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hydrocortisone,vitamin C,and thiamine may not improve the outcome of patients with sepsis or septic shock:a systematic review and meta-analysis

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Emergency and Critical Care Medicine 2023年第3期3卷 122-129页

作者： Zhuangli Li Xiaoli Zhang Yongliang Wu Chao Xie Chengjiang Liu Xiuyu He Zehua Wu Guofang Hua Yuedong Li Department of Critical Care Medicine The 901 Hospital of the Joint Logistic Support Force of the Chinese People’s Liberation ArmyClinic CollegeAnhui Medical UniversityHefeiAnhuiChina Department of General Medicine Affiliated Anqing First People’s Hospital of Anhui Medical UniversityAnqingAnhuiChina

Background This study aimed to conduct a systematic review and meta-analysis of the efficacy of hydrocortisone,vitamin C,and thiamine(HVT)in patients with sepsis or septic shock.Methods A literature search was performed in PubMed,Embase,Cochrane Library,and Web of Science from their inception to April 2021.Search terms included hydrocortisone,thiamine,vitamin C,sepsis,and septic shock.Only randomized controlled trials on HVT in treating sepsis and septic shock were analyzed.Risk ratio(RR)was generated using Review Manager 5.3 to evaluate binary variants,whereas mean±standard deviation(MD)was generated to assess continuous variants.Results A total of 7 randomized controlled trials,with 1233 patients,were included in this meta-analysis.There was no significant difference in long-term mortality(35.3%vs 33.2%;RR:1.07;95%confidence interval[95%CI]:0.90-1.27;P=0.45;I^(2)=0%),intensive care unit(ICU)mortality(17.4%vs 17.5%;RR:0.99;95%CI:0.75-1.30;P=0.95;I^(2)=0%),in-hospital mortality(27.4%vs 25.8%;RR:1.06;95%CI:0.84-1.34;P=0.63;I^(2)=0%),and acute kidney injury morbidity(RR:1.04;95%CI:0.91-1.18;P=0.60;I^(2)=0%)between HVT and control groups.For continuous variables,there was no significant effect of HVT therapy on delta Sequential Organ Failure Assessment(△SOFA)score(MD:−0.44;95%CI:−1.00 to 0.12;P=0.12;I^(2)=49%),length of ICU stay(MD:0.43;95%CI:−0.27 to 1.14;P=0.23;I^(2)=0%),and length of hospital stay(MD:0.80;95%CI:−0.38 to 1.97;P=0.18;I^(2)=0%).Only vasopressor duration was significantly reduced in the HVT group(MD:−17.75;95%CI:−25.56 to−9.94;Phydrocortisone,vitamin C,and thiamine use was not associated with improved mortality,lower acute kidney injury incidence,lower△SOFA,and shorter ICU and in-hospital stays among patients with sepsis and septic shock.

关键词： hydrocortisone Sepsis Septic shock Thiamine Vitamin C

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Immunotoxicity of hydrocortisone on Th1/Th2-Related Cytokine Production Is Associated with Yang-Deficient State in Traditional Chinese Medicine

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Cellular & Molecular Immunology 2007年第5期4卷 383-388页

作者： Chengfang Yao Li Wang Jian Zhang Xianbin Zhou Cai Zhang Institute of Immunopharmacology ＆ Immunotherapy School of Pharmaceutical Sciences Shandong University Jinan 250012 China Institute of Basic Medicine Shandong Academy of Medical Science 89 Jingshi Road Jinan 250062 China

