Background:Infants undergoing cardiac surgery with cardiopulmonary bypass(CPB)frequently receive intraoperative methylprednisolone(MP)to suppress CPB-related inflammation;however,the optimal dosing strategy and effica...Background:Infants undergoing cardiac surgery with cardiopulmonary bypass(CPB)frequently receive intraoperative methylprednisolone(MP)to suppress CPB-related inflammation;however,the optimal dosing strategy and efficacy of MP remain unclear.Methods:We retrospectively analyzed all infants under 90 days-old who received intra-operative MP for cardiac surgery with CPB from 2014–2017 at our institution.We combined real-world dosing data from the electronic health record(EHR)and two previously developed population pharmacokinetic/pharmacodynamic models to simulate peak concentration(Cmax)and area under the concentration-time curve for 24 h(AUC24)for MP and the inflammatory cytokines interleukin-6(IL-6)and interleukin-10(IL-10).We evaluated the relationships between post-operative,safety,and other clinical outcomes obtained from the EHR with each predicted exposure using non-parametric tests.Results:A total of 142 infants with median post-natal age 8(interquartile range[IQR]:5,37)days received a total dose of 30(19,49)mg/kg of MP.Twelve(8%)died,37(26%)met the composite post-operative outcome,114(80%)met the composite safety outcome,and 23(16%)had a major complication.Predicted median Cmax and AUC24 IL-6 exposure was significantly higher for infants meeting the composite post-operative outcome and those with major complications.Predicted median Cmax and AUC24 MP exposure was significantly higher for infants requiring insulin.No exposure was associated with death or other safety outcomes.Conclusions:Pro-inflammatory IL-6,but not MP exposure,was associated with post-operative organ dysfunction,suggesting current MP dosing may not adequately suppress IL-6 or increase IL-10 to impact clinical outcomes.Prospective study will be required to define the optimal exposure-efficacy and exposure-safety profiles in these infants.展开更多
BACKGROUND Patients with trisomy 8 consistently present with myeloid neoplasms and/or auto-inflammatory syndrome.A possible link between myelodysplastic syndromes(MDS)with trisomy 8(+8-MDS)and inflammatory disorders i...BACKGROUND Patients with trisomy 8 consistently present with myeloid neoplasms and/or auto-inflammatory syndrome.A possible link between myelodysplastic syndromes(MDS)with trisomy 8(+8-MDS)and inflammatory disorders is well recognized,several cases having been reported.However,inflammatory disorders in patients without MDS have been largely overlooked.Generally,Behçet's disease is the most common type in+8-MDS.However,inflammatory disorders with pulmonary involvement are less frequent,and no effective treatment has been established.CASE SUMMARY A 27-year-old man with recurrent fever,fatigue for>2 mo,and unconsciousness for 1 day was admitted to our emergency department with a provisional diagnosis of severe pneumonia.Vancomycin and imipenem were administered and sputum collected for metagenomic next-generation sequencing.Epstein–Barr virus and Mycobacterium kansasii were detected.Additionally,chromosomal analysis showed duplications on chromosome 8.Two days later,repeat metagenomic next-generation sequencing was performed with blood culture.Cordyceps portugal,M.kansasii,and Candida portugal were detected,and duplications on chromosome 8 confirmed.Suspecting hematological disease,we aspirated a bone marrow sample from the iliac spine,examination of which showed evidence of infection.We added fluconazole as further antibiotic therapy.Seven days later,the patient’s condition had not improved,prompting addition of methylprednisolone as an anti-inflammatory agent.Fortunately,this treatment was effective and the patient eventually recovered.CONCLUSION Severe inflammatory disorders with pulmonary involvement can occur in patients with trisomy 8.Methylprednisolone may be an effective treatment.展开更多
BACKGROUND Acute myelitis(AM)can lead to sudden sensory,motor and autonomic nervous dysfunction,which negatively affects their daily activities and quality of life,so it is necessary to explore optimization from a the...BACKGROUND Acute myelitis(AM)can lead to sudden sensory,motor and autonomic nervous dysfunction,which negatively affects their daily activities and quality of life,so it is necessary to explore optimization from a therapeutic perspective to curb the progression of the disease.AIM To investigate the effect of ganglioside(GM)combined with methylprednisolone sodium succinate(MPSS)on the curative effect and neurological function of patients with AM.METHODS First,we selected 108 AM patients visited between September 2019 and September 2022 and grouped them based on treatment modality,with 52 patients receiving gamma globulin(GG)+MPSS and 56 patients receiving GM+MPSS,assigned to the control group(Con)and observation group(Obs),respectively.The therapeutic effect,neurological function(sensory and motor function scores),adverse events(AEs),recovery(time to sphincter function recovery,time to limb muscle strength recovery above grade 2,and time to ambulation),inflammatory factors(IFs)[interleukin(IL)-6,C-reactive protein(CRP),and tumor necrosis factor(TNF)-α]and other data of the two groups were collected for evaluation and comparison.RESULTS The Obs had:(1)A significantly higher response rate of treatment than the Con;(2)Higher scores of sensory and motor functions after treatment that were higher than the baseline(before treatment)and higher than the Con levels;(3)Lower incidence rates of skin rash,gastrointestinal discomfort,dyslipidemia,osteoporosis and other AEs;(4)Faster posttreatment recovery of sphincter function,limb muscle strength and ambulation;and(5)Markedly lower posttreatment IL-6,CRP and TNF-αlevels than the baseline and the Con levels.CONCLUSION From the above,it can be seen that GM+MPSS is highly effective in treating AM,with a favorable safety profile comparable to that of GG+MPSS.It can significantly improve patients’neurological function,speed up their recovery and inhibit serum IFs.展开更多
Background: Previous studies focused on the treatment effect of steroids versus no steroids in treating severe COVID-19 patients, a few studies evaluated outcomes for treating those patients with either dexamethasone ...Background: Previous studies focused on the treatment effect of steroids versus no steroids in treating severe COVID-19 patients, a few studies evaluated outcomes for treating those patients with either dexamethasone or methylprednisolone. Currently, we evaluate the difference in mortality associated with treating COVID-19 patients with dexamethasone versus methylprednisolone. Methods: With a retrospective multicenter study, records were reviewed for the admitted patients with severe COVID-19 during the peak of the severe COVID-19 pandemic. All admitted patients on dexamethasone or methylprednisolone were included. Patients were analyzed as all populations and propensity scores matched patients. Propensity scores were calculated for several confounders by the generalized linear model, and a “greedy” near-neighbor matching algorithm was used. Continuous variables with nonnormal distribution were analyzed by Wilcoxon signed rank test. Chi-squared and Fischer exact test analyzed categorical variables. P-values were adjusted by the Bonferroni method for both data cohorts. Body mass index was in categories. Radiological findings were divided into five categories. The outcomes: mortality, the need for home oxygen therapy, recovery, and residual symptoms on discharge were analyzed by an independent two-sample test for equality of proportions (with Yates correction), and logistic regression analysis. Results: Among the 1128 reviewed records, patients on dexamethasone or methylprednisolone were 1071, and the propensity score-matched patients were 784: dexamethasone 393 and methylprednisolone 391. There was no significant difference in the characteristics of patients between the two steroids (p-value and adjusted p-value > 0.05) for most variables. PSM adjusted a few discrepant variables before analysis. The outcome of the unmatched patients demonstrated dexamethasone benefit in the need for home oxygen therapy ( 0.05). However, matched patients demonstrated significantly lower mortality associated with dexamethasone treatment (difference -2.68%, 95%CI, -1.0, -0.004, p = 0.03, and OR 1.7, p = 0.017), and no difference for the other outcomes, including the need for home oxygen therapy (p-value > 0.05). Conclusion: Dexamethasone treatment caused significantly less mortality than methylprednisolone in treating our COVID-19 patients, but no significant difference in recovery, the need for home oxygen therapy, and residual symptoms on discharge.展开更多
