ObjectiveTo systematically review the clinical efficacy and safety of glucocorticoids, acetaminophen and antimicrobial drugs in the treatment of intrapartum fever in labor analgesia. MethodsThe PubMed, Embase, Cochrane Library, Web of Science, CBM, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of glucocorticoids, acetaminophen, and antimicrobial drugs for intrapartum fever in labor analgesia from inception to June 30, 2023. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included literature. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 10 RCTs involving 1 337 women were included. Meta-analysis showed that the use of glucocorticoids reduced the incidence of intrapartum fever in women with labor analgesia compared with the control group (OR=0.52, 95%CI 0.33 to 0.82, P<0.01). But there was no statistically significant difference between acetaminophen or antimicrobial drugs and the control group. ConclusionCurrent evidence shows that the use of glucocorticoids can reduce the incidence of intrapartum fever in labor analgesia, but the use of acetaminophen and antimicrobial drugs cannot reduce the incidence of intrapartum fever. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo prepare curcumin loaded monomethoxyl poly(ethylene glycol)-poly(lactic-co-glycolicacid) (mPEG-PLGA) nanopaticles (CUR-NPs), investigate the effect of curcumin (CUR) and CUR-NPs on reversing corticosteroid resistance induced by cigarette smoke extract (CSE), and compare biological function between CUR and CUR-NPs in macrophages RAW264.7.
MethodsmPEG-PLGA nanoparticles loaded with CUR were prepared via emulsion solvent evaporation.In lipopolysaccharide (LPS) stimulated macrophages RAW264.7, budesonide (BUD) was used to treat macrophages RAW264.7.In LPS and CSE stimulated macrophages RAW264.7, BUD (10-10-10-5 mol/L), CUR(10-10-10-5 mol/L), CUR(10-7 mol/L)+BUD(10-9-10-5 mol/L), CUR(10-9-10-5 mol/L)+BUD(10-7 mol/L), and CUR-NPs(10-9-10-5 mol/L)+BUD(10-7 mol/L) were respectively used to treat macrophages RAW264.7 activated.The level of IL-8 in cell culture supernatant was measured by ELISA.In CSE stimulated macrophages RAW264.7, CUR(10-7 and 10-6 mol/L) and CUR-NPs(10-7 and 10-6 mol/L) were used to treat macrophages RAW264.7.The mRNA level of HDAC2 was measured by real-time PCR, the protein level of HDAC2 was measured by Western blot.Cellular uptake of CUR and CUR-NPs in macrophages RAW264.7 was determined by cellular fluorescence intensity observed and detected by laser confocal microscopy imaging.
ResultsThe morphology of CUR-NPs was spherical and the mean particle size was (356.4±146.6)nm.Compared with LPS stimulation, co-stimulation of LPS and CSE led to a significant decrease in the maximum inhibitory rate of BUD on IL-8 (P < 0.05) and a significant increase in the 50% inhibitory concentration (IC50) of BUD on IL-8 (P < 0.05).When using LPS+CSE to stimulate, compared with BUD (10-10-10-5 mol/L) group, the maximum inhibitory rate of BUD in CUR (10-7 mol/L)+BUD (10-9-10-5 mol/L) group on IL-8 was significantly higher (P < 0.05) and the IC50 of BUD decreased significantly (P < 0.05).When using LPS+CSE to stimulate, CUR and CUR-NPs in 10-9, 10-8 and 10-7 mol/L concentration, the inhibitory rate of CUR-NPs+BUD (10-7 mol/L) on IL-8 was significantly higher than that of CUR+BUD (10-7 mol/L) (P < 0.05). CSE stimulation induced a significant decrease in the mRNA and protein expression of HDAC2. Compared with CSE group, the mRNA and protein levels of HDAC2 of CUR(10-7 and 10-6 mol/L) group and CUR-NPs(10-7 and 10-6 mol/L) group were significantly higher (P < 0.05).In 10-7 mol/L concentration, the mRNA and protein levels of HDAC2 in CUR-NPs group were significantly higher than those in CUR group.In 10-7 mol/L concentration, cellular uptake of CUR in CUR-NPs was significantly higher than the native CUR.
ConclusionsCUR and CUR-NPs can reverse the corticosteroid resistance induced by CSE.CUR-NPs can improve the cellular uptake of CUR.In the case of low concentration, CUR-NPs have more biological activity than CUR.
