High-dose Methylprednisolone Pulse Therapy Research Articles

Clinical and imaging features of acute encephalopathy with biphasic seizures and late reduced diffusion in children

Objective: To explore the clinical and imaging features of acute encephalopathy with biphasic seizures and late reduced diffusion(AESD) in children. Methods: For the case series study, 21 children with AESD from Peking University First Hospital, Provincial Children's Hospital Affiliated to Anhui Medical University, Children's Hospital of Fudan University, and Shanxi Children's Hospital who were diagnosed and treated from October 2021 to July 2023 were selected. Clinical data were collected to summarize their clinical information, imaging, and laboratory tests, as well as treatment and prognostic characteristics. Descriptive statistical analysis was applicated. Results: Of the 21 cases with AESD, 11 were males and 10 were females, with the age of onset of 2 years and 6 months (1 year and 7 months, 3 years and 6 months). Of the 21 cases, 18 were typical cases with biphasic seizures. All typical cases had early seizures within 24 hours before or after fever onset. Among them, 16 cases had generalized seizures, 2 cases had focal seizures, and 7 cases reached the status epilepticus. Of the 21 cases, 3 atypical cases had late seizures in biphasic only. The late seizures in the 21 cases occurred on days 3 to 9. The types of late seizures included focal seizures in 12 cases, generalized seizures in 6 cases, and both focal and generalized seizures in 3 cases. Diffusion-weighted imaging (DWI) test on days 3 to 11 showed reduced diffusion of subcortical white matter which was named "bright tree sign" in all cases. The diffuse cerebral atrophy predominantly presented in the front-parietal-temporal lobes was found in 19 cases between day 12 and 3 months after the onset of the disease. Among 21 cases, 20 had been misdiagnosed as autoimmune encephalitis, central nervous system infection, febrile convulsions, posterior reversible encephalopathy syndrome, acute disseminated encephalomyelitis, and hemiconvulsion-hemiplegia-epilepsy syndrome. All the cases received high-dose gammaglobulin and methylprednisolone pulse therapy with poor therapeutic effect. By July 2023, 18 cases were under follow-up. Among them, 17 cases were left with varying degrees of neurologic sequelae, including 11 cases with post-encephalopathic epilepsy; 1 recovered completely. Conclusions: AESD is characterized by biphasic seizures clinically and "bright tree sign" on DWI images. Symptomatic and supportive treatments are recommended. The immunotherapy is ineffective. The prognosis of AESD is poor, with a high incidence of neurological sequelae and a low mortality.

High-dose methylprednisolone pulse therapy during refractory COVID-19 acute respiratory distress syndrome: a retrospective observational study

BackgroundCurrent COVID-19 guidelines recommend the early use of systemic corticoids for COVID-19 acute respiratory distress syndrome (ARDS). It remains unknown if high-dose methylprednisolone pulse therapy (MPT) ameliorates refractory COVID-19 ARDS after many days of mechanical ventilation or rapid deterioration with or without extracorporeal membrane oxygenation (ECMO).MethodsThis is a retrospective observational study. Consecutive patients with COVID-19 ARDS treated with a parenteral high-dose methylprednisolone pulse therapy at the intensive care units (ICU) of two University Hospitals between January 1st 2021 and November 30st 2022 were included. Clinical data collection was at ICU admission, start of MPT, 3-, 10- and 14-days post MPT.ResultsThirty-seven patients (mean age 55 ± 12 years) were included in the study. MPT started at a mean of 17 ± 12 days after mechanical ventilation. Nineteen patients (54%) received ECMO support when commencing MPT. Mean paO2/FiO2 significantly improved 3- (p = 0.034) and 10 days (p = 0.0313) post MPT. The same applied to the necessary FiO2 10 days after MPT (p = 0.0240). There were no serious infectious complications. Twenty-four patients (65%) survived to ICU discharge, including 13 out of 20 (65%) needing ECMO support.ConclusionsLate administration of high-dose MPT in a critical subset of refractory COVID-19 ARDS patients improved respiratory function and was associated with a higher-than-expected survival of 65%. These data suggest that high-dose MPT may be a viable salvage therapy in refractory COVID-19 ARDS.

