Pulsatile gonadotropin-releasing hormone therapy induces spermatogenesis in pituitary stalk interruption syndrome:A case report and review of the literature

BACKGROUND Pituitary stalk interruption syndrome(PSIS)is a rare anatomical defect of the pituitary gland falling under the spectrum of holoprosencephaly phenotypes.It is characterized by a deficiency in anterior pituitary hormones,such as growth hormone,gonadotropins,and thyroid hormones.Due to the syndrome's rarity and nonspecific manifestations,there is a lack of standardized treatment strategies.Consequently,early diagnosis through imaging and on-time intervention are crucial for improving patients’outcomes.CASE SUMMARY A 30-year-old man presented with absent secondary sexual characteristics and azoospermia.Laboratory evaluation revealed a deficiency in gonadotropins,while thyroid function was mostly within normal ranges.Magnetic resonance imaging of the pituitary gland showed pituitary stalk agenesis,hypoplasia of the anterior pituitary,and ectopic posterior pituitary,leading to the diagnosis of PSIS.Initially,the patient underwent 6 mo of gonadotropin therapy without significant changes in hormone levels and secondary sexual characteristics.Pulsatile gonadotropin-releasing hormone therapy was then administered,resulting in the detection of sperm in the semen analysis within 3 mo.After 6 mo,routine semen tests showed normal semen quality.The couple faced challenges in conceiving due to abstinence and underwent three cycles of artificial insemination,which was unsuccessful.They also attempted in vitro fertilization,but unfortunately,the woman experienced a miscarriage 10 wk after the embryo transfer.CONCLUSION Early detection,accurate diagnosis,and timely treatment are crucial in improving the quality of life and fertility of PSIS patients.

Analysis of the Effect of Hormone Therapy Combined with Hydroxychloroquine in the Treatment of IgA Nephropathy

Objective:To explore and analyze the effect of hormone therapy combined with hydroxychloroquine in the treatment of IgA nephropathy.Methods:30 patients with IgA nephropathy who were admitted to the Urology Department of Jiuquan hospital from August 2021 to May 2023 were selected as the research subjects,and they divided into an observation group and control group by drawing lots,with 15 cases in each group.The observation group underwent hydroxychloroquine treatment in addition of hormone therapy,and the control group underwent conventional treatment and hormone therapy.The rate of effectiveness of treatment,serum index,and renal function of both groups were compared.Results:The incidence of adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).There was no significant difference in serum creatinine and serum albumin(P>0.05)between the groups before treatment;after treatment,the serum creatinine and serum albumin in the steroid group were significantly better than those in the reference group(P<0.05).Besides,there was no significant difference in urine protein quantification and glomerular filtration rate between the groups before treatment(P>0.05);after treatment,the hormone group’s urine protein quantification and glomerular filtration rate were significantly better than those in the reference group(P<0.05).The rate of effectiveness of the hormone group was significantly higher than that of the reference group(P<0.05).Conclusion:Hormone therapy combined with hydroxychloroquine in the treatment of IgA nephropathy is more effective than hormone therapy alone,thus this treatment plan is worthy of promotion and application.

Effects of menopausal hormone therapy-based on the role of estrogens,progestogens,and their metabolites in proliferation of breast cancer cells

Menopausal hormone therapy(MHT)has been widely used for the clinical treatment of symptoms associated with menopause in women.However,the exact nature of the relationship between MHT and the increased risk of breast cancer has not been fully elucidated.The results of the Women’s Health Initiative’s randomized controlled clinical studies showed that estrogen monotherapy was associated with a lower incidence of breast cancer as compared to estrogen-progesterone combined therapy,with an elevated risk of breast cancer.The evidence currently available from randomized trials and observational studies is based on data from different populations,drug formulations,and routes of administration.Even though the risks of MHT and breast cancer have received a great deal of attention,information regarding the unpredictable toxicological risks of estrogen and progestogen metabolism needs to be further analyzed.Furthermore,the diversity and complexity of the metabolic pathways of estrogen and different progestogens as well as the association of the different estrogen and progestogen metabolites with the increased risk of breast cancer need to be adequately studied.Therefore,this review aimed to describe the biological effects of estrogen,progesterone,and their metabolites on the proliferation of breast cancer cells,based on relevant basic research and clinical trials,to improve our understanding of the biological functions of estrogen and progestogen as well as the safety of MHT.

