Early Hormonal Therapy Research Articles

The use of peritoneum in female genital gender-affirming surgery: A systematic review

Genital gender-affirming surgery (GAS) plays a crucial role in alleviating psychological discomfort and assisting transgender patients in achieving their transition goals. One of the most common procedures for primary genital reconstruction in transwomen is penile inversion vaginoplasty. But it presents a risk of vaginal stenosis and limited depth, particularly in cases with inadequate penile and scrotal tissue. This limitation becomes more relevant as transgender individuals increasingly seek early hormone therapy and puberty blockade. We conducted a literature review focusing on studies published between 2000 and 2022 to explore the application of peritoneal vaginoplasty, a technique primarily used in cisgender women with congenital vaginal agenesis, to address these challenges in transwomen.Data were extracted from 13 selected articles reporting 313 patients who underwent peritoneal vaginoplasty.Peritoneal vaginoplasty was found to offer advantages in terms of neovaginal depth and width, with an average depth of 13.8 cm and width of 3.5 cm. Patient reporting satisfaction rates for sexual intercourse and dilatation achievement were high, with 96.2% and 94.4% respectively. The technique did not result in an increased rate of complications compared to traditional penile inversion vaginoplasty.This review suggests that peritoneal vaginoplasty could be consider first for transwomen genital GAS, especially in cases with limited penile tissue. The well-vascularized peritoneum provides tissue with regenerative capacities and reduces the risk of stenosis. Moreover, peritoneum remains unaffected by hormonal treatments and allows deep enough neovaginal canals. This method is safe and does not lead to increased complications compared to traditional techniques.

Pituitary deficiency after brain radiation therapy in childhood

Introduction: As part of an anticancer therapy, craniospinal radiotherapy causes variable degrees of hormonal deficiencies. The onset of hormonal deficiencies depends on the dose delivered to the pituitary –hypothalamic region while their incidence and severity depends on dose fractionating and follow up duration.
 Objectives: Analyzing the long –term endocrine complications in children treated with craniospinal radiotherapy.
 Material and methods: A prospective study; including 4 medical files collected over a period of 2 years.
 Results: The study includes 4 patients with a sex ratio of 3M/1F; and a mean age of 18, 62 years. The average age at the time of irradiation was 9, 12 years. The delay between the end of radiotherapy and the first consultation varied between 1 year and 21 years. The radiotherapy was administred for medulloblastoma (n=1), Burkitt lymphoma (n=1), cavum cancer (n=1), Posterior Cranial Fossa Tumor (n=1).
 The hormonal assessment revealed: a central hypothyroidism in 3 patients, corticotropin insufficiency in 2 cases, and gonadotropin deficiency associated with micropenis in one case. No cases of diabetes insipidus have been reported. Pituitary hypothalamic MRI objectified an atrophic anterior pituitary gland in two cases. Hormonal substitutive therapy was started in all patients. Recombined human GH treatment was introduced in one case, but omitted in two others cases for bad control of the cancerous disease and for an achieved puberty in the fourth patient.
 Conclusion: The search of the hormonal deficiencies is essential for any child treated by craniospinal radiotherapy in order to institute an early hormonal substitutive therapy.
 Keywords: Craniospinal radiotherapy, hormonal deficiencies, substitutive therapy

Neurodevelopmental Outcome of Prenatally Diagnosed Boys With 47,XXY (Klinefelter Syndrome) and the Potential Influence of Early Hormonal Therapy

(Abstracted from Am J Med Genet 2020;182A:1881–1889) 47,XXY (Klinefelter syndrome) is characterized by disruption in neurodevelopment, the endocrine and musculoskeletal systems, and brain morphology. It is also associated with an increased risk of asthma, infertility, decreased muscle tone, emotional lability, and decreased libido.

