Triamcinolone acetonide nanoparticles incorporated in thermoreversible gels for age-related macular degeneration

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the US affecting millions yearly. It is characterized by intraocular neovascularization, inflammation and retinal damage which can be ameliorated through intraocular injections of glucocorticoids. However, the complications that arise from repetitive injections as well as the difficulty posed by targeting the posterior segment of the eye make this interesting territory for the development of novel drug delivery systems (DDS). In the present study, we described the development of a DDS composed of triamcinolone acetonide-encapsulated PEGylated PLGA nanoparticles (NP) incorporated into PLGA–PEG–PLGA thermoreversible gel and its use against VEGF expression characteristic of AMD. We found that the NP with mean size of 208?±?1.0?nm showed uniform size distribution and exhibited sustained release of the drug. We also demonstrated that the polymer can be injected as a solution and transition to a gel phase based on the biological temperature of the eye. Additionally, the proposed DDS was non-cytotoxic to ARPE-19 cells and significantly reduced VEGF expression by 43.5?±?3.9% as compared to a 1.53?±?11.1% reduction with triamcinolone. These results suggest the proposed DDS will contribute to the development of novel therapeutic strategies for AMD.     

4种机用镍钛器械在模拟弯曲根管内成形能力的实验研究

 目的    比较4种不同机用镍钛器械预备树脂模拟弯曲根管的成形能力，为临床应用提供实验依据。方法    将40个单弯树脂模拟根管随机分为4组，每组10个，分别为ProTaper Universal组、iRaCe组、Reciproc Blue组和HyFlex EDM组，采用4种不同机用镍钛器械进行根管预备，并记录各组预备时间。使用单反相机采集各组预备前后根管的形态照片，采用Adobe Photoshop CS5软件进行图像重叠，使用Image Pro Plus6.0软件测量10个观测点的根管内、外侧壁树脂去除量并计算器械的中心定位能力，采用SPSS 17.0软件对数据进行统计学分析。结果    iRaCe组预备时间最短，预备效率最高（P < 0.05）。在根尖区，iRaCe组的中心定位能力最好；在弯曲点附近，iRaCe组和HyFlex EDM组的中心定位能力较好，相对优于ProTaper Universal组和Reciproc Blue组；在弯曲点冠方，iRaCe组、Reciproc Blue组、HyFlex EDM组的中心定位能力均显著优于ProTaper Universal组（P < 0.05）。结论　4种机用镍钛器械均可较好地保持原始根管的走向，无明显的偏移及台阶等出现。与ProTaper Universal相比，iRaCe、Reciproc Blue和HyFlex EDM镍钛器械对弯曲根管表现出更加出色的成形能力，更适合用于弯曲根管的预备。     

曲安奈德口腔软膏联合半导体激光治疗牙龈扁平苔藓临床疗效研究

目的　探讨曲安奈德口腔软膏联合半导体激光治疗牙龈扁平苔藓（lichen planus，LP）的临床疗效。方法　选取2016年9月至2017年10月就诊于中国医科大学附属口腔医院急诊·黏膜科至少由2名临床医生做出相同诊断的牙龈LP患者90例，随机分为A、B、C 3组，每组30例。A组患者采用曲安奈德口腔软膏治疗，每日1次，睡前涂抹，持续1个月； B组患者采用半导体激光局部照射治疗，每2日1次，持续1个月；C组患者采用曲安奈德口腔软膏联合半导体激光治疗，半导体激光先照射（每2日1次），然后药膏睡前涂抹（每日1次），疗程为1个月。分别在治疗前和治疗后1周、2周、1个月观察记录各组患者创面的病损面积、疼痛程度、症状体征。采用SPSS 22.0软件对数据进行统计分析。结果　治疗后3组病损面积均缩小，疼痛程度、症状体征评分均降低，较治疗前差异均有统计学意义（P＜0.05）。治疗后不同阶段组间比较，C组病损面积均小于A组和B组，疼痛程度评分和症状体征评分亦均低于A组和B组，差异有统计学意义（P＜0.05）；A组病损面积均小于B组，B组疼痛程度评分均低于A组，差异有统计学意义（P＜0.05）。治疗后1周，A组和B组症状体征评分差异无统计学意义（P＞0.05），治疗后2周和1个月，A组症状体征评分均低于B组，差异有统计学意义（P＜0.05）。 结论　曲安奈德口腔软膏联合半导体激光治疗牙龈LP的总体效果优于单独用药和单独使用激光，值得临床推广。     

关节内注射曲安奈德对山羊颞下颌关节骨关节病的影响

目的:观察关节内注射曲安奈德后,山羊颞下颌关节骨关节病的组织病理学变化。方法:在10只山羊的双侧颞下颌关节上腔一次性注射Ⅰ型胶原酶0.8ml,诱导制作山羊骨关节病模型;随机将动物分为对照组和治疗组,每组5只,分别在注射Ⅰ型胶原酶后30、60d后,进行第1次和第2次治疗;第1次治疗90d后,处死2组动物,切取关节标本,进行光镜和扫描电镜观察,并对2组关节光镜下9个区的组织病理学变化进行评分,每个区得出平均分后,应用SAS统计软件GLM模型对治疗组和对照组的分数进行统计学处理,评价有无差异。结果:光镜和扫描电镜下观察,对照组髁突、关节盘、关节窝表现为骨关节病变化,治疗组表现出较对照组更严重的病理变化。光镜下治疗组与对照组的组织学得分有显著性差异(P<0.01)。结论:关节上腔注射曲安奈德,能加重骨关节病的程度。     

