Objective To evaluate the safety and efficacy of dexamethasone intravitreal implant 0.7 mg (DEX) for treatment of macular edema associated with retinal vein occlusion (RVO). Methods This study was a six-month, randomized, double-masked, sham-controlled, multicenter, phase 3 clinical trial with a 2-month open-label study extension. Patients with branch or central RVO received DEX (n=129) or sham procedure (n=130) in the study eye at baseline; all patients who met re-treatment criteria received DEX at month 6. Efficacy measures included Early Treatment Diabetic Retinopathy Study (ETDRS), best-corrected visual acuity (BCVA), and central retinal thickness (CRT) on optical coherence tomography. Results Time to ≥15-letter BCVA improvement from baseline during the first 6 months (primary endpoint) was earlier with DEX than sham (P＜0.001). At month 2 (peak effect), the percentage of patients with ≥15-letter BCVA improvement from baseline was DEX: 34.9%, sham: 11.5%; mean BCVA change from baseline was DEX: 10.6±10.4 letters, sham: 1.7±12.3 letters; and mean CRT change from baseline was DEX: ?407±212 μm, sham: ?62±224 μm (all P＜0.001). Outcomes were better with DEX than sham in both branch and central RVO. The most common treatment-emergent adverse event was in-creased intraocular pressure (IOP). Increase sin IOP generally were controlled with topical medication. Mean IOP normalized by month 4, and no patient required incisional glaucoma surgery. Conclusions DEX had a favorable safety profile and provided clinically significant benefit in a Chinese patient population with RVO. Visual and anatomic outcomes were improved with DEX relative to sham for 3 - 4 months after a single implant.
ObjectiveTo systematically review the efficacy of preoperative corticosteroids use as an adjunctive treatment for rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD). MethodsA evidence-based medicine study. The National Library of Medicine's PubMed, Web of Science, CNKI, and WanFang database were searched. Clinical controlled studies were selected the study object was RRDCD patients and the interventions were preoperative corticosteroids used as an adjunctive treatment. The search was conducted from January 2000 to January 2022. Duplicated, incomplete, or irrelevant articles were excluded. The conventional meta-analysis was used to evaluate the efficacy of corticosteroids used before surgery. The network meta-analysis was used to directly or indirectly compare the efficacy of oral corticosteroids or intravenous dexamethasone, peribulbar injection of glucocorticoids, prednisolone acetate eye-drops, intravitreal injection of triamcinolone acetonide (TA) and posterior sub-tenon injection of triamcinolone acetonide. Publication bias was evaluated by funnel plot. ResultsAccording to the search strategy, 43 articles were initially retrieved, and 929 eyes of 13 articles were finally included for analysis; 6 and 10 articles were included in the traditional meta-analysis and the network meta-analysis. Among the 6 studies included in the conventional meta-analysis, 5 studies were retrospective and 1 study was a randomized controlled trial, involving a total of 575 eyes. The analysis results showed that there was no significant difference in the primary retinal reattachment rate between the corticosteroids group and the control group [odds ratio (OR)= 1.53, 95% confidence interval (CI) 0.67-3.53, P=0.314]. Among the 10 studies included in the network meta-analysis, 7 studies were retrospective trials, 2 studies were randomized controlled trials, and 1 study was prospective trial, involving a total of 575 eyes. The analysis results showed that there were significant differences in the primary retinal reattachment rate between the triamcinolone acetonide intravitreal injection group and the no corticosteroid treatment group (OR=4.09, 95%CI 1.06-15.79). Sub-tenon injection triamcinolone acetonide had a higher incidence rate of ocular hypertension than oral glucocorticoid or intravenous dexamethasone (OR= 4.47, 95%CI 1.42-14.13). ConclusionsTriamcinolone acetonide intravitreal injection before surgery can improve the primary retinal reattachment rate in RRDCD patients. Patients with the posterior sub-tenon injection of triamcinolone acetonide should be alert to elevated intraocular pressure.
