Injection Of Hydrocortisone Research Articles

An Analysis of Cost Variation Among Drugs Available in the Indian Market for the Treatment of Chronic Bone-Related Ailments.

Treating widely prevalent bone illnesses such as back and neck pain, osteoarthritis, rheumatoid arthritis, gout, and osteoporosis with pharmacological medication can be excessively costly for both the individual and their family. This study aimed to conduct a cost minimization analysis by comparing the prices of Jan Aushadhi (JA) medications with the most expensive and least expensive branded alternatives available in India. The prices of the most costly, least costly branded, and JA medicines were acquired from the relevant websites. The cost difference, cost ratio, and percentage of cost variation were determined based on the guidelines outlined in the cost minimization analysis research. A total of 67 drugs/combinations used to treat various chronic bone ailments were analyzed. With regard to analgesic/anti-inflammatory drugs, the most expensive brand of diclofenac sodium + serratiopeptidase (50mg + 10mg) tablet was 32.5 times more expensive than the cheapest and 10.5 times more costly than the JA brand. Also, the paracetamol 325mg + tramadol 37.5mg combination of the branded tablets was more expensive than JA. Branded cyclosporine was 2.3 times more expensive than JA among immunosuppressants in the disease-modifying antirheumatic drugs (DMARD) group. The most expensive immunomodulator, leflunomide, costs four times more than JA. Hydrocortisone injection, an adjuvant, costs 10.8 times more than the cheapest and 2.1 times more than JA. IL-1 inhibitor + nutraceutical combination costs 4.8 times more than the costliest JA brand. Zoledronic acid was 16.1 and 6.8 times more expensive than the cheapest branded and JA drugs. Xanthine oxidase inhibitor febuxostat, used to treat gout, costs 5.2 and 3.3 times more than JA and the cheapest brands. This cost minimization study, the first to the best of our knowledge in the field of chronic musculoskeletal ailments, indicates the usefulness of JA drugs in reducing the patient's financial costs for most drugs.

7726 Central Adrenal Insufficiency From Inhaled Mometasone Manifesting As Growth Deceleration

Abstract Disclosure: S. Gurnurkar: None. F.I. Cooper: None. Introduction: While long courses and/or high-doses of oral steroids have been found to cause adrenal suppression and resultant insufficiency, inhaled corticosteroids from asthma management typically do not affect cortisol production. However, in this case, we describe a patient who presented with 3 years of growth deceleration and was found to have adrenal suppression from her inhaled corticosteroid/long-acting beta agonist, Dulera (mometasone furoate and formoterol fumarate). Case Presentation: An 11-year-old female with history of moderate persistent asthma presented to our endocrinology department with growth deceleration and resultant short stature. The parent noted that the child started to decelerate in height percentiles from the 50th percentile at age 8 to the 6th percentile at age 11. BMI gradually rose from the 85th to 95th percentiles. The parent noted that the child started having worsening asthma symptoms around the start of the growth deceleration, requiring a handful of oral steroid courses and the addition of daily inhaled corticosteroid, Dulera. She had remained on the Dulera for the previous three years, with her asthma under good control. She also took cetirizine daily and albuterol as needed. The last course of oral steroids was three months prior to her first endocrinology visit. The patient’s mid-parental target height was at the 50th percentile and she denied fatigue, headache, or abdominal pain. Family history was negative for endocrine conditions and short stature. Puberty began at age 10. Further workup was recommended. A bone age was concordant with chronologic age. Initial labs including a TSH, free T4, IGF-1, IGFBP-3, CBC, ESR, and CMP were within normal limits. A growth hormone stimulation test with arginine and clonidine was performed. Growth hormone peak was 11 ng/mL, but, interestingly, cortisol resulted as <1.0 ug/dl throughout the test. Due to concerns of adrenal insufficiency, she underwent a high dose ACTH stimulation test. Initial ACTH was 6.3 pg/mL (ref 6-48 pg/mL) and cortisol remained at <1.0 ug/dl at 0, 30, and 60 mins. She was diagnosed with central adrenal insufficiency and prescribed 11 mg/m2 BSA/day of hydrocortisone divided three times daily, with stress dosing and emergency hydrocortisone injection instructions. Conclusion: The existing literature suggests that Dulera (mometasone furoate and formoterol fumarate) does not significantly influence adrenal function nor growth velocity. However, we present the case of a child with 3 years of inhaled Dulera use and significant central adrenal insufficiency. This case report is the first of its kind to detail decreased adrenal function with Dulera in particular. Presentation: 6/2/2024

