• Title/Summary/Keyword: Evidence Combination

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Systematic Review : Comparative Safety and Efficacy of Mono- and Combination Therapy of Anti-hypertensive Agents Acting on the Renin-Angiotensin System (레닌-안지오텐신계에 작용하는 항고혈압 약제의 단독요법과 병용요법의 안전성 및 유효성에 대한 체계적 문헌고찰)

  • Choi, Kyung-Eob;Kim, Hyun-Kyung
    • Korean Journal of Clinical Pharmacy
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    • v.21 no.4
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    • pp.364-375
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    • 2011
  • Given that single blockade with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) can achieve only partial and undurable suppression of the Renin Angiotensin System (RAS), it has been hypothesized that dual blockage would be more beneficial in the management of blood pressure (BP) reduction and prevention of progressive chronic kidney disease (CKD) than either agent alone. Thus, it has been suggested that the combination of an ACEI and an ARB might provide renal benefits to hypertensive patients over and above BP reduction. However, this might also expose patients to additive or synergistic side effects. We attempted to conduct a systematic review to evaluate the benefits and harms of combination therapy in hypertensive patients with or without kidney diseases. MEDLINE and KoreaMed were searched for relevant randomized clinical trials in adult hypertensive patients with or without diabetes (restricted to 1997, limited to trials published in English). Results were summarized using the random-effects model, and between-studies heterogeneity was estimated with $I^2$. A final analysis of ten trials (23,928 patients) revealed that the combination of an ACEI and an ARB reduced blood pressure (SBP/DBP) by 3.95/2.02 mmHg (95% confidence interval [CI], -4.38 to -3.53/-2.33 to -1.71) compared with ACEI monotherapy, and 2.83/2.64 mmHg (95% CI, -3.25 to -2.41/-4.95 to -0.33) compared with ARB monotherapy. Eight trials (391 patients) demonstrated a significant reduction in 24h-proteinuria (weighted mean difference, 0.16 g/day, 95% CI, -0.26-0.05), but they did not translate into an improvement in GFR. Tests for heterogeneity showed no difference in effect among the studies. The combination therapy reduced proteinuria by 30% (95% CI, 23% to 37%) and 39% (95% CI, 31% to 48%) compared with ACEI monotherapy and ARB monotherapy, respectively. However, in patients who had proteinuria more than 0.5 g/day, the combination therapy failed to show significant reduction in urinary protein excretion. The current cumulative evidence suggests that diabetic patients with proteinuria on dual RAS blockade have an increase risk of adverse events such as hyperkalemia, hypotension, and so on, compared with ACEI or ARB alone. It is, therefore, proposed that the combination therapy should not be routinely used for the treatment of hypertension with or without compelling indications.

Synergistic Effect of Bacteriophage and Antibiotic against Antibiotic-Resistant Salmonella Typhimurium

  • Petsong, Kantiya;Vongkamjan, Kitiya;Ahn, Juhee
    • Journal of Food Hygiene and Safety
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    • v.35 no.2
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    • pp.189-194
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    • 2020
  • In this study, we investigated the efficacy of Salmonella phage P22 combined with antibiotics to inhibit antibiotic-resistant S. Typhimurium CCARM 8009. The synergistic effect of phage P22 and antibiotics was evaluated by using disk diffusion and broth dilution assays. The development of Antimicrobial resistance was determined after time-kill assay. The antibiotic susceptibility assay showed the inhibition zone sizes around the antibiotic disks were increased up to 78.8% in the presence of phage (cefotaxime; 13.6%, chloramphenicol; 19.3%, ciprofloxacin; 12.7% and erythromycin; 78.8%). The minimum inhibitory concentration values of the combination treatment significantly decreased from 256 to 64 mg/mL for tetracycline, 8 to 4 mg/mL for chloramphenicol, 0.0156 to 0.0078 mg/mL for ciprofloxacin, 128 to 64 mg/mL for erythromycin and 512 to 256 mg/mL for streptomycin. The number of S. Typhimurium CCARM 8009 was approximately 4-log lower than that of the control throughout the combination treatment with phage P22 and ciprofloxacin delete at 37℃ for 20 h. The results indicate that the development of antimicrobial resistance in S. Typhimurium could be reduced in the presence of phage treatment. This study provides promising evidence for the phage-antibiotic combination as an effective treatment to control antibiotic-resistant bacteria.

