• Journal of Korean Neurosurgical Society
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• 제51권2호
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• pp.86-90
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• 2012

Objective : Life-threatening hemispheric stroke is associated with a high mortality and morbidity. Decompressive hemicraniectomy has been regarded as an effective treatment option for refractory intracranial hypertension. Here, we reported the clinical course of 5 children with decompressive craniectomy and duroplasty after non-traumatic refractory intracranial hypertension. Methods : Four toddlers and one preschool-girl were included in this study; there were 3 boys and 2 girls with a mean age of 34.6 months (range 17-80). Decompressive craniectomy including duroplasty was performed in cases of dilatation of pupil size after intensified standard medical therapy had proven insufficient. All children had a Pediatric Glasgow Coma Scale score <8 at pre-operation state. The mean time-point of craniectomy after stroke attack was 12 hours (range 4-19). Results : During the long-term follow-up period (mean 47.6 months), no children died. One year later, when we checked their Glasgow Outcome Scale scores, only one toddler received a score of 4 (moderate disability). But the others had good recoveries although they had minor physical or mental deficits. According to the Pediatric Cerebral Performance Category Scale, 4 children received a score of 2 (mild disability). Conclusion : Despite our small cases, we suggest that decompressive hemicraniectomy and duroplasty is an acceptable and life-saving treatment for refractory intracranial hypertension after unilateral hemispheric stroke in toddlers and preschool children.

• Asian Pacific Journal of Cancer Prevention
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• 제17권3호
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• pp.1049-1052
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• 2016

Background: Myelodysplastic syndrome (MDS) is a clonal disorder of hemopoeitic stem cells, characterized by infective hematopoiesis, peripheral cytopenias along with hypercellularity of marrow and marked dysplastic features. Our aim was to study the spectrum of the WHO classification in adult Pakistani patients with MDS at disease presentation. Materials and Methods: This retrospective descriptive study was conducted at Liaquat National Hospital and Medical College, extending from January 2010 to December 2014. Patient data were retrieved from the maintained archives. Results: Overall, 45 patients were diagnosed at our institution with de novo MDS during the study period. There were 28 males and 17 females. Age ranged between 18 and 95 years with a mean of $57.6{\pm}17.4years$. The male to female ratio was 1.7:1. According to the WHO classification, 53.3% had refractory cytopenia with multilineage dysplasia, 22.2% had refractory cytopenia with unilineage dysplasia, 4.4% each had refractory anemia with excess of blasts-1 and II and 15.5% had MDS unclassified. The main presenting complaints were generalized fatigue (60%), fever (33.3%), dyspnea (15.5%), bleeding (13.3%) and weight loss (11.1%). Physical examination revealed pallor in 37.7%, followed by petechial and purpuric rashes in 20% of patients. Hemoglobin was <10 g/dl in 41 (91.1%). Pancytopenia and bicytopenia were noted in 18 (40%) and 14 (31.1%) respectively. Conclusions: MDS in our patients presents at a relatively young age. Refractory c ytopenia with multilineage dysplasia was the dominant disease variant in our setting.

• Journal of Neurogastroenterology and Motility
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• 제24권4호
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• pp.577-583
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• 2018

Background/Aims Potassium-competitive acid blockers are expected to be the next generation of drugs for the treatment of diseases caused by gastric acid. In 2015, vonoprazan fumarate, a novel potassium-competitive acid blocker, was approved by the Japanese health insurance system. Since its approval, patients refractory to vonoprazan can be encountered in clinical settings. We designed this study to clarify the pathophysiology of gastroesophageal reflux disease refractory to vonoprazan. Methods In this retrospective study, we involved patients who had refractory symptoms after administration of standard-dose proton pump inhibitors or vonoprazan and underwent diagnostic testing with esophageal high-resolution manometry and 24-hour multichannel intraluminal impedance and pH monitoring while using proton pump inhibitors or vonoprazan. Patients were diagnosed based on the Rome IV criteria for functional gastrointestinal disorders and diagnostic test results. Results Twenty-seven patients were analyzed during this study. Gastric pH ${\geq}4$ was sustained for a longer period of time, and the esophageal acid exposure time and number of acid reflux events were shorter in the vonoprazan group than in the proton pump inhibitor group. The percentage of patients diagnosed with acidic gastroesophageal reflux disease in the vonoprazan group was lower than that in the proton pump inhibitor group. Conclusions Intra-gastric pH and acid reflux were strongly suppressed by 20-mg vonoprazan. When patients with gastroesophageal reflux disease present symptoms after administration of 20-mg vonoprazan, the possibility of pathophysiologies other than acid reflux should be considered.