12575 Exploring Patient And Parent Perceptions Of Administering Hydrocortisone Injection During Adrenal Crisis: A Cross-Sectional Study

Abstract Disclosure: S.V. Llahana: None. J. Anhony: Employee; Self; Solution Medical LLC. Background: Adrenal insufficiency (AI) necessitates lifelong glucocorticoid replacement therapy for most patients, with parenteral hydrocortisone crucial for managing adrenal crisis, a potentially life-threatening complication. Despite this, approximately 1 in 6-12 patients are hospitalised at least once a year, while 1 in 200 patients die from a potentially preventable adrenal crisis. While timely self-administration of hydrocortisone mitigates these risks, the complexity of current injection devices, requiring up to 20 steps to administer, often impedes effective self-treatment. Evidence shows that although 70% of patients possess emergency hydrocortisone injection kits, only 19% have received training for self-administration. Aim: This study aimed to investigate the experiences and perceptions of patients with AI and their caregivers regarding the usage of Solu-Cortef Act-O-Vial (parenteral hydrocortisone) for adrenal crisis management. Methods: A cross-sectional online survey was conducted, involving participants recruited through USA-based patient advocacy groups, CARES Foundation and Adrenal Insufficiency United. Participants provided insights into factors influencing their ability to manage adrenal crisis using Solu-Cortef Act-O-Vial. Content analysis generated themes, which were quantitatively analyzed using SPSS descriptive statistics and correlations. Results: The survey encompassed 689 patients and caregivers. Content analysis revealed eighteen themes across three domains: patient-based factors, external influences, and emotional aspects. Predominant themes, identified by over 80% of participants, included the complexity of the hydrocortisone device, the necessity for assistance during adrenal crisis episodes, and emotional distress due to fear associated with injection. Conclusion: This study underscores the necessity for a simpler injection device to enhance patient self-confidence and self-administration ability. Heightened awareness among healthcare professionals and the public regarding adrenal crisis is imperative for timely management and prevention of avoidable hospital admissions. Presentation: 6/3/2024

Regulation of 11β-HSD1 reductase and the HPA axis by long-snake moxibustion in kidney-yang deficiency rats

BackgroundLong-snake moxibustion can improve hypothalamic-pituitary-adrenal (HPA) axis function in patients with kidney-yang deficiency (KYDS). 11β-HSD1 controls the HPA axis by boosting CORT production via reductase activity. However, the interaction and mechanism of long snake moxibustion and 11β-HSD1 remain unknown. This study examined the impact of lengthy snake moxibustion on the hypothalamus-pituitary-adrenal axis in KYDS rats. The potential significance of 11β-HSD1 in this process was explored. MethodsRats were randomly divided into two groups: the blank group and the experimental group. The KYDS model was established with an intramuscular injection of hydrocortisone. Rats were randomly assigned to four groups: model, sham intervention, long snake moxibustion, and long snake moxibustion plus 11β-HSD1 inhibitor. Physical indicators included body weight, toe temperature, rectal temperature, and spontaneous movement. The serum levels of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and CORT were measured. Immunohistochemical examination reveals 11β-HSD1 protein expression in the liver. Western blotting (WB) detected the levels of 11β-HSD1, H6PDH and NADPH/NADP + protein in the liver. ResultsThe experimental rats' body weight, toe temperature, rectal temperature, time and frequency of spontaneous activity all dropped, as did their serum ACTH, CORT, and CRH levels. The protein expressions of 11β-HSD1, H6PDH, and NADPH/NADP+ in the liver decreased significantly. Long-snake moxibustion improved HPA axis function in rats, boosting expression of 11β-HSD1, H6PDH, and NADPH/NADP+. Adding an 11β-HSD1 inhibitor to Long-snake moxibustion decreased its effect on the HPA axis. ConclusionLong-snake moxibustion improves KYDS symptoms in rats by increasing 11β-HSD1 expression and reductase activity, which regulates the HPA axis.