Different dosages of methylprednisolone therapy for acute necrotizing encephalopathy of childhood: a 6-year multicenter retrospective study.

Different dosages of methylprednisolone therapy for acute necrotizing encephalopathy of childhood: a 6-year multicenter retrospective study.

Kikuchi-Fujimoto disease as the initial manifestation of systemic lupus erythematosus complicated with macrophage activation syndrome: two case reports and a review of literature

BackgroundKikuchi-Fujimoto disease (KFD) is a self-limiting and benign disease characterized by cervical lymphadenopathy and fever. Although KFD should be made differentially diagnosed from infectious, autoimmune, and malignant diseases, it sometimes occurs in patients with systemic lupus erythematosus (SLE) and can be complicated with macrophage activation syndrome (MAS). However, it is rare that KFD is the initial manifestation of SLE and to be complicated with MAS.Case presentationA 9.6-year-old girl presented with high-grade fever, double-side cervical lymphadenopathy with mild pain of one week, leukopenia, alopecia, and rash on the cheek. During hospitalization, laboratory investigations showed positive antinuclear antibody (ANA), low complement 3 (C3), and low complement 4 (C4). Imaging investigations showed pleural and pericardial effusion. A 10.3-year-old girl presented with intermittent high-grade fever, double-sided cervical lymphadenopathy with obvious pain of 1-month duration, and discoid lesion on the cheek. During hospitalization, laboratory investigations showed positive ANA, leukopenia, thrombocytopenia, anemia with positive Coombs’ test, low C3, and positive Smith antibodies. Both cases were diagnosed with KFD using lymph node biopsy, simultaneously fulfilling the diagnostic criteria of SLE. Subsequently, the two girls became complicated with MAS, followed by interstitial lung disease and neuropsychiatric lupus, respectively. Both patients benefited from high-dose methylprednisolone pulse therapy combined with intravenous cyclophosphamide.ConclusionsMore attention should be paid to differential diagnosis, especially SLE, in children diagnosed with KFD. In addition, children with SLE who presented with KFD as the initial manifestation seem to have a higher risk of developing MAS and experiencing organ involvement.

Pneumocystis jirovecii-associated immune reconstitution inflammatory syndrome-like phenomenon in a child with leukaemia: a case report and literature review

BackgroundImmune reconstitution inflammatory syndrome (IRIS) refers to the phenomenon of intense immune responses against pathogens in patients with AIDS undergoing antiretroviral therapy to reconstitute immune function, resulting in functional impairment of multiple organs. Non-AIDS immunosuppressed hosts may also develop similar manifestations to IRIS during immune recovery.Case presentationAn 8-year-old girl presented with acute lymphoblastic leukaemia was admitted for scheduled chemotherapy treatment. During chemotherapy, she experienced pancytopenia and Pneumocystis jirovecii pneumonia, which was diagnosed based on the abnormal shadows observed on chest computed tomography, the elevation of serum β-D-glucan, and the positive mNGS results of Pneumocystis jirovecii in both sputum and blood. After treatment with Granulocyte Colony-Stimulating Factor, sulfamethoxazole, and caspofungin, aggravation of lung lesions was discovered and severe interstitial lung disease developed in a short period along with a rapidly increasing leukocyte count. Intravenous methylprednisolone pulse therapy was given, but lung function did not improve, and she finally died after the withdrawal of medical care.ConclusionsFor patients with acute lymphocytic leukaemia infected with Pneumocystis jirovecii, the rapid aggravation of pulmonary lesions in the process of blood recovery and immune reconstitution should raise vigilance against the possibility of IRIS-like reactions. The use of granulocyte stimulating factors may aggravate the inflammatory response in the lungs. The timing, dosage, and duration of treatment of glucocorticoids and the impact of high-dose methylprednisolone pulse therapy on the prognosis of patients should be explored in further research.

