2016 Vol. 7, No. 2

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Ovarian Aging Column
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  Objective  To observe the alterations of each menstrual factor in ovarian aging.  Methods  The data were obtained from one-year observation of a prospective cohort involving 323 healthy women in the age of 30-54 years in a community in Beijing. Menstrual diary was kept and serum level of follicle-stimulating hormone (FSH) was tested. The participants were divided into groups based on age, FSH level, and stages of reproductive aging. Alterations of length of menstrual cycle (LMC), length of menstrual period, and menstrual volume were analyzed in each group.  Results  Age:the mean LMC extended after the age of 40 years, obviously after 48, and peaked with (67.04±36.77) days in ≥ 52-year-old group. The mean length of menstrual period did not vary much with age. However, the variation of mean length of menstrual period gradually increased with age after 44 years old, peaked in 50- to 51-year-old group. The menstrual volume scores were approximately stable between 38 and 47 years of age, with a peak of(45.06±93.54) in 48- to 49-year-old group and a minimum of (15.87±13.81) in ≥ 52-year-old group. FSH level:LMC increased with elevation of FSH levels. There was no significant difference in the mean length of menstrual period among FSH level groups, but the variation of length of menstrual period was maximum in 20 < FSH ≤ 40 U/L group. The maximum mean menstrual volume score was (30.69±31.84), observed in 10 < FSH ≤ 15 U/L group, while the minimum was (17.38±24.38) in FSH > 40 U/L group. Stages of reproductive aging:the length of menstrual period and menstrual volume scores among each stage showed no statistically significant difference(P > 0.05).  Conclusions  The LMC altered significantly in ovarian aging, which could be used as staging criteria of reproductive aging. The length of menstrual period and menstrual volume are also showing some characteristic changes, possibly of some clinical values.
Original Contributions
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  Objective  To evaluate the safety and efficacy of cross-linked hyaluronic acid Revanesse Ultra for treatment of nasolabial folds in Chinese population.  Methods  A total of 120 participants were enrolled in this prospective, randomized, positive controlled, non-inferiority clinical trial in accordance to inclusion and exclusion criteria, and signed informed consents were obtained. The participants were numbered in the order of enrollment and randomized into Restylane group and Revanesse group, receiving hyaluronic acid injection to correct bilateral nasolabial folds. Each person received 1 or 2 times of injection (a touch-up injection could be administered 4 weeks post the first injection). According to the original depth of the wrinkles, no more than 2 ml hyaluronic acid was injected into each side. All the participants were followed up at 1, 3, 6, and 12 months after the last injection and standardized photographs were taken at each visit. All the participants were asked to fill the form of local adverse events within the first 15 days after injection. Investigators and the participants both evaluated wrinkles based on Wrinkle Severity Rating Scale (WSRS). The WSRS score according to the pictures of 6 months post-injection were compared with the pictures which were taken before the injection (baseline) by independent staff at the end of the trial. One or more grades of WSRS improvement compared with the baseline was considered as effective. Laboratory tests including blood and urine routine, liver and renal function tests were carried out at screening visit and 6 months after injection.  Results  The baseline features between the two groups were comparable (all P > 0.05). There was no significant difference in the WSRS 6 months after injection between the two groups (P > 0.05). There was no significant difference in the WSRS improvement compared with baseline between the two groups (P=0.105). There was no significant difference in the rate of effectiveness between the two groups (93.0% vs. 96.7%, P=0.431). Two participants reported minor adverse events, although both of which might not be associated with the product or procedure. No laboratory test change was found during the trial.  Conclusions  No severe adverse event associated with the injection material was observed during this clinical trial. According to the result, Revanesse Ultra may have good histocompatibility and tolerance. It could provide obvious improvement in the nasolabial folds, with effectiveness comparable to that of Restylane.
