Does the use of double hormone replacement therapy for trauma patient organ donors improve organ recovery for transplant

BACKGROUND With an ongoing demand for transplantable organs,optimization of donor management protocols,specifically in trauma populations,is important for obta-ining a high yield of viable organs per patient.Endocrine management of brain-dead potential organ donors(BPODs)is controversial,leading to heterogeneous clinical management approaches.Previous studies have shown that when levo-thyroxine was combined with other treatments,including steroids,vasopressin,and insulin,BPODs had better organ recovery and survival outcomes were increased for transplant recipients.AIM To determine if levothyroxine use in combination with steroids in BPODs increased the number of organs donated in trauma patients.METHODS A retrospective review of adult BPODs from a single level 1 trauma center over ten years was performed.Exclusion criteria included patients who were not solid organ donors,patients who were not declared brain dead(donation after circulatory death),and patients who did not receive steroids in their hospital course.Levothyroxine and steroid administration,the number of organs donated,the types of organs donated,and demographic information were recorded.Univariate analyses were performed with P<0.05 considered to be statistically significant.RESULTS A total of 88 patients met inclusion criteria,69(78%)of whom received levothyroxine and steroids(ST/LT group)vs 19(22%)receiving steroids without levothyroxine(ST group).No differences were observed between the groups for gender,race,pertinent injury factors,age,or other hormone therapies used(P>0.05).In the ST/LT group,68.1%(n=47)donated a high yield(3-5)of organ types per donor compared to 42.1%(n=8)in the ST group(P=0.038).There was no difference in the total number of organ types donated between the groups(P=0.068).CONCLUSION This study suggests that combining levothyroxine and steroid administration increases high-yield organ donation per donor in BPODs in the trauma patient population.Limitations to this study include the retrospective design and the relatively small number of organ donors who met inclusion criteria.This study is unique in that it mitigates steroid administration as a confounding variable and focuses specifically on the adjunctive use of levothyroxine.

Attributable Causes of Breast Cancer and Ovarian Cancer in China:Reproductive Factors,Oral Contraceptives and Hormone Replacement Therapy

Objective： To provide an evidence-based, consistent assessment of the burden of breast cancer attributable to reproductive factors （RFs, including nulliparity, mean number of children, age at first birth and breastfeeding）, use of oral contraceptives （OCs, restricted to the age group of 15-49 years）, and hormone replacement therapy （HRT）, as well as of the burden of ovarian cancer attributable to the mean number of children in China in 2005. Methods： We derived the prevalence of these risk factors and the relative risk of breast and ovarian cancer from national surveys or large-scale studies conducted in China. In the case of RFs, we compared the exposure distributions in 2001 and counterfactual exposure. Results： Exposure of RFs in 2002 was found to account for 6.74% of breast cancer, corresponding to 9,617 cases and 2,769 deaths, and for 2.78% of ovarian cancer （712 cases, 294 deaths）. The decrease in mean number of children alone was responsible for 1.47% of breast cancer and 2.78% of ovarian cancer. The prevalence of OC use was 1.74% and the population attributable fraction （PAF） of breast cancer was 0.71%, corresponding to 310 cases and 90 deaths. The PAF of breast cancer due to HRT was 0.31%, resulting in 297 cases and 85 deaths. Conclusion： RFs changes in China contributed to a sizable fraction of breast and ovarian cancer incidence and mortality, whereas HRT and OCs accounted for relatively low incidence of breast cancer in China.