High-dose methylprednisolone pulse therapy for the treatment of patients with severe COVID-19: Results from a prospective observational study

High-dose methylprednisolone pulse therapy for the treatment of patients with severe COVID-19: Results from a prospective observational study

Timing of Initiation of Methylprednisolone Pulse Therapy in Patients with COVID-19

High-dose methylprednisolone pulse therapy is widely used in patients with severe COVID-19. This therapy is known to have sufficient clinical effectiveness, but the optimal administration method is not known. In this study, we assessed the deterioration of oxygenation after methylprednisolone pulse therapy in patients with COVID-19 according to disease severity (oxygen requirement) at initiation of therapy. Ninety-nine patients with COVID-19 who received methylprednisolone pulse therapy at Saitama Medical University Hospital in Japan between October 2020 and October 2021 were retrospectively reviewed. Clinical outcomes were compared according to the fraction of inspired oxygen as a measure of disease severity at initiation of methylprednisolone pulse therapy. Based on the FIO2 level at initiation of methylprednisolone pulse therapy, patients were classified into an early treatment group (FIO2 ≤ 0.39; n = 21), a middle treatment group (FIO2 0.40–0.69; n = 38), and a late treatment group (FIO2 ≥ 0.70; n = 40). The frequency of administration of mechanical ventilation and the days of oxygen therapy in the middle group were lower than in the other groups. The frequency of adverse events was also lower in the middle group. Both late and early methylprednisolone pulse therapy may lead to further deterioration of COVID-19 and an increase in adverse events.

Observation on the efficacy of different methylprednisolone regimens in the treatment of myasthenia gravis.

Objective:To investigate the efficacy of different methylprednisolone regimens in the treatment of myasthenia gravis (MG).Methods:A total of 98 patients with MG admitted to Shijiazhuang People’s Hospital from December 2018 to November 2019 were randomly divided into two groups, with 49 cases in each group. Patients in the control group received high-dose methylprednisolone pulse therapy, while those in the experimental group received medium-dose periodic therapy of methylprednisolone. Anti-acetylcholine receptor antibodies (AChRab), clinical absolute scores, complement levels (C3, C4), T lymphocyte subsets (CD3+, CD4+, CD4+CD25+), cytokines [interferon-γ (INF-γ), transforming growth factor-β1 (TGF-β1), interleukin-6 (IL- 6), interleukin-18 (IL-18)], and changes in quality of life [15-item Myasthenia Gravis Quality of Life Scale (MGQOL-15) score] were compared between the two groups before treatment and one and three months after treatment. Moreover, the incidence of adverse drug reactions in the two groups during 3 months of treatment was compared.Results:After three months of treatment, ACHRAB, clinical absolute score, CD3+, CD4+, INF-γ, IL-6, IL-18 and MGQOL-15 scores in both groups were significantly decreased compared with those before treatment (p<0.05), and the scores of C3, C4, CD4+CD25+ and TGF-β1 in both groups were significantly higher than those before treatment (p<0.05), and the experimental group had more significant changes than the control group (p<0.05). During three months of treatment, the total incidence of adverse drug reactions in the experimental group was significantly lower than that in the control group (p<0.05).Conclusions:The medium-dose periodic therapy of methylprednisolone is more prominent in the long-term efficacy performance. It can improve the immunity and quality of life of patients, and it is safer and has high clinical application value.

Identification of patients with COVID-19 who are optimal for methylprednisolone pulse therapy.

BackgroundCorticosteroids have been reported to reduce the mortality rates in patients with coronavirus disease 2019 (COVID-19). Additionally, the role of high-dose methylprednisolone pulse therapy in reducing mortality in critically ill patients has also been documented. The purpose of this study is to identify patients with COVID-19 who are suitable for methylprednisolone pulse therapy.MethodsThis was a retrospective study that included patients with COVID-19 receiving methylprednisolone pulse therapy (≥250 mg/day for 3 days) with subsequent tapering doses at our hospital between June 2020 and January 2021. We examined the differences in background clinical factors between the surviving group and the deceased group.ResultsOut of 156 patients who received steroid therapy, 17 received methylprednisolone pulse therapy. Ten patients recovered (surviving group) and seven patients died (deceased group). The median age of the surviving and deceased groups was 64.5 years (range, 57-85) and 79 years (73-90), respectively, with a significant difference (p=0.004). Five of the deceased patients (71%) had developed serious complications associated with the cause of death, including pneumothorax, pneumomediastinum, COVID-19-associated pulmonary aspergillosis, cytomegalovirus infection, and bacteremia. On the other hand, out of the 10 survivors, only one elderly person had cytomegalovirus infection and the rest recovered without complications.ConclusionAdministration of methylprednisolone pulse therapy with subsequent tapering may be an effective treatment in patients with COVID-19 up to the age of early 70s; however, severe complications may be seen in elderly patients.

