Glucocorticoid Receptor Polymorphisms and Intraocular Pressure Response to Intravitreal Triamcinolone Acetonide

Background: Elevation of intraocular pressure (IOP) following injection of intravitreal triamcinolone acetonide (IVTA) is an important clinical problem. The etiology of the steroid response is poorly understood, although a genetic determinant has long been suspected. We performed a pharmacogenomic association study with glucocorticoid receptor polymorphisms. Materials and Methods: Fifty-two patients (56 eyes) who underwent treatment with IVTA for various retinal diseases were genotyped for six well-studied glucocorticoid receptor polymorphisms (ER22/23EK, N363S, BclI, N766N, and single nucleotide polymorphisms (SNPs) within introns 3 and 4). Results: Three polymorphisms (ER22/23EK, N363S, and the intron 3 SNP) were essentially nonpolymorphic within this population sample and excluded from further analysis. The remaining three polymorphisms (BclI, N766N, and within intron 4) passed the Hardy-Weinberg Equilibrium test, indicating good genotyping quality and normal population distribution of allelic frequency. No statistically significant correlations were found between these three polymorphisms and magnitude of IOP elevation following IVTA, using single point association and haplotype analyses. Conclusions: In this small, pilot study, we found no statistically significant relationship between glucocorticoid receptor polymorphisms and IOP elevation following IVTA. The precise etiology of the steroid response remains obscure. To our knowledge, this is the first published pharmacogenomic study of this common clinical entity.     

Efficacy of Methylprednisolone Acetate Versus Triamcinolone Acetonide Intra-articular Knee Injection in Patients With Chronic Inflammatory Arthritis: A 24-Week Randomized Controlled Trial

Purpose

Triamcinolone hexacetonide (TH), triamcinolone acetonide (TA), and methylprednisolone acetate (MPA) are commonly used intra-articular steroid preparations. Studies suggest that intra-articular TH is more efficacious than MPA and TA in chronic inflammatory arthritis. However, it is unclear which of the latter two preparations has better efficacy. Thus, we compared intra-articular knee injections of MPA and TA in patients with chronic inflammatory arthritis.

玻璃体腔内注射曲安奈德联合激光治疗视网膜静脉阻塞引起黄斑水肿

目的了解玻璃体腔内注射曲安奈德（TA）联合视网膜激光光凝治疗视网膜静脉阻塞（RVO）引起的黄斑水肿的有效性和安全性。方法经散瞳间接眼底镜检查、光学相干断层扫描（OCT）及眼底血管荧光造影（FFA）检查证实为视网膜静脉阻塞所致黄斑水肿病人35例35只眼（其中人工晶体眼9例9只眼）,玻璃体腔内注射40 g/L的TA 0.1 mL及视网膜激光光凝治疗,随访3～10个月,观察视力、眼压、晶状体、炎症反应、眼底情况,OCT检查视网膜厚度改变,FFA检查黄斑区毛细血管渗漏情况。结果治疗1、2个月时,所有患眼视力提高,在FFA指导下分次行视网膜激光光凝。最终随诊视力0.3～0.4占48.6%,视力≥0.5占28.5%,与治疗前比较97%患眼视力有不同程度提高,3%患眼视力无改善,无视力下降。3只眼在注药后1～3周眼压先后出现不同程度升高,达到3.1～4.3 kPa,2只眼在注药后第2、3天时出现下方局限性视网膜下小片状出血;3只眼注药后第3天出现前房炎症细胞,积脓1 mm,3只眼均为人工晶体眼,1周内炎症细胞消失。所有病人晶状体未受影响。结论玻璃体腔内注射TA联合视网膜激光光凝可以有效治疗RVO引起的黄斑水肿,提高视力,部分病人可出现高眼压、黄斑水肿复发等并发症。     

Identification of fluocinolone acetonide to prevent paclitaxel‐induced peripheral neuropathy

Paclitaxel (PTX) is among the most commonly used cancer drugs that cause chemotherapy‐induced peripheral neuropathy (CIPN), a debilitating and serious dose‐limiting side effect. Currently, no drugs exist to prevent CIPN, and symptomatic therapy is often ineffective. In order to identify therapeutic candidates to prevent axonal degeneration induced by PTX, we carried out a phenotypic drug screening using primary rodent dorsal root ganglion sensory neurons. We identified fluocinolone acetonide as a neuroprotective compound and verified it through secondary screens. Furthermore, we showed its efficacy in a mouse model of PTX‐induced peripheral neuropathy and confirmed with four different cancer cell lines that fluocinolone acetonide does not interfere with PTX's antitumor activity. Our study identifies fluocinolone acetonide as a potential therapy to prevent CIPN caused by PTX.     

