Efficacy of Chinese Herbal Medicines on Pregnancy Outcomes in Patients with Endometriosis in Long-Term Management: A Multicenter Retrospective Cohort Study / 中国结合医学杂志

OBJECTIVE@#To analyze the factors related to pregnancy of endometriosis and whether Chinese herbal medicines (CHMs) can improve pregnancy outcomes in patients with endometriosis in long-term management.@*METHODS@#This multicenter cohort study retrospectively analyzed the clinical data of endometriosis patients with fertility needs from January 2019 to November 2019. A total of 252 patients with endometriosis from 5 level-III Grade A hospitals in Beijing were included in this study. Univariate and multivariate logistic regression analysis were performed for the relevant factors. The propensity score matching (PSM) function of SPSS software was used to match the CHMs group with the non-CHMs group. The pregnancy rate and live birth rate were analyzed.@*RESULTS@#The results of univariate analysis showed that age, disease course, presence of infertility, presence of adenomyosis, time after surgery or use of gonadotropin-releasing hormone agonist (GnRH-a), use of CHMs and follow-up time were influencing factors of pregnancy in endometriosis patients (P<0.05). The results of multivariate analysis showed that age, presence of adenomyosis, time after surgery or use of GnRH-a, use of CHMs and follow-up time were independent factors affecting pregnancy in endometriosis patients, among which, age ⩾35 years old, presence of adenomyosis and follow-up time >6 months were independent risk factors (OR=0.445, 0.348, 0.140, respectively, P<0.05), time after surgery or use of GnRH-a ⩽6 months and use of CHMs were independent protective factors (OR=3.839, 3.842, respectively, P<0.05). After PSM, 99 pairs of two groups were matched successfully. The pregnancy rate of the CHMs group was higher than that of the non-CHMs group [55.56% (55/99) vs. 36.36% (36/99), P<0.05]. The live birth rate of the CHMs group was higher than that of the non-CHMs group [49.49% (49/99) vs. 35.35% (35/99), P<0.05].@*CONCLUSION@#CHMs can effectively improve clinical pregnancy rate and live birth rate of patients with endometriosis in the chronic disease management.

Thought and practice of long-term management for hepatobiliary and pancreatic malignant tumors / 中华肝胆外科杂志

Radical resection is the only measurement to cure patients of hepatobiliary and pancreatic tumors. The comprehensive application of endoscopy, interventional therapy, radiotherapy and systemic therapy can not only significantly improve the early diagnosis rate of the disease, and successfully transform some borderline resectable tumors into radical resectable states, but also reduce the recurrence rate of tumors after surgery, thus prolonging the survival time of patients. In recent years, the continuous emergence of new systemic therapeutic drugs has brought new opportunities for patients with hepatobiliary and pancreatic malignancies, but the number of doctors participating in diagnosis and treatment has also increased accordingly. Therefore, the contradiction between the division system based on treatment methods and the orderly and standardized treatment is becoming more and more prominent. According to the latest progress of hepatobiliary and pancreatic cancer research at home and abroad, and combined with our clinical experience, we proposed a long-term management concept based on hepatobiliary and pancreatic comprehensive multi-technical team. Based on this concept, we have carried out new thought and practice on the diagnosis and treatment of patients with hepatobiliary and pancreatic malignant tumors.

Reflection and practice of long-term management of hepatocellular carcinoma / 中华消化外科杂志

The treatment of hepatocellular carcinoma (HCC) has always been a hot spot of medical research worldwide. At present, surgical resection is the main therapy for HCC, supplemen-ted by interventional therapy, chemotherapy, radiotherapy, etc. Although the overall survival of HCC has been significantly improved in recent years, the overall effect is still unsatisfactory. New systemic therapeutic drugs are constantly emerging and applied to clinical practice, which bring new opportunities and challenges for the treatment of HCC. However, too many diagnosis and treatment topics bring obvious contradiction between the division system and the orderly and standardized HCC treatment. In the future, how to realize unified and standardized homogeneous diagnosis and treatment is the key problem to be solved urgently. The authors summarize the current status of diagnosis and treatment of HCC and propose the long-term management concept for HCC according to their own clinical experience and the current advances of the diagnosis and treatment at home and abroad, and carry out new practice and investigation on the patients with HCC by constructing a hepatobiliary multi-technical team.

Drug choice in medical therapy and long-term management for patients with adenomyosis of the uterus / 中国实用妇科与产科杂志

To relieve pain,reduce heavy menstrual flow and retain or enhance fertility are the dominant treatment target of adenomyosis of the uterus.Hysterectomy or adenomyomectomy remains the most important method of treatment for the disease up to now.The medical drugs in treatment of adenomyosis of the uterus are similar to those for endometriosis,with dienogest being the only specific drug at present. In this article,medical treatments for adenomyosis of the uterus on pain relief and menstrual flow reduction as well as the long-term management of patients are discussed.