Prevalence of hypothyroidism and effect of thyroid hormone replacement therapy in patients with non-alcoholic fatty liver disease:A population-based study

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is currently considered as the most common cause of chronic liver disease worldwide.Risk factors for NAFLD have been well-described,including obesity,type 2 diabetes mellites(T2DM),dyslipidemia(DLP)and metabolic syndrome.Hypothyroidism has been identified as an independent risk factor for the development of NAFLD,although the literature is inconsistent AIM To evaluate the prevalence of hypothyroidism in patients with NAFLD,assess if it is an independent risk factor and explore the effect of thyroxine replacement therapy.METHODS Our cohort’s data was obtained using a validated,large,multicenter database(Explorys Inc,Cleveland,OH,United States)aggregated from pooled outpatient and inpatient records of 26 different healthcare systems,consisting of a total of 360 hospitals in the United States,and utilizing Systematized Nomenclature of Medicine-Clinical Terms for coding.We evaluated a cohort of patients with hypothyroidism and NAFLD.Multivariate analysis was performed to adjust for confounding risk factors including hypertension(HTN),T2DM,DLP,obesity and metabolic syndrome.SPSS version 25,IBM Corp was used for statistical analysis,and for all analyses,a 2-sided P value of<0.05 was considered statistically significant.Exclusion criteria were limited to age<18 years.RESULTS Among the 37648180 included individuals in this database who are above the age of 18 years,there were a total of 2320 patients with NAFLD(6.16 per 100000)in the last five years(2015-2020),amongst which 520 patients(22.4%)had hypothyroidism.Baseline characteristics of patients in this database are described in Table 1.Patients with NAFLD were also more likely to have obesity,T2DM,DLP,HTN,and metabolic syndrome(Table 2).While males and females were equally affected,patients in the age group 18-65 years as well as Caucasians seem to be at a higher risk.There was an increased risk of NAFLD among patients with hypothyroidism(OR=1.587).Furthermore,thyroid hormone replacement was not associated with a decreased risk for developing NAFLD(OR=1.106,C=0.952-1.285,P=0.303).CONCLUSION Hypothyroidism seems to be an independent risk factor for the development of NAFLD.Thyroid hormone replacement did not provide a statistically significant risk reduction.Further studies are needed to evaluate the effect of thyroid hormone replacement and assess if being euthyroid while on thyroid replacement therapy affects development and/or progression of NAFLD.

Effect of Hormone Replacement Therapy on Serum Complement (C3, C4) and Immunoglobulin (IgG, IgM) Levels in Post-menopausal Women

Serum C3, C4, IgG and IgM levels were evaluated in healthy post-menopausal women receiving short-term hormone replacement therapy （HRT） regimens and in untreated women. Serum C3, C4, IgM and IgG levels were assessed in 54 women receiving HRT therapy （CEE 0.625 mg＋MPA 2.5 mg/day）, and in 54 control women not receiving HRT. The results showed that the mean serum C3 and C4 levels were significantly higher in women receiving HRT than those untreated women （P〈0.01）. There was significant difference in IgG and IgM levels between two groups. It was concluded that HRT might be involved in the development of cardiovascular diseases through inflammatory mechanisms, as suggested by increased serum levels of C3 and C4.

Effects of hormone replacement therapy on endothelial function in menopausal women

Objective To observe the effects of hormone replacement therapy (HRT) on endothelial function in menopausal women. Methods A total of 30 menopausal women were treated with 2.5 mg of Tibolone (Livial) daily. At the same time,30 women with natural menopause without any treatment served as the control group. Endothelium-dependent (EDD),endothelium-independent (NID) vasodilatation function,and estradiol (E2) were examined by the non-invasive high-resolution ultrasonography before the treatment and at 12th,24th,36th and 48th week of treatment,respectively. Results After hormone treatment,E2 increased significantly and EDD was improved significantly (P<0.05),and E2 was positively related with EDD (r=0.8092,P<0.001). No change of EDD was observed in the control group whereas a significant increase was observed in the treatment group. Conclusion Endothelium-dependent vasodilatation dysfunction is prominent in menopausal women. Tibolone can help improve the condition.