PURPOSE:To evaluate the activitv of protein kinase C(PKC) in response to retinal photochemical insult in rat. Furthermore, to investigate the effect of dexamethasone(DXM ) on PKC activity. METHODS :The experiments were performed on 48 SI') rats whieh were separated into two groups,control and treated groups,and the latter received daily intraperitoneal injections of DXM (1 mg/kg)for 5 consecutive days,starting 3 days before light exposure. The animals were continually exposed to green fluorescent light (510nm~560nm) with an illuminance level of (1 900plusmn;106.9)lx for 24 hrs.The retinal enzyme activity of PKC was tested at 6 hrs,1 day,3 days,7 days,and 14 days after light exposure respectively. RESULTS:In animal models,PKC activity showed a transient increase in both groups at 6 hrs after light exposure and then decrease persistently there alter. The activity of PKC was unresponsive to DXM intervention. CONCLUSIONS :These results suggested that the persistent lower PKC activity might result in disturbance of retinal function in rat retinal photochemical injury. （Chin J Ocul Fundus Dis,1997,13: 78-80）
COPD 和肺癌均為最常見的吸煙相關呼吸道疾病。吸入性糖皮質激素( ICS) 近年來被推薦用于重度COPD 的治療, 同時也被發現在肺癌的化學預防中起重要作用。本文通過綜述ICS、COPD 和肺癌之間的關系, 特別是吸入糖皮質激素在肺癌中的化學預防作用, 以期進一步明確ICS 在COPD和肺癌中的作用。
ObjectiveTo systematically review the clinical efficacy and safety of glucocorticoids, acetaminophen and antimicrobial drugs in the treatment of intrapartum fever in labor analgesia. MethodsThe PubMed, Embase, Cochrane Library, Web of Science, CBM, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of glucocorticoids, acetaminophen, and antimicrobial drugs for intrapartum fever in labor analgesia from inception to June 30, 2023. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included literature. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 10 RCTs involving 1 337 women were included. Meta-analysis showed that the use of glucocorticoids reduced the incidence of intrapartum fever in women with labor analgesia compared with the control group (OR=0.52, 95%CI 0.33 to 0.82, P<0.01). But there was no statistically significant difference between acetaminophen or antimicrobial drugs and the control group. ConclusionCurrent evidence shows that the use of glucocorticoids can reduce the incidence of intrapartum fever in labor analgesia, but the use of acetaminophen and antimicrobial drugs cannot reduce the incidence of intrapartum fever. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To systematically evaluate the effect and safety of systemic corticosteroids for acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 6, 2015), Wanfang Data, CBM, CNKI were searched to collect randomized controlled trails (RCTs) about systemic corticosteroids for acute exacerbation of COPD from inception to July 2015. The meta-analysis was conducted using RevMan 5.3 software. Results A total of 11 RCTs involving 1298 patients were included. The results of meta-analysis showed that a statistically significant increase in the treatment success rate when using systemic corticosteroids (RR=1.11, 95%CI 1.01-1.21,P=0.02), and a non-significant difference of effect in the subgroup of emergency department and ICU patients (RR=0.98, 95%CI 0.90-1.08,P=0.74;RR=1.19, 95%CI 0.84-1.69,P=0.34). Conclusions Current studies suggest that systemic corticosteroids is beneficial in terms of treatment success rate, but subgroup analysis shows that this benefit is controversial in emergency department and ICU. however, due to the limited quantity of the included studies, the above conclusions still need more high quality research to be verified.
