Hydrocortisone Sodium Succinate Research Articles

Hypersensitivity to intravenous succinate corticosteroids in patients with nonsteroidal anti-inflammatory drug-exacerbated respiratory disease.

Although there are many case reports of asthma exacerbations with intravenous corticosteroids, especially hydrocortisone succinate, in nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD), the frequency and mechanism remain unclear. We hypothesized that N-ERD patients are potentially hypersensitive to succinates, especially succinate corticosteroids, based on the results of previous provocation studies and considered specific mechanisms. The objective of this study was to determine the frequency and mechanism of succinate corticosteroids hypersensitivity in patients with N-ERD. Eleven patients with stable, moderate to severe N-ERD were tested with hydrocortisone sodium succinate (HCs), hydrocortisone sodium phosphate (HCp), methylprednisolone sodium succinate (MPSLs), prednisolone sodium succinate (PSLs), and chloramphenicol sodium succinate (CPs, without a steroidal chemical structure) at doses below the normal dose through intravenous administration using a single-blind test. As a comparison, seven patients with aspirin-tolerant asthma (ATA) also underwent an intravenous provocation test of HCs. The positive intravenous provocation test rates of HCs 100-500 mg, HCp 500 mg, MPSLs 80 mg, PSLs 20 mg, and CPs 500 mg in N-ERD patients were 82% (9/11), 9% (1/11), 50% (5/10), 33% (1/3), and 86% (6/7), respectively. Most positive reactions began with a severe cough within 5 min of intravenous injection. The course of these hypersensitivity symptoms differed from those seen with the usual aspirin challenge test. The HCs 100-500 mg intravenous test was negative in all seven patients with ATA. In conclusion, patients with N-ERD have high rates of potential hypersensitivity to the succinate ester structure, which is not linked to the corticosteroid structure, but to the succinate ester structure. We hypothesized that the mechanism of hypersensitivity observed during rapid intravenous administration of succinate corticosteroids is mast cell activation via succinate receptor stimulation, rather than due to the corticosteroid itself.

Surface modified walnut shell derived carbon particles for anti-acne skin treatment

Applied materials from bio-wastes are becoming the center of attention for researchers due to convincing concerns for their effectiveness, bio-sustainability, affordability, and environmental friendliness. In this research, different forms of carbon particles (CP) were produced from walnut shells to check their response against acne. Surface chemistry of CPs was modified in two steps: first, by thermal or oxidative-thermal treatment, and second, by biochemical treatment with the drugs triamcinolone acetonide (TA) or hydrocortisone sodium succinate (HSS) at pH 4 and 7. Prepared CPs have been analyzed for their surface chemistry, morphology and bioactivity. With the exception of GTOT, surface modifications have decreased oil absorption capacity and drug release pattern while increasing dispersion, pH and base contents. The GTOT and PTOT-N1 samples exhibited highest oil absorption capacities of 0.137 g/0.05 g and 0.130 g/0.05 g, respectively. Additionally, thermal and thermo-chemical modifications have slightly decreased in-vitro anti-inflammatory activity but substantially decreased cytotoxicity (almost 5–6 folds in comparison to unmodified particles). Anti-inflammatory response has been checked against P. acnes. Among various prepared samples, it was observed that Bio-PUT-4 and Bio-PTOT-7 exhibited the most significant levels of anti-inflammatory activity, at 94.19 % and 93.54 % respectively. Thermally modified samples, additionally, have shown magnetic behavior.

Fusion of Michael-acceptors enhances the anti-inflammatory activity of ginsenosides as potential modulators of the NLRP3 signaling pathway

Ginsenosides are a promising group of secondary metabolites for developing anti-inflammatory agents. In this study, Michael acceptor was fused into the aglycone A-ring of protopanoxadiol (PPD)-type ginsenosides (MAAG), the main pharmacophore of ginseng, and its liver metabolites to produce novel derivatives and assess their anti-inflammatory activity in vitro. The structure–activity relationship of MAAG derivatives was assessed based on their NO-inhibition activities. Of these, a 4-nitrobenzylidene derivative of PPD (2a) was the most effective and dose-dependently inhibited the release of proinflammatory cytokines. Further studies indicated that 2a-induced downregulation on lipopolysaccharide (LPS)-induced iNOS protein expression and cytokine release may be related to its inhibitory effect on MAPK and NF-κB signaling pathways. Importantly, 2a almost completely inhibited LPS-induced production of mitochondrial reactive oxygen species (mtROS) and LPS-induced NLRP3 upregulation. This inhibition was higher than that by hydrocortisone sodium succinate, a glucocorticoid drug. Overall, the fusion of Michael acceptors into the aglycone of ginsenosides greatly enhanced the anti-inflammatory activities of the derivatives, and 2a alleviated inflammation considerably. These findings could be attributed to the inhibition of LPS-induced mtROS to block abnormal activation of the NLRP3 pathway.

