Volume 103 ·  Issue 14 ·  2023

The pathogenesis of polycystic ovary syndrome (PCOS) is complex. The core features are ovarian hyperandrogenism caused by hypothalamus-pituitary-ovarian (HPO) axis dysfunction and hyperinsulinemia caused by insulin resistance. Common clinical manifestations include menstrual disorder, infertility, hyperandrogenism, polycystic ovarian morphology, etc., which can be accompanied by obesity, insulin resistance, dyslipidemia, and other metabolic abnormalities. They are high-risk factors for type 2 diabetes, cardiovascular diseases, and endometrial cancer. Comprehensive intervention measures are crucial to reduce the occurrence of PCOS and its complications. Early identification, early intervention, and reduction of metabolic dysfunction are important means of PCOS life-cycle management.

Androgen excess is a common endocrine and metabolic problem in clinical practice, which affects the health of women throughout their life cycle. Usually, its diagnosis and treatment need multidisciplinary cooperation. The etiological diagnosis of female hyperandrogenism should be based on the etiological characteristics at different ages and should be comprehensively evaluated from medical history, physical examination, determination of androgen and other endocrine hormones, functional tests, imaging, and genetic testing, etc. The general principle of androgen excess cause diagnosis is first to determine whether the patient has clinical and/or biochemical androgen excess, then determine whether she conforms to the diagnostic criteria of polycystic ovary syndrome (PCOS), and then determine whether it is a specific disease or not. Finally, mass spectrometry should be adopted for verifying the androgen levels in those without clear causes found to exclude pseudo-elevation, thus it can be diagnosed as idiopathic androgen excess. Exploring the clinical pathway for the etiological diagnosis of female hyperandrogenism has important reference significance for guiding the standardized and accurate diagnosis and treatment of female hyperandrogenism.

As the good functions of cutting, vaporization and hemostasis, the thulium laser has high safety and effectiveness in the enucleation of prostate. The surgery strategy of thulium laser also changes when enucleating different volumes of the prostate. In this paper, the prostate volume is divided into three types: small volume (<40 ml), moderate volume (40-80 ml), and large volume(>80 ml). The surgical strategies of thulium laser enucleation of the prostate in three different prostate volumes are discussed respectively. The operative techniques of thulium laser and preventive measures for complications are emphasized to cope with complex situations and provide reference for clinicians.

The wireless intelligent ultra-high-definition endoscope adopts a high speed wireless image transmission chip to achieve low-latency wireless transmission, storage,annotation and analysis of high-definition images with a resolution above 4K, thereby constructing a wireless connection, wireless transmission, high-definition image display, intelligent information exchange, and image intelligent analysis endoscopic system. It has the advantages of high clarity, easy connection, small size, and high degree of intelligence, which expands the application scenarios and target population of traditional endoscopic surgery. The wireless intelligent ultra-high-definition endoscope would bring profound changes to the minimally invasive treatment of urological diseases.

To investigate the effects of calorie-restricted diet (CRD), high protein diet (HPD), high protein, and high dietary fiber diet (HPD+HDF) on metabolic parameters and androgen level in overweight/obese patients with polycystic ovary syndrome(PCOS).

Ninety overweight/obese patients with PCOS from Peking University First Hospital from October 2018 to February 2020 were given medical nutrition weight loss therapy for 8 weeks and were randomly divided into CRD group, HPD group, and HPD+HDF group, with 30 patients in each group. Body composition, insulin resistance, and androgen level were detected before and after weight loss, and the efficacy of three weight loss therapies was compared through variance analysis and Kruskal-Wallis H test.

Eight patients in CRD group quit because they could not strictly complete the follow-up, therefore at the end of weight loss, 22, 30, and 30 patients in CRD group, HPD group and HPD+HDF group, respectively, were included in the final analysis. The baseline ages of the three groups were (31±2) years, (32±5) years and (31±5) years, respectively (P=0.952). After weight loss, the relevant indicators in HPD group and HPD+HDF group decreased more than those in CRD group. The body weight of CRD group, HPD group and HPD+HDF group decreased by 4.20 (11.92, 1.80), 5.00 (5.10, 3.32) and 6.10 (8.10, 3.07) kg, respectively (P=0.038); BMI of the three groups decreased by 0.80 (1.70, 0.40), 0.90 (1.23, 0.50) and 2.20 (3.30, 1.12) kg/m², respectively (P=0.002); homeostatic model assessment-insulin resistance(HOMA-IR) index decreased by 0.48(1.93, 0.05), 1.21(2.91, 0.18) and 1.22(1.75, 0.89), respectively (P=0.196); and free androgen index(FAI) decreased by 0.23(0.67, -0.04), 0.41(0.64, 0.30) and 0.44(0.63, 0.24), respectively (P=0.357).