糖皮質激素在甲型H1N1流感中的應用探討
Objective To explore the effect of early short-term use of low-dose steroids on early acute lung injury (EALI) after video-assisted thoracoscopic lobectomy. Methods Patients who underwent video-assisted thoracoscopic lobectomy in our department from January 2019 to January 2022 were selected for this retrospective cohort study. They were divided into an early steroid treatment group and a control group based on whether steroids were used in the early postoperative period. In the early steroid treatment group, in addition to routine postoperative treatment, low-dose methylprednisolone was administered intravenously, at 80-120 mg/d for 3 consecutive days. In the control group, routine postoperative treatment was given, but no steroids were used in the first 3 days. A chest computed tomography (CT) scan was performed on postoperative day (POD) 1, and POD3 or POD4 to assess lung injury. Chest CT scores, the EALI incidence, the length of hospital stay, and the incidence of poor incision healing were recorded. ResultsA total of 521 patients were included, consisting of 255 males and 266 females, aged 11-80 years. There were 203 patients in the early steroid treatment group and 318 patients in the control group. On POD1, the incidence of EALI was 16.0% in the control group and 13.8% in the steroid group, with no significant difference between the two groups (P>0.05). There was also no significant difference in the CT scores of patients with EALI in the two groups (P>0.05). On POD3/4, the incidence of EALI was 33.6% in the control group and 22.7% in the steroid group, showing a significant difference (P=0.007). When comparing the CT scores of patients with EALI in both groups, the scores were lower in the steroid group, but the difference was not significant (P>0.05). The overall incidence of EALI on POD1-4 was 37.4% in the control group and 26.1% in the steroid group, showing a significant difference (P=0.007). Of these, 28.9% of patients in the control group showed radiological progression, which means new EALI occurred or existing EALI progressed, while the progression rate was 14.8% in the steroid group (P<0.001). The length of hospital stay was significantly shorter in the steroid group compared to the control group (P<0.001), but the incidence of poor incision healing was not (P>0.05). Conclusion Early use of corticosteroids cannot reduce the incidence and severity of EALI on POD1, but it can reduce the incidence of EALI on POD3/4 and decrease the risk of radiological progression, and also lower the overall risk of EALI after surgery, without extended postoperative hospital stays or increased incidence of poor incision healing. Therefore, early postoperative use of low-dose corticosteroids can help to inhibit the occurrence and progression of EALI. It is suggested to use as early as possible especially in patients with high risks of postoperative EALI.
