Background: The adverse effects of the phosphodiesterase-4 inhibitor roflumilast, appear to be more frequent in clinical practice than what was observed in chronic obstructive pulmonary disease (COPD) clinical trials. Thus, we designed this study to determine whether adverse effects could be reduced by starting roflumilast at half the dose, and then increasing a few weeks later to $500{\mu}g$ daily. Methods: We retrospectively investigated 85 patients with COPD who had taken either $500{\mu}g$ roflumilast, or a starting dose of $250{\mu}g$ and then increased to $500{\mu}g$. We analyzed all adverse events and assessed differences between patients who continued taking the drug after dose escalation and those who had stopped. Results: Adverse events were reported by 22 of the 85 patients (25.9%). The most common adverse event was diarrhea (10.6%). Of the 52 patients who had increased from a starting dose of $250{\mu}g$ roflumilast to $500{\mu}g$, 43 (82.7%) successfully maintained the $500{\mu}g$ roflumilast dose. No difference in factors likely to affect the risk of adverse effects, was detected between the dose-escalated and the discontinued groups. Of the 26 patients who started with the $500{\mu}g$ roflumilast regimen, seven (26.9%) discontinued because of adverse effects. There was no statistically significant difference in discontinuation rate between the dose-escalated and the control groups (p=0.22). Conclusion: Escalating the roflumilast dose may reduce treatment-related adverse effects and improve tolerance to the full dose. This study suggests that the dose-escalated regimen reduced the rate of discontinuation. However, longer-term and larger-scale studies are needed to support the full benefit of a dose escalation strategy.
Journal of the Korean Institute of Oriental Medical Informatics
/
v.17
no.2
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pp.130-287
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2011
"zhenjiusunanyaozhi(鍼灸素難要旨)" is composed of three volumes and published in 1529 by Gao Wu(高武). Gao Wu(高武) is skillful in astronomy, the art of war and the law as well as a medical practitioner in Ming Dynasty. The books he wrote "zhenjiujuying(鍼灸聚英)", "zhizhi(直指)", "douzhenzhengzong(痘疹正宗)", "shexuezhinan(射學指南)", "zhenjiujieyao(鍼灸節要)". "zhenjiusunanyaozhi鍼灸素難要旨" is written by classifying the origin of acupuncture and moxibustion. In other words, it is edited by classifying the contents related to acupuncture and moxibustion out of the ancient Chinese medical book "yellow emperor's canon of medicine and yellow emperor eighty-one difficult" in which are composed of 3 volumes as follows, Volume 1 says the main diseases on "the nine acupuncture needles figure" (九針圖), "the reinforcing and reducing the meridian" (補瀉), "the needle depth" (針刺深淺), "the five shu points - metal, wood, water, fire, earth" (正,滎,輸,經,合) based on 18 chapters in terms of acupuncture in "yellow emperor eighty-one Difficult "難經"", in which it quotes the annotation of "the difficulty by the original meaning "難經本義"" written by Hua Shou(滑壽) in Yuan Dynasty. Volume 2 is composed of 2 parts. Part 1 says the method of treatment on 36 Chapters, the method of acupuncture use in the Linshu "靈樞" and the Suwen "素問" such as "the rule of acupuncture use" (用針方宜), "the nine-pin method" (九針式) and "the nine-pin to only use the time appropriate to consider nature of Heaven, Earth and person" (九針應天地人時以起用) etc., Part 2 says "the five difficult acupuncture(五亂刺)", "the rise and fall of energy and blood(氣血盛衰)". "the pain tolerance(耐痛)" and ect., in which are in terms of method of treatment collected the original texts of 59 chapters on acupuncture to each disease and of 8 chapters on moxibustion in the Linshu "靈樞" and the Suwen "素問". Volume 3 includes 10 chapters in which consist of "the stabbing to disease in 12 meridians (十二經病刺)", "the eight extra meridian disease (寄經八脈病)", "the twelve meridians(十二經脈)", "the fifteen collaterals (十五絡脈), the twelve meridian muscles (十二經筋)", "the acupoint (孔穴)" and etc. This is the book edited comprehensively by classifying the contents on the theory of acupuncture and moxibustion and the circulations of meridians in "yellow emperor's canon of medicine and yellow emperor eighty-one difficult" and there is no case story in particular except his comments in person. This study is for the purpose of helping researching and developing acupuncture and moxibustion and applying their clinical training.