Clinicopathological features and outcomes of SLE patients with renal injury characterised by thrombotic microangiopathy.

Non-immune complex (IC)-mediated renal thrombotic microangiopathy (TMA) has been reported in patients with systemic lupus erythematosus (SLE), but most studies included patients with both renal TMA and IC-mediated lupus nephritis (LN). In this study, the clinicopathological features and outcomes of renal injury characterised by only renal TMA were retrospectively analyzed. Patients with glomerular and/or vascular TMA in the absence of subendothelial or epithelial immune deposits were screened from 2,332 biopsied of SLE patients. The TMA lesions were divided into glomerular, vascular or both. Acute tubular-interstitial injury was semi-quantitatively analyzed. The podocyte foot process effacement (FPE) was measured by electronic microscopy. Two hundred fifty-seven (11.0%) renal biopsies revealed TMA, among which 237 biopsies showed TMA coexisting with LN, and 20 (0.9%) biopsies had only renal TMA without or with only mesangial immune deposits. All patients manifested with acute kidney injury and haematological disorders. Among them, 11 (55%) required renal replacement therapy, 12 (60%) had nephrotic syndrome and 13 (65.0%) showed microvascular haemolytic anaemia with thrombocytopenia. Seventeen (85%) biopsies revealed both glomerular TMA and vascular TMA, two had only glomerular TMA and one had vascular TMA. Eight (40%) had no glomerular immune deposits and 12 (60%) showed only mesangial immune deposits. The acute tubulointerstitial injury in patients requiring dialysis was more severe than those not needing dialysis ((43.6 ± 24.9) % vs. (21.7 ± 20.1) %, p = 0.047). FPE of podocytes was positively correlated with proteinuria (r2 = 0.347, p = 0.006). All patients received high-dose methylprednisolone pulse therapy. Four patients received plasma exchange. The renal function of 11 patients requiring dialysis initially recovered after 16.0 (interquartile range [IQR] 9.0, 30.0) days of treatment. During the follow-up of 58.0 (IQR 36.0, 92.3) months, remission was achieved in 19 (95%) patients; only one patient had no response. No patient died or progressed to end-stage renal disease; six patients (30%) relapsed. Renal TMA, usually accompanying severe renal injury, was not uncommon in SLE patients with renal disease and should be distinguished from immune complex-mediated severe classes of LN. Early intensive immunosuppressive treatment may be associated with a good long-term renal outcome. Key Points • Most previous reports of renal TMA in SLE patients were associated with severe types of immune complex-mediated lupus nephritis; • Renal TMA with glomerular pauci-immune or only mesangial immune deposits was found in SLE patients and clinically presented with severe acute renal injury but good renal outcome; • Renal TMA should be considered as a unique type of SLE-associated renal injury.

Akut Dissemine Ensefalomiyelite Bağlı Periferik Fasiyal Sinir Felci Gelişen Bir Çocuk Hasta

