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)
糖皮质激素在甲型H1N1流感中的应用探讨
Objective To explore the effect of early short-term use of low-dose steroids on early acute lung injury (EALI) after video-assisted thoracoscopic lobectomy. Methods Patients who underwent video-assisted thoracoscopic lobectomy in our department from January 2019 to January 2022 were selected for this retrospective cohort study. They were divided into an early steroid treatment group and a control group based on whether steroids were used in the early postoperative period. In the early steroid treatment group, in addition to routine postoperative treatment, low-dose methylprednisolone was administered intravenously, at 80-120 mg/d for 3 consecutive days. In the control group, routine postoperative treatment was given, but no steroids were used in the first 3 days. A chest computed tomography (CT) scan was performed on postoperative day (POD) 1, and POD3 or POD4 to assess lung injury. Chest CT scores, the EALI incidence, the length of hospital stay, and the incidence of poor incision healing were recorded. ResultsA total of 521 patients were included, consisting of 255 males and 266 females, aged 11-80 years. There were 203 patients in the early steroid treatment group and 318 patients in the control group. On POD1, the incidence of EALI was 16.0% in the control group and 13.8% in the steroid group, with no significant difference between the two groups (P>0.05). There was also no significant difference in the CT scores of patients with EALI in the two groups (P>0.05). On POD3/4, the incidence of EALI was 33.6% in the control group and 22.7% in the steroid group, showing a significant difference (P=0.007). When comparing the CT scores of patients with EALI in both groups, the scores were lower in the steroid group, but the difference was not significant (P>0.05). The overall incidence of EALI on POD1-4 was 37.4% in the control group and 26.1% in the steroid group, showing a significant difference (P=0.007). Of these, 28.9% of patients in the control group showed radiological progression, which means new EALI occurred or existing EALI progressed, while the progression rate was 14.8% in the steroid group (P<0.001). The length of hospital stay was significantly shorter in the steroid group compared to the control group (P<0.001), but the incidence of poor incision healing was not (P>0.05). Conclusion Early use of corticosteroids cannot reduce the incidence and severity of EALI on POD1, but it can reduce the incidence of EALI on POD3/4 and decrease the risk of radiological progression, and also lower the overall risk of EALI after surgery, without extended postoperative hospital stays or increased incidence of poor incision healing. Therefore, early postoperative use of low-dose corticosteroids can help to inhibit the occurrence and progression of EALI. It is suggested to use as early as possible especially in patients with high risks of postoperative EALI.
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.
目的：本研究通过观察经地塞米松处理前后培养的人小梁细胞的变化,探讨激素性青光眼房水排出阻力增加的机制。方法：将人类小梁细胞培养至接近体内的高分化状态，用地塞米松处理后,观察细胞形态的变化，并检测以下蛋白的分布和表达：(1)myocilin/TIGR蛋白；(2)纤连蛋白；(3)肌动蛋白交联网的形成；(4)血清淀粉样物质A蛋白。结果：人小梁细胞经地塞米松处理后(1)胞体变大，排列不规则，边界模糊，呈“融合”状；(2)细胞内外myocilin/TIGR蛋白表达均明显增加，其胞外表达与纤连蛋白位置一致,提示相互作用；(3)纤连蛋白表达增加；(4)CLANs形成，细胞间连接增强；(5)血清淀粉样物质A蛋白表达增加。结论：人类小梁细胞经地塞米松处理后形态发生变化，可能与应力纤维变化及myocilin蛋白在细胞内积聚有关。细胞间边界不清，与细胞外基质蛋白过度表达、沉积有关。小梁细胞外基质沉积以及异常的细胞间连接等改变与房水排出阻力增加的病理过程有关。
肺癌是全球范围内肿瘤致死的最常见原因，其死亡率超过了结肠癌、乳腺癌和前列腺癌之和[1]。虽然肺癌已成为全球最主要的死因之一，然而在其治疗方面仍然缺乏根本有效的方法。肿瘤的化学预防（chemoprevention）是一项有效的措施[2]，其含义是：应用天然或人工合成化合物阻断、逆转或预防侵袭性肿瘤的发生，降低具有侵袭性或有临床表现的癌症的发生率。肿瘤化学预防药物研究已成为目前肿瘤学和药学的研究热点之一。
Objective To systematically evaluate the effectiveness of N-acetylcysteine (NAC) combined with low-dose glucocorticoid for patients with idiopathic pulmonary fibrosis (IPF). Methods Such databases as The Cochrane Library (Issue 12, 2012), EMbase (January 1974 to July 2012), PubMed (January 1966 to July 2012), CHEST (January 1995 to July 2012), CNKI (January 1994 to July 2012), CBM (January 1978 to July 2012), VIP (January 1989 to July 2012) and WanFang Data (January 1995 to July 2012) were searched to collect the randomized controlled trials (RCTs) about NAC combined with low-dose glucocorticoid versus glucocorticoid alone for IPF patients. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality, and then the meta-analysis was performed using RevMan 5.1 software. Results A total of seven RCTs including 264 IPF patients were included. The results of meta-analysis demonstrated that, compared with the glucocorticoid used alone, a) NAC combined with low-dose glucocorticoid could significantly improve PaO2 (SMD=0.82 mmHg, 95%CI 0.30 to 1.35, P=0.002) and DLco (SMD=0.59 mmHg, 95%CI 0.16 to 1.03, P=0.008) with a significant difference. b) NAC combined with low-dose glucocorticoid could significantly improve all clinical symptoms (RR=1.56, 95%CI 1.26 to 1.92, Plt;0.000 1). Conclusion NAC combined with low-dose glucocorticoid for IPF patients can significantly improve PaO2, DLco, and the clinical symptoms such as cough, difficulty breathing after activities, cyanosis, and Velcro rales. Due to the quantity and quality limitation of included studies, this conclusion still needs to be further proved by more high quality and double blind RCTs.
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.