药物注射联合针刀治疗肩周炎临床疗效及安全性分析

为探讨针刀联合曲安奈德、正清风痛宁、利多卡因治疗肩周炎的临床疗效及安全性分析,本研究选取2016年1月至2017年12月来东南大学附属中大医院疼痛科就诊肩周炎患者120例,随机数字表法分为药物治疗组40例(曲安奈德+正清风痛宁+利多卡因+臭氧治疗),针刀治疗组40例,综合治疗组40例(曲安奈德+正清风痛宁+利多卡因+臭氧+针刀治疗),对比分析各组治疗前后肩关节功能评分、视觉模拟评分法(visual analogue score, VAS)评分、不良反应发生率。结果显示,组内比较,3组治疗后VAS和肩关节功能评分与治疗前比较,差异具有统计学意义(p<0.001)。组间比较,治疗前3组VAS和肩关节功能评分比较,差异不具有统计学意义;综合治疗组各时间点VAS评分均低于药物及针刀治疗组,综合治疗组肩关节功能评分在治疗后1个月和2个月高于药物及针刀治疗组,差异具有统计学意义(p<0.001)。3组的不良反应发生率,差异不具有统计学意义(p>0.05)。综上所述,针刀治疗联合曲安奈德、正清风痛宁、利多卡因及臭氧在关节腔及关节周围注射治疗肩周炎安全有效,值得在临床中推广应用。     

A sensitive voltammetric sensor for determination of synthetic corticosteroid triamcinolone, abused for doping

Edge plane pyrolytic graphite electrode (EPPGE) modified with single-wall carbon nanotubes (SWNTs) has been used as a sensor to determine triamcinolone, abused by athletes for doping. A comparison of the voltammetric behavior between SWNTs modified EPPGE and fullerene – C₆₀-modified EPPGE indicated that SWNTs modified EPPGE is more sensitive. The electrode exhibited an effective catalytic response with good reproducibility and stability. The effect of several parameters such as pH, square wave frequency and steroid concentration were studied. The square wave voltammetric response of the electrode to triamcinolone is linear in the range 0.1–25 nM with a detection limit and sensitivity of 8.9 × 10⁻¹⁰ M and 2.06 μA nM⁻¹, respectively. The method was applied for the determination of triamcinolone in several commercially available pharmaceuticals and real urine samples obtained from patients undergoing pharmacological treatment with triamcinolone. A comparison of the observed results with HPLC analysis indicated a good agreement. The product obtained after reduction of triamcinolone was also characterized using ¹H NMR and GC–MS and the site of reduction is found to be carbonyl group at position 20. The method described is rapid, simple and accurate and can be easily applied for detecting cases of doping.     

Investigations on the glucocorticoid-binding protein from rat thymocytes: II. Stability,kinetics and specificity of binding of steroids

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1. The glucocorticoid-binding protein from rat thymocytes was shown to be stabilized by 40% (v/v) glycerol at −5°.     

Fluocinolone acetonide intravitreal sustained release device--a new addition to the armamentarium of uveitic management

Uveitis is a potentially sight-threatening inflammatory eye disease caused by multiple infectious and non-infectious etiologies for which the standard of care involves corticosteroids or various immunomodulary therapy (IMT) drugs. These available treatments, although effective, may cause significant morbidity and sometimes mortality in uveitis patients due to their toxic side-effects and the necessity of long-term therapy to prevent recurrences. In order to avoid the systemic toxicity ofcorticosteroids and IMT or the repeated injections of local steroids necessary to control ocular inflammation, and to prevent development of cumulative damage resulting from recurrent episodes of inflammation, researchers have developed a number of local corticosteroid sustained-release devices that can be implanted directly into the vitreous of the eye, at the site of the inflammatory disease. Preliminary studies of such a device, the fluocinolone acetonide (Retisert) implant, have shown significant reductions in the number of inflammatory episodes and decreased reliance on systemic corticosteroids or other IMT. This review explores the current research evaluating the fluocinolone sustained-release intravitreal implant in the treatment of posterior uveitis and the implications for its future use on a wider scale.     

ANG II-induced attenuation of salt gland function in Pekin ducks is not catecholamine-dependent

Pekin ducks (Anas platyrhynchos) were bilaterally adrenalectomized (biADX), injected with 1 mg of triamcinolone (TRIAM) kg bw⁻¹ im and given 0.9% saline drinking water during a 24 h recovery period followed by chemical sympathectomy with 6OH DOPA 3 h before the start of experimental observations. Baseline plasma dopamine (DA) concentrations decreased from 283 ± 88.5 pmol ml⁻¹ to 42.4 ± 11.1 pmol ml⁻¹; epinephrine (E) from 142 ± 46 pmol ml⁻¹ to 18.4 ± 9.2 pmol ml⁻¹ and norepinephrine (NE) from 742 ± 84 pmol ml⁻¹ to 406 ± 38 pmol ml⁻¹ 1 day after biADX + TRIAM but before chemical sympathectomy. Baseline MABP increased from 132 ± 3.2 mmHg to 209 ± 14.3 mmHg (P < 0.05) in response to TRIAM. After chemical sympathectomy with 6OH DOPA there was an additional 90% decrease in plasma NE to 42 ± 9.4 pmol ml⁻¹ and a concurrent 60% decrease in MABP to 83.4 ± 6.9 mmHg (P < 0.05). Nasal fluid secretion was maintained by the continuous infusion of hypertonic saline (1,000 mosmol kg H₂O⁻¹ at a rate of 0.3 ml kg⁻¹ min⁻¹). Rates of nasal fluid secretion and fluid electrolyte concentrations were unchanged following biADX + TRIAM + 6OH DOPA. Angiotensin II (ANG II; dose 1 μg kg bw⁻¹ i.v.), attenuated nasal fluid secretion showing that the response to ANG II was not NE- dependent. Plasma NE concentrations decreased following Tyramine i.v. (33 ± 8.5 pmol ml⁻¹) there being no vasopressor response. This is the first report of the ANG II induced attenuation of duck salt gland secretion in the absence of measurable E and NE.     

