Use of steroids for facial nerve paralysis after parotidectomy: A systematic review

AIM: To systematically review the literature to assess the efficacy of corticosteroids in treating post-parotidectomy facial nerve palsy (FNP).METHODS: We searched the Cochrane library, EMBASE and MEDLINE (from inception to 2014) for studies assessing the use of corticosteroids in post-parotidectomy FNP. Studies were assessed for inclusion and quality. Data was extracted from included studies.RESULTS: Two randomised controlled trials met the inclusion criteria. One study assessed the use of dexamethasone and the other prednisolone. None of the studies demonstrated a significant difference in the outcome of FNP post-parotidectomy with the use of corticosteroids vs no therapy. The majority of FNP post-parotidectomy is transient. Preoperative factors (size of tumour and malignancy), intraoperative factors (extent of parotidectomy and integrity of facial nerve at the end of the operation) are important in determining prognosis of FNP if it does occur.CONCLUSION: Corticosteroids do not appear to improve FNP prognosis post-parotidectomy. Further studies assessing patients by cohort and with long term follow-up are required to increase scientific evidence.     

Incidence and risk factors of steroid-induced diabetes in patients with respiratory disease

Glucocorticoids are effective for treating several respiratory diseases. However, they can cause hyperglycemia. This study determined the incidence and risk factors of steroid-induced diabetes mellitus (S-DM) in patients treated with glucocorticoid for respiratory diseases. A retrospective study examined patients with respiratory diseases treated with a prednisolone-equivalent glucocorticoid dose exceeding 20 mg/day for at least 4 weeks between January 2003 and December 2008. Patients whose initial random glucose level exceeded 200 mg/dL or who had pre-existing diabetes were excluded. S-DM was defined as a fasting glucose concentration exceeding 126 mg/dL or a random glucose concentration exceeding 200 mg/dL at least twice after beginning steroid treatment. A total of 231 patients with respiratory diseases met the inclusion criteria. Their median age was 55 yr, and 139 were female. The median cumulative prednisolone-equivalent glucocorticoid dose was 4,965 mg, and the median duration of steroid treatment was 193 days. S-DM was diagnosed in 34 (14.7%) of 231 patients. Multivariate logistic regression identified older age (odds ratio 1.05, 95% confidence interval 1.02-1.09) as a risk factor for S-DM. S-DM is frequent among patients with respiratory diseases treated with glucocorticoid. Clinicians should be aware of the possibility of S-DM, especially among elderly patients.     

Liquid chromatography tandem mass spectrometry for analysis of steroids in clinical laboratories

Liquid chromatography tandem mass spectrometry is one of the most specific techniques available in clinical laboratories. In the past, immunoassays were the primary methodology for analysis of steroids in biological samples because they are rapid and easy to perform. However, these methods were shown to suffer from the lack of specificity for measuring many of the diagnostically important steroids. LC-MS/MS overcomes many of the limitations of immunoassays, enhances diagnostic utility of the testing, and expands diagnostic capabilities in endocrinology. In addition to the superior quality of the measurements, LC-MS/MS allows high throughput testing using small sample volume with minimal sample preparation, and frees the laboratory from dependence on suppliers of assay specific reagents. LC-MS/MS is being widely employed for routine measurement of steroids, and the methodology plays an important role in the standardization and harmonization of measurements among clinical laboratories.     

Predictors and prevalence of patients undergoing additional kyphoplasty procedures after an initial kyphoplasty procedure

Background context

Vertebral cement augmentation, including kyphoplasty, has been shown to be a successful treatment for pain relief for vertebral compression fracture (VCF). Patients can sustain additional symptomatic VCFs that may require additional surgical intervention.

Purpose

To examine the prevalence and predictors of patients who sustain additional symptomatic VCFs that were treated with kyphoplasty.

Study design

A retrospective review of patients who previously underwent kyphoplasty for VCFs and had additional VCFs that were treated with kyphoplasty.

