Objective To investigate the relationship among rats′ stress ulcer and gastric acid, prostaglandin (PGs) and adrenocorticotropin (ACTH) and to probe the pathogenesis, prophylaxis and therapy. Methods Rats′ stress ulcer model was made by cold water soaking and was properly treated with drugs such as hyoscine, dexamethasone, ranitidine and losec. The amount and pH of gastric juice, change of gastric mucosa and PGs and ACTH of blood were determined. Results After rats were fasted for 24 hours a little gastric juice was aspirated. After cold water soaking of rats gastric juice was increased with the pH decreased, there was gastric mucosal bleeding, blood PGs was decreased and ACTH was increased. These suggest that on stress gastric mucosa bleeding is related with decreased gastric juice pH, decreased PGs and increase ACTH.Conclusion To control stress ulcer, pH of gastric juice and amount of PGs should be increased. Losec can increase gastric juice pH, so losec is the first choice to control stress ulcer.
目的 观察糖皮质激素对胎盘组织促肾上腺皮质激素释放激素（CRH）的分泌水平的影响。 方法 收集2006年1月－3月住院分娩的正常妊娠妇女的胎盘组织与妊娠肝内胆汁淤积症（ICP）患者胎盘及其血清各10例。分3组进行胎盘组织培养，即正常胎盘组、ICP胎盘组，正常胎盘组织加ICP患者血清组，分别用放射免疫法测定各组加与不加地塞米松胎盘组织培养液中CRH的水平。 结果 正常组与正常胎盘加地塞米松组培养24、48、72、96 h其CRH分泌水平分别为：（74.81 ± 27.92）、（63.71 ± 24.72）、（91.87 ± 41.64）、（98.90 ± 42.52） pg/mL；（66.94 ± 29.62）、（77.39 ± 31.84）、（61.89 ± 33.94）、（75.13 ± 36.98） pg/mL，两组比较差异有统计学意义（P＞0.05）。ICP组与ICP加地塞米松组培养上清液中CRH水平在24、48、72、96 h其CRH分泌水平分别为：（48.28 ± 16.56）、（60.20 ± 29.97）、（72.92 ± 31.65）、（69.22 ± 29.33）pg/mL；（41.81 ± 25.00）、（57.36 ± 39.75）、（57.72 ± 23.29）、（61.43 ± 20.77）pg/mL, 两组比较差异有统计学意义（P＞0.05）；正常胎盘加ICP血清培养组与正常胎盘加ICP血清加地塞米松培养组上清液中CRH水平在24、48、72、96 h其CRH分泌水平分别为：（84.9 ± 34.98）、（74.5 ± 29.93）、（71.1 ± 27.26）、（81.0 ± 37.18）pg/mL；（76.29 ± 33.11）、（63.70 ± 24.20）、（64.85 ± 28.39）、（67.65 ± 33.20）pg/mL，两组比较差异有统计学意义（P＞0.05）。3组加入地塞米松培养的胎盘组织，CRH分泌水平并无明显改变。 结论 地塞米松不影响体外培养胎盘组织CRH分泌。
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.
To report a case of a 1-year-old female child admitted to the hospital with recurrent convulsions and diagnosed as West syndrome, also known as infantile spasms (IS). The child had been experiencing convulsions for 4 months prior to admission, characterized by forward head tilt and flexion of the limbs, with 8 ~ 10 episodes per day. After admission, West syndrome was identified by EEG and imaging evaluation, and adrenocorticotropic hormone (ACTH) shock therapy was started on day 5 of admission, supplemented with peripherally inserted central catheter (PICC), gastric protection, calcium and potassium supplementation and other supportive measures. During the course of treatment, the nursing team implemented meticulous monitoring and assessment to ensure that the child's vital signs were stabilized, and potential side effects were detected and treated in a timely manner. After 14 days of treatment, the child had no further spasticity episodes during 3 ~ 14 days, and was discharged from the hospital with continued oral hormone intake and regular follow-up. During the nursing process, the nursing staff provided psychological support and education to the child and her family to help the family understand the disease and enhance their ability to manage it. In addition, personalized nutritional support and monitoring were provided to ensure the healthy growth of the child. The successful management of this case not only enhanced the quality of clinical care, but also provided useful reference and inspiration for similar cases.
