OBJECTIVE:To systematically review the efficacy and safety of cinacalcet in the treatment of hemodialysis pa-tients with secondary hyperparathyroidism,and provide evidence-based reference for the clinical treatment. METHODS:Retrieved from Medline,Cochrane Library,EMBase and CBM,randomized controlled trials(RCT)about cinacalcet in the treatment of he-modialysis patients with secondary hyperparathyroidism (SHPT) were collected. Meta-analysis was performed by using Rev Man 5.3.5 software after data extract and quality evaluation by Cochrane systematic Rev Man 5.3.5. RESULTS:Totally 7 RCTs were en-rolled,involving 1 987 patients. Results of Meta-analysis showed cinacalcet can significantly reduce the rate of surgical parathyroid-ectomy[RR=0.23,95%CI(0.06,0.89),P=0.03],incidence of fracture[RR=0.26,95%CI(0.12,0.60),P=0.002] and increase the incidences of hypocalcemia[RR=9.81,95%CI(3.92,4.59),P<0.001],nausea[RR=1.97,95%CI(1.58,2.46),P<0.001] and vomit-ing[RR=1.91,95%CI(1.50,2.42),P<0.001],while it showed no significant effect on the the incidence of all-cause mortality and cardiovascular death. CONCLUSIONS:The clinical efficacy of cinacalcet in the treatment of hemodialysis patients with secondary hyperparathyroidism is good,but there are common adverse reactions such as nausea and vomiting,hypocalcemia.

Objective:To investigate the efficacy of gonadotropin releasing hormone agonist (GnRH-a) combined with a levonorgestrel-releasing intrauterine system (Mirena) in patients with adenomyosis and its effects on ovarian function, carbohydrate antigen (CA) 125, CA153 and carcino-embryonic antigen (CEA) expression.Methods:Seventy-eight patients with adenomyosis who received treatment from September 2017 to September 2020 in Shaoxing People's Hospital were included in this study. They were randomly divided into treatment and control groups ( n = 39/group). Patients in the control group were treated with a levonorgestrel-releasing intrauterine system. Patients in the treatment group were treated with GnRH-a, once per month in the first 3 months based on treatment with a levonorgestrel-releasing intrauterine system. After 6 months of treatment, changes in dysmenorrheal relief, menstrual volume, uterine volume, endometrial thickness, ovarian function, CA125, CA153 and CEA levels relative to before treatment were compared. Results:Visual analog scale score and pictorial blood assessment chart score in the treatment group were (1.36 ± 0.28) points and (38.98 ± 5.42) points, which were significantly lower than those in the control group [(1.78 ± 0.31) points, (63.42 ± 6.75) points, t = 6.27, 17.63, both P < 0.05). Uterine volume and endometrial thickness in the treatment group were (209.74 ± 15.65) cm 3 and (7.37 ± 0.57) mm, respectively, which were significantly lower than those in the control group [(278.39 ± 20.90) cm 3, (8.63 ± 0.86) mm, t = 16.45, 7.62, P < 0.05]. There were no significant differences in serum levels of luteinizing hormone, follicle stimulating hormone and estradiol between the two groups (all P > 0.05). Serum CA125, CA153 and CEA levels in the treatment group were (26.87 ± 7.21) U/L, (23.12 ± 7.38) U/mL and (5.45 ± 0.96) μg/L, respectively, which were significantly lower than those in the control group [(49.93 ± 8.97) U/L, (38.94 ± 6.21) U/mL, (8.23 ± 1.35) μg/L, t = 12.51,10.24,10.48, P < 0.05]. Conclusion:GnRH-a combined with a levonorgestrel-releasing intrauterine system (Mirena) can markedly relieve dysmenorrhea, reduce menstrual volume, uterine volume, and endometrial thickness, has no obvious effects on ovarian function, and greatly reduce the levels of CA125, CA153 and CEA. Therefore, the combined method is a safe and effective non-surgical treatment method of adenomyosis.

Objective To estimate the prevalence and related direct medical costs of chronic complications,especially cardiovascular diseases,cerebrovascular diseases,and nephropathy in patients with type 2 diabetes mellitus (T2DM) in China.Method Data were extracted from the hospital information system(HIS) database of 4 top level Chinese hospitals from January 1st,2012 to May 31st,2017.Patients with T2DM were identified through international classification of diseases,tenth version (ICD-10) diagnosis supplemented with Chinese descriptions.The prevalences of complications including cardiovascular diseases,cerebrovascular diseases,nephropathy,diabetic foot,lower extremity vascular diseases,diabetic retinopathy,and diabetic neuropathy were estimated among all identified patients with T2DM.The costs per hospitalization and per outpatient visit under the primary diagnoses of each chronic complication were further estimated.Results There were 61 139 patients with T2DM,with mean age of(62.1 ± 13.6) years,50.5％ being males.66.8％ of them had chronic complications,and patient suffered from more than 2 complications on average.The most common complication was nephropathy (30.5％),followed by diabetic neuropathy (26.8％),diabetic retinopathy (26.3％),cardiovascular disease (24.9％),and cerebrovascular disease (19.2％).The cost per hospitalization was highest for cardiovascular disease(21 176 yuan),followed by diabetic foot disease(18 999 yuan) and cerebrovascular disease (16 583 yuan).The cost per outpatients visit varied from 826 to 976 yuan across different complications except for lower extremity vascular diseases (522 yuan).Conclusions The majority of patients with T2DM suffered from chronic complications.The occurrence and development of chronic complications,especially cardiovascular diseases,cerebrovascular diseases,and nephropathy,led to increased direct medical costs among patients with T2DM.Effective interventions,such as regular physical examinations and proper glycemic control,should be implemented to prevent complications among the diabetic patients.

