The sole factor explaining AVN in the hip was the total dose of corticosteroids received. Conclusion? The use of corticosteroids in SARS has been debated; opinions conflict about whether the immediate benefits in terms of saving lives compensate for the adverse effects, including AVN. 2005; Li 2005). conditions such as trauma, corticosteroid usage, alcoholism, infections, blood disorders and autoimmune diseases. High doses of corticosteroids given over a short period of time to patients who are not predisposed to AVN generally do not confer a high risk of AVN (Wing 1998). But high doses of corticosteroids given over a longer period of time in patients who are predisposed to AVN (such as patients with systemic lupus erythematosus) are strongly correlated with AVN (Felson & Anderson 1987). Questions arose about risk factors for AVN observed in SARS patients. Was it solely associated with the amount and duration of corticosteroid treatment, or were there other predisposing factors? In this paper, we describe Lin28-let-7a antagonist 1 a cohort of patients from Beijing with a follow\up time of 3?years and investigate the relationship between osteonecrosis incidence, IgG antibody titre at enrolment, and treatment dose of corticosteroids. Patients and methods Study population Patients were diagnosed at the CPAF hospital in Beijing from March 2003 to April 2003 with clinical presentations fulfilling the WHO and National Department of Health definition of probable SARS (WHO 2003; CDC 2004). The diagnosis of SARS was subsequently confirmed serologically by enzyme\linked immunosorbent assay (ELISA) and neutralization assay for specific antibody against the SARS coronavirus (SARS\CoV) (Liu 2006). All patients were employees of the hospital and infected by two known sources: inpatients in the hospital at the time or (colleague) medical personnel. Because of the size of the outbreak, many of the infected employees were referred to three other hospitals in the city for treatment and returned to the CPAF hospital around the end of Lin28-let-7a antagonist 1 June 2003 for further recovery. At this time, the first case of AVN was found and it was decided to examine the whole group of patients on the presence of AVN, 71 individuals in total. All patients were followed for 3?years up to June 2006. Rabbit Polyclonal to CPZ Follow\up visits were every 6?months. Treatment of SARS All SARS patients were given treatment according to the protocols in the various hospitals at the time (Anonymous 2003). Indication for administering corticosteroids included one or more of the following criteria: (1) severe toxic symptoms, persistent high fever 39?C after the use of analgesics for 3?days and other problems including heat loss; (2) illness progressing within 48?h, lesions expanding by more than 50% and exceeding ? of the total lung area on P\A position chest radiographs; and (3) diagnostic criteria of acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The recommended dose of methylprednisolone for adults was 80C320?mg/day intravenously, but modifications were made according to the needs of individual patients. Radiological investigation All SARS patients underwent magnetic resonance imaging (MRI) and X\ray at the CPAF hospital in Beijing as part of the Lin28-let-7a antagonist 1 post\SARS follow\up assessments, using instruments from GE (USA). Images were taken of hips, knees, shoulders, ankles and wrists. Two musculoskeletal radiologists (one with more than 20?years experience and one with 5?years experience) interpreted the MRI examinations and findings were reached by consensus. Osteonecrosis was defined as a subchondral or intramedullary area demarcated by a distinct T1 hypo\intense marginal rim, and encompassing medullary fat in its centre. The ARCO Classification of osteonecrosis was used to describe the condition of the hip (Gardeniers 1993). Digits in the classification refer to ARCO stage (nature of radiographic findings) and the letters refer to the subclass expressing the location of the lesion and the extension of the lesion under weight bearing dome of the acetabulum on.