Steroid hormone serving as an immunosuppressor often induces immunotoxicity when administered in highest dosage or accumulated in long-term usage. The stage of high concentration of steroid hormone leading to a wide range of symptoms is associated to the yang.deficient state, which is the part of yin-yang imbalance involved in processes of many diseases in traditional Chinese medicine. Here we intend to investigate the profile of Th1/Th2- related cytokine transcriptions under yang-deficient conditions in a yang-deficient animal model by intramuscular injection of hydrocortisone （a kind of steroid hormone）. The yang.deficient symptoms were estimated by detecting activity, appetite, body weight and so on. T cell proliferation and cytokine transcriptions were analyzed. The results showed that yang-deficient mice were established successfully since typical yang.deficient symptoms were observed in this model with decreased activities, appetite, body weight and temperature. More interestingly, the transcriptions of IFN-γ, IL-2, IL-4 and IL-10 in this model were markedly suppressed and the proliferation of lymphocytes significantly decreased as well. The results suggested thatyang-deficient symptoms were related to the steroid-induced reduction of cytokine transcription and impairment of lymphocyte proliferation. Therefore, novel strategies through regulating cytokine production might be considered as potent approach to patients with yang.deficiency symptoms.

关键词： hydrocortisone yin-yang balance traditional Chinese medicine cytokine

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Effect of adrenalectomy and hydrocortisone on ventral prostate of rats

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Asian Journal of Andrology 2001年第4期3卷 289-300页

作者： Neena Nair R.S.Bedwal R.S.Mathur Cell Biology Laboratory Department of Zoology University of Rajasthan Jaipur 302004 IndiaCell Biology Laboratory Department of Zoology University of Rajasthan Jaipur 302004 IndiaCell Biology Laboratory Department of Zoology University of Rajasthan Jaipur 302004 India

Aim: To study the effects of adrenalectomy and hydrocortisone on the ventral prostate of SD rats. Methods: Inadrenalectomised (ADX) and ADX + hydrocortisone (1, 2, or 4 mg) treated rats, the prostatic histology and thecholesterol, protein, zinc, and copper levels and the enzymic profile (acid phosphatase, alkaline phosphatase, aryl sul-phatase, lactic dehydrogenase, and leucine aminopeptidase) in the prostatic tissue were determined; the serum hormon-al profile (testosterone, FSH and LH) was also assayed. Results; Adrenalectomy caused a progressive degenerationin prostatic structure that was not reversed by hydrocortisone treatment. The serum testosterone were significantly lowerin ADX than in sham operated rats and lower in ADX + hydrocortisone than in ADX-C rats (P hydrocortisone than in ADX-C rats (Phydrocortisone rats (P hydrocortisone rats (P hydrocortisone treatment at the doses employed did not reverse these changes. (Asian JAndrol 2001 Dec; 3: 289 - 300)

关键词： adrenalectomy ventral prostate hydrocortisone testosterone FSH LH cholesterol zinc copper acid phosphatase alkaline phosphatase aryl sulphatase lactic dehydrogenase leucine aminopeptidase

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Beneficial effects of hydrocortisone in induced acute pancreatitis of rats

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Chinese Medical Journal 2007年第20期120卷 1757-1761页

作者： SUN Wei WATANABE Yasuhiro TOKI Akira WANG Zhong-qiu Department of General Surgery Affiliated Shengjing Hospital China Medical University Shenyang 110004 China Department of Paediatric Surgery Faculty of Medicine Kagawa Medical University Takamatsu 761-0793 Japan

Background Little is known of the effects of hydrocortisone on cell adhesion molecules such as intercellular adhesion molecule-1 （ICAM-1） and its counterreceptors （LFA-1, Mac-1） in acute pancreatitis （AP）. We investigated the effects of prior treatment with hydrocortisone on the production of ICAM-1 and its counterreceptors （LFA-1 and Mac-1） in AP of rats to clarify the effect of hydrocortisone on induced acute pancreatitis.Methods Acute pancreatitis was induced by infusion of 5% chenodeoxycholic acid into the pancreatic duct, followed by ligation of pancreatic duct. Before induction of acute pancreatitis, rats were treated with hydrocortisone （n=20） or 0.9% saline （n=-20）. Blood and specimens from pancreas and lung were obtained from 5 rats from each treatment euthanized at 1 hour or 3 hours, 6 hours, 12 hours. Expression of ICAM-1 was assessed by immunohistochemistry and Western blot analysis of pancreas and lungs. The expression of LFA-1 and Mac-1 on neutrophils was detected by flow cytometer. The therapeutic effect of hydrocortisone was assessed from injuries to pancreas and lung.Results ICAM-1 expression in the pancreas of hydrocortisone group was significantly less than in control group at 3 hours and 6 hours. In the lungs of hydrocortisone group, ICAM-1 expression was significantly less than in control group at 3 hours, 6 hours and 12 hours. The expression of LFA-1 and Mac-1 on neutrophils in blood increased significantly in control group over hydrocortisone group. Increased expression of ICAM-1, LFA-1 and Mac-1 preceded leukocyte infiltration. Compared to untreated animals with acute pancreatitis, rats pretreated with hydrocortisone had significantly reduced histological lung injury and output of ascitic fluid.Conclusions Prior treatment with hydrocortisone before the induction of acute pancreatitis ameliorates pulmonary injury and the output of ascitic fluid and reduces the expression of ICAM-1 and its counterreceptors （LFA-1, Mac-1） in acute pancreatitis.