Exploring patient and caregivers' perceptions and experiences of administering hydrocortisone injection during an adrenal crisis: a mixed-methods cross-sectional study

Exploring patient and caregivers' perceptions and experiences of administering hydrocortisone injection during an adrenal crisis: a mixed-methods cross-sectional study

Efficacy of Intra-articular Platelet-rich Plasma versus Hydrocortisone with Local Anaesthetic Injection in Temporomandibular Joint Disorders - A Prospective Study

Abstract Introduction: Temporomandibular joint (TMJ) is subjected to many disorders commonly termed temporomandibular disorders (TMDs) which include TMJ hypermobility, ankylosis and internal derangement. In the past, many non-invasive conservative treatment modalities were tried out for their treatment which include joint unloading, the use of anti-inflammatory agents and physiotherapy. In recent times, injections of corticosteroids and platelet-rich plasma (PRP) into the TMJ have been proposed as alternative therapeutic methods. The main objective of the prospective study was to compare the efficacy of intra-articular injection of PRP and hydrocortisone with local anaesthetic agents in reducing the symptoms in patients with TMDs. Materials and Methods: This prospective study included 30 patients with TMDs, out of which 15 patients (Group I) received PRP injections and 15 patients (Group II) received hydrocortisone with local anaesthetics for arthrocentesis in their affected joints. The patients were assessed for pain, maximum interincisal mouth opening, TMJ sound and disc displacement. Results: The pain was markedly reduced in patients who received PRP injections (Group I) as compared to those who received hydrocortisone injection (Group II). An increase in mouth opening was similar in both the groups, and TMJ sounds were reduced in patients who received PRP. Magnetic resonance imaging also showed that PRP-treated patients showed better articular disc repair than patients treated with hydrocortisone. Discussion: PRP increases chondrocyte proliferation and production of matrix molecules and helps maintain the integrity of the chondral surface, thereby facilitating joint movement, whereas corticosteroids are more potent anti-inflammatory agents and they act by inhibiting prostaglandin synthesis which is the mediator of inflammation. Thus, the use of PRP has been proven to show better results in reducing the symptoms of TMDs and also helped in articular disc repair.

Hydrocortisone treatment as a tool to study conjunctival placode induction.

Conjunctival placodes are a series of placodes that develop into the conjunctival (scleral) papillae and ultimately induce a series of scleral ossicles in the eyes of many vertebrates. This study establishes a hydrocortisone injection procedure (incl. dosage) that consistently inhibits all conjunctival papillae in the embryonic chicken eye. The effects of this hydrocortisone treatment on apoptosis, vasculature, and placode-related gene expression were assessed. Hydrocortisone treatment does not increase apoptotic cell death or have a major effect on the ciliary artery or vascular plexus in the eye. β-catenin and Eda expression levels were not significantly altered following hydrocortisone treatment, despite the absence of conjunctival papillae. Notably, Fgf20 expression was significantly reduced following hydrocortisone treatment, and the distribution of β-catenin was altered. Our study showed that conjunctival papillae induction begins as early as HH27.5 (E5.5). Hydrocortisone treatment reduces Fgf20 expression independently of β-catenin and Eda and may instead affect other members of the Wnt/β-catenin or Eda/Edar pathways, or it may affect the ability of morphogens to diffuse through the extracellular matrix. This study contributes to a growing profile of gene expression data during placode development and enhances our understanding of how some vertebrate eyes develop these fascinating bones.