Clinical Analysis of Acute Lung Injury in 26 Cases of Diffuse Large B-Cell Lymphoma Treated with Rituximab Chemotherapy

To summarize and analyze the clinical characteristics, treatment and prognosis of acute lung injury in patients with diffuse large B-cell lymphoma (DLBCL) after chemotherapy with rituximab chemotherapy, so as to improve the understanding of the disease and guide the clinical treatment. Twenty-Six patients with DLBCL were treated with rituximab chemotherapy and developed to acute lung injury in Third Hospital of Peking University from January 2013 to September 2018 were selected. The clinical features, imaging findings, chemotherapy course, therapeutic effect and prognosis were analyzed. The main clinical symptoms of patients were fever, cough and chest tightness, among which 12 patients showed hypoxia and 3 patients showed respiratory failure type I. The mainly manifested chest CT was diffusive glass grinding in both lungs, and some patients were complicated with a small amount of pleural effusion. The onset chemotherapy time was mainly distributed in 2 to 4 courses, the time between the onset of symptoms and the infusion of rituximab was 8 to 49 days. 25 patients shows no obvious limitation in daily life after effective treatment, and 1 patient died of ineffective treatment. There are no typical clinical symptoms in the early stage of acute lung injury after rituximab chemotherapy in DLBCL. Early detection and early hormone therapy are very important to achieve good therapeutic effect.

A Systematic Review of Primary Vaginoplasty Techniques and Outcomes in the Male-to-Female Transgender Population: A Call to Action

PURPOSE: Primary vaginoplasty is an integral aspect of male-to-female (MtF) transgender surgery. Surgical techniques vary and outcomes, such as vaginal depth, complications, and patient-reported outcome measures (PROMs) are reported inconsistently. We aim to provide a synopsis of vaginoplasty technique variations and evaluation of outcomes. METHODS: A multi-database (EMBASE, Ovid, PubMed, and Web of Science) search (2008–2019) was performed using a search strategy executed with MeSH terms and keywords such as neovagina, vaginoplasty, and transgender. Studies describing primary MtF vaginoplasty that sufficiently detailed surgical technique and reported surgical outcomes and/or PROMs were selected. RESULTS: Twenty-three studies were included; 16 described unique populations representing 2021 MtF patients. Inversion vaginoplasty was performed in 96.6% of patients (n = 1952). Sixty-nine patients underwent intestinal vaginoplasty. Average length of admission was 8.5 days (range, 5.7–12.5 days). Average follow-up was 49.8 months (range, 6–92 months). Average vaginal depth achieved was 11.7 cm (range, 9.8–15 cm) with inversion vaginoplasty (n = 513) and 15.3 cm (range 12–16.3 cm) with intestinal vaginoplasty (n = 54). Neovagina was constructed with inversion flap only (69.8%), or augmented with full thickness skin graft (18.6%), spatulated urethra (9.5%), or both (2.0%). For intestinal vaginoplasty, either sigmoid (78.3%) or transverse (21.7%) colon was utilized. The most common complications were wound dehiscence after inversion vaginoplasty (19.2%) and introitus stricture after intestinal vaginoplasty (13.0%). Sixteen studies included PROMs. The most commonly utilized validated PROMs for sexual function were the Female Genital Self-Image Scale and Female Sexual Function Index. Patient satisfaction was high (88.7% inversion, 77.6% intestinal) while regret was low (1.0%). Rates of penetrative intercourse were similar (62.5% inversion, 51.2% intestinal). The majority of patients were able to achieve orgasm (74.5% inversion, 84.0% intestinal). CONCLUSIONS: Inversion vaginoplasty remains the most common method for neovagina creation. Utilization of adjunct tissue to augment neovaginal depth is more common, which correlates with increasing use of early hormonal therapy. Despite high satisfaction after primary vaginoplasty, standardized reporting of surgical complications and PROMs remains poor. Standardization of the way surgeons evaluate outcomes is critical to establish evidence-based guidelines for this surgical procedure.

