Treatment of Relapsed Chronic Subdural Hematoma in Four Young Children with Atorvastatin and Low-dose Dexamethasone

Chronic subdural hematoma (CSDH) can develop in children in rare cases. Burr-hole drainage (BHD) is the treatment of choice, but it is associated with a high rate of recurrence. This report describes four cases of pediatric patients (1–7 yrs of age) with post-BHD relapsed CSDH who were successfully treated with a drug regimen that included 2.5–5 mg atorvastatin daily combined with dexamethasone with stepwise-decreasing dosing for a total of 4 weeks. After 4 weeks of treatment, the hematoma was completely resolved in three patients and significantly reduced in one patient. During the treatment, no patient reported clinically significant adverse events. No patient experienced hematoma relapse during the follow-up period that lasted for up to 4 years. This case report suggests the need for a randomized placebo-controlled trial to evaluate this drug regimen for nonsurgical treatment of patients with relapsed CSDH.     

和厚朴酚对哮喘小鼠肺组织炎症反应的干预作用及其机制

目的：探讨和厚朴酚（HNK）对哮喘小鼠肺组织炎症反应的影响,阐明其干预作用及相关机制。方法：选取健康雌性C57BL/6J小鼠20只,随机分为对照组、模型组、地塞米松（DXM）组和HNK组,每组5只。采用鸡卵清蛋白（OVA）联合氢氧化铝[Al（OH）₃]悬液腹腔注射致敏和OVA滴鼻激发构建哮喘小鼠模型,在激发前30 min分别对DXM组和HNK组小鼠予以腹腔注射DXM和HNK溶液,模型组小鼠予以等量生理盐水。处死小鼠后取小鼠肺组织,HE染色观察评估肺组织病理形态表现;收集支气管肺泡灌洗液（BALF）,行快速迪夫染色,观察炎性细胞浸润程度;ELISA法检测各组小鼠血清中白细胞介素4（IL-4）、白细胞介素6（IL-6）和白细胞介素17（IL-17）水平,比色法检测各组小鼠肺组织匀浆中丙二醛（MDA）水平和超氧化物歧化酶（SOD）及谷胱甘肽过氧化物酶（GSH-Px）活性,Western blotting法检测各组小鼠肺组织中磷酸化c-Jun氨基末端激酶（p-JNK）、核因子κB（NF-κB）、含半胱氨酸的天冬氨酸蛋白水解酶（Caspase-3）、B淋巴细胞瘤-2（Bcl-2）和H2AX组蛋白（γH2Ax）表达水平,检测各组小鼠肺组织中γH2Ax免疫荧光强度。结果：与对照组比较,模型组小鼠气道上皮细胞脱落坏死数量明显增多,气道管壁增厚及气道旁炎症细胞浸润程度明显增加;与模型组比较,DXM组和HNK组小鼠上述表现减轻,而HNK组和DXM组小鼠肺组织病理改变表现相似。与对照组比较,模型组小鼠血清中IL-4、IL-6和IL-17水平升高（P<0.05）;与模型组比较,DXM组和HNK组小鼠血清中IL-4、IL-6和IL-17水平降低（P<0.05）;而HNK组小鼠血清中IL-4、IL-6和IL-17水平与DXM组比较差异无统计学意义（P>0.05）。与对照组比较,模型组小鼠肺组织匀浆中MDA水平升高（P<0.05）,而SOD和GSH-Px活性降低（P<0.05）;与模型组比较,DXM组和HNK组小鼠肺组织匀浆中MDA水平降低（P<0.05）,而SOD和GSH-Px活性升高（P<0.05）;HNK组小鼠MDA水平和SOD及GSH-Px活性与DXM组比较差异无统计学意义（P>0.05）。与对照组比较,模型组小鼠肺组织中p-JNK、NF-κB、Caspase-3和γH2Ax蛋白表达水平升高（P<0.05）,而Bcl-2蛋白表达水平降低（P<0.05）;与模型组比较,DXM组和HNK组小鼠肺组织中p-JNK、NF-κB、Caspase-3和γH2Ax蛋白表达水平降低（P<0.05）,而Bcl-2蛋白表达水平升高（P<0.05）;HNK组小鼠肺组织中p-JNK、NF-κB、Caspase-3、γH2Ax和Bcl-2蛋白表达水平与DXM组比较差异均无统计学意义（P>0.05）。与对照组比较,模型组小鼠肺组织中γH2Ax免疫荧光强度明显增强;与模型组比较,DXM组和HNK组小鼠肺组织中γH2Ax免疫荧光强度减弱,HNK组小鼠γH2Ax免疫荧光强度与DXM组接近。结论：HNK可在一定程度上抑制哮喘小鼠的肺组织损伤及炎症反应,其机制可能与其抑制氧化应激反应及DNA损伤有关。     