The effects of long-term low-dose hormone replacement therapy on blood pressure and vasoactive factors in postmenopausal women

Objective:To investigate the effects of long-term low-dose hormone replacement therapy(HRT)on blood pressure,the plasma renin activity(PRA),plasma angiotensin Ⅱ(AngⅡ)leveland serum nitric oxide(NO)concentration in postmenopausal women.Methods:A total of 140 postmenopausal women were selected from the medical staff of thePeking Union Medical College Hospital.Of these,63 subjects who had been treated with low-dose sex hormone for over 5(5-32)years were set up as HRT group,and 77 age-matched sub-jects who had never received HRT were designed as control group.The levels of serum estradiol(E_2),follicle stimulating hormone(FSH)and nitric oxide(NO),the concentration of plasma an-giotensin Ⅱ(AngⅡ),plasma rennin activity(PRA)and the blood pressure were evaluated inthese two groups.Results:The serum level of estradiol in HRT group was significantly higher than that in con-trol group(median,interquartile range;124.0 pmol/L,113.4 vs.78.2 pmol/L,121.8)(P<0.05)and systolic blood pressure in HRT groups was significantly lower than that in control group[(126.7±14.4)mmHg vs.(132.4+19.8)mmHg](P<0.05).Diastolic blood pressure[(79.7±7.9)mmHg vs.(79.6±10.4)mmHg],the serum level of FSH[(54.4±18.9)IU/L vs.(60.4±24.4)IU/L],the plasma level of PRA(median,interquartile range;0.14 pg/L/hr,0.11vs.0.12 pg/L/hr,0.10),AngⅡ(median,interquartile range;46.0,31.1 pg/ml vs.44.4,33.0pg/ml)and serum level of NO(median,interquartile range;63.8 μmol/L,58.9 vs.56.0 μmol/L,94.8)showed no significant difference between HRT and control groups(P>0.05).Conclusions:Long-term low-dose HRT decreased the systolic blood pressure,but showed noeffects on the diastolic blood pressure,plasma level of AngⅡ,PRA,and serum level of NO inpostmenopausal women.

Effect of Menopausal Hormone Replacement Therapy on Cytokine Patterns in a Perimenopausal Mouse Model Established by the Ovarian Castration Method

Objective: To investigate the effect of perimenopausal hormone replacement therapy(HRT) on cytokine patterns in a perimenopausal mouse model established by ovarian castration. Methods: The mice were divided into natural menopause group,ovariectomy group and HRT group, with 15 mice in each group, and the estrous cycle, estrous frequency and menopausal time of the mice were determined by vaginal cytology,and the estrous cycle, estrous frequency and menopausal time were compared among the three groups. The serum levels of estradiol(E2) and progesterone(P4) in each group were detected by double-antibody sandwich ELISA, and the levels of interferon gamma(IFN-γ), interleukin-2(IL-2), IL-4 and IL-10 in the spleen γ tissues of mice were detected by ELISA. Results: The time of menopause(53.07±3.99) d in the HRT group was between that of the natural menopause group(80.80±3.26) d and that of the ovariectomy group(16.27±4.35) d, with a statistically significant difference in the two-by-two comparison of the three groups(P<0.05). The levels of serum E2(694.4±128.3) ng/L and P4(14.2 ±6.0) ng/L in the HRT therapy group are between those of the ovariectomy group and the natural menopause group, with statistically significant differences between the groups(P<0.05). The levels of IL-2(30.9±5.3) pg/ml, IL-4(9.4±1.6) pg/ml, IL-10(19.7±3.1) pg/ml, IFN-γ(22.0±3.7) pg/ml in the HRT group were all between those of natural menopause group and ovariectomy group. The Th1/Th2 ratio in the ovariectomy group was 7.55±1.57, higher than that in the natural menopause group(1.53±0.48) and HRT group(2.38 ±0.44), with statistically significant differences(P<0.05). Conclusion:Menopausal HRT can partially correct the imbalance of Th1/Th2 cytokines, which is able to provide an experimental basis for the regulation of menopause-related immune imbalance by HRT.

Research status of hormone replacement therapy on mood and sleep quality in menopausal women

Menopausal syndrome is a common disease of clinical women,which refers to a series of physical and mental symptoms caused by the fluctuation or reduction of sex hormones before and after menopause.Many of these patients have sleep and mood abnormalities that affect their health and quality of life.At present,the understanding of it is gradually improving.This paper mainly analyzes its back-ground and current treatment.