• Asian Pacific Journal of Cancer Prevention
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• 제14권4호
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• pp.2421-2427
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• 2013

Background: To study the response rate, toxicity profiles, and survival of refractory or recurrent epithelial ovarian cancer (EOC) patients treated with paclitaxel. Materials and Methods: Patients with refractory or recurrent EOC who were treated with paclitaxel between January 2002 and December 2011 at the Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital were identified. Clinicopathological features of the patients including detailed data of paclitaxel treatment were collected. Results: During the study period, a total of 44 patients were identified, with a mean age of $52.9{\pm}8.2$ years. Some 13.6% (six patients) had refractory cancer to first-line chemotherapy while 86.4% (38 patients) had recurrent cancer. Among these, 35 (79.6%) and 9 (20.4%) patients were considered as platinum-sensitive and platinum-resistant, respectively. Three patients (6.8%) received fewer than 2 cycles of paclitaxel due to loss to follow-up, leaving 41 patients evaluable for response. The overall response rate observed in all 41 patients was 41.5% (17 patients; 12 complete and five partial responses): 12.5% or 1/8 patients with refractory or platinum-resistant cancer and 48.5% or 16/33 patients with platinum-sensitive disease. Stable disease was demonstrated in 17.0% (seven patients) while progressive disease was apparent in 41.5% (17 patients). Median time to progress was 4.5 months (range, 0.67-58.6 months). Median progression-free survival was not reached while median overall survival was 16.3 months (95% confidence interval, 11.0 months -21.6 months). Common toxicities were neutropenia, neuropathy, and alopecia. Conclusions: Paclitaxel is an active agent for refractory or recurrent EOC. Neutropenia, neuropathy and alopecia are common side effects.

• Natural Product Sciences
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• 제8권2호
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• pp.44-47
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• 2002

The effects of Eurycoma longifolia Jack on masculine copulatory behaviour were studied in the middle aged male Sprague-Dawley rats, 9 months old and retired breeders after dosing them with 500 mg/kg twice daily for 10 days prior to test. The test lasted for 30 minutes after a 20 minute adaptation period, was carried out on the 11th day during the dark phase of the light-dark cycle (2000-0700 hours) and in subdued light, using a modified copulation cage but with the presence of a piece of mirror of appropriate size to facilitate observation. Results showed that the mean values of EL-1, EL-2 and EL-3 of the control middle aged male rats were 103.20 sec, 91.21 sec and 80.00 sec but were significantly (p<0.05) increased to 118.40-120.20 sec, 101.24-171.28 sec and 100.42-110.21 sec respectively in the methanol-chloroform, methanol-butanol-water and methanol-butanol treated middle aged male rats. However, further results also showed that PEI-1 and PEI-2 of the control middle aged male rats were 182.30 sec and 257.2 sec but were significantly (p<0.05) decreased to 100.42-121.31 sec and 40.21-132.31 sec respectively in the methanol-chloroform-butanol-water and methanol-butanol treated middle aged male rats. In conclusion, this study showed that although E. longifolia Jack continued to enhance the sexual activity of the middle aged male rats by extending the duration of coitus and decreasing the refractory period between the different series of copulation, but to a smaller degree as compared to sexually active, adult male rats (Ang and Sim, 1997).

• Journal of Korean Neurosurgical Society
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• 제44권4호
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• pp.196-198
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• 2008

Objective : Vagus nerve stimulation (VNS) has been used in epilepsy patients refractory to standard medical treatments and unsuitable candidates for resective or disconnective surgery. In this study, we investigated the efficacy of VNS to patients who had refractory result to epilepsy surgery and patients with post-traumatic epilepsy. Methods : We analyzed the effect of VNS in 11 patients who had undergone previous epilepsy surgery and patients with intractable post-traumatic epilepsy associated with brain injury. All patients underwent VNS implantation between October 2005 and December 2006. Results : We evaluated seizure frequency before and after implantation of VNS and maximum follow up period was 24 months. In the first 6 months, 11 patients showed an average of 74.3% seizure reduction. After 12 months, 10 patients showed 85.2% seizure reduction. Eighteen months after implantation, 9 patients showed 92.4% seizure reduction and 7 patients showed 97.2% seizure reduction after 24 months. Six patients were seizure-free at this time. Conclusion : We conclude that the VNS is a helpful treatment modality in patients with surgically refractory epilepsy and in patients with post-traumatic epilepsy due to severe brain injury.

• 대한한방소아과학회지
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• 제34권3호
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• pp.1-17
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• 2020

Objectives The purpose of this study is to analyze clinical studies on effectiveness of herbal medicine in refractory nephrotic syndrome (RNS). Methods We searched the randomized controlled trials (RCTs) with herbal medicine treatment on RNS from the Pubmed, CNKI, OASIS, NDSL, J-stage, and CiNii. The demographic data, duration of illness, intervention, treatment period, outcome, adverse events, and composition of herbal medicine were analyzed for this study. Results 11 RCT studies were selected and analyzed. The children in the control group were given western medicine therapy, and the treatment group was given herbal medicine along with the same western medicine of the control group. The most commonly used herbal medicines were the prescriptions to treat 'Kidney Deficiency with Blood Stasis (腎虛兼瘀血)' which composed of 'Promoting blood circulation (化瘀)', 'Diuresis-inducing (利水)', or 'Heating Yang (溫陽)' medicine based on 'Replenishing Kidney or Spleen (補腎, 補脾)' medicine. In the treatment group, proteinuria and serum lipid was significantly decreased, serum albumin was significantly increased, and total effective rate was significantly higher than the control group. Hypercoagulation and relapse rate was also significantly reduced. Adverse events were significantly lower in the treatment group. Conclusions Herbal medicine treatment on pediatric RNS can be suggested as a new treatment for children who have less response to the conventional therapy. It can also supplement the limitations of the western medicine by reducing adverse events from the steroids and immuno-suppressive agents, and lower the relapse rate as well.