QUALITY OF KOREAN GINSENG DRIED WITH A PROTOTYPE CONTINUOUS FLOW DRYER USING FAR INFRARED RAY AND HEATED-AIR

  • Park, S. J.;Kim, S. M.;Kim, M. H.;Kim, C. S.;Lee, C. H.
    • Proceedings of the Korean Society for Agricultural Machinery Conference
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    • 2000.11b
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    • pp.388-395
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    • 2000
  • This study was performed to examine the effects of infrared (IR)/heated-air combination drying on some quality attributes of Korean white ginsengs. Ginseng roots were dried in a dryer where both the far infrared ray and heated-air are available as drying energy sources. Diametral shrinkage, external color, total saponin content, and ginsenosides and free sugar composition of the IR/heated-air combination dried ginsengs were measured and compared with those of commercial white ginseng products. The external color became lower in lightness and higher in saturation as the IR radiating plate temperature increased. IR/heated-air combination dried white ginsengs at IR plate temperature of 100$^{\circ}C$ was comparable to the commercial white ginseng products in color characteristics. Diametral shrinkage ratios ranged from 20 to 36% and appeared to be independent on the different drying methods. No definite evidence could be found whether the IR/heated-air combination drying and the conventional. hot-air drying practice resulted in white ginsengs having different ginsenoside contents and compositions. No conclusion could be made on whether the various drying treatments used in the study had effects on the free sugar contents and compositions of white ginsengs.

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Long-Term Acceptance of Fully Mhc-Mismatched Limb Allografts after a Short Course of Anti-${\alpha}{\beta}$-T Cell Receptor Monoclonal Antibody and FK506

  • Kanatani, Takako;Fujioka, H.;Lanzetta, M.;Kurosaka, M.;Matsumoto, T.;Bishop, G.A.
    • Archives of Reconstructive Microsurgery
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    • v.18 no.1
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    • pp.9-15
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    • 2009
  • Whether a seven days course of anti-${\alpha}{\beta}$-T cell receptor-antibody (${\alpha}{\beta}$-TCRmAb) combined with FK506 therapy promotes survival of limb allografts in fully MHC-mismatched combination (Brown Norway $\rightarrow$ Lewis) was examined. Eight animals received 250 ${\mu}g$/kg/day of ${\alpha}{\beta}$-TCRmAb for 7 days and 2 mg/kg/day of FK506 postoperatively (Combination therapy group). Eight animals had FK506 only (Mono-therapy group) and five animals did not have treatment (Control group). Clinical signs of early rejection with edema or erythema in the skin occurred at an average of 8.6${\pm}$1.5 days postoperatively in Control group and 59.0${\pm}$8.3 days in Mono-therapy group, both of which proceeded to irreversible rejection with necrosis of the epidermis and finally mummification. In Combination therapy group, all animals showed evidence of early rejection at an average of 56.8${\pm}$12.6 days postoperatively, however, in 4 of 8 limbs, early rejection resolved without any treatment and limbs survived >1 year. At 9 months postoperatively, donor skin grafts were accepted and third-party skin grafts were rejected by all four survivors, demonstrating donor-specific tolerance. Little or no detectable chimerism was observed in any of the 4 surviving animals at one-year postoperatively. Combination therapy of ${\alpha}{\beta}$-TCRmAb and FK506 resulted in long-term survival in fully MHC-mismatched limb transplants.

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A Study on the Combination Effect of Herbal Medicine and Western Medicine on BPSD in Patients with Alzheimer's Disease: A Systematic Review (알츠하이머병 환자의 이상행동심리증상(BPSD)에 대한 한약과 양약의 병용 효과에 대한 연구: 체계적 문헌 고찰)

  • Kim, Man-Gi;Chang, Seok-Joo;Hong, Min-Ho;Kim, Geun-Woo;Koo, Byung-Soo
    • Journal of Oriental Neuropsychiatry
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    • v.31 no.4
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    • pp.301-314
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    • 2020
  • Objectives: The purpose of this study was to provide clinical evidence to support the use of herbal medicine combined with western medicine for BPSD. Methods: Studies were identified by searching CNKI, Pubmed, EMBASE, Cochrane Library, SCIENCEON, RISS, KMbase, KISS, OASIS. Literature searches of Chinese, English, and Korean databases were performed. Two authors independently extracted the data and evaluated the quality of each study. Results: The literature search identified 203 articles. Of these, 7 were selected for the analysis. The risk of bias in most studies was unclear. The most frequently used diagnostic tools were the NINCDS-ADRDA and DSM-IV. The most commonly used results indicator was NPI. In 6 of the 7 papers, combination treatment (herbal & Western medicine) was statistically significantly more effective than single treatment (Western medicine alone) for BPSD. No significant adverse events were reported. Conclusions: Herbal medicine in combination with Western medicine is more effective for treating BPSD than Western medicine alone. However, the quality of the studies used in this study was uncertain and the sample size was too small. Based on the findings of this study, more high-quality clinical trials are needed to confirm the efficacy of combination treatment.

