Kim, Young-Il;Kim, Mi-Jung;Park, Sook Ryun;Kim, Hark Kyun;Cho, Soo-Jeong;Lee, Jong Yeul;Kim, Chan Gyoo;Kim, Gwang Ha;Park, Moo In;Nam, Byung-Ho;Park, Young Iee;Choi, Il Ju
Journal of Gastric Cancer
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v.17
no.2
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pp.120-131
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2017
Purpose: Tumor bleeding is a major complication in inoperable gastric cancer. The study aim was to investigate the effects of proton pump inhibitor (PPI) treatment for the prevention of gastric tumor bleeding. Materials and Methods: This study was a prospective double-blind, randomized, placebo-controlled trial. Patients with inoperable gastric cancer were randomly assigned to receive oral lansoprazole (30 mg) or placebo daily. The primary endpoint was the occurrence of tumor bleeding, and the secondary endpoints were transfusion requirement and overall survival (OS). Results: This study initially planned to enroll 394 patients, but prematurely ended due to low recruitment rate. Overall, 127 patients were included in the analyses: 64 in the lansoprazole group and 63 in the placebo group. During the median follow-up of 6.4 months, tumor bleeding rates were 7.8% and 9.5%, in the lansoprazole and placebo groups, respectively, with the cumulative bleeding incidence not statistically different between the groups (P=0.515, Gray's test). However, during the initial 4 months, 4 placebo-treated patients developed tumor bleeding, whereas there were no bleeding events in the lansoprazole-treated patients (P=0.041, Gray's test). There was no difference in the proportion of patients who required transfusion between the groups. The OS between the lansoprazole (11.7 months) and the placebo (11.0 months) groups was not statistically different (P=0.610). Study drug-related serious adverse event or bleeding-related death did not occur. Conclusions: Treating patients with inoperable gastric cancer with lansoprazole did not significantly reduce the incidence of tumor bleeding. However, further studies are needed to evaluate whether lansoprazole can prevent tumor bleeding during earlier phases of chemotherapy (ClinicalTrial.gov, identifier No. NCT02150447).
Son, Jun Gwang;Oh, In Jae;Jeong, Jong Pil;Kim, Soo Ok;Ju, Jin Yung;Lim, Jung Hwan;Cho, Gye Jung;Chae, Dong Ryeol;Kim, Kyu Sik;Kim, Yu Il;Lim, Sung Chul;Kim, Young Chul
Tuberculosis and Respiratory Diseases
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v.63
no.5
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pp.444-448
/
2007
Recently, intra-Muscular Stimulation (IMS) therapy is being increasingly used for musculoskeletal pain. This procedure is generally regarded as a safe procedure for the general public. Some cases of iatrogenic pneumothorax caused by acupuncture have been reported in the medical literature. However, a case of an IMS therapy associated pneumothorax has not reported. We experienced two cases of iatrogenic pneumothorax after IMS therapy. A 62 year-old man received IMS therapy on the right shoulder due to posterior neck pain. After IMS therapy, acute dyspnea and chest discomfort developed. The other patient was a 74 year-old woman who also received IMS therapy. This patient experienced a nonproductive cough and acute dyspnea after the treatment. As the popularity of this form of alternative medicine increases, we might expect to see more cases of iatrogenic pneumothorax. Physicians should be aware of the adverse events associated with IMS therapy.
