Recommendations on management of gynecological malignancies during the COVID-19 pandemic: perspectives from Chinese gynecological oncologists / 부인종양

The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 has rapidly spread globally. Cancer patients are at a higher risk of being infected with the coronavirus and are more likely to develop severe complications, as compared to the general population. The increasing spread of COVID-19 presents challenges for the clinical care of patients with gynecological malignancies. Concerted efforts should be put into managing gynecological malignancies in an orderly manner by strictly implementing the measures that are specifically developed for controlling the spread of COVID-19. We have drafted Recommendations on Management of Gynecological Malignancies during the COVID-19 Pandemic based on our experience on controlling COVID-19 pandemic in China. We recommend that patients with gynecological malignancies should be managed in hierarchical and individualized manners in combination with local conditions related to COVID-19. Medical care decision should be balanced between controlling COVID-19 pandemic spread and timely diagnosis and treatment for gynecologic oncology patients.

Recommendations on management of gynecological malignancies during the COVID-19 pandemic: perspectives from Chinese gynecological oncologists / 부인종양

The outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 has rapidly spread globally. Cancer patients are at a higher risk of being infected with the coronavirus and are more likely to develop severe complications, as compared to the general population. The increasing spread of COVID-19 presents challenges for the clinical care of patients with gynecological malignancies. Concerted efforts should be put into managing gynecological malignancies in an orderly manner by strictly implementing the measures that are specifically developed for controlling the spread of COVID-19. We have drafted Recommendations on Management of Gynecological Malignancies during the COVID-19 Pandemic based on our experience on controlling COVID-19 pandemic in China. We recommend that patients with gynecological malignancies should be managed in hierarchical and individualized manners in combination with local conditions related to COVID-19. Medical care decision should be balanced between controlling COVID-19 pandemic spread and timely diagnosis and treatment for gynecologic oncology patients.

Expression of Galectin-3 and Bcl-2 in Epithelial Ovarian Cancer and Their Clinical Significance / 中山大学学报(医学科学版)

[Objective] Examine the expression of Galectin-3 (Gal-3),B cell lymphoma-2 protein (Bcl-2) in epithelial ovarian cancer tissues with regard to clinicopathological and survival variables,testing whether they can serve as prognostic markers and provide evidence for further research.[Methods] 98 EOC tissues and 10 normal ovarian tissues were collected,as well as their clinical documents.The expression of Gal-3 and Bcl-2 was tested via immunohistochemical staining analysis.Then the correlation between these two proteins and the clinicopathological and survival variables of these patients were evaluated.[Results] Of the 98 EOC,Gal-3 and Bcl-2 were all cytoplasmic staining.Gal-3 was observed in a majority of the EOC tumor cell proper (75/98,76.5％) but not in normal ovarian tissues.Bcl-2 was observed in a majority of the EOC tumor cell proper (50/98,51.0％) but not in normal ovarian tissue.Spearman bivariate correlation test show that there was no correlation between the expression Gal-3 and Bcl-2 (P =0.867).Gal-3 expression in EOC was associated with histology and platinum sensitivity (P =0.043,P =0.038),while Bcl-2 was associated with FIGO stage (P =0.029).Cox univariate analysis revealed that Gal-3,Bcl-2 expression,platinum sensitivity,stage were associated with overall survival (P =0.008,P =0.021,P ＜ 0.001,P ＜ 0.001).Further multivariate analysis showed that only Gal-3 expression,platinum sensitivity,stage affected the survival of these patients (P =0.014,P =0.021,P ＜ 0.001).[Conclusions]The expression of Gal-3 and Bcl-2 in EOC was significantly higher than that in normal ovarian tissue,supposed that they may involve in the development and progression of EOC.Gal-3 expression was associated with histology,platinum sensitivity and survival,it may be an independent predictive factor for EOC prognosis.There was no correlation between the expression Gal-3 and Bcl-2 in EOC,the functional mechanism between these two protein need further research.