Association of Vitamin C, Thiamine, and Hydrocortisone Infusion With Long-term Cognitive, Psychological, and Functional Outcomes in Sepsis Survivors

Sepsis is associated with long-term cognitive impairment and worse psychological and functional outcomes. Potential mechanisms include intracerebral oxidative stress and inflammation, yet little is known about the effects of early antioxidant and anti-inflammatory therapy on cognitive, psychological, and functional outcomes in sepsis survivors. To describe observed differences in long-term cognitive, psychological, and functional outcomes of vitamin C, thiamine, and hydrocortisone between the intervention and control groups in the Vitamin C, Thiamine, and Steroids in Sepsis (VICTAS) randomized clinical trial. This prespecified secondary analysis reports the 6-month outcomes of the multicenter, double-blind, placebo-controlled VICTAS randomized clinical trial, which was conducted between August 2018 and July 2019. Adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction who survived to discharge or day 30 were recruited from 43 intensive care units in the US. Participants were randomized 1:1 to either the intervention or control group. Cognitive, psychological, and functional outcomes at 6 months after randomization were assessed via telephone through January 2020. Data analyses were conducted between February 2021 and December 2022. The intervention group received intravenous vitamin C (1.5 g), thiamine hydrochloride (100 mg), and hydrocortisone sodium succinate (50 mg) every 6 hours for 96 hours or until death or intensive care unit discharge. The control group received matching placebo. Cognitive performance, risk of posttraumatic stress disorder and depression, and functional status were assessed using a battery of standardized instruments that were administered during a 1-hour telephone call 6 months after randomization. After exclusions, withdrawals, and deaths, the final sample included 213 participants (median [IQR] age, 57 [47-67] years; 112 males [52.6%]) who underwent long-term outcomes assessment and had been randomized to either the intervention group (n = 108) or control group (n = 105). The intervention group had lower immediate memory scores (adjusted OR [aOR], 0.49; 95% CI, 0.26-0.89), higher odds of posttraumatic stress disorder (aOR, 3.51; 95% CI, 1.18-10.40), and lower odds of receiving mental health care (aOR, 0.38; 95% CI, 0.16-0.89). No other statistically significant differences in cognitive, psychological, and functional outcomes were found between the 2 groups. In survivors of sepsis, treatment with vitamin C, thiamine, and hydrocortisone did not improve or had worse cognitive, psychological, and functional outcomes at 6 months compared with patients who received placebo. These findings challenge the hypothesis that antioxidant and anti-inflammatory therapy during critical illness mitigates the development of long-term cognitive, psychological, and functional impairment in sepsis survivors. ClinicalTrials.gov Identifier: NCT03509350.

Design, Synthesis, and Anti-Inflammatory Activities of 12-Dehydropyxinol Derivatives.

Pyxinol skeleton is a promising framework of anti-inflammatory agents formed in the human liver from 20S-protopanaxadiol, the main active aglycone of ginsenosides. In the present study, a new series of amino acid-containing derivatives were produced from 12-dehydropyxinol, a pyxinol oxidation metabolite, and its anti-inflammatory activity was assessed using an NO inhibition assay. Interestingly, the dehydrogenation at C-12 of pyxinol derivatives improved their potency greatly. Furthermore, half of the derivatives exhibited better NO inhibitory activity than hydrocortisone sodium succinate, a glucocorticoid drug. The structure-activity relationship analysis indicated that the kinds of amino acid residues and their hydrophilicity influenced the activity to a great extent, as did R/S stereochemistry at C-24. Of the various derivatives, 5c with an N-Boc-protected phenylalanine residue showed the highest NO inhibitory activity and relatively low cytotoxicity. Moreover, derivative 5c could dose-dependently suppress iNOS, IL-1β, and TNF-α via the MAPK and NF-κB pathways, but not the GR pathway. Overall, pyxinol derivatives hold potential for application as anti-inflammatory agents.

