Background Hyperprolactinaemia is a common adverse effect of antipsychotics （APs）. The results of Peony-Glycyrrhiza decoction （PGD） as a potentially useful adjunctivetreatment for hyperprolactinaemia are inconsis...Background Hyperprolactinaemia is a common adverse effect of antipsychotics （APs）. The results of Peony-Glycyrrhiza decoction （PGD） as a potentially useful adjunctivetreatment for hyperprolactinaemia are inconsistent.Aim This meta-analysis of randomised controlled trials （RCTs） examined the effcacy and safety of adjunctive PGDtherapy for AP-induced hyperprolactinaemia.Methods English （PubMed, Embase, Cochrane Library, PsycINFO） and Chinese （Chinese National Knowledge Infrastructure, Wanfang Data） databases were systematicallysearched up to 10 June 2018. The inclusion criteria were based on PICOS-Participants： adult patients with schizophrenia; Intervention： PGD plus APs; Comparison： APs plus placebo or AP monotherapy; Outcomes： effcacy and safety; Study design： RCTs. The weighted mean difference （WMD） and risk ratio （RR） along with their 95% CIs were calculated using Review Manager （RevMan） V.5.3 software.Results Five RCTs （n=450） were included and analysed. Two RCTs （n=140） were double-blind and four RCTs （n=409） reported ‘random’ assignment with specifc description. The PGD group showed a signifcantly lower serum prolactin level at endpoint than the control group （n=380, WMD： ？32.69 ng/mL （95% CI -41.66 to 23.72）, p〈0.00001, I2=97%）. Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale （n=403, WMD： -0.62 （95% CI -2.38 to 1.15）, p=0.49, I^2=0%）. There were similar rates of all-cause discontinuation （n=330, RR 0.93 （95% CI 0.63 to 1.37）, p=0.71, I^2=0%） and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from ‘very low’ （14.3%）, ‘low’ （42.8%）, ‘moderate’ （14.3%）, to ‘high’ （28.6%）.Conclusions Current evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactin-induced symptoms without signifcant adverse events in adult patients with AP-induced hyperprolactinaemia. High-quality RCTs with longer duration are needed to confrm these fndings.展开更多
Introduction: Turner syndrome is a rare genetic disorder characterised by the presence of one X chromosome and the absence of part or all of an X or Y chromosome and patients may experience delayed puberty and inferti...Introduction: Turner syndrome is a rare genetic disorder characterised by the presence of one X chromosome and the absence of part or all of an X or Y chromosome and patients may experience delayed puberty and infertility. Our study aimed to evaluate the diagnostic delay in our practice and analyze the impact of this diagnostic delay on the effectiveness of patient management. Patients and Methods: Turner syndrome patients were identified from the endocrinology-diabetology nutrition department Database We examined the records of patients in whom the karyotype analysis favoured Turner syndrome. Results: We have selected 5 patients’ records of female patients with Turner syndrome. The mean age was 25, ranging from 19 to 29 years. Primary amenorrhea and characteristic dysmorphic features were observed in all patients. One married patient, who sought consultation for infertility, expressed a desire for pregnancy. Short stature was identified in 3 patients. Primary hypothyroidism and hypertension were respectively found in 1 and 2 patients. Gonadal dysgenesis was noted in 100% of cases. Karyotype analysis revealed monosomy X in 2 patients and mosaic patterns in others. All patients received estrogen-progestin treatment. Antihypertensive therapy was initiated for 2 patients. One patient is on L-thyroxine. In the short term, treatment led to the onset of menstruation after the initial months. Evaluation of treatment efficacy on internal genital organs is yet to