IMPORTANCE The timing and selection of patients with Kawasaki disease for corticosteroid use to prevent coronary artery complications remain controversial. OBJECTIVE To evaluate the effect of corticosteroid therapy in KD. DATA SOURCES Databases of Medline, The Cochrane Library, and the Clinicaltrials.gov website until July 2015. We used the key words ["Kawasaki disease"] and ["steroid" OR "corticosteroid"] to retrieve potentially relevant studies in the databases of Medline, the Cochrane Library, and the Clinicaltrials.gov website until July 2015. Both English and non-English literature was identified. Titles and abstracts were reviewed by 2 authors (S.C. and Y.D.) to determine suitability for inclusion. Relevant articles were reassessed by reviewing the full text. Discrepancies in study inclusion were resolved by consensus (M.G.K.). STUDY SELECTION Clinical studies that compared corticosteroids plus intravenous immunoglobulin (IVIG) therapy with IVIG therapy alone in treating patients with KD. Studies either using corticosteroids as initial therapy or as rescue therapy were included. DATA EXTRACTION AND SYNTHESIS Investigators independently extracted the data information. Data were quantitatively synthesized using random-effects analysis. MAIN OUTCOMES AND MEASURES Rate of coronary artery abnormalities. RESULTS Sixteen comparative studies characterizing 2746 patients were analyzed. The duration of illness before corticosteroids therapy was significantly shorter in the initial corticosteroids subset than in the rescue corticosteroids subset. The rate of coronary artery abnormalities was significantly lower in adjunctive corticosteroids therapy than in IVIG therapy (odds ratio [OR], 0.424; 95% CI, 0.270-0.665). Meta-regression based on known variables demonstrated that the overall efficacy was negatively correlated with the duration of illness before corticosteroid therapy (P < .001). Subgroup analysis, including studies using corticosteroids plus IVIG as initial therapy, showed a more advantageous effect than IVIG alone regarding coronary artery abnormality prevention (OR, 0.320; 95% CI, 0.183-0.560), whereas this benefit was not found in a subgroup of studies using corticosteroids as rescue therapy. Further analysis found that patients predicted at baseline to be at high risk of IVIG resistance seemed to obtain the greatest benefit from adjunctive corticosteroid therapy regarding coronary artery abnormality prevention (OR, 0.240; 95% CI, 0.123-0.467). The fever duration was significantly reduced in the corticosteroids group. The favorable effects of corticosteroids were conferred without an increased risk of adverse events. CONCLUSIONS AND RELEVANCE This study highlights the importance of timing to prevent coronary artery complication in treating KD. High-risk patients with KD benefit greatly from a timely and potent adjunctive corticosteroid therapy strategy.

Our meta-analysis suggests that compared with placebo, administration of L. rhamnosus strain GG as maintenance therapy may increase the relapse rates of Crohn disease. L. johnsonii is inefficacious in reducing the incidence of relapse.

R esistant hypertension has been linked to chronic excessive sympathetic drive, especially elevation of renal sympathetic activity in some groups of patients.1,2 Against this background, renal artery ablation selectively denervating the kidneys emerges as an alternative treatment for such patients. Although initial trials 3,4 showed promising results with regard to large reductions in blood pressure (BP), disappointingly, the potential therapeutic role of renal denervation (RDN) in lowering BP is being challenged after the failure of recent SYMPLICITY HTN-3 trial 5 to show a benefit of RDN over the optimal medical therapy.The concept of RDN is supported by both experimental and early human evidence when surgical sympathectomy procedures were done and found to have huge effect on BP. [6][7][8] However, for the time being, the BP-lowering effect of catheter-based RDN is highly variable (the rates of nonresponse to RDN vary between 8% and 37%).9 Kaiser et al 10 reported that repeated RDN could significantly decrease BP in nonresponders to previous radiofrequency ablation procedure. These findings suggest that lack of BP reductions after RDN may be the results of incomplete denervation. Therefore, to minimize treatment failure of blind ablation, a method that could convert what is currently a purely anatomic procedure to one that involves quantifying the efficacy of RDN intraprocedurally and mapping the renal nerves to enable a targeted therapy is of great clinical significance.Background-Electric stimulation has been proved to be available to monitor the efficacy of renal denervation (RDN). This study was to evaluate the effectiveness of high-frequency stimulation (HFS)-guided proximal RDN. Methods and Results-A total of 13 Chinese Kunming dogs were included and allocated to proximal RDN group (n=8) and control group (n=5). HFS (20 Hz, 8 V, pulse width 2 ms) was performed from proximal to distal renal artery in all dogs. Radiofrequency ablations were delivered in proximal RDN group and only at the proximal positive sites where systolic blood pressure (BP) increased ≥10 mm Hg during HFS. Postablation HFS was performed over the previously stimulated sites. BP, heart rate, and plasma norepinephrine were analyzed. In 8 denervated dogs, preablation HFS caused significant BP increases of 6.0±5.0/3.4±5.5, 16.9±11.7/11.1±8.5, and 17.1±8.4/8.5±5.3 mm Hg during the first, second, and third 20 s of HFS at the proximal positive sites. After ablation, these sites showed a negative response to postablation HFS with increases of BP by 1.3±3.0/1.0±2.5, 0.8±3.9/1.5±3.