Managing Vogt–Koyanagi–Harada disease during pregnancy with steroid pulse therapy:A case report

BACKGROUND High-dose steroid administration is a common initial therapeutic approach for Vogt–Koyanagi–Harada disease(VKH).Nonetheless,administering substantial doses of steroids to pregnant women necessitates meticulous consideration due to the potential impacts on the mother and fetus.We present a case wherein steroid pulse therapy was administered to a patient who developed VKH during the late stages of pregnancy.CASE SUMMARY The patient was a 26-year-old nulliparous woman.At 33 weeks and 1 day of her pregnancy,she experienced a decline in visual acuity and noticed metamorphopsia in her left eye.Examination revealed bilateral serous retinal detachment,leading to VKH diagnosis.A collaborative effort involving the departments of ophthalmology,internal medicine,and neonatology was initiated.Steroid pulse therapy was administered at 34 weeks and 1 day of pregnancy under hospital supervision.Complications,such as threatened preterm labor and gestational diabetes,emerged,necessitating the initiation of oral ritodrine hydrochloride and insulin therapy.Then,serous retinal detachment was resolved,and visual acuity was restored.Labor pains initiated 32 days post-initiation of steroid pulse therapy(at 38 weeks and 4 days of gestation),culminating in a normal delivery.Mother and newborn experienced an uneventful puerperal course and were discharged from the hospital on the 5th day following delivery.CONCLUSION VKH management in pregnancy requires multidisciplinary coordination,emphasizing collaboration with ophthalmologists and specialists in internal medicine and neonatology.

Systematic review and meta-analysis of the efficacy and safety of immunosuppressive pulse therapy in the treatment of paraquat poisoning

Paraquat(PQ),a highly effective herbicide,is widely used worldwide.PQ poisoning can cause multiple organ failure,in which the lung is the primary target organ.After PQ poisoning,the patient mortality rate is as high as 90%,and there is currently no specific antidote.The main clinical treatment is the use of glucocorticoids and cyclophosphamide for pulse therapy,but its effectiveness and safety are still uncertain.We investigated the effectiveness and safety of immunosuppressive pulse therapy with glucocorticoids and cyclophosphamide to evaluate the treatment value in patients with acute PQ poisoning.This meta-analysis,combined with seven trials that enrolled a total of 426 patients,showed that immunosuppressive pulse therapy with glucocorticoids and cyclophosphamide for PQ poisoning significantly reduced mortality of the study group(59.3%,134/226) compared with the control group(81.0%,162/200).There was no significant difference of hepatitis or renal failure between the control and study groups,indicating that immunosuppressive pulse therapy was relatively safe.Several patients were reported to have leukopenia and returned to normal after 1-2 weeks without any abnormalities.Two cases of non-fatal sepsis were reported and considered to be a side effect of the immunosuppressive pulse therapy.Thus,immunosuppressive pulse therapy can efficiently reduce the mortality of PQ poisoning and it is relatively safe.

Defect-rich titanium nitride nanoparticle with high microwaveacoustic conversion efficiency for thermoacoustic imaging-guided deep tumor therapy

Pulse microwave excite thermoacoustic(TA)shockwave to destroy tumor cells in situ.This has promising applications for precise tumor therapy in deep tissue.Nanoparticle(NP)with high microwave-acoustic conversion is the key to enhance the efficiency of therapy.In this study,we firstly developed defect-rich titanium nitride nanoparticles(TiN NPs)for pulse microwave excited thermoacoustic(MTA)therapy.Due to a large number of local structural defects and charge carriers,TiN NPs exhibit excellent electromagnetic absorption through the dual mechanisms of dielectric loss and resistive loss.With pulsed microwave irradiation,it efficiently converts the microwave energy into shockwave via thermocavitation effect,achieving localized mechanical damage of mitochondria in the tumor cell and yielding a precise antitumor effect.In addition to the therapeutic function,the NP-mediated TA process also generates images that provide valuable information,including tumor size,shape,and location for treatment planning and monitoring.The experimental results showed that the TiN NPs could be efficiently accumulated in the tumor via intravenous infusion.With the deep tissue penetration characteristics of microwave,the proposed TiN-mediated MTA therapy effectively and precisely cures tumors in deep tissue without any detectable side effects.The results indicated that defect-rich TiN NPs are promising candidates for tumor therapy.