Top Cited

2018 Chinese Guideline on Menopause Management and Menopause Hormone Therapy
, Qi YU
2018, 9(6): 512-525. doi: 10.3969/j.issn.1674-9081.2018.06.007
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This guideline has been announced by experts of Menopause Group, Obstetrics and Gynecology Branch, Chinese Medical Association on menopause management and menopause hormone therapy (MHT) to help healthcare professionals in optimizing their management of transitionally menopausal and postmenopausal women. New results on MHT and menopause management after 2012 as well as all of the important information from main international guidelines were reviewed. Levels of evidence and grades of recommendations were also included. The standardized MHT flowcharts of diagnosis and treatment were retained and improved from the last version. The menopause staging system, Stages of Reproductive Aging Workshop +10 (STRAW+10), was added to facilitate the understanding on clinical, biological, and endocrine changes in the reproductive aging process for doctors in this field. Vasomotor symptoms (VMS), genitourinary syndrome of menopause, and prevention ofmenopause-related low bone mass and osteoporosis were reconfirmed as the indications for MHT. The risks of MHT depend on types, dosages, time of use, management, start-up time, and whether progesterone is used. To maximize the benefits and minimize the risks, MHT should be individualized based on the updated evidence, and the benefit-risk ratio should be reassessed annually. For women within 10 years after menopause, or younger than 60 years old with no contraindications, MHT for the treatment of VMS and prevention of bone loss and fractures has the most favorable benefit-risk ratio. Premature ovarian insufficiency patients should be treated with hormone replacement therapy till the average age of natural menopause and followed by the postmenopausal MHT.
2017, 8(6): 352-358. doi: 10.3969/j.issn.1674-9081.2017.06.007
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Risk Factors of Breast Cancer in China: A Case-Control Study
Ya-li XU, Qiang SUN, Guang-liang SHAN, Jin Zhang, Hai-bo Liao, Shi-yong Li, Jun JIANG, Zhi-min Shao, Hong-chuan JIANG, Nian-chun SHEN, Yue SHI, Cheng-ze YU, Bao-ning ZHANG, Yan-hua CHEN, Xue-ning DUAN, Bo LI
2011, 2(1): 7-14. doi: 10.3969/j.issn.1674-9081.2011.01.002
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  Objective  To screen the risk factors associated with breast cancer among Chinese women, with an attempt to provide evidence for the evaluation of breast cancer risks among Chinese women on an individual level.  Methods  A case-control study on 416 breast cancer patients and 1156 age-and region-matched controls was conducted in 14 hospitals in 8 provinces/municipalities of China.Conditional logistic regression was applied to analyze the association between risk factors and breast cancer.  Results  The risk factors of breast cancer among Chinese women included higher body mass index(BMI ≥ 24)(OR=4.07, 95%CI:2.98-5.55), history of benign breast disease biopsy(OR=1.68, 95%CI:1.19-2.38), age of menarche ≥ 14 years(OR=1.41, 95%CI:1.07-1.87), psychological depression(for grade 1-4, OR=2.15, 95% CI:1.26-3.66;for grade 5-9, OR=3.48, 95% CI:2.03-5.95), menostasia(OR=2.22, 95% CI:1.50-3.28), family history of breast cancer(OR=1.72, 95%CI:1.15-2.58), and family history of cancer other than breast cancer(OR=1.55, 95%CI:1.22~1.98)(all P < 0.05 when compared between the 416 breast cancer patients and 1156 controls).Although use of oral contraceptives(OC)(OR=1.59, 95% CI:0.83-3.05)was associated with an increased risk of breast cancer, the difference was not statistically significant(P > 0.05).  Conclusions  Many risk factors including BMI ≥ 24, history of benign breast disease biopsy, age of menarche ≥ 14 years, psychological depression, menostasia, family history of breast cancer, and family history of cancer other than breast cancer may contribute to breast cancer among Chinese women.This research provides a basis for the individualized evaluation of risks of breast cancer and the population-based interventions in China.
