Steroid receptors in endometrium and their dynamics after RU486 treatment

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<i>In-Vitro</i>Effect of Steroids on Melanoma Cell Growth—A Prelude to Melanoma Treatment?

Skin is not only a target organ for various sex steroids and hormones, but also an endocrine organ, which produces sex steroids. It has been suggested by Nikolakis et al. that impairment in skin steroidogenesis may result in inflammatory or autoimmune or other skin disorders. Melanoma is one such skin disease or disorder, which is believed to be caused by UV rays. But, epidemiological, clinical, in-vivo and in-vitro studies suggested the involvement of steroids in the regulation of melanoma growth. However, these studies either did not identify the steroid involved or did not relate to the protective function of the steroid in menstruating females in melanoma, as reported by the clinical studies. In this context, our studies with mouse and human melanoma cell lines showed that female sex steroid progesterone not only inhibited melanoma cell growth, but also affected adhesion and migration functions. In addition, our studies also showed that the effect of progesterone was not a toxic or spurious, but a specific effect on melanoma cells. Hence, our in-vitro studies along with previous other studies subscribed to the idea proposed earlier by Slominski et al. that modulation of local steroids could be a new therapeutic approach for treatment of skin disease or disorder, melanoma.

Diagnosis and treatment of autoimmune pancreatitis: experience with 100 patients

BACKGROUND： Autoimmune pancreatitis （ALP） is increasingly recognized as a unique subtype of pancreatitis. This study aimed to analyze the diagnosis and treatment of AIP patients from a tertiary care center in China. METHODS： One hundred patients with AIP who had been treated from January 2005 to December 2012 in our hospital were enrolled in this study. We retrospectively reviewed the data of clinical manifestations, laboratory tests, imaging examinations, pathological examinations, treatment and outcomes of the patients. RESULTS： The median age of the patients at onset was 57 years （range 23-82） with a male to female ratio of 8.1：1. The common manifestations of the patients included obstructive jaundice （49 patients, 49.0%）, abdominal pain （30, 30.0%）, and acute pancreatitis （11, 11.0%）. Biliary involvement was one of the most extrapancreatic manifestations （64, 64.0%）. Fifty-six （56.0%） and 43 （43.0%） patients were classified into focal- type and diffuse-type respectively according to the imaging examinations. The levels of serum IgG and IgG4 were elevated in 69.4% （43/62） and 92.0% （69/75） patients. Pathological analysis of specimens from 27 patients supported the diagnosis of lymphoplasmacytic sclerosing pancreatitis, and marked （〉10 ceUs/HPF） IgG4 positive cells were found in 20 （74.1%） patients.Steroid treatment and surgery as the main initial treatments were given to 41 （41.0%） and 28 （28.0%） patients, respectively. The remission rate after the initial treatment was 85.0%. Steroid was given as the treatment after relapse in most of the patients and the total remission rate at the end of follow-up was 96.0%. CONCLUSIONS： Clinical manifestations, laboratory tests, imaging and pathology examinations in combination could increase the diagnostic accuracy of AIP. Steroid treatment with an initial dose of 30 or 40 mg prednisone is effective and safe in most patients with AIP.

Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review

Steroids are drugs that have been used extensively in a variety of conditions. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being hyperglycemia one of the most common and representative. In the present review, we discuss the main epidemiologic characteristics associated with steroid use, with emphasis on the identification of high risk populations. Additionally we present the pathophysiology of corticosteroid induced hyperglycemia as well as the pharmacokinetics and pharmacodynamics associated with steroid use. We propose a treatment strategy based on previous reports and the understanding of the mechanism of action of both, the different types of glucocorticoids and the treatment options, in both the ambulatory and the hospital setting. Finally, we present some of the recent scientific advances as well as some options for future use of glucocorticoids.

Advances in diagnosis and non-surgical treatment of Bell's palsy

Bell’s palsy is a commonly seen cranial nerve disease and can result in compromised facial appearance and functions. Its etiology, prognosis and treatment are still being debated. This paper is a review of recent development in the understanding of etiology, diagnosis and non-surgical treatment of Bell’s palsy.

