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Study of the Effects of glucocorticoid on Growth and Adult Final Height in Children with Primary Nephrotic Syndrome

Open Journal of Nephrology 2024年第1期14卷 1-9页

作者： Fazhan Zhong Miao Zhang Yan Gao Department of Pediatric Nephrology Guangzhou Women and Children’s Medical Center Guangzhou Medical University Guangzhou China

Objective: To analyze the epidemiological characteristics of growth, as well as factors associated with growth retardation in children with primary nephrotic syndrome (PNS), and to investigate the effect of glucocorticoid (GC) use duration on growth retardation in these children. Methods: Clinical and laboratory data of 353 PNS children treated at our hospital from July 2014 to June 2015 were collected through the medical record management system. Height, weight, and GC usage were recorded. Follow-up assessments were conducted in August 2022 for the original group, recording height, weight, and GC usage. Height and weight were evaluated using standard deviation scores (SDS). Categorical data were analyzed using chi-square test while continuous measurement data were analyzed using t-test or rank-sum test. Linear regression was used to assess the association between two single independent variables, and logistic regression analysis was used to screen for risk factors related to growth retardation in children with PNS. Results: Among the 353 PNS children enrolled in this study, male-to-female ratio of 2.64:1 (256 males vs 97 females). A total of 119 children exhibited growth retardation, incidence rate of 33.71%. The duration of GC usage among those with growth retardation was significantly longer compared to those without it (762.81 ± 934.50 days vs 263.77 ± 420.49 days;p Conclusion: PNS children treated with GC have a high incidence of growth retardation, and a high proportion of short stature in adulthood, especially in children with growth retardation in childhood, most of them have short stature after grown up. Time of GC usage is a risk factor for growth retardation in children with PNS.

关键词： Primary Nephrotic Syndrome glucocorticoid Children Growth Retardation Adult Height

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Long-term prognosis and its associated predictive factors in patients with eosinophilic gastroenteritis

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World Journal of Gastroenterology 2024年第2期30卷 146-157页

作者： Kai-Wen Li Ge-Chong Ruan Shuang Liu Tian-Ming Xu Ye Ma Wei-Xun Zhou Wei Liu Peng-Yu Zhao Zhi-Rong Du Ji Li Jing-Nan Li Department of Gastroenterology Chinese Academy of Medical Sciences and Peking Union Medical College HospitalBeijing 100730China Department of Allergy Chinese Academy of Medical Sciences and Peking Union Medical College HospitalBeijing 100730China Department of Pathology Chinese Academy of Medical Sciences and Peking Union Medical College HospitalBeijing 100730China Department of Radiology Chinese Academy of Medical Sciences and Peking Union Medical College HospitalBeijing 100730China Affairs Office Chinese Academy of Medical Sciences and Peking Union Medical College Hospital(West campus)Beijing 100032China

BACKGROUND Eosinophilic gastroenteritis(EGE)is a chronic recurrent disease with abnormal eosinophilic infiltration in the gastrointestinal tract.glucocorticoids remain the most common treatment method.However,disease relapse and glucocorticoid dependence remain notable problems.To date,few studies have illuminated the prognosis of EGE and risk factors for disease relapse.AIM To describe the clinical characteristics of EGE and possible predictive factors for disease relapse based on long-term follow-up.METHODS This was a retrospective cohort study of 55 patients diagnosed with EGE admitted to one medical center between 2013 and 2022.Clinical records were collected and analyzed.Kaplan-Meier curves and log-rank tests were conducted to reveal the risk factors for long-term relapse-free survival(RFS).RESULTS EGE showed a median onset age of 38 years and a slight female predominance(56.4%).The main clinical symptoms were abdominal pain(89.1%),diarrhea(61.8%),nausea(52.7%),distension(49.1%)and vomiting(47.3%).Forty-three(78.2%)patients received glucocorticoid treatment,and compared with patients without glucocorticoid treatments,they were more likely to have elevated serum immunoglobin E(IgE)(86.8%vs 50.0%,P=0.022)and descending duodenal involvement(62.8%vs 27.3%,P=0.046)at diagnosis.With a median follow-up of 67 mo,all patients survived,and 56.4%had at least one relapse.Six variables at baseline might have been associated with the overall RFS rate,including age at diagnosis24 kg/m^(2)(HR 0.3922,95%CI:0.1916-0.8027,P=0.014),disease duration from symptom onset to diagnosis>3.5 mo(HR 2.4725,95%CI:1.220-5.0110,P=0.011),vomiting(HR 3.1259,95%CI:1.5246-6.4093,P=0.001),total serum IgE>300 KU/L at diagnosis(HR 0.2773,95%CI:0.1204-0.6384,P=0.022)and glucocorticoid treatment(HR 6.1434,95%CI:2.8446-13.2676,P=0.003).CONCLUSION In patients with EGE,younger onset age,longer disease course,vomiting and glucocorticoid treatment were

