Objective To observe the changes of intraocular pressure (IOP) after intravitreous injection wih triamcinolone acetonide (TA) and their affected factors. Methods The clinical data of 125 patients (125eyes) who had undergone intravitreous injection with TA were retrospectively analyzed. The patients (52 males and 73 females) aged from 17 to 83 years with the average age of 56.5. There were 49 patient (39.2%) with diabetic retinopathy (DR), 56 (44.8%) with retinal vein occlusion (RVO), and 20 (16.0%) with exudative age-related macular degeneration (AMD). One day before the treatment, IOP was measured by Goldmann applanation tonometry, and the basic IOP was 7~31 mm Hg (1 mm Hg=0.133 kPa) and the average IOP was (14.69plusmn;3.72) mm Hg. The patients were divided into two groups according to the basic IOP:below 15 mm Hg group (n=64) and 15 mm Hg or above group (n=61). All of the patients underwent intravitreous injection with 4mg TA. IOP was measured 1 day, 3 days, 1 week, 2 weeks, and 1 month after the treatment in the same way, respectively, and later was measured once every 1 month. The follow-up period was 3~21 months with the mean of 5 months. The elevation of IOP would be defined as the pressure of 21mmHg or higher. The changes of IOP in patients before and after the treatment, and with different diseases and ages were analyzed. Results Thirty-six patients (28.8%) had elevation of IOP after the treatment, out of whom 97.2% had the elevation within 3 months after the injection and decreased to the basic level 7 months after the injection. In these patients, there were 11 (17.19%) in the below 15 mm Hg group and 25 (40.98%) in 15 mm Hg or above group, and the difference between the two groups was statistically significant (P＜0.01）. During the followup period, the mean maximum IOP was (20.09plusmn;7.58) mmHg, which was 5.43 mmHg higher than that before the treatment（P＜0.001）. The mean maximum IOP of 53 patients (42.4%) after the treatment was 5 mm Hg higher than that before the treatment. The mean maximum IOP during the followup period was （18.19plusmn;4.73）mmHg in DR group，（22.50plusmn;9.30）mmHg in RVO group, and（18.12plusmn;6.09）mmHg in AMD group. The occurrence of the elevation of IOP in RVO group was obviously higher than that in the other 2 groups (P＜0.01）. The result of regression analysis showed that age was correlative with the elevation of IOP after the treatment: more risks of occurrence of high IOP were found in younger patients (P=0.000). Conclusion Elevation of IOP after intravitreous injection with TA is common, which is correlative with the basic IOP, age, and pathogeny. After the intravitreous injection with TA, the elevation of IOP often occurs in patients with high basic IOP before treatment, younger age, and RVO. (Chin J Ocul Fundus Dis, 2007, 23: 115-117)
Objective To evaluate the efficacy of long-term inhaled salmeterol / fluticasone combined with low-dose oral erythromycin in patients with bronchiectasis. Methods Sixty-two patients with bronchiectasis after exacerbation and maintained stable were randomly divided into three groups. Group A was treated with low-dose oral erythromycin, group B inhaled salmeterol/fluticasone, and group C inhaled salmeterol/fluticasone plus low-dose oral erythromycin. The study duration lasted for 6 months. The clinical symptoms, dyspnea scale, exacerbation frequency, and pulmonary function parameters were measured and compared. Results Fifty-four patients completed the whole study and 8 cases withdrew. The results showed that 6 months of low-dose erythromycin therapy can improve the clinical symptoms, whille exacerbation frequency was also decreased. Inhaled salmeterol/fluticasone improved lung function, however, had no effect on cough, expectoration and exacerbation frequency. Inhaled salmeterol/fluticasone combined with erythromycin was more significantly effective in improving lung functions as well as symptoms. Conclusions Long-terminhaled salmeterol/fluticasone combined with low-dose oral erythromycin can improve the clinical symptoms and lung function, decrease the frequency of exacerbation in patients with bronchiectasis. It may be as an alternative to the maintenance treatment of bronchiectasis.
