Objective
To observe the level of vitamin D in patients with steroid resistant (SR) asthma, and investigate the effect of 1,25-(OH)2D3 on JNK/AP-1 and glucocorticoid receptor of T lymphocytes in SR asthmatics.
Methods
Sixty-two outpatients and inpatients with asthma with acute exacerbation between 2014 and 2015 were recruited in the study, including 26 cases of steroid sensitive (SS) asthmatics and 36 cases of SR asthmatics. Meanwhile 25 healthy volunteers were recruited as control. Clinical data were collected and peripheral venous blood was sampled for measuring the level of 25-(OH)D and separating the T lymphocytes. T lymphocytes were assigned to six groups, ie. a healthy control group (Group A), a SS asthmatics control group (Group B), a SR asthmatics control group (Group C), a SR asthmatics with JNK inhibitor (SP600125)+1,25-(OH)2D3 group (Group D), a SR asthmatics with JNK inhibitor (SP600125) group (Group E), and a SR asthmatics with 1,25-(OH)2D3 group (Group F). T lymphocytes were cultured for 48 hours. By the end of culture, the expression of phospho-JNK (p-JNK) and phospho-glucocorticoid receptor (p-GR) of T lymphocytes were detected by Western blot method, and the expression of c-Jun mRNA was detected by RT-PCR method.
Results
The level of 25-(OH) D was lower in Group B and Group C than Group A (P<0.05), and lower in Group C than Group B (P<0.05). The level of p-JNK was higher in Group B and Group C than Group A (P<0.05), higher in Group C than Group B (P<0.05), lower in Group E and Group F than Group C (P<0.05), lower in Group D than Group F (P<0.05). The level of p-GR was lower in Group C than Group A and Group B (P<0.05), higher in Group E and Group F than Group C (P<0.05), higher in Group D than Group F (P<0.05). The level of c-Jun mRNA was higher in Group B and Group C than Group A (P<0.05), higher in Group C than Group B (P<0.05), lower in Group E and Group F than Group C (P<0.05), and lower in Group D than Group F (P<0.05). The 25-(OH) D level was negatively correlated with the expression of p-JNK and c-Jun mRNA in Group C (r=–0.69, r=–0.65, P<0.05). However, there was a positive correlation between the 25-(OH) D level and p-GR (r=0.72, P<0.05).
Conclusions
There is a high prevalence of vitamin D deficiency or lack in SR asthmatics. 1,25-(OH)2D3 can promote the expression of p-GR by inhibiting the JNK/AP-1 signaling pathway of T lymphocytes in SR asthmatics, which may be one of the mechanisms of vitamin D to improve glucocorticoid resistance in SR asthmatics.
ObjectiveTo observe the clinical characteristics and treatment prognosis of patients with ocular toxocariasis (OT). MethodsA retrospective clinical trial. From March 2018 to September 2021, 40 eyes of 40 OT patients diagnosed by ophthalmic examination in the First Affiliated Hospital of Zhengzhou University were included in the study. All patients underwent best corrected visual acuity (BCVA) and scanning laser ophthalmoscope (SLO) examination. Color Doppler ultrasound flow imaging (CDFI), fluorescein fundus angiography (FFA) and optical coherence tomography (OCT) were performed in 25, 26 and 26 eyes, respectively. Among the 40 patients, there were 23 males (57.5%, 23/40) and 17 females (42.5%, 17/40). All patients were monocular. Thirty patients (75.0%, 30/40) were younger than 18 years old, with the mean age of (9.60±0.60) years. Ten patients (25.0%, 10/40) were great than or equal to 18 years old, with the mean age of (34.60±4.52) years. Thirty-three patients (82.5%, 33/40) lived in rural areas for a long time. There were 27 patients (67.5%, 27/40) with a history of contact with dogs and cats. In 40 eyes, peripheral granuloma (peripheral type), posterior pole granuloma (posterior pole type), vitreous opacity similar to endophthalmitis (turbid type) and hybrid type were 18(45.0%, 18/40), 11(27.5%, 11/40), 6(15.0%, 6/40) ang 5(12.5%,5/40), respectively. All patients were treated with drugs and/or surgery after