Cystic lymphangioma of the breast

It usually presents as a painless, soft, and movable mass in the breast. We report the case of an 8- year-old girl admitted for breast cystic lymphangioma (BCL) progressively increasing in size. Medical treatment with hydrocortisone injection did not yield results, hence the decision to operate on the patient.

Exploring experiences of patients with adrenal insufficiency (AI) using parenteral hydrocortisone injection device to manage adrenal crisis: a qualitative interview study

Exploring experiences of patients with adrenal insufficiency (AI) using parenteral hydrocortisone injection device to manage adrenal crisis: a qualitative interview study

Expression of BAX and eNOS in Rabbit Pancreatic Tissues Injured by Hydrocortisone

Background: There have been cases of acute pancreatitis brought on by steroids, but identifying it is challenging and necessitates careful monitoring. However, according to new research, 3–5% of all cases of illness may be caused by drug-induced acute pancreatitis, making it the third most common cause. Objective: Evaluation of the effect of hydrocortisone injections on pancreatic structure immunohistochemically using BAX and eNOS markers. Methods: White New Zealand female rabbits weighing between 1.2 and 1.5 kg were used, and they were given free access to food. The rabbits were split into six groups, with five animals in each group receiving intramuscular hydrocortisone injections for 14 and 21 days, respectively, at a dose of 5 mg and 20 mg/kg for short and long durations, and two control groups. Results: There was an increase in weight in both long-duration groups (GL1 and GL2) after week 2 of injection when compared to both control and short-duration groups. There was a highly statistical difference in the expression of BAX in both short- and long-duration groups compared to the control group, and there was also a decrease in the expression of BAX when duration increased. Similarly, there was a highly statistical difference in the expression of eNOS in both the GS and GL groups when compared to the control group. Conclusions: The pancreas can be injured by high and low doses of hydrocortisone if used for more than 2 weeks.

(Invited) Voltammetric Measurement of Neuropeptides and Neurohormones with Carbon-Fiber Microelectrode Biosensors

Carbon fiber microelectrodes (CFMEs) have been used to detect neurotransmitters and other biomolecules using fast-scan cyclic voltammetry (FSCV) for the past several years. These assays typically measure small molecule neurotransmitters such as dopamine and serotonin. The carbon fiber is relatively small, biocompatible, and makes minimally invasive measurements at high spatial and temporal resolution. Carbon fiber multielectrode arrays have been utilized to measure multiple neurotransmitters in several brain regions simultaneously with multi-waveform application on each electrode. We have extended this work to measure larger molecule neuropeptides such as Neuropeptide Y and Oxytocin, pleiotropic peptide hormones, that are physiologically important for adaptation, development, reproduction, and social behavior. These neuropeptides function as a stress-coping molecules, an anti-inflammatory agents, and serves as antioxidants with protective effects especially during adversity or trauma. Here, we measure tyrosine within these neuropeptides using the Modified Sawhorse Waveform (MSW), enabling enhanced electrode sensitivity for the amino acid and peptide, decreased surface fouling, and codetection with other catecholamines. As both oxytocin and Neuropeptide Y contain tyrosine, the MSW was also used to detect these neuropeptides. Additionally, we demonstrate that applying the MSW on CFMEs allows for real time measurements of exogenously applied neuropeptides on rat brain slices. These results may serve as novel assays for neuropeptide detection in a fast, sub-second timescale with possible implications for in vivo measurements and further understanding of the physiological role of neuropeptides such as Neuropeptide Y and oxytocin.Cortisol is also a vital steroid neurohormone that has been known as the “stress hormone,” which is elevated during times of high period of anxiety which is biologically critical. The enhanced detection of cortisol is fundamentally important as it will help further our understanding of stress during several physiological states. Several methods exist to detect cortisol, however, they suffer from low biocompatibility and spatiotemporal resolution and are relatively slow. In this study, we developed an assay to detect cortisol CFMEs and FSCV. FSCV is typically utilized to measure small molecule neurotransmitters by producing a readout cyclic voltammogram (CV) for the specific detection of biomolecules on a fast, sub second timescale with biocompatible CFMEs. It has seen enhanced utility in measuring peptides and other larger compounds. We developed a waveform that scanned from -0.5 V to -1.2 V at 400 V/sec to electro-reduce cortisol at the surface of CFMEs. The sensitivity of cortisol was found to be 0.87 +/- 0.05 nA/μM (n=5) and was found to be adsorption controlled on the surface of CFMEs and stable over several hours. Cortisol was able to be co-detected with several other biomolecules such as dopamine, and the waveform was fouling resistant to repeated injections of cortisol on the surface of the CFMEs. Furthermore, we also measured exogenously applied cortisol into simulated urine to demonstrate biocompatibility and potential use in vivo. The specific and biocompatible detection of cortisol with high spatiotemporal resolution will help further elucidate its biological significance and further understand its physiological importance.