关键词： Eosinophilic gastroenteritis Prognosis Relapse glucocorticoid glucocorticoid dependence

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Penetrating canaloplasty in corticosteroid-induced glaucoma:a report of two cases

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International Journal of Ophthalmology(English edition) 2024年第4期17卷 770-772页

作者： Fang Liu Liu-Shan Zhou Wei-Wei Zhang Department of Ophthalmology Daqing Longnan Hospitalthe Fifth Affiliated Hospital of Qiqihar Medical CollegeDaqing 163453Heilongjiang ProvinceChina

Dear Editor,We have treated two patients of glucocorticoid-induced glaucoma with penetrating canaloplasty(PCP)since 2021.PCP is a new type internal drainage surgery for glaucoma,which is a bleb-independent filtering surgery combined canaloplasty with trabeculectomy,and the surgery shows a great efficacy of intraocular pressure(IOP)reduction with no surgical complication.PCP surgery started with a fornix-based conjunctival flap and double scleral flap,and Schlemm’s canal was opened,a 10-0 prolene suture was positioned and tensioned within Schlemm’s canal,trabucular meshwork segment was excised and peripheral iridectomy was performed,the scleral flap and the conjunctival flap were closed watertight with 10-0 prolene sutures.

关键词： glaucoma surgery glucocorticoid

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glucocorticoid pulse therapy in an elderly patient with post-COVID-19 organizing pneumonia:A case report

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World Journal of Clinical Cases 2023年第17期11卷 4152-4158页

作者： Shinhee Park Youngeun Jang So-My Koo Bo Da Nam Hee-Young Yoon Division of Allergy and Pulmonary Medicine Department of Internal MedicineSoonchunhyang University Bucheon HospitalBucheon 14584South Korea Division of Allergy and Respiratory Diseases Department of Internal MedicineSoonchunhyang University Seoul HospitalSeoul 04401South Korea Department of Radiology Soonchunhyang University Seoul HospitalSeoul 04401South Korea

BACKGROUND Pulmonary fibrosis often occurs as a sequel of coronavirus disease 2019(COVID-19);however,in some cases,it can rapidly progress,similar to the acute exacerbation of interstitial lung disease.glucocorticoids are the standard treatment for severe COVID-19 pneumonia requiring oxygen supply;however,the post-COVID-19 efficacy of high-dose steroid therapy remains unclear.Here,we presented a case of an 81-year-old man who developed acute respiratory failure after COVID-19 and was treated with glucocorticoid pulse therapy.CASE SUMMARY An 81-year-old man with no respiratory symptoms was admitted due to a diabetic foot.He had been previously treated for COVID-19 pneumonia six weeks prior.However,upon admission,he suddenly complained of dyspnea and required a high-flow oxygen supply.Initial simple chest radiography and computed tomography(CT)revealed diffuse ground-glass opacities and consolidation in both lungs.However,repeated sputum tests did not identify any infectious pathogens,and initial broad-spectrum antibiotic therapy did not result in any clinical improvement with the patient having an increasing oxygen demand.The patient was diagnosed with post-COVID-19 organizing pneumonia.Thus,we initiated glucocorticoid pulse therapy of 500 mg for three days followed by a tapered dose on hospital day(HD)9.After three days of pulse treatment,the patient's oxygen demand decreased.The patient was subsequently discharged on HD 41,and chest radiography and CT scans have almost normalized nine months after discharge.CONCLUSION glucocorticoid pulse therapy may be considered when the usual glucocorticoid dose is ineffective for patients with COVID-19 sequelae.