关键词： hydrocortisone acute pancreatitis intercellular adhesion molecule-1 LFA-1 Mac-1

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Determination of hydrocortisone in Cosmetics by CdSe/CdS Quantum Dots-Based Fluoroimmunoassay Using Magnetic Fe304/Au Nanoparticles as Solid Carriers

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Chinese Journal of Chemistry 2011年第3期29卷 587-591页

作者： Wang, Xiuling Wei, Lu Tao, Guanhong Dai, Long School of Chemistry Chemical Engineering and Materials Science Suzhou University Suzhou Jiangsu 215123 China School of Chemical and Biological Engineering Suzhou University of Science and Technology Suzhou Jiangsu 215009 China Yantai Entry-exit Inspection and Quarantine Bureau Yantai Shandong 264000 China

This work demonstrated the feasibility of detecting hydrocortisone in cosmetics using a novel CdSe/CdS quan- tum dots-based competitive fluoroimmunoassay with magnetic core/shell Fe3Oa/Au nanoparticles （MCFN） as solid carriers. hydrocortisone antigen was labeled with the synthesized core/shell CdSe/CdS quantum dots （QDs） to form the antigen-QDs conjugate. Meanwhile, hydrocortisone antibody was incubated with MCFN and the immobilized antibody was obtained. The immobilized antibody was then mixed sequentially with hydrocortisone and a slightly excess amount of the QDs-labeled hydrocortisone antigen, allowing their competition for binding with the antibody immobilized on MCFN. The bound hydrocortisone and the antigen-QDs conjugates on MCFN were removed subsequently after the mixture was applied to a magnetic force. The analyte concentration was obtained by measuring the fluorescence intensity of the unbound hydrocortisone antigen-QDs conjugates. The proposed method was characterized by simplicity, rapidity, and high sensitivity with a wide linear working range of 0.5 to 15000 pg·mL^-1 and a low detection limit of 0.5 pg.mL^- 1. The proposed method was successfully applied to the determination of hydrocortisone in cosmetics with satisfactory results.

关键词： hydrocortisone fluoroimmunoassay CdSe/CdS quantum dots magnetic core/shell Fe3O/Au nanoparticles

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Timing, method and discontinuation of hydrocortisone administration for septic shock patients

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World Journal of Critical Care Medicine 2017年第1期6卷 65-73页

作者： Miguel A Ibarra-Estrada Quetzalcóatl Chávez-Pe?a Claudia I Reynoso-Estrella Jorge Rios-Zerme?o Pável E Aguilera-González Miguel A García-Soto Guadalupe Aguirre-Avalos Critical Care Unit Instituto Jalisciense de Cancerología Critical Care Unit Hospital General Regional #180 Instituto Mexicano del Seguro Social Transplant Care Unit Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social Centro Universitario de Ciencias de la Salud Universidad de Guadalajara Critical Care Unit Hospital Civil Fray Antonio Alcalde

