• 자원환경지질
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• 제48권3호
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• pp.241-246
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• 2015

Helicobacter pylori는 사람의 위점막에서 발견되는 전염성이 있는 중요한 병원균이다. 장기간 기생하면서 만성위염, 소화성궤양, 위 변연부 B세포 림프종, 그리고 위암을 일으키는 세균으로 알려져 있다. 국내에서는 프로톤펌프 억제제(proton pump inhibitor, PPI)와 두 가지 항생제(amoxicillin, clarithromycin)를 포함하는 표준 삼제 요법을 1차 치료로 사용하여 왔으나, 점점 증가하고 있는 항생제 내성으로 인해 제균율은 점차 감소하고 있다. 여기서는 H. pylori의 현재의 치료법들과 이들 치료법들의 문제점들을 검토하고, 표적치료의 필요성과 표적치료에 활용할 수 있는 약물전달체로서의 점토광물의 가능성에 대해 알아보고, 이들을 이용한 새로운 치료 방향에 대한 향후 연구계획 등에 대해서 논하고자 한다.

• 생물정신의학
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• 제22권3호
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• pp.95-100
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• 2015

Treatment of schizophrenia is one of the most challenging areas in the field of psychiatry. There has been much improvement in psycho-pharmacotherapy, and at present, psycho-pharmacotherapy along with milieu therapy and social rehabilitation is the standard first-line treatment for schizophrenia. Healing environment, a concept which has arisen from the architectural field, has similarities in meaning to milieu therapy in psychiatry. In other words, healing environment may be an encountering point between psychiatry and architecture. In this encountering, each field can understand each other and expand its concept to aid the treatment of schizophrenia and to plan the build-up of the entire environment considering its social and psychological effects. In this paper, we aim to establish the basic concept of healing environment to alleviate the psychopathologies in schizophrenic patients. We worked under the premise that physical setting affects human behavior and mind, and that physical setting should play a role as a medium with therapeutic potential for patients with medical problems. The aims of this paper are as follows. First, theoretical discussion of the concept and the constructs of healing environment : second, understanding of the schizophrenic symptoms that may be affected by supporting environment : and third, discussion of supporting environment that may alleviate the symptoms of schizophrenia.

• The Journal of Korean Physical Therapy
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• 제33권1호
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• pp.16-20
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• 2021

Purpose: This study examined the effects of the type of video contents used for action observations on the ability to control posture. Methods: The participants were 48 healthy adults. The two hands of the participants were crossed on both shoulders, and the other foot was placed in a straight line in front of the target to allow them to watch a video of the monitor. The videos were presented in random order with three video contents (natural, stable balance posture, and unstable balance posture) consisting of 30 seconds each. A 15-second resting time was given between each video. During action observation using various video content forms, the posture control ability was measured using a TekScan MetScan^® system. Results: The results revealed statistically significant differences in the area of movement and the distance by COP and distance by the type of action-observation videos, and the distance by the anteroposterior and mediolateral sides (p<0.05). The stable balance posture and unstable balance posture video showed significant differences in the distance by the COP, anteroposterior, and mediolateral distance. (p<0.05) Conclusion: This study suggests that choosing the contents of the videos is important during action-observation training, and action-observation training can help improve postural control.

• Journal of Yeungnam Medical Science
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• 제33권1호
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• pp.64-67
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• 2016

We report on a 64-year-old man with leptomeningeal metastasis (LM) from an epidermal growth factor receptor (EGFR)-mutated adenocarcinoma of the lung. He was treated with paclitaxel, cisplatin. After completion of chemotherapy, he complained of headache, nausea, and vomiting. EGFR-mutated tumor cells were identified from the cerebrospinal fluid (CSF). Second-line therapy with gefitinib, methotrexate was started. After receiving gefitinib for 4 weeks, he had no more headaches or vomiting. Eleven months after initiation of gefitinib, he developed headache and nausea. Chest computed tomography showed aggravation of bone metastasis. Third-line therapy was started with gemcitabine and carboplatin. Two weeks later, he experienced disorientation. After a fourth relapse within the central nervous system, the therapy was switched to erlotinib and significant improvement of LM was achieved. This case shows that LM can be diagnosed by detecting EGFR mutation in CSF and EGFR tyrosine kinase inhibitors are effective for LM from EGFR mutant non-small cell lung cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제15권10호
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• pp.4117-4123
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• 2014