Methylprednisolone exhibits anti-inflammatory antioxidant properties, and rosiglitazone acts as an anti-inflammatory and antioxidant by activating peroxisome proliferator-activated receptor-γ in the spinal cord. Meth...Methylprednisolone exhibits anti-inflammatory antioxidant properties, and rosiglitazone acts as an anti-inflammatory and antioxidant by activating peroxisome proliferator-activated receptor-γ in the spinal cord. Methylprednisolone and rosiglitazone have been clinically used during the early stages of secondary spinal cord injury. Because of the complexity and diversity of the inflammatory process after spinal cord injury, a single drug cannot completely inhibit inflammation. Therefore, we assumed that a combination of methylprednisolone and rosiglitazone might promote recovery of neurological function after secondary spinal cord injury. In this study, rats were intraperitoneally injected with methylprednisolone(30 mg/kg) and rosiglitazone(2 mg/kg) at 1 hour after injury, and methylprednisolone(15 mg/kg) at 24 and 48 hours after injury. Rosiglitazone was then administered once every 12 hours for 7 consecutive days. Our results demonstrated that a combined treatment with methylprednisolone and rosiglitazone had a more pronounced effect on attenuation of inflammation and cell apoptosis, as well as increased functional recovery, compared with either single treatment alone, indicating that a combination better promoted recovery of neurological function after injury.展开更多
BACKGROUND: Methylprednisolone (MP) can affect the survival of CD4 + T lymphocytes and plays an important role in adaptive immune responses; however, its mechanism of action is not clear. Recent studies have shown tha...BACKGROUND: Methylprednisolone (MP) can affect the survival of CD4 + T lymphocytes and plays an important role in adaptive immune responses; however, its mechanism of action is not clear. Recent studies have shown that toll- like receptors (TLRs) on CD4 + T cells can directly modulate adaptive immune responses by affecting the survival and proliferation of activated CD4 + T cells. This study aimed to investigate the relationship between MP, TLRs and activated CD4 + T cells. METHODS: We separated and purified CD4 + T cells from mice, activated them in vitro, and co-cultured them with TLR ligands, MP or inhibitors of nuclear factor-kappa B (NF-κB) and activator protein 1 (AP-1). We then assessed CD4 + T cell survival and proliferation and the expression of NF-κB and AP-1. RESULTS: Activated CD4 + T cells showed increased TLR-3 and TLR-9 mRNA expression, but polyinosinic-polycytidylic acid (poly I:C) and MP had no effect on the expression of these mRNAs. Still, poly I:C and CpG oligodeoxynucleotides (CpG DNA) increased the survival of activated CD4 + T cells whereas MP reduced the survival of activated CD4 + T cells and could inhibit the survival effects of poly I:C and CpG DNA. The NF-κB essential modifier-binding domain (NBD) inhibited the survival of activated CD4 + T cells induced by poly I:C and CpG DNA, but the AP-1 inhibitor crucumin did not have the same effect. The increased expression of NF-κB induced by poly I:C and CpG DNA in activated CD4 + T cells could be inhibited by MP, but the same was not true for the increased expression of AP-1 induced by poly I:C and CpG DNA. Finally, the proliferation of activated CD4 + T cells was not affected by poly I:C or MP. CONCLUSION: The survival of activated CD4 + T cells is promoted by TLR ligands, but this effect is inhibited by MP.展开更多
BACKGROUND Based on the results of some large randomized controlled trials(RCTs)confirmed the efficacy of corticosteroids in coronavirus disease 2019(COVID-19),corticosteroids have been included in World Health Organi...BACKGROUND Based on the results of some large randomized controlled trials(RCTs)confirmed the efficacy of corticosteroids in coronavirus disease 2019(COVID-19),corticosteroids have been included in World Health Organization guidelines,but remain controversial.AIM To investigate the efcacy and safety of low-to-moderate dose(30 to 40 mg/d)short-term methylprednisolone for COVID-19 patients.METHODS The clinical data of 70 patients diagnosed with COVID-19 who received antiviral therapy with Arbidol for 7-10 d before admission but had no obvious absorption on chest computed tomography(CT)imaging were retrospectively analyzed.Arbidol(as the control group)and methylprednisolone(as the corticosteroid group)were given respectively after admission.After treatment,chest CT was reexamined to evaluate the absorption of pulmonary lesions.Additionally,we evaluated and compared the lymphocyte count,erythrocyte sedimentation rate(ESR),interleukin-6(IL-6),serum ferritin,lactate dehydrogenase(LDH),creatine kinase-MB(CK-MB),hypersensitive C-reactive protein(hs-CRP)and D-dimer levels,and also analyzed the incidence of toxic and side effects.RESULTS All patients in the corticosteroid group had varying degrees of CT absorption,which was significantly better than that in the control group(CT obvious absorption rate:89.47%vs 12.5%,P<0.05).The average daily dose and course of methylprednisolone in the patients with significant improvement on chest CT was(38.55±13.17)mg and(6.44±1.86)d respectively.During the treatment,the lymphocyte count,ESR,IL-6,serum ferritin,LDH,CK-MB,hs-CRP and D-dimer levels all improved gradually,indicating that both Arbidol and methylprednisolone therapy were contributed to improving the condition of COVID-19 patients.The corticosteroid regimen did not prolong the clearance time of severe acute respiratory syndrome coronavirus 2.There were no severe adverse reactions such as gastrointestinal bleeding,secondary severe infection,hypertension,diabetic ketoacidosis,mental disorders or electrolyte disorders during the whole corticosteroid treatment process.CONCLUSION Low-to-moderate dose short-term methylprednisolone can accelerate the chest CT imaging absorption of COVID-19 so as to improve symptoms and alleviate the condition in a short term,reduce the hospital stay,meanwhile avoid severe COVID-19 phases.The protocol has been proven to be effective and safe in clinical use.展开更多
Objective:To study the effects of methylprednisolone combined with montelukast on immune function and cytokines in children with recurrent Henoch-Schonlein purpura.Methods:Children who were diagnosed with recurrent He...Objective:To study the effects of methylprednisolone combined with montelukast on immune function and cytokines in children with recurrent Henoch-Schonlein purpura.Methods:Children who were diagnosed with recurrent Henoch-Schonlein purpura in Zigong Third People's Hospital between September 2015 and August 2017 were selected as the research subjects and randomly divided into the intervention group who received methylprednisolone combined with montelukast therapy and the control group who received hydrocortisone therapy. The levels of Th1/Th2 and Th17/Treg immunity indexes in peripheral blood as well as cytokines in serum were measured before treatment as well as 4 and 8 weeks after treatment.Results: 4 weeks and 8 weeks after treatment, Th1 and Treg cell contents as well as T-bet and FoxP3 mRNA expression in peripheral blood of both groups of patients were significantly higher than those before treatment whereas Th2 and Th17 cell contents as well as GATA-3 and RORγt mRNA expression in peripheral blood and NF-κB, OPN, IL-33, MK and HMGB1 contents in serum were significantly lower than those before treatment, and Th1 and Treg cell contents as well as T-bet and FoxP3 mRNA expression in peripheral blood of intervention group were significantly higher than those of control group whereas Th2 and Th17 cell contents as well as GATA-3 and RORγt mRNA expression in peripheral blood and NF-κB, OPN, IL-33, MK and HMGB1 contents in serum were significantly lower than those of control group.Conclusion: methylprednisolone combined with montelukast treatment of recurrent Henoch-Schonlein purpura can regulate the immune function and inhibit the cytokine secretion.展开更多