Variability in Content of Hydrocortisone Sodium Succinate.

SOLU-CORTEFⓇ Sterile Powder is a type of anti-inflammatory glucocorticoid that contains hydrocortisone sodium succinate as its active ingredient. It can be administered intravenously or intramuscularly, and comes in several packages including 100 mg plain vials without diluent. The diluent, which is part of the ACT-O-VIAL system, contains only Water for Injection and no preservatives. The pH of each formula is adjusted with sodium hydroxide to ensure it falls within the specified range of 7 to 8 after reconstitution. Intralot variability was detected in lot GA6092. Measuring in the PC subspace using just PCs 4, 5 and 6, vial 12 plots 4.2 BEST SDs from the center of the cluster, and vial 7 is 3.7 SDs from the center. Vial 18 appears 3.1 SDS from the center of the cluster (3/18, 17%). Interlot variability was also found in the spectral library (lots GA6092, GK7048, GM6839, GR8925, FL8062, FN6860, FR1914, and FR5098) containing the spectra of 126 hydrocortisone sodium succinate vials.

Evaluation of the stability of hydrocortisone sodium succinate in solutions for parenteral use by a validated HPLC-UV method.

This study aimed to determine the in-use stability (t95%) of hydrocortisone sodium succinate (HSS) infusion solutions and provide evidence-based guidelines on their usability.HSS infusion solutions were prepared and stored as recommended by the manufacturer and under common conditions in our hospital. The effects of HSS concentration (1and 4 mg/mL), solvent (isotonic saline and glucose), temperature (ambient and 30°C), and light on its stability were evaluated using a validated stability-indicating HPLC-UV method.HSS degradation followed first-order kinetics. No significant difference in its stability was observed between the two evaluated concentrations, solvents and light exposure (t95% between 25 and 30 h). Elevated temperature (30°C) affected HSS stability and significantly reduced the t95% (4.6-6.3h).HSS infusion solutions are physically and chemically stable (˂5% degradation) for at least 6 h if stored below 30°C. The in-use stability may be extended up to 24 h if stored below 24°C.

Stability of Hydrocortisone Sodium Succinate in Intensive Care Units: Focus on Practical Points

Background: Although single daily 24 hours preparation of hydrocortisone solution infusion is widely used in intensive care clinical practice, most manufacturers limit its infusion time to only four hours. The data on efficacy of this practice are scarce. Objective: To determine the physical and chemical stability of hydrocortisone solution used in intensive care units (ICU). Materials and Methods: Powder form of 100 mg hydrocortisone was reconstituted first with sterile water for injection (SWI) and then added to normal saline solution (NSS) to obtain 1 and 2 mg/mL solutions, or first reconstituted with NSS then added to bag of NSS to obtain 1 mg/mL solution. The solutions were then stored in three different conditions, refrigerator (4±2℃), ICU (25±3℃), and hospital room (30±2℃) temperatures for 48 hours. The physical and chemical stabilities were assessed at an initial time, 4, 8, 12, 24, and 48 hours. Results: Hydrocortisone reconstituted in SWI showed an acceptable labeled amount range (100.28±3.83%), similar to reconstitution in NSS (96.05±1.00%). Hydrocortisone solutions of 1 and 2 mg/mL stored at 4±2℃, 25±3℃, and 30±2℃ showed similar percent label amount, and the statistical tests were not significantly different among the three ranges of temperatures (p>0.05). Conclusion: Hydrocortisone reconstituted using SWI followed by NSS to obtain final concentrations of 1 to 2 mg/mL or using only NSS to obtain a final concentration of 1 mg/mL, provided an acceptable range of % hydrocortisone remaining up to 48 hours when stored at 4±2℃, 25±3℃, and 30±2℃. Keywords: Hydrocortisone; Intensive care units; Normal saline solution; Stability; Sterile water for injection

DEVELOPMENT AND EVALUATION OF MUCOADHESIVE MICROSPHERES OF HYDROCORTISONE SODIUM SUCCINATE IN THE TREATMENT OF CHRONIC SINUSITIS

Objective: In the world, chronic sinusitis is one of the most common illness disorders. However, no viable medication has been identified to fully cure it as of yet. Patients are necessitated to use sprays, inhalers, and other devices to treat chronic sinusitis in contrast to all of its dangerous symptoms. However, these dosage forms need for concurrent administration, which cause inconvenient in the long term. An effort has been made to create a controlled release dosage form to increase patient compliance. Methods: Two polymers Chitosan and HPMC were used to create hydrocortisone sodium succinate microspheres through the orifice-ionic gelation process. Result and Discussion: It had a yield of about 89.33±2.33% drug entrapment efficiency and 86.65±0.25% percentage yield. The evaluation results for formulation F6 were the best of all the formulations. Conclusion: It concluded that the most effective and promising dosage form was microspheres made from the drug (hydrocortisone sodium succinate), sodium alginate, and HPMC in the ratio of 1:2:2.