The three medical nutrition therapies can effectively reduce the weight of overweight/obese patients with PCOS, and improve insulin resistance and hyperandrogenism. Compared with CRD group, HPD group, and HPD+HDF group have better fat-reducing effect, and can better preserve muscle and basal metabolic rate while losing weight.

To explore the effects of hyperandrogenism (HA) on pregnancy outcomes in women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET).

A retrospective study was conducted on infertile women with PCOS undergoing IVF/ICSI-ET from January 2017 to June 2021 in our center. Patients were divided into HA group and NON-HA group according to the levels of testosterone. Propensity score matching (PSM) was used to balance the influence of female age and IVF/ICSI-ET for patients with gonadotropin-releasing hormone (GnRH)antagonist protocol and GnRH agonist protocol, separately. After the PSM procedure, 191 cases in HA group and 382 cases in NON-HA group, were included. Hormone levels and pregnancy outcomes were compared in the two groups.

The female age was comparable in two groups [HA: (29.6±3.7) vs NON-HA: (29.5±3.6), P=0.665]. The basal luteinizing hormone [(10.82±6.73) vs (7.76±5.30) IU/L], testosterone [(3.27±0.97) vs (1.60±0.59) nmol/L], free androgen index (7.13 vs 2.77), anti-mullerian hormone [(11.37±5.74) vs (9.67±4.67) ng/ml], fasting glucose [(5.18±0.49) vs (5.06±0.42) mmol/L], 1h glucose [(9.34±2.42) vs (7.99±2.21) nmol/L], 2 h glucose [(7.66±2.17) vs (6.64±1.84) nmol/L], 2 h insulin [(129.81±145.49) vs (97.51±86.92) mU/L], total cholesterol [(5.35±0.89) vs (4.92±0.92) mmol/L], triglycerides [(1.55±1.28) vs (1.33±0.77) mmol/L], and low density lipoprotein cholesterol levels [(3.38±0.66) vs (3.14±0.71) mmol/L] were significantly higher in HA group, compared with NON-HA group (P<0.05). The initiated gonadotropin dose was higher in HA group than that in NON-HA group [(126.96±33.65) vs (137.60±38.12) U, P=0.001], but moderate-severe ovarian hyperstimulation syndrome (OHSS) rate was similar in two groups (P>0.05). The rates of implantation, clinical pregnancy, miscarriage, and live birth were comparable between the two groups (P>0.05). Also, in the subgroups, the rates of implantation, clinical pregnancy, live birth, and miscarriage were similar in HA group and NON-HA group.

The risks of hormonal abnormality and glucose-lipid metabolic disorder were higher in PCOS women with HA, whereas satisfactory pregnancy outcomes could be achieved under proper ovarian stimulation undergoing IVF/ICSI-ET.

To explore the clinical and biochemical discriminants of hyperandrogenism in functional hypothalamic amenorrhea (FHA).

From January to September 2022, a total of 56 patients with FHA group in the Obstetrics and Gynecology Hospital of Fudan University outpatient clinic were included in this retrospective cross-sectional analysis. According to the clinical or biochemical features of hyperandrogenism, FHA patients can be divided into two subgroups, namely hyperandrogenic FHA and non-hyperandrogenic FHA. Explore the differences and its significances between hyperandrogenic FHA and non-hyperandrogenic FHA by comparing anthropometry, reproductive hormones, AMH, ultrasonic manifestation, the scores of eating attitude test, depression questionnaire and anxiety scale respectively and analyzing their correlations.

The age of 56 FHA patients was 15-32(23.36±4.90) years, and body mass index(BMI) was (18.91±2.49) kg/m². The age of hyperandrogenic FHA and non-hyperandrogenic FHA was (21.76±4.40) and (24.05±5.00) (P=0.109) years old respectively, and BMI was (19.14±3.15 )and (18.81±2.18) kg/m² (P=0.702). Compared to the non-hyperandrogenic FHA, the AMH (6.46 and 3.63 ng/ml, P=0.025) and PRL (278.78 and 149.46 mU/ml, P=0.002) levels were higher in hyperandrogenic FHA group. There was no significant difference between the hyperandrogenic and non-hyperandrogenic FHA group in body composition.GAD-7 (r=0.455, P=0.005) and PHQ-9 (r=0.664, P<0.001) were correlated with EAT-26 scores in non-hyperandrogenic FHA group, but no significant correlation was shown between PHQ-9 (r=0.091, P=0.766)、GAD-7 (r=0.304, P=0.313) and EAT-26 in hyperandrogenic FHA group.

Some patients with FHA had clinical manifestations of hyperandrogenism and mildly elevated AMH and PRL, with underlying PCOS endocrine characteristics.

