Controversies in plastic surgery: Suction-assisted lipectomy (SAL) and the hCG (human chorionic gonadotropin) protocol for obesity treatment

The advent of SAL (suction-assisted lipectomy) has dramatically increased the number of obese patients coming to our consultation offices. Despite several articles suggesting a conservative approach to fat suction, some reports insinuate that SAL might be a useful tool for obesity treatment. This hypothesis is refuted by a vast body of evidence that concludes that the adipose tissue may regenerate in adult humans. Therefore, surgical procedures are not advised as the method of choice to manage the disease. On the other hand, the terms obesity and being overweight may not be interchangeable. Obesity may be a disease whereas being overweight is asign of the disease. Consequently, proper preoperative selection of candidates for SAL becomes mandatory. The hCG (human chorionic gonadotropin) method for obesity treatment appears to be a complete program for the management of obesity. It contains pharmacologic, dietetic, and behavior modification aspects in a 40-day course of treatment. Some data suggest hCG to be lipolytic, thus explaining former clinical observations regarding body fat redistribution in treated patients. hCG commercial preparations contain -endorphin, an opioid peptide linked to mood behavior. This article speculates on the possible actions of the complex hCG -endorphin in the neuromodulation of mood and energy metabolism. The method comprises a behavior modification that helps in handling the patient better. There are some correlations between a current behavior modification program and the basic guidelines contained in the hCG protocol. Thus, the hCG method appears to be a reasonable alternative in the management of a long-standing, unsolved problem of human metabolism.     

A Modern Approach to the Gonadotropin Treatment in Oligozoospermia

A critical review of the gonadotropin therapy in male infertility or hypofertility is presented. In the author's opinion, the poor and conflicting results so far obtained wih this kind of treatment are mainly due to inadequate selection of the patients admitted to the treatment itself. The author stresses some points concerning the modern knowledge on the physiology of gonadotropin secretion in males; points that must be borne in mind in approaching this type of treatment, and which in some way revolutionize the old concept of "low" or "high" plasma gonadotropin levels. In this concern, the gonadotropin therapy can be applied not only to the hypogonadotropic hypogonadism, as for the past, but also to the spermatogenic arrests and to the idiopathic oligospermiogenesis wtih "normal" gonadotropin levels. The author then exposes the rigid criteria adopted in the Andrologic Center of the 5th Medical Clinic of the University of Rome for the selection of the patients to be admitted to the treatment; criteria which are based on hormonal, morphological and seminal parameters. In the final part the results are reported obtained in the selected patients with a treatment schedule with associated HMG + MCG (150--300 I.U. as FSH per week and 2000--6000 I.U. as LH per week for 12--16 weeks). The results seem very encouraging: in 85% of the patients a quantitative and qualitative amelioration of the spermatogenesis was obtained; in 30% of these cases an outcome of pregnancies in the partner has been documented so far.     

LHRH拮抗剂Cetrorelix对子宫内膜癌细胞生长周期的影响及其机理

目的 :研究LHRH拮抗剂Cetrorelix对子宫内膜癌细胞生长周期及周期相关蛋白的影响 ,探讨其抑制内膜癌细胞生长的机理。方法 :用流式细胞仪细胞周期分析及Westernblotting蛋白分析法 ,研究在Cetrorelix的作用下子宫内膜癌细胞系HEC 1A细胞生长周期及相关周期蛋白的改变。结果 :1 0 -5mol/LCetrorelix可导致HEC 1A细胞生长停滞于G2 /M期 ,而与G2 /M期停滞相关的p5 3 ,磷酸化p5 3 (phospho p5 3 ) (丝氨酸 3 92 )及磷酸化cdc2 (phospho cdc2 ) (酪氨酸 1 5 )蛋白水平均显著增高。结论 :Cetrorelix抑制内膜癌细胞增殖作用的机理是结合细胞表面受体后引起一系列抑制性信号传递 ,导致细胞周期停滞于G2 /M期 ,主要表现为G2 期停滞。其中p5 3激活及cdc2磷酸化失活是引起细胞周期停滞的重要因素     

