Long-term efficacy and safety of levonorgestrel releasing intrauterine system in the treatment of adenomyosis: evidence mapping.

PURPOSE: To summarize evidence on levonorgestrel releasing intrauterine system (LNG-IUS) in the treatment of adenomyosis (AM) and to identify potential research gaps. METHODS: Search was conducted in MEDLINE, The Cochrane Library, EMBASE, CBM, CNKI, and Wanfang. We included studies investigating patients with AM treated with LNG-IUS combined with conservative therapy. RESULTS: Thirty-nine studies compared LNG-IUS with other conservative therapeutic drugs. The most common comparison was GnRH-a + LNG-IUS vs. LNG-IUS alone, followed by LNG-IUS vs. mifepristone, expected treatment, and GnRH-a. GnRH-a + LNG-IUS was more beneficial in reducing the intensity of dysmenorrhea than LNG-IUS alone at the 6-month follow-up in patients with an enlarged uterus and moderate to severe dysmenorrhea. Large and well-designed studies are needed to confirm the efficacy of LNG-IUS and GnRH-a on reducing uterine volume at 6-month follow-up. Thirty-two studies investigated LNG-IUS as the postoperative management. The most common comparison was surgical excision + LNG-IUS vs. surgical excision. Results showed VAS scores were lower in the surgical excision + LNG-IUS group than in the surgical excision group at the 1-year follow-up. Evidence on endometrial thickness, quality of life, adverse events and beneficial effect at 3 and 5 years are needed. CONCLUSIONS: Combined GnRH-a and LNG-IUS treatment was more efficacious than LNG-IUS alone for patients with an enlarged uterus and moderate to severe dysmenorrhea. Moreover, LNG-IUS seemed to show potential long-term benefits in postoperative therapy, warranting further meta-analysis for confirmation.

Preventive therapeutic options for postoperative recurrence of ovarian endometrioma: gonadotropin-releasing hormone agonist with or without levonorgestrel intrauterine system insertion.

PURPOSE: Here, we compared endometrioma recurrence rates in patients who have undergone a laparoscopic cystectomy and treated with a gonadotropin-releasing hormone agonist (GnRHa) alone or a GnRHa combined with a levonogestrel intrauterine system (LND-IUS). METHODS: We enrolled endometrioma patients who underwent laparoscopic cyst enucleation and divided them into two groups according to postoperative management: GnRHa alone and GnRHa in combination with LND-IUS. We compared preoperative history, perioperative parameters, postoperative endometrioma recurrence, and symptoms between these two groups. RESULTS: A total of 320 patients were included in the final analysis. With a median 84.6 months of follow-up, we detected significant differences between the two groups with respect to age at surgery (31.6 ± 4.8 vs. 37.6 ± 4.2 years, χ2 = 1.978, p < 0.001), gravida (0 vs. 2, χ2 = 4.391, p < 0.001), parity (0 vs. 1, χ2 = 0.035, p < 0.001), body mass index (21.0 ± 2.5 vs. 21.9 ± 2.4, χ2 = 0.0096, p = 0.009), r-AFS score (48 vs. 64, χ2 = 4.888, p = 0.001), and operation time (60 vs. 75 min, χ2 = 9.119, p = 0.003). Patients treated with both GnRHa and LND-IUS achieved significantly less endometrioma recurrence (23.6 vs. 11.5%, χ2 = 5.202, p = 0.023) and higher rates of pain remission (92.1 vs. 100%, χ2 = 6.511, p = 0.011), while those with GnRHa alone suffered more recurrent and painful symptoms (χ2 = 9.280, p = 0.026). Multivariate analysis using a Cox regression demonstrated that combined GnRHa and LNG-IUS treatment correlated with a decreased endometrioma recurrence rate after laparoscopic cystectomy (RR 0.369, 95% CI 0.182-0.749, p = 0.006). CONCLUSIONS: Combination treatment of GnRHa and LNG-IUS exhibited superior pain relief and recurrence prevention among endometrioma patients after fertility-sparing surgery. Thus, combination treatment is a preferable long-term option for patients without intent for pregnancy in the near future.

Clinical characteristics difference between early and late recurrence of ovarian endometriosis after laparoscopic cystectomy.

BACKGROUND: Ovarian endometriosis is the most frequent type of endometriosis. Despite the use of surgery and medication, many patients suffer from recurrence within near future. Currently, there are no effective clinical characteristics available to predict the time to recurrence in ovarian endometriosis patients. PURPOSE: To identify the effective clinical indicators for early and late endometrioma recurrence, we compared the clinical characteristics of early and late recurrence after treatment. METHODS: We collected 358 patients with ovarian endometriosis who had a minimum of 5 years of postoperative follow-up after undergoing a laparoscopic excision of ovarian endometrioma performed at Peking Union Medical College Hospital from January 2009 to April 2013. RESULTS: A total of 358 patients were recruited in the validation set, with a median follow-up time of 83 months (60-120 months). Till the last follow-up, 68 patients exhibited recurrence. Three-year and 5-year recurrence rates were 9.2% and 15.4%, respectively. Univariate analysis in our study showed that patient with endometrioma surgery history had higher incidence of recurrence in 3 years after re-surgery (OR: 5.594, P = 0.029). Univariate and multivariate analyses using the logistic regression showed that the presence of tenesmus before surgery affected the incidence of early recurrence with a ratio of 57.9% (11/19) and 89.5% (17/19) in 3 years and 5 years after surgery, respectively. CONCLUSIONS: Presence of tenesmus before surgery may be linked to the early recurrence of endometrioma.