To investigate the effect of information management of intravenous drugs on anemia in maintenance hemodialysis patients.

The information management of intravenous drugs was a management system developed by the Hemodialysis Center of Shanghai Jiao Tong University School of Medicine Affiliated Sixth People′s Hospital in April 2020. The parameters six months before and after the use of the information management system were retrospectively collected and compared, including the rate of reaching the standard of hemoglobin, ferritin, transferrin saturation rate and the incidence of cardiovascular events. Specifically, the control stage was from October 2019 to March 2020, which was before the use of information management, and the study stage was from April to September 2020, which was after the use of information management.

There were 285 patients (190 males and 95 females) included in the control stage, with an average age of (62.4±13.2) years, while 278 patients (193 males and 85 females) were included in the study stage, with an average age of (62.8±13.2) years. Compared with the control stage, the rate of reaching the standard of hemoglobin [47.8% (797/1 668) vs 40.2% (687/1 710), P<0.001], ferritin [39.0% (217/556) vs 31.2% (178/570), P=0.006], and transferrin saturation [64.7% (360/556) vs 58.6% (334/570), P=0.034] increased in the study stage. The incidence of cardiovascular events in the study stage was 11.2% (31/278), which was significantly lower than that in the control stage [16.5% (47/285)] (P=0.043).

The information management of intravenous drugs in the hemodialysis center may help improve the anemia status in maintenance hemodialysis patients.

The current study analyzed the mutation rate of BRAF^V600E in papillary thyroid carcinoma patients and the correlation between BRAF^V600E mutation and aggressive biological behavior of papillary thyroid carcinoma. A total of 160 patients with papillary thyroid carcinoma who underwent surgical treatment in the Affiliated Cancer Hospital of Zhengzhou University from October 2020 to November 2021 were retrospectively included. All patients underwent BRAF^V600E gene detection. There were 37 males and 123 females, with a mean age of (46.5±11.1) years. The mutation rate of BRAF^V600E was 86.3% (138/160). There was no significant correlation between the mutation of BRAF^V600E and aggressive factors such as age (P=0.917), single focal/multifocal tumor (P=0.673), tumor size (P=0.360), tumor invasion (P=0.150) and regional lymph node metastasis (P=0.406). Therefore, for papillary thyroid cancer, mutations in a single gene like BRAF^V600E fail to determine more active diagnosis and treatment.

This article reports the diagnosis and treatment of a 30-year-old patient with spontaneous ovarian hyperstimulation syndrome (sOHSS) complicated with hyperandrogenemia. The patient with polycystic ovary syndrome was pregnant naturally and had symptoms such as abdominal distension and oliguria at 9 weeks of pregnancy. Color ultrasound found that the patient's bilateral ovaries were enlarged and a large amount of fluid accumulated in the pelvic and abdominal cavities. Considering that the patient had sOHSS and hyperandrogenemia, after high-protein diet, anticoagulation and other treatments, as well as close cooperation between reproductive medicine, obstetrics, endocrinology and pediatrics, a healthy baby boy was successfully delivered. The hyperandrogenic clinical manifestations in this woman disappeared at 2 months postpartum. After 18 months of follow-up, the physical examination indexes of children were normal. sOHSS focuses on early recognition, and its course of disease is often self-limiting. Early treatment measures can significantly relieve patients 'symptoms and improve patients' prognosis. Hyperandrogenism in pregnancy focuses on clarifying the cause, and it is necessary to rule out pregnancy complicated by ovarian tumors and adrenal cortical tumors.

A case of Sertoli-Leydig cell tumor in the testis of a middle-aged man is reported. The patient was 44 years old and was admitted to hospital for more than 6 months because of the discovery of a mass in the left scrotum. The main clinical manifestation was progressive enlargement of the mass and palpable mass in the scrotum. After radical resection of the tumor in the left scrotum, he was cured and discharged from hospital. Histological and immunohistochemical analysis confirmed that it was differentiated Sertoli-Leydig cell tumor in the left testis. No adjuvant treatment was used after operation. During the follow-up period, the quality of life was good, and there was no tumor recurrence or metastasis.

Lung cancer is one of the malignant tumors with the highest morbidity and mortality rate in the world, which seriously endangers human health. This article reviews the research progress in the field of lung cancer epidemiology at home and abroad from January 1 to December 10, 2022. The study found that with the deepening of lung cancer etiology research and the development of precision medicine, the global incidence and mortality of lung cancer have been controlled to a certain extent; The construction of large-scale population cohorts and biobanks has promoted the etiology research of lung cancer, and clarifying the association between the incidence of lung cancer and smoking, air pollution, comorbidities of chronic diseases, diet and living habits is of positive significance for the formulation of primary prevention strategies for lung cancer; The development of high-throughput omics detection technology has promoted the discovery of novel biomarkers such as rare germline variation, chimeric genomic variation, "apparent clock", circulating cell-free DNA (cfDNA) methylation and plasma metabolites, which helps to optimize the individualized risk assessment model of lung cancer and improve the early screening effect of lung cancer; Artificial intelligence algorithms such as deep learning can reveal the deep relationship between imagomics features and clinical diagnosis and treatment data, and improve the screening efficiency of lung cancer. The above research findings provide technical support and theoretical basis for the effective development of precise prevention and treatment of lung cancer.