Optimizing menopausal hormone therapy:for treatment and prevention,menstrual regulation,and reduction of possible risks

Menopausal hormone therapy(MHT)is used to treat menopausal complaints including the genitourinary syndrome of menopause,to prevent osteoporosis,and to treat bleeding problems.Since these can be the indications also in young women,especially with POI(premature ovarian insufficiency)or with surgical menopause(bilateral oophorectomy),also the old term"Hormone Replacement Therapy(HRT)”is still used.The effective component is the estrogen component without relevant difference in the efficacy of the various MHT-preparations.Additional preventive benefits are reduction of cardiovascular disease(including prevention of diabetes mellitus and metabolic syndrome),reduction of colon cancer,and perhaps also Alzheimer's disease,if started within a Kwindow of opportunity",i.e.in perimenopause or within 6-10 years after menopause.Primary indication for progestogen addition is to avoid the development of estrogen-dependent endometrial cancer,i.e.addition not recommended in hysterectomized women.Two main schedules,sequential-or continuous-combined estrogen/progestogen regimens,are used for treatment of bleeding problems.For this and for optimizing menstrual regulation detailed recommendations are given including proposed dosages for the available different progestogens if added to oral or transdermal estradiol in different estrogen dosages.The WHI-study demonstrated the main risks using MHT within a“worst-case scenario",i.e.start of MHT in old women with high risk for breast cancer and cardiovascular diseases,whereby only^conjugated equine estro-gens”and^medroxprogesterone acetate”have been tested.One main result was that the progestogen component is decisive for the risk of breast cancer,which according to own experimental research and observational studies may be reduced using the physiological progesterone or its isomer dydrogesterone.In addition we propose to push forward research for screening patients with increased breast cancer risk like we have done in the past decade demonstrating that certain membrane-bound receptors in breast cancer tissue or blood can increase this risk.To reduce the risk of venous thromboembolism and stroke,transdermal estradiol(gels,patches,)should be used,in free combination with progesterone or dydrogesterone as"golden standard"in patients with increased risk.To increase the compliance in our patients without special risks we mostly use the available fix-combinations of estradiol/dydrogesterone getting strong efficacy,good menstrual regulation or amenorrhea,respectively,but also other combinations may be indicated to take advantage of for example androgenic or antiandrogenic progestogens.

Radiotherapy of Oligoprogressive Lesions in Castration-Resistant Prostate Cancer: Impact on Second-Generation Hormone Therapy

Background: The therapeutic standard for oligoprogressive prostate cancer resistant to castration is second-generation hormone therapy. This systemic treatment is expensive. There are oligoprogressive lesions accessible to radiotherapy. Objectives: To study the impact of radiotherapy of oligoprogressive lesions on the implementation of second generation hormone therapy. Patients and Methods: A retrospective study from 2012 to 2020 was carried out. All patients with oligoprogressive prostate cancer who had received radiotherapy on one or more lesions in progression were collated. Survival was calculated using the Kaplan-Meier method. Results: 8 patients were treated with stereotactic and conformational radiotherapy between August 2012 and August 2020 in the context of oligoprogressive prostate cancer resistant to castration. The median age at diagnosis of oligoprogression was 73 years with a median PSA level of 3.11 ng/ml. Nine lesions were diagnosed with PET scan PSMA. All the lesions were treated by radiotherapy with different regimens. After a median follow-up of 12.5 months, 7 patients showed a biochemical response to treatment with a median decrease in PSA of 67%. The median survival without clinical or biochemical progression was 7 months. The median survival without the need for further systemic treatment was 9 months. During the follow-up period, six patients received second-generation hormone therapy to treat their relapse, and the other two showed no clinical or biochemical relapse. Conclusion: Radiotherapy may be an alternative to delay the introduction of difficult-to-access second-generation hormone therapy in developing countries. A prospective study could validate this therapeutic approach.

Impact of gender-affirming hormone therapy on the development of COVID-19 infections and associated complications:A systematic review