2017, 8(2-3): 131-138. doi: 10.3969/j.issn.1674-9081.2017.03.010
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Chinese Guidelines for Diagnosis and Treatment of HIV/AIDS (2018)
and Hepatitis C Professional Group AIDS, Tai-sheng LI, Fu-sheng WANG, Fu GAO
2019, 10(1): 31-52. doi: 10.3969/j.issn.1674-9081.2019.01.006
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Acquired immunodeficiency syndrome (AIDS) is an important public health problem in China. In 2005, the first edition of the guidelines for the diagnosis and treatment of AIDS was formulated by the AIDS Professional Group of Society of Infectious Diseases of Chinese Medical Association, which was updated in 2011 and 2015, respectively. The fourth edition of the guidelines in 2018 is revised on the basis of the third edition and updated according to national clinical practice and the latest research results. The new research progress in opportunistic infections and human immunodeficency virus(HIV) associated cancers, antiretroviral therapy, HIV post-exposure prophylaxis, and prevention of mother to child transmission were updated in these guidelines. In the 2018 edition, pre-exposure prophylaxis is mentioned for the first time. The strategy of whole course management of HIV infection is put forward and how to do the whole course management of HIV infection is detailed in this version. These guidelines will be updated regularly according to the latest clinical evidence.
Clinical Practice Guideline for Primary Lung Cancer(2022 Version)
General Office of National Health Commission of the People's Republic of China
2022, 13(4): 549-570. doi: 10.12290/xhyxzz.2022-0352
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Epidemiological Survey on Postoperative Delirium in Elderly Noncardiac Surgical Patients
Gang TAN, Xiang-yang GUO, Ai-lun LUO, Yu-guang HUANG, Jian-qing XU
2011, 2(4): 319-325. doi: 10.3969/j.issn.1674-9081.2011.04.008
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  Objective  To investigate the incidence of delirium after noncardiac surgery among elderly patients and explore the possible perioperative risk factors.  Methods  In this cross-sectional study using cluster sampling, totally 718 patients aged 65 or older who had undergone elective noncardiac surgeries in our hospital from August to December 2006 were enrolled. Patients were interviewed at the day before surgery and an informed consent was obtained. The same interviewer evaluated the patients prospectively for delirium with the Confusion Assessment Method (CAM) on the preoperative day 1, postoperative day 1, day 2, and day 3. Other information including previous medical history, comorbidities, anesthetics, and perioperative medications were also recorded.  Results  Delirium occurred in 80 patients (11.1%) at during the first three postoperative days, among whom transient symptoms were more frequent than continuous delirium status (68, 85% vs. 12, 15%). The Logistic stepwise regression analysis indicated that the perioperative risk factors of delirium included advanced age (OR:1.480, 95% CI:1.070-2.046), history of stroke (OR:2.862, 95% CI:1.432-5.720), use of meperidine (OR:3.196, 95% CI:1.574-6.488) or scopolamine (OR:2.537, 95% CI:1.523-4.227), hypotention during the operation (OR:1.780, 95% CI:1.070-2.960), long-duration operations (≥ 3 h) (OR:2.610, 95% CI:1.538-4.431), and ICU admission after surgeries (OR:2.187, 95% CI:1.077-4.442).  Conclusions  Advanced age or previous history of stroke are the most important risk factors of postoperative delirium. The incidence of postoperative delirium may be decreased by avoiding other risk factors such as perioperative hypotension, usage of meperidine and scopolamine, and long-duration operation.
2010, 1(1): 34-39.
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Campaigning for the Transformation from Anesthesiology to Perioperative Medicine: Interpretation on the Anesthesia Part of Consensus on ERAS and Guidelines for the Pathway Management in China (2018)
Tian-long WANG, Yu-guang HUANG
2018, 9(6): 481-484. doi: 10.3969/j.issn.1674-9081.2018.06.001
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As Consensus on ERAS and Guidelines for the Pathway Management in China (2018) was published, China has taken an important step forward in promoting the enhanced recovery protocol. The interpretation of its anesthesia part has an important guidance for anesthesiologists to better understand clinical practice methods and the pathway of perioperative management. The interpretation made a deep evidence-based exploration in the anesthesia-related core parts from the guideline, aiming to further disclose the direction of the development of clinical practice of anesthesiology in the near future from the vision of perioperative medicine.