克罗米酚与HCG促排卵作用的临床观察

目的　认识克罗米酚 (CC)促排卵的缺陷 ,评价人绒毛膜促性腺激素 (HCG)的辅助作用。方法　具有正常月经周期的妇女 95例 ,对照组 39例 ;单独使用CC组 30例 ;CC +HCG组 2 6例。观察三组受试者排卵率、子宫内膜厚度及回声类型、排卵日 (LH +0 )及种植窗期 (LH +7)激素水平。结果　CC使子宫内膜变薄 ,回声类型改变 ;CC使黄素化不破裂卵泡综合征 (LUFS)的发生率 (36 6 7% )增加 ,与对照组 (5 13% )比较P <0 0 5 ;CC使种植窗期E2 异常增高 (对照组 115 0 0pg ml,CC组 2 89 5 0pg ml,P <0 0 5 ) ;E2 、P水平与内膜厚度无明显相关性 ,且不能预测LUFS的发生 ;HCG有望降低LUFS的发生率。结论　CC可能使子宫内膜厚度、回声类型、血清激素环境偏离种植所需的理想状态 ;并增加LUFS的发生率 ,HCG的使用有望纠正CC在促排卵过程中的这一缺陷     

溴隐亭对高泌乳素血症妇女促性腺激素诱导排卵的影响

目的:探讨比较高泌乳素血症患者促排卵治疗中溴隐亭应用时机对诱导排卵的影响。方法:回顾性分析62例高泌乳素血症患者促卵泡激素药物促排卵治疗方式,分为A、B两组,A组:溴隐亭与促排卵药物治疗同时进行。B组:溴隐亭治疗高泌乳素血症后促排卵治疗。结果:两组治疗方案,A组促排卵治疗用药量、用药时间明显增加,妊娠率低,流产率高,促排卵周期雌二醇水平较B组低;B组方案促排卵率高、妊娠率高,流产率低。结论:溴隐亭治疗高泌乳素血症后,使用促卵泡激素药物促排卵治疗不育疗效显著。     

高强度聚焦超声消融联合GnRHa治疗子宫腺肌病的临床研究

目的：将高强度聚焦超声（HIFU）消融与促性腺激素释放激素激动剂（GnRHa）联合用于子宫腺肌病患者的治疗,并结合临床实际探讨其应用价值。方法：将石家庄市第一医院妇产科2015年1月—2018年1月诊治的89例子宫腺肌病患者作为研究对象。将入组病例分为2组：HIFU联合GnRHa组（41例）和单纯HIFU组（48例）,比较2组患者治疗后随访1年的疗效指标。结果：HIFU联合GnRHa组病灶体积缩小率和子宫体积缩小率均大于单纯HIFU组,差异有统计学意义（均P＜0.05）。HIFU联合GnRHa组血红蛋白水平高于单纯HIFU组,差异有统计学意义（P=0.044）。HIFU联合GnRHa组痛经VRS评分亦优于单纯HIFU组,差异有统计学意义（P=0.018）。2组患者血清CA125水平和不良反应发生率比较,差异无统计学意义（均P＞0.05）。结论：与仅采用HIFU消融比较,HIFU联合GnRHa治疗子宫腺肌病能更有效地缩小病灶体积和子宫体积,同时改善血红蛋白水平和痛经症状。     

促性腺激素释放激素拮抗剂治疗卵泡提前黄素化

目的小剂量促性腺激素释放激素(GnRH)拮抗剂用于促排卵方案,研究其对卵泡提前黄素化的治疗效果。方法选取15例反复发生卵泡提前黄素化的患者,分别进行两个周期促排卵治疗行夫精人工授精,A组进行常规促排卵治疗,B组加用西曲瑞克0.125mg/d促排卵治疗。观察治疗结局。结果 A组15个周期,发生卵泡提前黄素化13例,B组15个周期,发生卵泡提前黄素化1例,有显著差异(P<0.01);A组HCG日LH(12.2±8.6)IU/L,孕酮(2.7±1.9)ng/mL,B组:HCG日LH(4.0±4.8)IU/L(P=0.008),孕酮(0.9±1.8)ng/mL(P=0.012),均有显著差异;A组使用HMG用量(750.0±138.8)IU,HCG日E2(607.4±315.3)pg/mL,优势卵泡(2.0±1.1)个,卵泡最大直径(17.5±0.8)mm,子宫内膜厚度(10.1±1.5)mm;B组使用HMG用量(907.5±208.4)IU(P=0.003),HCG日E2(1264.0±763.4)pg/mL(P=0.006),优势卵泡(3.2±1.5)个(P=0.044),卵泡最大直径(18.1±0.7)mm(P=0.013),均有显著差异,子宫内膜厚度(11.1±1.6)mm(P=0.062),没有统计学差异。结论促排卵治疗过程中加入西曲瑞克0.125mg/d可以有效减少卵泡提前黄素化发生率,促排卵后成熟卵泡增多,子宫内膜没有出现显著变化。     

Seasonal cyclicity of secretogranin-II expression and its modulation by sex steroids and GnRH in the female goldfish pituitary

