Acute disseminated encephalomyelitis: the importance of early magnetic resonance imaging

The diagnosis of acute disseminated encephalomyelitis (ADEM) is frequently missed or delayed with consequent delay in instituting therapy in the crucial phase of the illness. The role of MRI in the diagnosis of ADEM is well established, however, the value of its early utilization of treatment on the outcome of patients has not been adequately stressed. Three patients with ADEM are described. Delay in the diagnosis of the first was associated with severe sequelae, while in the other two early diagnosis and institution of corticosteroid therapy which was facilitated by MRI, was associated with a better outcome. MRI should be carried out early once the diagosis of ADEM is entertained.     

Corticosteroid therapy does not prevent nephritis in Henoch-Schönlein purpura

Nephritis occurs in 20%–50% of children with Henoch-Schönlein purpura (HSP), and the onset of renal involvement may be delayed for weeks or months in a substantial proportion of patients. The present study was performed to determine whether corticosteroid therapy was effective in preventing delayed nephritis in children with HSP. The medical records of 69 children with HSP were reviewed. Nineteen patients had acute nephritis occurring from 1–12 days after the onset of other signs and symptoms. The remaining 50 patients had no evidence of acute renal involvement. Of these 50 patients, 20 were treated during the acute phase of the illness with corticosteroids, while 30 never received corticosteroid therapy. Delayed nephritis (>3 weeks following an initial normal urinalysis) occurred in 4 of 20 (20%) patients who received prior corticosteroid treatment, and in 6 of 30 (20%) patients who were not treated. These results indicate that early corticosteroid therapy does not prevent delayed nephritis in children with HSP.     

Open-field behavior, habituation and passive avoidance learning: Effect of ACTH and hydrocortisone on Normal and adrenalectomized rats

Exploratory behavior (GMA) and habituation rate (IH) were studied in an open-field situation in normal and adrenalectomized rats. Following this procedure the rats were subjected to passive avoidance learning (PA). Wide-spreading individual differences were observed in the exploratory behavior and the tendency of habituation of normal rats. As compared to the normal values, either the adrenalectomy which was performed 24 hr, 7 days and 28 days prior to the experiments or the ACTH and hydrocortisone treatment failed to modify the GMA and the IH significantly. An improvement of PA was found in the normal rats following ACTH and hydrocortisone treatment. In the adrenalectomized animals the hydrocortisone proved to be effective, whereas ACTH did not influence PA. No correlation was found between GMA, IH versus PA values and the influence of ACTH and hydrocortisone administration on these parameters. It is concluded that the direction of PA is unpredictable on the basis of the open-field test performed on R-Amsterdam strain of rats, and the effect of ACTH on passive avoidance learning is mediated through the adrenal glands.     

兔激素性股骨头坏死的血液流变学改变

目的　探讨血液流变学指标在激素性股骨头坏死过程中的变化规律及其作用。方法　20只兔随机分成2组，每组10只。A组（激素性股骨头坏死动物模型组）：间隔24h耳缘静脉内2次注射大肠杆菌内毒素，每次40μg/kg，注射内毒素后注射醋酸泼尼松龙20mg/kg。B组（正常对照组）。两组分别在注射后24h、72h、7d、14d 及21d，进行血浆黏度、全血黏度、血小板计数及血脂测定，21d取股骨头和肝脏行病理组织学观察。结果　A组用药后24h血浆黏度、全血黏度升高，血脂升高(P<0.01)血小板计数减少(P<0.01)，用药后72h、7d、14d 及21d，持续异常，与B组相比差异显著。A组21d时病理切片见股骨头骨细胞和肝细胞变性、坏死。结论　在激素性股骨头坏死动物模型中，血液流变学指标异常在引起血栓前状态，形成血栓导致骨坏死过程中可能发挥了重要作用。     

Effects of frustration on behaviour and plasma corticosteroid levels in pigs

Frustration was elicited in pigs by not rewarding the operant response of subjects having learnt to press a panel with their snout to get a food reward. When pigs were exposed singly to this situation, they extinguished their operant responding. Plasma corticosteroid levels increased during frustration and the number of responses emitted was correlated negatively with the initial plasma corticosteroid levels. When two pigs were submitted together to the frustration situation, they developed aggressive behaviour accompanied by increases of plasma corticosteroid levels. These experiments demonstrate that pigs are sensitive to the effects of frustration elicited by the omission of an expected reward.     

LASIK术后糖皮质激素应用方案比较

目的　评价LASIK术后糖皮质激素的合理应用时间。方法　采用前瞻性研究 (双盲 ) ,观察行LASIK治疗的 10 0例 (2 0 0眼 )患者 ,根据术后用药不同随机分为试验组、对照组 ,各10 0眼。其中试验组LASIK术后使用典必殊滴眼液一周 ,对照组使用 0 1%氟美童滴眼液一月及托百士滴眼液一周 ,两组患者除术后糖皮质激素应用不同外 ,术前准备、手术方法及术后其他用药均相同 ;为不掩盖症状 ,术后均不使用人工泪液。观察指标包括术前、术后一日、术后三日、术后一周、术后二周、术后一月、术后三月的眼部症状 (包括疼痛、眼干、异物感 )及体症 ,包括裸眼视力、最佳矫正视力及有效球镜、弥漫性角膜基质炎 (DLK)、荧光素染色 (FL)、眼压。等级资料采用非参数独立样本U检验 (Mann -WhitneyTest) ,计量资料采用计量资料统计学方法。结果　术后二周时试验组和对照组DLK存在统计学差异 (P <0 0 5 ) ;角膜荧光素染色 ,试验组二周时恢复术前水平 ,对照组三月时尚未恢复术前水平 ;其他观察指标各时间段差异均无显著意义 (P >0 0 5 )。结论　LASIK术后短期应用强效激素 (一周 )即可获得预期临床效果 ,更有效预防DLK ,以避免长时间使用激素的副作用 ,同时方便患者使用提高治疗依从性     