Evaluation of 5 versus 10 granulocyteaphaeresis sessions in steroid-dependent ulcerative colitis: A pilot, prospective, multicenter, randomized study

瞄准：与活跃类固醇依赖者 ulcerative 在病人与 10 个 granulocyteaphaeresis 会议相比评估 5 的功效。方法：在这名飞行员，未来，多集中使随机化的试用，有中等活跃的类固醇的 20 个病人 -- 依赖 ulcerative 被使随机化到 5 或 10 个 granulocyteaphaeresis 会议。主要目的是在 wk 的临床的宽恕 17。第二等的措施包括了内视镜的宽恕和类固醇消费。结果：九个病人被使随机化到 5 个 granulocyteaphaeresis 会议(组 1 ) 和 11 个病人到 10 个 granulocyteaphaeresis 会议(组 2 ) 。在 wk 17，在在组 2 的组 1 病人和 45.45% 的 37.5% 病人在临床的宽恕。临床的宽恕被内视镜的宽恕在所有情况中伴随。完成宽恕的百分之 86 个病人在 wk 是没有类固醇的 17。每日的类固醇要求在组 2 是显著地更低的。病人的 89% 在一年后续期间留在宽恕。一个严肃的不利事件不与学习治疗有关，被报导。结论：Granulocyteaphaeresis 为类固醇依赖者 ulcerative 的治疗安全、有效。在这张人口，增加 aphaeresis 会议的数字没与更高的宽恕率被联系，但是负担得起重要类固醇圆材效果。

The Clinical Efficacy of Low-Dose Tacrolimus Combined with Tripterygium to Treat the Steroid-Resistant Nephrotic Syndrome

Objective: To observe the clinical efficacy and safety of low dose tacrolimus (TAC) combined with tripterygium (TW) in treatment of steroid resistant nephritic syndrome (SRNS). Method: The patients, who were diagnosed with mesangial proliferative glomerulonephritis (MesPGN) and focal segmental glomerulosclerosis (FSGS) by biopsy and failed to respond to a 3-month treatment with prednisone (1 mg/kg·d), were randomly divided into 2 groups (TAC + TW Group and TW Group). Initially TAC + TW group took TAC 0.05mg/(kg·d) 2 h after meal at 12 h interval. The plasma TAC level was examined after 3 days and was kept at 1.5 - 4 ng·ml;meanwhile, TW was given at 60 mg/d before meal. TW group only took TW (60 mg/d). The efficacy, adverse reactions and plasma TAC levels were observed in each group. Results: 1) Totally 20 SRNS patients completed the trial, 11 of TAC + TW Group and 9 of TW Group. There is no statistical difference between the two groups in terms of age, gender, duration since onset of the disease, blood pressure, 24 h UPQ, serum albumin, creatinine, cholesterol, triglyceride, FBG, kidney pathological categories, time of taking prednisone etc.;2) Urine protein started to decrease after 1 month treatment in both of TAC + TW and TW groups. By the 12th month of treatment, TAC + TW group showed 8 cases of complete remission (72.7%), 2 cases of partial remission (18.2%) and 1 case of no improvement (9.1%), while those of TW groups were 2 (22.2%), 4 (44.5%) and 3 (33.3%), respectively;3) With treatment, the TAC + TW Group patients’ plasma protein was significantly higher than that of pretreatment stage and recovered to normal level after 6 month of treatment. However, there was no significant plasma protein increase in TW Group. No obvious changes were observed on serum creatinine level of patients of both the two groups;4) The incidence of adverse reactions was not significantly different between the two groups. Conclusion: TAC + TW reduced proteinuria of SRNS patients, increased clinical remission rate and was tolerant to SRNS patients. We conclude that TAC + TW treatment is an effective way to treat patients with SRNS.

Prevention and management of non-steroidal anti-inflammatory drugs-induced small intestinal injury

Non-steroidal anti-inflammatory drug Nindu cedsmall bowel injury is a topi that deserves attentionsin e the advent of apsule endos opy and balloon enteros opy. N enteropathy is ommon and is mostly asymptomati . However,massive bleeding,stri ture,or perforation may o ur. The pathogenesis of small intestine injury by N s is omplex and different from that of the upper gastrointestinal tra t. No drughas yet been developed that an ompletely preventor treat N enteropathy. There fore,a long-termr and omized study in hroni N users is needed.