Соотношение возбудительных и тормозных синаптических процессов в антиноцицептивных ядрах PAG и RMG в их реципрокных взаимоотношениях в интактном препарате с воздействием гидрокортизона

Microelectrophysiological studies were carried out on 12 intact Albino rats (250±30 g) with hydrocortisone injection, compared with the norm. A software mathematical analysis of a single spike activity of 282 neurons was carried out. The spike activity of single PAG and RMG neurons was recorded extracellularly in separate series of experiments, with successive involvement of each of them as stimulated and recorded. When assessing the relative degree severity of depressor and excitatory post-stimulus effects, using the example of diagrams of the average spike frequency in PAG at HFS RMG under hydrocortisone exposure in normal conditions, both in the depressor and excitatory sequences, in comparison with those without hydrocortisone, no significant changes were detected, but there was a greater severity of these values in the norm without hydrocortisone, in particular, preceding excitatory effects, which indicates not only the harmlessness of the indicated dose of hydrocortisone, but also a certain improvement in the normal status. In RMG neurons on HFS PAG, both in the norm without and under hydrocortisone exposure, a protective increase in tetanic depression was revealed in both sequences, without excess of poststimulus excitability. In general, for both PAG and RMG, a greater severity of pre- and post-stimulus frequency, preceding and accompanying excitatory effects in the norm without hydrocortisone, and a greater balance of depressor and excitatory post-stimulus manifestations of activity under hydrocortisone exposure than in the norm were revealed, which indicates the safety and even the benefit of that dose of hydrocortisone.

Electroanalytical Measurement of Steroid Hormone with Carbon Electrode Sensor

Cortisol is a vital steroid hormone that has been known as the “stress hormone,” which is elevated during times of high stress and anxiety. The improved detection of cortisol is critically important as it will help further our understanding of stress during several physiological states. Several methods exist to detect cortisol, however, they suffer from low biocompatibility, spatiotemporal resolution, and are relatively slow. In this study, we developed an assay to measure cortisol with carbon fiber microelectrodes (CFMEs) and fast-scan cyclic voltammetry (FSCV). FSCV is typically utilized to measure small molecule neurotransmitters by producing a readout CV for the specific detection of biomolecules on a fast, subsecond timescale with biocompatible CFMEs. It has seen enhanced utility in measuring peptides and other larger and more complex molecules. We developed a waveform to electro-reduce cortisol at the surface of CFMEs. The sensitivity of cortisol was found to be 5 nA/uM and was adsorption controlled on the surface of CFMEs and stable over several hours. Cortisol was co-detected with several other biomolecules such as dopamine and serotonin, and the waveform was fouling resistant to repeated injections of cortisol on the surface of the CFMEs. Furthermore, we also measured exogenously applied cortisol onto brain tissue and simulated urine to demonstrate biocompatibility and potential use in vivo. The specific biocompatible detection of cortisol with high spatiotemporal resolution will help further elucidate its biological significance and further understand its physiological importance in the brain.