ObjectiveTo evaluate the effect of low-to-moderate doses of corticosteroids on human infections with avian influenza A (H7N9) virus, and explore when to initiate the treatment of corticosteroids and the duration of corticosteroids administration.MethodsThe study collected clinical data of 8 cases with avian influenza A (H7N9) virus infection admitted from January 25, 2017 to May 12, 2017. The final analysis included 5 severe patients who had received adjuvant corticosteroid treatment. The variation curves of WBC, CRP, PCT, CK, HBDH, LDH, temperature, ratio of SpO2/FiO2 were depicted and analyzed. The progress of clinical improvements, deterioration and prognosis were observed and discussed.ResultsThere were 1 female and 4 males in the 5 included patients with a median age of 58.0 years, among them 3 survived. The median time of illness onset to hospitalization and diagnosis confirmed were 4 days and 8 days respectively; the median duration of hospitalization to admission to infective ICU were 3 days. The first course of adjuvant corticosteroid treatment was initiated 11 days (median) after admission with a duration of 4 days (median), during which, the serum levels of HBDH and LDH decreased remarkably except the patient 3, and the oxygenation (SpO2/FiO2) improved except the patient 3. The second course of systemic administration of corticosteroid was given at a median of 26.5 days after admission with a duration of 9 days (median), during which, the patients survived with improved oxygenation (SpO2/FiO2), and weaned from mechanical ventilation.ConclusionsFor patients suffered severe human infection with avian influenza A (H7N9) virus, low-to-moderate doses of corticosteroids may decrease the level of inflammation, regulate the aberrant immune response, improve the oxygenation, make an early unassisted breathing. And corticosteroids treatment can be initiated at the time of disease deterioration, after/at the peak inflammatory response, and within 10-14 days of ARDS. Also, the adjuvant corticosteroids may be administered when oxygenation is dificult to be improved by other ways, or dificult to be liberated from mechanical ventilation, suffering severe septic shock, and refractory fever. And the duration of corticosteroids may be prolonged to 10-14 days, or until the higher level of HBDH and LDH decreased again.
Objective To investigate the clinical significance of low dose corticosteroid applied in early period after lung volume reduction surgery（LVRS）. Methods From Apr. 2001 to Mar. 2004, 27 patients with chronic obstructive pulmonary disease were undergone video-assisted unilateral LVRS assisted with mini-incision in our department were retrospectively reviewed. According to whether dispensed with postoperative corticosteroid or not, patients were divided into corticosteroid group and non-corticosteroid group. Corticosteroid group received dexamethasone 10mg iv tid for 3 days and then declined to prednisone 5mg qd for 7 days. Both groups were measured and compared the quantity of thoracic drainage flow, duration of chest tube drainage, the time of air leaks and fever, and so on. At same time, blood gas analysis and blood routine test were performed at 1, 3, 7 and 30 d after operation. Results Corticosteroid and non-corticosteroid groups had no statistically differences in the air leaks time （P 〉 0.05）, but the quantity of thoracic drainage flow of corticosteroid group was lower than that of non-corticosteroid group evidently （700±210ml vs. 950±150ml, P = 0.001）. There was significant difference in average duration of chest tube drainage between both groups （9±3 d vs. 12±2 d, P = 0. 05）. Compared with non-corticosteroidgroup, PaO2 of corticosteroid group was higher at 1, 3d after operation （P〈0.05）. The amount of blood leukocyte of corticosteroid group was lower than that of non-corticosteroid group at 3, 7d after operation, there was no statistically significant in two groups （P 〉 0. 05）. At early period after surgery, both groups had no significant infection and death patient. Conclusion The low dose corticosteroid applied in early period after LVRS for short time（10 days in this research） could shorten the duration of chest tube drainage, decrease the quantity of thoracic drainage flow and the extent of inflammation in pleural cavity. In the mean time, this treatment does not increase the occurrence of significant complications during the early postoperative period, and there is no negative influence to the blood gas analysis.
Objective
To evaluate the methodological and reporting quality of systematic reviews/meta-analyses related to the efficacy and safety of corticosteroid-assisted treatment for severe pneumonia.
Methods
PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data and VIP databases were searched by computer, and the systematic reviews/meta-analyses of corticosteroid hormone as an auxiliary means for the treatment of severe pneumonia which were published from establishment of the databases to October 25th, 2018 were searched. A Measurement Tool to Assess Systematic Review-2 (AMSTAR-2) was used to assess the methodological quality of the included studies, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to evaluate the quality of literature reports.