关节腔冲洗配合醋酸曲安缩松及玻璃酸钠治疗膝骨性关节炎的临床研究

目的探讨关节腔冲洗配合醋酸曲安缩松及玻璃酸钠关节腔内注射治疗膝关节骨性关节炎的疗效。方法生理盐水1500—2500ml加20％甘露醇注射液250ml关节腔冲洗。冲洗完毕后，关节腔内注射醋酸曲安缩松5mg。1次／周，共3次，最后一次术后3d开始关节腔内注入玻璃酸钠注射液2．5ml，1次／周，连用5次，以后每隔3个月均注射玻璃酸钠1次。结果经13～25个月随访，总显效率为90．2％，总有效率为96．8％。结论本方法是一种治疗膝关节骨性关节炎安全有效的方法。     

曲安奈德鼻喷雾剂治疗湿疹皮炎类疾病急性发作期疗效观察

目的评价曲安奈德鼻喷雾剂治疗湿疹皮炎类疾病急性发作期的有效性和安全性。方法 176例患者随机分为治疗组和对照组各88例。2组均给予盐酸西替利嗪滴剂口服,治疗组给予曲安耐德鼻喷雾剂外用;对照组给予乳酸依沙吖啶溶液外用。观察2组总有效率及瘙痒、皮损评分情况。结果治疗组总有效率为94.3%高于对照组的84.1%,差异有统计学意义(P<0.05);治疗后2组瘙痒、皮损评分均明显低于治疗前,且治疗组低于对照组,差异均有统计学意义(P<0.05)。结论曲安奈德鼻喷雾剂治疗湿疹皮炎类疾病急性发作期效果确切、安全。     

玻璃酸钠联合曲安奈德关节腔内注射治疗膝骨性关节炎的疗效观察

目的：观察玻璃酸钠联合曲安奈德关节腔内注射治疗骨性膝关节炎的疗效。方法：将101例患者随机分为4组,联合治疗组选择30例骨性膝关节炎患者,关节腔内联合注射玻璃酸钠和曲安奈德,玻璃酸钠每周1次,共5次,曲安奈德第1周和第3周注射,共2次。曲安奈德组仅关节腔内注入曲安奈德。玻璃酸钠组仅关节腔内注射玻璃酸钠。对照组仅关节腔内注射0.9%氯化钠溶液。观察和比较治疗前、治疗后1个月和治疗后6个月膝关节功能评分结果。结果：治疗后1个月和治疗后6个月膝关节功能评分显著好转,并疗效优于单用玻璃酸钠或曲安奈德（P〈0.05）。结论：玻璃酸钠联合曲安奈德关节腔内注射可以明显改善骨性膝关节炎的临床症状,远期效果较好,而且副作用少。     

视网膜中央静脉阻塞黄斑水肿患者中心凹光感受器层状态与视力的相关性

目的:研究视网膜中央静脉阻塞(CRVO)伴黄斑水肿(ME)患者视力与中心凹部光感受器层状态间的相关性。方法:回顾性分析CRVO伴ME患者21例21眼行玻璃体腔内注射曲安奈德(IVTA)之前以及治疗后4周视力及光学相干断层扫描(OCT)影像中视网膜内外光感受器的连接部(IS/OS)的状态。结果:注射IVTA后4周,本组研究中所有患者ME均明显消退。IS/OS(+)组,11眼(52.3%)可以观察到中心凹处部分或完整的IS/OS线。IS/OS(-)组,10眼(47.62%)中心凹处IS/OS线影响缺失。治疗前后两组患者视力及中心凹厚度的改变均具有统计学意义而且治疗前患者的视力情况与IS/OS的状态存在明显的相关性。结论:对于CRVO伴ME患者的治疗,在消除黄斑水肿的同时应该注重对中心凹部光感受器细胞的保护。     

中心组合设计-效应面法优化曲安奈德固体脂质纳米粒处方

目的采用中心组合设计-效应面法优化曲安奈德固体脂质纳米粒(TACA-SLN)的处方。方法采用中心组合设计-效应面优化法筛选处方,以曲安奈德包封率作为评价指标,考察泊洛沙姆188的浓度,单硬脂酸甘油酯和大豆卵磷脂的质量比,药物和脂质材料的质量比,水相和有机相的体积比对评价指标的影响。采用高温乳化-低温固化法制备TACA-SLN。结果优选的最佳处方为:泊洛沙姆188浓度1.89%,单硬脂酸甘油酯与大豆卵磷脂质量比1.95,药物与脂质质量比0.15,水相与油相体积比5.68,实验值与理论值偏差0.07%。结论中心组合设计-效应面法能有效优选TACA-SLN处方。     

玻璃体切割联合曲安奈德注射治疗增生型糖尿病视网膜病变

目的观察玻璃体切割联合曲安奈德玻璃体腔内注射治疗增生型糖尿病视网膜病变的临床疗效及并发症。方法收集2011年2月至2012年1月增生型糖尿病视网膜病变患者60例69眼,患者均接受玻璃体切割手术,术中注射曲安奈德。观察术后视力及眼压情况,光学相干视网膜断层成像检测黄斑中心凹厚度变化及术后并发症。结果术后患者视力均有提高,术后3月稳定。最佳矫正视力为0.56±0.18.术后黄斑水肿减退,黄斑中心凹厚度减低,3月后基本恢复正常253±169μm。眼压术后有增加,术后7d为19.42±6.97mmHg,术后1月为24.14±11.25mmHg,用药后基本可以降至正常,术后3月19.21±6.45mmHg。结论玻璃体切割联合曲安奈德玻璃体腔内注射能减轻黄斑水肿,逐步改善视功能,是治疗增生型糖尿病视网膜病变的有效,安全手段。