BACKGROUND Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)can produce a wide range of clinical manifestations from asymptomatic to life-threatening.Various researchers have worked to elucidate the pathogenic mechanisms underlying these variable presentations.Differences in individual responses to systemic inflammation and coagulopathy appear to be modulated by several factors,including sex steroid hormones.Transgender men or non-binary individuals who undergo gender-affirming hormone therapy(GAHT)are a unique population of interest for exploring the androgen-mediated coronavirus disease 2019(COVID-19)hypothesis.As the search for reliable and effective COVID-19 treatments continues,understanding the risks and benefits of GAHT may mitigate COVID-19 related morbidity and mortality in this patient population.AIM To investigate the potential role of GAHT in the development of COVID-19 infections and complications.METHODS This systematic review implemented an algorithmic approach using PRISMA guidelines.PubMed,Scopus,Google Scholar top 100 results,and archives of Plastic and Reconstructive Surgery was on January 12,2022 using the key words“gender”AND“hormone”AND“therapy”AND“COVID-19”as well as associated terms.Non-English articles,articles published prior to 2019(prior to COVID-19),and manuscripts in the form of reviews,commentaries,or letters were excluded.References of the selected publications were screened as well.RESULTS The database search resulted in the final inclusion of 14 studies related to GAHT COVID-19.Of the included studies,only two studies directly involved and reported on COVID-19 in transgender patients.Several clinical trials looked at the relationship between testosterone,estrogen,and progesterone in COVID-19 infected cis-gender men and women.It has been proposed that androgens may facilitate initial COVID-19 infection,however,once this occurs,testosterone may have a protective effect.Multiple clinical studies have shown that low baseline testosterone levels in men with COVID-19 are associated with worsening outcomes.The role of female sex hormones,including estrogen and progesterone have also been proposed as potential protective factors in COVID-19 infection.This was exemplified in multiple studies investigating different outcomes in pre-and post-menopausal women as well as those taking hormone replacement therapy.Two studies related specifically to transgender patients and GAHT found that estrogen and progesterone could help protect men against COVID-19,and that testosterone hormone therapy may increase the risk of contracting COVID-19.CONCLUSION Few studies were found related to the role of GAHT in COVID-19 infections.Additional research is necessary to enhance our understanding of this relationship and provide better care for transgender patients.

Investigation of Cognition Status of Menopausal Hormone Therapy in Medical Institutions Staff

Objective:To investigate the cognition,application and commendation of menopausal hormone therapy(MHT)among medical institution staff with different professional background.Methods:Female staff aged 40-60 years in 4 tertiary hospitals were randomly selected.The participants'characteristics and the information of cognition,application and recommendation of MHT were collected by questionnaire.Results:A total of 341 people participated in this study,the cognition rate of MHT was 37%and the recommendation rate was 44%.For people with indications of MHT,the utilization rate is 15%,and 84.6%of them have used MHT for less than 3 years.84.6%of those who did not use MHT considered menopause is not a disease and there was no need to use medication.Compared with nurses,doctors know more about MHT(P<0.01),and MHT recommendation rate of doctors was higher than that of nurses(P<0.01).The cognition of MHT were analyzed in menopause group,irregular menstruation group and regular menstruation group,there was no difference was found among these three groups(P>0.05).Conclusion:Strengthening the training of MHT related knowledge in medical institutions,will be helpful to improve the cognition and utilization rate of medical institutions and promote the whole society to study and use MHT.

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.

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.

Hormone replacement therapy for menopausal mood swings and sleep quality:The current evidence

Marked alterations in the normal female hormonal milieu in the perimenopausal period significantly affect women’s health,leading to decreased well-being,psychological distress,and impaired quality of life.Common menopausal symp-toms include hot flashes,sleep and mood changes,fatigue,weight gain,and urogenital disturbances.Clinicians often neglect mood swings and disrupted sleep,although those can significantly limit the productivity of women and impair their cognitive function and mental health.Evidence-based management should include a personalized,holistic approach to alleviate symptoms and careful consideration of the risks vs benefits of hormone replacement therapy(HRT),with due consideration of personal preferences.A research paper in the recent issue of the World Journal of Psychiatry by Liu et al investigated the role of HRT in altering mood changes and impaired sleep quality in menopausal women,which helps us to understand the benefits of this treatment approach.

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.

Systemic oncological therapy in breast cancer patients on dialysis

The advancement of renal replacement therapy has significantly enhanced the survival rates of patients with end-stage renal disease(ESRD)over time.How-ever,this prolonged survival has also been associated with a higher likelihood of cancer diagnoses among these patients including breast cancer.Breast cancer treatment typically involves surgery,radiation,and systemic therapies,with ap-proaches tailored to cancer type,stage,and patient preferences.However,renal replacement therapy complicates systemic therapy due to altered drug clearance and the necessity for dialysis sessions.This review emphasizes the need for opti-mized dosing and administration strategies for systemic breast cancer treatments in dialysis patients,aiming to ensure both efficacy and safety.Additionally,ch-allenges in breast cancer screening and diagnosis in this population,including soft-tissue calcifications,are highlighted.

