<span style="font-family:Verdana;">Based on Russian and the Middle East corticosteroids trials in MERS-CoV, we performed methylprednisolone pulse therapy (MPT), resulting in a clinical trial still with...<span style="font-family:Verdana;">Based on Russian and the Middle East corticosteroids trials in MERS-CoV, we performed methylprednisolone pulse therapy (MPT), resulting in a clinical trial still without result. Our previous cohort (not compared n = 18) showed 76% of MPT patients did not progress to orotracheal intubation as MTP blocked the cytokine storm, a lower result compared to Tehran’s study explained by performing MPT in any lung phase. The Middle East study had been carried out during the initial lung phase. We are in an international emergency. Considering previous protocols and clinical practice, we understand that MPT must be used in COVID-19, and the indication to avoid going to the hospital when the first symptoms appear should be changed urgently for the population with inflammatory comorbidities. This article aims </span><span style="font-family:Verdana;">to: 1) show the Iranian protocol to reduce deaths and intubations b</span><span style="font-family:Verdana;">y COVID-19;2) present a possible approach to the patient COVID-19 with methylprednisolone pulse and strict criteria for orotracheal intubation to avoid hypoxemia;3) highlight that there is already a protocol that can be an international guideline-based on the Iranian work for the treatment of COVID-19;and 4) argue that corticosteroids are not controversial, but their use in a period outside the best timing period makes it controversial;and 5) emphasise the urgency of modifying the current protocol that postpones the visit of patients to the hospital in case of symptoms, since late hospital evaluation has been catastrophic for a world population.展开更多
Background: Intravenous methylprednisolone pulse therapy has been used since the late 1960s for acute transplant rejection or severe renal involvement in systemic lupus erythematosus and primary glomerulonephritis. Ho...Background: Intravenous methylprednisolone pulse therapy has been used since the late 1960s for acute transplant rejection or severe renal involvement in systemic lupus erythematosus and primary glomerulonephritis. However, reports of serious adverse effects such as life-threatening cardiac arrhythmias and sudden death raise questions about its safety. Objective: To investigate the incidence of significant adverse effects associated with low-dose methylprednisolone pulse therapy (LDMPT) in pediatric patients. Methods: We retrospectively analyzed adverse effects during and after LDMPT in 68 patients (median age: 11.4 years;43% male) with various glomerular diseases who were admitted to Saitama Children’s Medical Center between April 2007 and December 2010. LDMPT consisted of pulse methylprednisolone (15-20 mg/kg;maximum 600 mg/d) for 3 consecutive days weekly for 2-3 weeks. Results: Although adverse effects occurred in 54 of 68 patients (79%), most were mild and transient. Transient glycosuria was noted in 46 patients (68%), hypertension in 6 (9%), elevated intraocular pressure in 6 (9%), hypokalemia in 5 (7%), and liver damage in 2 (3%). No late-onset adverse effects such as osteoporotic fractures, steroid diabetes mellitus, or short stature were observed. Conclusion: LDMPT appears to be relatively safe and well tolerated in children with various glomerular diseases.展开更多
Although the administration of systemic steroid for nonsegmental vitiligo in the progressive stage is a recommended treatment according to guidelines, the clinical efficacy of this regimen has not been fully establish...Although the administration of systemic steroid for nonsegmental vitiligo in the progressive stage is a recommended treatment according to guidelines, the clinical efficacy of this regimen has not been fully established. In this study, we evaluated the clinical efficacy of half-dose steroid treatment and stratified the evidence regarding its usefulness in progressive vitiligo patients. Half-dose steroid pulse therapy (500 mg/day of methylprednisolone for three sequential days) was administered intravenously three times monthly in five vitiligo patients. The visual changes in vitiligo lesions were evaluated on photographs and quantified using a spectrophotometer. As results, all patients completed three cycles of treatment without severe adverse events. Three of the five patients achieved disease arrest with decrease in white contrast. Therefore, short-term and halfdose steroid therapy is well tolerated and effective for achieving disease arrest in progressive nonsegmental vitiligo. The whiteness assessed by a spectrophotometer is possibly associated with therapeutic response to steroid therapy.展开更多