Normocomplementemic urticarial vasculitis with laryngeal and intestinal tract edema

AbstractAn 81‐year‐old Japanese man presented with a history of recurrent eyelid swelling and purpura on the face, neck, and limbs. Because the initial clinical presentation was angioedema alone, the patient was treated with an H1‐receptor antagonist and tranexamic acid as for an idiopathic angioedema. The patient also experienced dyspnea simultaneously with edema on the face and limbs and was thus taken to the emergency room, where laryngeal edema was confirmed on laryngeal fiber. A good response to hydrocortisone injection was observed in the patient. ACE inhibitors were never prescribed for the patient, and there was no family history of angioedema. Laboratory data indicated normocomplementemia, and skin biopsies revealed leukocytoclastic vasculitis. Therefore, the patient was diagnosed with NUV. Following hospitalization, the patient experienced appetite loss and the CRP level increased, presenting with thickening and stranding around colon tissues on abdominal CT. These symptoms responded well to prednisone treatment. Given that the initial clinical manifestation of the current case was mainly angioedema, physicians should consider that angioedema may in rare cases be diagnostic for UV.

Carbon Electrode Sensor for the Measurement of Cortisol with Fast-Scan Cyclic Voltammetry.

Cortisol is a vital steroid hormone that has been known as the "stress hormone", which is elevated during times of high stress and anxiety and has a significant impact on neurochemistry and brain health. The improved detection of cortisol is critically important as it will help further our understanding of stress during several physiological states. Several methods exist to detect cortisol; however, they suffer from low biocompatibility and spatiotemporal resolution, and they are relatively slow. In this study, we developed an assay to measure cortisol with carbon fiber microelectrodes (CFMEs) and fast-scan cyclic voltammetry (FSCV). FSCV is typically utilized to measure small molecule neurotransmitters by producing a readout cyclic voltammogram (CV) for the specific detection of biomolecules on a fast, subsecond timescale with biocompatible CFMEs. It has seen enhanced utility in measuring peptides and other larger compounds. We developed a waveform that scanned from -0.5 to -1.2 V at 400 V/s to electro-reduce cortisol at the surface of CFMEs. The sensitivity of cortisol was found to be 0.87 ± 0.055 nA/μM (n = 5) and was found to be adsorption controlled on the surface of CFMEs and stable over several hours. Cortisol was co-detected with several other biomolecules such as dopamine, and the waveform was fouling resistant to repeated injections of cortisol on the surface of the CFMEs. Furthermore, we also measured exogenously applied cortisol into simulated urine to demonstrate biocompatibility and potential use in vivo. The specific and biocompatible detection of cortisol with high spatiotemporal resolution will help further elucidate its biological significance and further understand its physiological importance and impact on brain health.

Kidney Yang Deficiency Syndrome Exacerbates Aβ25-35-Induced Pathological Changes, and Ginsenoside Re Ameliorates Synapse Lesions in Aβ25-35- Injected Rats with Kidney Yang Deficiency Syndrome.

Traditional Chinese medicine (TCM) indicates that Alzheimer's disease (AD) is considered the consequence produced by Kidney Yang Deficiency Syndrome (KDS-Yang), which has similar clinical characteristics to glucocorticoid withdrawal syndrome. Ginsenoside Re (G-Re) has been found to ameliorate the symptoms and pathological impairments of AD. However, it's not clear whether G-Re could protect memory and synapse lesions against kidney deficiency dementia. Subcutaneous injection of hydrocortisone for 14 days was used to produce KDS-Yang. On the 15th day, Aβ25-35 peptide was injected into the intracerebroventricular (icv) of KDS-Yang rats. Spine density was analyzed by Golgi staining and the ultrastructural morphology of the synapse was detected using Transmission Electron Microscopy (TEM). Western blot was used to examine the expression of pS396, pS404, Tau-5, tGSK-3β, pS9GSK-3β, Syt, Syn I, GluA1, GluN2B, PSD93, PSD95, β2-AR and pS346-b2-AR. Hyperphosphorylation of tau in Aβ25-35-injected rats with KDS-Yang was stronger than in Aβ25-35-injected rats at the sites of Ser396 and Ser404. G-Re improved spatial memory damage detected by Morris water-maze (MWM), enhanced spines density, the thickness of postsynaptic density (PSD) and increased the expression of Syt, Syn I, GluA1, GluN2B, PSD93 and PSD95. Moreover, GRe decreased the hyperphosphorylation of β2-AR at serine 346 in Aβ25-35-injected rats with KDS-Yang. KDS-Yang might exacerbate AD pathological lesions. Importantly, G-Re is a potential ingredient for protecting against memory and synapse deficits in kidney deficiency dementia.