Background: To determine prognostic value of excision repair cross-complementation 1 (ERCC1) in patients with malignant pleural mesothelioma (MPM). Materials and Methods: The study included 60 patients with MPM who were diagnosed and treated in the Radiation Oncology Department of Kayseri Teaching Hospital and Medical Oncology Department of Erciyes University, Medicine School between 2005 and 2013. By using immunohistochemical methods, ERCC1 expression in biopsy specimens was evaluated. We retrospectively assessed whether there is a correlation between ERCC1 and response to anti-neoplastic therapy or survival. Results: There were 50 men and 10 women with median age of 62 years (range: 39-83). Histological type was epithelial mesothelioma in the majority of the cases (85%), most commonly presenting in stage four. Of the cases, 20 (33%) received radiotherapy, 60 (%100) received first-line chemotherapy and 15 (%25) received second-line chemotherapy. In the assessment after therapy, it was found that there was partial response in 12 cases (20%), stable disease in 19 cases (31.4%) and progression in 25 cases (41.7%). ERCC1 was positive in 43% of the cases. Mean OS was 11.7 months and mean DFS was 9.5 months in ERCC1-positive cases regardless of therapy, while they were 19.2 months and 17.1 months in ERCC1-negative cases, respectively. The difference was found to be significant (p<0.05). In univariate analysis, stage, comorbidity, response to treatment and ERCC1 expression were found to be significantly associated with OS (p=0.083; p=0.043; p=0.041; p=0.050). In multivariate analysis, response to treatment remained to be significant for OS (p=0.005). In univariate and multivariate analyses, response to treatment and ERCC1 were found to be significantly associated with DFS (p=0.049; p=0.041). Conclusions: ERCC1 was identified as poor prognostic factor in patients with MPM.

• Journal of Digestive Cancer Research
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• 제4권1호
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• pp.36-38
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• 2016

Biliary tract cancer, a relatively rare disease, is usually found in an unresectable stage. Weekly cisplatin plus gemcitabine has been applied as a standard first-line therapy for advanced biliary tract cancer, but almost up to 3-5% patients experience drug induced renal impairment. Many anticancer medication guidelines recommend drug adjustment when kidneys are damaged, but weekly cisplatin is somewhat low dose so that there is a controversy on reducing the dose. And it is known that the cumulative dose of cisplatin is the most important factor contributing to renal impairment. Therefore, clinicians face troubles whether or not to maintain the chemotherapy. Here, we reported a patient whose renal function (eGFR) had been decreased as the number of chemotherapy increased, so her chemotherapy should be stopped. Since we held the chemotherapy on her, the disease progressed aggressively. Weekly cisplatin regimen is just 25 mg/m², so it may be meaningless to reduce this dose, and it is well known that cumulative dose of cisplatin is the most important factor contributing to renal impairment, it is better not to use cisplatin anymore. Therefore, we recommend that if the patient responds well to weekly cisplatin plus gemcitabine regimen, it would be beneficial to use gemcitabine alone.

• Journal of Periodontal and Implant Science
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• 제30권2호
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• pp.455-472
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• 2000