<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:Previous studies have shown that autonomic dysfunction results in gastrointestinal motility disorders and ultimately results in bacterial translocation following acute spinal cord in-jury (SCI). Intensive m...BACKGROUND:Previous studies have shown that autonomic dysfunction results in gastrointestinal motility disorders and ultimately results in bacterial translocation following acute spinal cord in-jury (SCI). Intensive methylprednisolone dosing improves neurological recovery in SCI patients. However,it remains uncertain whether high-dose methylprednisolone inhibits bacterial translocation and endotoxin release following acute SCI. OBJECTIVE:To investigate the inhibitory effect of methylprednisolone on bacterial translocation and endotoxin release from the gut in paraplegic rats. DESIGN,TIME AND SETTING:The randomized,controlled study was performed at the Orthopedic Lab,First Affiliated Hospital,Nanchang University,China,from April to December 2008. MATERIALS:Methylprednisolone (Pfizer,USA),automatic microbial identification instrument ATB Expression and reagent ID 32 system (BioMérieux,France),Limulus test kit (ACC,USA),and optical microscope (Olympus,Japan) were used in this study. METHODS:A paraplegia model was established following SCI in 48 Wistar rats,aged 7 weeks. The rats were equally and randomly assigned to saline and methylprednisolone groups. Immediately post-injury,the methylprednisolone group was administered 30 mg/kg methylprednisolone via caudal intravenous infusion,followed by a 23-hour infusion of 5.4 mg/kg per hour. The saline group received an equal volume of saline as placebo. MAIN OUTCOME MEASURES:At 24 hours,72 hours,and 1 week after SCI,blood samples were collected for bacterial cultures,and bacteria and endotoxin were identified using ATB Expression and Limulus test kits. In addition,mesenteric lymph node,spleen,and liver samples were collected for bacterial cultures. Histological examinations of mesenteric lymph node,spleen,liver,jejunum,and ileum were performed 1 week post-injury. Locomotor function in the hind limb was evaluated using the Basso,Beattie,and Bresnahan score at pre-injury time point,as well as 24 hours,72 hours,and 1 week post-injury. RESULTS:Endotoxemia and bacterial growth were identified at 24 hours post-injury in both groups. However,plasma endotoxin levels were significantly decreased in the methylprednisolone group compared with the saline group at 72 hours and 1 week post-injury (P < 0.05). Translocated bacteria mainly comprised Bacillus coli,Enterobacter cloacae,Escherichia coli,Proteus vulgaris,and Enterococcus faecalis following SCI combined with paraplegia. Histological changes were not as severe in the methylprednisolone group compared with the saline group 1 week after injury. Basso,Beattie,and Bresnahan scores were significantly better in the methylprednisolone group compared with the saline group 1 week after injury (P < 0.05). CONCLUSION:High-dose methylprednisolone inhibited bacterial translocation from the gut and endotoxin release in rats with SCI.展开更多
Objective:An increasing number of pediatric patients are being diagnosed with anti-N-methyl-Daspartate receptor(NMDAR)encephalitis,whose treatment requires immunotherapy through nursing interventions.This study aimed ...Objective:An increasing number of pediatric patients are being diagnosed with anti-N-methyl-Daspartate receptor(NMDAR)encephalitis,whose treatment requires immunotherapy through nursing interventions.This study aimed to analyze the clinical features and long-term prognosis of pediatric anti-NMDAR encephalitis and to gather nursing experiences of immunotherapy.Methods:Seventeen children diagnosed with anti-NMDAR encephalitis were admitted to the pediatric department.They were subjected to a therapy of intravenous immunoglobulin(IVIG)accompanied with high-dose methylprednisolone(HDMP).Multidisciplinary cooperation and intensive care were used to manage them.The effects of nursing intervention and therapy were repeatedly assessed and analyzed throughout the course of treatment and recovery.Results:None of the patients manifested adverse drug reaction(ADR)during IVIG administration.At the first administration of HDMP,ADRs were promptly and efficiently treated in four patients(24%;i.e.,one case each of hyperglycosemia,hypertension,aggravated symptoms,and gastrointestinal bleed).Two patients underwent rehabilitation,and six patients received hyperbaric oxygenation during hospitalization.Nine patients with indwelling gastric tubes experienced four times of unplanned extubation.Hospital stay ranged from 11 days to 59 days,with the mean duration of 26 days.Discharge evaluation revealed that 16 patients who scored 0e2 on the modified Rankin scale presented obvious remission,and one patient who had a mRS score of 4 exhibited less improvement.The mRS scores of hospitalization,discharge,and six-month follow-up displayed statistically significant differences.Conclusions:Nursing interventions of immunotherapy ensures the security of IVIG administration.Multidisciplinary cooperation promotes remission.Our findings can serve as reference for healthcare teams.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)outbreak has brought great challenges to public health.Aggravation of COVID-19 is closely related to the secondary systemic inflammatory response.Glucocorticoids are us...BACKGROUND The coronavirus disease 2019(COVID-19)outbreak has brought great challenges to public health.Aggravation of COVID-19 is closely related to the secondary systemic inflammatory response.Glucocorticoids are used to control severe diseases caused by the cytokine storm,owing to their anti-inflammatory effects.However,glucocorticoids are a double-edged sword,as the use of large doses has the potential risk of secondary infection and long-term serious complications,and may prolong virus clearance time.Nonetheless,the risks and benefits of glucocorticoid adjuvant therapy for COVID-19 are inconclusive.AIM To determine the effect of methylprednisolone in severe and critically ill patients with COVID-19.METHODS This single-center retrospective study included 102 adult COVID-19 patients admitted to a ward of a designated hospital in Wuhan,Hubei Province from January to March 2020.All patients received general symptomatic treatment and organ function support,and were given different respiratory support measures according to their conditions.In case of deterioration,considering the hyperinflammatory state of the patients,methylprednisolone was intravenously administered at 0.75-1.5 mg/kg/d,usually for less than 14 d.Patient vital signs and oxygenation were closely monitored,in combination with imaging and routine blood tests such as C-reactive protein,biochemical indicators(liver and kidney function,myocardial enzymes,electrolytes,etc.),and coagulation function.Patient clinical outcomes were discharge or death.RESULTS A total of 102 severe and critically ill COVID-19 patients were included in this study.They were divided into treatment(69,67.6%)and control groups(33,32.4%)according to methylprednisolone use.Comparison of baseline data between the two groups showed that the treatment group patients had higher aspartic acid aminotransferase,globulin,hydroxybutyrate dehydrogenase,and lactate dehydrogenase.There was no significant difference in other baseline data between the two groups.With regard to prognosis,29(78.4%)patients in the treatment group died as opposed to 40(61.5%)in the control group.The mortality was higher in the treatment group than in the control group;however,according to the log-rank test and the Kaplan–Meier survival curve,the difference in mortality between both groups was insignificant(P=0.655).The COX regression equation was used to correct the variables with differences,and the results showed that methylprednisolone treatment did not improve prognosis.CONCLUSION Methylprednisolone treatment does not improve prognosis in severe and critical COVID-19 patients.展开更多
Bickerstaff brainstem encephalitis (BBE) is a rare post-infectious neurological syndrome for which an effective treatment strategy has not been established. Here, we report a case of a 71-year-old male who suffered fr...Bickerstaff brainstem encephalitis (BBE) is a rare post-infectious neurological syndrome for which an effective treatment strategy has not been established. Here, we report a case of a 71-year-old male who suffered from an upper respiratory tract infection, and 7 days later, developed numbness of the bilateral upper and lower limbs, unsteady gait and dysarthria. Brain magnetic resonance imaging was normal, nerve conduction study and cerebral spinal fluid analysis were nonspecific. Based on the clinical features, we tentatively diagnosed Guillain-Barré syndrome and started immunoadsorption plasmapheresis. However, consciousness progressively declined to coma level within 10 days. Electroencephalogram showed diffuse slowing, and auditory evoked brainstem response (ABR) demonstrated absence of waves II, III and V. Serum anti-GQ1b IgG autoantibody and anti-GM1b IgG autoantibody were negative. Subsequently, we diagnosed BBE, and clinical symptoms resolved after treatment with intravenous immunoglobulin and methyllprednisolone. On day 62, neurological symptoms were remarkably alleviated with an improvement in ABR. Our observations suggest that immunoadsorption plasmapheresis should be used only when anti-ganglioside antibodies are detected. Combination therapy with intravenous immunoglobulin and methylprednisolone or plasma exchange?is recommended as initial therapy.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