Simultaneous Combination Treatment Using High-Intensity Focused Ultrasound and Fractional Carbon Dioxide Laser Resurfacing for Facial Rejuvenation

  • Kang, Hee Yong;Park, Eun Soo;Nam, Seung Min
    • Medical Lasers
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    • v.8 no.1
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    • pp.13-18
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    • 2019
  • Background and Objectives High-intensity focused ultrasound (HIFU) can produce small zones of thermal damage. A HIFU procedure is non-invasive and it can achieve rejuvenation of facial skin. Fractional CO2 laser resurfacing delivers thermal damage to the pixilated columnar zone of the skin and so evoke collagen remodeling, the same as HIFU. In many cases, the patients who want rejuvenation with HIFU are also good candidates for cutaneous photorejuvenation such as can be accomplished via fractional CO2 resurfacing. If patients are treated in a single session by remodeling both the superficial and deep compartments of skin by using both modalities, then improvement in rhytides and tightening of sagging skin will optimize the aesthetic result. Materials and Methods Between May 2014 and January 2018, a total of 44 patients were treated with combination HIFU and fractional CO2 laser resurfacing according to our protocol. First, the HIFU was applied to the entire face with an average of 300 treatment lines. Immediately after HIFU treatment, the ultrasound gel was washed off and then fractional CO2 laser resurfacing was performed. We evaluated the patients using 4-point grading scales. The clinician examined the skin for evidence of complications after the completion of treatment. Results All the patients' skin quality showed improvement. Further. the clinical results after duel modality treatment were substantially better than that after the use of either modality alone. The recovery times and the incidence of adverse events when quickly and consecutively performing both treatments were similar as compared to those with employing stepwise treatment. We encountered no complications whatsoever. Conclusion When compared with stepwise therapy, combination therapy with HIFU and fractional CO2 resurfacing offers better, safer and more effective clinical results. Thus, for targeting multiple layers of aging facial skin, this combination therapy can be safely performed in a single treatment session.

Systematic review of the effect of omega-3 fatty acids on improvement of blood flow while focused on evaluation of claims for health functional food (건강기능식품의 기능성을 중심으로 한 오메가-3 지방산 함유유지의혈행개선 효과에 대한 체계적 고찰)

  • Jeong, Sewon;Kim, Ji Yeon;Paek, Ju Eun;Kim, Joohee;Kwak, Jin Sook;Kwon, Oran
    • Journal of Nutrition and Health
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    • v.46 no.3
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    • pp.226-238
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    • 2013
  • Omega-3 polyunsaturated fatty acids are essential fatty acids because humans cannot synthesize them de novo and must obtain them in their diet. Fish and fish oil are rich sources of omega-3 fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Significant evidence of the beneficial role of dietary intake of omega-3 fatty acids in blood flow has been reported and putative mechanisms for improvement of blood flow include anti-thrombotic effects, lowered blood pressure, improved endothelial function, and anti-atherogenic effects. Edible oils containing omega-3 fatty acids were registered as functional ingredients in the Korea Health Functional Food Code. Although omega-3 fatty acids have been evaluated by the Korea Food and Drug Administration (KFDA) based on scientific evidence, periodic re-evaluation may be needed because emerging data related to omega-3 fatty acids have accumulated. Therefore, in this study, we re-evaluated scientific evidence for the effect of omega-3 fatty acids as a functional ingredient in health functional food on improvement of blood flow. A comprehensive literature search was conducted for collection of relevant human studies using the Medline and Cochrane, KISS, and IBIDS databases for the years 1955-2012. Search keywords were used by combination of terms related to omega-3 fatty acids and blood flow. The search was limited to human studies published in Korean, English, and Japanese. Using the KFDA's evidence based evaluation system for scientific evaluation of health claims, 112 human studies were identified and reviewed in order to evaluate the strength of the evidence supporting a relation between omega-3 fatty acids and blood flow. Among 112 studies, significant effects on improvement of blood flow were reported in 84 studies and the daily intake amount was ranged from 0.1 to 15 g. According to this methodology of systematic review, we concluded that there was possible evidence to support a relation between omega-3 fatty acid intake and blood flow. However, because inconsistent results have recently been reported, future studies should be monitored.