关键词： Coronavirus glucocorticoid Lung disease Interstitial Organizing pneumonia Case report

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glucocorticoid-induced thrombotic microangiopathy in paroxysmal nocturnal hemoglobinuria:A case report and review of literature

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World Journal of Clinical Cases 2023年第8期11卷 1799-1807页

作者： Xiao-Dong Yang Bo Ju Jia Xu Nuan-Nuan Xiu Xiao-Yun Sun Xi-Chen Zhao Department of Hematology The Central Hospital of Qingdao West Coast New AreaQingdao 266555Shandong ProvinceChina

BACKGROUND Thrombotic microangiopathy(TMA)is a group of disorders that converge on excessive platelet aggregation in the microvasculature,leading to consumptive thrombocytopenia,microangiopathic hemolysis and ischemic end-organ dysfunction.In predisposed patients,TMA can be triggered by many environmental factors.glucocorticoids(GCs)can compromise the vascular endothelium.However,GC-associated TMA has rarely been reported,which may be due to the lack of awareness of clinicians.Given the high frequency of thrombocytopenia during GC treatment,particular attention should be given to this potentially fatal complication.CASE SUMMARY An elderly Chinese man had a 12-year history of aplastic anemia(AA)and a 3-year history of paroxysmal nocturnal hemoglobinuria(PNH).Three months earlier,methylprednisolone treatment was initiated at 8 mg/d and increased to 20 mg/d to alleviate complement-mediated hemolysis.Following GC treatment,his platelet counts and hemoglobin levels rapidly decreased.After admission to our hospital,the dose of methylprednisolone was increased to 60 mg/d in an attempt to enhance the suppressive effect.However,increasing the GC dose did not alleviate hemolysis,and his cytopenia worsened.Morphological evaluation of the marrow smears revealed increased cellularity with an increased percentage of erythroid progenitors without evident dysplasia.Cluster of differentiation(CD)55 and CD59 expression was significantly decreased on erythrocytes and granulocytes.In the following days,platelet transfusion was required due to severe thrombocytopenia.Observation of platelet transfusion refractoriness indicated that the exacerbated cytopenia may have been caused by the development of TMA due to GC treatment because the transfused platelet concentrates had no defects in glycosylphosphatidylinositol-anchored proteins.We examined blood smears and found a small number of schistocytes,dacryocytes,acanthocytes and target cells.Discontinuation of GC treatment resulted in rapidly increased platelet counts and steady increases

关键词： Aplastic anemia Paroxysmal nocturnal hemoglobinuria glucocorticoid Methylprednisolone Thrombotic microangiopathy Platelet transfusion refractoriness Case report

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glucocorticoid reduction induced chorea in pediatric-onset systemic lupus erythematosus:A case report

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World Journal of Clinical Cases 2023年第32期11卷 7872-7875页

作者： Yan-Qiu Xu Miao Wang Ying Zhang Department of Rheumatology Chongqing Hospital of Traditional Chinese MedicineChongqing 400021China

BACKGROUND Pediatric-onset systemic lupus erythematosus(SLE)is typically more severe than adult-onset SLE,with a higher incidence of nervous system involvement.Chorea is a relatively rare neurological complication reported in 2.4%-7%of SLE patients.In particular,chorea induced by glucocorticoid dose reduction is even rarer.Herein,we report the case of a girl with SLE,who developed chorea during the process of glucocorticoid therapy reduction.CASE SUMMARY We describe a 14-year-old girl who was diagnosed with SLE.She was treated with methylprednisolone and rituximab,and her symptoms improved.On the second day after the methylprednisolone dose was reduced according to the treatment guidelines,the patient developed chorea.Her condition improved after adjusting her glucocorticoid regimen.CONCLUSION This case is a reminder that extra attention to chorea is required in SLE patients during glucocorticoid dose reduction.