Corrosion protection of mild steel in Hydrochloric acid solutions using expired Hydrocortisone sodium succinate drug

The erosion hindrance of carbon steel in 1M HCl in nearness and nonappearance of terminated Hydrocortisone Sodium Succinate has been examined utilizing mass-loss. Comes about gotten appeared that the restraint productivity expanded with the increment of the concentration of the utilized medicate and diminished with the increment of temperature. The adsorption of this sedate on carbon steel surface takes after Langmuir’s adsorption isotherm. A few thermodynamic parameters were calculated. The motor parameters of erosion of carbon steel in HCl arrangement have been examined. Keywords: Corrosion inhibition; Carbon steel; Hydrocortisone

A Case of Anaphylactic Shock due to Hydrocortisone Sodium Succinate Suspected to Be Associated with Aspirin Asthma

25 歳，男性。耳鼻科で両茎状突起過長症に対し，全身麻酔下で切除術を施行した際，麻酔離脱時にヒドロコルチゾンコハク酸エステルナトリウム（HC コハク酸 Na）とフルルビプロフェンアキセチル（ロピオン®）を投与後より，酸素飽和度低下・血圧低下を認めたため，輸液速度を上げアドレナリン筋注を行い回復傾向となった。薬剤によるアナフィラキシーショックが疑われ，皮内テストを行ったところ HC コハク酸 Na で陽性であり同剤による薬剤性アナフィラキシーショックと診断した。またエステル基の異なるヒドロコルチゾンリン酸エステルナトリウム（HC リン酸エステル Na）は皮内テスト陰性であり，コハク酸エステルがアナフィラキシー反応に関与したと考えた。自験例では，後日施行された呼吸器内科の検査でアスピリン喘息の併発が疑われた。

Methylprednisolone-induced anaphylaxis diagnosed by intradermal skin test: a case report

BackgroundGlucocorticoids rarely cause anaphylaxis. Common methods for the determination of allergens include in vivo skin prick test (SPT) and intradermal skin test (IDST) and the in vitro basophil activation test (BAT). However, to our knowledge, the best strategy for diagnosing glucocorticoid-induced anaphylaxis has not been elucidated.Case presentationA 10-year-old boy was admitted to our hospital because of 2 weeks of fever and arthralgia. He had not been treated with glucocorticoids before, including methylprednisolone (mPSL). He was suspected to have bacterial myositis and was treated with ceftriaxone. However, his symptoms persisted for > 2 weeks. Autoinflammatory arthritis was suspected, and he was treated with mPSL sodium succinate (MPS) pulse therapy (30 mg/kg). After 15 min of mPSL injection, he had wheezing and generalized wheal formation with decreased oxygen saturation. As anaphylaxis was suspected, mPSL was discontinued, and olopatadine and oxygen were administered. The symptoms improved considerably without the use of epinephrine and disappeared in 30 min. One month after discharge, SPT, IDST, and BAT were performed without discontinuing his prescribed oral prednisolone. SPTs for MPS, hydrocortisone sodium succinate (HCS), prednisolone sodium succinate (PSS), dexamethasone sodium phosphate (DSP), and betamethasone sodium phosphate (BSP) were negative. IDSTs for MPS, HCS, and PSS were positive, whereas those for DSP and BSP were negative. By contrast, BATs for MPS, HCS, and PSS were negative. Although glucocorticoid-induced hypersensitivity caused by nonmedicinal ingredients such as lactose, carboxymethylcellulose, polyethylene glycol, and hexylene glycol has been reported; the glucocorticoids tested in this patient did not contain any of these nonmedicinal ingredients. As the glucocorticoids that were positive on IDST share a succinate ester, this might have caused MPS-induced anaphylaxis.ConclusionsWe report the case of MPS-induced anaphylaxis diagnosed by IDST but not BAT. In case reports of glucocorticoid-induced anaphylaxis in the literature, most patients were diagnosed with SPT or IDST. These results suggest that BAT should be considered when IDST and SPT are negative. Further studies are necessary to clarify the best strategy for diagnosing glucocorticoid-induced anaphylaxis.