Results
A total of 16 systematic reviews/meta-analyses were included, all of which were non-Cochrane systematic reviews. In terms of methodological quality assessed by AMSTAR-2, there was no plan in all studies; only one study explained the reasons for inclusion in the study type; eight studies did not describe the dose and follow-up time of the intervention/control measures in detail; three studies did not indicate the evaluation tools and did not describe the risk bias; six studies did not explicitly examine publication bias. In terms of reporting quality assessed by PRISMA, all studies had no pre-registered study protocol or registration number; thirteen studies did not describe the specific amount of articles retrieved from each database; three studies did not present their retrieval strategies or excluded reasons in detail; no funding sources were identified in included studies; eight studies reported both whether the study was funded and whether there was a conflict of interest.
Conclusions
At present, there are many systematic review/meta-analysis studies on the efficacy and safety of corticosteroid-assisted treatment for severe pneumonia, and the overall quality of the study has been gradually improved. However, the common problems in the study are relatively prominent. The follow-up period and dose of intervention in the study of severe pneumonia are different, so the baseline is difficult to be unified. Suggestions: strengthening the training of researchers, standardize the research process, and report articles in strict accordance with the PRISMA statement; subgroup analysis being conducted according to the dose and duration of the hormone.
Objective To formulate an evidence-based treatment for a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Methods According to the principles of evidencebased clinical practice, we searched The Cochrane Library (Issue 2, 2008), Ovid-Reviews (1991 to 2008), MEDLINE (1950 to 2008), and http://www.guideline.org. to identify the best evidence for treating a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Results Nine guidelines, 2 systematic reviews, and 11 randomized controlled trials were included. The evidence showed that corticosteroids could help reduce the risk of death and disabling residual neurological deficiencies in patients with tuberculous meningitis. After adjusting for age and gender, the overall death rate of patients with tuberculous pericarditis was significantly reduced by prednisolone (P=0.044), as well as the risk of death from pericarditis (P=0.004). But for patients with pulmonary tuberculosis, there was still a controversy about the use of corticosteroids. Given the evidence, the patient’s clinical conditions, and his preferences, dexamethasone was used for the boy in question. After 7 weeks of treatment, his cerebrospinal fluid returned to normal and pericardial effusion disappeared. Conclusion Corticosteroids should be recommended in HIV-negative people with tuberculous meningitis or/and tuberculous pericarditis. The difference in the effectiveness of various corticosteroids such as dexamethasone, prednisolone, or methylprednisolone and the optimal duration of corticosteroid therapy is still unknown.
Objective To analyze the risk factors for postoperative cognitive confusion in a surgical intensive care unit. Methods A total of 388 consecutive patients in Surgical Intensive Care Unit of General Hospital of PLA were retrospectively studied. We posed clinical questions according to the patients with older age and large dosage corticosteroid. Using “Postoperative cognitive confusion” and“Intensive Care” as key words, we searched for evidence from MEDLINE (1968-2004). Results We found 3.1% (10/388) of the patients developed postoperative cognitive confusion. Of the 10 postoperative cognitive confusion patients, 9 were over 65 years old. 6.6% (9/136) of the patients (≥ 65 years old) developed postoperative cognitive confusion. While 0.4%(1/252) of the patients (＜65 years old) developed postoperative cognitive confusion. Older age (≥ 65 years old) may induce more postoperative cognitive confusion (P＜0.05). While 7.0% (5/71) of the patients treated by large dose corticosteroids (≥1 000 mg) developed postoperative cognitive confusion. And 1.65% (5/317) of the patients received corticosteroid with large dosage (＜1 000 mg) developed postoperative cognitive confusion. Large dosage corticosteroid (≥1 000 mg) may induce more postoperative cognitive confusion (P＜0.05). Conclusion Older age (≥ 65 years old) and high dose corticosteroid (≥1 000 mg) may be the two main risk factors for postoperative cognitive confusion.
Objective To systematically evaluate the effect and safety of systemic corticosteroids for acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 6, 2015), Wanfang Data, CBM, CNKI were searched to collect randomized controlled trails (RCTs) about systemic corticosteroids for acute exacerbation of COPD from inception to July 2015. The meta-analysis was conducted using RevMan 5.3 software. Results A total of 11 RCTs involving 1298 patients were included. The results of meta-analysis showed that a statistically significant increase in the treatment success rate when using systemic corticosteroids (RR=1.11, 95%CI 1.01-1.21,P=0.02), and a non-significant difference of effect in the subgroup of emergency department and ICU patients (RR=0.98, 95%CI 0.90-1.08,P=0.74;RR=1.19, 95%CI 0.84-1.69,P=0.34). Conclusions Current studies suggest that systemic corticosteroids is beneficial in terms of treatment success rate, but subgroup analysis shows that this benefit is controversial in emergency department and ICU. however, due to the limited quantity of the included studies, the above conclusions still need more high quality research to be verified.