definite diagnosis. There were 28 eyes of peripheral type, posterior pole type and hybrid type, 17 eyes were treated with surgery and 11 eyes with drug treatment, respectively. Five eyes with turbid type were only treated with drugs. In 40 patients, 33 patients participated in follow-up. The follow-up time after treatment was (18.78±9.44) months. The improvement of BCVA was observed. The number of eyes with different BCVA before and after treatment was compared by χ2 test or Fisher's test. ResultsAt the first visit, the BCVA ranged from light perception to 0.6, including 20 eyes with BCVA ＜0.1, 13 eyes with BCVA 0.1-0.3, and 7 eyes with BCVA ＞0.3. The posterior vitreous anterior limiting membrane was thickened in 24 eyes (60.0%, 24/40). There were 27 eyes (67.5%, 27/40) with lamellar vitreous opacity and 22 eyes (55.0%, 22/40) with peripheral/posterior pole granulomas. Among 25 eyes examined by CDFI, 14 eyes (56.0%, 14/25) showed characteristic stratified or diffuse opacity in vitreous body. Of the 26 eyes examined by FFA, 15 eyes (57.7%, 15/26) had "fern-like" leakage of retinal capillaries, and the lesion had a patchy non-perfused area. In 26 eyes examined by OCT, epiretinal membrane, cystoid macular edema and vitreoretinal traction were 8 (30.8%, 8/26), 5 (19.2%, 5/26) and 2 (7.7%, 2/26) eyes, respectively. At the last follow-up, compared with before treatment, the BCVA of 5 eyes with turbid type increased, and the difference was statistically significant (P＜0.05). In 28 eyes with peripheral type, posterior pole type and hybrid type, 17 eyes with surgical treatment improved BCVA, and the difference was statistically significant (χ2=6.258, P＜0.05). In 11 eyes only treated with drugs, BCVA remained unchanged, and the difference was not statistically significant (χ2=0.594, P＞0.05). ConclusionsOT patients are mostly children; retinal granulomas, gray-white hyperplastic membrane behind lens or vitreous stratified opacity are specific characteristics. OT is mainly treated by glucocorticoid drugs and vitrectomy.
PURPOSE: To investigate the treatment of severe bacterial endophthalmitis. METHODS:The curative effects of vitrectomy after intravitreal antibiotics and steroids (IVAS)for the treatment of 23 patients with bacterial endophthalmitis
(group I)and vitrectomy and IVA at the same time for the treatment of 28 patients with bacterial endopbthalmitis (group I)were analyzed retrospectively. RESULTS: The rate of curative effects of two groups were similar,while the marked curative effects in group I (47.8% )was significantly higher than that of the group I (17.9%). The average period of eliminating infiamation of group I was longer than that of group I , and the incidence of postoperative retinal detachment of group Ⅱ was 3 times more than that of group I . CONCLUSION :It was indicated that vitrectomy after IVAS may increase the security of vitrectomy and the curative effects of severe bacterial ndophthalmitis.
In recent years, with the development of neuroimaging and the improvement of people’s awareness, the incidence of cerebral venous sinus thrombosis (CVST) has been increasing year by year. CVST with venous infarction or haemorrhage is severe, accounting for about 60% of CVST, and its clinical manifestations are serious. The current therapies including anticoagulation and intravascular treatment have not significantly improved the prognosis of severe CVST patients. The incidence of long-term poor prognosis (modified Rankin scale score≥2) is up to 56.1%. Recent research indicates that inflammation may be an important factor leading to severe CVST and is significantly associated with poor prognosis. Anti-inflammatory treatment with glucocorticoids may provide a novel method for severe CVST, but further clinical studies are needed to verify it. This paper introduces the relationship between inflammation and severe CVST in order to explore the feasibility of glucocorticoid for severe CVST.