Steroids reduce local inflammatory mediator secretion and mucosal permeability in collagenous colitis patients

AIM: To study the effect of oral steroids upon clinical response and rectal mucosa secretion of eosinophil cationic protein (ECP), myeloperoxidase (MPO), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF) and albumin in patients with collagenous colitis (CC). METHODS: A segmental perfusion technique was used to collect perfusates from rectum of CC patients once before and twice (one and four weeks) after the start of steroid treatment. Clinical data was monitored and ECP, MPO, bFGF, VEGF and albumin concentrations were analyzed by immunochemical methods in perfusates and in serum. RESULTS: Steroids reduced the number of bowel movements by more than five times within one week and all patients reported improved subjective well- being at wk 1 and 4. At the same time, the median concentrations of ECP, bFGF, VEGF and albumin in rectal perfusates decreased significantly. MPO values were above the detection limit in only 3 patients before treatment and in none during treatment. VEGF, bFGF, ECP and albumin concentrations correlated with each other with the exception of ECP and albumin. A decrease of serum ECP and VEGF concentrations was also seen even if the overtime reduction was not significant.CONCLUSION: Oral steroid treatment in CC patients induced a simultaneous reduction of bowel movements and rectal release of ECP, bFGF, VEGF and albumin, suggesting that these polypeptides and increased mucosal permeability are important components of the pathophysiology in collagenous colitis.

Advances in the diagnosis and treatment of Ig G4-related sclerosing cholangitis: a review

Immunoglobulin G4-related sclerosing cholangitis(Ig G4-SC) is an Ig G4-related disease characterized by bile duct fibroinflammatory wall-thickening and stenosis, resulting in obstruction jaundice, weight loss. Different regions of the bile duct can be involved, with the distal region being the most common. Ig G4-SC can also have other organ involvement, such as the pancreas, urinary tract, salivary glands and lacrimal glands. In clinical practice, the manifestation of Ig G4-SC is very similar to cholangiocarcinoma(CC) and primary sclerosing cholangitis(PSC), as well as pancreatic malignancies, while the treatment and prognosis are totally different. Japanese researchers ever established the clinical diagnostic criteria in 2012:(1) characteristic biliary imaging findings;(2) elevated serum Ig G4 concentrations;(3) the coexistence of Ig G4-related diseases except those of the biliary tract; and(4) characteristic histopathological features. According to our observations, Ig G4-SC can be distinguished from CC with 100% specificity only at a cutoff of six times the upper normal limit. Imaging findings have low specificity for diagnosis, with the exception of intraductal ultrasonography, which can reflect the lesion with relatively high specificity. Ig G4 plasma cell infiltration can be found in bile duct biopsy tissue, although this procedure is difficult. According to recent studies, the treatment of Ig G4-SC relies mainly on corticosteroids. Following steroid treatment, most Ig G4-SC patients can recover and their symptoms are resolved although a few patients relapse after steroid withdrawal. Maintenance of steroid therapy or alternative drugs is necessary in such cases. There is, however, no strong evidence for malignant transformation in Ig G4-SC.

Antiviral treatment in patients with cytomegalovirus positive ulcerative colitis

Cytomegalovirus(CMV) is a common virus in patients with ulcerative colitis receiving immunosuppressive drugs. Many studies suggested that CMV infection is an exacerbating factor in patients with ulcerative colitis. The role of CMV in exacerbations of ulcerative colitis has been discussed. One of studies starting this discussion is an article entitled "CMV positive ulcerative colitis: A single center experience and literature review" by Kopylov et al. However, we think that there are some points that should be emphasized about the study. Especially, the small number of patients in the study has led to meaningless results. Large controlled prospective trials are needed to clarify the benefit of antiviral therapy for active ulcerative colitis patients.