A Multi-center,Randomized,Controlled and Open Clinical Trial of Heyan Kuntai Capsule (和颜坤泰胶囊) and Hormone Therapy in Perimenopausal Women

Objective： To evaluate the efficacy and safety of Heyan Kuntai Capsule（和颜坤泰胶囊, HYKT） and hormone therapy（HT） on perimenopausal syndromes（PMSs）. Methods： From 2005 to 2008, 390 women with PMSs were recruited from 4 clinic centers. The inclusion criteria included ages 40 to 60 years, estradiol（E2） below 30 ng/L, and follicle stimulating hormone（FSH） above 40 IU/L, etc. The patients were randomly assigned to HYKT group or HT group by random number table method, administrated HYKT or conjugated estrogen with/without medroxyprogesterone acetate tablets for 12 months. During treatment, the patients were interviewed quarterly, Kupperman Menopausal Index（KMI） scores, hot flush scores, insomnia scores, Menopause-Specific Quality of Life（MENQOL） scores and adverse effects were used for evaluating drug efficacy and safety respectively. The last interview was made at the end of 12-month treatment. Results： After treatment, KMI scores of HYKT group and HT group were both significantly decreased compared with baseline（P〈0.01） and there was no significant difference between groups（P〉0.05）, except that KMI of HYKT group was higher after 3-month treatment（P〈0.05）. After treatment, hot flush and insomnia scores were both improved significantly in two groups（P〈0.01）; and HT had a better performance than HYKT in improving hot flush（P〈0.05）. MENQOL were significantly improved in both groups after treatment（P〈0.01）; but there was no significant difference between two groups（P〉0.05）. The incidence of adverse event in the HYKT group was much lower than that in the HT group（P〈0.01）. Conclusions： HYKT could effectively relieve PMSs and improve patient quality of life without severe adverse reactions. Although HYKT exerted curative effects more slowly than hormone, it possessed better safety profile than hormone.

Neoadjuvant hormone therapy for patients with high-risk prostate cancer:a systematic review and meta-analysis

This study aimed to identify the pathological outcomes and survival benefits of neoadjuvant hormone therapy(NHT)combined with radical prostatectomy(RP)and radiotherapy(RT)administered to patients with high-risk prostate cancer(HRPCa).We searched PubMed,Embase,and the Cochrane Library for studies comparing NHT plus RP or RT with RP or RT alone,administered to patients with HRPCa.We used a random-effects model to compute risk estimates with 95%confidence intervals(CIs)and quantified heterogeneity using the I2 statistic.Subgroup and sensitivity analyses were performed to identify potential sources of heterogeneity.We selected 16 studies.NHT before RP significantly decreased lymph node involvement(risk ratio[RR]=0.69,95%CI:0.56–0.87)and increased the rates of pathological downstaging(RR=2.62,95%CI:1.22–5.61)and organ-confinement(RR=2.24,95%CI:1.54–3.25),but did not improve overall survival and biochemical progression-free survival(bPFS).The administration of NHT before RT to patients with HRPCa was associated with significant benefits for cancer-specific survival(hazard ratio[HR]=0.51,95%CI:0.39–0.68),disease-free survival(HR=0.51,95%CI:0.44–0.60),and bPFS(HR=0.54,95%CI:0.46–0.64).Short-term NHT combined with RT administered to patients with HRPCa conferred significant improvements.Although the advantage of local control was observed when NHT was administered before RP,there was no significant survival benefit associated with HRPCa.Therefore,short-term NHT combined with RT is recommended for implementation in standard clinical practice but not for patients who undergo RP.

Low dose hormone therapy in reproductive endocrinology in China

The human endocrine system normally functions in abalanced physiological state. Any excess or deficiencywill cause an endocrine imbalance and result in hyper-orhypo-function, requiring readjustment by hormonesuppression or supplementation in order to reestablish anormal physiological balance.

Effect of hormone therapy on carotid elasticity in postmenopausalwomen by Echo-tracking technique

Background Studies showed that arterial elasticity changes appear earlier than any structural changes, therefore, its accurate evaluation could be applied at early stage to prevent disease. Echo-tracking（E-tracking） technique can track the wall motion trajectory in real-time, calculate the change in vascular diameter automatically, and assessment of vascular stiffness and flexibility directly. This article aims to assess the change of elasticity of carotid artery after hormone therapy （HT） using Echo-tracking technology. Methods Echotracking was used to evaluate the carotid elastic moduli, such as the pressure-strain elastic modulus （Ep）, stiffness parameter （β）, arterial compliance （AC）, pulse wave conducting velocity （PWVβ） and augmentation index （AI） by Aloka α10 color Doppler ultrasound diagnosis system. Results Ep,β and PWVβ in HT group were significantly lower than those in the control group （P 〈 0.01）, while AC was obviously higher than the control group （P 〈 0.01）. E2 was negatively related to β, Ep and PWVβ （r = -0.607, r = -0.573, r = -0.574, P 〈 0.001）, while positively related to AC （r = 0.574, P 〈 0.001）; endothelial-dependent dilatation （EDD） was negatively related to β, Ep and PWVβ （r = -0.521, r = -0.411, r = -0.456, P 〈 0.001）, while positively related to AC （r = 0.443, P 〈 0.001）; But IMT was positively related to β, Ep and PWVβ（r = 0.553, r = 0.444, r = 0.529, P 〈 0.001）, while negatively related to AC （r = -0.400, P 〈 0.001）. Conclusions Arterial stiffness increases and compliance decreases in menopausal women. As EDD decreases arterial elasticity recedes, and HT can improve arterial elasticity. E-tracking technology can discover the early changes in arterial stiffness effectively and it is more sensitive in finding out the changes of stiffness in early atherosclerosis than IMT of carotid artery.