Objective?To investigate the effect of glucocorticoid on the expression levels of osteoprotegerin (OPG)/receptor activator of nuclear factor kappa B ligand (RANKL)-matrix metalloproteinases (MMP)/tissue inhibitor of matrix metalloproteinase (TIMP) system in bone tissues of femoral head of rats, and to discuss its interrelated action mechanism in glucocorticoid-induced avascular necrosis of femoral head (ANFH).?Methods?Forty adult Sprague Dawley rats, weighing 250-300 g, half males and half females, were randomly divided into 4 groups: high dose glucocorticoid group (HD, n=10), medium dose glucocorticoid group (MD, n=10), low dose glucocorticoid group (LD, n=10), and control group (n=10). The rats in HD group, MD group, and LD group were intramuscularly injected with 25.0, 12.5, and 7.0 mg/kg of prednisolone respectively, and the rats in the control group were injected with physiological saline. After 4 weeks intervention, the osteonecrosis of left femoral heads was observed by HE staining, total RNA was extracted from the right femoral head bone tissue and the mRNA expression levels of OPG, RANKL, MMP-2, MMP-9, TIMP-1, and TIMP-2 were detected by RT-PCR.?Results?After injection of prednisolone, 4 rats of HD group and 1 rat of MD group died of systemic failure caused by the decreased food and weight culminating in cachexia. HE staining showed that the integrity of bone trabecula and osteon was destroyed at different levels, discontinuous bone chips formed, and osteocytes were replaced by granulation tissue in some lacunae in HD, MD, and LD groups; the integrated osteon was observed, the lamellar structure formed concentric circles around the blood vessel and osteocytes were seen in the lacunae in the control group. The necrosis rates of femoral head were 83.3% (5/6), 66.7% (6/9), 30.0% (3/10), and 0 (0/10) in HD, MD, LD, and control groups. The results of RT-PCR showed: the mRNA expression levels of the OPG, TIMP-1, TIMP-2 in HD, MD, and LD groups were lower than those in the control group, showing significant differences (P lt; 0.05) and there was negative correlation with the hormone dosage. The difference in OPG expression was significant between the hormone groups (P lt; 0.05); the differences in the TIMP-1 and TIMP-2 expressions were not significant between the LD group and MD group (P gt; 0.05), but there were significant differences when compared with HD group (P lt; 0.05). The RANKL, MMP-2, and MMP-9 mRNA expression levels in HD, MD, and LD groups were higher than those in the control group and there was a positive correlation with the hormone dosage, showing significant differences when compared MD and HD groups with control group (P lt; 0.05); there was no significant difference in RANKL expression between HD group and MD group (P gt; 0.05), but there was significant difference when compared HD and MD groups with LD group (P gt; 0.05); no significant difference was observed in the MMP-2 and MMP-9 expression between MD group and LD group (P gt; 0.05), but the differences were significant when compared with HD group (P lt; 0.05).?Conclusion?Glucocorticoid-induced ANFH may be related to the expression levels of OPG/RANKL-MMP/TIMP mRNA regulated by glucocorticoid.
ObjectiveTo analyze the phasic changes of bone mass, bone turnover markers, and estrogen levels at different time points after glucocorticoid (GC) intervention in rat and their correlation.
MethodsThirty-four female 3-month-old Sprague Dawley rats were randomly divided into the following 3 groups:baseline group (n=6), dexamethasone (DXM) group (n=14), and control group (n=14). Rats were injected with DXM at the dose of 0.75 mg/kg, twice a week for 12 weeks in DXM group, with salt solution lavage in control group, and no treatment was given in baseline group. The body mass, adrenal weight, and uterus weight were measured. Bone mineral density (BMD), bone mineral content (BMC), and bone area (BA) of lumbar vertebral and femurs were detected by dual energy X-ray absorptiometry. Meanwhile, the serum levels of N-terminal propeptide of type I procollagen (PINP), C-terminal cross-linking telopeptide of type I collagen (β-CTX), and estrogen levels were determined by ELISA before experiment in baseline group and at 4, 8, and 12 weeks after experiment in control and DXM groups. At last, the correlation was analyzed among body weight, BMD, PINP, β-CTX, estrogen levels, and GC intervention duration of DXM group.