Instrumentation for periodontal therapy may induce marginal damage which increases plaque accumulation and result in periodontal disease. But there have not been many reports of instrumentations on the artificial crown so far. Therefore this study is conducted to evaluate the effects of various repeated instrumentations on the porcelain crown marginal portion. Of the 10 extracted periodontally diseased maxillary first premolars, were 12 proximal surface used in this study. The finishing line of the preparation was placed on the root surface below CEJ and then the crown was cast and cemented in usual manner. Every 4 surfaces of the 3 instruments-curet, ultrasonic scaler, and ultrasonic curet- is used. and four samples used in each instruments. The relevant procedures and measurements were repeated 3 times in each surfaces. Marginal gap is measured by the microscope and surface roughness, Scannig Probe Microscope. Measurements are made at 5 points in each surfaces, making 20 points in each instrument. The results evaluated statistically were as follows 1. As instrumentation was repeated, both marginal gap and roughness were increased in all group 2. In the hand curet, marginal gap was increased every instrumentation and roughness was increased after second. 3. In the ultrasonic scaler, both marginal gap and roughness were increased every instrumentation. 4. In the ultrasonic curet, marginal gap was increased after third instrumentation and roughness was increased after second. 5. Marginal gap and roughness used by the ultrasonic curet were lower than the others and no difference was seen between the hand curet and ultrasonic scaler From the results of this study, the ultrasonic curet was useful in some aspect, but careful instrumentation was needed. Furthermore it was important to minimize the instrumentation through complete periodontal therapy before setting and adequate plaque control.

• 대한방사선치료학회지
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• 제24권2호
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• pp.107-114
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• 2012

목 적: 기존의 광자선을 이용한 선형가속기와는 달리, 양성자 치료의 경우 물질과의 상호작용으로 발생되는 중성자를 비롯한 여러 핵종 등으로 인해 다량의 이차방사선이 생성되기 때문에 방사선 작업 종사자의 피폭은 더욱 주의 깊은 관심이 필요하다. 이에 방사선 측정 시에 널리 이용되고 있는 열형광선량계를 이용하여 방사선 작업 종사자의 피폭정도를 평가하고 이를 토대로 양성자 치료 시 방사선 피폭선량에 관한 기초 자료를 제시하고자 한다. 대상 및 방법: 본원의 양성자 치료실에서 근무한 방사선 작업 종사자를 대상으로 열형광선량계 뱃지를 이용해 피폭현황을 측정한 데이터를 비교했다. 양성자의 빔 라인 주변에서 발생하는 이차방사선의 신체부위별 피폭선량 분포를 알아보고자 신체부위(외안각, 목, 유두점, 배꼽, 등, 손목)에 가로, 세로가 각각 3 mm인 정사각형 모양의 열형광선량계를 부착하여 일일 8시간의 근무시간동안 유지하도록 하였고 총 80시간 측정하여 평균 데이터를 얻었다. 그리고 치료실 내 공간적인 방사선량의 분포를 보기 위하여 빔 사출구, PPS (Patient Positioning System), Pendant, 차폐체보관장, DIPS (Digital Image Positioning System) Console, 출입통로에 각각 열형광선랑계를 부착하고 일일 근무시간 동안의 평균 방사선량을 측정하였다. 결 과: 방사선 작업 종사자의 열형광선량계 뱃지로 측정된 피폭량을 조사한 결과 분기별 평균 0.174 mSv, 연평균 0.543 mSv로 나타났고 신체부위별로 측정한 결과에서 가장 많은 피폭량을 보인 곳은 목이였으며 가장 적은 피폭량을 보인 곳은 등(양견갑골 상각을 이은 선의 중간 지점)으로 나타났다. 작업 동선에 따른 공간적 방사선량을 알아본 결과에서는 빔 사출구 근처에서 상대적으로 높게 나타났고 거리가 멀어짐에 따라 줄어들었다. 결 론: 적은 양의 피폭일지라도 동일 장소에서 장기 근무하게 되면 피폭 누적량은 증가할 수밖에 없고 특정 부위의 누적량은 건강상의 위험을 가져다 줄 수도 있다. 그러므로 국제 방사선 방어 위원회가 권고하는 ALARA의 원칙에 따라 가능한 합리적으로 감소시킬 수 있도록 스스로 개인별 피폭관리에 철저를 기하고 피폭을 최소화시키는데 최선의 노력을 다해야 할 것이다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권2호
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• pp.799-805
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• 2016