标准治疗方案联合糖皮质激素对川崎病冠状动脉瘤发生率影响的Meta分析

目的评价标准治疗方案+糖皮质激素对川崎病(KD)冠状动脉瘤(CAA)发生率的影响。方法制定原始文献的纳入标准及检索策略,检索Medline、EMBASE、Cochrane图书馆、万方数据库、中国期刊全文数据库和中国维普数据库,检索时间均从建库至2010年6月。纳入标准治疗方案(大剂量IVIG+阿司匹林)+糖皮质激素对KD CAA发生率影响的相关文献。依据KD诊断标准、研究设计、冠状动脉影像学随访时间和冠状动脉检查是否采用盲法进行文献质量评价。计数资料采用相对危险度(RR)及其95%CI表示;计量资料采用加权均数差(WMD)及其95%CI表示。采用Stata11.0软件进行Meta分析。结果 7篇文献进入Meta分析,均为英文文献,其中4篇为RCT文献,3篇为回顾性对照研究。文献质量评价结果显示,评分2分3篇,5分1篇,6分3篇。Meta分析结果显示,标准治疗方案+糖皮质激素可显著降低CAA的发生率(RR=0.34,95%CI:0.13~0.89)。由于纳入文献间存在显著的异质性,进行亚组分析,显示研究设计(RCT和非RCT)、样本量(100和100)、糖皮质激素的类型(泼尼松龙和其他)是异质性产生的原因。RCT研究及样本量100文献的Meta分析结果显示,标准治疗方案+糖皮质激素未能显著降低CAA的发生率(RR分别为0.79和0.73,95%CI分别为0.43~1.43和0.42~1.28)。标准治疗方案+糖皮质激素可显著降低IVIG再治疗率(RR=0.48,95%CI:0.32~0.72),显著减少发热天数(WMD=-1.66d,95%CI:-2.58~-0.73d),对不良反应事件发生率无显著影响(RR=0.87,95%CI:0.35~2.16)。结论现有证据提示标准治疗方案+糖皮质激素未能显著降低CAA的发生率,可减少IVIG再治疗率和发热天数。     

白三烯受体拮抗剂对吸烟哮喘患者病情控制的影响

目的：探讨白三烯受体拮抗剂对吸烟哮喘患者病情控制的影响。方法：选取2013年3-12月在门诊就诊的110例吸烟哮喘患者,按照随机数字表法将其分为对照组54例和观察组56例。对照组给予吸入糖皮质激素（布地奈德）治疗,必要时吸入β2受体激动剂;观察组在此治疗基础上加用孟鲁司特钠治疗,疗程4周。观察比较两组治疗前后哮喘控制测试（ACT）评分、哮喘症状评分、晨间及夜间呼气峰流速（PEF）。结果：观察组治疗后ACT评分、晨间及夜间PEF%pred均明显高于治疗前及对照组,且哮喘症状评分明显低于治疗前及对照组,差异均有统计学意义（P〈0.05）。对照组治疗前后各项指标比较差异均无统计学意义（P〉0.05）。结论：白三烯受体拮抗剂能够使吸烟哮喘患者的病情控制得到改善,可能是治疗吸烟哮喘患者的一种有效药物。     

糖皮质激素对鼻息肉缺氧诱导因子-1α及血管内皮生长因子表达的影响

目的 探讨组织缺氧诱导因子-1α(HIF-1α）及血管内皮生长因子（VEGF）在鼻息肉组织中的表达及相关性, 探讨局部应用糖皮质激素类药物对鼻息肉的作用机制。方法 采用免疫组化SP法检测鼻息肉组织在应用丙酸氟替卡松鼻喷剂治疗前、后及下鼻甲HIF-1α及VEGF的表达变化。结果 鼻息肉组织中HIF-1α和VEGF的表达水平明显高于下鼻甲组织（P均＜0.01）;激素治疗后HIF-1α、VEGF表达下降(P＜0.05)。鼻息肉的发病与组织中HIF-1α、VEGF的表达呈明显正相关（r=0.627, P＜0.05）。结论 局部应用糖皮质激素可降低HIF 1α、VEGF的表达,有效治疗鼻息肉。     

右美托咪定在胃癌根治术中的临床应用研究

目的：观察不同剂量右美托咪定对胃癌根治术患者血流动力学及应激反应的影响。方法：选择90例全麻下行胃癌根治术的患者,随机分为三组（ C、D1和D2组）,每组30例。 C组为对照组,给予等量生理盐水;D1、D2组为右美组,于麻醉诱导前10min 内分别给予负荷剂量0．5μg/kg、0．8μg/kg,术中维持速度分别为0．5μg· kg-1· h-1、0．8μg· kg-1· h-1。记录三组病人：入室时（T0）、气管插管毕即刻（T1）、切皮时（T2）、进腹（T3）、手术开始后30min（T4）、术毕（T5）各时点心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、血浆皮质醇（Cor）和血糖（Glu）以及不良反应例数。结果：T1、T2、T3时点C组HR、SBP、DBP、MAP明显高于D1、D2组（ P＜0．05）;T5时点C组的Cor、Clu浓度高于D1、D2组（P＜0．05）。 C组各时点血流动力学波动明显（P＜0．05）,而D1、D2组波动不大（P＞0．05）。不良反应例数D2组多于D1组。结论：中等剂量右美0．5μg/kg更适用于胃癌根治术患者临床应用。