Effects of hormone replacement therapy on mood and sleep quality in menopausal women

BACKGROUND Hormone replacement therapy is an effective treatment strategy for the management of symptoms in naturally menopausal women.However,some patients report experiencing adverse effects.AIM To analyze the effects of hormone replacement therapy in menopausal female patients.METHODS A total of 152 menopausal female patients admitted to the Gynecology Department of the Ganzhou Maternal and Child Health Hospital between January 2021 and December 2023 were divided into the observation group(n=76,conventional treatment+hormone replacement therapy)and the control group(n=76,conventional treatment only)via random casting.The improvement observed in the following items were compared between the groups:Kupperman menopausal index(KMI),emotional state[The Positive and Negative Affect Scale(PANAS)],sleep quality[Self-Rating Scale of Sleep(SRSS)],treatment effectiveness,and treatment safety.RESULTS The modified KMI and SRSS scores of the observation group were lower than those of the control group after three rounds of treatment.The improvement in the PANAS score observed in the observation group was greater than that observed in the control group(P<0.05).The total treatment effectivity rate in the observation group was higher than that in the control group(86.84%vs 96.05%,χ2=4.121,P=0.042).The incidence rate of adverse reactions in the two groups was comparable(6.58%vs 9.21%,χ2=0.361,P=0.547).CONCLUSION Hormone replacement therapy effectively improved the clinical symptoms,actively channeled negative emotions,and improved the quality of sleep in menopausal patients,indicating its effectiveness and safety.

Postoperative pituitary hormonal disturbances and hormone replacement therapy time and dosage in children with craniopharyngiomas

Background The proliferative activity and penetration into the hypothalamic structures in children craniopharyngiomas （CP） often make radical resection difficult. Therefore, complete resection of CP often results in permanent multiple pituitary hormone deficiency （MPHD）. This study aimed to elucidate the postoperative pituitary hormonal disturbances, and hormone replacement therapy （HRT） time and dosage in children with CP. Methods Twenty patients with growth retardation and CP after resection, comprising 14 boys and 6 girls, with a mean age of （10.63±3.18） years （Group A） and 10 male patients of group A aged 〉10 years （Group B） were entolled. Thirty age-, sex- and Tanner stage-matched normal children （control Group A）, and 44 male older children 〉10 years （control Group B） served as controls. The serum concentrations of insulin-like growth factor-1 （IGF-1）, growth hormone （GH）, free thyroxine （FT4）, thyroid-stimulating hormone （TSH）, adrenocorticortropic hormone （ACTH）, cortisol （COR）, follicle stimulating hormone （FSH）, luteinizing hormone （LH）, prolactin （PRL）, testosterone （T） and estradiol （E2） were measured in the CP patients after resection and in controls. The appropriate time and dosage of HRT were investigated. Linear correlation analysis was made between levothyroxine （L-T4） dosage and primary FT4 in CP patients after resection. Results All cases had MPHD. The serum peak GH, IGF-1, FT4 and COR levels of Group A were significantly lower than that of the control Group A. The serum IGF-1 concentration increased to the normal level after 3 months of rhGH therapy; the serum FSH, LH, and T levels were significantly decreased （P 〈0.001）; however, E2 and PRL were significantly increased （P 〈0.001） in Group B compared with the control Group B; 18 cases were found to have central diabetes insipidus （DI） by water deprivation test and MRI. There was a significant negative linear regression （r=-0.8, P 〈0.001） between L-T4 and primary FT4 in Group A patients with CP after resection, giving a regression equation of L-T4 dosage （μg·kg^-1·d^-1） = 3.5-0.2×FT4 （μg·kg^-1·d^-1）. The time and corresponding dosage of HRT for CP after resection were： rhGH started 1 year after resection and no recurrence of CP on MRI, when IGF-1 reached the normal range, the rhGH dosage was （0.13±0.04） U·kg-1·d-1; hydrocortisone （H-C） was started as soon as possible, and was kept in the lower normal range, at a dosage of （12.6±4.8） mg/m^2; levothyroxine started after H-C or at the same time to maintain FT4 in the higher normal range, at a dosage of （1.65±0.70） μg·kg^-1·d^-1; Minirin （DDAVP） was started as soon as possible, elicited no symptoms, and maintained normal electrolyte levels; the dosage was （0.16±0.04） mg/m^2. Conclusion Patients with CP after resection often displayed MPHD, and needed total HRT at appropriate time and dosage to improve the quality of life and normal growth.