Ticagrelor and the risk of infections during hospitalization in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention.

BACKGROUND AND AIMS: Although ticagrelor exerts an antibacterial activity, its effect on infections in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) is unclear. We aimed to assess whether ticagrelor and clopidogrel affect infections in these patients during hospitalization. METHODS: A total of 2116 consecutive patients with STEMI undergoing PCI were divided into the ticagrelor (n = 388) and clopidogrel (n = 1728) groups. The primary outcome was infection onset. Secondary outcomes were in-hospital all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE). Propensity score analyses were conducted to test the robustness of the results. RESULTS: Infections developed in 327 (15.4%) patients. There was no significant difference in infection between both groups (ticagrelor vs. clopidogrel: 13.1% vs. 16.0%, p = 0.164). Patients in the ticagrelor group had lower rates of in-hospital all-cause death and MACCE than patients in the clopidogrel group. Multivariate logistic regression analysis determined that ticagrelor and clopidogrel had a similar preventive effect on infections during hospitalization (adjusted odds ratio [OR] = 1.20; 95% confidence interval [CI] = 0.80-1.78, p = 0.380). Compared to the patients treated with clopidogrel, patients treated with ticagrelor had a slightly lower risk of other outcomes, but no statistical difference. Propensity score analyses demonstrated similar results for infections and other outcomes. CONCLUSIONS: Compared with clopidogrel treatment, ticagrelor treatment did not significantly alter the risk of infections during hospitalization among STEMI patients undergoing PCI, but was associated with a slightly lower risk of in-hospital all-cause death and MACCE.

Effect of metronidazole combined with autolytic debridement for the management of malignant wound malodor.

OBJECTIVE: To explore the effect of metronidazole combined with autolytic debridement for the management of malignant wound malodor. METHODS: Patients with malignant wounds who underwent dressing change at a wound outpatient clinic from September 2016 to February 2019 were randomized to an observation group (36 patients) or a control group (37 patients). The observation group was treated with metronidazole combined with debridement gel while the control group received wet dressing therapy combined with silver sulfadiazine. Malodor control was compared between the two groups from treatment initiation to days 3 and 12 after dressing change, and the social impact scale was used to compare stigma caused by malodor between the groups before and after treatment. RESULTS: The observation group had significantly superior malodor control on days 3 and 12 after dressing change compared with the control group. There was no difference in stigma between the two groups before treatment, but stigma in the observation group was significantly lower than that in the control group after treatment. CONCLUSION: Metronidazole combined with autolytic debridement can effectively reduce the malodor of cancerous wounds while controlling infection, and alleviate patient stigma caused by malodor.

The comparative efficacy of group- versus home-based exercise programs in patients with ankylosing spondylitis: Protocol for a meta-analysis.

BACKGROUND: Ankylosing spondylitis (AS) is an important factor to not only cause employment obstacle, but also result in serious social economic load. Several randomized controlled trials investigated the efficacy of group- versus home-based exercise programs in patients with AS. This systematic review will collect and summarize the available evidence to realize the effectiveness of group- and home-based programs in patients with AS. METHODS: A search in PubMed, Web of Science, EMBASE, and the Cochrane Library will be electronically performed by 2 independent investigators to capture all potential studies comparing group- and home-based in patients with AS. The time limit of search will be from their inception to April 2018. Two independent investigators provide their agreement in presencial meeting for a final selection, and at a later stage, the articles will be reviewed in full-text by the all authors. Quantitative analysis will be performed with Review Manager (RevMan) software (version 5.3.0). RESULTS: This meta-analysis will provide a high-quality synthesis of current evidence of group- versus home-based exercise programs in patients with AS. CONCLUSION: The conclusion of our meta-analysis will provide the evidence which program is an effective intervention for patient with AS.

[Effects of Migu Tablet on bone mineral density, serum levels of osteoprotegerin and its ligand and bone metabolic markers in patients with postmenopausal osteoporosis].

