宫颈腺癌的研究进展

宫颈腺癌是宫颈癌的一种特殊病理类型,较鳞癌少见.近年来,宫颈腺癌的发病率及其在宫颈癌中所占比例不断上升,且发病趋于年轻化,预后比同期鳞癌差.此外,宫颈腺癌卵巢转移率高于鳞癌,对放、化疗的敏感性显著低于鳞癌,这些均对宫颈腺癌的诊治有重要影响.从宫颈腺癌致病因素(雌激素、孕激素与人乳头瘤病毒)、卵巢转移高危因素及卵巢保留以及放化疗进展3个热点问题着手,简述近年来宫颈腺癌的研究进展.     

Consecutive Cyproterone Acetate and Estradiol Treatment in Late-Pubertal Transgender Female Adolescents

BackgroundCyproterone acetate (CA) is an antiandrogenic progestin commonly used in adult transwomen to suppress endogenous androgens, often in combination with estrogens to induce feminization.AimTo assess the (side) effects and biochemical changes of CA alone and in combination with estrogens in adolescent trans-girls.MethodsThis study was a retrospective analysis of clinical and biochemical data from 27 trans-girls who presented at Tanner stage G4 and were treated with CA monotherapy for at least 6 months (mean = 12 months) and then in combination with incremental doses of estrogens (CA + E; mean = 16 months). Statistical analysis of data included paired or unpaired Student t-test or Wilcoxon signed-ranks or Mann-Whitney U-test as appropriate.OutcomesAnthropometrics, reported beneficial and side effects, safety parameters, and hormone levels.ResultsPhysical changes included decrease of facial and non-facial hair growth. One third showed breast development under CA (Tanner stages B2–B3), which increased to Tanner stages B3 and B4 in 66.7% and 9.5% respectively, during CA + E. Reported side effects during CA and CA + E were breast tenderness, emotionality, fatigue, and flushes. No relevant weight changes were observed. Main safety parameters showed the following changes. Hemoglobin and hematocrit decreased and liver enzymes transiently and modestly increased during CA. Triglycerides and cholesterol levels slightly decreased during CA but returned to baseline during CA + E; glucose metabolism was unaffected. Relevant hormonal changes included a decrease in gonadotropins during CA + E and in total and free testosterone levels throughout treatment. Prolactin levels increased during CA and were restored during CA + E.Clinical ImplicationsCA produced modest feminizing effects in trans-girls and therefore might be a valuable alternative in situations in which gonadotropin-releasing hormone analogues are not the treatment of choice and/or are not reimbursed.Strengths and LimitationsThis is the first study to report on the effects of CA in the treatment of trans-girls and one of the few to report on the use of estrogens in this population. Limitations are the modest sample size and the retrospective nature of this study.ConclusionTreatment with CA in late-pubertal trans-girls overall was safe and well tolerated and induced mild clinical and biochemical feminizing changes. Rapid further feminization was observed with incremental doses of E.Tack LJW, Heyse R, Craen M, et al. Consecutive Cyproterone Acetate and Estradiol Treatment in Late-Pubertal Transgender Female Adolescents. J Sex Med 2017;14:747–757.     

黄体酮治疗先兆性流产的临床疗效观察

目的 探讨黄体酮治疗因黄体功能不全而引起的先兆性流产的临床疗效.方法 选取2010-2012年在我院门诊治疗的符合条件的先兆性流产患者128例,采用肌肉注射黄体酮注射液治疗,观察临床治疗效果.结果 肌肉注射黄体酮注射液治疗因黄体功能不全而引起的先兆性流产的有效率为91.4%,不良反应比较轻,并且发生率较低.结论 黄体酮治疗因黄体功能不全而引起的先兆性流产的疗效确切、安全、可靠,可在临床上推广使用.     