ObjectiveTo evaluate the effectiveness and safety of glucocorticoids in the treatment of non-arteritic anterior ischaemic optic neuropathy (NAION).MethodsGlucocorticoids published in the National Library of Medicine PubMed; Netherlands Medical Abstracts Database Embase; Cochrane Library, an evidence-based medical library; China Cnkipedia; China Biomedical Literature Service; Chongqing Vipul Chinese Science and Technology Journal Database, and Wanfang Science and Technology Journal Full Text Database were searched about computer. Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) for the treatments of NAION were subjected to meta-analysis. The search period was from the establishment of each database to March 2020. The literature was screened and data were extracted according to the inclusion and exclusion criteria. The methodological quality of the RCT and NRCT studies was evaluated using the Risk of Bias Assessment Tool and the MINORS evaluation scale, respectively. The data were analyzed using RevMan version 5.3 software which was provided by the Cochrane Collaboration Network.ResultsAn initial search of 395 papers was conducted, and 10 papers were finally included for this meta-analysis, including 3 RCT studies and 7 NRCT studies. A total of 1057 patients with NAION were included. The 3 RCT studies were analyzed descriptively as the outcome indicators were described in different ways. A meta-analysis of 7 NRCT studies showed that patients in the treatment group showed significantly better visual prognosis (relative risk=1.28, 95% confidence interval 1.09 to 1.51, P=0.003) and retinal nerve fibre layer thickness were obviously improved (mean difference=7.76, 95% confidence interval 1.58 to 13.94, P=0.01) than the control group. Four studies reported the occurrence of adverse reactions in the treatment versus control groups. None of the above studies provided a detailed analysis of the prognosis of patients with adverse reactions.ConclusionThe efficacy and safety of glucocorticoids in the treatment of NAION is unclear and needs to be validated in a larger sample of RCTs.
The aim of this study is to investigate the apoptotic inhibition and its molecular mechanism of dexamethasone (DEX) acting on cisplatin (CDDP)-induced apoptosis of human lung adenocarcinoma cell SPC-A1. SPC-A1 cells were pre-cultured in vitro for 24 hours with DEX in different concentrations and then CDDP was added in different concentrations for culturing for further 48 hours. The survival rates of the cells were determined by MTT. The expression of serum/glucocorticoid-induced kinase (SGK-1) and mitogen-activated protein kinase phosphatase-1 (MKP-1) in SPC-A1 cells after being cultured by 1 μmol/L DEX at different time was detected by semi-quantitative RT-PCR technology. The expression of glucocorticoid receptor (GR) in SPC-A1 cells was measured by immunohistochemistry (IHC) with biotin-labeled anti-GR. The results of MTT showed that SPC-A1 cells had resistance to CDDP-induced apoptosis with pre-cultured DEX and the resistance intensity presented DEX concentration-dependent. The expressing quantity of SGK-1 in SPC-A1 cells stimulated by DEX could be elevated and increased with intention of time, but the express of MKP-1 was not detected. Up-regulated expression of GR in SPC-A1 cells stimulated by DEX was detected by IHC. The number of cells expressing GR in SPC-A1 cells was significantly higher than that in the control group. The results showed that DEX inhibited apoptosis of SPC-A1 cells induced by CDDP. The possible molecular mechanism is that elevated expression of GR induced by DEX up-regulates the expression of SGK-1 which locates at the downstream of anti-apoptosis pathway. The apoptosis resistance of SPC-A1 cells may account for all above the factors.
Objective To investigate the potential effect of glucocorticoids (referred to as 'hormones' here) on decreasing case fatality rate in patients with human immunodeficiency virus (HIV) negative Pneumocystis jirovecii pneumonia (PJP). Methods The clinical data of a cohort of 93 patients that were diagnosed with HIV-negative PJP at Jiangxi Provincial People's Hospital between April 2019 and April 2022 were retrospectively analyzed. These patients were classified into two groups based on the partial pressure of oxygen in arterial blood (PaO2), specifically PaO2 ≥70 mm Hg and PaO2 <70 mm Hg. The association between case fatality rate and various factors such as underlying diseases, hormone use, mechanical ventilation, and others was examined. Results Over a period of three years, 93 cases of HIV-negative PJP were identified. The most prevalent underlying diseases were solid organ transplantation (n=34, 36.6%), rheumatic system diseases (n=26, 28.0%), and malignant tumors (n=15, 16.1%). 51 cases had arterial PaO2 levels ≥70 mm Hg, while 42 cases had levels <70 mm Hg. Moreover, 19 patients required invasive ventilation, 39 patients were treated with non-invasive ventilation, while 50 patients received oxygenation using a nasal cannula. Out of the 93 patients, 31 died from the disease, resulting in an overall case fatality rate of 33.3%. Meanwhile, 62 patients survived. In patients with arterial PaO2 levels ≥70 mm Hg, the administration of hormones did not significantly affect the case fatality rate (P > 0.05); In patients with arterial PaO2 level <70 mm Hg, the administration of hormones did not significantly affect the case fatality rate (P > 0.05). Conclusion Hormone use did not contribute to improved survival rates in HIV-negative PJP patients, regardless of arterial PaO2 level.