Forty￣nine Cases of Shenmai Injection Administration for Elderly with Orthostatic Hypotension / 医药导报

Objective To investigate the effect of Shenmai injection in treating elderly with orthostatic hypotension. Methods The total of 97 cases of patients with orthostatic hypotension were randomly divided into 2 groups, which was injected intravenously with 100 mL Shenmai injection once daily as the treatment group, with 100 mL glucose as the control.The treatment lasted 14 days. The clinical symptom score, the difference of blood pressure, the P￣selectin, and the platelet maximum aggregation were measured. Results Compared with the control, Shenmai injection significantly reduced the clinical symptom scores of patients (P<0.05), lowered the difference of blood pressure for upright and supine significantly (P<0.05), decreased the platelet maximum aggregation and P￣selectin remarkably (P<0.05). Conclusion Shenmai injection significantly reduces the difference of blood pressure for upright and supine of the elderly with orthostatic hypotension, and inhibits the activities of platelets, thus improves the clinical symptoms.

Relationship between orthostatic hypotension and antihypertensive therapy in the elderly hypertensive population / 中华老年医学杂志

Objective To investigate the relationship between orthostatic hypotension (OH) and antihypertensive therapy in the elderly hypertensive population.Methods A total of 1174 elderly retired people (849 cases with hypertension and 325 cases without hypertension) in Guangzhou Military Region underwent health physical examination.All people were surveyed by questionnaires.The orthostatic blood pressure and heart rate were measured in supine position after resting for more than 5 minutes and then at 0 and 2 minutes after standing.Comparative analysis was made on the prevalence of OH and the relationship between OH and antihypertensive therapy.Results A significant difference in the prevalence of OH was observed between hypertensive patients and nonhypertensive patients [29.4％ (250/849) vs.15.7％ (51/325),x2 =23.32,P＜0.01].There was no significant difference in the prevalence of orthostatic hypotension in patients with versus without antihypertensive therapy [30.5％ (220/721) vs.23.4％ (30/128),x2 =2.62,P＞0.05].Conclusions Orthostatic hypotension is common observed in elderly hypertensive patients.Antihypertensive therapy may not increase the prevalence of OH.

Prevalence of symptomatic orthostatic hypotension and orthostatic blood pressure changes / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the prevalence and orthostatic blood pressure changes in subjects with symptomatic orthostatic hypotension (OH), and to observe the relation between symptoms and orthostatic blood pressure change in this population.</p><p><b>METHODS</b>A total of 193 subjects who consulted physicians due to OH related symptoms were selected, and divided into three groups: young (n = 37), middle-aged (n = 66) and elder (n = 90). Height, body weight, waist circumference, hip circumference and resting heart rate were measured. Symptom scores of every subject were obtained. CAVI and ABI were measured. Blood pressure including recumbent position, orthostatic systolic and diastolic blood pressure was measured at the morning and at the afternoon on two separate examination days with at least one week interval. After that, orthostatic changes in systolic blood pressure (OCs) and orthostatic changes in diastolic blood pressure (OCd) were calculated.</p><p><b>RESULTS</b>OH prevalence was 32.6% in this cohort. The prevalence of three groups was similar [young: 32.4%, middle-aged: 25.8%, and elderly: 37.8%, respectively (P > 0.05)]. Only 9 cases (14.29% of confirmed OH cases) reached the OH diagnostic criteria with equal or more than 2 times orthostatic blood pressure measurements. OH was diagnosed in 63 patients during the 4 times orthostatic blood pressure check, of which 19.5% to 57.14% cases were diagnosed with single orthostatic blood pressure check. Age, weight, body mass index, waist-to-hip ratio, smoking, drinking habit, sex, coronary heart disease, hypertension, Parkinson's disease, stroke history, antihypertensive drug use were similar between OH group and non-OH group. Height, waist circumference, hip circumference, and resting heart rate were significantly lower in OH group than in non-OH group (P < 0.05). The values of the factors in OH group were lower. CAVI was 8.45 ± 0.19 in non-OH group and 8.37 ± 0.27 in OH group (P > 0.05), ABI was significantly lower in OH group than in non-OH group (1.004 ± 0.013 vs. 1.051 ± 0.009, P < 0.01).</p><p><b>CONCLUSION</b>The prevalence of OH in people with related symptoms is high. Repeated orthostatic blood pressure measurements can improve OH detection rate.</p>

The correlation between postural hypotension and myocardial infarction in the elderly population / 中华内科杂志