关键词： glucocorticoid Chorea Pediatric systemic lupus erythematosus Case report

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glucocorticoid reduces the efficacy of afatinib on the head and neck squamous cell carcinoma

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BIOCELL 2023年第2期47卷 329-338页

作者： DONGYANG WANG YI CHEN JING HUANG YOU ZHANG CHONGKUI SUN YINGQIANG SHEN State Key Laboratory of Oral Diseases National Clinical Research Center for Oral DiseasesChinese Academy of Medical Sciences Research Unit of Oral Medicine of Carcinogenesis and ManagementWest China Hospital of StomatologySichuan UniversityChengdu610041China

glucocorticoids(GC)are widely used to counter the adverse events during cancer therapy;nonetheless,previous studies pointed out that GC may reduce the efficacy of chemotherapy on cancer cells,especially in epidermal growth factor receptor(EGFR)-targeted therapy of head and neck squamous cell carcinoma(HNSCC)remaining to be elucidated.The primary aim of the present study was to probe into the GC-induced resistance of EGFR-targeted drug afatinib and the underlying mechanism.HNSCC cell lines(HSC-3,SCC-25,SCC-9,and H-400)and the human oral keratinocyte(HOK)cell lines were assessed for GC receptor(GR)expression.The promoting tumor growth effect of GC was evaluated by the CCK-8 assay and flow cytometry.Levels of signaling pathways participants GR,mTOR,and EGFR were determined by quantitative polymerase chain reaction and western blotting.GC increased the proliferation of HNSCC cells in a GR-dependent manner and promoted AKT/mTOR signaling.But GC failed in counteracting the inhibition of rapamycin in the mTOR signaling pathway.Besides,GC also induced resistance to EGFR-targeted drug afatinib through AKT/mTOR instead of the EGFR/ERK signaling pathway.Thus,GCs reduce the efficacy of afatinib on HNSCC,implicating a cautious use of glucocorticoids in clinical practice.

关键词： glucocorticoid Head and neck squamous cell carcinoma Afatinib EGFR Targeted therapy mTOR

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Efficacy of the herbal pair, Radix Achyranthis Bidentatae and Eucommiae Cortex, in preventing glucocorticoid-induced osteoporosis in the zebrafish model

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Journal of Integrative Medicine 2022年第1期20卷 83-90页

作者： Joon-ho Lee Yuan-ji Wei Zhong-yan Zhou Yu-ming Hou Cheng-long Wang Li-bo Wang Hong-jin Wu Yu Zhang Wei-wei Dai Central Laboratory of Science and Technology Department Longhua HospitalShanghai University of Traditional Chinese MedicineShanghai 200032China Cardiovascular Department Longhua HospitalShanghai University of Traditional Chinese MedicineShanghai 200032China

Objective: In traditional Chinese medicine, the herbal pair, Radix Achyranthis Bidentatae(RAB) and Eucommiae Cortex(EC), is widely used to treat osteoporosis. Herein, we determined whether this herbal pair can be used to ameliorate glucocorticoid(GC)-induced osteoporosis(GIOP) and find its optimal dosage in zebrafish.Methods: The characteristics of the aqueous extract of RAB and EC were separately characterized using high-performance liquid chromatography. Osteoporosis was induced in 5-day post-fertilization zebrafish larvae by exposing them to 10 lmol/L dexamethasone(Dex) for 96 h. Seven combinations of different ratios of RAB and EC were co-administered. Treatment efficacy was determined by calculating zebrafish vertebral area and sum brightness, via alizarin red staining, and by detecting alkaline phosphatase(ALP)activity. Multiple regression analysis was conducted to test the optimal dosage ratio.Results: According to the Chinese Pharmacopoeia(2015), b-ecdysone(b-Ecd) is a major bioactive marker in RAB extract, while pinoresinol diglucoside(PDG) is the major marker in EC extract. Both of b-Ecd and PDG content values aligned with the Chinese Pharmacopoeia standards. Treatment with 10 lmol/L Dex reduced zebrafish vertebral area, sum brightness, and ALP activity, but RAB and EC attenuated these effects. Combining 50 mg/m L RAB and 50 mg/m L EC was optimal for preventing GIOP in zebrafish.Reverse transcription-quantitative polymerase chain reaction was used to evaluate the m RNA expression of osteogenesis-related genes. A treatment of 10 lmol/L Dex decreased runt-related transcription factor 2(Runx2), osteogenic protein-1(OP-1), bone c-carboxyglutamic acid-containing protein(BGLAP), and bcatenin levels. This effect was counteracted by RAB and EC co-treatment(P < 0.05). Additionally, the effect of using the two herbal extracts together was better than single-herb treatments separately. These results demonstrated that RAB and EC preserve osteoblast function in the presence of GC. The best mass ratio was 1:1.Conclus