Neurocognitive development and capabilities in boys with 49,XXXXY syndrome

49,XXXXY was previously associated with profound to severe intellectual deficits. However, prior research papers on the cognitive profiles of this population were confounded by small samples sizes, wide age spreads, and incomplete histories of testosterone replacement therapy. This study is the first comprehensive, international investigation of the neurocognitive aspects of 49,XXXXY, and the potential effects of biological treatment on this profile. Sixty-seven boys from infancy to 11 years of age were enrolled in this longitudinal study, with the majority of boys postnatally diagnosed though chromosomal analysis. These boys received a comprehensive neurocognitive evaluation tailored to specific language-based deficits and cognitive challenges. Results revealed higher neurocognitive capacities, both verbally and nonverbally, than previously reported in this disorder. Infant boys with 49,XXXXY who received early hormonal therapy (EHT) had significantly higher scores on the cognitive domain of the Bayley Scales of Infant Development than untreated infants (p=.013). In addition, treated school-aged participants had significantly better scaled scores than untreated boys in form completion (p=.042), a task that requires deductive reasoning, on nonverbal testing on the Leiter International Performance Scales. This study indicates greater cognitive capacities with a wide range of abilities in the child with 49,XXXXY, thus warranting further investigation to identify and understand the critical influences on the etiology and the variability of those capacities.

Neurodevelopmental outcome of prenatally diagnosed boys with 47,XXY (Klinefelter syndrome) and the potential influence of early hormonal therapy.

This cross-sectional study examined the neurodevelopment of a large, prenatally diagnosed population of boys with 47,XXY; investigated the potentially positive effects of early hormonal therapy (EHT) on language, cognition, and motor in this population; and identified novel at risk biomarkers associated with 47,XXY. Two-hundred and seventy two evaluations were collected from 148 prenatally diagnosed boys with 47,XXY between 0 and 36 months and separated into one of three groups, depending on visit age: Y1 (0-12 months; n = 100), Y2 (13-24 months; n = 90), and Y3 (25-36 months; n = 82). Those who received EHT (administered by 12 months) were further separated (Y1, n = 37; Y2, n = 34; Y3, n = 30). Neurodevelopmental evaluations consisted of Preschool Language Scales, Early Language Milestone Scale, and Bayley Scales of Infant and Toddler Development and evaluated the effect of EHT on auditory comprehension, expressive communication, receptive language, cognition, and motor. EHT was found to be associated with a positive effect within the first year of life in these domains, as well as in the second and third year of life. Additionally, three novel at-risk biomarkers were identified in this cohort: feeding difficulties in infancy, positional torticollis, and the need for orthotics. The positive effects of EHT observed in language, cognition, and motor at variable stages within the first 3 years of life provide additional evidence into the possible efficacy of early biological treatment for boys with 47,XXY to address the neurodevelopmental dysfunction.

Clinical Characteristics of Transarterial Chemoembolization in Treatment of Primary Hepatocellular Carcinoma Complicated With Respiratory Distress Syndrome.

Objective:The present study aims to analyze the clinical characteristics and etiology of transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) complicated with acute respiratory distress syndrome (ARDS), in order to improve the early diagnosis rate and cure rate.Methods:A total of 816 patients with primary HCC received 2,200 TACE treatments from January 2014 to May 2018. Among these patients, 6 patients developed ARDS after TACE. The clinical data, lesion characteristics, laboratory tests, treatment process and prognosis of 6 patients were retrospectively analyzed.Results:The longest lesion diameter ranged within 5.0-10.2 cm (mean: 6.6 cm) in the 6 patients with primary HCC. Among these patients, 4 patients had lesions mainly located in the left lateral lobe of the liver, while 5 patients had no hepatic arteriovenous fistula detected before TACE. Nedaplatin, epirubicin and iodinated oil suspension chemoembolization were used in all 6 patients during TACE, and all of them experienced ARDS symptoms within 24-48 hours after TACE. However, no clear pathogenic bacteria were incubated in the sputum culture after the onset of the disease. Diffused exudative changes of both lungs were found in the chest X-ray, and the oxygenation index (PaO2/FiO2) was within 100-300 mmHg. The symptoms of 6 patients improved after 3-6 days of hormone therapy.Conclusion:In this study, we found that although the incidence of ARDS after TACE was low in the treatment for HCC, the symptoms after onset were serious, and the early hormone therapy may be beneficial to improve the prognosis and reduce mortality. Further research with larger samples is still needed to confirm the pathogenesis of ARDS after TACE in the treatment for HCC.

