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2.
J Chin Med Assoc ; 86(2): 133-134, 2023 Feb 01.
Article in English | MEDLINE | ID: mdl-36652564
3.
J Chin Med Assoc ; 86(1): 3-4, 2023 Jan 01.
Article in English | MEDLINE | ID: mdl-36599138
4.
J Chin Med Assoc ; 2022 Dec 17.
Article in English | MEDLINE | ID: mdl-36528800
5.
J Chin Med Assoc ; 2022 Nov 22.
Article in English | MEDLINE | ID: mdl-36440991
9.
Taiwan J Obstet Gynecol ; 61(6): 927-934, 2022 Nov.
Article in English | MEDLINE | ID: mdl-36427994

ABSTRACT

Endometriosis, manifested by pain and infertility, is a chronic inflammatory disease, associated with a large disability of daily living, causing a socio-economic diastrophic problem and burden. The main goal of therapy attempts to reduce pain, correct infertility and possibly avoid or delay occurrence of long-term endometriosis-associated sequelae, such as fibrosis, adhesion and malignant transformation. Although the advanced technology (minimally invasive diagnostic tools, magnetic resonance imaging, high-resolution vaginal ultrasound etc.) and the better understanding pathophysiology of endometriosis for development of new therapeutic strategy is continuous for both diagnosis and management of endometriosis, there is still presence of many debated issues, which commonly occur in routine clinical practice. For example, the timing and duration of medications may be one of most frequently discussed issues. In this part I, we would like to overview the general background knowledge (basic concept) about the endometriosis, and emphasize the role of clinical diagnosis and possible empirical medical treatment (therapeutic test) for the management of women with endometriosis.


Subject(s)
Endometriosis , Infertility, Female , Humans , Female , Endometriosis/diagnosis , Endometriosis/therapy , Endometriosis/complications , Infertility, Female/complications , Ultrasonography , Chronic Disease , Vagina , Pain
10.
Taiwan J Obstet Gynecol ; 61(6): 951-959, 2022 Nov.
Article in English | MEDLINE | ID: mdl-36427997

ABSTRACT

Endometrial cancer (EC) has become one of rapidly increasing women's cancers, contributing to the most common cancer of the female genital tract in high- and middle-incomed countries, including Taiwan. In general, EC is believed its favorable outcome; however, high-grade endometrial cancers have a tendency to recur and also have a high risk to be presented as an advanced stage or accompanied with metastatic lesions, which result in a biggest therapeutic challenge. The standard therapy includes complete staging surgery (sentinel node sampling)/optimal debulking surgery, and subsequent adjuvant therapy, by either radiotherapy locally or systemic therapy as chemotherapy or targeted therapy, or in combination or in subsequential strategy is made based on the risk stratification using clinicopathological prognostic factors. All efforts are made to minimize the risk of recurrence and possible therapeutic failure. In this part I, we would like to overview the general background knowledge (basic concept) about the cancer of uterine corpus, and discuss the recent transformation to patients-tailored therapy based on modern molecular technology as the optimal strategy to balance the therapeutic efficacy and treatment-related toxicity. Optimally, it is possible to reach the best benefits.


Subject(s)
Endometrial Neoplasms , Female , Humans , Endometrial Neoplasms/pathology , Combined Modality Therapy , Taiwan
11.
J Chin Med Assoc ; 2022 Oct 21.
Article in English | MEDLINE | ID: mdl-36279128

ABSTRACT

Type 2 diabetes mellitus (DM) is characterized by inability of faulty pancreatic ß-cells to secret a normal amount of insulin to maintain normal body consumption, and/or peripheral tissue has a decreased susceptibility to insulin, resulting in hyperglycemia and insulin resistance. Similar to other chronic systemic inflammatory diseases, DM is a result from dysregulated interactions between ethnic, genetic, epigenetic, immunoregulatory, hormonal and environmental factors. Therefore, it is rational to suppose the concept as "To do one and to get more", while using anti-diabetic agents (ADA), a main pharmacologic agent for the treatment of DM, can provide an extra-glycemia effect on co-morbidities or concomittent co-morbidities to DM. In this review, based on the much strong correlation between DM and metabolic dysfunction-associated fatty liver diseases (MAFLD) shown by similar pathophysiological mechanisms and a high prevalence of DM in MAFLD and its vice versa (a high prevalence of MAFLD in DM), it is possible to use the strategy to target both diseases simultaneously. We focus on a new classification of ADA, such as glucagon-like peptide 1 receptor (GLP1R) agonist and sodium-glucose cotransporter-2 (SGLT-2) inhibitors to show the potential benefits of extra-glycemic effect on MAFLD. We conclude that the management of DM patients, especially for those who need ADA as adjuvant therapy should include healthy lifestyle modification to overcome the metabolic syndrome, contributing to the urgent need of an effective weight reduction strategy. GLP1R agonist is one of effective body weight-lowering medications, which may be a better choice for DM complicated with MAFLD or its-associated severe form as MASH, although the role of SGLT-2 inhibitors are also impressive. The prescription of these two classes of ADA may satisfy the concept "To do one and to get more", based on successful sugar-lowering effect for controlling DM and extra-glycemia benefits of hepatoprotective activity in DM patients.