Concept Renewal Leads to Behavior Progress: Interpretation on the Surgical Part of Consensus on ERAS and Guidelines for Pathway Management in China (2018)
Xiao-dong TIAN, Yin-mo YANG
2018, 9(6): 485-489. doi: 10.3969/j.issn.1674-9081.2018.06.002
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The concept and pathway of enhanced recovery after surgery (ERAS) have been widely accepted and proved to be beneficial in terms of improving postoperative outcomes in China. In 2018, experts from the Chinese Society of Surgery and the Chinese Society of Anaesthesia jointly organized and published the Consensus on ERAS and Guidelines for Pathway Management in China (2018) in both Chinese Journal of Practical Surgery and Chinese Journal of Anesthesiology at the same time. This consensus is incorporated with the latest literature and the experts' own clinical practice experience, and it marks a great progress of the ERAS practice in China. In this paper, we try to make an interpretation of the surgery part of the consensus, and the highlights and hot issues will be further discussed.
Application of Deep Learning in Medical Imaging Research
Li-ming XIA, Jian SHEN, Rong-guo ZHANG, Shao-kang WANG, Kuan CHEN
2018, 9(1): 10-14. doi: 10.3969/j.issn.1674-9081.2018.01.003
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Deep learning, as the most popular research field in artificial intelligence, has been developing rapidly in recent years and become the focus of global attention. Deep learning has demonstrated a powerful role in many application areas. In some visual and auditory recognition tasks, deep learning even shows better performance than human beings. In medical domain, deep learning has become the top choice for researchers to analyze big data, especially medical imaging. This review briefly introduces the history and development of deep learning, and elaborates on the progress of research on deep learning in medical imaging by reviewing the latest and most influential research results. In addition, this paper briefly discusses application of deep learning in medical imaging analysis, as well as the future prospect and challenges of deep learning.
2018, 9(1): 36-41. doi: 10.3969/j.issn.1674-9081.2018.01.008
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2014, 5(2): 225-227. doi: 10.3969/j.issn.1674-9081.2014.02.022
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2014, 5(1): 106-109. doi: 10.3969/j.issn.1674-9081.2014.01.023
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Influence of Laparoscopic Cystectomy on Ovarian Reserve Function and Pregnantic Outcome in Women with Ovarian Endometriotic Cyst
Jing-hua SHI, Jin-hua LENG, Meng-hui LI, Shuang-zheng JIA, Jing-he LANG
2011, 2(2): 124-128. doi: 10.3969/j.issn.1674-9081.2011.02.007
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  Objective  To investigate the influence of laparoscopic ovarian cystectomy on ovarian reserve function and pregnantic outcome in women with ovarian endometriotic cyst.  Methods  A total of 176 women with ovarian cyst undergoing laparoscopic cystectomy were divided into six groups:40 patients with uni-lateral teratoma(con1), 10 patients with bilateral teratoma(con2), 40 patients with unilateral ovarian endometriotic cyst less than 35y(A), 26 patients with unilateral ovarian endometriotic cyst no less than 35y(B), 41 patients with bilateral ovarian endometriotic cyst less than 35y(C), and 19 patients with bilateral ovarian endometriotic cyst no less than 35y(D).Blood samples were obtained from patients before operation, 24 hours after operation and on the second and third day of the menstrual cycle 6 months after operation.Mean ovarian diameter were evaluated by ultrasound 6 months after operation and pregnancy outcome was recorded in the following 18 months after the operation.  Results  In the bilateral groups(C and D), the serum level of follicle stimulating hormone(FSH)increased significantly after the operation(P < 0.05), while estradiol decreased significantly(P < 0.05).No significant difference between pre-and post-operational hormone levels were observed in the unilateral groups(A and B)and control group Serum basal FSH recovered to normal 6 months after the operation in 77.8% of patients in group C and 53.3% in group D(P < 0.05).The reduction of mean ovarian diameter six months after operation was significantly different between the affected and contralateral ovaries(P < 0.05).During the follow-up, the pregnancy rate was 92.9% in controlled group, compared to 45.2% in the endometriosis group(P < 0.05)and 60%, 37.5%, 46.2%, and 16.7%, respectively, for group A, B, C, and D.  Conclusion  The ovarian reserve function decreases after laparoscopic ovarian cystectomy in women with ovarian endometriotic cyst.However, most young patients recover after 6 months.Peri-operative ovarian function assessment and ovarian protection should be carefully designed and performed for women who intend to get pregnant.