Akut dissemine ensefalomiyelit (ADEM), nörogörüntülemede multifokal demiyelinasyon lezyonlarının kanıtıyla birlikte yaygın nörolojik belirti ve semptomlarla karakterize, santral sinir sisteminin monofazik akut demiyelinizan bir bozukluğu olarak kabul edilir. Yaygın görülen semptomlar letarji, ateş, kusma, baş ağrısı, meningeal belirtiler ve nöbetlerdir. Nörolojik belirtiler arasında duyusal değişiklikler, çoklu kraniyal sinir tutulumu, kuadripleji ve parapleji, distoni ve koreiform hareketler, ataksi, nistagmus, mesane tutulumu, konuşma bozukluğu ve çift görme vardır. Periferik fasiyal sinir felci nadiren eşlik eder. Akut dissemine ensefalomiyelit ile sağ periferik fasiyal sinir felci gelişen 7 yaşındaki bir kız çocuğu olgusunu sunuyoruz. Hastaneye görme azlığı, depresif ruh hali, yürüme bozukluğu ve yüz ifadelerinde bozulma yakınmaları ile başvurdu. Horizontal ve vertikal nistagmus, sağ periferik yüz felci, ataksik yürüyüş ve derin tendon reflekslerinde artış vardı. Beyin omurilik sıvısı (BOS) incelemesi normaldi. Serebral manyetik rezonans görüntülemede (MRG) çoklu beyaz cevher lezyonları görüldü. Yüksek doz metilprednizolon pulse tedavisi ile klinik bulgularda belirgin bir iyileşme gözlemledik.

Successful Treatment of Pemphigus Vulgaris with a Modified Regimen of Rituximab Biosimilar(CT-P10) Combined with IVIG

Keywords: Pemphigus vulgaris;Modified Regimen;Rituximab biosimilar; IVIG Pemphigus Vulgaris (PV) has been known as fatal autoimmune bullous diseases affecting the skin and mucous membranes. Here, we report that a patient with PV responded rapidly to a modified regimen of rituximab biosimilar (CT-10, Truxima®)combined with Intravenous Immunoglobulin (IVIG). A 53-year-old man presented with extensive erosions due to blistering on the whole body following initial mucosal erosions which started at 3 years ago. Laboratory tests revealed an eosinophil count of 16.7% (normal range: 0~5%) with normal liver and renal functions. Antinuclear antibody was a nuclear membrane pattern with a titer of 1:40. Anti-dsDNA, anti-Ro/La, anti-Scl-70, and anti-phospholipid antibodies were negative. Myeloperoxidase and PR3 antineutrophil cytoplasmic autoantibody were both negative. Histological examination showed suprabasala cantholysis, while direct and indirect immunofluorescence assays demonstrated a deposition of immunoglobulin G (IgG) on anintercellular surface at 1:640 dilutions (Figure. 1a, b). Based on the blistering on the whole body and characteristic biopsy result, the patient was diagnosed as PV. Although he was initially treated with topical and highdose methylprednisolone (1000 mg/day) pulse therapy for 3 consecutive days, there was no significant improvement in skin blistering lesions. We decided to administer CT-P10 combined with IVIG. We treated the patient with CT-P10 (500, 500, and 1000mg once weekly for 3 weeks) combined with IVIG (1g/ kg at first and third week). During the treatment of CT-P10 combined with IVIG, a clinical response rapidly appeared, and levels of antibodies were decreased from 1:640 to 1:40 (Figure. 1c). Disease activity was dramatically controlled within 3 weeks. It achieved the end of the consolidation phase for PV within 5 weeks after starting CT-P10 combined with IVIG (Figure. 1dg). Then, we tapered oral prednisolone and steroid-sparing agents including mycophenolate mofetil and cyclosporine for maintenance therapy. Until now, there has been no recurrence of PV on 36 months follow up.

Plasma C3d levels as a diagnostic marker for complete complement factor I deficiency

Plasma C3d levels as a diagnostic marker for complete complement factor I deficiency

Prolonged Fever and Intravenous Immunoglobulin Resistance in Kawasaki Disease: Should Macrophage Activation Syndrome Be Considered?

Introduction: Macrophage activation syndrome (MAS) is a rare and potentially fatal complication of Kawasaki disease (KD). Typically, MAS presents as the exacerbation of KD, manifested by prolonged fever and resistance to treatment. Early and accurate diagnosis might be challenging due to overlapping features of MAS and intravenous immunoglobin (IVIG)-resistant KD and lack of validated diagnostic criteria. Case Presentation: In this article, we report four cases of KD with prolonged fever that were eventually diagnosed and treated as MAS. Three cases were boys and one infant was a girl. The mean age of the cases was 29 months. Three cases had typical and one case had atypical KD. Two cases had abnormal findings in echocardiography and three cases had hepatomegaly. In laboratory evaluation, all of them had thrombocytopenia, increased liver enzymes, and hyperferritinemia. All the patients were treated with intravenous high-dose methylprednisolone (pulse therapy) after IVIG therapy, two cases with oral cyclosporine, and one case with infliximab. There was no mortality in our cases, and in long-term follow-up, all the patients had normal clinical, laboratory, and echocardiography findings. Conclusions: KD resistant to IVIG and sustained fever have high diagnostic values in MAS with underlying KD.