The Asian dust storms which originated in the deserts of Mongolia and China transported particles to Korea and led to a high concentration of atmospheric particulate matters (PM) of more than $1000{\mu}g/m^3$ throughout the country in the spring, of 2007. Public concern, in Korea, about the possible adverse effects of these dust events has increased, as these dust storms can contain various air pollutants emitted from heavily industrialized eastern China. The objectives of this study were to understand the concentration characteristics of PM as a function of particle size between the Asian dust storm episodes and non-Asian dust period and to consider the mass size distribution of PM in the Asian dust storms and their water soluble ion species on the potential, possible effects on deposition levels in the three regions (nasopharyngeal, tracheobronchial, and alveolar) of the human respiratory system. The size distribution of PM mass concentration during the Asian dust storms showed a peak in the coarse particle region due to the long-range transport of soil particles from the deserts of Mongolia and China, which was identified by HYSPLIT-4 model for backward trajectory analysis of air arriving in the sampling site of Iksan. During the non-Asian dust period, there were two different types in PM size distribution: bimodal distribution when low concentrations of $PM_{2.5}$ were observed, while unimodal distribution having a peak in fine particle region when high concentrations of $PM_{2.5}$ were showed. This unimodal distribution with high concentrations of fine particulate and secondary air pollutants such as ${SO_4}^{2-}$, ${NO_3}^-$, ${NH_4}^+$ was found to be due to the long-range transport of air pollutants from industrialized eastern China. During the Asian dust storms, the mean concentrations of PM that can be deposited in the nasopharyngeal, tracheobronchial, and alveolar region were $128.8{\mu}g/m^3$, $216.5{\mu}g/m^3$, and $89.6{\mu}g/m^3$, respectively. During the non-Asian dust period, the mean concentrations of PM that can be deposited in the nasopharyngeal, tracheobronchial, and alveolar region were $8.4{\mu}g/m^3$, $9.5{\mu}g/m^3$ and $38.5{\mu}g/m^3$, respectively.
When an accident occurs at nuclear power plant and radionuclide material is released to the area around the plant, public evacuation is considered as a measure to protect the safety of the residents nearby. This study draws factors required to estimate evacuation time and make estimation of the time to evacuate all residents from the EPZ of Wolsong site in consideration of traffic condition in the neighborhood and on the basis of field data around the site for each factor. The traffic capacity and the traffic volume by season were investigated for the traffic analysis and simulation within EPZ of Wolsong site. As a result, the background traffic volume by season were established. To estimate TGT(Trip Generation Time), the questionnaire surveys were carried out for resident and transient. The TSIS code was applied to traffic analysis in the events of daytime/night and normal/adverse weather under normal day/summer peak traffic condition. The results showed that the evacuation time required for total vehicles to move out from EPZ took generally from 118 to 150 minutes. The evacuation time took longer maximum 17 minutes at night than daytime during summer peak traffic.
Objectives: The aim of this study was to evaluate the effectiveness and safety of electroacupuncture for non-alcoholic fatty liver disease (NAFLD). Methods: A randomized, controlled pilot trial was conducted. Twenty-two participants were randomized into one of the two groups: an acupuncture group (n=11) and wait-list group (n=11). The treatment group received 8 sessions of electroacupuncture over 8 weeks. Twenty points (CV4, CV12, both LR14, GB26, ST25, ST34, ST40, ST36, SP4, SP6, LR3) were selected for needling. The control group did not receive acupuncture treatment during study period and followup were done in the 4th and 8th weeks after randomization in both groups. The primary outcome was body fat computed tomography and the secondary outcomes included blood test (aspartate aminotransferase, alanine transferase, triglyceride, total cholesterol, high density lipoproteincholesterol, low density lipoprotein-cholesterol, blood sugar test, ${\gamma}$-guanosine triphosphate) and body composition test (body mass index, weight, body fat mass, body fat rate, waist hip ratio). Safety was assessed at every visit. Results: There was no significant differences in between the experimental group and control group. There were no adverse events. Conclusions: The results suggest that In patients with NAFLD, electroacupuncture treatment did not induce worsening of liver disease and liver function, but it was no improvement symptoms of fatty liver. Study of herb medicine treatments and other acupuncture therapy of NAFLD are required later.