Background Our previous study had demonstrated that ulinastatin （UTI） had a neuroprotective effect in experimental autoimmune encephalomyelitis （EAE）. Methylprednisolone has been recommended to be a standard drug ...Background Our previous study had demonstrated that ulinastatin （UTI） had a neuroprotective effect in experimental autoimmune encephalomyelitis （EAE）. Methylprednisolone has been recommended to be a standard drug in multiple sclerosis （MS） therapies. The present study was to investigate the protective effects of UTI combined methylprednisolone in EAE. Methods Mice were divided into a UTI treatment group, a methylprednisolone treatment group, a combined treatment group with UTI and methylprednisolone, a normal saline treatment group, and a normal control group. EAE mice were induced in groups receiving different combined treatments, or respective monotherapies. Demyelination was evaluated by Solochrome cyanin staining. 2＇,3＇-cyclic nucleotide 3＇- phosphodiesterase （CNP）/myelin basic protein （MBP）/the precursor form of nerve growth factor （proNGF）/p75/inducible nitric oxide synthase （iNOS） proteins in cerebral cortex of EAE were detected by Western blotting. Results The combined treatment group had a lower clinical score （0.61±0.06） and demyelinating score （1.33±0.33） than the groups with normal saline （clinical score： 1.39±0.08, P 〈0.001; demyelinating score： 2.75±0.49, P 〈0.05） or monotheraphies. Compared with the saline treated EAE group, UTI combined methylprednisolone significantly increased expressions of CNP （1.14±0.06 vs. 0.65±0.04, P 〈0.001）, MBP （1.28±0.14 vs. 0.44±0.17, P 〈0.001）, and decreased expressions of proNGF （1.08±0.10 vs. 2.32±0.12, P 〈0.001）, p75 （1.13±0.13 vs. 2.33±0.17, P 〈0.001）, and iNOS （1.05±0.31 vs. 2.17±0.13, P 〈0.001） proteins in EAE. Furthermore, UTI combined methylprednisolone could significantly upregulate MBP （1.28±0.14 vs. 1.01±0.15, P 〈0.05） expression and downregulate iNOS （1.05±0.31 vs. 1.35±0.14, P 〈0.05） expression compared to methylprednisolone treatment EAE group. And proNGF expression was significantly lower in combined treatment （1.08±0.10） than that in UTI （1.51±0.24, P 〈0.05） or methylprednisolone （1.31±0.04, P 〈0.05） treatment group. Conclusion Combination treatment of UTI with methylprednisolone was shown to protect EAE, suggesting that combination therapy is a potential novel treatment in MS.展开更多
文摘<span style="font-family:Verdana;">Based on Russian and the Middle East corticosteroids trials in MERS-CoV, we performed methylprednisolone pulse therapy (MPT), resulting in a clinical trial still without result. Our previous cohort (not compared n = 18) showed 76% of MPT patients did not progress to orotracheal intubation as MTP blocked the cytokine storm, a lower result compared to Tehran’s study explained by performing MPT in any lung phase. The Middle East study had been carried out during the initial lung phase. We are in an international emergency. Considering previous protocols and clinical practice, we understand that MPT must be used in COVID-19, and the indication to avoid going to the hospital when the first symptoms appear should be changed urgently for the population with inflammatory comorbidities. This article aims </span><span style="font-family:Verdana;">to: 1) show the Iranian protocol to reduce deaths and intubations b</span><span style="font-family:Verdana;">y COVID-19;2) present a possible approach to the patient COVID-19 with methylprednisolone pulse and strict criteria for orotracheal intubation to avoid hypoxemia;3) highlight that there is already a protocol that can be an international guideline-based on the Iranian work for the treatment of COVID-19;and 4) argue that corticosteroids are not controversial, but their use in a period outside the best timing period makes it controversial;and 5) emphasise the urgency of modifying the current protocol that postpones the visit of patients to the hospital in case of symptoms, since late hospital evaluation has been catastrophic for a world population.