Cost-effectiveness of Hydrocortisone Injection, Symbicort Inhaler and Prednisolone Tablets Used in Treatment of Asthma in Alshaab Teaching Hospital Khartoum, Sudan

Mansir Abdulrahman1, Mousnad Mohamed Awad1, Asma Noureldaim Mohamed Ahmad1 and Ahmed El Sayed2 Author informationArticle notesCopyright and License information 1Department of Pharmacy Practice, Faculty of Pharmacy, International University of Africa, Khartoum, SUDAN 2Department of Surgery, Alzaeim Alazhari University, Khartoum North, SUDAN Corresponding author. Correspondence: Dr. Mohamed Awad Mousnad Department of Pharmacy Practice, Faculty of Pharmacy,

Research on the effect of Dipsaci Radix before and after salt-processed on kidney yang deficiency syndrome rats and the preliminary mechanism study through the BMP-Smad signaling pathway

Ethnopharmacological relevanceDipsaci Radix (DR) is the dry root of Dipsacus asper Wall. ex DC. Aim of the studyThe purpose of this study was to compare the effects of DR on rats before and after salt-processed with kidney yang deficiency syndrome (KYDS), and we selected the BMP-Smad signaling pathway to explore the mechanism of DR. Materials and methodsThe model of KYDS was established by subcutaneous injection of hydrocortisone, the crude DR (CDR) and salt-processed DR (SDR) were given the corresponding dose (2 g/kg, 4 g/kg, and 6 g/kg). The organ index and the contents of adrenocorticotropic hormone (ACTH), cortistatin (CORT), thyroid hormone (T4), tumor necrosis factor-alpha (TNF-α), testosterone (T), estradiol (E2), cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate (cGMP), Na+-K+-ATPase, and growth hormone (GH) in serum were measured to evaluate the intervention effect of DR on KYDS rats. The expression of Smad 1, Smad 4, Smad 5, Smad 8, and BMP 7 protein in kidney was determined by immunohistochemistry, quantitative PCR (qPCR) and Western blot analysis. The effects of DR on 5 expression factors in the BMP-Smad signaling pathway were studied. Constituents absorbed into blood were identified by UPLC-Q-TOF/MS. ResultsThe results showed that compared with the model group, the thymus and kidney index, as well as the contents of ACTH, CORT, cAMP, GH, Na+-K+-ATPase, T, T4, and E2 were significantly increased in the CDR and SDR groups, and the contents of cGMP and TNF-α were significantly decreased. Compared with the CDR high dose group, ACTH, Na+-K+-ATPase, T, and T4 were significantly increased in the SDR high dose group. The results of immunohistochemistry, qPCR, and Western blot analysis showed that compared with the model group, the expression levels of Smad 1, Smad 4, Smad 5, Smad 8 and BMP 7 proteins in the kidney of DR groups were significantly increased. And SDR groups tended to be better than CDR groups. 8 constituents migrating to blood were identified. ConclusionThis study showed that both CDR and SDR could have a good therapeutic effect on KYDS, and SDR was better than CDR. This study chose the BMP-Smad signaling pathway to study the mechanism of DR in the treatment of KYDS and provided a scientific basis for the processing mechanism of salt-processed.

Efficacy of suspended moxibustion stimulating Shenshu (BL23) and Guanyuan (CV4) on the amygdala-HPA axis in rats with kidney-deficiency symptom pattern induced by hydrocortisone.