Background: There is no standard treatment for patients with platinum-resistant or refractory epithelial ovarian cancer. Single agent chemotherapies have evidence of more efficacy and less toxicity than combination therapy. Most are very expensive, with appreciable toxicity and minimal survival. Since it is difficult to make comparison between outcomes, economic analysis of single-agent chemotherapy regimens and best supportive care may help to make decisions about an appropriate management for the affected patients. Objective: To evaluate the cost effectiveness of second-line chemotherapy compared with best supportive care for patients with platinum-resistant or refractory epithelial ovarian cancer. Materials and Methods: A Markov model was used to estimate the effectiveness and total costs associated with treatments. The hypothetical patient population comprised women aged 55 with platinum-resistant or refractory epithelial ovarian cancer. Four types of alternative treatment options were evaluated: 1) gemcitabine followed by BSC; 2) pegylated liposomal doxorubicin (PLD) followed by BSC; 3) gemcitabine followed by topotecan; and 4) PLD followed by topotecan. Baseline comparator of alternative treatments was BSC. Time horizon of the analysis was 2 years. Health care provider perspective and 3% discount rate were used to determine the costs of medical treatment in this study. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Treatment effectiveness data were derived from the literature. Costs were calculated from unit cost treatment of epithelial ovarian cancer patients at various stages of disease in King Chulalongkorn Memorial Hospital (KCMH) in the year 2011. Parameter uncertainty was tested in probabilistic sensitivity analysis by using Monte Carlo simulation. One-way sensitivity analysis was used to explore each variable's impact on the uncertainty of the results. Results: Approximated life expectancy of best supportive care was 0.182 years and its total cost was 26,862 Baht. All four alternative treatments increased life expectancy. Life expectancy of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 0.510, 0.513, 0.566, and 0.570 years, respectively. The total cost of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 113,000, 124,302, 139,788 and 151,135 Baht, respectively. PLD followed by topotecan had the highest expected quality-adjusted life-years but was the most expensive of all the above strategies. The incremental cost-effectiveness ratios (ICER) of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 344,643, 385,322, 385,856, and 420,299 Baht, respectively. Conclusions: All of the second-line chemotherapy strategies showed certain benefits due to an increased life-year gained compared with best supportive care. Moreover, gemcitabine as second-line chemotherapy followed by best supportive care in progressive disease case was likely to be more effective strategy with less cost from health care provider perspective. Gemcitabine was the most cost-effective treatment among all four alternative treatments. ICER is only an economic factor. Treatment decisions should be based on the patient benefit.

• Asian Pacific Journal of Cancer Prevention
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• 제16권13호
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• pp.5289-5296
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• 2015

Background: Despite the decreased incidence, gastric cancer is still a frequent cause of cancer related death. The 1st line 2 or 3 drugs regimen is still a debatable issue. HER2 targeted therapy has emerged as the standard of care, but it is unavailable in the Brazilian Public Health System. The end-point of this trial was overall survival (OS) in patients with metastatic gastric cancer treated in a public university hospital in Brazil. The secondary end-points were efficacy and safety of regimens with 2 (F+P) or 3 (EOX) drugs to develop an institutional guideline to facilitate optimal treatments. Materials and Methods: In this retrospective study, 1st line regimens were evaluated for OS and PFS stratified by age and ECOG using Cox regression. Results: 47 patients were treated over the last 3 years. In 1st line, 29 were treated with F+P (mean 59.3 years, 34.5% ECOG 2 and a mean of 5.69 cycles) and 16 with EOX (mean 47 years, 18.8% ECOG 2 and a mean of 5.44 cycles). The median OS was 13.8 months (95%CI 10.7-16.9). Response was evaluated in 40 cases and was 64.3% for EOX and 37.5% for F+P (p=0.25). The median PFS was 9.5 months for EOX and 5.6 months for F+P (HR 0.85, 95%CI 0.41-1.74). However, among patients with ECOG 2 mPFS was 3.70 vs 5.40 months, respectively (p=0.86). Regimens showed similar manageable adverse events. A total of 34 patients suffered progression and 14 received $2^{nd}$ line therapy. Diffuse histology (HR 1.89, 95%CI 1.22-2.88), achieving 2nd line (HR: 0.25, 95%CI 0.11-0.58) and treatment response (HR 0.23, 95%CI 0.12-0.47) were OS prognostic factors. Conclusions: Patients treated in our hospital had outcomes compatible with the literature. The regimen choice should be related to patient features. Second line treatment should be considered.