AIM To characterize the prescribing patterns for hydrocortisone for patients with septic shock and perform an exploratory analysis in order to identify the variables associated with better outcomes.METHODS This prospective cohort study included 59 patients with septic shock who received stress-dose hydrocortisone.It was performed at 2 critical care units in academic hospitals from June 1st, 2015, to July 31 st, 2016. Demographic data, comorbidities, medical management details, adverse effects related to corticosteroids, and outcomes were collected after the critical care physician indicated initiation of hydrocortisone. Univariate comparison between continuous and bolus administration of hydrocortisone was performed, including multivariate analysis, as well as Kaplan-Meier analysis to compare the proportion of shock reversal at 7 d after presentation. Receiver operating characteristic(ROC) curves determined the best cut-off criteria for initiation of hydrocortisone associated with the highest probability of shock reversal. We addressed the effects of the taper strategy for discontinuation of hydrocortisone, noting risk of shock relapse and adverse effects.RESULTS All-cause 30-d mortality was 42%. hydrocortisone was administered as a continuous infusion in 54.2% of patients; time to reversal of shock was 49 h longer in patients who were given a bolus administration [59 h(range, 47.5-90.5) vs 108 h(range, 63.2-189); P = 0.001]. The maximal dose of norepinephrine after initiation of hydrocortisone was lower in patients on continuous infusion [0.19 μg/kg per minute(range, 0.11-0.28 μg)] compared with patients who were given bolus [0.34 μg/kg per minute(range, 0.16-0.49); P = 0.004]. Kaplan-Meier analysis revealed a higher proportion of shock reversal at 7 d in patients with continuous infusion compared to those given bolus(83% vs 63%; P = 0.004). There was a good correlation between time to initiation of hydrocortisone and time to reversal of shock(r = 0.80; P < 0.0001); ROC curve analysis revealed that the best crit

关键词： Corticosteroids hydrocortisone Timing Administration Discontinuation Septic shock

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Efficacy of stimulating Mingmen(GV4) and Guanyuan(CV4) on kidney Yang deficiency in rat model: laser irradiation vs traditional moxibustion

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Journal of Traditional Chinese Medicine 2022年第6期42卷 972-979页

作者： FANG Jing PAN Wen WANG Xiangyun LI Fengxing ZHAO Ling HUANG Zouqin SHEN Xueyong Acupuncture and Tuina School Shanghai University of Traditional Chinese MedicineShanghai 201203China Department of Acupuncture Shanghai Pudong New District Hospital of Traditional Chinese MedicineShanghai 201203China Shanghai Research Center of Acupuncture&Meridian Shanghai 201203China

OBJECTIVE: To investigate the effect of 10.6-μm laser moxibustion(LM) and traditional moxibustion(TM) on kidney Yang deficiency(KYD) model rats. METHODS: Forty rats were randomly divided into normal, model, 10.6-μm LM, and TM groups. KYD was induced through intramuscular hydrocortisone injections. RESULTS: hydrocortisone injections decreased the body weight, activity, and temperature and induced changes in the organ coefficients. Compared with the model group, TM and LM treatment prevented body weight loss and improved organ coefficients after treatment(P 0.05). TM treatment increased the temperature of Mingmen(GV4) and Guanyuan(CV4) compared to the model group(P 0.05). There was a positive correlation between Mingmen(GV4)/Guanyuan(CV4) temperature and 17-OHCS levels. CONCLUSIONS: LM and TM treatment can improve KYD symptoms, and acupoint temperature changes may be an objective indicator of KYD.

关键词： hydrocortisone temperature acupoints microcirculation Kidney-Yang deficiency laser moxibustion

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HAT therapy for sepsis:A review of the therapeutic rationale and current clinical evaluation status

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Journal of Intensive Medicine 2023年第4期3卷 320-325页

作者： Yali Sun Yongfang Yang Zhuoyi Ye Tongwen Sun Department of General ICU The First Affiliated Hospital of Zhengzhou UniversityHenan Key Laboratory of Critical Care MedicineZhengzhou Key Laboratory of SepsisZhengzhou 450052HenanChina Henan Engineering Research Center for Critical Care Medicine Department of General ICUThe First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052HenanChina

Vitamin C-based cluster therapy,which involves the combined application of hydrocortisone,vitamin C,and thiamine(HAT),is a recently proposed new treatment option for sepsis on top of conventional treatment.This therapy has a strong theoretical basis,but its clinical efficacy remains inconclusive.This review summarizes the rationale for HAT therapy for sepsis and describes the evaluation of its efficacy in clinical observational studies and randomized controlled trials,with the aim of providing a reference for the future clinical practice application of HAT therapy in sepsis.