ResultsThe body mass, adrenal weight, and uterus weight in DXM group were significantly lower than those in baseline group and control group at all the time points (P<0.05). The levels of PINP and β-CTX elevated slowly in DXM group, significant difference was found at 12 weeks (P<0.05), but no significant difference at the 4 and 8 weeks (P>0.05) when compared with those in baseline group and control group. The estrogen level in DXM group was significantly lower than that in baseline group and control group at all the time points (P<0.05). BMD, BMC, and BA of lumbar vertebral and femurs in DXM group were significantly lower than those in control group at all the time points after GC intervention (P<0.05). Loss of bone mass of L2 and femoral trochanteric region in DXM group was the lowest of all ranges of interest (ROIs). BMC and BA of lumbar vertebrae and BA of femoral shaft in DXM group at 4 weeks were significantly lower than those in baseline group (P<0.05). But there was no significant difference in BMD, BMC, and BA of other lumbar vertebrae and femurs' ROIs between DXM group and baseline group at all the time points (P>0.05). After GC intervention, BMD of lumbar vertebrae and femurs had negative correlation with PINP and β-CTX (P<0.05) and positive correlation with estrogen level (P<0.05).
ConclusionThe bone mass decreases rapidly at the early stage after GC intervention and then maintains a low level with time, the levels of bone turnover markers show a progressive increase, and the estrogen levels show a decrease trend. In addition, body weight, the levels of bone turnover markers and estrogen are associated with the change of bone mass.
ObjectiveTo evaluate the efficacy and safety of bisphosphonates in preventing and treating glucocorticoid induced osteoporosis.
MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), CNKI, WanFang Data and VIP were searched to collect randomized controlled trials (RCTs) related bisphosphonates for the prevention and treatment of glucocorticoid induced osteoporosis from inception to January 2016. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Meta-analysis was performed using RevMan 5.3 software.
ResultsA total of 20 RCTs were included, which involved 2 330 patients. The results of meta-analysis showed that, compared with the placebo group, the bisphosphonates group could significantly increase the bone mineral density (BMD) at lumbar and femoral neck (MD=3.70, 95%CI 2.65 to 4.75, P<0.000 01; MD=2.18, 95%CI 1.30 to 3.06, P<0.000 01), but the bisphosphonates group could not decrease the incidence rates of vertebral fracture or non-vertebral fracture (OR=0.66, 95%CI 0.38 to 1.16, P=0.15; OR=0.73, 95%CI 0.42 to 1.28, P=0.28). There were no significant differences in the incidence rates of total adverse reactions and total severe adverse reactions between the two groups (OR=0.89, 95%CI 0.62 to 1.28, P=0.53; OR=0.93, 95%CI 0.62 to 1.39, P=0.72).
ConclusionCurrent evidence shows that, compared with placebo, bisphosphonates canld effectively prevent and treat the decrease of bone mineral density of glucocorticoid induced osteoporosis, not decrease the incidence of fracture, but not increase the incidence of adverse reactions.
ObjectiveTo explore the clinical characteristics of idiopathic hypereosinophilic syndrome (IHES), and improve the early diagnosis and treatment of such diseases.MethodsThe clinical diagnosis and treatment data were retrospectively analyzed from the patients with confirmed IHES hospitalized in China-Japan Friendship Hospital between September 2010 to May 2018.ResultsFifteen patients were included. There were 3 women and 12 men in the study, with an average age of 53.7±21.3 years. Eleven patients had respiratory problems, with an average course of 7 months. Most lesions occurred in both lungs. Patchy distribution, ground glass opacity, pleural effusion and mediastinal lymph node enlargement were common in the chest computed tomography. Serum total IgE was significantly increased. Four patients had other systems involved rather than respiratory system. One of them had digestive problems and another 3 had skin diseases. There was a significant increase in eosinophils in peripheral blood, bone marrow and histopathology, the same as eosinophils in sputum, pleural effusion, and bronchoalveolar lavage fluid. Hypoxemia was common in patients with respiratory problems. The blood eosinophil and total IgE were reduced after glucocorticoid treatment, and the hypoxemia was significantly improved.ConclusionsThe clinical symptoms, signs and image of chest computed tomography are not specific in IHES, so the rate of misdiagnosis and wrong diagnosis is high. This disease involves many organs or systems, so the pathological examination should be completed as soon as possible to make a clear diagnosis to prevent further damage. Glucocorticoid treatment is effective in this disease.
