[Pregnancy outcomes in patients with adenomyosis with fertility requirements: retrospective analysis of clinical data from real world].

Objective: To retrospectively analyze the pregnancy outcomes of patients with adenomyosis requiring fertility in a single center under real world condition. Methods: From June 2015 to May 2020, 231 cases of pregnancy complicated with adenomyosis diagnosed by ultrasound with fertility requirements were treated in the Women's and Children's Hospital Affiliated to Qingdao University with complete clinical data. And they were divided into three groups according to the treatment of adenomyosis before pregnancy: expectation group, drug group and operation group. The relevant data before pregnancy of the three groups were analyzed, and the pregnancy outcomes of the patients were summarized. According to whether the early pregnancy was treated with medication, the patients who were naturally conceived without symptoms of threatened abortion were divided into observation group and fetus protection group, and the pregnancy outcomes of the two groups were compared. Results: (1) Compared with the expectation group, the ages of patients in the drug group and the operation group were larger [(31.5±1.8) vs (34.1±3.7) vs (36.9±3.6) years old], and the difference was statistically significant (P<0.05). Only 9 patients (11.5%, 9/78) had clinical symptoms in the expectation group, while the patients in the drug group and the operation group had a higher proportion of dysmenorrhea and increased menstrual volume. The uterine volume of the drug group and the operation group were larger than that of the expectation group [(151±46) vs (166±27) vs (97±18) cm3], the difference was statistically significant (P<0.05). 78.6% (33/42) of the operation group were focal adenomyosis. The proportion of natural pregnancy in the expectation group was 97.4% (76/78), and in vitro fertilization and embryo transfer was mainly used in the drug group and the operation group. (2) The abortion rates of the three groups were 48.7% (26/111), 4/17, 67.5% (27/78) respectively. Compared with the drug group and the operation group, the preterm birth rate was lower [55.9% (33/111) vs 11/17 vs 12.5% (5/78)] and the natural delivery rate was higher [44.1% (26/111) vs 4/17 vs 67.5% (27/78)] in the expectation group. (3) There were 89 cases of spontaneous pregnancy without threatened abortion symptoms, including 31 cases in the observation group and 58 cases in the fetus protection group. Compared with the observation group, the abortion rate of patients in the fetus protection group was lower [41.9% (13/31) vs 34.5% (20/58)], and the difference was statistically significant (P<0.05). Conclusions: Patients with adenomyosis who have fertility requirements should be comprehensively evaluated and individualized treatment plans should be given. Pregnancy patients with adenomyosis have a high rate of miscarriage, and they should be included in the management of high-risk pregnant women. Active fetal protection treatment during early pregnancy might improve pregnancy outcomes.

Effect of embolic microspheres in the treatment of primary hepatic carcinoma.

The purpose of this study was to evaluate the clinical effect of embolic microspheres in the treatment of primary hepatic carcinoma. Fifty-eight patients who were confirmed with primary hepatic carcinoma by imaging were retrospectively analyzed. They were firstly perfused with 50 mg of oxaliplatin and 40 mg of epirubicin. Embolic microspheres were then injected into the distal end of targeted blood vessels. After this procedure, dynamic observation was carried out until tumor stain disappeared. Liver function and blood indexes were reexamined on days 5, 6, 7 and 28 after treatment, and moreover, the liver was examined with Magnetic Resonance Imaging (MRI) or computed tomography (CT). Compared to traditional lipiodol embolization, embolic microspheres did not aggregate the damage on liver function and the imaging examination suggested necrosis of some tumor tissues. Embolic microspheres proved to be effective in treating primary hepatic carcinoma. It produces no damage on liver function and can lead to significant shrinkage of hepatic carcinoma and necrosis of some tumor tissues. Embolic microspheres, which merely block distal branches of tumor-feeding artery, can avoid collateral circulation induced by permanent blocking, thus achieve a good treatment effect.

The correlation between cognitive impairment and ambulatory blood pressure in patients with cerebral small vessel disease.

OBJECTIVE: The present study was aimed to analyze the correlation between cognitive impairment and ambulatory blood pressure in patients with cerebral small vessel disease (CSVD). PATIENTS AND METHODS: 108 patients with CSVD received in our hospital were selected. Assessment of cognitive impairment was by the Montreal Cognitive Assessment (MoCA). 39 cases were established as the impairment group and 69 cases were established as the normal group. 24 h ambulatory blood pressure was monitored, and changes in ambulatory blood pressure parameters between the two groups were compared. Also, the correlation between blood pressure parameters and MoCA score were analyzed. RESULTS: Comparisons of ambulatory systolic blood pressure, ambulatory pulse pressure and the ratios of night blood pressure reduction of patients in both groups showed statistical differences (p < 0.05), while the changes in diastolic blood pressure showed no statistical differences (p > 0.05). The comparison of the blood pressure curves in both groups showed statistical differences (p < 0.05). The ambulatory systolic blood pressure, ambulatory pulse pressure and the ratio of night blood pressure reduction of patients with CSVD showed prominently negative correlations with MoCA score (p < 0.05). CONCLUSIONS: Cognitive impairment and the ambulatory blood pressure of patients with CSVD are intimately correlated. The rise of ambulatory systolic blood pressure, pulse pressure, and the decline of blood pressure may represent risk factors for cognitive impairment in patients with CSVD. Improving blood pressure management will reduce the incidence of cognitive impairment caused by CSVD.