关键词： Sepsis HAT therapy hydrocortisone Vitamin C Thiamine Metabolic resuscitation

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Comparative Study of Herbal Extracted Gel and 1% hydrocortisone Gel in the Treatment of Mosquito Bite Reaction

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Journal of Cosmetics, Dermatological Sciences and Applications 2014年第1期4卷 31-36页

作者： Montree Udompataikul Suthee Rattanamongkolgul Anchalee Intarawichian Department of Preventive and Social Medicine Faculty of Medicine Srinakharinwirot University Bangkok Thailand Skin Center Faculty of Medicine Srinakharinwirot University Bangkok Thailand

Background: Mosquito bite reaction is a common skin disease. Topical steroids and oral antihistamines are the conventional treatment. However, the side effects from prolonged use of topical steroids are the limitation of the treatment. Recently, herbal extracts are emerging interest for an alternative anti-inflammatory dermatoses therapy. Objective: To assess the effectiveness of herbal extracted gel containing, Perilla frutescens, Portulaca oleracea, Ipomoea pescaprae, Aloe vera, Centella asiatica and Broussonetia papyrifera in comparing with 1% hydrocortisone (HC) gel. Material and Methods: An experimental study was conducted on 50 mosquito bite hypersensitive volunteers (15 - 19 years old) with double-blinded split randomized control method. After the volunteers were exposed for one bite on their arms by a non-infectious mosquito, Aedes albopictus, the drugs were applied twice daily. The diameter of lesion, pruritus analog score, erythema and melanin index were measured at 2, 6, 24 hours and 2, 3, 4 weeks. The volunteers “self-satisfaction” and side effects were recorded. Results: The mean age was 17.42 ± 1.14 years old. The diameter of lesion, pruritus analog score, erythema and melanin index were decreased on both sides at each visit with significant difference (p 0.05). The post-inflammatory hyperpigmentation rate of 1% HC and herbal gel was 64% and 54% respectively without significant difference (p = 0.267). Conclusion: The herbal gel was as effective as 1% HC for the treatment of acute and late reaction of mosquito bite reaction in adolescent. It may be used as the alternative treatment for mosquito bite reaction.

关键词： Herbal Extract Mosquito Bite Reaction Anti-Inflammatory hydrocortisone

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Studies on the Stability of Corticosteroids: Degradation of Clobetasol Propionate, Desonide and hydrocortisone in Topical Formulations by HPLC and UPLC-MS/MS

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American Journal of Analytical Chemistry 2020年第4期11卷 147-171页

作者： Kishore Kumar Hotha Subathra Ramamoorthy Hiren Patel Analytical Research & Development LUPIN SOMERSET Somerset NJ USA Product Development LUPIN SOMERSET Somerset NJ USA

Corticosteroids are the most widely used class of anti-inflammatory medications in the pharmaceutical industry. There are several pharmaceutical dosage forms available using different corticosteroids. Topical steroids of varying potencies are available in creams, ointments, solutions and other vehicles. Chemical instability and drug degradation are the key quality concerns for these topical dosage forms. Nature of the dosage forms, excipient quality, product composition, and process optimization are some of the common factors which affect the stability of corticosteroids. This article describes drug degradation behavior of three different corticosteroids in different topical dosage forms. Drug degradation patterns of hydrocortisone, Clobetasol propionate and Desonide formulations observed in stability studies of respective finished drug products under ICH recommended storage conditions were investigated. HPLC, UPLC-MS/MS methods were developed for the separation and characterization of impurities. The structural elucidation of the unknown impurities observed for these steroids and mechanistic consideration of potential degradation pathways has been discussed. Detailed discussion on the analytical methodologies is included as well.

关键词： Topical Steroids Chemical Degradation Clobetasol Propionate Desonide hydrocortisone Steroids UPLC-MS/MS

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