Identification of Koala (Phascolarctos cinereus) Faecal Cortisol Metabolites Using Liquid Chromatography-Mass Spectrometry and Enzyme Immunoassays.

The koala (Phascolarctos cinereus) is an arboreal folivorous marsupial endemic to Australia. Anthropogenic activities and climate change are threats to this species’ survival and are potential stressors. A suitable non-invasive method is needed to objectively detect stress in koalas. Under conditions of stress, the concentration of the hormone cortisol in plasma or in saliva is elevated, and this would provide a convenient measure; however, collecting blood or saliva from wild animals is both practically difficult and stressful, and so likely to confound any measurement. In contrast, measurement of cortisol metabolites in faeces provides a practical and non-invasive method to objectively measure stress in koalas. Unfortunately, the identity of the main faecal cortisol metabolites of koalas is unknown. In this study, we have used both untargeted liquid chromatography–mass spectrometry (LC-MS) and enzyme immunoassays (EIAs) to identify several faecal cortisol metabolites in two koalas, one female (18 months old, 4.1 kg) and one male (4 years old, 6.95 kg) upon administration of hydrocortisone (cortisol) sodium succinate. The LC-MS analysis identified tetrahydrocortisol along with several other isomers as cortisol metabolites. After a survey of five enzyme immunoassays, we found that two metabolites, tetrahydrocortisol and 3β-allotetrahydrocortisol, could be detected by EIAs that used antibodies that were raised against their structurally similar corticosterone counterparts, tetrahydrocorticosterone and 3β-allotetrahydrocorticosterone, respectively. While the 3β-allotetrahydrocortisol metabolite was detected in the faeces of only one of the two animals studied, tetrahydrocortisol was detected in both. These results ultimately indicate that tetrahydrocortisol is likely the main faecal cortisol metabolite in koalas, and we demonstrate that it can be measured by an EIA (50c) that was originally developed to measure tetrahydrocorticosterone.

RF9 Rescues Cortisol-Induced Repression of Testosterone Levels in Adult Male Macaques.

Cortisol inhibits hypothalamic-pituitary-gonadal (HPG) axis whereas RF9, a potent agonist of kisspeptin receptor (GPR54) activates HPG-axis during fasting-induced stress and under normal physiological conditions. However, the effect of RF9 on the cortisol-induced repressed HPG-axis is not studied yet. This study investigated whether exogenous cortisol-induced repression of the HPG-axis can be rescued by RF9. Six intact adult male rhesus monkeys (Macaca mulatta) habituated to chair-restraint were administered hydrocortisone sodium succinate at a rate of 20 mg/kg of body weight (BW) per day for 12 days. Single blood sample was taken by venipuncture from each animal on alternate days for hormones analyses. On experimental day 12, hydrocortisone treated monkeys received a single intravenous bolus of RF9 (n = 3) and vehicle (n = 3). The animals were bled for a period of 4 h at 60 min intervals from an indwelling cannula in the saphenous vein. RF9 was administered intravenously at the dose of 0.1 mg/kg BW immediately after taking 0 min sample. Plasma cortisol and testosterone concentrations were measured by using specific enzyme immunoassays. Hydrocortisone treatment increased plasma cortisol levels (P ≤ 0.0001) and decreased plasma testosterone (P ≤ 0.0127) levels. Interestingly, compared to vehicle, RF9 treatment significantly increased plasma testosterone levels at 120 min (P ≤ 0.0037), 180 min (P ≤ 0.0016), and 240 min (P ≤ 0.0001) intervals in the hydrocortisone treated monkeys. From these results, we concluded that RF9 administration relieves the suppressed HPG-axis in term of plasma testosterone levels in the cortisol treated monkeys.

Efficacy of oral steroid gel in preventing esophageal stricture after extensive endoscopic submucosal dissection: a randomized controlled trial.