文摘Background: Intravenous methylprednisolone pulse therapy has been used since the late 1960s for acute transplant rejection or severe renal involvement in systemic lupus erythematosus and primary glomerulonephritis. However, reports of serious adverse effects such as life-threatening cardiac arrhythmias and sudden death raise questions about its safety. Objective: To investigate the incidence of significant adverse effects associated with low-dose methylprednisolone pulse therapy (LDMPT) in pediatric patients. Methods: We retrospectively analyzed adverse effects during and after LDMPT in 68 patients (median age: 11.4 years;43% male) with various glomerular diseases who were admitted to Saitama Children’s Medical Center between April 2007 and December 2010. LDMPT consisted of pulse methylprednisolone (15-20 mg/kg;maximum 600 mg/d) for 3 consecutive days weekly for 2-3 weeks. Results: Although adverse effects occurred in 54 of 68 patients (79%), most were mild and transient. Transient glycosuria was noted in 46 patients (68%), hypertension in 6 (9%), elevated intraocular pressure in 6 (9%), hypokalemia in 5 (7%), and liver damage in 2 (3%). No late-onset adverse effects such as osteoporotic fractures, steroid diabetes mellitus, or short stature were observed. Conclusion: LDMPT appears to be relatively safe and well tolerated in children with various glomerular diseases.
文摘Although the administration of systemic steroid for nonsegmental vitiligo in the progressive stage is a recommended treatment according to guidelines, the clinical efficacy of this regimen has not been fully established. In this study, we evaluated the clinical efficacy of half-dose steroid treatment and stratified the evidence regarding its usefulness in progressive vitiligo patients. Half-dose steroid pulse therapy (500 mg/day of methylprednisolone for three sequential days) was administered intravenously three times monthly in five vitiligo patients. The visual changes in vitiligo lesions were evaluated on photographs and quantified using a spectrophotometer. As results, all patients completed three cycles of treatment without severe adverse events. Three of the five patients achieved disease arrest with decrease in white contrast. Therefore, short-term and halfdose steroid therapy is well tolerated and effective for achieving disease arrest in progressive nonsegmental vitiligo. The whiteness assessed by a spectrophotometer is possibly associated with therapeutic response to steroid therapy.
基金This research was supported by grants from the National Natural Science Foundation of China （No. 81171126） and Medical Research Foundation of Guangdong Province （No. B2013124）.
文摘Background Our previous study had demonstrated that ulinastatin （UTI） had a neuroprotective effect in experimental autoimmune encephalomyelitis （EAE）. Methylprednisolone has been recommended to be a standard drug in multiple sclerosis （MS） therapies. The present study was to investigate the protective effects of UTI combined methylprednisolone in EAE. Methods Mice were divided into a UTI treatment group, a methylprednisolone treatment group, a combined treatment group with UTI and methylprednisolone, a normal saline treatment group, and a normal control group. EAE mice were induced in groups receiving different combined treatments, or respective monotherapies. Demyelination was evaluated by Solochrome cyanin staining. 2＇,3＇-cyclic nucleotide 3＇- phosphodiesterase （CNP）/myelin basic protein （MBP）/the precursor form of nerve growth factor （proNGF）/p75/inducible nitric oxide synthase （iNOS） proteins in cerebral cortex of EAE were detected by Western blotting. Results The combined treatment group had a lower clinical score （0.61±0.06） and demyelinating score （1.33±0.33） than the groups with normal saline （clinical score： 1.39±0.08, P 〈0.001; demyelinating score： 2.75±0.49, P 〈0.05） or monotheraphies. Compared with the saline treated EAE group, UTI combined methylprednisolone significantly increased expressions of CNP （1.14±0.06 vs. 0.65±0.04, P 〈0.001）, MBP （1.28±0.14 vs. 0.44±0.17, P 〈0.001）, and decreased expressions of proNGF （1.08±0.10 vs. 2.32±0.12, P 〈0.001）, p75 （1.13±0.13 vs. 2.33±0.17, P 〈0.001）, and iNOS （1.05±0.31 vs. 2.17±0.13, P 〈0.001） proteins in EAE. Furthermore, UTI combined methylprednisolone could significantly upregulate MBP （1.28±0.14 vs. 1.01±0.15, P 〈0.05） expression and downregulate iNOS （1.05±0.31 vs. 1.35±0.14, P 〈0.05） expression compared to methylprednisolone treatment EAE group. And proNGF expression was significantly lower in combined treatment （1.08±0.10） than that in UTI （1.51±0.24, P 〈0.05） or methylprednisolone （1.31±0.04, P 〈0.05） treatment group. Conclusion Combination treatment of UTI with methylprednisolone was shown to protect EAE, suggesting that combination therapy is a potential novel treatment in MS.