丹参混合口服液治疗放射性食管炎效果观察

[目的]探讨丹参混合口服液治疗食管癌放射性黏膜损伤的效果。[方法]将80例食管癌病人随机分为实验组、对照组,各40例,对照组给予生理盐水、地塞米松、庆大霉素、2%利多卡因混合后口服;实验组在对照组的基础上加入丹参。[结果]在食管癌放疗所致食管黏膜损伤治疗和护理中,实验组优于对照组,两组疗效比较差异有统计学意义。[结论]丹参混合液口服治疗放射性食管炎具有较好的功效。     

六黄合剂对胰岛素抵抗大鼠胰岛素敏感性影响

目的探讨中药复方六黄合剂对胰岛素抵抗大鼠胰岛素敏感性的影响。方法应用地塞米松致大鼠胰岛素抵抗模型,观察六黄合剂对大鼠血糖、血清胰岛素水平和胰岛素敏感指数的影响。结果六黄合剂能够降低胰岛素抵抗大鼠口服葡萄糖耐量试验后2 h血糖浓度(2 hBG)和空腹血清胰岛素水平(FINS),提高胰岛素敏感指数(ISI)(P<0.01)。结论中药复方六黄合剂能够增强胰岛素抵抗大鼠胰岛素敏感性。     

Comparison of the osteogenic capacity of minipig and human bone marrow‐derived mesenchymal stem cells

Minipigs are a recommended large animal model for preclinical testing of human orthopedic implants. Mesenchymal stem cells (MSCs) are the key repair cells in bone healing and implant osseointegration, but the osteogenic capacity of minipig MSCs is incompletely known. The aim of this study was to isolate and characterize minipig bone marrow (BM) and peripheral blood (PB) MSCs in comparison to human BM‐MSCs. BM sample was aspirated from posterior iliac crest of five male Göttingen minipigs (age 15 ± 1 months). PB sample was drawn for isolation of circulating MSCs. MSCs were selected by plastic‐adherence as originally described by Friedenstein. Cell morphology, colony formation, proliferation, surface marker expression, and differentiation were examined. Human BM‐MSCs were isolated and cultured from adult fracture patients (n = 13, age 19–60 years) using identical techniques. MSCs were found in all minipig BM samples, but no circulating MSCs could be detected. Minipig BM‐MSCs had similar morphology, proliferation, and colony formation capacities as human BM‐MSCs. Unexpectedly, minipig BM‐MSCs had a significantly lower ability than human BM‐MSCs to form differentiated and functional osteoblasts. This observation emphasizes the need for species‐specific optimization of MSC culture protocol before direct systematic comparison of MSCs between human and various preclinical large animal models can be made. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:1019–1025, 2012     

托烷司琼联合地塞米松预防小儿脑瘫术后曲马多镇痛恶心呕吐的临床观察

目的研究托烷司琼联合地塞米松用于预防小儿脑瘫术后曲马多PCIA镇痛恶心呕吐的临床效果。方法选择60例小儿脑瘫II期手术术后接受曲马多PCIA镇痛的患儿,随机分为三组。镇痛泵中曲马多用量均为15mg/kg。I组病人在手术时静注生理盐水2ml,泵中加入生理盐水至100ml。II组病人手术结束时静注托烷司琼0.1mg/kg,泵中加入托烷司琼0.1mg/kg,并稀释至100ml。III组病人麻醉诱导时静注地塞米松0.2mg/kg,手术结束时静注托烷司琼0.05mg/kg,泵中加入托烷司琼0.1mg/kg,并稀释至100ml。比较各组患儿术后24h恶心呕吐的发生率。结果 II、III组恶心呕吐发生率明显低于I组(P<0.01).II、III组的发生率比较差异无统计学意义(P>0.05)。结论托烷司琼联合地塞米松可有效预防曲马多PCIA镇痛的恶心呕吐,且可提高疗效,减少单一药物的用量。     

地塞米松对大鼠烧伤合并海水浸泡后内皮祖细胞数目的影响

目的观察早期应用地塞米松对大鼠烧伤合并海水浸泡后内皮祖细胞数目的影响。方法将52只SD大鼠随机分成6组：正常对照组,单纯烧伤组,烧伤合并海水浸泡组,单纯注射地塞米松组,烧伤＋地塞米松组和烧伤合并海水浸泡＋地塞米松组。在模型制备后的30分钟、2小时、6小时和24小时,使用双色荧光标记流式细胞术检测不同组别大鼠的血中的内皮祖细胞（EPC）数目。结果烧伤和海水浸泡均可显著降低血中EPC的数目。地塞米松可以部分逆转烧伤和海水浸泡对EPC数目减少的作用。结论在烧伤和海水浸泡情况下,地塞米松的使用有助于增加血EPC数目,并可能增强创面的修复能力。     