关键词： glucocorticoid Osteoporosis Radix Achyranthis Bidentatae Eucommiae Cortex Zebrafish

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PTGS2 identified as a biomarker of glucocorticoid-induced osteonecrosis of the femoral head and an enhancer of osteogenesis

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Genes & Diseases 2023年第1期10卷 14-17页

作者： Qingyu Zhang Shun Lu Dongsheng Zhou Jun Dong Fanxiao Liu Department of Orthopaedics Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandong 250021China

Due to the use of more adjuvant therapies and the increasing prevalence of associated diseases,nontraumatic osteonecrosis of the femoral head(ONFH)has become a substantial worldwide health issue;while glucocorticoid administration was the highest-ranked risk factor,with a proportion ranging from 26.35 to 55.75%.1 Albeit with similar radiological features,glucocorticoid-induced ONFH(GONFH)manifested a greater probability for advance-tolate-stage(post-collapse)lesions in comparison with its non-glucocorticoid-induced counterparts.i1 Therefore,an accurate and timely diagnosis of osteonecrosis following glucocorticoid therapy is of great significance to initiate nonoperative treatment regimens or joint-preserving procedures,slow disease progression,and defer or avert joint arthroplasty.

关键词： glucocorticoid diagnosis operative

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Antibiotic and glucocorticoid-induced recapitulated hematological remission in acute myeloid leukemia:A case report and review of literature

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World Journal of Clinical Cases 2022年第22期10卷 7890-7898页

作者： Xiao-Yun Sun Xiao-Dong Yang Xiao-Qiu Yang Bo Ju Nuan-Nuan Xiu Jia Xu Xi-Chen Zhao Department of Hematology The Central Hospital of Qingdao West Coast New AreaQingdao 266555Shandong ProvinceChina Department of Pharmacology The Central Hospital of Qingdao West Coast New AreaQingdao 266555Shandong ProvinceChina

BACKGROUND Leukemic hematopoietic cells acquire enhanced self-renewal capacity and impaired differentiation.The emergence of symptomatic leukemia also requires the acquisition of a clonal proliferative advantage.Untreated leukemia patients usually experience an aggressive process.However,spontaneous remission occasionally occurs in patients with acute myeloid leukemia(AML),most frequently after recovery from a febrile episode,and this is generally attributed to the triggering of antineoplastic immunity.There may be another explanation for the spontaneous remission as implicated in this paper.CASE SUMMARY A 63-year-old Chinese man presented with high fever,abdominal pain and urticaria-like skin lesions.He was diagnosed with AML-M4 with t(8;21)(q22;q22)/RUNX1-RUNX1T1 based on morphological,immunological,cytogenetic and molecular analyses.He had a complex chromosome rearrangement of 48,XY,t(8;21)(q22;q22),+13,+13[9]/49,idem,+mar[9]/49,idem,+8[2].He also had a mutated tyrosine kinase domain in fms-like tyrosine kinase 3 gene.He was treated with antibiotics and glucocorticoids for gastrointestinal infection and urticaria-like skin lesions.The infection and skin lesions were quickly resolved.Unexpectedly,he achieved hematological remission along with resolution of the febrile episode,gastrointestinal symptoms and skin lesions.Notably,after relapse,repeating these treatments resulted in a return to hematological remission.Unfortunately,he demonstrated strong resistance to antibiotic and glucocorticoid treatment after the second relapse and died of sepsis from bacterial infection with multidrug resistance.The main clinical feature of this patient was that symptomatic AML emerged with flaring of the gut inflammatory disorder and it subsided after resolution of the inflammation.Learning from the present case raises the possibility that in a subgroup of AML patients,the proliferative advantage of leukemia cells may critically require the presence of inflammatory stresses.CONCLUSION Inflammatory stresses,most likely arising

关键词： Acute myeloid leukemia Fms-like tyrosine kinase 3 tyrosine kinase domain glucocorticoid Antibiotic Spontaneous remission Gastrointestinal infection Case report

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