Patient sample

A total of 256 patients underwent kyphoplasty for VCFs from 2000 to 2007 at a single medical center.

Outcome measures

The outcome measure of interest was the need for an additional kyphoplasty procedure for a symptomatic VCF.

Methods

Risk factors such as age, sex, smoking status, and steroid use were assessed, as well as bisphosphonate use. Sagittal spinal alignment via Cobb angles for thoracic, thoracolumbar, and lumbar regions was assessed.

Results

About 22.2% of the patients had an additional symptomatic VCF that was treated with a kyphoplasty procedure. Steroid use was the only significant risk factor for predicting patients with additional symptomatic VCFs who underwent additional kyphoplasty. The average time to the second VCF was 33 days. Adjacent-level VCFs were most common in the thoracic and thoracolumbar spine. Bisphosphonate use was not shown to be protective of preventing additional VCFs during this follow-up period.

Conclusion

This is the first single-center review of a large cohort of patients who underwent additional-level kyphoplasty for symptomatic VCFs after an index kyphoplasty procedure. Our results suggest that patients with a VCF who use chronic oral steroids should be carefully monitored for the presence of additional symptomatic VCFs that may need surgical intervention. Patients with prior thoracic VCFs who have additional back pain should be reevaluated for a possible adjacent-level fracture.     

Synthesis,Characterization, and Evaluation of Cytotoxic Effects of Novel Hybrid Steroidal Heterocycles as PEG Based Nanoparticles

Anticancer agents featuring hybrid molecules can improve effectiveness and diminish drug resistance. The current study aimed to introduce newly synthesized heterocyclic steroids of promising anticancer effects loaded in polyethylene glycol (PEG)•based nanoparticles form. Several heterocyclic steroids (1-9) were synthesized via multicomponent reactions (MCRs) and confirmed via the analytical and spectral data. Compounds 1, 2, 3, 4, 5, 6, 7 and 9, were investigated individually in their free and PEG based nano-size hybrid forms as anticancer agents against three human cell lines: hepatocellular carcinoma cells (HepG2); breast cancer cells (MCF-7); and colon cancer cells (HCT116). The neutral red supravital dye uptake assay was employed. Compound 6 in its PEG based nano-size form exhibited the best cytotoxic effects against HepG2 and HCT116 cell lines, with IC50 values of 2.44 μmol/l and 2.59 μmol/l, respectively. In addition, it demonstrated a low IC50 value against MCF-7 (3.46μmol/l) cells. This study introduced promising anticancer agents acting through conversion into PEG-based nanoparticles.     

Rare case of sclerosing mesenteritis and low grade follicular lymphoma

An unusual case of long standing sclerosing mesenteritis; initially presented with recurrent abdominal pain and a mesenteric mass with surrounding fat oedema and stranding with a pseudocapsule and fat ring sign were clearly visualised on the initial computed tomography scan. Laparotomy showed diffuse thickening at the root of the mesentery and histology from this specimen revealed fat necrosis and reactive lymphoid tissue consistent with sclerosing mesenteritis. Initial treatment with steroids and tamoxifen relieved the symptoms and the mass. He was maintained on tamoxifen. Three years later he developed a recurrence of his symptoms and abdominal mass that responded to a course of steroids. Two years following this, he developed a follicular Hodgkin’s lymphoma.     

卵泡发育过程中的Wnt信号通路

Wnt蛋白与细胞膜上相应受体结合,引起胞质中β-catenin集聚并向核内转移,激活下游相关靶基因的转录。该信号通路是调节卵泡生长发育的一个关键途径。Wnt2影响β-catenin的细胞定位来调节颗粒细胞的增殖;Wnt4是一个多功能因子,在卵泡发育的许多阶段都有表达并通过多种途径来调节卵泡的生长、发育和成熟。受体Fzd1调节卵丘扩展相关因子的表达。β-catenin还参与合成卵巢甾体激素和黄体的生成。该通路受损时,会引起卵巢早衰、诱发颗粒细胞肿瘤、排卵障碍和黄体功能不足等。阐述经典的Wnt信号通路及其在调节卵泡发育过程中的作用及其分子机制。     