Prospects and Challenges:when Medical Imaging Meets Artificial Intelligence
Zheng-yu JIN
2018, 9(1): 2-4. doi: 10.3969/j.issn.1674-9081.2018.01.001
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With the rapid development of artificial intelligence, there is a general consensus of opinion that radiologists' workload can be dramatically reduced with the aid of intelligent image recognition. On the issues of comprehensive diagnosis and treatment, however, there is no certain answer whether or not artificial intelligence can provide better suggestions and comments. Currently, in China, the artificially intelligent imaging technique is mainly focused on simple image recognition, but there is a lack of experience in the accumulation of medical data and the analysis of radiological reports. The mode of integrating artificial intelligence with medical imaging science has just begun. We believe that the progress of science and technology will continue to be the engine of human civilization.
Role of Bakri Balloon in Management of Postpartum Haemorrhage
Chen-wei FU, Jun-tao LIU, Jian-qiu YANG, Xu-ming BIAN, Jin-song GAO, Ying SHAN, Yu GU
2013, 4(1): 31-34. doi: 10.3969/j.issn.1674-9081.2013.01.007
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  Objective  To investigate the role of Bakri balloon insertion following unsuccessful medical management of postpartum haemorrhage (PPH).  Methods  The clinical features of patients with PPH managed with Bakri balloon in our department between January and July 2012 were retrospectively reviewed. The therapeutic role of Bakri balloon was analyzed.  Results  Eight cases were managed with Bakri balloon during the study period. Caesarean section (CS) was performed in all these cases, among whom seven were due to placenta previa. Two cases had disseminated intravascular coagulation (DIC). Three cases needed a second procedure to stop the bleeding, among whom two had placenta previa, previous CS, and placenta accreta. No patient experienced postpartum abdominal pain or fever.  Conclusions  Bakri balloon tamponade is effective and safe in the management of PPH unresponsive to standard management. Patients should be carefully monitored after the placement of Bakri balloon. Central placenta previa with a history of CS, placenta accreta or placenta adherence may impact the success of Bakri balloon placement.
How to Distinguish between Clinical Practice Guidelines and Expert Consensus
Yao-long CHEN, Xu-fei LUO, Ji-yao WANG, Xiao-qing LIU, Hong-cai SHANG, Ke-hu YANG
2019, 10(4): 403-408. doi: 10.3969/j.issn.1674-9081.2019.04.018
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As the most important guiding documents in the medical practice, clinical practice guidelines and expert consensuses have received more and more attention in recent years. However, partial domestic experts also have understanding biases on guidelines and consensus. Thus, we analyzed and compared guidelines and consensuses on their definition, status, development, connection, and difference. Combined with the example, we introduced good practice statement along with its formation conditions. Finally, we proposed five recommendations on how to improve the quality of clinical practice guidelines and expert consensus in China.
2017, 8(4-5): 239-243. doi: 10.3969/j.issn.1674-9081.2017.05.009
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Expert Consensus on Anesthesia Management of Enhanced Recovery after Adult Ambulatory Surgery
Working Group of "Expert Consensus on Anesthesia Management of Enhanced Recovery after Ambulatory Surgery"
2019, 10(6): 562-569. doi: 10.3969/j.issn.1674-9081.2019.06.003
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The definition of ambulatory surgery by the China Ambulatory Surgery Alliance refers to an operation (excluding outpatient surgery) completed within one day (24 h). For the patients with special conditions who have to prolong hospital stays, the length of hospital stays should not exceed 48 h.Enhanced recovery after surgery (ERAS) is a series of optimized perioperative treatments with evidence-based medicine that can reduce perioperative stress and inflammatory responses, promote rapid recovery, and improve patients' perioperative safety and comfort. Ambulatory surgery has the advantages of short hospital stay and high rate of bed rotation. Based on these characteristics, optimized anesthesia management under the concept of ERAS can enhance the safety, comfort, and efficacy of ambulatory surgery.
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