The present study was undertaken to examine the effects of methylprednisolone on the expression and activity of calpain in spinal cord tissue following spinal cord ischemia-reperfusion injury in rats. Adult male Sprag...The present study was undertaken to examine the effects of methylprednisolone on the expression and activity of calpain in spinal cord tissue following spinal cord ischemia-reperfusion injury in rats. Adult male Sprague-Dawley rats were subjected to sham operations, ischemia-reperfusion and vehicle treated, or ischemia-reperfusion with methylprednisolone administration after injury. The expression of calpain I in the injured segments of the spinal cord as well as the degradation of the 68 kD neurofilament protein (NFP), a calpain-specific substrate, was determined at 3 h, 24 h, 72 h and 7 days after reperfusion using immunohistochemical labeling and western blot analysis, respectively. Three hours after spinal cord reperfusion, calpain I-positive cells and NFP degradation products were evident. The number of positive cells and immunoreactivity increased with time and peaked at 72 h after reperfusion. In addition, the number of calpain I-positive cells and the abundance of NFP degradation products were significantly lower in the methylprednisolone group, compared with vehicle treated animals following ischemia-reperfusion injury. The results of this study suggest that methylprednisolone can inhibit the expression and degradation activity of calpain following ischemia-reperfusion injury, providing further insight into the therapeutic benefits of methylprednisolone treatment for spinal cord injury.展开更多
Background: Graves’ ophthalmopathy (GO) is the most frequent extrathyroidal manifestation of Graves’ disease (GD). The effect of intravenous methylprednisolone on the signs and symptoms of GO has not been evaluated ...Background: Graves’ ophthalmopathy (GO) is the most frequent extrathyroidal manifestation of Graves’ disease (GD). The effect of intravenous methylprednisolone on the signs and symptoms of GO has not been evaluated in the Bangladeshi population. Objective: To observe the effect of intravenous methylprednisolone in active Graves’ ophthalmopathy. Materials/Methods: This prospective study conducted in a tertiary hospital of Bangladesh from May 2009 to November 2010 included 30 patients having moderate to severe ophthalmopathy. In addition to the clinical activity score (CAS), eye involvement was assessed by using the “NOSPECS” scoring system. Results: The mean (±SD) age of the patients was 38.1 ± 10.6 years and male-female ratio was 1.2:1. NOSPECS eye findings before treatment and during the final (3rd) visit of the patients were observed. It was found that lid retraction or lid lag was improved in 21 (70%) of the patients during the final visit. All of the patients had soft tissue swelling initially and all of them improved at the final visit. Bilateral proptosis was present in 19 patients before treatment and improved in 12 (62%) patients during the final visit. Right eye proptosis was present in 9 patients before treatment and improved in 5 (60%) patients during final visit. Extraocular muscle involvement (Diplopia) was present in 15 patients before treatment but improved in 13 (86.0%) patients during the final visit. A significant number of subjects showed significant improvement in all of the NOSPECS eye findings (except unilateral right eye proptosis) during the final visit;all had inactive GO (CAS Conclusion: Intravenous methylprednisolone appears to be an effective treatment option for active Graves’ ophthalmopathy.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
Objective: To explore the therapeutic effect of montelukast sodium + methylprednisolone+ azithromycin therapy for patients with mycoplasma pneumonia. Methods: A total of 88 patients with mycoplasma pneumonia who were ...Objective: To explore the therapeutic effect of montelukast sodium + methylprednisolone+ azithromycin therapy for patients with mycoplasma pneumonia. Methods: A total of 88 patients with mycoplasma pneumonia who were treated in our hospital between July 2015 and June 2017 were collected and divided into group A (oral azithromycin), group B (oral azithromycin + methylprednisolone), group C (oral azithromycin + montelukast sodium) and group D (oral montelukast sodium + methylprednisolone + azithromycin), and they were continuously treated for 1 week. The differences in therapeutic effect, systemic inflammatory response and stress response were compared among the four groups of patients. Results:After 1 week of treatment, the overall response rate of group D was higher than that of group A, group B and group C, and the overall response rate of group B and group C were higher than that of group A respectively;serum inflammatory factors C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), cortisol (COR), malondialdehyde (MDA) and advanced oxidation protein product (AOPP) levels of group D were lower than those of group A, group B and group C, and serum CRP, IL-6, TNF-α, COR, MDA and AOPP levels of group B and group C were lower than those of group A respectively. Conclusion:Montelukast sodium + methylprednisolone + azithromycin therapy can significantly improve the therapeutic effect and inhibit the systemic inflammatory and stress response in patients with mycoplasma pneumonia.展开更多
Objective:To investigate the effects of Pulmicort Respules,Ventolin combined with methylprednisolone in the adjuvant treatment of bronchiolitis in children.Methods:A total of 100 children with bronchiolitis in our hos...Objective:To investigate the effects of Pulmicort Respules,Ventolin combined with methylprednisolone in the adjuvant treatment of bronchiolitis in children.Methods:A total of 100 children with bronchiolitis in our hospital from March 2018 to March 2020 were selected and divided into 2 groups with 50 cases in each group by using random number table.Both groups received conventional treatment.Based on this,the control group was given Pulmicort Respules and Ventolin,and the observation group was given methylprednisolone in combination with the conventional regimens on the basis of the control group treatment,the course of treatment was 5 days.The levels of inflammatory factors[tumor necrosis factor-a(TNF-a),interleukin 6(IL-6)]and the time to symptom disappearance before and after treatment were compared and analyzed between the two groups.Results:After treatment,the levels of serum TNF-a and IL-6 in the two groups decreased,and the observation group was lower than the control group,the difference was statistically significant(P<0.05);the disappearance of pulmonary moist rales,lung wheezing,cough and wheezing in the observation group were all earlier than the control group,the difference was statistically significant(P<0.05).Conclusion:Pulmicort Respules,Ventolin combined with methylprednisolone is effective in adjuvant treatment of bronchiolitis in children,which can reduce inflammation and promote the recovery of children.展开更多
Toxic hepatitis due to drugs is an important and frequent drug adverse reaction in clinical practice. Here, we report a case of high dose methylprednisolone-induced acute hepatitis in a 51-year-old woman that suffers ...Toxic hepatitis due to drugs is an important and frequent drug adverse reaction in clinical practice. Here, we report a case of high dose methylprednisolone-induced acute hepatitis in a 51-year-old woman that suffers from multiple sclerosis while steroids are usually safe drugs with regards to liver injury and even they are the treatment choice of autoimmune hepatitis, but the literatures about corticosteroids showed are not entirely safe to liver injury and they have occasionally linked to hepatotoxicity. Although recent reports have demonstrated that prednisolone may cause hepatitis. This case report includes a brief review of the relevant literature on corticosteroids-induced hepatitis that is presented.展开更多
基金Funded by the National Institute of General Medical Sciences(NIGMS)T32 UNCDuke Collaborative Clinical Pharmacology Postdoctoral Training Program(5T32GM086330-08)C.Hornik was funded by Grant Number is R01HD106588.