This article reviews the clinical progress in the field of non-small cell lung cancer (NSCLC) treatment at home and abroad in 2022. In the neoadjuvant treatment of NSCLC, nivolumab combined with chemotherapy significantly prolonged the event-free survival of patients with resectable stage IB to IIIA NSCLC compared with chemotherapy alone. At the same time, osimertinib significantly improved the objective response rate (ORR) of neoadjuvant therapy in patients with epidermal growth factor receptor (EGFR) sensitive mutation positive (EGFRm) stage II to IIIB. In patients with advanced unresectable NSCLC, the third-generation anaplastic lymphoma kinase (ALK) inhibitor loratinib and the third-generation domestic drugs befutinib and ametinib targeting EGFR can effectively prolong patient progression-free survival (PFS). Targeted drugs with rare mutations have made certain breakthroughs and progress. At the same time, antibody-conjugated drugs (ADCs) are progressing rapidly, and clinical research on ADC drugs targeting human epidermal growth factor receptor-2 (HER-2) is currently being actively explored. The research and development of new oncology drugs in China is changing with each passing day. More indications for targeted therapy and immunotherapy in the neoadjuvant treatment of resectable NSCLC and postoperative maintenance therapy are also being actively explored, and considerable efficacy and safety have been achieved. For patients with advanced NSCLC whose disease progresses after first-line immunization and targeted therapy, new combinations and strategies are still needed in the latter-line therapy.

Chronic pancreatitis (CP) is an inflammatory disease of pancreatic fibrosis caused by multiple factors, and the quality of life of patients is significantly reduced. At present, its pathogenesis is not fully understood, and early diagnosis and targeted treatment are lacking. In 2022, a number of high-quality basic and clinical studies were published at home and abroad, mainly focusing on the new understanding of CP by genetic and environmental factors, the mechanism of action of acinar cell ferroptosis, cell burial and energy metabolism, the mechanism of stellate cell activation and the screening of antifibrotic drugs, the diagnostic value of endoscopic ultrasound, the comprehensive assessment of pain, and the comparative study of pancreatic duct stone lithotripsy and stent placement.

Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine metabolic disease in women of childbearing age. Most patients are overweight or obese, especially increased visceral fat (VAT) interacts with hyperandrogenic status and insulin resistance (IR) to form a vicious circle. Weight-loss diet is the first-line treatment for PCOS, but there is limited evidence of the effect of energy-limited meals (CRD) on VAT, while recent studies have shown that glucagon-like peptide 1 receptor agonist (GLP-1 RA) can significantly reduce body weight and VAT in patients with PCOS. Therefore, the aim of this study was to evaluate the improvement of fat distribution, androgenic status, and metabolic indicators in overweight/obese PCOS patients with GLP-1 RA weekly formulation dulaglutide with or without CRD with equivalent weight loss.

Polycystic ovary syndrome (PCOS) is the most common endocrine disease in women of childbearing age. Insulin resistance (IR) plays a key role in the pathogenesis of PCOS, which exists in most patients with PCOS, especially in overweight and obese people. Metformin is able to reduce IR and is therefore recommended for patients with PCOS to improve ovulation and metabolic abnormalities and reduce androgen levels. However, the variability and unmeasurability of the response to metformin treatment in patients with PCOS limits its wide application. Artificial neural network (ANN) is a mathematical method especially suitable for analyzing the nonlinear correlation between independent variables such as PCOS. Therefore, this study aimed to apply ANN to determine reliable predictors of response to metformin treatment in patients with PCOS.

Polycystic ovary syndrome (PCOS) is the most common endocrine disease in women of childbearing age, and obesity is closely associated with PCOS, so weight loss is essential for managing obese PCOS. Lifestyle interventions are the first-line treatment for obese PCOS, but the weight loss effect is limited, thus requiring drug therapy as an adjunct. The glucagon-like peptide 1 receptor agonist (GLP-1RA) liraglutide (LIRA) 3 mg once daily has been approved for weight loss treatment in obese patients, which can reduce body weight by about 5% to 10%. Therefore, the aim of this study was to investigate the efficacy and safety of LIRA 3 mg in reducing body weight and hyperandrogenism in obese women with PCOS.