Hormonal replacement therapy and its potential influence on working memory and competency/adaptive functioning in 47,XXY (Klinefelter syndrome).

This cross-sectional, retrospective analysis investigated the possible effect of hormonal replacement therapy (HRT) on working memory (WM) and competency/adaptive functioning (CAF) in boys with 47,XXY; the effect of timing of 47,XXY diagnosis on these variables; and the relationship between WM and CAF, if any. A total of 111 boys with 47,XXY, ranging from 6 to 16 years of age (M = 9 years 4 months; SD = 2 years 1 month), were evaluated using the Wechsler Intelligence Scale for Children, and Child Behavior Checklist. Participants were grouped by HRT status and timing of diagnosis. Analysis of variance testing performed on the prenatally diagnosed boys revealed a statistically significant difference in WM for the HRT groups (F[3,84] = 7.467, p = .000174), where WM of the no-HRT group (M = 92.37, SD = 17.83) was lower than that of the early hormonal therapy group (M = 106.39, SD = 12.01; p = .0092). Additionally, there was a positive correlation between low WM capabilities and poor school performance (r = .5106, p = .0027) in the prenatally diagnosed, untreated boys. Our results highlight the potentially positive effects of HRT on WM and CAF in boys with 47,XXY. Further research is required to better determine the underlying relationship among the biological mechanisms of HRT, WM, and CAF outcomes, and timing of diagnosis in boys with 47,XXY.

Effects of dexamethasone on autophagy and apoptosis in acute spinal cord injury.

Previous studies have indicated that spinal cord injury can induce autophagy. To a certain extent, increased autophagy has a protective effect on neurons. Early hormone therapy is well recognized as a treatment for spinal cord injury. However, whether the protective effect of autophagy is important in recovery from spinal cord injury remains unclear. In this study, we established an in-vitro model of spinal cord injury to study the effects of dexamethasone on mechanical injury, autophagy, and apoptosis in spinal cord neurons. The results showed that dexamethasone inhibited the level of autophagy in the injured nerve cells in a dose-dependent manner. High doses of dexamethasone protected the damaged spinal cord neurons by inhibiting apoptosis, but a protective effect from low hormone concentrations was not obvious. When autophagy was inhibited in damaged spinal cord neurons, apoptosis decreased significantly; in contrast, impairment of autophagy-induced activation of spinal cord neurons and apoptosis levels were significantly increased.

Evaluation of women in the perimenopausal period with gestagen test

The perimenopausal period starts with climacteric symptoms and lasts until the end of the first postmenopausal year. Clinical, terminological and laboratory variations make this period difficult to diagnose. Most of the patients undergo unnecessary and early hormone therapy when only laboratory findings are taken into consideration. Evaluation of the perimenopausal patients mainly with gestagen response was aimed in our study regardless of the laboratory findings.

LONG TERM EFFECTS ON COGNITIVE TRAJECTORIES OF EARLY VERSUS LATE POSTMENOPAUSAL HORMONE THERAPY

LONG TERM EFFECTS ON COGNITIVE TRAJECTORIES OF EARLY VERSUS LATE POSTMENOPAUSAL HORMONE THERAPY

Development of a PSA tracking system for patients wtih prostate cancer following definitive radiotherapy to enhance rural health.