A Successfully Treated Case of Recurrent Focal Segmental Glomerulosclerosis (FSGS) with Plasmapheresis and High dose Methylprednisolone Pulse Therapy

Focal segmental glomerulosclerosis (FSGS) in children, which is a kind of nephrotic syndrome showing steroid resistance, usually progresses to a substantial number of end stage renal disease (ESRD). Although the pathogenesis of primary FSGS is unclear, several recent studies have reported that FSGS is associated with circulating immune factors such as soluble urokinase-type plasminogen activator receptor (suPAR) or anti-CD40 autoantibody. We report a successfully treated case of a 19-year-old female patient who experienced a recurrence of primary FSGS. After the diagnosis of FSGS, the patient progressed to ESRD and received a kidney transplantation (KT). Three days later, recurrence was suspected through proteinuria and hypoalbuminemia. She has been performed plasmapheresis and high dose methylprednisolone pulse therapy and shown remission status without increasing proteinuria for four years after KT. In conclusion, strong immunosuppressive therapy may be helpful for a good prognosis of recurrent FSGS, suppressing several immunologic circulating factors related disease pathogenesis. Key words: Focal segmental glomerulosclerosis (FSGS); End stage renal disease (ESRD); Soluble urokinase-type plasminogen activator receptor (suPAR); Anti-CD40 autoantibody

Pulmonary hemorrhage as an unusual initial manifestation of systemic lupus erythematosus

Pulmonary hemorrhage as the initial manifestation of systemic lupus erythematosus (SLE) has been rarely reported in children. We present the case of a 10-year-old girl who was admitted to Kangbuk Samsung Hospital with hemoptysis. She had a 5-day history of cough with dyspnea. On physical exam, breath sound was significantly decreased combined with rales on both lung fields. Blood tests revealed pancytopenia, decreased complement levels (C3, 21.28 mg/dL; C4, 3.10 mg/dL), positive antinuclear antibody (>1:640) and anti-double-stranded DNA antibody (262.5 IU/mL). Chest computed tomography revealed patchy ground glass opacity on both lung fields. She had proteinuria and diffuse lupus nephritis (International Society of Nephrology/Renal Pathology Society class IV-G(A)) confirmed by renal biopsy. High-dose methylprednisolone pulse therapy (30 mg/kg/day) was given for 3 days and then switched to a maintenance dose (1 mg/kg/day). Initially hemoptysis resolved after administration of methylprednisolone, but recurred on the 14th day of treatment. She was then treated with cyclophosphamide pulse therapy and hemoptysis subsided without recurrence. She was discharged on the 31st day of admission. She continued to receive monthly cyclophosphamide pulse therapy until the occurrence of leukopenia and then her regimen was switched to mycophenolate and hydroxychloroquine. SLE continues to be well controlled after 18 months of treatment. Recognition of pulmonary hemorrhage as a possible initial manifestation of SLE is crucial for early diagnosis. SLE was successfully treated with good outcome. (Allergy Asthma Respir Dis 2015;3:370-374)