截止至2002年5月,現有早產治療的臨床證據如下: (1) 高危早產:在一些國家實施的RCT發現,在降低早產危險方面,加強產前保健與普通產前保健沒有明顯差異.包括5個RCT的1個系統評價發現,對有宮頸改變的婦女行宮頸環扎術有不同的結果,沒有明確的結論.1個大樣本的RCT發現,孕9～29周宮頸功能可能不全的婦女進行預防性宮頸環扎手術與不環扎相比,能明顯降低早產(＜33孕周),但也會明顯增加產褥感染的危險.另外4篇較小樣本的RCT發現,孕10～30周、具各種早產高危因素的婦女,進行預防性宮頸環扎手術與不環扎相比,并不能降低早產(＜34孕周).1篇系統評價的2個RCT報告,對有宮頸改變的婦女進行環扎術有不同的結果,其中1個RCT發現其并不能明顯降低早產(＜34孕周),而另外1個較小樣本的RCT卻發現宮頸環扎手術加臥床休息與單純臥床休息比較,能明顯降低34周前的早產.沒有1個RCT證實行環扎術加臥床休息與單純臥床休息相比,能降低圍生兒死亡率. (2) 胎膜早破:1個系統評價發現,對胎膜早破的婦女,抗生素較安慰劑能明顯延長孕周、降低新生兒發病率的危險,如新生兒感染、出生后氧療、腦部超聲異常等.阿莫西林加克拉維酸治療與新生兒壞死性小腸結腸炎的發生率明顯增加有關.一個基于1個RCT的系統評價發現,沒有充足的證據證實羊膜腔灌注與不灌注比較能改善胎膜早破后的新生兒結局. (3) 先兆早產的治療:①β-腎上腺素興奮劑:1個系統評價發現,β-腎上腺素興奮劑與安慰劑或不治療相比,并不能明顯降低圍生兒死亡率、呼吸窘迫綜合征及低體重兒(＜2 500 g)發生率,且與與安慰劑或不治療相比,β-腎上腺素興奮劑增加孕母副反應,如胸痛、心悸、呼吸困難、震顫、惡心、嘔吐、頭痛、高血糖、低鉀血癥.②鈣離子通道拮抗劑: 沒有關于鈣離子通道拮抗劑與安慰劑比較的系統評價或RCT.1個系統評價發現,鈣離子通道抑制劑與其它保胎藥(主要是β-腎上腺受體興奮劑)比較,能顯著降低48 h內的早產分娩,減少因孕母副反應退出治療和新生兒發病率.③硫酸鎂:1個系統評價發現,硫酸鎂與安慰劑比較,并不能明顯降低孕36周前的早產率、圍生兒死亡率、呼吸窘迫綜合征的發生率.另一個系統評價發現,硫酸鎂和其他宮縮抑制劑(β-腎上腺素興奮劑、鈣離子通道拮抗劑、前列腺素合成抑制劑、硝化甘油、酒精和葡萄糖注射劑)比較,并不能明顯降低48 h內早產率(盡管結果沒有差異).④垂體受體拮抗劑(阿托西班):1個系統評價納入 2個RCT,對阿托西班和安慰劑治療早產進行比較有不同的結果.較大樣本的RCT發現,阿托西班較安慰劑能延長孕周,但阿托西班增加了孕28周以下的胎兒死亡率.另一個RCT發現,阿托西班增加了48 h內的早產.⑤前列腺素抑制劑(消炎痛):1個系統評價發現,消炎痛與安慰劑比較,能明顯降低孕37周前的48 h和7天的早產率的證據有限.然而,同時發現消炎痛與安慰劑或不治療相比,并不能明顯降低圍生兒死亡率、新生兒呼吸窘迫綜合征、肺支氣管發育不良、壞死性小腸結腸炎、新生兒敗血癥或低體重兒.但這個系統評價樣本太小,尚不能發現有臨床意義的差異. (4) 擇期或非擇期剖宮產對早產婦女治療效果:1個系統評價結果發現,擇期剖宮產較非擇期剖宮產會增加孕母的發病率,卻不能降低新生兒的發病率和死亡率.但尚不能證明此效果是否對新生兒有臨床意義. (5) 改善早產妊娠結局的干預措施:①對早產者采用皮質類固醇:1個系統評價認為,對可能發生早產的婦女使用皮質激素較安慰劑或不處理能明顯降低早產兒出生后呼吸窘迫綜合征、新生兒死亡率和顱內出血的發生.②促甲狀腺激素釋放激素在早產中的運用:1個系統評價發現,在早產的高危婦女中,促甲狀腺激素釋放激素和類固醇激素聯合應用與單用皮質類固醇激素比較,對新生兒結局的影響無明顯差異,但會明顯增加孕母和胎兒的不良反應.③抗生素:1個系統評價發現,抗生素與安慰劑比較,不能延長孕周、降低新生兒死亡率,但可降低孕母感染率.
Objective To formulate an evidence-based treatment for a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Methods According to the principles of evidencebased clinical practice, we searched The Cochrane Library (Issue 2, 2008), Ovid-Reviews (1991 to 2008), MEDLINE (1950 to 2008), and http://www.guideline.org. to identify the best evidence for treating a patient with pulmonary tuberculosis combined with tuberculous meningitis and tuberculous pericarditis. Results Nine guidelines, 2 systematic reviews, and 11 randomized controlled trials were included. The evidence showed that corticosteroids could help reduce the risk of death and disabling residual neurological deficiencies in patients with tuberculous meningitis. After adjusting for age and gender, the overall death rate of patients with tuberculous pericarditis was significantly reduced by prednisolone (P=0.044), as well as the risk of death from pericarditis (P=0.004). But for patients with pulmonary tuberculosis, there was still a controversy about the use of corticosteroids. Given the evidence, the patient’s clinical conditions, and his preferences, dexamethasone was used for the boy in question. After 7 weeks of treatment, his cerebrospinal fluid returned to normal and pericardial effusion disappeared. Conclusion Corticosteroids should be recommended in HIV-negative people with tuberculous meningitis or/and tuberculous pericarditis. The difference in the effectiveness of various corticosteroids such as dexamethasone, prednisolone, or methylprednisolone and the optimal duration of corticosteroid therapy is still unknown.