• The Korean Journal of Pain
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• v.26 no.3
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• pp.270-276
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• 2013

Background: Ketamine, an N-methyl-D-aspartate receptor antagonist, might play a role in postoperative analgesia, but its effect on postoperative pain after caesarean section varies with study design. We investigated whether the preemptive administration of low-dose intravenous ketamine decreases postoperative opioid requirement and postoperative pain in parturients receiving intravenous fentanyl with patient-controlled analgesia (PCA) following caesarean section. Methods: Spinal anesthesia was performed in 40 parturients scheduled for elective caesarean section. Patients in the ketamine group received a 0.5 mg/kg ketamine bolus intravenously followed by 0.25 mg/kg/h continuous infusion during the operation. The control group received the same volume of normal saline. Immediately after surgery, the patients were connected to a PCA device set to deliver 25-${\mu}g$ fentanyl as an intravenous bolus with a 15-min lockout interval and no continuous dose. Postoperative pain was assessed using the cumulative dose of fentanyl and visual analog scale (VAS) scores at 2, 6, 24, and 48 h postoperatively. Results: Significantly less fentanyl was used in the ketamine group 2 h after surgery (P = 0.033), but the difference was not significant at 6, 12, and 24 h postoperatively. No significant differences were observed between the VAS scores of the two groups at 2, 6, 12, and 24 h postoperatively. Conclusions: Intraoperative low-dose ketamine did not have a preemptive analgesic effect and was not effective as an adjuvant to decrease opioid requirement or postoperative pain score in parturients receiving intravenous PCA with fentanyl after caesarean section.

• The Korean Journal of Pain
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• v.30 no.3
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• pp.183-191
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• 2017

Background: Current therapy for the treatment of neuropathic pain is often unsatisfactory. Considerable variation in treatment pattern still exists in spite of availability of sufficient literature from various guidelines. Recent Indian market data suggested that the utilization (sale) of drugs such as amitriptyline, pregabalin, and gabapentin was more for low-dose unit packs than that of the high-dose unit packs, raising the belief that these drugs are prescribed at a lower dose than is actually recommended in the guidelines. To test this hypothesis, a survey was conducted across speciality throughout the country to observe the prescription pattern of these drugs amongst the health care providers in India. Methods: Three hundred fifty survey forms were distributed of which 281 forms were included for analysis. Results: It was observed that the commonly used initiation and maintenance dose for amitriptyline, pregabalin, and gabapentin was 5-10 mg/day, 50-75 mg/day, and 100-300 mg/day, respectively. The reason to select the lower dosages was to have a balancing effect to achieve good efficacy with minimum side effects. Care-givers reported no side effects/not many side effects as a reason in 22.2%, 16.88%, and 23.86% patients with amitriptyline, pregabalin, and gabapentin, respectively. Sedation and giddiness were commonly reported with all three drugs. Conclusions: Commonly prescribed drugs for management of neuropathic pain, such as amitriptyline, pregabalin, and gabapentin are preferred at lower doses in Indian clinical settings. Acceptable efficacy and low tolerance to the standard dosage is believed to be the reason behind the prescribed dose.

• YAKHAK HOEJI
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• v.48 no.4
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• pp.247-253
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• 2004