Purpose: Intense multidisciplinary team effort is required for the intestinal rehabilitation of patients afflicted with the short bowel syndrome (SBS). These include enteral and parenteral nutrition (PN) support, monitoring of complications related to treatment, and considering further medical or surgical options for intestinal adaptation. Methods: In the Intestinal Rehabilitation Team (IRT) at the Samsung Medical Center, we have experienced 20 cases of adult SBS requiring multidisciplinary intestinal rehabilitation. This study is a retrospective review of the collected medical records. Results: Of the 20 subjects treated, 12 patients were male and 8 patients were female. At the time of referral to the IRT, the mean age was 51.5 years, and the mean body weight was 50.1 kg, which was 90% of the usual body weight. The diseases or operative managements preceding massive bowel resection were malignancy in 11 cases, cardiac surgery in 2 cases, trauma in 2 cases and one case, each of tuberculosis, corrosive esophagitis, atrial fibrillation, simultaneous pancreas and kidney transplantation, and perforated appendicitis. Of these, there were 14 survivals and 6 mortalities. The fatalities were attributed to progression of disease, intestinal failure-associated liver disease, and sepsis (unrelated to intestinal failure) (2 cases each). Among the 14 surviving patients, 8 patients have been weaned off PN, whereas 6 are still dependent on PN (mean PN dependence 36%). Conclusion: This paper reports the results of multidisciplinary intestinal rehabilitation of adult short bowel patients treated at the Samsung Medical Center. Further studies are required to improve survival and enteral tolerance of these patients.
Pulmonary rehabilitation has been known to improve dyspnea and exercise tolerance in patients with chronic lung disease, although it does not improve pulmonary function. The mechanism of this improvement is not clearly explained till now; however some authors suggested that the improvement in the skeletal muscle metabolism after the rehabilitation could be a possible mechanism. The metabolc changes in skeletal muscle in patients with COPD are characterized by impaired oxidative phosphorylation which causes early activation of anaerobic glycolysis and excess lactate production with exercise. In order to evaluate the change in the skeletal muscle metabolism as a possible cause of the improvement in the exercise tolerance after the rehabilitation, noninvasive $^{31}P$ magnetic resonance spectroscopy(MRS) of the forearm flexor muscle was performed before and after the exercise training in nine patients with chronic lung disease who have undertaken intensive pulmonary rehabilitation for 6 weeks. 31p MRS was studied during the sustained isometric contraction of the dominant forearm flexor muscles up to the exhaustion state and the recovery period. Maximal voluntary contraction(MVC) force of the muscle was measured before the isometric exercise, and then 30% of MVC force was constantly loaded to each patient during the isometric exercise. After the exercise training, exercise endurance of upper and lower extremities and 6 minute walking distance were significantly increased(p<0.05). There were no differences of baseline intracellular pH (pHi) and inorganic phosphate/phosphocreatine(Pi/PCr). After rehabilitation pHi at the exercise and the exhaustion state showed a significant increase($6.91{\pm}0.1$ to $6.99{\pm}0.1$ and $6.76{\pm}0.2$ to $6.84{\pm}0.2$ respectively, p<0.05). Pi/PCr at the exercise and the recovery rate of pHi and Pi/PCr did not show significant differences. These results suggest that the delayed intracellular acidosis of skeletal muscle may contribute to the improvement of exercise endurance after pulmonary rehabilitation.