12.
J Chin Med Assoc ; 2022 Oct 18.
Article in English | MEDLINE | ID: mdl-36250911
13.
Taiwan J Obstet Gynecol ; 61(5): 739-740, 2022 Sep.
Article in English | MEDLINE | ID: mdl-36088037

ABSTRACT

Fourth, before shared decision making with pregnant women, the exact benefits and risks of both TOLAC and ERCD should be fully and thorough in discussion. A speedy recovery, the enjoying self-control natural birth, immediately entering into a bonding with their newborns and breastfeeding faster of mothers and avoidance of C/S related morbidity, such as intrauterine adhesion, pelvic adhesion, the risk of subsequent pregnancy (placenta accreta spectrum), and postpartum hemorrhage are reported to encourage women favor the TOLAC; and by contrast, for ERCD, the possible advantages include easily controlling labor pain, avoidance of vaginal or pelvic floor damage with subsequent development of sequela, such as stress urinary incontinence, lower genito-urinary tract dysfunction, pelvic organ prolapse etc., and the ease of a scheduled birth and following postpartum care [5,6,9,19-21].


Subject(s)
Cesarean Section , Urinary Incontinence, Stress , Cesarean Section/adverse effects , Female , Humans , Infant, Newborn , Parturition , Pelvic Floor , Pregnancy , Trial of Labor
15.
Taiwan J Obstet Gynecol ; 61(5): 744-745, 2022 09.
Article in English | MEDLINE | ID: mdl-36088039
16.
J Chin Med Assoc ; 85(11): 1061-1067, 2022 11 01.
Article in English | MEDLINE | ID: mdl-36083636

ABSTRACT

BACKGROUND: Oxytocin is commonly used to reduce blood loss during suction curettage for missed abortion. However, the potential of oxytocin to mitigate blood loss in early pregnancy remains controversial. Based on the hypothesis that the "timing" of oxytocin administration may be a critical factor, we investigated whether the timing of intravenous (IV) administration is associated with reduced perioperative blood loss during first-trimester suction curettage for missed abortion. METHODS: The medical charts of 146 patients with ultrasound-confirmed first-trimester missed abortion who underwent suction curettage with IV oxytocin administration were retrospectively reviewed. RESULTS: Among the patients, 67 received 10 IU of IV oxytocin before suction curettage (early-oxytocin administration group), while 79 patients received 10 IU of IV oxytocin after suction curettage (late-oxytocin administration group). The demographic features between the two groups did not significantly differ. However, there was a lower proportion of nulliparous patients in the early-oxytocin administration group than in the late-oxytocin administration group (38.8% vs 60.8%, p = 0.006). The perioperative blood loss amount was significantly lower in the early-oxytocin administration group than in the late-oxytocin administration group (60 [range: 50-100] vs 100 [range: 30-250] mL, p = 0.001). Moreover, the multivariate logistic regression analysis showed that the early-oxytocin administration group had a lower risk for a perioperative blood loss amount of ≥100 mL than the late-oxytocin administration group (0.23 [range: 0.10-0.55], p = 0.001); a gestational age of 9-12 weeks ( p = 0.009) was found to be associated with an increased risk for a perioperative blood loss amount of ≥100 mL. CONCLUSION: Compared with late-oxytocin administration, early-oxytocin administration could reduce perioperative blood loss during first-trimester suction curettage for missed abortion. However, the results require further investigation.