The secretory vesicle protein secretogranin-II (SgII), a precursor for the bioactive peptide secretoneurin, is expressed at all levels of the goldfish reproductive axis, including the hypothalamus, pituitary and ovaries. These findings led us to hypothesize that SgII is involved in reproduction and is physiologically regulated. We investigated the effects of different sex steroids on pituitary SgII expression throughout the seasonal reproductive cycle of the female goldfish, as well as the effects of GnRH and testosterone on pituitary LHbeta subunit, GH, and SgII expression in sexually recrudescent female fish using northern blot analysis. We demonstrated that SgII expression levels vary seasonally, with levels being highest in winter and lowest in spring. Sex steroids did not alter SgII expression at any of the time periods studied. In sexually mature goldfish, injection of a GnRH agonist stimulated the expression of LHbeta and SgII specifically in the pars distalis but not the neurointermediate lobe of the pituitary. Although testosterone alone did not alter the expression of either of these genes, it did abolish the stimulatory effects of GnRH on both LHbeta and SgII expression. This represents the first study where testosterone is shown to modulate SgII expression in the pituitary.     

促性腺释放激素类似物联合环磷酰胺治疗系统性红斑狼疮的安全性

目的：探讨促性腺释放激素类似物(GnRHa)联合环磷酰胺(CTX)治疗对系统性红斑狼疮(SLE)患者病情的影响,以及GnRHa作为CTX治疗的SLE患者卵巢保护剂的安全性。方法选取2013年3月~2014年12月在北京大学深圳医院风湿科确诊为SLE的育龄女性24例,根据是否使用GnRHa分为CTX+GnRHa组和CTX组,每组各12例。采用双能X线骨密度仪检测两组患者腰椎(L1~L4正位)骨密度;比较两组患者治疗前后病情、CTX的累积治疗量、骨密度及治疗后副作用。结果①SLE病情：治疗后两组SLE患者临床症状均消失,两组治疗前后系统性红斑狼疮疾病活动指数(SLEDAI)评分组内比较,差异均有高度统计学意义(t=23.534、19.187,均P=0.000);治疗后两组SLEDAI评分比较,差异有高度统计学意义(t=3.425,P=0.002)。②CTX的累积治疗量：CTX+GnRHa组与CTX组的CTX的累积治疗量分别为(6.9±2.0)、(7.0±1.5)g,两组比较差异无统计学意义(t=0.217,均P=0.830)。③骨密度：两组SLE患者治疗前后腰椎(L1~L4正位)骨密度值比较,差异均无统计学意义(t=0.126、0.175,P=0.901、0.863)。④治疗后的副作用、围绝经期症状及月经改变：CTX+GnRHa组在使用第2次GnRHa后均出现闭经,并伴有不同程度的潮热、多汗、睡眠困难等低雌激素症状,而停用GnRHa、月经恢复后上述症状缓解消失。CTX组有7例出现月经不规则,其中3例月经淋漓不尽,4例月经稀发,但均无低雌激素症状。结论 GnRHa联合CTX治疗对SLE患者的病情无明显的负面影响,GnRHa具有保护CTX治疗中SLE患者卵巢的功能,但其作为CTX治疗的SLE患者的卵巢功能保护剂的安全性及有效性仍有待进一步证实。     

促性腺激素释放激素激动剂联合反加疗法治疗卵巢子宫内膜异位囊肿的临床观察

目的:探讨促性腺激素释放激素激动剂(Gn RH-a)联合反加疗法对卵巢子宫内膜异位囊肿患者内分泌激素水平、低雌激素症状及骨质丢失的影响。方法:选取2012年1月-2014年6月本院收治的卵巢内膜异位囊肿患者100例作为研究对象,采用随机数字表法将所选患者分为研究组与对照组,各50例。对照组单纯应用Gn RH-a治疗6个月,研究组在此基础上于Gn RH-a治疗1个月后联合反向添加疗法。观察比较两组围绝经期症状发生情况及FSH、CA125、E2水平。结果:(1)研究组潮热出汗症状的发生情况显著低于对照组(P0.05);其他各项围绝经期症状比较差异无统计学意义(P0.05)。(2)两组FSH、CA125及E2水平均显著优于治疗前,研究组血浆E2水平明显高于对照组,以上各项比较差异均有统计学意义(P0.05)。结论:相较于单纯Gn RH-a治疗,联合反向添加疗法治疗EM患者能有效减轻使用Gn RH-a引起的低雌激素症状,且未对整体疗效造成影响,是一种安全、有效且能提高患者依从性的治疗方案,适于临床应用。