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  Objective  To derive a formula for predicting intraoperative resection weights of reduction mammoplasty with double-circle periareolar incision.  Methods  Data were collected from 78 consecutive patients receiving reduction mammoplasty with double-circle periareolar incision (133 sides) between 2003 and 2015, including preoperative bilateral clavicle-to-nipple distance, sternal notch-to-nipple distance, nipple-to-ipsilateral costoclavicular line distance, nipple-to-inframammary crease distance, nipple-to-anterior axillary line distance(cm), and resected weight (g) on each side of breast measured during the surgery. Multiple stepwise regression analysis was performed to establish the relationship between preoperative measurements and the resection weight.  Results  Formulas were established as follows:resected weight=(32×clavicle-to-nipple distance+31×nipple-to-inframammary crease distance+8×nipple-to-ipsilateral costoclavicular line distance)-986, or resected weight=(25×sternal notch-to-nipple distance+32×nipple-to-inframammary crease distance+13×nipple-to-ipsilateral costoclavicular line distance)-868.  Conclusion  This formula summarizes the experience of reduction mammoplasty with double-circle periareolar incision, which could guide the surgeon in preoperative estimation, intraoperative resection, and postoperative maintenance of breast symmetry.
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  Objective  To investigate the clinical manifestations, outcomes after surgical management, and prognostic factors of large cell neuroendocrine carcinoma (LCNEC) of the lung.  Methods  We retrospectively analyzed the data of 35 consecutive cases (29 males, 6 females) of LCNEC of the lung surgically treated and pathologically confirmed in Peking Union Medical College Hospital from January 2000 to January 2014. Their outcomes after receiving surgery-based comprehensive therapy and related prognostic factors were explored.  Results  The median age of patients was 63(47-77)years and the median duration of disease was 2(1-14)months. No specific symptom was found and preoperative pathological diagnosis was not definitive. Surgical methods included open or thoracoscopic lobectomy and lymph node dissection based on the specific conditions of tumor in each case. Postoperative pathological staging showed stage Ⅰ in 12 cases, stage Ⅱ in 7, stage Ⅲ in 13, and stage Ⅳ in 3. Twenty-three patients received adjuvant therapy. Median survival was 17 months[95% confidence interval (CI):11.4-22.6 months]. The 1-year, 3-year, and 5-year survival rates were 60.6%, 29.0%, and 24.8%, respectively. Tumor stage was significantly related with the overall survival (Cox regression analysis, hazard ration=2.608, 95% CI:1.572-4.327, P=0.000).  Conclusions  LCNEC is a rare malignancy with tremendous aggressiveness and poor prognosis. Stage of tumor may be the independent risk factor affecting the prognosis. Surgery-based comprehensive therapy could achieve good survival for patients of early stages, especially stages Ⅰ and Ⅱ.
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  Objective  To evaluate the effectiveness of brachytherapy combined with external beam radiation therapy and hormonal therapy in treating localized high-risk prostate cancer patients.  Methods  We retrospectively analyzed 132 prostate cancer patients treated with brachytherapy from December 2003 to December 2007 in Department of Urology, Peking Union Medical College Hospital, including 97 localized high-risk patients, and 35 localized low- to intermediate-risk patients. Postoperative prostate specific antigen (PSA) level was monitored regularly in follow-up visits. Biochemical relapse, progression to castration-resistant prostate cancer (CRPC) or metastasis, and deaths were documented. Biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) of the patients were evaluated.  Results  The bPFS, CSS, and OS of the 132 patients were 83.3%, 91.7%, and 84.8%, respectively; those indexes of the 97 localized high-risk patients were 81.4%, 88.7%, and 81.4%, respectively; and those of the 35 localized low- to intermediate-risk patients were 88.6%, 100%, and 94.3%, respectively. No significant difference was observed in bPFS and OS between high-risk and low-to intermediate-risk patients (P=0.433, 0.098), while CSS was significant higher in low-to intermediate-risk patients than in high-risk patients (P=0.037). After patients were grouped based on Gleason score, tumor-node-metastasis (TNM) clinical stage, or preoperative PSA levels, differences in bPFS among groups were not statistically significant (P=0.084, 0.537, 0.850).  Conclusion  Brachytherapy combined with external beam radiation therapy and hormonal therapy may effectively control PSA level and delay biochemical relapse in localized high-risk prostate cancer.