39 Background: Patients with prostate cancer (PC) may benefit from early intervention when they experience relapse/recur. About 50% of our PC patients are rural and experience barriers to care due to distance, cost, and convenience. We sought to create a PSA tracking system with the Veterans Administration’s (VA) Electronic Medical Record (EMR) that would provide a remote way to monitor disease progression after definitive radiotherapy (XRT) by annual PSA testing alone. Methods: Using VA’s EMR, we developed a query tool to identify all patients ever treated at our center with XRT for prostate cancer who were alive, had not been seen in our clinic in more than a year, did not have metastatic disease, and had a rising PSA of at least 0.5 ng/ml above nadir, or who had no PSA drawn within 15 months. Results: Among roughly 50,000 unique patients in the McGuire VAMC EMR, we found 1,858 patients treated with XRT for PC more than 5 years ago between 1997 and 2015. Of these 1,190 were still alive and 455 had not been seen by our clinic in 400 days or more. Of these 455 patients, 159 patients had not had a PSA drawn within 15 months and/or their most recent PSA was more than 0.5 ng/ml above nadir, triggering a chart review followed by either a phone call, repeat testing, in person follow up visit, or removal from follow up monitoring if clinically indicated. 296 patients were receiving appropriate care outside of our clinic and had no sign of significant rise in PSA. An analysis by the VA showed annual savings of $60,360 per year in fuel costs by avoiding unnecessary visits. Conclusions: The VA’s robust EMR and a new query tool can identify patients with prostate cancer who are lost to follow up or who needed intervention from among thousands of patients in the EMR, improving quality while reducing cost and unnecessary time and travel for rural and all patients. More importantly, our tool could be modified to improve survival for all VA patients with prostate cancer by creating a VA-wide PSA failure detection system. The system would alert providers to any patient who may benefit from early salvage radiotherapy or hormonal therapy before their disease progresses beyond the therapeutic window of benefit.

Management of Node Only Recurrence after Primary Local Treatment for Prostate Cancer: A Systematic Review of the Literature

We analyzed all available studies assessing the management of node only recurrence after primary local treatment of prostate cancer. We systematically reviewed the literature in January 2015 using the PubMed, Web of Sciences and Embase databases according to PRISMA guidelines. Studies exclusively reporting visceral or bone metastatic disease were excluded from analysis. Eight radiotherapy and 12 salvage lymph node dissection series were included in our qualitative study. All 248 radiotherapy and 480 salvage lymph node dissection studies were single arm case series including a total of 728 patients. Choline positron emission tomography/computerized tomography was the reference imaging technique for nodal recurrence detection. Globally 50% of patients remained disease-free after short-term followup. Nevertheless, approximately two-thirds of patients received adjuvant hormone therapy, leading an overestimation of prostate specific antigen-free survival rates obtained after salvage treatment. Combining radiotherapy with salvage lymph node dissection may improve oncologic control in the treated region without improving the outfield relapse risk or the prostate specific antigen response. Great heterogeneity among series in adjuvant treatments, endpoints, progression definitions and study populations made it difficult to assess the precise impact of salvage treatment on the prostate specific antigen response and compare outcomes between radiotherapy and salvage lymph node dissection series. Toxicity after radiotherapy or salvage lymph node dissection was acceptable without frequent high grade complications. The benefit of early hormone therapy as the only salvage treatment remains unknown. Although a high level of evidence is currently missing to draw any strong conclusion, published clinical series show that in select patients salvage treatment directed to nodal recurrence could lead to good oncologic outcomes. Although the optimal timing of androgen deprivation therapy in this setting is still unknown, such an approach could delay time to systemic treatment with an acceptable safety profile. Future prospective trials are awaited to better clarify this potential impact on well-defined endpoints.

Positive effects of early androgen therapy on the behavioral phenotype of boys with 47,XXY.