A comparison of two different dosages of conjugated equine estrogen in continuous combined hormone replacement therapy with progestin

To investigate the effects of two different dosages of conjugated equine estrogen (CEE) on preventing bone loss and relieving the symptoms of menopausal syndrome in women at an early stage of menopause Methods A total of 236 postmenopausal women were randomly allocated to one of the following groups: Group A: 0 625 mg CEE+2 mg medroxyprogesterone acetate (MPA)+1 tab Caltrate-D per day; Group B: 0 3 mg CEE+2 mg MPA+1 tab Caltrate-D per day; Group C: 1 tab Caltrate-D per day as the control group The study was continued for 2 years The following parameters were monitored: ① L2-4 bone mineral density (BMD) (measured with dual energy X-ray absorptiometry (DEX)), ② menopausal syndr ome improvement (assessed by comparing Kupperman scores), ③ vaginal bleeding rate, and the thickness of the endometrium and breast in each group Results Overall, 213 cases (90%) completed the 1-year study and 176 cases (75%) completed the 2-year study The percentage changes in L2-4 BMD at the 12th and 24th month in Group A were +2 3% and +3 7%, respectively, with the posttreatment values being significantly higher than pretreatment values (P<0 001) The percentage changes were +2 7% at 12th month (P<0 05) and +0 7% at 24th month (P>0 05) in Group B And that of Group C were -0 4% at 12t h month and -1 6% at 24th month (P>0 05) L2-4 BMD in both Group A and B w as significantly higher than that in Group C at 12th and 24th month (A vs C, P<0 001; B vs C, P<0 05) Kupperman Sco res were significantly reduced after 1, 3, 6 ,12 and 24 months in all 3 groups when compared with baseline (P<0 001) Scores in Group A and Group B were significantly lower than that in Group C (P<0 001) However, the vaginal bleeding rates in Group A were significantly higher than that in Group B or in Group C There was no atypical hyperplasia of endometrium in the 3 groups by the end of the study One p atient in Group A developed superficial thrombophlebitis by the end of 12th month Conclusion Continuous combination of CEE and MPA is effective in preventing bone loss and relieving the symptoms of menopausal syndrome in women at an early stage of menopause The vaginal bleeding rates in the Group treated with 0 625 mg/d CEE were significantly higher than those treated with 0 3 mg/d CEE

Efficacy of Postoperative Hormone Replacement Therapy on Prognosis of Patients with Serous Ovarian Carcinoma

Background： Ovarian cancer is the most common cause of gynecological cancer-associated death. Iatrogenic menopause might adversely affect the quality of life and health outcomes in young female cancer survivors. We evaluated whether postoperative hormone replacement therapy （HRT） had a negative influence on the progression-free survival （PFS） of patients with papillary serous ovarian cancer （SOC）. Methods： We retrospectively reviewed the medical records of patients with papillary SOC, treated from January 1980 to December 2009, who suffered from menopause with or without HRT. Clinical characteristics of patients were compared between the two groups （HRT and non-HRT）. Blood samples were collected from all the participants to detect serum cancer antigen （CA） 125. Hazard ratios with 95% confidential intervals for each variable were calculated by univariable and multivariable conditional Logistic regression analyses. Results： Among 112 identified patients, 31 were HRT users and 81 were not. The two groups did not significantly differ in median age at diagnosis （t = 0.652, P = 0.513）, International Federation of Gynecology and Obstetrics （FIGO） stage （X2 = 0.565, P = 0.754）, differentiation （X2 = 1.728, P = 0.422）, resection status （X2 = 0.070, P = 0.791）, relapse （X2 = 0.109, P = 0.741）, chemotherapy course （t = -1.079, P - 0.282）, follow-up interval （t = 0.878, P = 0.382）, or PFS （t = 0.580, P = 0.562）. Median Kupperman score at the onset of HRT was 30.81 and 12.19 after the therapy （t： 3.302, P = 0.001）. According to the analysis, the strongest independent variables in predicting PFS were FIGO stage and disease that was not optimally debulked. Conclusions： Postoperative HRT is not a prognostic factor for PFS of patients with papillary SOC. However, multicenter studies are needed to verify and extend our findings.