ObjectiveTo evaluate the efficacy and safety of bisphosphonates in preventing and treating glucocorticoid induced osteoporosis. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), CNKI, WanFang Data and VIP were searched to collect randomized controlled trials (RCTs) related bisphosphonates for the prevention and treatment of glucocorticoid induced osteoporosis from inception to January 2016. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 20 RCTs were included, which involved 2 330 patients. The results of meta-analysis showed that, compared with the placebo group, the bisphosphonates group could significantly increase the bone mineral density (BMD) at lumbar and femoral neck (MD=3.70, 95%CI 2.65 to 4.75, P<0.000 01; MD=2.18, 95%CI 1.30 to 3.06, P<0.000 01), but the bisphosphonates group could not decrease the incidence rates of vertebral fracture or non-vertebral fracture (OR=0.66, 95%CI 0.38 to 1.16, P=0.15; OR=0.73, 95%CI 0.42 to 1.28, P=0.28). There were no significant differences in the incidence rates of total adverse reactions and total severe adverse reactions between the two groups (OR=0.89, 95%CI 0.62 to 1.28, P=0.53; OR=0.93, 95%CI 0.62 to 1.39, P=0.72). ConclusionCurrent evidence shows that, compared with placebo, bisphosphonates canld effectively prevent and treat the decrease of bone mineral density of glucocorticoid induced osteoporosis, not decrease the incidence of fracture, but not increase the incidence of adverse reactions.
ObjectiveTo investigate the clinical, laboratory and imaging evaluation, treatment and prognosis of patients with idiopathic hypertrophic pachymeningitis (IHP) with ophthalmic manifestations as the first symptom.MethodsA retrospective case analysis. Eight patients displaying symptoms of IHP were recruited from the Neuro-ophthalmology Department in the First Medical Center of Chinese PLA General Hospital from January 2016 to April 2019 were inculed in this study. There were 6 males and 2 females, aged from 11 to 65 years, with an average age of 48.00±19.08 years. The course of disease ranged from 30 days to 7.5 years, with an average course of 17.00±30.08 months. The age, symptoms and signs of all patients were recorded. All patients underwent ophthalmic examination, orbit or brain MRI or CT examinations, blood routine examination, biochemistry, tumor markers, immunity, hepatitis B, syphilis, HIV, thyroid function and other laboratory tests, and lumbar puncture was performed to measure the cerebrospinal fluid (CSF) pressure and indicators. The clinical manifestations, orbital or brain MRI imaging and laboratory examination characteristics were summarized. Treatment and prognosis were also observed.ResultsIn total of 8 patients, visual loss was presented in 6 patients, visual loss and diplopia were presented in 1 patient, and diplopia was presented in 1 patient. Binocular involvement in 7 patients and monocular involvement in 1 patient. Other symptoms including headache and hear loss and so on. Optic disc edema in 1 eye and optic disc pallor in 6 eyes were reviewed by fundus examination. The laboratory examination showed that the angiotensin converting enzyme abnormal in 4 patients, the anti-thyroid peroxidase antibody abnormal in 3 patients and immunoantibodies positive in 3 patients. CSF measurements showed that the protein level elevated in all patients. Orbit and/or brain MRI and CT examination showed that optic nerve involvement in 6 patients, oculomotor nerve involvement in 1 patient, and cavernous sinus region involvement in 2 patients. Glucocorticoid was effective in all patients, and the visual acuity significantly improved in 4 patients, the diplopia was completely resolved in 2 patients, and the disease modifying therapy (DMT) was combined to prevent recurrence in 7 patients. No recurrence was observed in an average follow-up time of 26.63±16.55 months.ConclusionsIHP patients may be first visit an ophthalmologist due to vision loss in bilateral eyes simultaneous or sequentially. IHP patients are often associated with headache and other cranial nerve paralysis symptoms. Definitive diagnosis of IHP depends on imaging examination. Glucocorticoid treatment is effective in early phase, but it is tendency to progress and relapse, suggesting combined with DMT as early as possible.