Objective To investigate the clinical features, diagnosis, treatment and prognosis of ectopic adrenocorticotropic hormone (ACTH) syndrome caused by bronchopulmonary carcinoid. Methods Twenty patients (13 males and 7 females) with ectopic ACTH syndrome caused by bronchopulmonary carcinoid confirmed by surgical pathology were selected from March 2007 to May 2016 in our hospital. We collected and arranged the important clinical data of 20 patients and analyzed carefully. Results The mean age of 20 patients including 14 patients of typical carcinoid and 6 patients of atypical carcinoid was 38.85±15.31 years ranged 13-70 years. All patients had the typical clinical manifestation of Cushing's syndrome. All the thoracic lesions were located by thoracic computed tomography (CT) eventually. The concentration of serum cortisol and ACTH significantly decreased after surgery. Postoperative complications in 3 patients (15.00%) were severe pulmonary infection. Eighteen patients including 13 patients of typical carcinoid and 5 patients of atypical carcinoid were followed up. The median time of follow-up was 31.5 (12-122) months. There were 7 patients of stage Ⅰa, 1 patient of stage Ⅰb, 2 patients of stage Ⅱa and 8 patients of stage Ⅲa in the patients followed up. One patient underwent postoperative radiotherapy, and 4 patients with postoperative chemotherapy. During the follow-up period, one patient relapsed and there was no death. Conclusion Ectopic ACTH syndrome caused by bronchopulmonary carcinoid is a very rare disease. It is every difficult for clinicians to make early diagnosis and draw up plans of treatment without multidisciplinary collaboration. Chest CT is an important method of finding lesions and assessing the viability of surgery. Surgical treatment in early stage will be effective for this disease. And almost all of patients can achieve long-term survival after complete resection of tumors early.
Objective To explore the evaluation value of burden of amplitudes and epileptiform discharges score (BASED) in the efficacy of adrenocorticotropic hormone (ACTH) combined with magnesium sulfate therapy for infantile epileptic spasms syndrome (IESS). Methods Retrospective collection the clinical and EEG data of 124 patients admitted to the Dongguan Maternal and Child Health Care Hospital from 2015 to 2023, who were diagnosed with IESS and treated with ACTH combined with magnesium sulfate. According to whether there were epileptic seizures 14 days after ACTH treatment, the patients were divided into two groups: non seizure group (n=74 cases) and seizure group (n=50 cases). The BASED system was used to evaluate the relationship between changes in EEG before and after ACTH treatment and clinical efficacy in both groups. The analysis of electroencephalogram included: ① abnormally high amplitude background waves, ② >3 spike foci , ③ grouped multifocal spikes, ④ paroxysmal voltage attenuation. ResultThe control rate of ACTH combined with magnesium sulfate in the treatment of IESS was 59.7% (74/124), and there was no statistically significant difference in the control rate among children with different etiologies (P=0.09). The BASED score suggests that the overall response rate of electroencephalogram (EEG) in infants with epileptic spasm syndrome after treatment was 57.2%. The EEG remission rate in the seizure control group was 81% (60/74), while in the uncontrolled group was 22% (11/50). The EEG remission rate in the seizure control group was significantly higher than that in the uncontrolled group after treatment (P<0.001), and the EEG score was closely related to clinical efficacy (Spearman correlation coefficient rp=0.601, P<0.001). ConclusionThe BASED score is related to clinical efficacy, and it can provide a quantitative basis for evaluating the efficacy of ACTH combined with magnesium sulfate in the treatment of IESS.
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）
ObjectiveThe purpose of this study was to explore the expression of Corticotropin releasing hormone (CRH), Corticotropin releasing hormone receptor 1 (CRHR1), Protein kinase C (PKC) in epileptogenic zone of Infantile spasm (IS).MethodsCollected 17 cases of tissues of IS patients from operation and 6 cases of normal brain tissues from clinical autopsy during June 2011 to June 2014. Westen blot was used to detected the protein expression of CRH, CRHR1, PKC. PCR was used to exam the mRNA expression of CRH, CRHR1, PKC. Immunohistochemistry and fluorescenceimmuno assay were used to detect the expression of CRH, CRHR1, PKC.ResultsThe mRNA expression of CRH and CRHR1 in IS group are higher than control group, and the protein expression of CRH and CRHR1 in IS group are higher than control group. CRH are slightly expressed in the controls, medium and strong expressed in IS, CRH and NF200 both expressed in IS; CRH is negative in GFAP positive astrocyte; CRH is negative in HLA positive microglial cell. CRHR1 are slightly and medium expressed in the controls, medium and strong expressed in IS, CRHR1 and NF200 both expressed in IS; CRHR1 and GFAP are both positive in astrocyte; CRHR1 and HLA are both positive in microglial cell. PKC are slightly and medium expressed in the controls, medium and strong expressed in IS, PKC and NF200 both expressed in IS; PKC and GFAP are both positive in astrocyte; PKC and HLA are both positive in microglial cell. Spearman analysis showed positive correlation between the expression of CRH, CRHR1, PKC with epileptic spasm in IS patients, as well as positive correlation between PKC with CRHR1.ConclusionsOver expression of CRH, CRHR1, PKC with epileptic spasm in IS patients were positive related with epileptic seizure in IS patients, indicated that CRH signal pathway is related with IS pathogenesis.