Ultrasonographic evaluation of gastrointestinal graft‐versus‐host disease after hematopoietic stem cell transplantation

Gastrointestinal graft‐versus‐host disease (GI‐GVHD) is a major and life‐threatening complication of hematopoietic stem cell transplantation (HSCT). This study evaluated the efficacy of ultrasonography (US) for assessing and monitoring GI‐GVHD. GI tract was evaluated by US in 81 patients. US findings were positive in 43 patients, including 11 false positive, and negative in 38 patients. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US for the diagnosis of GI‐GVHD were 100%, 78%, 74%, 100%, and 86%, respectively. Diffuse wall thickening of the ileum was the most frequent finding in patients with GI‐GVHD. Severity of GI‐GVHD was correlated with the thickness of internal low echoic layer of the wall, the echogenicity of mesenteric fat tissue, and the intensity of Doppler signaling. We classified US findings of GI‐GVHD into four US grades. There was a significant correlation between clinical stage of GI‐GVHD and the US grade. These ultrasonographic abnormalities were improved with clinical improvement of GI‐GVHD upon treatment. Thus, US is an effective and efficient non‐invasive means of identifying the extent and severity of GI‐GVHD and monitoring response to treatment.     

大剂量甲基强的松龙冲击疗法治疗系统性红斑狼疮48例临床分析

目的观察大剂量甲基强的松龙冲击疗法的临床疗效及与常规激素疗法进行比较.方法对我院1993年～2000年资料较完整的48例系统性红斑狼疮重点在治疗效果上进行分析.结果经采用大剂量甲基强的松龙冲击疗法治疗的36例中,好转31例(86.1%),无效4例(11.1%),死亡1例(2.8%);经常规激素治疗的12例中,好转7例(58.3%),无效2例(16.7%),死亡3例(25%).结论大剂量甲基强的松龙冲击疗法在疗效等方面优于常规激素疗法.     

地塞米松与甲基强的松龙冲击治疗肾病综合征的比较研究

目的 :比较大剂量地塞米松 (Dexamethasone ,Dex)与甲基强的松龙 (Methylprednisolone,MP)冲击治疗成人原发性肾病综合征 (Nephroticsyndrome ,NS)的疗效、不良反应 ,为价廉的Dex代替昂贵的MP提供临床可行性依据。方法 :Dex组 30例用Dex 2 .0mg/ (kg·d) ,3d为 1疗程 ,3周重复 ,共 2～ 4疗程 ,间歇期以强的松 (Prednisone ,Pred) 0 .6mg/ (kg·d)口服 ,缓解者 8周或用药 12周无效者逐渐减量 ,至 15mg/d维持 ,总疗程 18月 ;MP组 12例用MP 1.0g/d ,3d为 1疗程 ,余同Dex组。结果 :两组的疗效和副作用无统计学差异 (P >0 .0 5 )。结论 :Dex可以替代MP对NS患者进行冲击治疗 ,获得满意疗效及较好的耐受性 ,并为病人节省开支。     

Effects of methylprednisolone and betamethasone injections on the rotator cuff: an experimental study in rats

Thirty-one female Sprague-Dawley rats were used to determine the effects of subacromial corticosteroid injections on the rotator cuff. The injection technique was tested in 6 animals, which were excluded from the study. The remaining 25 rats were randomly divided into three groups of 8 animals each; a single rat received no injections. Every other week for 8 weeks, one shoulder in each rat was injected with methylprednisolone, betamethasone, or saline in a dosage equivalent to that used in humans. The supraspinatus and infraspinatus tendons were removed 10 days after the last injection and evaluated. There were no pathologic changes in the tendons injected with saline. In 43% of the methylprednisolone-treated rats and 29% of the betamethasone-treated rats, the tendons were abnormally soft and light-colored. In 43% of the methylprednisolone group and 71% of the betamethasone group, fragmentation of collagen bundles and inflammatory cell infiltration were evident. Subacromial injections of methylprednisolone or betamethasone repeated frequently can cause deleterious changes in the normal structure of the rat rotator cuff. In light of these findings, therapy for subacromial impingement syndrome of the shoulder with frequent, repeated steroid injections is potentially harmful.     