We investigated the hypoglycemic effect of formula containing Euonymus alatus (EA) and Mori Folium (MF) in multiple low dose (MLD) streptozotocin (STZ)-induced diabetic rats. In order to iduce hyperglycemic state 25 mg/kg of STZ was injected intraperitoneally for 5 consecutive days. SD rats were randomly divided into diabetic control and treatment groups. Treatment groups were administered with either 250 mg/kg of EA and 250 mg/kg of MF (E1Ml), or 500 mg/kg of EA mixed with same dose of MF (E2M2) for 3 weeks. Blood glucose levels and body weights were measured every 5th or 6th day. E1Ml and E2M2 both significantly reduced food intake, water intake, and fasting blood and urine glucose levels as compared to those in diabetic control group in a dose dependent manner. Body weight in diabetic control group was increased slightly after 3 weeks. Treatment group, however, showed gradual increase in body weights during 3 week-period. While plasma insulin levels of the diabetic control group were decreased to the level of 387$\pm$14 pg/ml from 534$\pm$36 pg/ml, those levels in E1Ml and E2M2-treated groups were both markedly increased by 13% and 26%, respectively. Urine glucose levels in E1Ml and E2M2-treated groups were also remarkably reduced by 17 and 26% compared to the levels of diabetic control group. While expression of membrane-bound glucose transporter-4 (GLUT-4) protein in skeletal muscle was reduced by 45% in diabetic control compared to the normal control, GLUT-4 protein expressions in E1Ml and E2M2-treated groups were augmented by 2 and 3.5 times compared to the diabetic control, respectively. Pancreatic HE staining experiments showed that E2M2-treated group revealed much less infiltrated mononuclear cells, indicating that E2M2 efficiently blocked insulitis induced by multiple low dose streptozotocin. Taken together, we conclude that formula containing EA and MF may prevent or delay the development of hyperglycemia through overexpression of GLUT-4 protein in skeletal muscle and prevention of insulitis.

• Journal of the Korean Society of Radiology
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• v.11 no.1
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• pp.63-68
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• 2017

To reduce the exposure dose in head CT, the use of low tube voltage is required. However, increasing noise may cause errors in the second data processing. In this study, we proposed a method to reduce noise by using low tube voltage. Experimental results show that the noise level is high at 100kVp and lowest at 140 kVp. The dose was lower at 100 kVp and higher at 140 kVp. As a result of applying the wavelet according to the threshold value, the noise value in the wavelet Th30 decreased to 4.51. Using the parameter condition(100 kVp, rotation time 0.5 sec, dose: 40.64 mGy) and the wavelet Th 30, the dose reduction of 65.3% was possible. We believe that applying the proposed method to head CT images will help to patient safety and interpret accurate information.

• Progress in Medical Physics
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• v.29 no.1
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• pp.16-22
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• 2018

Current dosimetry protocols recommend the use of parallel-plate chambers in electron dosimetry because the electron fluence perturbation can be effectively minimized. However, substitutable methods to calibrate and measure the electron output and energy with the widely used cylindrical chamber should be developed in case a parallel-plate chamber is unavailable. In this study, we measured the correction factors and absolute dose-to-water of electrons with energies of 4, 6, 9, 12, 16, and 20 MeV using Farmer-type and Roos chambers by varying the dose rates according to the AAPM TG-51 protocol. The ion recombination factor and absolute dose were found to be varied across the chamber types, energy, and dose rate, and these phenomena were remarkable at a low energy (4 MeV), which was in good agreement with literature. While the ion recombination factor showed a difference across chamber types of less than 0.4%, the absolute dose differences between them were largest at 4 MeV at approximately 1.5%. We therefore found that the absolute dose with respect to the dose rate was strongly influenced by ion-collection efficiency. Although more rigorous validation with other types of chambers and protocols should be performed, the outcome of the study shows the feasibility of replacing the parallel-plate chamber with the cylindrical chamber in electron dosimetry.

• Korean Journal of Acupuncture
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• v.33 no.4
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• pp.194-203
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• 2016