Estrogen can protect splenocytes from the toxic effects of the environmental pollutant 4-tert-octylphenol

Four-tert-octylphenol (OP), an environmental pollutant, exerts apoptotic effects on cultured mouse splenocytes. Although OP binds to estrogen receptors, these apoptotic effects are not exerted by 17β-estradiol (E). It remained possible that OP might bind to estrogen receptors and subsequently exert apoptotic effects not exerted by E after it binds to the same receptors. It also remained possible that E-primed splenocytes might respond to OP differently than splenocytes not exposed to E. Thus, we investigated OP and E interactions on the viability of mouse splenocytes in culture. The total number of splenocytes (cells stained and not stained with trypan blue) was not altered or altered slightly after incubation with any agent for 24 h. Incubation of splenocytes in medium containing 5×10⁻⁵ or 5×10⁻⁷ M OP decreased the percentage of viable cells by approx 47% and 25%, respectively. The addition of 0.8×10⁻⁵ to 0.8×10⁻⁹ M E to cultures was without effect or decreased the percentage of viable cells by only approx 5%. The addition of these concentrations of E simultaneously with or at 2 h after the addition of 5×10⁻⁵ M or 5×10⁻⁷ M OP to cultures did not interfere with the OP-induced decreases in cell viability. By contrast, incubation of splenocytes in medium containing E for 2 h prior to the subsequent addition of either dose of OP blocked the OP-induced decreases in cell viability in a dose-response manner. There was a marked reduction in the percentage of viable cells (70%) when splenocytes were incubated with 0.5×10⁻⁵ M dexamethasone. The addition of 0.8×10⁻⁵ M E at 2 h prior to the addition of dexamethasone did not prevent the decreased cell viability. Incubation of cells in medium with 0.8×10⁻⁵ M testosterone caused a small decrease in splenocyte viability similar to that observed with E. However, unlike E, the addition of testosterone at 2 h prior to the addition of 5×10⁻⁵ M OP did not prevent the OP-induced decrease in cell viability. These data suggest the presence of estrogen receptors in some splenocytes. They also suggest that if OP binds to these estrogen receptors or other receptors in the absence or initial presence of E, the resulting effect is toxic to the cells. By contrast, exposure of splenocytes to E prior to their exposure to OP can prevent the toxicity of OP. A portion of this work has been published in abstract form in Molecular Biology of the Cell, Supplement to Vol. 7, 1996, Abstract 3843.     

Calorie restriction counteracts the impairment of adipocyte insulin-stimulated lipogenesis in aging rats, but not that induced by dexamethasone treatment

In order to detect metabolic derangements that could be implicated in the pathogenesis of age-related insulin resistance, insulin-stimulated lipogenesis was investigated in isolated adipocytes from 24-month-old Sprague-Dawley rats, and the protective influence of caloric restriction was assessed. For comparison, the effects of glucocorticoid administration, used as a pharmacological tool to alter insulin sensitivity, were also studied. Caloric restriction consisted in a 40% reduction of the daily food intake of controls starting at 3 months of age. Dexamethasone (0.13 mg/kg/day) was administered for 14 days prior to sacrifice to both ad libitum-fed and dietary-restricted aging rats. Three-month-old animals, treated or untreated with dexamethasone, served as young controls. The results showed a significant age-related decrease of insulin-stimulated lipogenesis, which was fully prevented by a lifelong regimen of dietary restriction. Dexamethasone treatment markedly reduced insulin-stimulated lipogenesis in adipocytes isolated from all groups of rats, including those submitted to calorie restriction. In conclusion, our data indicate that the mechanism by which aging alters adipose tissue insulin-induced lipogenesis is reversed by dietary intervention and appears to be different from that triggered by dexamethasone. This particular defect might contribute to an imbalance of fat distribution among tissues that could induce or aggravate peripheral insulin resistance in old age.     

Clarithromycin with low dose dexamethasone and thalidomide is effective therapy in relapsed/refractory myeloma

A combination of clarithromycin, low dose of thalidomide and low dose dexamethasone was used in a phase II study to treat patients with relapsed and refractory myeloma. Thirty patients received clarithromycin 250 mg twice daily and thalidomide 50 mg at night on an ongoing basis with 4-d pulses of 10 mg dexamethasone given monthly. Eight patients had permitted escalation of thalidomide dosage up to 200 mg daily. The combination was well tolerated and could be given to elderly, infirm and severely cytopenic patients. Response rates were high, with 89% achieving at least 50% reduction in paraprotein and a 96% overall response rate. Although clarithromycin has only minimal anti-myeloma properties when used as a single agent, its combination with thalidomide and dexamethasone appears very effective, allowing these to be used in lower and more tolerable doses with good clinical effects.