47, XXY occurs in up to 1 in 650 male births and is associated with androgen deficiency, neurodevelopmental delays, and atypical social-behaviors. Previously, we showed that young boys with 47, XXY who received early hormonal therapy (EHT) had significantly improved neurodevelopment. The objective of this follow-up study was to examine the effects of EHT on social behavior in boys with 47, XXY. The study consisted of boys prenatally diagnosed with 47, XXY who were referred for evaluations. Twenty-nine boys received three injections of 25 mg testosterone enanthate and 57 controls did not receive EHT. Behavioral functioning was assessed using the Behavior Rating Inventory of Executive Function, Social Responsiveness Scale, 2nd Ed., and the Child Behavior Checklist for Ages 6-18. The hypothesis that EHT may affect behavior was formulated prior to data collection. Questionnaire data was prospectively obtained and analyzed to test for significance between two groups. Significant differences were identified between group's scores over time in Social Communication (P=0.007), Social Cognition (P=0.006), and Total T-score (P=0.001) on the SRS-2; Initiation (P=0.05) on the BRIEF; and Externalizing Problems (P=0.024), Affective Problems (P=0.05), and Aggressive Behaviors (P=0.031) on the CBCL. This is the third study revealing positive effects of EHT on boys with XXY. There was a significant improvements associated with the 47, XXY genotype in boys who received EHT. Research is underway on the neurobiological mechanisms, and later developmental effects of EHT.

Hormonal treatment increases the response of the reward system at the menopause transition: a counterbalanced randomized placebo-controlled fMRI study.

Preclinical research using rodent models demonstrated that estrogens play neuroprotective effects if they are administered during a critical period near the time of cessation of ovarian function. In women, a number of controversial epidemiological studies reported that a neuroprotective effect of estradiol may be obtained on cognition and mood-related disorders if hormone therapy (HT) begins early at the beginning of menopause. Yet, little is known about the modulatory effects of early HT administration on brain activation near menopause. Here, we investigated whether HT, initiated early during the menopause transition, increases the response of the reward system, a key brain circuit involved in motivation and hedonic behavior. We used fMRI and a counterbalanced, double-blind, randomized and crossover placebo-controlled design to investigate whether sequential 17β-estradiol plus oral progesterone modulate reward-related brain activity. Each woman was scanned twice while presented with images of slot machines, once after receiving HT and once under placebo. The fMRI results demonstrate that HT, relative to placebo, increased the response of the striatum and ventromedial prefrontal cortex, two areas that have been shown to be respectively involved during reward anticipation and at the time of reward delivery. Our neuroimaging results bridge the gap between animal studies and human epidemiological studies of HT on cognition. These findings establish a neurobiological foundation for understanding the neurofunctional impact of early HT initiation on reward processing at the menopause transition.

Critical window hypothesis of hormone therapy and cognition: a scientific update on clinical studies.

The critical window hypothesis of hormone therapy (HT) and cognitive function states that the effects of HT depend on timing of initiation with respect to age, the menopausal transition, or both, and that optimal effects are evident with early initiation. This article reviews clinical studies that bear on this hypothesis. Recognizing that the typical pattern of HT use is early HT initiation, this review describes findings from observational studies of ever use of HT and observational studies that looked specifically at the timing of HT on Alzheimer's disease (AD) and cognitive test performance. Randomized trials of HT and verbal memory are discussed, and neuroimaging studies bearing on the hypothesis are reviewed. Observational data suggest that HT generally reduces the risk of AD. Three of three observational studies that specifically examined the timing of initiation in relation to AD risk each provide support for the window, whereas three of five observational studies of HT timing and cognitive test performance do. Randomized clinical trials of estrogen therapy in younger women find support for the hypothesis. Conjugated equine estrogens/medroxyprogesterone acetate increases risks regardless of timing. Little is known about the cognitive effects of other combination HT formulations. A definitive trial to test the critical window hypothesis is not feasible. Evidence drawn from other sources provides initial support for the hypothesis. Although these findings are relevant to women who use HT to treat vasomotor symptoms, HT is currently not indicated for the treatment of cognitive complaints or for dementia prevention.