文摘Background:Infants undergoing cardiac surgery with cardiopulmonary bypass(CPB)frequently receive intraoperative methylprednisolone(MP)to suppress CPB-related inflammation;however,the optimal dosing strategy and efficacy of MP remain unclear.Methods:We retrospectively analyzed all infants under 90 days-old who received intra-operative MP for cardiac surgery with CPB from 2014–2017 at our institution.We combined real-world dosing data from the electronic health record(EHR)and two previously developed population pharmacokinetic/pharmacodynamic models to simulate peak concentration(Cmax)and area under the concentration-time curve for 24 h(AUC24)for MP and the inflammatory cytokines interleukin-6(IL-6)and interleukin-10(IL-10).We evaluated the relationships between post-operative,safety,and other clinical outcomes obtained from the EHR with each predicted exposure using non-parametric tests.Results:A total of 142 infants with median post-natal age 8(interquartile range[IQR]:5,37)days received a total dose of 30(19,49)mg/kg of MP.Twelve(8%)died,37(26%)met the composite post-operative outcome,114(80%)met the composite safety outcome,and 23(16%)had a major complication.Predicted median Cmax and AUC24 IL-6 exposure was significantly higher for infants meeting the composite post-operative outcome and those with major complications.Predicted median Cmax and AUC24 MP exposure was significantly higher for infants requiring insulin.No exposure was associated with death or other safety outcomes.Conclusions:Pro-inflammatory IL-6,but not MP exposure,was associated with post-operative organ dysfunction,suggesting current MP dosing may not adequately suppress IL-6 or increase IL-10 to impact clinical outcomes.Prospective study will be required to define the optimal exposure-efficacy and exposure-safety profiles in these infants.
基金Major Project of Jinhua Science and Technology Bureaun,No.2021-3-025。
文摘BACKGROUND Patients with trisomy 8 consistently present with myeloid neoplasms and/or auto-inflammatory syndrome.A possible link between myelodysplastic syndromes(MDS)with trisomy 8(+8-MDS)and inflammatory disorders is well recognized,several cases having been reported.However,inflammatory disorders in patients without MDS have been largely overlooked.Generally,Behçet's disease is the most common type in+8-MDS.However,inflammatory disorders with pulmonary involvement are less frequent,and no effective treatment has been established.CASE SUMMARY A 27-year-old man with recurrent fever,fatigue for>2 mo,and unconsciousness for 1 day was admitted to our emergency department with a provisional diagnosis of severe pneumonia.Vancomycin and imipenem were administered and sputum collected for metagenomic next-generation sequencing.Epstein–Barr virus and Mycobacterium kansasii were detected.Additionally,chromosomal analysis showed duplications on chromosome 8.Two days later,repeat metagenomic next-generation sequencing was performed with blood culture.Cordyceps portugal,M.kansasii,and Candida portugal were detected,and duplications on chromosome 8 confirmed.Suspecting hematological disease,we aspirated a bone marrow sample from the iliac spine,examination of which showed evidence of infection.We added fluconazole as further antibiotic therapy.Seven days later,the patient’s condition had not improved,prompting addition of methylprednisolone as an anti-inflammatory agent.Fortunately,this treatment was effective and the patient eventually recovered.CONCLUSION Severe inflammatory disorders with pulmonary involvement can occur in patients with trisomy 8.Methylprednisolone may be an effective treatment.
基金This study was approved by the Ethic Committee of Basic Medical College of Qingdao University(Approval No.QDWMkj-2020-012).
文摘BACKGROUND Acute myelitis(AM)can lead to sudden sensory,motor and autonomic nervous dysfunction,which negatively affects their daily activities and quality of life,so it is necessary to explore optimization from a therapeutic perspective to curb the progression of the disease.AIM To investigate the effect of ganglioside(GM)combined with methylprednisolone sodium succinate(MPSS)on the curative effect and neurological function of patients with AM.METHODS First,we selected 108 AM patients visited between September 2019 and September 2022 and grouped them based on treatment modality,with 52 patients receiving gamma globulin(GG)+MPSS and 56 patients receiving GM+MPSS,assigned to the control group(Con)and observation group(Obs),respectively.The therapeutic effect,neurological function(sensory and motor function scores),adverse events(AEs),recovery(time to sphincter function recovery,time to limb muscle strength recovery above grade 2,and time to ambulation),inflammatory factors(IFs)[interleukin(IL)-6,C-reactive protein(CRP),and tumor necrosis factor(TNF)-α]and other data of the two groups were collected for evaluation and comparison.RESULTS The Obs had:(1)A significantly higher response rate of treatment than the Con;(2)Higher scores of sensory and motor functions after treatment that were higher than the baseline(before treatment)and higher than the Con levels;(3)Lower incidence rates of skin rash,gastrointestinal discomfort,dyslipidemia,osteoporosis and other AEs;(4)Faster posttreatment recovery of sphincter function,limb muscle strength and ambulation;and(5)Markedly lower posttreatment IL-6,CRP and TNF-αlevels than the baseline and the Con levels.CONCLUSION From the above,it can be seen that GM+MPSS is highly effective in treating AM,with a favorable safety profile comparable to that of GG+MPSS.It can significantly improve patients’neurological function,speed up their recovery and inhibit serum IFs.