The long－term management of cystic kidney disease in children / 中华实用儿科临床杂志

Cystic kidney disease in children is a group of kidney diseases with single or multiple cysts in the kidney that are caused by different reasons. According to the etiologies,cystic kidney disease can be divided into genetic or non_genetic type,and few of those are caused by another disease. Cyst in kidney can be isolation,and also can be one of the phenotypes of another syndrome disease. It can occur in infancy,childhood or adulthood,or both of them. The therapies are different because of the different pathogenesis and pathology,and also because of the changing clinical fea_ture in different age stage. These diseases should be detected,diagnosed and treated early,and it is absolutely important to make a systematic long_term management of these diseases.

Treatment and Management of Late Complications in Hereditary Hemolytic Anemia / 임상소아혈액종양

Hereditary hemolytic anemia is a very heterogeneous disorder in which abnormalities of red blood cell structural protein, globin protein, or enzyme defect lead to shortened life span. There has been much progress in revealing its pathophysiology and genetic backgrounds, but the lifelong plans for caring these patients are not well established yet. All patients with hereditary hemolytic anemic have three common problems: transfusion dependency, iron overload and iron chelation therapy. Patients with hereditary spherocytosis (HS) usually manifest severe anemia in neonatal period and infancy, but transfusion requirements may decrease in adulthood. But patients with thalassemia or sickle cell disease usually transfusion-dependent throughout life. Maintaining the optimal hemoglobin (Hb) levels in these patients is crucial because correction of anemia and dilution of abnormal Hb helps prevent certain complications that frequently occur in these patients. Frequent transfusion leads to transfusion-mediated infection and hemochromatosis. Iron chelation therapy should be started early to prevent permanent organ damage. Folate therapy can be helpful in patients with hereditary spherocytosis. Regular evaluations for cholestasis should be started at age 5, and splenectomy with concurrent cholecystectomy can be considered if the patient has cholecystitis. Hydroxyurea can be used to reduce transfusion requirements and prevent complications in patients with β-thalassemia and sickle cell disease. Consensus on long-term management of patients with hereditary hemolytic anemia is lacking, especially for adult patients. But further efforts to build guidelines for long-term follow-up and management of the patients with hereditary hemolytic anemia in the context of Korean society are needed.

Treatment and Management of Late Complications in Hereditary Hemolytic Anemia / 임상소아혈액종양

Hereditary hemolytic anemia is a very heterogeneous disorder in which abnormalities of red blood cell structural protein, globin protein, or enzyme defect lead to shortened life span. There has been much progress in revealing its pathophysiology and genetic backgrounds, but the lifelong plans for caring these patients are not well established yet. All patients with hereditary hemolytic anemic have three common problems: transfusion dependency, iron overload and iron chelation therapy. Patients with hereditary spherocytosis (HS) usually manifest severe anemia in neonatal period and infancy, but transfusion requirements may decrease in adulthood. But patients with thalassemia or sickle cell disease usually transfusion-dependent throughout life. Maintaining the optimal hemoglobin (Hb) levels in these patients is crucial because correction of anemia and dilution of abnormal Hb helps prevent certain complications that frequently occur in these patients. Frequent transfusion leads to transfusion-mediated infection and hemochromatosis. Iron chelation therapy should be started early to prevent permanent organ damage. Folate therapy can be helpful in patients with hereditary spherocytosis. Regular evaluations for cholestasis should be started at age 5, and splenectomy with concurrent cholecystectomy can be considered if the patient has cholecystitis. Hydroxyurea can be used to reduce transfusion requirements and prevent complications in patients with β-thalassemia and sickle cell disease. Consensus on long-term management of patients with hereditary hemolytic anemia is lacking, especially for adult patients. But further efforts to build guidelines for long-term follow-up and management of the patients with hereditary hemolytic anemia in the context of Korean society are needed.

Current Concepts in the Management of Endometriosis / 대한산부인과학회지

Endometriosis has been known as the benign malignancy which encompasses the unpredictable clinical symptoms and signs with formidable personal morbidity. There are many unresolved controversies in terms of the management of endometriosis with the innate chronic gynecologic disease. In many cases of endometriosis patients, the diagnosis might be delayed without the appropriate clinical concerns. Furthermore, the superficial endometriotic lesions will progress into the deeply infiltrating lesions. The malignant transformation such as endometriosis-associated ovarian cancers can be occurred without the adequate surgical removal of ovarian endometriosis. Deeply infiltrating lesions can invade into the vital organs such as ureter, rectum, bladder, and peripheral nerves. These inappropriate clinical evaluation and management will eventually leave the persistent endometeriotic lesions in the female pelvis and these will cause chronic relentless incapacitating pain. These situations will decrease the quality of life in the endometriosis patients. Therefore the liberal use of laparoscopic surgery should be introduced in the clinically suspicious endometriosis patients and the long-term intervention should be provided to avoid recurrences and long-term complications of endometriosis.