Reyes, Nash Jett DG.;Cho, Hanna;Geronimo, Franz Kevin F.;Jeon, Minsu;Kim, Leehyung
Journal of Wetlands Research
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v.21
no.4
/
pp.354-364
/
2019
Sri Lanka is an island nation susceptible to climate-related disasters and extreme weather events. Kurunegala City is the developing capital city of the North-Western Province of Sri Lanka. Changes in rainfall patterns and a steadily increasing annual average temperature amounting to 0.69±0.37℃ were observed in the city area. Generally, urban areas are at risk due to the lack of climate change adaptation provisions incorporated in the development plans. This study was conducted to investigate the characteristics of Krunegala City, Sri Lanka and develop an appropriate climate change adaptation plan for the city. Site investigation and qualitative risk assessment were conducted to devise a plan relevant to the climate change adaptation needs of the city. Qualitative risk analyses revealed that drinking water, water resources, and health and infrastructure risks were among the major concerns in Kurunegala City. Low impact development (LID) technologies were found to be applicable to induce non-point source pollutant reduction, relieve urban heat island phenomenon, and promote sound water circulation systems. These technologies can be effective means of alleviating water shortage and reducing urban temperature. The measures and strategies presented in this study can serve as reference for developing climate change adaptation plans in areas experiencing similar adverse effects of climate change.
Background: D-dimer testing is widely applied as a first step in the diagnostic work-up of pulmonary embolism (PE). Although this is the most sensitive assay for ruling out PE, the prognostic implications of D-dimer testing in patients with normotensive PE are not well known. The aim of this study was to determine if D-dimer testing on admission predicts major adverse cardiac events (MACE) in patients with normotensive PE. Methods: A total of 180 consecutive patients with normotensive PE admitted between January 2003 and June 2009 were included. The group was divided into quartiles on the basis of their D-dimer levels. We compared the frequency of MACE by quartile of D-dimer level and estimated sensitivity, specificity, and predictive values for MACE in the first and fourth quartile. Results: In the 37 (20.6%) patients with MACEs, the median D-dimer level (7.94[IQR:4.03~18.17]${\mu}g/mL$) was higher than in patients with a benign course (5.29[IQR:2.60~11.52]${\mu}g/mL$, p<0.01). The occurrence of MACEs was increased with increasing D-dimer level (p=0.017). In the first quartile (D-Dimer <$2.76{\mu}g/mL$) sensitivity, specificity, and positive and negative predictive values for predicting MACEs were, respectively, 91.9%, 29.4%, 25.2%, and 93.3%. Conclusion: Patients with D-dimer levels below $2.76{\mu}g/mL$ have a low risk of MACEs. Our study suggest that D-dimer level may be used to identify low risk patients with normotensive PE.
Background: Postoperative fluid retention is a factor that causes delay in recovery and unexpected adverse events. It is important to prevent intraoperative fluid retention, which is putatively caused by intraoperative release of stress hormones, such as ADH (anti-diuretic hormone) or others. We hypothesized that intraoperative analgesia may prevent pathological fluid retention. We retrospectively explored the relationship between analgesics and in-out balance in surgical patients from anesthesia records. Methods: Anesthetic records of 80 patients who had undergone orthognathic surgery were checked in this study. Patients were anesthetized with either TIVA (propofol and remifentanil) or inhalational anesthesia (sevoflurane and remifentanil). During surgery, acetated Ringer's solution was infused for maintenance at a rate of 3-5 ml/kg/h at the discretion of the anesthetist. The perioperative parameters, including the amount of crystalloid and colloid infused, and the amount of urine and bleeding were checked. Furthermore, we checked the amount and administration rate of remifentanil during the surgical procedure. The correlation coefficient between the remifentanil dose and the in-out balance or the urinary output was analyzed using the Pearson correlation coefficient. The contributing factor to fluid retention, including urinary output, was statistically examined by means of multivariate logistic regression analysis. Results: A significant positive correlation was found between remifentanil dose and urinary output. Urinary output less than 0.04 ml/kg/min was suggested to cause positive fluid balance. Although in-out balance approaches zero balance with increase in remifentanil administration rate, no contributing factor for near-zero fluid balance was statistically picked up. The remifentanil administration rate was statistically picked up as the significant factor for higher urinary output (> 0.04 ml/kg/min) (OR, 2,644; 95% CI, 3.2-2.2 × 106) among perioperative parameters. Conclusions: In conclusion, remifentanil contributes in maintaining the urinary output during general anesthesia. Although further prospective study is needed to confirm this hypothesis, it was suggested that fluid retention could be avoided through suppressing intraoperative stress response by means of appropriate maintenance of remifentanil infusion rate.