Effect of hormone replacement therapy on heart rate variability in postmenopausal women

To assess the characteristics of autonomic control of heart rate in postmenopausal women before and after hormone replacement therapy (HRT) Methods Time domain and spectral domain heart rate variability (HRV) were performed in 58 postmenopausal women before and after HRT Results Compared with examinations at baseline, values of all HRV measurements in subjects given HRT were increased at the fourth month ( P <0 05), while they remained unchanged in the control group ( P >0 05) Results showed an inverse correlation between all measures of HRV and mean R R interval in the treatment group Conclusion HRT reduces sympathetic drive in postmenopausal symptomatic women HRV may be an index of imbalance of autonomic control in perimenopausal women

Effects of hormone replacement therapy on platelet activation in postmenopausal women

Objective To assess the effects of hormone replacement therapy (HRT) on platelet activation in postmenopausal women compared with premenopausal women. Methods The expressions of CD41 and CD62P in fifteen postmenopausal women before and after HRT were detected using flow cytometry (FCM),with fifteen premenopausal women with a mean age of 47 years as controls.Results The expressions of CD41 and CD62P in postmenopausal women were higher than those in the control group. CD62P(%),CD62P(I) and CD41 were reduced from 36.40±5.9,37.75±5.8,and 470.11±74.0 to 27.97±5.6,26.64±4.9,and 303.23±72.8 after six months of HRT ( P <0.05). Conclusions Platelet activation in postmenopausal women was higher than in premenopausal women and was reduced significantly after six months of HRT. HRT may have a favorable effect on reduction of platelet activity.

Risk of venous thromboembolic disease in postmenopausal women taking oral or transdermal hormone replacement therapy

Objective: The influence of hormone replacement therapy (HRT) on hemostasis processes depends on the type of hormone,the combination of doses,the time of taking HRT,and the route of administration (oral,transdermal,implanted).The aim of the current study was to assess some parameters of coagulation,especially tissue factor pathway inhibitor (TFPI) and tissue factor (TF) in postmenopausal women using oral or transdermal HRT.Methods: The study was conducted on 76 healthy women,including 46 women aged 44–58 years who were taking oral (26) or transdermal (20) HRT,and 30 women aged 44–54 years who did not take HRT as the control group.Plasma concentrations of TF,TFPI,thrombin-antithrombin complex (TAT),and D-dimer were performed by enzyme-linked immunosorbent assay (ELISA).Moreover,the concentration of fibrinogen and activity of protein C were measured by chromogenic and chronometric methods.Results: We observed a significantly higher concentration of TF and a significantly lower concentration of TFPI in women taking oral and transdermal HRT in comparison with the control group.We also found a significantly lower concentration of fibrinogen in women taking oral HRT vs.the control group.Moreover,no statistically significant changes in concentrations of TAT and D-dimer,or activity of protein C were noted.Conclusions: In this study,the occurrence of an increased TF concentration simultaneously with a decreased concentration of TFPI in women taking HRT indicates hypercoagulability.No significant modification of TAT or D-dimer occurred,and thus there may not be increased risk of thrombosis.

