Influence of immunosuppressive drugs on the CD30 molecule in kidney transplanted patients

Background

Soluble CD30 (sCD30) is a suggested marker for kidney transplantation outcomes. We investigated whether sCD30 serum levels are influenced by immunosuppression and whether they correlate with findings in protocol biopsies and with CD30 gene expression in peripheral blood mononuclear cells (PBMC).

Efficacy of mizoribine followed by low-dose prednisone in patients with idiopathic membranous nephropathy and nephrotic-range proteinuria

Abstract

Background: Idiopathic membranous nephropathy (IMN) patients with persistent high-grade proteinuria are at the highest risk for developing end-stage renal failure. We previously reported the effects of treatment with mizoribine followed by low-dose prednisone treatment in 4 IMN patients. The purpose of the present study was to further assess the effects of this combined treatment in a larger study group. Method: Thirteen patients with IMN and nephrotic-range proteinuria received combined treatment. Mizoribine was initiated at a dose of 150?mg/day, and 2–3 months later, 20?mg/day prednisone was added to the mizoribine regimen. The dosage of prednisone and/or mizoribine was tapered according to the urinary protein-to-creatinine ratio (P/C). We evaluated patient responses for up to 12 months after the initiation of combination therapy. Results: Before treatment, patient urinary P/C ranged from 3.7 to 15.9?g/g. Although these values did not decrease during mizoribine monotherapy, all patients showed dramatic P/C decreases over the course of combination therapy. At 3, 6, and 12 months after combination therapy, 15%, 31%, and 62% of patients attained complete remission, respectively, and all patients were in partial or complete remission 6 months after combination therapy. No notable side effects were observed. Conclusion: The addition of prednisone after mizoribine monotherapy can be beneficial for all IMN patients with nephrotic-range proteinuria syndrome. The risks associated with immunotherapy can be decreased by initially prescribing mizoribine alone, which might act as a base for establishing therapy, followed by low-dose prednisone treatment.     

Randomized, Controlled Trial of Inhaled Budesonide as an Adjunct to Oral Prednisone in Acute Asthma

Objective: To compare the clinical effect of nebulized budesonide with placebo in acute pediatric asthma.
Methods: A randomized, controlled, double-blind trial with parallel design was used in the ED of a tertiary care children's hospital. Children aged 6 months to 18 years with a moderate to severe exacerbation of asthma [Pulmonary Index Score (PIS) ≥5 or ≤11 after a salbutamol nebulization of 0.15 mg/kg] were eligible. All patients received prednisone 1 mg/kg orally and nebulized salbutamol (0.15 mg/kg) every 30 minutes for 3 doses and then every hour for 4 hours. The intervention was 2 mg (4 mL) of nebulized budesonide or 4 mL of nebulized normal saline.
Results: Baseline characteristics were comparable in the budesonide group ( n = 24) and in the placebo group ( n - 20). There were no significant differences in the primary outcome measure (PIS) between the 2 groups. However, the PIS at 1 hour had a tendency to be lower in the budesonide group (median = 5) as compared with the placebo group (median = 6; p = 0.07). Survival analysis of release/discharge from the ED/hospital showed a more rapid rate in the budesonide group as compared with the placebo group (p = 0.02). No adverse effects were seen.
Conclusion: Although these preliminary results suggest that nebulized budesonide may be an effective adjunct to oral prednisone in the management of moderate to severe asthma exacerbations, a larger trial will be required before the widespread use of inhaled budesonide in acute asthma can be advocated.     

Steroids for Migraine Headaches: A Randomized Double-Blind, Two-Armed, Placebo-Controlled Trial

Background: Recurrence of migraine headache after treatment in the emergency department (ED) is common. Conflicting evidence exists regarding the utility of steroids in preventing migraine headache recurrence at 24–48 h. Objective: To determine if steroids decrease the headache recurrence in patients treated for migraine headaches in the ED. Methods: Double-blind placebo-controlled, two-tailed randomized trial. Patients aged >17 years with a moderately severe migraine headache diagnosed by treating Emergency Physician were approached for participation. Enrollees received either dexamethasone (10 mg i.v.) if intravenous access was utilized or prednisone (40 mg by mouth × 2 days) if no intravenous access was obtained. Each medication was matched with an identical-appearing placebo. Patients were contacted 24–72 h after the ED visit to assess headache recurrence. Results: A total of 181 patients were enrolled. Eight were lost to follow-up, 6 in the dexamethasone group and 2 in the prednisone arm. Participants had a mean age of 37 years (±10 years), with 86% female. Eighty-six percent met the International Headache Society Criteria for migraine headache. Of the 173 patients with completed follow-up, 20/91 (22%) (95% confidence interval [CI] 13.5–30.5) in the steroid arm and 26/82 (32%) (95% CI 21.9–42.1) in the placebo arm had recurrent headaches (p = 0.21). Conclusion: We did not find a statistically significant decrease in headache recurrence in patients treated with steroids for migraine headaches.     