Esophageal stricture is a distressing issue for patients with early esophageal cancer following extensive endoscopic submucosal dissection (ESD), and the current steroid-based approaches are unsatisfactory for stricture prophylaxis. We evaluated the efficacy of oral hydrocortisone sodium succinate and aluminum phosphate gel (OHA) for stricture prophylaxis after extensive ESD. Patients undergoing > 3/4 circumferential ESD were randomized to either the endoscopic loco-regional triamcinolone acetonide injection (ETI) plus oral prednisone group or the OHA group. The primary endpoint was incidence of esophageal stricture, and the secondary endpoints included adverse events (AEs) and endoscopic balloon dilations (EBDs). The incidence of esophageal stricture in OHA group (per-protocol analysis, 9.4%, 3/32; intention-to-treat analysis, 12.1%, 4/33) was significantly less than that of control group (per-protocol analysis, 35.5%, 11/31, P = 0.013; intention-to-treat analysis, 39.4%, 13/33, P = 0.011). Two sessions of EBD were necessary to release all strictures in the OHA group, while the similar EBDs (median 2, range 1-4) for 11 of the control. Operation-related AEs included infection (control vs. OHA group = 9.7% vs. 31.3%, P = 0.034), operation-related hypokalemia (19.4% vs. 31.3%, P = 0.278), perforation (3.2% vs. 3.1%), post-ESD hemorrhage (6.5% vs. 0%), and cardiac arrhythmia (0% vs. 6.3%). Steroid-related AEs included steroid-related hypokalemia (16.1% vs. 25%) and bone fracture (3.2% vs. 0%). Multivariate logistic regression analysis demonstrated that OHA was an independent protective factor for stricture (OR 0.079; 95%CI 0.011, 0.544; P = 0.01) and mucosal defect > 11/12 circumference was an independent risk factor (OR 49.91; 95%CI 6.7, 371.83; P < 0.001). OHA showed significantly better efficacy in preventing esophageal stricture after > 3/4 circumferential ESD compared to ETI plus oral prednisone.

Formulation and Evaluation of Hydrocortisone Sodium Succinate Mucoadhesive Buccal Tablet

Background: The present study involves the formulation and in-vitro assessment of mucoadhesive tablets of hydrocortisone sodium succinate. Local treatment for buccal inflammatory injuries such as aphthous wounds relies on the fact that a high amount of drug can be delivered at the target site, as well as reduction or avoidance of steroidal adverse effects seen by systemic administration routes. Methods: Tablets contained acacia as the mucoadhesive component with different concentrations (10, 20 and 30%w/w). To this, lactose, magnesium stearate and active pharmaceutical ingredient were added and mixed thoroughly. These tablets were prepared by direct compression technique. Buccal tablets were tested for thickness, hardness, weight and content uniformity, surface pH and mucoadhesive strength. Kinetic of drug release was also calculated for the best formulation. Dissolution parameters were also measured in-vitro for the selected formulation and compared with Corlan® as the standard reference tablet. Results: All of the tests confirmed the proper formulation according to the standards of conventional oral tablets. Mucoadhesive strength of one of formulations was about 50% more than the reference tablet. The optimized formulation that was made by 10% acacia provided adequate release comparable to Corlan®. Release profile was best fitted to Hixson-Crowell model. Conclusion: We concluded that our formulated buccal tablet was comparable and similar in-vitro bioequivalent) to the reference tablets.

Design, synthesis and anti-inflammatory activity of 3-amino acid derivatives of ocotillol-type sapogenins

Ocotillol-type sapogenins (OTS) are major ginsenoside metabolites in human hepatic tissue. In order to better utilize OTS and derivatives thereof as anti-inflammatory compounds, present study produced multiple novel 3-amino acid OTS derivatives and evaluated their anti-inflammatory activity in vitro. The nitric oxide (NO) inhibitory activity of these compounds was used for OTS structure-activity relationship (SAR) evaluations, revealing that both R/S stereochemistry at C-24 and the amino acid type at C-3 influence such NO inhibitory activity. This activity was highest for an N-Boc-protected neutral aliphatic amino acid derivative of 24R-OTS (5a), which performed better than even hydrocortisone sodium succinate in vitro. Compound 5a was also able to markedly suppress the LPS-induced upregulation of TNF-α, IL-6, iNOS, and COX-2 via the NF-κB and MAPK pathways. This suggests that OTS derivatives may be valuable anti-inflammatory compounds worthy of further preclinical evaluation.

Efficacy of hydrocortisone sodium succinate and aluminum phosphate gel for stricture prevention after ≥3/4 circumferential endoscopic submucosal dissection.