Blau综合征一例

Blau综合征是一种罕见的遗传性疾病,其特征为肉芽肿性关节炎、葡萄膜炎和皮炎三联征。患者通常表现出多系统受累,包括眼部、皮肤和骨骼异常。Blau综合征发病率极低,全球范围内儿童中的患病率不到百万分之一。本次多学科会诊为一例21岁的青年女性患者,病程始于儿童时期,表现为患者多关节肿痛、皮肤病变、眼睑分泌物增多,确诊为葡葡膜炎,并伴高血压和动脉异常等。患者自6岁开始接受激素治疗,并尝试了多种药物治疗,在改善关节肿痛和眼部症状方面有一定疗效。通过罕见病多学科会诊,以明确患者的分子诊断、多系统评估、治疗方案的选择与制订。同时通过本病例的报道,提高临床医师对Blau综合征诊断和综合治疗策略的认知,从而提高罕见病的管理和治疗水平。

超声引导下经皮针刀松解联合类固醇激素注射治疗扳机指

目的评估超声引导下经皮针刀松解联合类固醇激素注射治疗扳机指(TF)短期疗效。方法纳入79例TF患者,分为联合组(n=48,接受超声引导下经皮针刀松解及类固醇激素注射治疗)及松解组(n=31,仅接受超声引导下经皮针刀松解);比较治疗前、治疗后2周及4周组间Quinnell分级、视觉模拟评分法(VAS)评分及治疗满意度等差异。结果2组患者治疗前Quinnell分级及VAS评分差异均无统计学意义(P均>0.05)。治疗后2周,联合组Quinnell分级和VAS评分均低于(P均<0.05)、且Quinnell分级较治疗前降低程度则大于松解组(P<0.05);组间VAS降低分数差异无统计学意义(P>0.05);联合组治疗满意度高于松解组(97.92%vs.83.87%,P<0.05)。治疗后4周,2组患者手指屈伸功能均恢复至正常,无弹响或绞索症状,临床治愈率均为100%(79/79),治疗满意度均为100%(79/79),组间Quinnell分级和VAS评分均无显著差异(P均>0.05);组间Quinnell分级、VAS评分较治疗前降低程度及分数差异均无统计学意义(P均>0.05)。治疗后4周内患指均无感染,指间神经、血管及指屈肌腱无明显损伤,无其他并发症。结论超声引导下经皮针刀松解术可有效治疗TF;联合类固醇激素注射可早期明显改善手指关节功能、提高治疗满意度。

IPNA临床实践建议:儿童激素敏感型肾病综合征的诊断和治疗

特发性肾病综合征是最常见的儿童肾小球疾病,其特征是大量蛋白尿、低蛋白血症和(或)伴有水肿,全球每年儿童患病率为(1.15~16.90)每10万例。约有85%~90%的患者在接受糖皮质激素治疗的4~6周内可达到蛋白尿完全缓解,表现为激素敏感型肾病综合征(SSNS)。约70%~80%的SSNS患者在随访期间至少复发1次,其中多达50%的患者出现频繁复发或依赖糖皮质激素以维持蛋白尿缓解。为延长复发间隔时间,激素治疗的用药剂量和用药时长始终是热点问题之一,且患者出现激素相关并发症的概率较高。临床已应用多种激素助减药物(免疫抑制药物),但在疾病治疗过程中这些药物的选择和用药时机存在明显差异。因此,需要国际循证临床实践建议(CPRs)来指导临床实践、减少实践差异。国际儿科肾脏病学会(IPNA)召集专家小组通过对12个临床相关PICO(研究对象、干预措施、对照、结果/结局)问题进行系统的文献回顾,制定了关于儿童SSNS诊断和治疗的建议和分级。对治疗转归提出了新的定义,有助于指导治疗改变,并为重要的研究问题提供了参考。

9-羟基雄烯二酮药物菌渣好氧堆肥无害化及安全利用

为降低甾体药物菌渣的环境污染风险、减少资源浪费,实现9-羟基雄烯二酮(9α-OH-AD)药物菌渣无害化与资源化,本研究确立了9α-OH-AD菌渣好氧堆肥处理体系,讨论初始碳氮比分别为15(低)、20(中)、25(高)的堆体在堆肥过程中的特征变化,并通过土壤模拟实验评估其作为肥料的可行性和安全性。研究结果表明:优化后的好氧堆肥工艺可以实现9α-OH-AD菌渣的有效降解及稳定,所得菌渣肥的理化指标均满足有机肥标准,且部分指标优于商品肥标准。施入1%菌渣肥一段时间后,土壤和蚯蚓中未检出9α-OH-AD残留,蚯蚓雌雄生殖系统无明显变化,同时施肥土壤的酶活性和微生物多样性都有所提高。研究表明,9α-OH-AD菌渣可以通过好氧堆肥有效转化为稳定无害的肥料,并实现资源回收与土地安全利用。