be performed. Due to uncertain benefits at this age, growth hormone therapy was not considered for our patients. We provided counseling on assisted reproductive options for couples desiring to conceive. In our study, all patients were placed on estrogen-progestin therapy, and the response appeared favorable. Conclusion: In our practice, the diagnosis of Turner syndrome occurs very late in adulthood, at an age when growth hormone treatment is nearly ineffective. Treatment typically revolves around estrogen-progestin therapy, along with managing other comorbidities such as hypertension and primary hypothyroidism.展开更多
目的:基于网络药理学和分子对接技术探讨川牛膝治疗继发性闭经(secondary amenorrhea, SA)的作用机制。方法:从中药系统药理学数据库与分析平台(traditional Chinese medicine systems pharmacology database and analysis platform, TC...目的:基于网络药理学和分子对接技术探讨川牛膝治疗继发性闭经(secondary amenorrhea, SA)的作用机制。方法:从中药系统药理学数据库与分析平台(traditional Chinese medicine systems pharmacology database and analysis platform, TCMSP)检索川牛膝的活性成分及作用靶点,从GeneCards数据库获取SA的疾病靶点,采用R软件得到两者的交集靶点。借助STRING数据库构建蛋白质-蛋白质相互作用(protein-protein interaction, PPI)网络,通过Cytoscape 3.8.2软件进行聚类分析和拓扑分析从而筛选核心靶点。应用R软件进行基因本体(gene ontology, GO)和京都基因与基因组百科全书(Kyoto encyclopedia of genes and genomes, KEGG)富集分析(P<0.05)。最后,采用Autodock Vina软件进行分子对接验证。结果:川牛膝活性成分4个,即槲皮素、β-谷甾醇、甜菜素、红苋甾酮;川牛膝作用靶点178个,SA相关靶点1 366个,两者的交集靶点56个;基于Network Analyzer插件的拓扑分析筛选得到9个核心靶点,包括丝氨酸/苏氨酸蛋白激酶(serine/threorine protein kinase, AKT1)、丝裂原活化蛋白激酶1(mitogen activated protein kinase 1,MAPK1)、雌激素受体1(estrogen receptor 1,ESR1)等。GO功能分析主要涉及对类固醇激素的反应、活性氧代谢过程、上皮细胞增殖等;KEGG通路135条,主要包括HIF-1信号通路、内分泌抵抗、雌激素信号通路等。分子对接显示,活性成分(槲皮素、β-谷甾醇)与核心靶点(AKT1、MAPK1)具有较好的结合活性。结论:川牛膝治疗SA具有多成分、多靶点、多途径的特点,其可能通过槲皮素、β-谷甾醇等成分作用于AKT1、MAPK1、ESR1等靶点,调控雌激素信号通路、内分泌抵抗等通路。展开更多
基金supported by the University of Macao(SRG2014-00019-FHSMYRG2015-00230 FHS+4 种基金MYRG2016-00005-FHS)the Affiliated Brain Hospital of Guangzhou Medical University(2016YFC0906302816713342014Y2-001052015BAI13B02)
文摘Background Hyperprolactinaemia is a common adverse effect of antipsychotics （APs）. The results of Peony-Glycyrrhiza decoction （PGD） as a potentially useful adjunctivetreatment for hyperprolactinaemia are inconsistent.Aim This meta-analysis of randomised controlled trials （RCTs） examined the effcacy and safety of adjunctive PGDtherapy for AP-induced hyperprolactinaemia.Methods English （PubMed, Embase, Cochrane Library, PsycINFO） and Chinese （Chinese National Knowledge Infrastructure, Wanfang Data） databases were systematicallysearched up to 10 June 2018. The inclusion criteria were based on PICOS-Participants： adult patients with schizophrenia; Intervention： PGD plus APs; Comparison： APs plus placebo or AP monotherapy; Outcomes： effcacy and safety; Study design： RCTs. The weighted mean difference （WMD） and risk ratio （RR） along with their 95% CIs were calculated using Review Manager （RevMan） V.5.3 software.Results Five RCTs （n=450） were included and analysed. Two RCTs （n=140） were double-blind and four RCTs （n=409） reported ‘random’ assignment with specifc description. The PGD group showed a signifcantly lower serum prolactin level at endpoint than the control group （n=380, WMD： ？32.69 ng/mL （95% CI -41.66 to 23.72）, p〈0.00001, I2=97%）. Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale （n=403, WMD： -0.62 （95% CI -2.38 to 1.15）, p=0.49, I^2=0%）. There were similar rates of all-cause discontinuation （n=330, RR 0.93 （95% CI 0.63 to 1.37）, p=0.71, I^2=0%） and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from ‘very low’ （14.3%）, ‘low’ （42.8%）, ‘moderate’ （14.3%）, to ‘high’ （28.6%）.Conclusions Current evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactin-induced symptoms without signifcant adverse events in adult patients with AP-induced hyperprolactinaemia. High-quality RCTs with longer duration are needed to confrm these fndings.