Objective To explore the value and clinical safety of low-dose dexamethasone used after operation of anastomotic colorectal resection with fast-track surgery in patients with colorectal cancer. Methods Between January 2008 and December 2009, 470 patients undergoing anastomotic colorectal resection were analyzed retrospectively, who were divided into dexamethasone group and control group according to the use of low-dose dexamethasone treatment or not after operation. Postoperative adverse effect, complications, and early rehabilitations were studied. Results There was no statistical significance in postoperative incidence of adverse effect or complications between two groups (Pgt;0.05). In early rehabilitation, first ambulation of patients in the dexamethasone group was significantly earlier than that in the control group (Plt;0.05), while there was no statistical significance in first time of passing flatus, stool, and oral intake, the retain time of nasogastric tubes, urinary catheter, and drains, and postoperative hospital stay (Pgt;0.05). Conclusion Using low-dose dexamethasone after operation anastomotic colorectal resection in patients with colorectal cancer is safe and may have potential to enhance recovery after operation.
ObjectiveTo compare and observe the fundus imaging characteristics of eyes with glucocorticoid-related central serous chorioretinopathy (CSC). MethodsA retrospective clinical study. A total of 149 CSC patients with 166 eyes diagnosed at Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University from March 2021 to October 2024 were included in the study. The duration of the disease from the appearance of symptoms to treatment was less than 3 months. All affected eyes underwent best-corrected visual acuity (BCVA), fundus color photography, swept-source optical coherence tomography (SS-OCT), and fundus fluorescein angiography (FFA) examinations. BCVA was tested using an international standard vision chart and converted into logarithm of the minimum angle of resolution (logMAR) visual acuity for statistical analysis. The SS-OCT instrument measured subfoveal choroidal thickness (SFCT), central macular thickness (CMT), choroidal vascular volume (CVV), and the width and height of flat irregular pigment epithelial detachment (FIPED). FIPED, subretinal fibrin, and choroidal layer strong reflective spots were identified from SS-OCTA B-scan images; multiple leakages (leak points >3) were identified from FFA images. Based on the presence or absence of a clear history of glucocorticoid administration before the onset, patients were divided into glucocorticoid-related and non-glucocorticoid-related groups, comprising 41 patients with 53 eyes and 108 patients with 113 eyes, respectively. Clinical and fundus imaging characteristics of the two groups were compared. The comparison of quantitative data between the two groups was performed using independent samples t test or non-parametric independent samples Wilcoxon test; the comparison of qualitative data was performed using χ2 test. ResultsCompared with the non-glucocorticoid-related group, the glucocorticoid-related group had a smaller male-to-female ratio and a higher bilateral incidence, and the differences were statistically significant (χ2=4.925, 17.849; P＜0.05). The logMAR BCVA for the glucocorticoid-related and non-glucocorticoid-related groups were 0.45±0.33 and 0.21±0.21, respectively; SFCT were (644.43±131.91) and (507.26±121.79) μm; CMT were (389.51±233.45) and (362.59±140.85) μm; CVV were (4.44±1.07) and (3.67±0.82) mm3; FIPED incidence were 58.49% (31/58) and 20.35% (23/113), respectively; FIPED width and height were (1 122.01±533.98) and (742.90±388.79) μm, and (99.13±92.17) and (33.01±15.99) μm; subretinal fibrin were observed in 24 (45.28%, 24/53) and 15 (13.27%, 15/113) eyes; choroidal strong reflections were found in 38 (71.70%, 38/53) and 45 (39.82%, 45/113) eyes; multiple leak points were identified in 35 (66.03%, 35/53) and 40 (35.40%, 40/113) eyes, respectively. Compared with the non-glucocorticoid-related group, the glucocorticoid-related group had worse BCVA (Z=?4.984), thicker SFCT (t=6.586), larger CVV (t=5.160), higher incidence of FIPED (χ2=23.908), and greater width and height of FIPED (t=2.895, Z=?3.703). The glucocorticoid-related group also had a significantly increased incidence of subretinal fibrin, choroidal strong reflections, and multiple leak points, with all differences being statistically significant (χ2=20.565, 14.663, 13.675; P＜0.05); however, the comparison of CMT showed no statistically significant difference (Z=?0.651, P＞0.05). ConclusionCompared with non-glucocorticoid-related CSC, glucocorticoid-related CSC patients have poorer vision, are more likely to affect both eyes, show no gender bias; choroidal vascular dilation is more significant, and damage to the outer retina and retinal pigment epithelium is more severe.