Purpose: Colorectal cancer is becoming an increasing concern in the middle-aged population of Iran. This study aimed to compare the preliminary results of short-course and long-course neoadjuvant chemoradiotherapy treatment for rectal cancer patients. Materials and Methods: In this clinical trial we recruited patients with rectal adenocarcinoma located from 5 cm to 15 cm above the anal verge. Patients in group I (short-course) received three-dimensional conformational radiotherapy with a dose of 25 Gy/5 fractions in 1 week plus concurrent XELOX regimen (capecitabine 625 mg/㎡ from day 1-5 twice daily and oxaliplatin 50 mg/㎡ on day 1 once daily). Patients in group II (long-course) received a total dose of 50-50.4 Gy/25-28 fractions for 5 to 5.5 weeks plus capecitabine 825 mg/㎡ twice daily. Both groups underwent consolidation chemotherapy followed by delayed surgery at least 8 weeks after radiotherapy completion. The pathological response was assessed with tumor regression grade. Results: In this preliminary report on complications and pathological response, 66 patients were randomized into two study groups. Mean duration of radiotherapy in the group II (long-course) was 5 ± 1 days (range, 5 to 8 days) and 38 ± 6 days (range, 30 to 58 days). The median follow-up was 18 months. Pathological complete response was achieved in 32.3% and 23.1% of patients in the shortcourse and long-course groups, respectively (p = 0.558). Overall, acute grade 3 or higher treatment-related toxicities occurred in 24.2% and 22.2% of patients in group I and II, respectively (p = 0.551). No acute grade 4 or 5 adverse events were observed in either group except one grade 4 hematologic toxicity that was seen in group II. Within one month of surgery, no significant difference was seen regarding grade ≥3 postoperative complications (p = 0.333). Conclusion: For patients with rectal cancer located at least 5 cm above the anal verge, short-course radiotherapy with concurrent and consolidation chemotherapy and delayed surgery is not different in terms of acute toxicity, postoperative morbidity, complete resection, and pathological response compared to long-course chemoradiotherapy.
Cho, Hee-Jeong;Seo, Sang-Kyung;Baek, Dong Won;Park, Sung-Woo;Lee, Yoo-Jin;Sohn, Sang-Kyun;Lee, Ho-Sup;Lee, Won Sik;Lee, Ji Hyun;Kim, Sung Hyun;Moon, Joon-Ho
Journal of Yeungnam Medical Science
/
v.35
no.1
/
pp.76-83
/
2018
Background: Elderly patients with multiple myeloma (MM) are vulnerable to adverse events (AEs). This study evaluated adherence to chemotherapy and treatment outcomes in elderly patients treated with a frontline bortezomib (BTZ), melphalan, and prednisone (VMP) regimen and regimens without BTZ. Methods: One-hundred and forty elderly patients who were diagnosed with MM from March 2007 to March 2015 were included in this retrospective study. To evaluate regimen adherence, patients who were treated with more than 4 cycles were assigned to the good adherence group. Results: Among the 140 patients, 71 were treated with a frontline VMP and 69 with non-BTZ regimens. The median age was 71 years (range, 65-90 years). The VMP group showed a higher complete response rate than the non-BTZ group: 26.8% vs. 7.2%. More patients in the VMP group achieved ${\geq}$very good partial response (VGPR) and ${\geq}PR$. In the VMP group, 27 patients (38.0%) received less than 4 cycles. The VMP good adherence group showed a higher 3-year overall survival (OS) rate (70.9%) than the poor adherence group (60.2%, p=0.059). In the multivariate analysis, treatment with ${\geq}4$ cycles of VMP was a favorable factor for OS. Conclusion: A good adherence to a frontline VMP regimen resulted in favorable long-term survival. Adequate management of AEs will be needed to achieve favorable outcomes in elderly patients with MM.
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