文摘Background: Previous studies focused on the treatment effect of steroids versus no steroids in treating severe COVID-19 patients, a few studies evaluated outcomes for treating those patients with either dexamethasone or methylprednisolone. Currently, we evaluate the difference in mortality associated with treating COVID-19 patients with dexamethasone versus methylprednisolone. Methods: With a retrospective multicenter study, records were reviewed for the admitted patients with severe COVID-19 during the peak of the severe COVID-19 pandemic. All admitted patients on dexamethasone or methylprednisolone were included. Patients were analyzed as all populations and propensity scores matched patients. Propensity scores were calculated for several confounders by the generalized linear model, and a “greedy” near-neighbor matching algorithm was used. Continuous variables with nonnormal distribution were analyzed by Wilcoxon signed rank test. Chi-squared and Fischer exact test analyzed categorical variables. P-values were adjusted by the Bonferroni method for both data cohorts. Body mass index was in categories. Radiological findings were divided into five categories. The outcomes: mortality, the need for home oxygen therapy, recovery, and residual symptoms on discharge were analyzed by an independent two-sample test for equality of proportions (with Yates correction), and logistic regression analysis. Results: Among the 1128 reviewed records, patients on dexamethasone or methylprednisolone were 1071, and the propensity score-matched patients were 784: dexamethasone 393 and methylprednisolone 391. There was no significant difference in the characteristics of patients between the two steroids (p-value and adjusted p-value > 0.05) for most variables. PSM adjusted a few discrepant variables before analysis. The outcome of the unmatched patients demonstrated dexamethasone benefit in the need for home oxygen therapy ( 0.05). However, matched patients demonstrated significantly lower mortality associated with dexamethasone treatment (difference -2.68%, 95%CI, -1.0, -0.004, p = 0.03, and OR 1.7, p = 0.017), and no difference for the other outcomes, including the need for home oxygen therapy (p-value > 0.05). Conclusion: Dexamethasone treatment caused significantly less mortality than methylprednisolone in treating our COVID-19 patients, but no significant difference in recovery, the need for home oxygen therapy, and residual symptoms on discharge.
文摘Methylprednisolone exhibits anti-inflammatory antioxidant properties, and rosiglitazone acts as an anti-inflammatory and antioxidant by activating peroxisome proliferator-activated receptor-γ in the spinal cord. Methylprednisolone and rosiglitazone have been clinically used during the early stages of secondary spinal cord injury. Because of the complexity and diversity of the inflammatory process after spinal cord injury, a single drug cannot completely inhibit inflammation. Therefore, we assumed that a combination of methylprednisolone and rosiglitazone might promote recovery of neurological function after secondary spinal cord injury. In this study, rats were intraperitoneally injected with methylprednisolone(30 mg/kg) and rosiglitazone(2 mg/kg) at 1 hour after injury, and methylprednisolone(15 mg/kg) at 24 and 48 hours after injury. Rosiglitazone was then administered once every 12 hours for 7 consecutive days. Our results demonstrated that a combined treatment with methylprednisolone and rosiglitazone had a more pronounced effect on attenuation of inflammation and cell apoptosis, as well as increased functional recovery, compared with either single treatment alone, indicating that a combination better promoted recovery of neurological function after injury.
文摘BACKGROUND: Methylprednisolone (MP) can affect the survival of CD4 + T lymphocytes and plays an important role in adaptive immune responses; however, its mechanism of action is not clear. Recent studies have shown that toll- like receptors (TLRs) on CD4 + T cells can directly modulate adaptive immune responses by affecting the survival and proliferation of activated CD4 + T cells. This study aimed to investigate the relationship between MP, TLRs and activated CD4 + T cells. METHODS: We separated and purified CD4 + T cells from mice, activated them in vitro, and co-cultured them with TLR ligands, MP or inhibitors of nuclear factor-kappa B (NF-κB) and activator protein 1 (AP-1). We then assessed CD4 + T cell survival and proliferation and the expression of NF-κB and AP-1. RESULTS: Activated CD4 + T cells showed increased TLR-3 and TLR-9 mRNA expression, but polyinosinic-polycytidylic acid (poly I:C) and MP had no effect on the expression of these mRNAs. Still, poly I:C and CpG oligodeoxynucleotides (CpG DNA) increased the survival of activated CD4 + T cells whereas MP reduced the survival of activated CD4 + T cells and could inhibit the survival effects of poly I:C and CpG DNA. The NF-κB essential modifier-binding domain (NBD) inhibited the survival of activated CD4 + T cells induced by poly I:C and CpG DNA, but the AP-1 inhibitor crucumin did not have the same effect. The increased expression of NF-κB induced by poly I:C and CpG DNA in activated CD4 + T cells could be inhibited by MP, but the same was not true for the increased expression of AP-1 induced by poly I:C and CpG DNA. Finally, the proliferation of activated CD4 + T cells was not affected by poly I:C or MP. CONCLUSION: The survival of activated CD4 + T cells is promoted by TLR ligands, but this effect is inhibited by MP.
基金Supported by the Fujian Medical University COVID-19 Prevention and Treatment Research Contingency Key Project,No.2020YJ006the Science and Technology Program Guided Projects,Fujian Province,China,No.2020Y0036.
文摘BACKGROUND Based on the results of some large randomized controlled trials(RCTs)confirmed the efficacy of corticosteroids in coronavirus disease 2019(COVID-19),corticosteroids have been included in World Health Organization guidelines,but remain controversial.AIM To investigate the efcacy and safety of low-to-moderate dose(30 to 40 mg/d)short-term methylprednisolone for COVID-19 patients.METHODS The clinical data of 70 patients diagnosed with COVID-19 who received antiviral therapy with Arbidol for 7-10 d before admission but had no obvious absorption on chest computed tomography(CT)imaging were retrospectively analyzed.Arbidol(as the control group)and methylprednisolone(as the corticosteroid group)were given respectively after admission.After treatment,chest CT was reexamined to evaluate the absorption of pulmonary lesions.Additionally,we evaluated and compared the lymphocyte count,erythrocyte sedimentation rate(ESR),interleukin-6(IL-6),serum ferritin,lactate dehydrogenase(LDH),creatine kinase-MB(CK-MB),hypersensitive C-reactive protein(hs-CRP)and D-dimer levels,and also analyzed the incidence of toxic and side effects.RESULTS All patients in the corticosteroid group had varying degrees of CT absorption,which was significantly better than that in the control group(CT obvious absorption rate:89.47%vs 12.5%,P<0.05).The average daily dose and course of methylprednisolone in the patients with significant improvement on chest CT was(38.55±13.17)mg and(6.44±1.86)d respectively.During the treatment,the lymphocyte count,ESR,IL-6,serum ferritin,LDH,CK-MB,hs-CRP and D-dimer levels all improved gradually,indicating that both Arbidol and methylprednisolone therapy were contributed to improving the condition of COVID-19 patients.The corticosteroid regimen did not prolong the clearance time of severe acute respiratory syndrome coronavirus 2.There were no severe adverse reactions such as gastrointestinal bleeding,secondary severe infection,hypertension,diabetic ketoacidosis,mental disorders or electrolyte disorders during the whole corticosteroid treatment process.CONCLUSION Low-to-moderate dose short-term methylprednisolone can accelerate the chest CT imaging absorption of COVID-19 so as to improve symptoms and alleviate the condition in a short term,reduce the hospital stay,meanwhile avoid severe COVID-19 phases.The protocol has been proven to be effective and safe in clinical use.