ObjectiveEndoscopic submucosal dissection (ESD) is widely used in early-stage esophageal cancer, but the quality of life of patients with postoperative stricture is markedly reduced, requiring long-term repeat, periodic endoscopic balloon dilatation. We evaluated the combination of hydrocortisone sodium succinate and aluminum phosphate gel administered orally for stricture prevention.MethodsWe retrospectively assigned 27 patients who underwent ≥3/4 circular ESD for esophageal superficial squamous cell cancer to one of two groups according to the preventative strategy: endoscopic intralesional steroid injection and systemic steroid (IT+ST group) and oral combination of hydrocortisone sodium succinate and aluminum phosphate gel (OHA group). Stricture rate was compared between the two groups.ResultsThere were six and seven complete and ≥3/4 circular ESD cases, respectively, in the IT+ST group and four and ten cases in the OHA group. Stricture rates in the IT+ST and OHA groups were 53.8% and 7.1%, respectively. Nine patients in each group developed hypokalemia after glucocorticoid administration.ConclusionsOHA is a promising treatment strategy for stricture prevention following large-circumference ESD in patients with early stage esophageal carcinoma.

Sexual Transformation in the Swordtail Fish Xiphophorues helleri under the Influence of Hydrocortisone Hormone and Temperature

Background: Sex in vertebrates is generally determined by two mechanisms: Genetic Sex Determination (GSD) and Environmental Sex Determination (ESD).Aim: This study evaluated the identification of sex in fish by external factors such as temperature, as well as the role of hormones, such as corticosteroids. The mature Xiphophorus helleri were obtained from aquarium fish shops in Basrah Governorate. The experiments were designed by conducting two experiments involving 40 fishes, the first was in the summer from 30 July 2017 to 28 August 2017 under laboratory temperature (28- 37C°). The water temperature was between (28- 34C°) and 14-hour lighting. The second experiment was in the winter from 3 December 2017 to 2 January 2018 under laboratory temperature (17-21C°) and a water temperature between (16-21C°) and an 11 hours lighting. The mature fishes were divided into two groups, each containing 20, 12 female (1.63g) and 8 male(2.72g), placed in 60-litre glass basins with ventilators and thermometers to measure the water temperature. The first was considered as a control group for both the summer and the winter experiments. The second group was treated for a month with the Hydrocortisone Sodium Succinate (Roxcortisone) with a concentration of 2.5 mg /l.Results: Showed that the phenotypic changes in the female X. helleri treated with Hydrocortisone and temperature (28-34°C) and (16-21°C) were caused by gradual elongation of the ventral part of the caudal fin, where the elongation reached the significant limit (6.08±0.03- 1.52±0.83) between females treated in the summer and winter groups respectively and the females of the control group. There was also elongation in the female groups treated in summer and winter but did notreach the significant limit at the probability level (P≤ 0.05).As the results of the microscopic examination for the ovaries of X. helleri treated with Hydrocortisone and temperature (28-34C°) showed the presence of some ovaries containing large numbers of atrophy eggs, ovaries containing lysis embryos and eggs, while other ovaries contained complete growth embryos but dead. As for the ovaries of other female group treated with Hydrocortisone and the temperature of (16-21Co), they were characterized by containing many embryos which are dead and some of them appeared with various congenital malformations, such as those with a puffy head in the cavernous region. It was also noted that some embryos had sprains in different areas of the spine.Conclusion: The hydrocortisone act as a promote to sexual transformation under different temperatures. This sexual transformation is done on one of the external features only, that is the emergence of the sword in females.

Mo1085 EFFICACY OF ORAL MIXTURE OF HYDROCORTISONE SODIUM SUCCINATE AND ALUMINUM PHOSPHATE GEL FOR THE PREVENTION OF ESOPHAGEAL STRICTURE AFTER ≥ 3/4 CIRCUMFERENTIAL ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) — RCT STUDY FROM SINGLE CENTER OF CHINA

ESD has become the mainstream method for superficial esophageal cancer, but consequent stricture of esophagus after over 3/4 circumferential mucosal defect also leads to lower quality of life and more medical expenses for many patients. Many methods occurred for preventing esophagus stricture, and the use of steroid showed a better effect, based on which we explore an innovative strategy with oral mixture of hydrocortisone sodium succinate and aluminum phosphate gel (OHA) for the prevention of esophageal stricture.