal patients with HR + HER2- disease received chemotherapy as initial palliative treatment in China, which was not associated with worsened survival. Further studies with larger sample size across China are needed to explore the relationship between this guideline non-adherence and clinical outcomes.     

低分子肝素联合激素、环磷酰胺治疗难治性肾病综合征临床效果评价

目的：分析低分子肝素联合激素、环磷酰胺治疗难治性肾病综合征的临床效果。方法收集2011年1月～2014年1月收治的96例难治性肾病综合征患者的临床资料,随机分为观察组与对照组,各48例,对照组给予激素、环磷酰胺治疗,观察组采取低分子肝素联合激素、环磷酰胺治疗。观察两组患者临床疗效。结果观察组患者治疗的总有效率为93.75%,明显优于对照组（75.00%）,差异有统计学意义（P＜0.05）;观察组患者的24h 尿蛋白定量、尿素氮、肌酐水平等指标的改善均明显优于对照组,差异有统计学意义（P＜0.05）。结论低分子肝素联合激素、环磷酰胺治疗难治性肾病综合征,能改善患者的临床症状,疗效显著,值得推广。     

宫腔镜手术与刮宫术对不孕症患者子宫内膜息肉激素表达水平及预后影响的对比观察

目的比较宫腔镜手术与刮宫术治疗子宫内膜息肉（EP）型不孕症患者激素表达水平及预后的影响。方法选取本院2010年1月～2013年3月不孕门诊诊治EP型不孕症患者85例为观察组,随机分为宫腔镜亚组45例、刮宫亚组40例。分别予宫腔镜手术与刮宫术治疗,并对患者进行1年的随访;另选择同期因男性因素或输卵管因素不孕就诊、并经阴道B型超声及官腔镜检查除外EP和其他内膜病变的已婚妇女43例为对照组。观察和比较3组的激素表达水平及预后情况。结果3组的雌二醇（E2）、雌激素受体（ER）、孕激素受体（PR）表达水平比较差异无统计学意义（19〉0．05）;宫腔镜亚组的1年内妊娠率（77．78％）明显高于刮宫亚组（40．00％）（P〈0．05）;宫腔镜亚组的EP复发率（6．67％）低于刮宫亚组（15．00％）（P〈0．05）。结论官腔镜手术治疗EP相对于刮宫术,其日后受孕率高,复发率低。     

Daily production and metabolic clearance of growth hormone in juvenile diabetes mellitus

Summary Daily production (PR) of human growth hormone (HGH) was calculated in patients with juvenile diabetes and control subjects by determining metabolic clearance rate (MCR) of¹³¹I HGH, at equilibrium, and mean endogenous HGH levels throughout a 24 h day. Half hourly sampling or a constant withdrawal pump were used to obtain an integrated mean endogenous HGH level. MCR (liters/day) was significantly reduced in all diabetic subjects both in absolute terms (96 ± 15 vs 274 ± 37) and relative to surface area (62 ± 8 vs 171 ± 21) (p < 0.01). Mean HGH levels were 8.4 ng/ml in the diabetics and 5.5 ng/ml in age matched controls. Daily HGH PR in the diabetic subjects (339 to 1365 g/day) did not exceed values in the control subjects (1005–1426 g/day). The results indicate that the elevated plasma HGH levels and increased HGH response to stimuli observed in diabetes, reflect reduced metabolic clearance, rather than increased pituitary secretion.     

脑损伤恢复期神经内分泌改变及临床意义

目的探讨脑损伤恢复期神经内分泌激素异常的发生率及其临床意义。方法用放射免疫法测定患者脑损伤后3,6,12月周围静脉血中FT3、FT4、TSH、ACTH、GH、Cor、PRL、T、E2、P、FSH、LH的浓度,统计分析脑损伤恢复期神经内分泌激素异常的发生率及其与病情严重程度及恢复时间的关系。结果激素异常发生率和损伤严重程度呈正相关,损伤越重,激素异常发生率越高,差异有统计学意义(P0.05)。激素异常发生率随着时间的推移逐渐降低,3个月时为17.6%,6个月为16.2%,12个月为15.4%。但差异无统计学意义(P0.05)。结论颅脑损伤恢复期神经内分泌激素水平异常有一定的发生率,损伤越重,激素异常率越高,随着恢复时间的延长有下降趋势,可作为恢复期一项重要的检测指标,用于指导临床治疗。     

人工周期中使用雌激素天数对冻融胚胎移植结局的影响

目的通过对月经规律患者冻融胚胎移植(FET)人工周期准备子宫内膜的临床结局分析,探讨人工周期雌激素应用天数与妊娠结局的关系。方法回顾性分析武汉同济医院生殖中心2011年12月至2012年8月以人工周期准备子宫内膜,B超监测子宫内膜厚度≥8mm时行复苏移植2个优质囊胚的月经规律患者共153个周期的临床资料。用黄体酮前雌激素应用天数按2分隔点分为≤15d组和15d组,比较不同雌激素应用天数的一般情况和妊娠结局;并对超出理想内膜增生期的天数按3分隔点分为0、0~3和3d组,比较三组间的一般情况和妊娠结局。结果 (1)黄体酮转化前用雌激素总天数15d组的流产率高于≤15d组,继续妊娠率低于≤15d组,但两组间胚胎着床率、临床妊娠率、流产率、继续妊娠率均无统计学差异(P0.05);(2)应用雌激素超出理想内膜增生期0~3d组的胚胎着床率、临床妊娠率、继续妊娠率稍高于其他两组,而流产率稍低于其他两组,但三组间妊娠结局无统计学差异(P0.05)。结论人工周期是一种较好的FET内膜准备方法,雌激素应用天数未显著影响妊娠结局,雌激素最佳应用天数有待增加样本量进一步研究。