文摘Objective:To study the effects of methylprednisolone combined with montelukast on immune function and cytokines in children with recurrent Henoch-Schonlein purpura.Methods:Children who were diagnosed with recurrent Henoch-Schonlein purpura in Zigong Third People's Hospital between September 2015 and August 2017 were selected as the research subjects and randomly divided into the intervention group who received methylprednisolone combined with montelukast therapy and the control group who received hydrocortisone therapy. The levels of Th1/Th2 and Th17/Treg immunity indexes in peripheral blood as well as cytokines in serum were measured before treatment as well as 4 and 8 weeks after treatment.Results: 4 weeks and 8 weeks after treatment, Th1 and Treg cell contents as well as T-bet and FoxP3 mRNA expression in peripheral blood of both groups of patients were significantly higher than those before treatment whereas Th2 and Th17 cell contents as well as GATA-3 and RORγt mRNA expression in peripheral blood and NF-κB, OPN, IL-33, MK and HMGB1 contents in serum were significantly lower than those before treatment, and Th1 and Treg cell contents as well as T-bet and FoxP3 mRNA expression in peripheral blood of intervention group were significantly higher than those of control group whereas Th2 and Th17 cell contents as well as GATA-3 and RORγt mRNA expression in peripheral blood and NF-κB, OPN, IL-33, MK and HMGB1 contents in serum were significantly lower than those of control group.Conclusion: methylprednisolone combined with montelukast treatment of recurrent Henoch-Schonlein purpura can regulate the immune function and inhibit the cytokine secretion.
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.
基金a Grant from the Research Fund of Department of Health of Jiangxi Province,No.20061072
文摘BACKGROUND:Previous studies have shown that autonomic dysfunction results in gastrointestinal motility disorders and ultimately results in bacterial translocation following acute spinal cord in-jury (SCI). Intensive methylprednisolone dosing improves neurological recovery in SCI patients. However,it remains uncertain whether high-dose methylprednisolone inhibits bacterial translocation and endotoxin release following acute SCI. OBJECTIVE:To investigate the inhibitory effect of methylprednisolone on bacterial translocation and endotoxin release from the gut in paraplegic rats. DESIGN,TIME AND SETTING:The randomized,controlled study was performed at the Orthopedic Lab,First Affiliated Hospital,Nanchang University,China,from April to December 2008. MATERIALS:Methylprednisolone (Pfizer,USA),automatic microbial identification instrument ATB Expression and reagent ID 32 system (BioMérieux,France),Limulus test kit (ACC,USA),and optical microscope (Olympus,Japan) were used in this study. METHODS:A paraplegia model was established following SCI in 48 Wistar rats,aged 7 weeks. The rats were equally and randomly assigned to saline and methylprednisolone groups. Immediately post-injury,the methylprednisolone group was administered 30 mg/kg methylprednisolone via caudal intravenous infusion,followed by a 23-hour infusion of 5.4 mg/kg per hour. The saline group received an equal volume of saline as placebo. MAIN OUTCOME MEASURES:At 24 hours,72 hours,and 1 week after SCI,blood samples were collected for bacterial cultures,and bacteria and endotoxin were identified using ATB Expression and Limulus test kits. In addition,mesenteric lymph node,spleen,and liver samples were collected for bacterial cultures. Histological examinations of mesenteric lymph node,spleen,liver,jejunum,and ileum were performed 1 week post-injury. Locomotor function in the hind limb was evaluated using the Basso,Beattie,and Bresnahan score at pre-injury time point,as well as 24 hours,72 hours,and 1 week post-injury. RESULTS:Endotoxemia and bacterial growth were identified at 24 hours post-injury in both groups. However,plasma endotoxin levels were significantly decreased in the methylprednisolone group compared with the saline group at 72 hours and 1 week post-injury (P < 0.05). Translocated bacteria mainly comprised Bacillus coli,Enterobacter cloacae,Escherichia coli,Proteus vulgaris,and Enterococcus faecalis following SCI combined with paraplegia. Histological changes were not as severe in the methylprednisolone group compared with the saline group 1 week after injury. Basso,Beattie,and Bresnahan scores were significantly better in the methylprednisolone group compared with the saline group 1 week after injury (P < 0.05). CONCLUSION:High-dose methylprednisolone inhibited bacterial translocation from the gut and endotoxin release in rats with SCI.
基金We thank the First Affiliated Hospital of the Guangxi Medical University for supplying the case data.We also thank teachers in the pediatric department for their assistance.
文摘Objective:An increasing number of pediatric patients are being diagnosed with anti-N-methyl-Daspartate receptor(NMDAR)encephalitis,whose treatment requires immunotherapy through nursing interventions.This study aimed to analyze the clinical features and long-term prognosis of pediatric anti-NMDAR encephalitis and to gather nursing experiences of immunotherapy.Methods:Seventeen children diagnosed with anti-NMDAR encephalitis were admitted to the pediatric department.They were subjected to a therapy of intravenous immunoglobulin(IVIG)accompanied with high-dose methylprednisolone(HDMP).Multidisciplinary cooperation and intensive care were used to manage them.The effects of nursing intervention and therapy were repeatedly assessed and analyzed throughout the course of treatment and recovery.Results:None of the patients manifested adverse drug reaction(ADR)during IVIG administration.At the first administration of HDMP,ADRs were promptly and efficiently treated in four patients(24%;i.e.,one case each of hyperglycosemia,hypertension,aggravated symptoms,and gastrointestinal bleed).Two patients underwent rehabilitation,and six patients received hyperbaric oxygenation during hospitalization.Nine patients with indwelling gastric tubes experienced four times of unplanned extubation.Hospital stay ranged from 11 days to 59 days,with the mean duration of 26 days.Discharge evaluation revealed that 16 patients who scored 0e2 on the modified Rankin scale presented obvious remission,and one patient who had a mRS score of 4 exhibited less improvement.The mRS scores of hospitalization,discharge,and six-month follow-up displayed statistically significant differences.Conclusions:Nursing interventions of immunotherapy ensures the security of IVIG administration.Multidisciplinary cooperation promotes remission.Our findings can serve as reference for healthcare teams.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)outbreak has brought great challenges to public health.Aggravation of COVID-19 is closely related to the secondary systemic inflammatory response.Glucocorticoids are used to control severe diseases caused by the cytokine storm,owing to their anti-inflammatory effects.However,glucocorticoids are a double-edged sword,as the use of large doses has the potential risk of secondary infection and long-term serious complications,and may prolong virus clearance time.Nonetheless,the risks and benefits of glucocorticoid adjuvant therapy for COVID-19 are inconclusive.AIM To determine the effect of methylprednisolone in severe and critically ill patients with COVID-19.METHODS This single-center retrospective study included 102 adult COVID-19 patients admitted to a ward of a designated hospital in Wuhan,Hubei Province from January to March 2020.All patients received general symptomatic treatment and organ function support,and were given different respiratory support measures according to their conditions.In case of deterioration,considering the hyperinflammatory state of the patients,methylprednisolone was intravenously administered at 0.75-1.5 mg/kg/d,usually for less than 14 d.Patient vital signs and oxygenation were closely monitored,in combination with imaging and routine blood tests such as C-reactive protein,biochemical indicators(liver and kidney function,myocardial enzymes,electrolytes,etc.),and coagulation function.Patient clinical outcomes were discharge or death.RESULTS A total of 102 severe and critically ill COVID-19 patients were included in this study.They were divided into treatment(69,67.6%)and control groups(33,32.4%)according to methylprednisolone use.Comparison of baseline data between the two groups showed that the treatment group patients had higher aspartic acid aminotransferase,globulin,hydroxybutyrate dehydrogenase,and lactate dehydrogenase.There was no significant difference in other baseline data between the two groups.With regard to prognosis,29(78.4%)patients in the treatment group died as opposed to 40(61.5%)in the control group.The mortality was higher in the treatment group than in the control group;however,according to the log-rank test and the Kaplan–Meier survival curve,the difference in mortality between both groups was insignificant(P=0.655).The COX regression equation was used to correct the variables with differences,and the results showed that methylprednisolone treatment did not improve prognosis.CONCLUSION Methylprednisolone treatment does not improve prognosis in severe and critical COVID-19 patients.