Systematic Review of the Effect of Glucosamine on Joint Health while Focused on the Evaluation of Claims for Health Functional Food (건강기능식품의 기능성을 중심으로 한 글루코사민의 관절건강 기능성에 대한 체계적 고찰)

  • Kim, Joohee;Kim, Ji Yeon;Kwak, Jin Sook;Paek, Ju Eun;Jeong, Sewon;Kwon, Oran
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.43 no.2
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    • pp.293-299
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    • 2014
  • Although the functional ingredient has been evaluated based on scientific evidence by the Ministry of Food and Drug Safety (MFDS), the levels of scientific evidence and consistency of the results might vary according to the emerging data. Therefore, a periodic re-evaluation may be needed in some functional ingredients. In this study, we re-evaluated the scientific evidence for the joint health of glucosamine as a functional ingredient in health functional food. Literature searches were conducted using Pubmed, Cochrane, KISS, and IBIDS databases with the search term of glucosamine in combination with osteoarthritis. The search was limited to human studies published in English, Korean and Japanese. Using the MFDS's evidence based evaluation system for scientific evaluation of health claims, 34 human studies were identified and reviewed in order to evaluate the strength of the evidence supporting the relation between glucosamine and joint health. Among the 34 studies, significant effects for joint health were reported in 28 studies, and their daily intake amount was 1.5 to 2 g. Eleven out of 34 studies were identified, excluding severe radiographic osteoarthritis, and ten from those eleven studies reported significant effects for joint health. Based on this systematic review, we concluded that there was possible evidence to support a relation between glucosamine intake and joint health.

A Systemic Review of Korean Medical Treatment Combined with Continuous Passive Motion Therapy on the Knee Joint Postoperative Rehabilitation (슬관절 수술 후 재활에 대한 Continuous Passive Motion 치료와 한의 병행치료의 체계적 문헌 고찰)

  • Ha, Hyun Ju;Oh, Min-Seok
    • Journal of Korean Medicine Rehabilitation
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    • v.27 no.3
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    • pp.33-45
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    • 2017
  • Objectives The objective of this study is to report the evidence that continuous passive motion (CPM) therapy combined with Korean Medicine is effective for knee injuries. Methods We searched 2 Korean medical electronic databases, and 2 Chinese electronic databases to find randomized controlled clinical trials (RCTs) that treat knee injuries with Korean Medicine combined with CPM therapy. We selected studies by screening. We extracted data from selected RCTs, and analyzed RCTs by using Cochrane's Risk of bias criteria. Results 386 studies are searched, and 7 RCTs are selected. According to the study, several kinds of Korean Medicine such as hydrotherapy, decoction, acupuncture, moxibustion, and manual therapy are used with CPM therapy for the knee joint postoperative rehabilitation. We found the encouraging evidence that Korean Medicine and CPM combined therapy is more effective than single CPM therapy by alleviating pain, increasing range of motion, and improving knee function, etc. However, the risk of bias in most RCTs was judged to be uncertain. Conclusions Combination of Korean Medicine and CPM therapy can compensate the defect of single CPM therapy, and promotes the recovery of knee joint function.

FORMATION OF THE MILKY WAY

  • HESSER J. E.;STETSON P. B.;HARRISM W. E.;BOLTE M.;SMECKER-HANE T. A.;VANDENBERG D. A.;BELL R. A.;BOND H. E.;BERGH S. VAN DEN;MCCLURE R. D.;FAHLMAN G. G.;RICHER H. B.
    • Journal of The Korean Astronomical Society
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    • v.29 no.spc1
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    • pp.111-118
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    • 1996
  • We review observational evidence bearing on the formation of a prototypical large spiral galaxy, the Milky Way. New ground- and space-based studies of globular star clusters and dwarf spheroidal galaxies provide a wealth of information to constrain theories of galaxy formation. It appears likely that the Milky Way formed by an combination of rapid, dissipative collapse and mergers, but the relative contributions of these two mechanisms remain controversial. New evidence, however, indicates that initial star and star cluster formation occurred simultaneously over a volume that presently extends to twice the distance of the Magellanic Clouds.

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