The Effect of Preoperative Intra-Articular Methylprednisolone on Pain After TKA: A Randomized Double-Blinded Placebo Controlled Trial in Patients With High-Pain Knee Osteoarthritis and Sensitization

In a randomized, double-blind, placebo controlled trial, we investigated the postoperative analgesic effect of a single intra-articular injection of 40?mg methylprednisolone acetate (MP) administered 1 week before total knee arthroplasty (TKA). Forty-eight patients with high pain osteoarthritis (≥5 on a numeric rating scale during walk) and sensitization (pressure pain threshold?<250?kPa), aged 50 to 80 years and scheduled for primary unilateral TKA under spinal anaesthesia were included. The primary outcome was the proportion of patients with moderate/severe pain during a 5-m walk test 24 hours postoperatively. Secondary outcomes included pain at 48 hours, during the first 14 days, sensitization (quantitative sensory testing with pressure pain threshold and wind-up from temporal summation), and inflammatory changes (systemic C-reactive protein, intra-articular interleukin [IL]-6). No difference in the proportion of patients with moderate/severe pain was found between MP/placebo groups at 24 hours (67% and 74%, χ²?=?.2, P?=?.63, odds ratio = .7, 95% confidence interval = .2–2.8) or at 48 hours (57% and 68%, χ²?=?.5, P?=?.46, odds ratio = .6, 95% confidence interval = .2–2.3), and no difference between groups in postoperative sensitization was found (P?>?.4) despite reduced preoperative intra-articular inflammation (IL-6) in the MP group versus placebo (median change in IL-6 = ?70?pg/mL, interquartile range = ?466 to 0 vs. 32?pg/mL, interquartile range = ?26 to 75, P = .029). Alternative central or peripheral analgesic interventions in this high-risk group are required.

不同剂量甲强龙治疗小儿重症支原体肺炎临床研究

目的对比静脉使用不同剂量甲强龙对小儿重症支原体肺炎的疗效,探讨更佳的治疗方案。方法将46例重症支原体肺炎患儿随机分为冲击剂量组及常规剂量组。除常规治疗外,冲击剂量组静脉给予甲强龙15~30 mg/(kg·d),常规剂量组静脉给予甲强龙1~2mg/(kg·d),均连续用3 d后改强的松口服。结果冲击剂量组和常规剂量组总有效率分别为95.7%和73.9%,统计学差异显著(P0.05)。冲击剂量组在发热、咳嗽、肺部体征改善时间及胸部X线片恢复时间上明显低于对照组(P0.05)。结论治疗小儿重症支原体肺炎时,冲击剂量甲强龙疗效优于常规剂量。     

回顾性分析不同方法治疗甲状腺相关性眼病眼压的变化

目的:比较甲基强的松龙静脉冲击治疗及眼外肌手术治疗甲状腺相关性眼病(thyroid-associated ophthalmopathy,TAO)前后眼压(intraocular pressure,IOP)的变化.方法:回顾性分析收集2008-01/2010-12于我院眼科就诊的26例42眼TAO患者,患者行甲基强的松龙静脉冲击治疗或眼外肌手术,比较术前、术后第一眼位及上视时的眼压变化.结果:患者16例32眼采用甲强龙冲击治疗,治疗前平均眼压第一眼位时为21.13±4.10mmHg,向上注视时为23 75±5.67mmHg,治疗后分别为16.81±3.69mmHg(P＜0.05),18.50±4.03mmHg(P＜0.05);10例10眼采用眼外肌斜视手术,术前平均眼压第一眼位时为18.40±2 49mmHg,上视时为24.70±3.63mmHg,术后分别为17 30±1.55mmHg(P＞0.05),18.60±2.20mmHg(P＜0 01);术前眼压≥21mmHg的TAO患者眼压下降明显(P＜0.05).结论:两组患者用不同的方法治疗后眼压显著下降,但是眼外肌斜视手术前后眼压在第一眼位时的变化没有统计学差别.     