Neuroendocrine differentiation does not have independent prognostic value in conservatively treated prostate cancer

In vitro studies have implicated neuroendocrine differentiation in the development of hormone resistant prostate cancer following administration of androgen blockers. Studies on clinical material are equivocal. We wished to understand the significance of neuroendocrine differentiation in our large and well-characterised cohort of clinically localised prostate cancer, treated conservatively. Immunohistochemical expression of chromogranin-A was assessed semi-quantitatively on tissue samples of 806 patients in a tissue microarray approach. The correlation of expression with 10-year prostate cancer survival was examined. Multivariate analysis including contemporary Gleason score was performed and sub-group analysis of early hormone treated patients was also undertaken. Chromogranin-A expression correlated with high Gleason score (χ(2) = 28.35, p < 0.001) and early prostate cancer death (HR = 1.61, 95 %CI = 1.15-2.27, p < 0.001). In univariate analysis, NE differentiation correlated significantly with outcome (HR = 1.61, 95 % CI 1.15-2.27, p < 0.001) However in multivariate analysis including Gleason score, chromogranin-A expression was not an independent predictor of survival (HR = 0.97, 95 %CI = 0.89-1.37, p = 0.87). Although chromogranin-A expression was higher in patients with early hormone therapy (χ(2) = 7.25, p = 0.007), there was no association with prostate cancer survival in this sub-group (p = 0.083). Determination of neuroendocrine differentiation does not appear to have any bearing on the outcome of prostatic carcinoma and does not add to the established prognostic model.

The Impact of Early Hormonal Therapy in Catastrophic Brain-Injured Patients and Its Effect on Organ Procurement

The purpose of this study was to evaluate the impact of early hormonal therapy on organ procurement from catastrophic brain-injured patients. All catastrophic brain-injured patients admitted to a high-volume academic Level I trauma center who underwent successful organ procurement over a 3-year period (2006 to 2008) were reviewed. Patients were divided into two groups, those who received hormone therapy (HT) before brain death (BD) declaration and those who received HT after BD declaration. Thirty-two (60.4%) received HT before BD and 21 (39.6%) HT after BD. Trauma was the most common cause of brain injury in both groups (before BD 96.9 vs after BD 90.5%, P = 0.324). There were no significant differences in demographics and clinical data. Patients receiving HT before BD were more hypotensive on admission (28.2 vs 9.5%, P = 0.048); however, they required vasopressors less frequently (62.5 vs 100.0%, P = 0.001), for a shorter duration (17.2 ± 16.3 hours vs 33.1 ± 34.9 hours, P = 0.043), and at a lower dosage. Time from admission to procurement did not differ between the two groups (109.8 ± 83.1 hours vs 125.0 ± 79.9 hours, P = 0.505). Patients receiving HT before BD had significantly more organs procured (4.5 ± 1.5 vs 3.5 ± 1.3, P = 0.023). Although catastrophic brain-injured patients receiving early hormonal therapy were more hypotensive, they required less vasopressors and had higher procurement rates. The early use of hormonal therapy may decrease the need for vasopressors and increase the salvage of potentially transplantable organs.

Clinical Analysis of Patients with Autoimmune Disease Complicated by Mesenteric Vein Thrombosis: A Retrospective Study in a Hospital

To analyze the clinical characteristics of patients with mesenteric venous thrombosis related to autoimmune disease (AID). Retrospective study of 5 AID patients with mesenteric vein thrombosis in a single hospital. All 5 patients were female with an average age of 57.6 years. At the clinical visit all patients had clinical manifestations with signs of mesenteric blood vessel involvement and a significant increase of inflammatory markers. Surgical exploration identified peritonitis in all 5 cases - 2 cases of intestinal stenosis with mucosal ulcers and 3 cases of intestinal necrosis complicated by perforation. All 5 patients underwent partial bowel resection. Pathological examination confirmed chronic inflammation and vasculitis of intestinal connective tissue, combined with the formation of mesenteric vein thrombosis. Mesenteric vein thrombosis is a serious complication of AID. AID patients with digestive tract symptoms should be screened by abdominal imaging. In addition to early hormonal therapy and immunosuppressant treatment of the primary disease, surgical treatment should be performed as soon as possible if the disease progresses.