Practical Applications of New Frontiers in Risk and Asset Allocation

<h3>Objective:</h3> To explore various post covid immune mediatedneurological manifestations in children <h3>Background:</h3> The neurological manifestation following a SARS-CoV2 infection is varied and till now there are only few studies reported regarding the same. Our study aimed to identify the varied spectrum of neurological manifestation following SARS-CoV2 infection. <h3>Design/Methods:</h3> Retrospective data were collected from May 2021 to September 2021, including all children aged from 1month to 18 years of age who presented to our pediatric emergency or OPD (a tertiary care center from western Rajasthan, India) with the neurological manifestation with history of COVID-19 infection or exposure and positive SARS-CoV-2 serology. Those who are RT PCR positive were excluded. The neurological manifestations were further categorized in a pre-designed proforma. <h3>Results:</h3> Case records of the 18 children who fulfilled the criteria were included in the study, among them 7 (38.8%) were male and 11 (61.1%) were female. Predominant presentation in our study group was seizures (6/18) and Gullian Barre Syndrome (5/18). Other manifestations included stroke (2/18), ADEM (1/18), MS (1/18), LETM (1/18), Autoimmune encephalitis[NMDAR](2/18). In our study group, 13/18 (72.2%) required immunomodulatory therapy either IVIG or high dose methylprednisolone pulse therapy. Steroids were used upfront in patients with elevated inflammatory markers. Cerebrovascular complications in children were less common compared to adults. Most of the children had favourable outcomes except for one mortality in our cohort. <h3>Conclusions:</h3> Delayed complications following SARS-CoV2 infection with varied manifestations are seen in children. A temporal correlation between the COVID 19 infection and the increasing number of neurological cases after the second wave was noted. Steroids are beneficial while treating such patients. Testing for SARS-CoV2 serology during the pandemic can give a clue to the underlying etiology. However, further studies are required to understand the CNS effects of SARS-CoV2 infection in children. <b>Disclosure:</b> Dr. Saini has nothing to disclose. Dr. Krishna has nothing to disclose. Sarbesh Tiwari has nothing to disclose. Dr. Khera has nothing to disclose. Dr. KUMAR has nothing to disclose. Dr. Goyal has nothing to disclose. Dr. Choudhary has nothing to disclose. Prof. Singh has nothing to disclose.

High-dose methylprednisolone pulse therapy upregulated FcγRIIb expression on B cells in primary Sjögren’s syndrome patients with thrombocytopenia

Abnormalities in B cell are characteristic feature of primary Sjögren's syndrome (pSS). As FcγRIIb is a key regulator of B cells, the objective of this study is to investigate the role of the inhibitory receptor FcγRIIb in B cells from pSS patients, and whether glucocorticoid can affect B cell subpopulations or FcγRIIb expression. Thirty pSS patients and 15 healthy controls were enrolled in this study. The results showed that the percentage of memory CD19(+)CD27(+) B cells was significantly lower in pSS patients compared to in healthy controls. FcγRIIb expression on memory CD19(+)CD27(+) B cells from active pSS patients was significantly reduced compared with those from inactive or healthy controls. The level of FcγRIIb on memory CD19(+)CD27(+) B cells from active pSS patients was negatively correlated with anti-SSA antibody titers and Sjögren's syndrome disease activity index. After a high-dose methylprednisolone pulse therapy for 3days, FcγRIIb expression on memory B cells was upregulated, with the raised level of platelets. In vitro, dexamethasone could elevate FcγRIIb expression on B cells of pSS patients in a dose-dependent manner. Taken together, our data suggest that the upregulation of FcγRIIb may be expected to be a new therapeutic strategy in pSS patients.

SAT0170 Decreased expression of FCΓRIIB on B cells from primary sjögren’s syndrome patients

BackgroundAbnormalities in B cell are characteristic features of primary Sjögren’s syndrome (pSS). FcγRIIb (CD32b), an inhibitory receptor on B cells, is a key regulator of B cells and might be...

Study on the therapeutic effect and nursing on acute spinal cord injury treatment with large-dose of methylprednisolone

Objective To explore the short-term effect of high dose methylprednisolone (MP) pulse therapy for acute spinal cord injury,to observe its complications,and to summary nursing experience.Method We retrospectively reviewed nursing process of 80 patients who received high-dose MP pulse therapy with acute spinal cord injury in hospital.Results Patients receiving high-dose MP pulse therapy didn't appear any serious complications,at the same time sensory and motor function improved significantly,Conclusions For patients with acute spinal cord injury,the use of high-dose MP pulse therapy can be effective in preventing secondary spinal cord injury and improving spinal function.During the application of MP,close nursing and observation is one of the keys to ensure successful treatment. Key words: Methylprednisolone; Spinal cord injury; Nursing