Nd:YAG激光联合曲安奈德治疗口腔黏膜下纤维化的临床研究

  目的  采用Nd:YAG激光联合曲安奈德治疗口腔黏膜下纤维化患者,观察治疗后纤维化组织的修复、愈合及病情进展情况。  方法  选取2018年6月—2019年10月于杭州师范大学附属医院口腔科就诊的80例口腔黏膜下纤维化患者,采用随机数字表法分为观察组与对照组,每组40例。对照组患者使用曲安奈德注射液治疗,观察组在此基础上使用Nd:YAG激光治疗,2组均持续治疗9周。2组患者治疗前后采用视觉模拟评分法(VAS)评分进行评价,并测量张口程度和口腔黏膜病损面积;采用酶联免疫吸附法(ELISA)测定血清血管内皮生长因子(VEGF)、血小板反应蛋白(TSP)、基质金属蛋白酶-2(MMP-2)水平及血清IL-6、TNF-α水平。  结果  治疗后,对照组口腔黏膜病损面积为(1.47±0.62)cm2,观察组为(0.86±0.23)cm2,观察组口腔黏膜病损面积小于对照组(P < 0.05);2组患者血清VEGF均升高,观察组高于对照组[(0.75±0.19)pg/mL vs.(0.61±0.23)pg/mL, P < 0.05],而血清TSP、MMP-2、IL-6和TNF-α水平均降低,观察组低于对照组(均P < 0.05)。  结论  Nd: YAG激光联合曲安奈德可有效缓解口腔黏膜下纤维化患者口腔灼痛,抑制纤维化发展,并促进纤维化组织的修复与愈合,控制病情进一步发展。      

曲安奈德外周神经干周围注射治疗原发性三叉神经痛86例

目的:探讨醋酸曲安奈德外周神经干注射对原发性三叉神经痛的治疗效果.方法:对86例原发性三叉神经痛患者在圆孔、卵圆孔外口的神经干周围注射醋酸曲安奈德50 mg,每周1次,5次为一疗程.结果:疼痛消失70例,疼痛明显减轻14例,总有效率97.6%,其中显效率为81.4%;1年后随访70 例,复发率8.6%,3年后随访60例,复发率30%.结论:醋酸曲安奈德治疗原发性三叉神经痛方法简单、安全,疗效显著.     

Malignant transformation of oral lichen planus by a chronic inflammatory process. Use of topical corticosteroids to prevent this progression?

Background: Oral lichen planus is a potentially malignant disorder with a capacity, although low, for malignant transformation. Of all the factors related to the process of malignant transformation, it is believed that the chronic inflammatory process plays a key role in the development of oral cancer. This inflammatory process is capable of providing a microenvironment based on different inflammatory cells and molecules that affect cellular growth, proliferation and differentiation. Objectives: The objectives of our study are: to review the available evidence about the possible relationship between the chronic inflammatory process present in oral lichen planus and its malignant transformation, to discuss the potential therapeutic implications derived from this relationship and to study the role that topical corticosteroids play in the control of oral lichen planus inflammation and its possible progression to malignant transformation. Conclusion: The maintenance of a minimum dose of topical corticosteroids could prevent the inflammatory progression of oral lichen planus to oral cancer.     

皮损内注射联合异维A酸治疗囊肿性痤疮的疗效观察

目的:观察曲安奈德及庆大霉素皮损内注射联合异维A酸治疗囊肿性痤疮的临床疗效。方法:治疗组45例,采用异维A酸胶丸口服,每次20mg,每天2次,连用4周后剂量减半,改为每次10mg,每天2次,再用4周,总疗程为8周;同时于皮损内注射曲安奈德及庆大霉素适量,2周1次,最多4次;对照组40例,单纯口服异维A酸胶丸,用法、用量及疗程同治疗组。结果:两组痊愈率分别为77.8%和52.5%,两者差异有显著性(χ2=6.02,P<0.05),两组的有效率分别为91.1%和87.5%,比较差异无显著性(χ2=0.29,P>0.05)。结论:应用异维A酸胶丸治疗囊肿性痤疮有效,尤其是联合曲安奈德及庆大霉素皮损内注射见效快,复发率低。     

瘢痕切除即刻局部注射曲安奈德联合放疗治疗耳廓瘢痕疙瘩疗效观察

目的:探讨手术切除,术中曲安奈德局部注射,术后放疗联合治疗耳廓瘢痕疙瘩的效果。方法:将病例分为三组:第一组:12例,24个瘢痕疙瘩(手术+曲安奈德注射+放疗),手术切除瘢痕疙瘩,术中注射醋酸曲安奈德,注射剂量依切缘大小而异,每次注射量不大于40mg,术后每周1次,连续4～8次,术后24h内行局部浅层放疗3天;第二组:11例,22个瘢痕疙瘩(手术+放疗),手术切除瘢痕疙瘩,术后24h内行放疗3天;第三组:17例,23个瘢痕疙瘩(手术+曲安奈德注射),手术切除瘢痕疙瘩,术中即刻注射曲安奈德,术后每周1次,连续4～8次。结果:第一组、第二组、第三组有效率分别为95.83%、77.27%、52.17%。第一组与第二组、第三组比较有显著差异(P<0.05)。结论:手术切除,术中曲安奈德局部注射联合术后放疗治疗耳廓瘢痕疙瘩副作用小、复发率低,值得临床应用。