激素性股骨头坏死的中西医治疗进展

激素性股骨头坏死是非创伤性股骨头坏死的常见病。临床上激素的不合理使用导致激素性股骨头坏死的发病率大大增加。手术治疗是股骨头坏死后期不可避免的,而中医对激素性股骨头坏死的治疗有着独到的见解,并且中医治疗激素性股骨头坏死具有经济实惠、疗效显著、副作用小等优点。但西医对该病的发生、发展及治疗也有着一定的借鉴参考作用。本文对激素性股骨头坏死的中、西医研究进展进行综述,为广大医学人士提供思路和治疗方法。

犬急性类固醇反应性脑膜炎的病例诊治与分析

犬类固醇反应性脑膜炎是一种系统性免疫介导引起的、中枢神经系统的特发性炎性疾病,临床上常见急性发作。临床接诊1只突然呕吐、间歇性抽搐、体温升高的拉布拉多犬病例,经过临床基本检查、神经学检查、血常规检查、血液生化检查、C-反应蛋白检测、核磁共振检查、脑脊液染色镜检等方法进行诊断,确诊为急性类固醇反应性脑膜炎。采用泼尼松龙联合抗癫痫药物、营养神经药物治疗,用药4周后痊愈。该病例的诊治过程为犬类固醇反应性脑膜炎的诊断和治疗提供了参考。

中药有效成分干预激素性股骨头缺血性坏死的作用机制

激素性股骨头缺血性坏死(steroid-induced avascular necrosis of the femoral head,SANFH)是一种进行性骨疾病,会导致软骨下骨微骨折和显著疼痛。如治疗不及时,SANFH患者将终身残疾,严重影响患者的生活质量。糖皮质激素是临床上广泛使用的药物,一直是诱发非创伤性股骨头坏死的主要原因。中医药在防治股骨头坏死方面历史悠久,能够发挥积极作用。近年来,针对中药有效成分治疗股骨头坏死进行了大量的研究,发现中药有效成分黄酮类、皂苷类、酚类、多糖类、生物碱类等多种化学成分,通过改善微循环调节炎症反应、促进血管再生、调节骨代谢等多种作用机制改善激素性股骨头缺血性坏死。本文将常用中药的有效成分治疗激素性股骨头缺血性坏死的机制研究进展做一综述,以期为激素性股骨头缺血性坏死的临床治疗及基础研究提供思路。

基于“壮火食气,少火生气”论激素依赖型哮喘的中西医诊治

糖皮质激素(GC)是治疗哮喘等呼吸系统疾病的首选药物,具有较强的抗炎、抗过敏、解痉平喘等作用,然而对糖皮质激素GC治疗不敏感的患者,需长期依赖口服大剂量激素才能实现对症状的控制,易发展为激素依赖型哮喘(SDA)。过量使用激素药物引发严重的不良反应与并发症,严重限制了其长期使用,成为临床亟待解决的难题。从中医学角度看,激素与肾脏同源,皆是“水中之火”,兼具正、邪两种属性,传统的“壮火食气,少火生气”观点认为运用药物调节机体,将病理之火(壮火)转化为生理之火(少火),可有效改善体内的生理功能失和。基于“壮火食气,少火生气”理论,论述了SDA的中西医诊疗机制,分别对SDA发病机制、西医治疗手段及其不良反应进行分析,从理论和实践应用两方面分析了中医诊治的出发点和功效,为SDA的中医治疗提供了理论基础。

非甾体抗炎药在猫临床疼痛管理中的应用

疼痛是猫常见且多发的问题,诱发原因很多。近几年,随着国内外兽医对宠物猫的慢性疼痛问题以及临床中疼痛管理日益重视,疼痛管理已成为临床兽医必须面对的重要课题之一。非甾体抗炎药因其解热、抗炎和镇痛的特性而逐渐被广泛应用于动物医学。国内有关非甾体类抗炎药在猫临床疼痛管理中的应用少见报道。主要就国外发表的一些关于猫长期使用非甾体抗炎药的相关文献进行综述,以期为非甾体抗炎药在猫临床疼痛管理中的进一步应用提供参考。