The effect of steroid pulse therapy on the development of acute pancreatitis induced by closed duodenal loop in rats

Background: Background: The aim of the present study was to evaluate the effect of a high dose of methylprednisolone (MP) on the development of acute pancreatitis (AP) in rats induced by closed duodenal loop (CDL). Methods: Pancreas web weight, volume of ascites, hematocrit, serum amylase activity, concentrations of interleukin (IL)-1β and IL-6, organ blood flow in both the pancreas and the kidney, and histological findings of the pancreas were studied 6 h after the induction of AP. Results: The intravenous administration of MP (30 mg/kg body weight) significantly reduced the increase in pancreas web weight, volume of ascites, hematocrit, serum amylase activity, concentrations of IL-1β and IL-6, histological edema, and necrosis observed in CDL pancreatitis. The administration of MP also apparently improved both the pancreatic and the renal blood flow. Conclusions: The present results suggest that these cytokines influence at least the progression of AP, and that the mechanism by which MP pulse therapy inhibits the development of AP partly involves the inhibition by MP of the release of the cytokines. Received: July 19, 2001 / Accepted: December 14, 2001     

Serum cytokine changes induced by direct hemoperfusion with polymyxin B-immobilized fiber in patients with acute respiratory failure

BackgroundPolymyxin B-immobilized Fiber therapy (PMX-DHP) may improve the prognosis of patients with rapidly progressive interstitial lung diseases (ILDs). However, the mechanisms by which PMX-DHP ameliorates oxygenation are unclear. The present study aimed to clarify the changes in serum cytokine concentrations during PMX-DHP with steroid pulse therapy.MethodsPatients with acute respiratory failure (ARF) and rapidly progressive ILDs, acute exacerbation of idiopathic pulmonary fibrosis (IPF), or acute respiratory distress syndrome (ARDS), and treated with PMX-DHP were assessed, including patients with IPF. The serum concentrations of 38 cytokines were compared between the ARF and IPF groups before treatment. In the ARF group, cytokine levels were compared before, immediately after PMX-DHP, and the day after termination of steroid pulse therapy.ResultsFourteen ARF and eight IPF patients were enrolled. A comparison of the cytokine levels before treatment initiation revealed that EGF, GRO, IL-10, MDC, IL-12p70, IL-15, sCD40L, IL-7, IP-10, MCP-1, and MIP-1β were significantly different between the two groups. In the ARF group treated with PMX-DHP, the concentrations of MDC, IP-10, and TNF-α continuously decreased during treatment (P < 0.01). Further, the cytokine levels of GRO, IL-10, IL-1Ra, IL-5, IL-6, and MCP-1 decreased after the entire treatment period, with no change observed during the steroid-only period (P < 0.01, except GRO and MCP-1). Although PMX-DHP significantly reduced eotaxin and GM-CSF serum levels (P < 0.01 and P < 0.05), these levels did not change after treatment.ConclusionsPMX-DHP combined with steroid pulse therapy might reduce GRO, IL-10, IL-1Ra, IL-5, IL-6, and MCP-1 levels in ARF, contributing to better oxygenation in the disorder.     

甲强龙、地塞米松治疗突发性耳聋的应用比较

目的探讨甲强龙（MTH）及地塞米松（DEx）在治疗突发性耳聋中的·l盏床疗效。方法将95例（107耳）突发性耳聋患者随机分为MTH组和DEX组。MTH组行鼓室注射62．5mg／mLMTH0．5mL,每2天注射1次,10天为1个疗程;DEX组行鼓室注射10．0mg／mLDEX0．5mL,每2天注射1次,10天为1个疗程。两组均给予营养神经、吸氧等对症支持治疗。比较2周后4个频率（0．5kHz、lkHz、2kHz、4kHz）气导纯音听阈均值（PTA）,提高15分贝（dB）以上为有效。结果MTH组总有效49耳,有效率为86．0％。DEX组34耳,有效率为68．0％。X2=4．94,两组比较差异有显著性（P〈O．05）。结论鼓室内注射类固醇激素为治疗难治性突发性耳聋安全、有效的方法之一,并且MTH效果优于DEX。