Objective To investigate the association between the systolic/diastolic orthostatic hypotension (OH-S/OH-D) and myoeardial infarction (MI) in the elderly.Methods Health screening physical examination were carried in 1081 subjects without MI aged over 65 years in Guangzhou Military region.The orthostatic blood pressure and heart rate were measured in supine position after resting for more than 5 minutes and at 0 and 2 minutes after standing.All the cases were divided into systolic or diastolic group on the basis of definition of orthostatic hypotension and followed up by telephone or inpatient medical records with mean period of 315.8 days.The primary endpoint was MI occurrence.Results The prevalence of OH in this cohort was 24.5％ ( OH-S/OH-D:19.3％/17.2％ ).Significant differences in the occurrence of OH and OH-S were found in the elderly and the very elderly subjects( ≥80 years) (26.1％ vs 20.1％,P=0.045; 21.0％ vs 14.6％,P =0.018),while no difference was found in OH-D.The prevalence of MI in the OH positive subjects was significantly higher than that in the OH negative subjects,as well as in OH-S or OH-D group.After adjustment of age,supine blood pressure,creatinine and cerebrovascular history by logistic regression,the association was observed between MI and OH ( HR 15.635,95 ％ CI 3.299-74.091,P=0.001),OH-S(HR 8.760,95％CI2.487-30.851,P=0.001)and OH-D(HR 3.889,95％ CI 1.097-13.790,P =0.035 ).Conclusion OH-S and OH-D hypotension are robust predictors for MI in the elderly.

A clinical analysis of morning blood pressure surge in middle and old aged male hypertensive patients / 中华内科杂志

ObjectiveTo investigate the morning blood pressure surge(MBPS) and its relationship with 24-hour blood pressure variability and anti-hypertensive drugs in middle-aged and elderly hypertensive patients.Methods A total of 521 middle-age and elderly men were surveyed with ambulatory blood pressure monitoring and ambulatory electrocardiograms recordings as well as questionnaire investigation from January 2009 to December 2010.Subjects were divided into MBPS positive group and MBPS negative group according to the level of MBPS[ ＞35 mm Hg (1 mm Hg=0.133 kPa) or ≤35 mm Hg].ResultsIn all the cases,the prevalence of MBPS was 19.4％,of which the elderly and very elderly had higher prevalences ( 18.9％ and 21.8％,respectively) than the middle-aged (5.6％,both P ＜0.01 ).Significant differences could be found in age [ ( 81.6 ± 6.4 ) years vs ( 78.7 ± 9.7 ) years ],day mean systolic blood pressure [ ( 132.8 ± 13.3) mm Hg vs ( 128.8 ±13.3) mm Hg],fasting blood glucose [ (5.96 ± 1.59) mmol/L vs (5.68 ± 1.22) mmol/L] and 24-hour blood pressure variability between the two groups ( all P ＜ 0.05 ).Significant difference could be observed in the prevalence of MBPS between the diuretics-taking group and non-taking group (27.4％ vs 17.6％,P ＜0.05 ).ConclusionsThe elderly hypertensive patients are prone to appear MBPS phenomenon.Fasting blood glucose level,24-hour blood pressure variability may be associated with MBPS.Diuretic antihypertensive treatment may not be conductive for MBPS control.

Primary clear cell carcinoma of the cervix:report of five cases and review of the literature / 中华妇产科杂志

Objective To review the survival outcomes in patients with endometrial stromal sarcoma(ESS)in Cancer Hospital，Peking Union Medical College，Chinese Academy of Medical Sciences，and to discuss prognostic factors and the role of post-operative adjuvant radiotherapy and chemotherapy.Methods Hospital records and pathology reports for 97 patients with ESS were reviewed.Among 97 patients，69 had low-grade ESS(LGESS)，16 had high-grade ESS(HGESS)and 12 had unclear grade.The median age at diagnosis was 44.0 years.The median follow-up time was 62 months(5-277 months).Atypical vaginal bleeding(43％)and prolonged and increased menses(36％)were the main symptoms.Results Totally 2-year and 5-year cumulative survival rates were 93％and 84％，respectively.Cumulative survival curves were significantly different between LGESS and HGESS，and so did cumulative survival curves between stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ(P＜0.05).Totally，34 patients(37％)had local or distant recurrence.The median time-to-recurrence(TTR)was 27 months.The recurrence rates of the patients with or without preserve of ovary were 89％and 24％，respectively(P=0.000).The local-control-rates of the patients who received or did not receive post-operative radiotherapy were 81％and 43％，respectively(P=0.011).Conclusions The prognosis of HGESS is obviously worse than that of LGESS.The risk of recurrence of patients with preserve of ovary was remarkably higher than that of patients without preserve of ovary.Postoperative radiotherapy could increase the local-control-rates.