Simultaneous HPLC analysis of triamcinolone acetonide and budesonide in microdialysate and rat plasma: application to a pharmacokinetic study

A specific and reliable HPLC-PDA method for the quantitative determination of triamcinolone acetonide, budesonide and fluticasone propionate (as internal standards) in small volumes of microdialysate and rat plasma was developed. An efficient solid-phase extraction (SPE) procedure for plasma samples yielded extremely clean extracts with overall recovery of 104.3% and 95.7% for triamcinolone acetonide (TA) and fluticasone propionate, respectively. Plasma extracts obtained after SPE and microdialysis samples were directly injected on a C18 column to separation. The method has been validated with good linearity, sensitivity, specificity and high accuracy (RE -5.28% to 9.14%) and precision (CV 0.50% to 6.62%) on both matrices. In stability studies, TA and budesonide were stable during storage and assay procedures. The method was applied to a pharmacokinetic study in rodents using microdialysis to determine protein unbound TA concentrations in blood and muscle.     

Capture and reconstitution of G protein-coupled receptors on a biosensor surface

Surface plasmon resonance (SPR) biosensors offer a unique opportunity to study the binding activity of G protein-coupled receptors (GPCRs) in real time with minimal sample preparation. Using two chemokine receptors (CXCR4 and CCR5) as model systems, we captured the proteins from crude cell preparations onto the biosensor surface and reconstituted a lipid environment to maintain receptor activity. The conformational states of the receptors were probed using conformationally dependent antibodies, and by characterizing the binding properties of a native chemokine ligand (stromal cell-derived factor 1alpha). The results suggest that the detergent-solubilized receptors are active for ligand binding in the presence and absence of a reconstituted bilayer. There are three advantages to using this receptor-capturing approach: (1) there is no need to purify the receptor prior to immobilization on the biosensor surface, (2) the receptors are homogeneously immobilized through the capturing step, and (3) the receptors can be captured at high enough densities to allow the study of relatively low-molecular-mass ligands (2000-4000Da). We also demonstrated that the receptors are sensitive to the solubilizing conditions, which illustrates the potential for using SPR biosensors to rapidly screen solublization conditions for GPCRs.     

Characteristics of androgen binding in rat adrenal tissue using [3H]methyltrienolone (R1881) as tracer

A high level of binding of [3H]methyltrienolone (R1881 = 17beta-hydroxy-17alpha-methyl-estra-4, 9, 11-trien-3-one) was found in cytosol prepared from adrenals of castrated male rats. Binding of [3H]R1881 was of high affinity (DK = 6.2 nM) and highly specific for androgens. The [3H]R1881 complex migrates at 7-9S on sucrose gradients in low ionic strength buffer and at 4-5S in buffer containing 0.4M KC1. All binding studies have been performed in parallel with rat ventral prostate and adrenal cytosol. The present data suggest the presence of an androgen binding component in rat adrenal tissue.     

Enzyme activity of rat tibialis anterior muscle differs between treatment with triamcinolone and prednisolone and nutritional deprivation

The maximal activity of a selection of enzymes involved in muscle carbohydrate handling, citric acid cycle and fatty acyl beta-oxidation were studied after treatment with the fluorinated corticosteroid triamcinolone and compared to a similar treatment of the non-fluorinated corticosteroid prednisolone in an equipotent anti-inflammatory dose. Furthermore, because triamcinolone causes loss of body mass and muscle wasting, the effects of triamcinolone were investigated relative to a control group, with the same loss of body mass, due to nutritional deprivation. The study was performed in male Wistar rats in the following treatment groups: TR, triamcinolone treatment (0.25 mg x kg(-1) x day(-1) for 2 weeks), which resulted in a reduction of body mass (24%); ND, nutritional deprivation (30% of normal daily food intake for 2 weeks) resulting in a similar (24%) decrease of body mass as TR; PR, prednisolone treatment (0.31 mg x kg(-1) x day(-1) for 2 weeks), with a 10% increase in body mass; FF, free-fed control group, with a 12% increase in body mass in 2 weeks. Compared to FF, TR induced an increase in phosphofructokinase (PFK) activity (P < 0.01), glycogen synthase [GS(i + d)] activity (P < 0.05) and glycogen content (P < 0.01) in the tibialis anterior muscle. The PR and ND caused no alterations in PFK or citrate synthase (CS) activity compared to FF. Compared to PR, TR induced an increase in PFK (P < 0.01), CS (P < 0.05) and GS(i + d) activity (P < 0.01). Both TR and PR caused an increased muscle glycogen content, being more pronounced in TR (P < 0.05). Compared to ND, TR induced an increased CS (P < 0.05) and GS(i + d) activity (P < 0.01) and glycogen content (P < 0.01). The ND resulted in a decreased glycogen content compared to FF (P < 0.05). None of the treatments affected the activity of glycogen phosphorylase, beta-hydroxyacyl coenzyme A dehydrogenase and lactate dehydrogenase. It was concluded that corticosteroids led to an increased muscle glycogen content; however, the changes in the enzymes of carbohydrate metabolism were corticosteroid type specific and did not relate to undernutrition, which accompanied the triamcinolone treatment.