孕激素治疗月经期癫痫的临床证据评价

目的 采用循证医学方法评价孕激素治疗月经期癫痫的疗效和药物不良反应,为月经期癫痫提供有循证依据的最佳治疗方案。方法 以月经期癫痫痫（catamenial epilepsy）、药物治疗（drugtherapy）、孕激素（progesterone）、四氢孕酮（allopregnanolone）、系统评价（systematic review）、随机对照试验（randomized controlled trials）等中英文词汇为检索词,分别检索万方数据库、维普期刊资源整合服务平台、中国知网中国知识基础设施工程、英国Cochrane图书馆、美国国立医学图书馆、Google学术搜索等国内外数据库,获得系统评价、随机对照试验、开放性试验、前瞻性或回顾性病例分析研究、病例观察研究和综述等文献,采用Jadad量表质量标准评价文献质量。结果 经筛选共纳入孕激素治疗月经期癫痫相关英文文献18篇,包括系统评价1篇、随机对照试验3篇、开放性试验1篇、前瞻性病例研究2篇、病例随访研究1篇、综述10篇。其中10篇为高质量文献（评分≥4分）,8篇为低质量文献（评分〈4分）。对各项临床试验治疗原则以及疗效和安全性评价显示：（1）孕激素作为抗癫痫药物的添加方案治疗月经期癫痫,可显著减少月经期癫痫发作频率,且安全性和耐受性良好。（2）天然孕激素和人工合成孕激素均可用于月经期癫痫的治疗。（3）孕激素治疗月经期癫痫的方式包括周期性孕激素治疗和抑制治疗,以前者更常用。结论 借助循证医学评价方法可为孕激素治疗月经期癫痫提供最佳临床证据。     

Best Practices for Counseling Adolescents about the Etonogestrel Implant

Among young persons, ease of use, high efficacy, and high acceptability makes the etonogestrel contraceptive implant an important choice for this age group. Adolescent-friendly, patient-centered counseling considers the patient's cognitive development, the influence of friends and family, as well as their own preferences and values. Age-appropriate language, graphics, and models are useful to explain contraceptive options and relevant side effects. Effectiveness, reversibility, safety, noncontraceptive benefits, and side effects are important attributes and should be discussed when teens are choosing a contraceptive method. In this review we describe suggested best practices for counseling adolescents about the etonogestrel implant so they can make informed, prudent decisions about using this contraceptive method.     

Progestins in HRT: Sufferance or desire?

While the benefits of progestins in hormonal replacement therapy are well recognized as far as endometrial protection is concerned the data on breast tissue and the cardiovascular system are contentious. Following the Women's Health Initiative study, the Million Women Study and The Women's International Study of Long-duration (O)estrogen after Menopause the question can be raised: When dealing with optimal hormonal therapy after the menopause, is the progestin component accepted here on sufferance or is it desired? The answer is partly made up by the fact that the recent epidemiological data may have been not only wrongly translated in relation to the clinical settings, but also to the whole class of therapies. The various progestins available for hormonal therapy exert different partial effects at cellular level according to the biochemical composition. Due to the structural differences the progestins result in a variety of tissue transforming changes as well as metabolic and hemostatic changes. Since no single test or algorithm presently serves as golden standard for all desired hormonal effects the least changes or no changes from the premenopausal physiology may often be advantageous. In our opinion targeting this goal includes a sustained desire for an estrogen/progestin combination as optimal future hormone therapy. Moreover the strategy not only includes evaluation of the specific steroidal formula, but also a titration of the dose and choosing the optimal route of administration. With special reference to cardiovascular disease this review therefore makes a plea for differentiating between the array of chemically and functionally distinct progestins used therapeutically after the menopause in combination therapy.     

子宫内膜异位症保守性手术后药物治疗进展

子宫内膜异位症(EMs)是育龄妇女的常见病,保守性手术后复发率高,有必要予以术后药物治疗.目前的术后用药多样,但几乎都表现为用药依赖,往往需要数年甚至更久的维持用药.口服避孕药、孕激素因其经济、方便,不良反应少,可作为术后治疗的一线选择;而促性腺激素释放激素类似物长期用药的益处相比于其昂贵的医疗费用及不良反应优势并不明...