Rapid progression of heart failure secondary to radioactive iodine treatment of hyperthyroidism:A case report

BACKGROUND The deterioration of thyroid health is involved in the progression of heart failure(HF).This is usually a lengthy process,so there are almost no reports on its rapid development.Here we report a case of a young male who rapidly developed hypothyroid cardiomyopathy secondary to radioactive iodine treatment,suggesting that severe HF might occur even after a short period of hypothyroidism.CASE SUMMARY A 26-year-old man was referred to our hospital for HF presenting with dyspnea on exertion and chest discomfort lasting for 1 mo.He received radioactive iodine treatment for hyperthyroidism 1 year ago and had an almost normal echocardiogram 6 mo ago.Admission echocardiogram and cardiac magnetic resonance(CMR)revealed left ventricle(LV)global hypokinesia and severely depressed systolic function.In addition,late gadolinium enhancement indicated no obvious changes in the myocardium.Thyroid function tests showed decreased serum levels of thyroid hormone(TH)and elevated thyroid-stimulating hormone.Based on an exclusionary examination,the patient was diagnosed with hypothyroid cardiomyopathy and was started on replacement therapy.His HF symptoms were completely relieved during the six-month follow-up,and echocardiogram and CMR revealed recovered LV size and ejection fraction.CONCLUSION This report demonstrates that severe fluctuations in TH levels may lead to acute HF,which can completely recover with timely thyroid hormone replacement.In addition,our findings highlight the importance of routinely detecting cardiac function in patients treated with radioactive iodine.

Vaginal Progesterone (VP) versus VP plus Intermittent Intramuscular Progesterone (IMP) Use in Frozen/Thawed Blastocyst Transfer Cycles: An Observational Cohort Study

Objective: Comparison of vaginal progesterone (VP) versus VP and intermittent intramuscular progesterone (IMP) use in frozen/thawed blastocyst transfer cycles. Study Design: A single center retrospective analyses of 470 elective FET cycles which were performed between January 2015 and September 2019 were evaluated. Patients were divided into two groups. Control group was consisted of VP (n = 272), the study group was consisted of VP plus IMP (n = 198) users. Results: The number of transfer attempts in control and study groups was 272 and 198, respectively. Age (29.8 ± 4 vs 30.6 ± 4;p = 0.09), BMI (22 ± 2 vs 21.9 ± 3;p = 0.79) and the number of transferred embryos (1.4 ± 0.5 vs 1.4 ± 0.5;p = 0.48) were comparable between groups. Altough, implantation rates (43.7% vs 43.6%;p = 0.9), ectopic pregnancy (0.8% vs 0.3%;p = 0.46) and abortion rates (8.2% vs 4.8%;p = 0.07) were similar. Biochemical pregnancy rate (8.4% vs 3.4% p = 0.01) in control group and ongoing pregnancy rate (OPR) (27.9% vs 38.1%;p = 0.005) in study group were significantly higher. Conclusion: Within the FET cycles in which good quality blastocyst are being transferred additional IMP supplementation to VP may increase OPR while reducing the biochemical pregnancy rate.

Aging men-Challenges ahead

The prolongation of life expectancy and the drastic reduction of fertility rate are the primary cause of an agingworld. It is projected that the elderly (above 65) will increase within the next 25 years by 82% , whereas the new bornonly by 3% . Despite the enormous medical progress during the past few decades, the last years of life are still accom-panied by increasing ill health and disability. The ability to maintain active and independent living for as long as possi-ble is a crucial factor for aging in health and dignity. Therefore, the promotion of healthy aging and the prevention ofdisability in men, must assume a central role in medical research and medical practice as well as in the formulation ofnational health and social policies. Effective programs promoting health and aging will ensure a more efficient use ofhealth and social services and improve the quality of life in older persons by enabling them to remain independent andproductive. The most important and drastic gender differences in aging are related to organs and or systems dependantor influenced by reproductive hormones. In distinction to the course of reproductive aging in women, with the rapid de-cline in sex hormones and expressed by the cessation of menses, aging men experience a slow and continuous decline ofhormones. This decline in endocrine function involves; A decrease of testosterone, dehydroepiandrosterone (DHEA),oestrogens, thyroid stimulating hormone (TSH), growth hormone (GH), insulin-like growth factor-1 (IGF-1), andmelatonin. This decrease is concomitant with an increase of LH and FSH. In addition sex hormone binding globulin's(SHBG) increase with age resulting in further lowering the concentrations of free biologically active androgens. Inter-ventions such as hormone replacement therapy may prevent, delay or alleviate the debilitating conditions which may re-sult from secondary partial endocrine deficiency. Primary and secondary preventive strategies such as the promotion of asafe environment, healthy lifestyle including proper nutrition, appropriate exercise, avoidance of smoking, avoidanceof drug and alcohol abuses, if done effectively, should result in a significant reduction of the health and social costs,reduce pain and suffering, increase the quality of life of the elderly and enable them to remain productive and contributeto the well-being of society. In light of this, public awareness of medical knowledge needs to be increased and basic,clinical, socio-economic and epidemiological research intensified. (Asian J Androl 2001 Sep; 3; 161 - 168)