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  Objective  To compare body composition between Tibetan adolescents and Han adolescents with a large-scale population survey.  Methods  Totally, 707 Tibetan adolescent living in a 3000-meter-altitude area and 733 Han adolescents living in a low-altitude area, all aged from 10-18 years, were surveyed in Sichuan province with two-stage stratified cluster sampling. Their body composition were arrayed with Biodynamics BI-310 body composition analyzer.  Results  The average height of Tibetan adolescents was lower than that of Hans (male:150.06 cm vs. 154.03 cm, P < 0.001; female:147.28 cm vs. 151.06 cm, P < 0.001). There were not significant differences in body weight and body mass index in boys; the body weight in girls also showed nosignificant difference, while Tibetan girls' body mass index was bigger than that of Hans (19.33 kg/m2 vs. 18.46 kg/m2, P < 0.001). The lean body mass of Tibetan adolescents was significantly smaller than that of Hans (male:35.20 kg vs. 39.05 kg, P < 0.001; female:32.25 kg vs. 35.60 kg, P < 0.001), but fat body weight of Tibetan adolescents was significantly larger than that of Hans(male:5.90 kg vs. 3.40 kg, P < 0.001; female:9.65 kg vs. 7.25 kg, P < 0.001). Fat mass index of Tibetan adolescents was higher than that of Hans, but fat-free mass index in Tibetan adolescents was significantly lower. The body fat percentages of Tibetan boys and girls were higher than Han adolescents by 6.62%(14.89% vs. 8.27%, P < 0.001) and 6.42%(23.26% vs. 16.84%, P < 0.001), respectively. In the age range of 10-17 years, body fat percentage of Tibetan adolescents was larger by 4% to 7% than that of Han adolescents in all age groups in both sexes.  Conclusions  The body compositions of Tibetan adolescents living in high-altitude areas may be significantly different from that of Hans living in low-altitude areas because of genetic, environmental, and other factors. Tibetan adolescents have higher body fat percentage compared with Han adolescents in same age and sex.
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  Objective  To study the ultrasonographic features of benign thyroid nodules that were misdiagnosed as malignant nodules.  Methods  The thyroid ultrasonic examination results of 31 822 healthy people who visited the Department of Health Management, Peking Union Medical College Hospital from January 2011 to December 2014 were analyzed. Fine needle aspiration or surgical resection were performed in those highly suspected as malignant nodules according to some specific ultrasonographic features.  Results  A total of 162 nodules were suspected malignant in ultrasonography, among which 33 (20.37%) were benign based on pathologic results, primarily nodular goiter with calcinosis/fibrosis(12, 36.36%). Microcalcification(20), irregular boundary of the nodules(9), a taller-than-wide shape(6), and abundant and abnormal blood flow(6) were the most common ultrasonographic signs in turn in those misdiagnosed nodules.  Conclusions  Ultrasonography is the diagnostic technique of choice for thyroid nodules. Accurate interpretation of the ultrasonographic features of thyroid nodules can improve the accuracy of diagnosis and facilitate the decision in surgery.
2016, 7(2): 119-122. doi: 10.3969/j.issn.1674-9081.2016.02.008
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2016, 7(2): 123-127. doi: 10.3969/j.issn.1674-9081.2016.02.009
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2016, 7(2): 128-131. doi: 10.3969/j.issn.1674-9081.2016.02.010
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2016, 7(2): 132-135. doi: 10.3969/j.issn.1674-9081.2016.02.011
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2016, 7(2): 136-140. doi: 10.3969/j.issn.1674-9081.2016.02.012
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2016, 7(2): 141-146. doi: 10.3969/j.issn.1674-9081.2016.02.013
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2016, 7(2): 147-151. doi: 10.3969/j.issn.1674-9081.2016.02.014
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2016, 7(2): 152-155. doi: 10.3969/j.issn.1674-9081.2016.02.015
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2016, 7(2): 156-160. doi: 10.3969/j.issn.1674-9081.2016.02.016
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2016, 7(2): 160-160.
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