A new rice variety 'Jinbo' is a japonica rice (Oryza sativa L.) with good eating quality, lodging tolerance, and resistance to rice stripe virus (RSV) and bacterial blight disease (BB). It was developed by the rice breeding team of Yeongdeog Substation, National Institute of Crop Science (NICS), RDA in 2009. This variety was derived from a cross between 'Yeongdeog26' with good grain quality and wind tolerance and 'Koshihikari' with good eating quality in 1998 summer season. A promising line, YR21324-56-1-1, selected by pedigree breeding method, was designated as the name of 'Yeongdeog45' in 2005. After the local adaptability test was carried out at nine locations from 2006 to 2008, 'Yeongdeog45' was released as the name of 'Jinbo' in 2009. 'Jinbo' has short culm length as 74 cm and medium maturating growth duration. This variety is resistant to $K_1$, $K_2$, and $K_3$ races of bacterial blight and stripe virus and moderately resistant to leaf blast disease with durable resistance, and also it has tolerance to unfavorable environments such as cold and dried wind. 'Jinbo' has translucent and clear milled rice kernel without white core and white belly rice, and good eating quality as a result of panel test. The yield potential of 'Jinbo' in milled rice is about 5.65 MT/ha at ordinary fertilizer level in local adaptability test. This cultivar would be adaptable to middle plain, mid-west costal area, east-south coastal area, and south mid-mountainous area.
A Pseudomonas fluorescens was selected from mushrooms and studied in both batch and fed-batch cultures in order to get maximal biomass concentration. P. fluorescens is an aerobic bacterium and antagonistic to Pseudomonas tolaasii which causes blotch disease on the mushroom cap. P fluarescens and P. tolaasii were identified by Gram staining, gelatin liquefaction, oxidase test, etc. and were characterized by pigment production, temperature sensitivity, salt tolerance and rapid pitting test, etc., Celts of P. fluorescens well in medium containing 30g/L of glucose, whereas the growth was inhibited at the glucose levels at higher than 30g/L. The highest values of specific growth rate and productivity were obtained when using 10g/1 of yeast extract. Optimum concentrations of $NH_4Cl$ and ${(NH_4Cl)}_2SO_4$ for culture were found to be 1.0g/L and 0.1g/L respectively. Optimum concentration of $MgSO_4{\cdot}7H_2O$ used as a sulfursource was 1.0g/L. It was also found that the cell concentrations reached the maximum level when grown on the medium containing 1.0g/L of $KH_2PO_4$ and 0.1g/L of $CaCl_2$. Also, the optimum culture conditions were $30^{\circ}C$ and pH 6.0. Cultivation of P. fluarescens at high dissolved oxygen (DO) concentration led to a decrease of bacterial productivity in batch culture. Maximum productivity was achieved at 40% DO concentration.
Ji, Hee-Chung;Choi, Gi-Jun;Sung, Byung-Ryul;Seo, Sung;Kim, Ki-Young;Lee, Joung-Kyong;Kim, Won-Ho;Park, Hyung-Soo;Moon, Chung-Sup
Journal of The Korean Society of Grassland and Forage Science
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v.28
no.1
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pp.1-6
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2008
Korditwo is a new orchardgrass(Dactylis glomerata L.) variety developed by the National Institute of Animal Science(NIAS) in 2005. To develope the new variety of orchardgrass, 5 superior clones, Dg8533, Dg9518, EDg9133, U8504 and U8519, were selected and polycrossed for seed production. That synthetic variety was designated newly as "Korditwo", and it's agronomic growth characteristics and forage productivity were examined at Suwon from 2001 to 2002, and regional yield trials were conducted in Suwon, Pyungchang, Youngju, Iksan, and Jeju from 2003 to 2005, respectively. "Korditwo" showed medium type growth habit in fall and spring and short in length of flag leaf and upper internode. Plant height of "Korditwo" was similar to that of standard variety, "Ambassador" and heading date was 4 days later than 14th May compared to Ambassador. Characteristics such as winter hardiness, lodging tolerance, disease resistance of "Korditwo" were stronger or better than those of Ambassador, specially in winter hardiness and lodging tolerance. "Korditwo" showed 10% higher dry matter yield(11.3 ton/ha) compared to Amabassador. Nutritive value was appeared to be similar in both varieties.