Subject(s)
Abortion, Induced , Abortion, Missed , Pregnancy , Female , Humans , Infant , Vacuum Curettage , Pregnancy Trimester, First , Abortion, Missed/prevention & control , Oxytocin , Retrospective Studies , Blood Loss, Surgical
17.
J Chin Med Assoc ; 85(10): 965-971, 2022 10 01.
Article in English | MEDLINE | ID: mdl-36066352

ABSTRACT

Type 2 diabetes mellitus (T2DM), is a chronic metabolic disease, characterized by the presence of hyperglycemia and insulin resistance. The key treatment strategies for T2DM include modification of lifestyle, medications, and continuous glucose monitoring. DM patients often have DM-associated morbidities and comorbidities; however, disorders of musculoskeletal system are often neglected, compared to other major systems in DM patients. Based on sharing similar pathophysiology of DM and osteoporosis, it is supposed that the use of antidiabetic agents (ADAs) may not only provide the lowering glucose level effect and the maintenance of the sugar homeostasis to directly delay the tissue damage secondary to hyperglycemia but also offer the benefits, such as the prevention of developing osteoporosis and fractures. Based on the current review, evidence shows the positive correlation between DM and osteoporosis or fracture, but the effectiveness of using ADA in the prevention of osteoporosis and subsequent reduction of fracture seems to be inconclusive. Although the benefits of ADA on bone health are uncertain, the potential value of "To do one and to get more" therapeutic strategy should be always persuaded. At least, one of the key treatment strategies as an establishment of healthy lifestyle may work, because it improves the status of insulin resistance and subsequently helps DM control, prevents the DM-related micro- and macrovascular injury, and possibly strengthens the general performance of musculoskeletal system. With stronger musculoskeletal system support, the risk of "fall" may be decreased, because it is associated with fracture. Although the ADA available in the market does not satisfy the policy of "To do one and to get more" yet, we are looking forward to seeing the continuously advanced technology of drug development on diabetic control, and hope to see their extra-sugar-lowering effects.


Subject(s)
Diabetes Mellitus, Type 2 , Fractures, Bone , Hyperglycemia , Insulin Resistance , Osteoporosis , Blood Glucose , Blood Glucose Self-Monitoring , Diabetes Mellitus, Type 2/drug therapy , Fractures, Bone/complications , Humans , Hyperglycemia/complications , Hypoglycemic Agents/therapeutic use , Osteoporosis/complications , Osteoporosis/prevention & control
18.
19.
Int J Environ Res Public Health ; 19(15)2022 07 26.
Article in English | MEDLINE | ID: mdl-35897496

ABSTRACT

Polycystic ovary syndrome (PCOS) is a common metabolic problem in women of reproductive age. Evidence suggests pregnant women with PCOS may have a higher risk of the development of adverse pregnancy outcomes; however, the relationship between pre-pregnancy overweight/obesity and pregnancy outcomes in women with PCOS remains uncertain. We try to clarify the relationship between pre-pregnancy overweight/obesity and subsequent pregnancy outcomes. Therefore, we conducted this systematic review and meta-analysis. We used the databases obtained from the PubMed, Embase, Web of Science, and Cochrane databases, plus hand-searching, to examine the association between pre-pregnancy overweightness/obesity and pregnancy outcomes in women with PCOS from inception to 4 February 2022. A total of 16 cohort studies, including 14 retrospective cohort studies (n = 10,496) and another two prospective cohort studies (n = 818), contributed to a total of 11,314 women for analysis. The meta-analysis showed significantly increased odds of miscarriage rate in PCOS women whose pre-pregnancy body mass index (BMI) is above overweight (OR 1.71 [95% CI 1.38-2.11]) or obese (OR 2.00 [95% CI 1.38-2.90]) under a random effect model. The tests for subgroup difference indicated the increased risk was consistent, regardless which body mass index cut-off for overweight (24 or 25 kg/m2) or obesity (28 and 30 kg/m2) was used. With the same strategies, we found that pregnant women in the control group significantly increased live birth rate compared with those pregnant women with PCOS as well as pre-pregnancy overweight/obesity (OR 0.79 [95% CI 0.71-0.89], OR 0.78 [95% CI 0.67-0.91]). By contrast, we did not find any association between PCOS women with pre-pregnancy overweight/obesity and preterm birth. Based on the aforementioned findings, the main critical factor contributing to a worse pregnancy outcome may be an early fetal loss in these PCOS women with pre-pregnancy overweight/obesity. Since PCOS women with pre-pregnancy overweightness/obesity were associated with worse pregnancy outcomes, we supposed that weight reduction before attempting pregnancy in the PCOS women with pre-pregnancy overweightness/obesity may improve the subsequent pregnancy outcomes.


Subject(s)
Polycystic Ovary Syndrome , Premature Birth , Female , Humans , Infant, Newborn , Obesity/complications , Obesity/epidemiology , Overweight/complications , Overweight/epidemiology , Polycystic Ovary Syndrome/complications , Polycystic Ovary Syndrome/epidemiology , Pregnancy , Pregnancy Outcome/epidemiology , Prospective Studies , Retrospective Studies
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