• 대한한의학회지
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• 제30권6호
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• pp.112-117
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• 2009

Objective: Rhus verniciflua Stokes (RVS) has anticancer effect confirmed by preclinical studies and historical records. We thus tried to evaluate retrospectively the effect of RVS as a complementary medicine for patients with advanced non-small-cell lung cancer (NSCLC) showing refractory to conventional chemotherapy. Patients and Methods: From June 1, 2006 to June 30, 2007, patients with advanced NSCLC who received both the standardized RVS extract and a standard course of second or more line therapy such as pemetrexed ($Alimta^{(R)}$), erlotinib ($Tarceva^{(R)}$), and gefitinib ($Iressa^{(R)}$) were checked. A total of 13 patients were eligible for the final analysis after fulfilling inclusion/exclusion criteria. Time to progression (TTP) of these patients treated with the standardized RVS extract was checked in the aftercare period. Results: Patients received RVS treatment for a median period of 296 (range 84-698) days. The median TTP was 220.5 (range 36-489) days, and three patients (23.1%) had TTP values of 15 more months. No significant side effects from RVS treatment have been observed. Conclusion: The standardized RVS extract might have synergetic effects by assisting apoptosis in advanced NSCLC with concurrent standard therapy agents, since it prolonged TTP without significant adverse effects. This study suggests that the standardized RVS extract is beneficial to patients with chemotherapy-refractory NSCLC. Further clinical trials and preclinical studies are necessary to determine the efficacy and safety of the standardized RVS extract in NSCLC.

• 대한수의학회지
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• 제27권1호
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• pp.27-34
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• 1987

To verify the direct effects of the thyroid hormone ($T_3$) on the rabbit heart, $T_3$-Tyrode solution in vitro was perfused on the normal atrial muscles and enzymatically isolated ventricular myocytes of the rabbit. All the experimental procedures were conducted at $35^{\circ}C$ and the same procedures were repeated after Ca. 120 minutes from the beginning of $T_3$-Tyrode perfusion. Compared to the state between the normal Tyrode solution and $T_3$-Tyrode solution, results were observed on the same cells by electrophysiological methods (conventional intracellular recording and whole cell patch clamping) as soon as possible. The results obtained were as follows : 1. Action potential duration (APD) on the left atrial muscle was reduced under the perfusion of $T_3$-Tyrode. 2. Absolute refractory Period was shortened by $T_3$-Tryrode perfusion. (117 msec./114 msec., 90 msec./78 msec.) 3. Maximal Ca currents ($i_{Ca}$) were decreased in single: ventricular myocytes under the $T_3$-Tyrode (2.98 nA) than under the normal Tyrode (6.65 nA) 4. On I-V relation, reversal potential was shifted to lower membrane potential and membrane potential showing maximal $i_{Ca}$was lowered from +10mV to -20mV by $T_3$ effect. 5. Above results were likely to explain that tachycardia in the hyperthyroid state was caused in part by the reduced repolarization phase and the reduced refractory period due to the decrease of the Ca current.

• 대한약리학회지
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• 제11권1호
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• pp.7-13
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• 1975

In Chinese medicine, it is said that Aconiti tuber has cardiotonic, diuretic and analgesic effects. Kim et al reported that alkaloid free part of Aconiti tuber, $CHCI_3$ insoluble fraction, showed inotropic effect on isolated frog heart and inotropic effect is potenciated by n-butanol fractionation. To investigate the effect of Aconiti tuber butanol fraction on the mechanical and electrical properties of heart, change of active tension, excitability and refractory period of isolated rabbit atrium in the presence of butanol fraction were measured and the comparison with that of ouabain and quinidine was done. The observed results are as follows. 1. $5{\times}10^{-4}g/ml$ concentration of Aconiti tuber butanol fraction showed approximately same effect with therapeutic concentration of ouabain on the increment of contractile force, and the effect of $2{\times}10^{-3}g/ml$ was greater than that of $1{\times}10^{-5}g/ml$ of ouabain. 2. Acceleration of rate of contractile force increment in the presence of Aconiti tuber butanol fraction was greater than in ouabain, and the time to maximum tension was shorter in Aconiti tuber butanol fraction than in ouabain. 3. The excitability of isolated atrium was slightly increased at low concentration of Aconiti tuber butanol fraction, while decreased at higher concentration. 4. Aconiti tuber butanol fraction slightly prolonged refractory period of isolated right atrium at the concentration of $2{\times}10^{-3}g/ml$.