Recent topics related to testosterone deficiency syndrome n Japan

Androgens, the levels of which decrease with ageing, play many physiological roles in various organs. Testosterone deficiency syndrome （TDS） has received widespread attention in the last several years. First-line treatment for TDS should be testosterone replacement therapy （TRT）, which is reported to improve several TDS symptoms. Recently, a clinical practice manual for TDS was written and published by a collaborative team from the Japanese Urological Association and the Japanese Society for the Study of the Aging Male to recommend standard procedures for the diagnosis, treatment, prevention and monitoring of adverse reactions to TRT and for post-treatment assessment. In this manual, intramuscular injection of testosterone enanthate or human chorionic gonadotropin and the testosterone gel ＇Glowmin＇ were recommended as TRT. Currently, two topics related to TDS are being focused on in Japan： the relationship between TDS and metabolic syndrome and treatment options for eugonadal patients with TDS symptoms. In this review, the possibility of TRT for metabolic syndrome as well as the relationship between testosterone and adiponectin, which is a key molecule in metabolic syndrome, is discussed. Finally, the possibility of herbal medicines as a treatment option for patients with TDS is addressed, especially for eugonadal patients, because eugonadal men with TDS symptoms account for approximately 30% of the general population. The increase in the levels of several cytokines, such as IL-8, IL-13, interferon.y and tumor necrosis factor-α, after herbal medicine treatment may be the reason for this efficacy.

Hypopituitary syndrome with pituitary crisis in a patient with traumatic shock:A case report

BACKGROUND Shock is among the most common conditions that clinicians face in intensive care unit(ICU),of which hypovolemic shock is encountered most frequently;some patients instead suffer from neurogenic,cardiogenic,or infectious forms of shock.However,there are additional types of shock from unusual causes that are often undiagnosed.Here,we report the case of a patient who was initially misdiagnosed with hypovolemic shock,but exhibited persistent hypotension because of continuous fluid replacement and vasoactive drug administration,and was eventually diagnosed with hypopituitarism with crisis.CASE SUMMARY A 73-year-old Chinese man was admitted to the neurosurgery department following injury caused by a heavy object with symptoms of anemia and high fever.He was transferred to the ICU on the fourth day after hospitalization because of hypotension and unconsciousness.Blood analysis indicated that the patient was suffering from anemia and thrombocytopenia.Ultrasonography showed that there was no apparent abnormality in the cardiac structure but there was mild tricuspid regurgitation.Computed tomography revealed that there were signs of hemorrhage at the right basal ganglia;accordingly,hypovolemic shock,possibly septic shock,was initially considered.Even after routine treatment for shock,the hypotension remained severe.The patient was again thoroughly examined to investigate the underlying cause.The antishock therapy was supplemented with corticosteroids to counter potential hypopituitarism.The patient made a full recovery,and the blood pressure returned to normal.CONCLUSION A case of pituitary adenoma with multiple injuries was identified.Because of hypopituitarism,functionality of the corresponding endocrine system was restricted,with the most pronounced manifestation being unstable blood circulation requiring hormone replacement therapy.Such cases are relatively rare but may occur if multiple injuries are sustained.The present case represents a reference for the clinical treatment of patients with multiple injuries.