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.

Hormonal therapy might be a better choice as maintenance treatment than capecitabine after response to first-line capecitabine-based combination chemotherapy for patients with hormone receptor-positive and HER2-negative,metastatic breast cancer

Background:Both hormonal therapy(HT) and maintenance capecitabine monotherapy(MCT) have been shown to extend time to progression(TTP) in patients with metastatic breast cancer(MBC) after failure of taxanes and anthracycline?containing regimens.However,no clinical trials have directly compared the efficacy of MCT and HT after response to first?line capecitabine?based combination chemotherapy(FCCT) in patients with hormone receptor(HR)?positive and human epidermal growth factor receptor 2(HER2)?negative breast cancer.Methods:We retrospectively analyzed the charts of 138 HR?positive and HER2?negative MBC patients who were in non?progression status after FCCT and who were treated between 2003 and 2012 at the Cancer Institute and Hospital,Chinese Academy of Medical Sciences,in Beijing,China.The median number of first?line chemotherapy cycles was 6(range,4–8);combined agents included taxanes,vinorelbine,or gemcitabine.Of these 138 patients,79 received MCT,and 59 received HT.Single?agent capecitabine was administered at a dose of 1250 mg/m2 twice daily for 14 days,followed by a 7?day rest period,repeated every 3 weeks.Of the 59 patients who received HT,37 received aromatase inhibitors(AIs),8 received selective estrogen receptor modulators(SERMs),and 14 received goserelin plus either AIs or SERMs.We then compared the MCT group and HT group in terms of treatment efficacy.Results:With a median follow?up of 43 months,patients in the HT group had a much longer TTP than patients in the MCT group(13 vs.8 months,P ease?free surviv= 0.011).When TTP was adjusted for age,menopausal status,Karnofsky performance status score,disal,site of metastasis,number of metastatic sites,and response status after FCCT,extended TTP was still observed for patients in the HT group(hazard ratio:0.63;95% confidence interval:0.44–0.93;P = 0.020).We also observed a trend of overall survival advantage for patients in the HT group vs.patients in the MCT group,but the difference was not significant(43 vs.37 months,P tients in the MCT g= 0.400).In addition,patients in the HT group gen?erally tolerated the treatment well,whereas paroup experienced grades 3–4 adverse events,the most frequent of which were hand?foot syndrome(15.8%) and hematologic abnormalities(7.6%).Conclusion:For HR?positive and HER2?negative MBC patients,HT might be considered a treatment after response to FCCT but prior to MCT as a long?term administration.

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.

Study on drug retention in menopausal women with sequential hormone therapy and tibolone

In the present study, we aimed to retrospectively analyze the medication prescriptions of menopausal women diagnosed with menopausal syndrome in our hospital from 2015 to 2018, and compare the retention rate of estrogen and progesterone sequential therapy and hormone continuous therapy in menopausal women. The rational drug management system of Ningbo Women and Children’s hospital was used to screen the prescriptions of menopausal syndrome in 4 years. After the age, year included in the study, and prescription cost were adjusted, Kaplan-Meier regression analysis was performed to compare the prescription retention rates of the two drug regimens. The distribution of the two HRT regimens in the 4 years showed an increasing trend year by year, and the age groups of the two HRT regimens were mainly distributed between 41 and 60 years old, accounting for 97.1% and 87.06%, respectively. The cost distribution for the other two HRT regimens was approximately the same. Compared with the two HRT regimens, the drug retention rate of hormone continuous regimens was higher than that of hormone sequential regimens within 4 years. Kaplan-Meier regression analysis showed that the trend was significant(Tarone-Ware, Chi-square value = 3.857, P = 0.050). This study found that the median retention time of HRT therapy in menopausal women in our hospital was about half a year, which was significantly lower than that reported in previous studies of 1 year or longer. In addition, the present study found that compared with Femoston, the tibolone regimen significantly increased retention time in the treatment of menopausal syndrome.