ObjectiveTo investigate the perioperative safety of patients with myasthenia gravis who take high doses of oral corticosteroids. MethodsA retrospective analysis was conducted on the clinical data of patients with myasthenia gravis who received oral corticosteroids and underwent thoracoscopic thymectomy at the Department of Thoracic Surgery, the University of Hong Kong-Shenzhen Hospital from April 2013 to October 2019. Patients were divided into a high-dose steroid group and a medium-to-low dose steroid group based on the dosage of oral steroids, and the clinical data of the two groups were compared. ResultsA total of 102 patients were included, including 19 (18.62%) males and 83 (81.37%) females, with an average age of (32.25±9.83) years. All patients in both groups successfully completed the surgery without major intraoperative bleeding, conversion to open chest surgery, delayed extubation, severe infection, or perioperative death. The daily oral steroid dose for the high-dose steroid group was (35.81±4.29) mg, and for the medium-to-low dose steroid group it was (15.29±2.17) mg. There was no statistical difference in the operation time [(124.69±23.51) min vs. (117.89±21.46) min, P=0.172] and intraoperative blood loss [(21.19±3.48) mL vs. (20.56±3.41) mL, P=0.419] between the two groups. Postoperatively, 12 (11.76%) patients developed complications: one patient of myasthenic crisis (medium-to-low dose steroid group), which was improved after short-term respiratory support and intravenous immunoglobulin treatment; 11 patients of respiratory/swallowing difficulties (9 in the low-dose steroid group and 2 in the high-dose steroid group), which were improved after anticholinergic treatment to reduce oral secretions and sputum suction, and the patients were discharged smoothly. There was no statistical difference in the incidence of postoperative complications between the two groups (P=0.637). ConclusionOn the basis of good perioperative management, it is safe and feasible for patients with myasthenia gravis who take high dose of oral steroids to undergo thymectomy, and they have the same perioperative safety as patients with medium-to-low dose steroids.
ObjectiveTo compare and observe the fundus imaging characteristics of eyes with glucocorticoid-related central serous chorioretinopathy (CSC). MethodsA retrospective clinical study. A total of 149 CSC patients with 166 eyes diagnosed at Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University from March 2021 to October 2024 were included in the study. The duration of the disease from the appearance of symptoms to treatment was less than 3 months. All affected eyes underwent best-corrected visual acuity (BCVA), fundus color photography, swept-source optical coherence tomography (SS-OCT), and fundus fluorescein angiography (FFA) examinations. BCVA was tested using an international standard vision chart and converted into logarithm of the minimum angle of resolution (logMAR) visual acuity for statistical analysis. The SS-OCT instrument measured subfoveal choroidal thickness (SFCT), central macular thickness (CMT), choroidal vascular volume (CVV), and the width and height of flat irregular pigment epithelial detachment (FIPED). FIPED, subretinal fibrin, and choroidal layer strong reflective spots were identified from SS-OCTA B-scan images; multiple leakages (leak points >3) were identified from FFA images. Based on the presence or absence of a clear history of glucocorticoid administration before the onset, patients were divided into glucocorticoid-related and non-glucocorticoid-related groups, comprising 41 patients with 53 eyes and 108 patients with 113 eyes, respectively. Clinical and fundus imaging characteristics of the two groups were compared. The comparison of quantitative data between the two groups was performed using independent samples t test or non-parametric independent samples Wilcoxon test; the comparison of qualitative data was performed using χ2 test. ResultsCompared with the non-glucocorticoid-related group, the glucocorticoid-related group had a smaller male-to-female ratio and a higher bilateral incidence, and the differences were statistically significant (χ2=4.925, 17.849; P＜0.05). The logMAR BCVA for the glucocorticoid-related and non-glucocorticoid-related groups were 0.45±0.33 and 0.21±0.21, respectively; SFCT were (644.43±131.91) and (507.26±121.79) μm; CMT were (389.51±233.45) and (362.59±140.85) μm; CVV were (4.44±1.07) and (3.67±0.82) mm3; FIPED incidence were 58.49% (31/58) and 20.35% (23/113), respectively; FIPED width and height were (1 122.01±533.98) and (742.90±388.79) μm, and (99.13±92.17) and (33.01±15.99) μm; subretinal fibrin were observed in 24 (45.28%, 24/53) and 15 (13.27%, 15/113) eyes; choroidal strong reflections were found in 38 (71.70%, 38/53) and 45 (39.82%, 45/113) eyes; multiple leak points were identified in 35 (66.03%, 35/53) and 40 (35.40%, 40/113) eyes, respectively. Compared with the non-glucocorticoid-related group, the glucocorticoid-related group had worse BCVA (Z=−4.984), thicker SFCT (t=6.586), larger CVV (t=5.160), higher incidence of FIPED (χ2=23.908), and greater width and height of FIPED (t=2.895, Z=−3.703). The glucocorticoid-related group also had a significantly increased incidence of subretinal fibrin, choroidal strong reflections, and multiple leak points, with all differences being statistically significant (χ2=20.565, 14.663, 13.675; P＜0.05); however, the comparison of CMT showed no statistically significant difference (Z=−0.651, P＞0.05). ConclusionCompared with non-glucocorticoid-related CSC, glucocorticoid-related CSC patients have poorer vision, are more likely to affect both eyes, show no gender bias; choroidal vascular dilation is more significant, and damage to the outer retina and retinal pigment epithelium is more severe.