OBJECTIVE: To study the effects of Migu Tablet (MGT) on bone mineral density (BMD), serum levels of osteoprotegerin (OPG) and its ligand (OPGL), and bone metabolic markers in patients with postmenopausal osteoporosis (PMO). METHODS: BMD in 192 women of natural menopause, 48 to 65 years old, were determined. Among them, 160 women with PMO were randomized into 4 groups, 54 in the Migu Tablet group (MGTG), 53 in the Xianlin Gubao group (XLGBG) and 53 in the Leli Calcium group (LCG). And the other 32 women with BMD in normal range were set as the control group. Serum levels of OPG, OPGL, bone alkaline phosphates (sBAP), osteocalcin (sOC), cross-linked C-telopeptides of collagen type I (sCTx), and urine level of bone cross-linked N-telopeptides of collagen type I (uNTx) were measured before treatment and at the 12th and 24th week of treatment, with enzyme-linked immunosorbent assay (ELISA); BMD of orthophoric lumbar vertebrae, femoral neck, Ward's triangle and trochanter were determined by dual-energy X-ray absorptiometry at the same time as well. RESULTS: After 24-week treatment, BMD was heightened to different degree, serum levels of OPG, sCTx, uNTx/Cr were significantly decreased and OPGL, sBAP, sOC were increased in the MGTG and XLGBG, while these indexes showed insignificant change in the LCG and the control group. CONCLUSION: The effect of MGT in treating PMO were notable, just like that of XLGB, but single medication of calcium tablet cannot alleviate the disease and also incapable to prevent the loss of bone.

Percutaneous bipolar radiofrequency thermocoagulation for the treatment of lumbar disc herniation.

Lumbar disc herniation is usually managed with conservative treatment or surgery. However, conservative therapy seldom yields good results, and surgery is associated with multiple complications. This study aimed to assess bipolar radiofrequency thermocoagulation for the treatment of lumbar disc herniation. A total of 168 patients with lumbar disc herniation suitable for radiofrequency thermocoagulation were enrolled and randomized to monopolar radiofrequency thermocoagulation (control group, n=84) or bipolar radiofrequency thermocoagulation (experimental group, n=84) treatment groups. Ablation sites were targeted under CT scan guidance, and consecutive radiofrequency therapy was used. One and two probes were used for monopolar and bipolar thermocoagulation, respectively. Thermocoagulation was achieved at 50°C, 60°C, and 70°C for 60s each, 80°C for 90s, and 92°C for 100s. Symptoms and complications were evaluated using the modified Macnab criteria and Visual Analog Scale at 7, 30, and 180days postoperatively. At 180days, a significantly higher efficacy rate was obtained in the experimental group compared with control patients (91.6% versus 79.7%, P<0.05). No severe complications were occurred in either group. Targeted ablation via bipolar radiofrequency thermocoagulation is efficient for lumbar disc herniation treatment, and should be further explored for broad clinical application.

[Randomized controlled study on acupuncture treatment for chronic fatigue syndrome].

OBJECTIVE: To observe the therapeutic effect of acpuncture treatment for chronic fatigue syndrome (CFS). METHODS: Nighty cases of CFS were randomly divided into an observation group and a control group, 45 cases in each group. The observation group was treated with acupunture at Renying (ST 9), Fengfu (GV 16), Baihui (GV 20); the control group was treated with 250 mL 5% Glucose injectio combined with 20 mL Shenmai injectio. Fatigue Scale (FS) was used to compare the scores between the two groups after treatment. RESULTS: The total scores in the observation group were 9.37 +/- 2.33 and 5.41 +/- 1.96 before and after treatment respectively, and in the control group, they were 9.08 +/- 2.27 and 7.34 +/- 2.03 respectively. FS brainwork integral, physical fatigue integral, and total integral all decreased after treatment in two groups (all P < 0.001), and it decreased much more obviously in the observation group (P < 0.05, P < 0.01). CONCLUSION: Both of the acpuncture treatment and Shenmai injectio are able to decrease fatigue scale score, improve the fatigue symptoms of CFS patients, and the effect of acupucture treatment is obviously superior to that of Shenmai injectio.

[Study of on-board emission measurement for heavy-duty diesel vehicle and its impact with load].

Real world vehicle emission tests were conducted on two heavy-duty diesel trucks on un-loaded and loaded condition by using a portable emission measurement system. By analysis, the results indicate high fuel consumption and emission rates are concentrated on the high speed and acceleration areas of the speed-acceleration emission maps and the areas are much wider on loaded condition. The impact of load on fuel use and emissions will be highest while the vehicle is cruising or accelerating on (30 +/- 2.5) km x h(-1), which are 1.6 - 3.2 times of those on un-loaded condition. Synthetically, the comprehensive fuel consumption and CO, HC, NO(x) emission factors of truck I and truck II on loaded condition are respectively 1.6, 3.5, 1.1, 1.5 times and 1.2, 1.0, 0.9, 1.5 times of those without load. Load has greatest impact on fuel consumption and NO(x) emission and less effect on HC emission. As for the CO emission, it depends on the maintenance of the truck. It can be figured out from the results on two trucks that the impact of same load will be lower on a vehicle with lager type and more powerful engine, which means if one vehicle is loaded on its acceptable range of GVWR, fuel use and emissions caused by heavy loads could be decreased correspondingly.