Objective: To explore the clinical efficacy and toxic and side effects of recombinant human endostatin (rhendostatin/endostar) combined with chemotherapy in the treatment of advanced gastric cancer. Materials and Methods: A total of 70 patients with advanced gastrointestinal adenocarcioma confirmed by histopathology and/or cytological examination were divided into group A (37 patients) and group B (33 patients). Patients in group A were given intravenous drip of 15 mg endostar added into 500 mL normal saline, once every other day until the cessation of chemotherapy or patients' maximal tolerance to chemotherapy. Patients in group B received chemotherapy alone. Two groups selected the same chemotherapy regimens. FOLFIRI scheme: 90-min intravenous drip of $180mg/m^2$ irinotecan, intravenous drip of $200mg/m^2$ calcium folinate (CF) and $400mg/m^2$ 5-fluorouracil (5-Fu) on d1, and continuous intravenous pumping of 2 $400mg/m^2$ 5-Fu for 46 h. FOLFOX4 scheme: intravenous injection of $85mg/m^2$ oxaliplatin (L-OHP), $200mg/m^2$ calcium folinate (CF) and $400mg/m^2$ 5-FU on d1 for 2 h, and then continuous intravenous pumping of 2 $400mg/m^2$ 5-Fu for 46 h. XELOX scheme: oral administration of 1 $500mg/m^2$ xeloda (or tegafur 50~60 mg) in twice during d1~14 and intravenous drip of $135mg/m^2$ L-OHP on d1 for 2 h. The modified FOLFOX scheme: intravenous injection of $135mg/m^2$ L-OHP on d1 for 2 h, $200mg/m^2$ CF and 1.0 g tegafur during d1~5. Whereas, control Group B received chemotherapy regimens which were same as Group A, but no addition of endostar. Before chemotherapy, patients were given intravenous injection of 8 mg ondansetron, intramuscular injection of 10 mg metoclopramide and 20 mg diphenhydramine for prevention of vomiting, protection of liver and stomach as well as symptomatic supportive treatment. One cycle was 21 d, 4~6 cycles in total. The efficacy was evaluated every 2 cycles. Results: 32 patients in Group A could be evaluated, and the response rate (RR) and disease control rate (DCR) were 59.38% and 78.13%, respectively. 31 patients in Groups could be evaluated, and the RR and DCR were 32.26% and 54.84%, respectively. The differences between 2 groups were significant. The toxic effects include myelosuppression, gastrointestinal reaction, fatigue, cardiotoxicity and peripheral neurotoxicity. Conclusions: Preliminary observations show that endostar (once every other day) combined with chemotherapy is effective in the treatment of advanced gastrointestinal cancer, with low toxic effects, good tolerance, deserving further study.
This study was conducted to verify the potential of Allium hookeri to control blood glucose metabolism in diabetes model. We fed the experimental diets(ALE, ARE) supplemented with the extract of Allium hookeri leaf or root at 1% of diet to the diabetic mice (C57BLKS/J, db/db) for 8 weeks. Hetero and control mice were fed the control diet without any extract of Allium hookeri leaf or root. At 8th week of feeding the diets, we measured body weight, blood glucose, HbA1c, and plasma insulin levels and conducted an oral glucose tolerance test (OGTT) and staining insulin immunoreactive cells in islets of pancreas. ARE group treated with the root of A. hookeri showed significantly lower blood glucose levels than the Cont group at 120 min in the OGTT. However, HbA1c level was significantly reduced in both ALE and ARE groups, and higher serum insulin levels and increased density of insulin immunoreactive cells compared with the Cont group were found in these 2 groups. Based on these results, A. hookeri is considered to be effective in improving glucose tolerance by partially affecting insulin secretion and it may be used to prevent and treat diabetic disease.
This study was conducted to verify the potential of Allium hookeri to control glucose metabolism in a diabetes model. We fed the experimental diets (AL, AR, Dex) supplemented with the powder of leaf, root, or dextrin as a positive control, respectively at 3% of diet to the diabetic mice (C57BLKS/J, db/db) for 8 weeks. Control mice were fed with the diet supplemented with cornstarch (Cont) at 3% level of diet. At 8th week of feeding the diets, we measured body weight, blood glucose, HbA1c, and plasma insulin levels and conducted an oral glucose tolerance test (OGTT) and staining insulin immunoreactive cells in islets of pancreas. AL group treated with the leaf of A. hookeri showed significantly lower blood glucose and HbA1c levels, higher plasma insulin levels, and increased density of insulin immunoreactive cells compared with the Cont group. During the OGTT, AL group showed lower blood glucose levels than the Cont group for 120 min. Based on these results, leaf of A. hookeri is considered to be effective in improving glucose tolerance by partially affecting insulin secretion and it may be used to prevent and treat diabetic disease.
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