文摘Bickerstaff brainstem encephalitis (BBE) is a rare post-infectious neurological syndrome for which an effective treatment strategy has not been established. Here, we report a case of a 71-year-old male who suffered from an upper respiratory tract infection, and 7 days later, developed numbness of the bilateral upper and lower limbs, unsteady gait and dysarthria. Brain magnetic resonance imaging was normal, nerve conduction study and cerebral spinal fluid analysis were nonspecific. Based on the clinical features, we tentatively diagnosed Guillain-Barré syndrome and started immunoadsorption plasmapheresis. However, consciousness progressively declined to coma level within 10 days. Electroencephalogram showed diffuse slowing, and auditory evoked brainstem response (ABR) demonstrated absence of waves II, III and V. Serum anti-GQ1b IgG autoantibody and anti-GM1b IgG autoantibody were negative. Subsequently, we diagnosed BBE, and clinical symptoms resolved after treatment with intravenous immunoglobulin and methyllprednisolone. On day 62, neurological symptoms were remarkably alleviated with an improvement in ABR. Our observations suggest that immunoadsorption plasmapheresis should be used only when anti-ganglioside antibodies are detected. Combination therapy with intravenous immunoglobulin and methylprednisolone or plasma exchange?is recommended as initial therapy.
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The present study was undertaken to examine the effects of methylprednisolone on the expression and activity of calpain in spinal cord tissue following spinal cord ischemia-reperfusion injury in rats. Adult male Sprague-Dawley rats were subjected to sham operations, ischemia-reperfusion and vehicle treated, or ischemia-reperfusion with methylprednisolone administration after injury. The expression of calpain I in the injured segments of the spinal cord as well as the degradation of the 68 kD neurofilament protein (NFP), a calpain-specific substrate, was determined at 3 h, 24 h, 72 h and 7 days after reperfusion using immunohistochemical labeling and western blot analysis, respectively. Three hours after spinal cord reperfusion, calpain I-positive cells and NFP degradation products were evident. The number of positive cells and immunoreactivity increased with time and peaked at 72 h after reperfusion. In addition, the number of calpain I-positive cells and the abundance of NFP degradation products were significantly lower in the methylprednisolone group, compared with vehicle treated animals following ischemia-reperfusion injury. The results of this study suggest that methylprednisolone can inhibit the expression and degradation activity of calpain following ischemia-reperfusion injury, providing further insight into the therapeutic benefits of methylprednisolone treatment for spinal cord injury.
文摘Background: Graves’ ophthalmopathy (GO) is the most frequent extrathyroidal manifestation of Graves’ disease (GD). The effect of intravenous methylprednisolone on the signs and symptoms of GO has not been evaluated in the Bangladeshi population. Objective: To observe the effect of intravenous methylprednisolone in active Graves’ ophthalmopathy. Materials/Methods: This prospective study conducted in a tertiary hospital of Bangladesh from May 2009 to November 2010 included 30 patients having moderate to severe ophthalmopathy. In addition to the clinical activity score (CAS), eye involvement was assessed by using the “NOSPECS” scoring system. Results: The mean (±SD) age of the patients was 38.1 ± 10.6 years and male-female ratio was 1.2:1. NOSPECS eye findings before treatment and during the final (3rd) visit of the patients were observed. It was found that lid retraction or lid lag was improved in 21 (70%) of the patients during the final visit. All of the patients had soft tissue swelling initially and all of them improved at the final visit. Bilateral proptosis was present in 19 patients before treatment and improved in 12 (62%) patients during the final visit. Right eye proptosis was present in 9 patients before treatment and improved in 5 (60%) patients during final visit. Extraocular muscle involvement (Diplopia) was present in 15 patients before treatment but improved in 13 (86.0%) patients during the final visit. A significant number of subjects showed significant improvement in all of the NOSPECS eye findings (except unilateral right eye proptosis) during the final visit;all had inactive GO (CAS Conclusion: Intravenous methylprednisolone appears to be an effective treatment option for active Graves’ ophthalmopathy.
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.
文摘Objective: To explore the therapeutic effect of montelukast sodium + methylprednisolone+ azithromycin therapy for patients with mycoplasma pneumonia. Methods: A total of 88 patients with mycoplasma pneumonia who were treated in our hospital between July 2015 and June 2017 were collected and divided into group A (oral azithromycin), group B (oral azithromycin + methylprednisolone), group C (oral azithromycin + montelukast sodium) and group D (oral montelukast sodium + methylprednisolone + azithromycin), and they were continuously treated for 1 week. The differences in therapeutic effect, systemic inflammatory response and stress response were compared among the four groups of patients. Results:After 1 week of treatment, the overall response rate of group D was higher than that of group A, group B and group C, and the overall response rate of group B and group C were higher than that of group A respectively;serum inflammatory factors C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), cortisol (COR), malondialdehyde (MDA) and advanced oxidation protein product (AOPP) levels of group D were lower than those of group A, group B and group C, and serum CRP, IL-6, TNF-α, COR, MDA and AOPP levels of group B and group C were lower than those of group A respectively. Conclusion:Montelukast sodium + methylprednisolone + azithromycin therapy can significantly improve the therapeutic effect and inhibit the systemic inflammatory and stress response in patients with mycoplasma pneumonia.
文摘Objective:To investigate the effects of Pulmicort Respules,Ventolin combined with methylprednisolone in the adjuvant treatment of bronchiolitis in children.Methods:A total of 100 children with bronchiolitis in our hospital from March 2018 to March 2020 were selected and divided into 2 groups with 50 cases in each group by using random number table.Both groups received conventional treatment.Based on this,the control group was given Pulmicort Respules and Ventolin,and the observation group was given methylprednisolone in combination with the conventional regimens on the basis of the control group treatment,the course of treatment was 5 days.The levels of inflammatory factors[tumor necrosis factor-a(TNF-a),interleukin 6(IL-6)]and the time to symptom disappearance before and after treatment were compared and analyzed between the two groups.Results:After treatment,the levels of serum TNF-a and IL-6 in the two groups decreased,and the observation group was lower than the control group,the difference was statistically significant(P<0.05);the disappearance of pulmonary moist rales,lung wheezing,cough and wheezing in the observation group were all earlier than the control group,the difference was statistically significant(P<0.05).Conclusion:Pulmicort Respules,Ventolin combined with methylprednisolone is effective in adjuvant treatment of bronchiolitis in children,which can reduce inflammation and promote the recovery of children.
文摘Toxic hepatitis due to drugs is an important and frequent drug adverse reaction in clinical practice. Here, we report a case of high dose methylprednisolone-induced acute hepatitis in a 51-year-old woman that suffers from multiple sclerosis while steroids are usually safe drugs with regards to liver injury and even they are the treatment choice of autoimmune hepatitis, but the literatures about corticosteroids showed are not entirely safe to liver injury and they have occasionally linked to hepatotoxicity. Although recent reports have demonstrated that prednisolone may cause hepatitis. This case report includes a brief review of the relevant literature on corticosteroids-induced hepatitis that is presented.