Objective To evaluate the value of histogram parameters of dynamic contrast-enhanced MRI (DCE-MRI) in the diagnosis of cellular leiomyoma. Methods Seventy one patients with leiomyomas confirmed by pathology who underwent preoperative DCE-MRI were enrolled in this retrospective study. Quantitative perfusion histogram parameters (including median, mean, skewness, kurtosis, energy, entropy) were measured for each patient. Leiomyoma was divided into degeneration, ordinary and cellular types according to pathology. One-way analysis of variance and Least significant difference were used to compare the differences among the parameters of the three groups which were normal distribution and equal variances, while Kruskal-Walls test and Mann-Whitney U test were used to compare the parameters that did not conform to normal distribution or variance. ROC curves were drawn to evaluate the diagnostic efficiency of different parameters. Results Among the three groups,the values of Ktrans(median, mean, kurtosis, energy, entropy), Kep(median, mean, skewness, kurtosis, entropy), Ve(median, mean, skewness, kurtosis) and Vp(median, mean, skewness, kurtosis, energy, entropy) had statistical difference (all P<0.05). The values of Ktrans, Kep, Vp (median, mean) and Ktrans (entropy) of the cellular group were higher than those of the degeneration and ordinary groups. While the values of Ktrans (kurtosis, energy) and Kep (skewness) of the cellular group were lower than the other two groups;then the value of Kep (kurtosis) of the cellular group was lower than the ordinary group and the value of Kep (entropy) of the cellular group was higher than the ordinary group;and the values of Ve (median, mean, kurtosis) and Vp (entropy) of the cellular group were higher than those of the ordinary group. The values of Ve (skewness) and Vp (skewness, kurtosis and energy) of the cellular group were lower than those of degeneration group. ROC curves found that when Ktrans(median)was 0.994/min, its sensitivity was 100.0％, the specificity was 73.8％, and the area under ROC was 0.905;when Ktrans(mean) was 1.170/min, its sensitivity was 90.0％, the specificity was 85.2％, the area under ROC was 0.921. And the areas under ROC of Ktrans (kurtosis, energy, entropy), Kep (median, mean, skewness, kurtosis, entropy), Ve (median, mean, skewness), Vp (median, mean, skewness) were also high (ranging from 0.711 to 0.872). Conclusion Histogram analysis of DCE-MRI quantitative perfusion is applicable for identification of cellular leiomyoma.

:To explore the value of quantitative perfusion histogram parameters of dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） in pathological classification of uterine leiomyoma and its correlation with Ki-67 protein expression. Thirty five patients with uterine leiomyoma confirmed by operation and pathology at Shaoxing People's Hospital from October 2015 to September 2017 were analyzed retrospectively，including 15 cases of ordinary type，8 cases of cellular type and 12 cases of degenerative type. All patients were examined by pelvic DCE-MRI before operation，and the histogram parameters （median，mean，skewness，kurtosis，energy，entropy） of various quantitative perfusion parameters，including volume transport constant （K），rate constant （K），extravascular extracellular space distribute volume per unit tissue volume （V），blood plasma volume per unit volume of tissue （V） were calculated，and the efficacy of different parameters in pathological classification of uterine leiomyoma was evaluated by ROC curve. The expression of Ki-67 protein in uterine leiomyoma was detected by immunohistochemical method，and the correlation between histogram parameters and Ki-67 protein expression was analyzed by Pearson and Spearman correlation analysis. The median and mean values of K，K，V and V in the cellular group were higher than those in the degenerative group and the ordinary group（<0.05 or <0.01），while the skewness of V，the skewness and kurtosis of K in the cellular group were lower than those in the ordinary group （all <0.05）. The entropy of K in the cellular group was higher than that in the degenerative group and the ordinary group （all < 0.05）. The entropy of V in the cellular group was higher than that in the ordinary group （<0.01）. The median，mean，skewness of K，median and mean of K，median and mean of V，median，mean，energy and entropy of V were correlated with Ki-67 expression（all <0.05）. The results of ROC curve analysis showed that the median threshold of K was 0.994/min，the sensitivity and specificity for the diagnosis of cellular uterine leiomyoma were 100.0% and 77.8% respectively，and the area under the ROC curve was 0.949. When the mean threshold of K was 1.170/min，the sensitivity and specificity for diagnosing cellular uterine leiomyoma were 100.0% and 77.8% respectively，and the area under the ROC curve was 0.958. The area under the ROC curve of K （entropy），K （median，mean），V （median，mean，entropy） in the diagnosis of cellular uterine leiomyoma were 0.755-0.907. :DCE-MRI quantitative perfusion histogram parameters have high diagnostic value in differentiating pathological types of uterine leiomyoma，especially for cellular uterine leiomyoma.
Contrast Media ; Humans ; Leiomyoma/diagnostic imaging* ; Magnetic Resonance Imaging ; Perfusion ; Retrospective Studies