免疫球蛋白联合小剂量糖皮质激素治愈疱疹样脓疱病1例

患者女,19岁,孕34周,初次妊娠。躯干、四肢皮肤出现脓疱20d。查体：躯干、四肢皮肤浸润性红斑,其上见大量浅表白色脓疱,在红斑边缘聚集成群或排列成环形。皮损组织病理示：局灶性角化不全,角质层下中性粒细胞性脓疱,血管周围淋巴细胞及中性粒细胞浸润。临床结合病理表现符合疱疹样脓疱病诊断。患者对大剂量糖皮质激素反应不佳。给予静滴免疫球蛋白联合小剂量糖皮质激素,皮损痊愈。     

Italian multicentre study on retinopathy of prematurity

The aim of this prospective multicentre study was to evaluate the influence of a number of perinatal factors on the development of ROP in high risk preterm infants with gestational age ≤30 weeks. All infants consecutively born in, or transferred to, one of the 14 participating centres from 1 January 1992 through 31 December 1993, who had a gestational age of 30 weeks or less and no congenital anomalies and survived to the age of 6 months, were included in the study. Of the 380 infants with mean ± SD gestational age of 28.4 ± 1.6 weeks (range 23–30 weeks) and birth weight of 1157 ± 335 g (range 485–2480 g) that were eligible for the study, 82 (21.5%) developed ROP stage 1 or 2 and 57 (15%) ROP stage 3 or 3+. Step-wise logistic regression analysis showed that the following factors had a significant predictive value for the development of ROP stage 3 or 3+: gestational age (Odds Ratio (OR)=0.6144 for each increment of 1 week of gestational age), birth weight (OR=0.843 for each increment of 100 g of birth weight), prenatal steroids (OR 4.044 for lacking or incomplete prophylaxis), RDS (OR 2.294), oxygen dependency at 60 days (OR 2.085), necrotising enterocolitis (OR 2.597). Conclusion This study confirms the role of prematurity, low birth weight and RDS in the pathogenesis of ROP, and emphasises the importance of prenatal steroid prophylaxis of RDS in very preterm infants. Furthermore, our data suggest that infants with oxygen dependency at 60 days or necrotising enterocolitis are at very high risk of developing ROP. Received: 29 September 1996 and in revised form: 28 January 1997 / Accepted: 1 April 1997     

Effectiveness of glucocorticoids in orthognathic surgery: an overview of systematic reviews

For decades, short-term glucocorticoids have been advocated to reduce postoperative swelling, pain, trismus, and nausea and vomiting in patients experiencing maxillofacial surgeries. The purpose of this systematic overview was to identify and assess the best evidence regarding the efficacy of glucocorticoid administration in patients who undergo orthognathic surgery. Five databases (Medline, Embase, The Cochrane Library, Web of Science, and Epistemonikos) were searched from their inception to October 2020. The risk of bias assessment was performed using the ROBIS tool, and the quality of the evidence reported was rated using the GRADE approach. Six systematic reviews were identified, of which three were included in this overview (n=527). According to the rating of the overall risk of bias, one achieved a low score and two were rated as high. The quality of the evidence reported ranged from very low to moderate. Corticoids may reduce the incidence of moderate or severe postoperative nausea and vomiting in the early postoperative period (0-6 hours) compared to metoclopramide, but the evidence is very uncertain. Some significant therapeutic effects on neurosensory recovery have been reported, but there was inconsistency across the studies. Finally, based on a moderate quality of evidence, it is possible to establish that the administration of glucocorticoids is likely to reduce oedema in the early postoperative period (0-48 hours) in patients who undergo orthognathic surgery, and to have no significant adverse effects. Further quantitative syntheses based on well-designed and standardised clinical studies are suggested to determine direction and strength of the intervention on the other outcomes.