泼尼松反应在CCLG-ALL 2008方案中预后价值的探讨

目的:评估泼尼松反应在儿童急性淋巴细胞白血病(ALL)治疗体系中的预后价值。方法:对入组598例初治ALL患儿,予以泼尼松预治疗,根据结果分为泼尼松反应良好(PGR)组和泼尼松反应不良(PPR)组,行后续治疗并随访,分析比较临床特征及治疗效果。结果:与PGR组相比,PPR组患儿具有年龄较大,初诊白细胞数较高,T细胞表型相对多见,费城染色体阳性急性淋巴细胞白血病(Ph+ALL)相对多见的特点(P0.05);PPR组患儿2年和5年无事件生存率(EFS)相对于PGR组明显降低(P0.05),PPR组患儿累积无事件生存率的下降主要发生在2年内;PPR组复发率较高,且以早期复发为主(P0.05);PPR组患儿治疗第33天及12周的微小残留病(MRD)发生率较高(P0.05);高危组ALL患儿不论泼尼松反应是否良好,其无事件生存率,复发时间均无差别(P0.05);在COX回归分析中,PPR、BCR-ABL1及MLL的存在均为显著预后不利因素(P0.05)。结论:泼尼松反应在CCLG-ALL 2008方案中仍然具有重要预后价值,泼尼松反应不良的ALL患儿整体预后较差,而泼尼松反应对高危组ALL预后评价意义不大。     

泼尼松脉冲片的制备研究

目的制备泼尼松脉冲片并考察其在体外的释放特性。方法采用粉末直接压片法制备速释片芯,以羟丙甲纤维素(HPMC)为溶胀层包衣材料,以乙基纤维素(EC)为控释层包衣材料,采用多层包衣技术制备泼尼松脉冲片。考察了致孔剂PEG 400、增塑剂PEG 6000比例与用量以及控释层包衣增重对释放的影响。以迟滞时间和累积释放度为指标,考察泼尼松脉冲片的体外释放特性。结果以片芯崩解剂用量为11%,致孔剂用量为10%,增塑剂用量为1%,溶胀层和控释层包衣分别增重为5%、10.5%制备的泼尼松脉冲片效果最佳。按照最优处方工艺制备的泼尼松脉冲片体外释放迟滞时间为4 h,时滞后0.5~1.0 h累积释放度达95%以上。结论泼尼松脉冲片处方组成合理,工艺简便可行,体外释放特性符合脉冲释放设计要求。     

青紫汤加减治疗小儿过敏性紫癜22例

目的:观察青紫汤加减治疗小儿过敏性紫癜的临床疗效。方法:选取过敏性紫癜患儿44例,随机分为对照组和治疗组各22例,对照组给予扑尔敏、潘生丁等西药常规治疗,治疗组在对照组治疗的基础上加用青紫汤加减治疗。两组均1周为1个疗程,1个疗程后比较两组疗效。结果:对照组有效率为81.82%,治疗组有效率为95.45%,两组有效率比较差异有统计学意义(P0.05),治疗组优于对照组。结论:青紫汤加减治疗小儿过敏性紫癜疗效显著。     

Steroid-based treatments for patients with total sudden sensorineural hearing loss

Conclusions: In patients with total sudden sensorineural hearing loss (SSNHL), oral prednisone (OP) alone or intratympanic dexamethasone (ITD) alone have comparable results. The addition of salvage ITD following OP does not seem to add over either single modality treatment. Objectives: To study the effect of steroid-based treatments in patients with total SSNHL. Methods: The medical charts of 59 patients with total loss of hearing, defined as pure tone thresholds in the profound range (> 90 dB) with an unobtainable speech reception threshold (SRT) that were treated with OP (n = 20), ITD (n = 13), or OP followed by salvage ITD (n = 26) were analyzed. Response to treatment was evaluated by means of pure tone thresholds, SRT, and speech discrimination score (SDS), immediately after treatment and on a follow-up visit. Results: Forty-nine patients (83%) responded to treatment, with mean significant improvements of 36, 34, 31, and 25 dB at 500, 1000, 2000, and 4000 Hz, respectively. The mean improvement in SRT was 33 dB, and SDS improved by 32%. There were no differences in improvement in pure tone thresholds and SRT among the three treatment groups. The late effect of OP was similar to the effect of salvage ITD.