To investigated the effects of suspended moxibustion stimulating Shenshu (BL23) and Guanyuan (CV4) acupoints on the amygdala and HPA axis in our rat model and elucidated the possible molecular mechanisms of moxibustion on kidney- deficiency symptom pattern (KYDS). Sixty male Sprague Dawley rats were randomly divided into a control group ( 12) and an experimental group ( 48). Rats in the experimental group were given intramuscular injections of hydrocortisone to establish a KYDS model. The 48 rats successfully modeled were then randomly divided into a model group (model, 12), a carbenoxolone intraperitoneal injection group (CBX, 12), a moxibustion group (moxi, 12), and a moxi + CBX group ( 12). In the moxi, the Shenshu (BL23) and Guanyuan (CV 4) acupoints were treated with moxibustion for 14 d. After treatment, measures were taken of serum levels of corticosterone (CORT), adrenocorticotropic hormone (ACTH), and corticotropin-releasing hormone (CRH). The expression of mineralocorticoid receptors (MRs), glucocorticoid receptors (GRs), 11beta-hydroxysteroid dehydrogenase type 1 (11β-HSD1), CRH, and ACTH in the rats' amygdala, hypothalamus, or pituitary (as appropriate) was detected. Data were analyzed using one-way analysis of variance. Compared with those of the control group, the serum levels of CRH, ACTH, and CORT; the mRNA and protein expressions of MR, GR, and 11β-HSD1 in the amygdala; the mRNA and protein expressions of 11β-HSD1 in the hypothalamus; the CRH mRNA expression in the amygdala and hypothalamus; and the ACTH mRNA expression in the pituitary of the rats in the model group were all significantly decreased (0.05 or 0.01). After treatment with moxibustion, all the aforementioned observation indices except for 11β-HSD1 mRNA expression were ameliorated compared with those in the model group (0.05 or 0.01). Suspended moxibustion can effectively improve the serum levels of ACTH, CRH, and CORT and can up-regulate the mRNA and protein expressions of MR, GR, 11β-HSD1, CRH, and ACTH in the amygdala and hypothalamus of KYDS rats. This may be one of the molecular mechanisms with which moxibustion alleviates KYDS.

Electrolyte abnormalities and stress dosing predict illness-related hospitalizations among infants and toddlers with congenital adrenal hyperplasia.

Infants and toddlers with classical congenital adrenal hyperplasia (CAH) are at high risk for morbidity/mortality arising from life-threatening adrenal crisis. Management of acute illnesses in CAH requires an understanding of factors leading to emergency department (ED) visits and hospitalizations in the first few years of life. We, therefore, examined adrenal crisis at prehospital and ED stages of illness in young children with CAH as they related to medical outcomes. Retrospective cohort study of 39 children with CAH due to 21-hydroxylase deficiency (0-4 years of age) and 27 age-matched controls. ED visit, acute illness symptoms (fever, vomiting, diarrhoea) and other characteristics (hospitalizations, administration of stress-dose hydrocortisone, electrolyte abnormalities). CAH infants and toddlers had significantly higher rates of ED visits (0.50 [0.25-0.88] per person-year) than controls (0 [0-0] per person-year; p < .001). Moreover, CAH children under 6 months old had significantly higher rates of ED visits compared with older ages. Only 50% (51/102) of illness-related ED visits in CAH children were preceded by the administration of either oral (46/51) or intramuscular (11/51) stress dosing by parents. A total of 10.8% of ED visits resulted in hospital admission. Controlling for age and 17-hydroxyprogesterone at diagnosis, electrolyte abnormalities and administration of parenteral hydrocortisone in the ED significantly predicted hospital admission. Receiving a hydrocortisone injection before the ED was a significant predictor of having electrolyte abnormalities. Infants and toddlers with classical CAH are at high risk for acute illness and hospitalizations and often do not receive adequate stress dosing before the ED.