文摘Introduction: Turner syndrome is a rare genetic disorder characterised by the presence of one X chromosome and the absence of part or all of an X or Y chromosome and patients may experience delayed puberty and infertility. Our study aimed to evaluate the diagnostic delay in our practice and analyze the impact of this diagnostic delay on the effectiveness of patient management. Patients and Methods: Turner syndrome patients were identified from the endocrinology-diabetology nutrition department Database We examined the records of patients in whom the karyotype analysis favoured Turner syndrome. Results: We have selected 5 patients’ records of female patients with Turner syndrome. The mean age was 25, ranging from 19 to 29 years. Primary amenorrhea and characteristic dysmorphic features were observed in all patients. One married patient, who sought consultation for infertility, expressed a desire for pregnancy. Short stature was identified in 3 patients. Primary hypothyroidism and hypertension were respectively found in 1 and 2 patients. Gonadal dysgenesis was noted in 100% of cases. Karyotype analysis revealed monosomy X in 2 patients and mosaic patterns in others. All patients received estrogen-progestin treatment. Antihypertensive therapy was initiated for 2 patients. One patient is on L-thyroxine. In the short term, treatment led to the onset of menstruation after the initial months. Evaluation of treatment efficacy on internal genital organs is yet to be performed. Due to uncertain benefits at this age, growth hormone therapy was not considered for our patients. We provided counseling on assisted reproductive options for couples desiring to conceive. In our study, all patients were placed on estrogen-progestin therapy, and the response appeared favorable. Conclusion: In our practice, the diagnosis of Turner syndrome occurs very late in adulthood, at an age when growth hormone treatment is nearly ineffective. Treatment typically revolves around estrogen-progestin therapy, along with managing other comorbidities such as hypertension and primary hypothyroidism.
文摘目的:基于网络药理学和分子对接技术探讨川牛膝治疗继发性闭经(secondary amenorrhea, SA)的作用机制。方法:从中药系统药理学数据库与分析平台(traditional Chinese medicine systems pharmacology database and analysis platform, TCMSP)检索川牛膝的活性成分及作用靶点,从GeneCards数据库获取SA的疾病靶点,采用R软件得到两者的交集靶点。借助STRING数据库构建蛋白质-蛋白质相互作用(protein-protein interaction, PPI)网络,通过Cytoscape 3.8.2软件进行聚类分析和拓扑分析从而筛选核心靶点。应用R软件进行基因本体(gene ontology, GO)和京都基因与基因组百科全书(Kyoto encyclopedia of genes and genomes, KEGG)富集分析(P<0.05)。最后,采用Autodock Vina软件进行分子对接验证。结果:川牛膝活性成分4个,即槲皮素、β-谷甾醇、甜菜素、红苋甾酮;川牛膝作用靶点178个,SA相关靶点1 366个,两者的交集靶点56个;基于Network Analyzer插件的拓扑分析筛选得到9个核心靶点,包括丝氨酸/苏氨酸蛋白激酶(serine/threorine protein kinase, AKT1)、丝裂原活化蛋白激酶1(mitogen activated protein kinase 1,MAPK1)、雌激素受体1(estrogen receptor 1,ESR1)等。GO功能分析主要涉及对类固醇激素的反应、活性氧代谢过程、上皮细胞增殖等;KEGG通路135条,主要包括HIF-1信号通路、内分泌抵抗、雌激素信号通路等。分子对接显示,活性成分(槲皮素、β-谷甾醇)与核心靶点(AKT1、MAPK1)具有较好的结合活性。结论:川牛膝治疗SA具有多成分、多靶点、多途径的特点,其可能通过槲皮素、β-谷甾醇等成分作用于AKT1、MAPK1、ESR1等靶点,调控雌激素信号通路、内分泌抵抗等通路。