Objectives : The aim of this study was to observe the dose-dependent effects of bee venom (BV) pharmacopuncture on the serious ankle sprain in rats. Methods : The grade III ankle sprain was produced by surgically damaging the lateral ligaments complex of Sprague-Dawley rats. BV pharmacopuncture with the different doses($5{\mu}g/kg$, $10{\mu}g/kg$, $50{\mu}g/kg$) were treated on the different acupoints(GB34, GB39 and GB42) of the affected hind limb, respectively. By measuring foot weight bearing force ratio(FWBFR), the pain levels by ankle sprain and the pain recovery for 7 days were observed under BV pharmacopuncture on each acupoint. Results : In the normal and ankle sprained rat, the BV single administration decreased FWBFR in a dose - dependent pattern. The higher the BV dose, the higher the pain resulted in the normal and the sprained ankles. Especially, the dose - dependent effects of BV resulted in the most pronounced decrease in FWBFR in GB34. The recovery of FWBFR was shown at the low dose($5{\mu}g/kg$) BV and the effect was most remarkable in the BV of GB34, but the others showed no recovery effect compared with the control group. Conclusions : BV pharmacopuncture does not exhibit analgesic effects in acute phase of ankle sprain. However, the recovery of ankle sprain was more effective than the natural recovery in the case of low dose of BV repeated over time. Considering this, it is presumed that it would be important to select appropriate clinic guidelines for acute phase of ankle sprain.

• Journal of Radiation Protection and Research
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• v.40 no.1
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• pp.25-35
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• 2015

We analyzed the differential effects of histopathology, apoptosis and expression of radiation response genes after chronic low dose rate (LDR) and acute high dose rate (HDR) radiation exposure in spleen, lung and liver of rats. Female 6-week-old Sprague-Dawley rats were used. For chronic low-dose whole body irradiation, rats were maintained for 14 days in a $^{60}Co$ gamma ray irradiated room and received a cumulative dose of 2 Gy or 5 Gy. Rats in the acute whole body exposure group were exposed to an equal dose of radiation delivered as a single pulse ($^{137}Cs$-gamma). At 24 hours after exposure, spleen, lung and liver tissues were extracted for histopathologic examination, western blotting and RT-PCR analysis. 1. The spleen showed the most dramatic differential response to acute and chronic exposure, with the induction of substantial tissue damage by HDR but not by LDR radiation. Effects of LDR radiation on the lung were only apparent at the higher dose (5 Gy), but not at lower dose (2 Gy). In the liver, HDR and LDR exposure induced a similar damage response at both doses. RT-PCR analysis identified cyclin G1 as a LDR-responsive gene in the spleen of rats exposed to 2 Gy and 5 Gy gamma radiation and in the lung of animals irradiated with 5 Gy. 2. The effects of LDR radiation differed among lung, liver, and spleen tissues. The spleen showed the greatest differential effect between HDR and LDR. The response to LDR radiation may involve expression of cyclin G1.

• Radiation Oncology Journal
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• v.38 no.2
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• pp.138-147
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• 2020

Purpose: To evaluate the dosimetric variations in patients of head and neck cancer treated with definitive or adjuvant radiotherapy using optimized non-coplanar (ncVMAT) beams with coplanar (cVMAT) beams using volumetric arc therapy. Materials and Methods: Twenty-two patients of head and neck cancer that had received radiotherapy using VMAT in our department were retrospectively analyzed. Each of the patients was planned using coplanar and non-coplanar orientations using an optimized couch angle and fluences. We analyzed the Conformity Index (C_IRTOG), Dose Homogeneity Index (DHI), Heterogeneity Index (HI_RTOG), low dose volume, target and organs-at-risk coverage in both the plans without changing planning optimization parameters. Results: The prescription dose ranged from 60 Gy to 70 Gy. Using ncVMAT, C_IRTOG, DHI and HI_RTOG, and tumor coverage (ID_95%) had improved, low dose spillage volume in the body V_5Gy was increased and V_10Gy was reduced. Integral dose and intensity-modulated radiation therapy factor had increased in ncVMAT. In the case of non-coplanar beam arrangements, maximum dose (D_max) of right and left humeral head were reduced significantly whereas apex of the right and left lung mean dose were increased. Conclusion: The use of ncVMAT produced better target coverage and sparing of the shoulder and soft tissue of the neck as well as the critical organ compared with the cVMAT in patients of head and neck malignancy.

• Korean Journal of Clinical Pharmacy
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• v.14 no.1
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• pp.1-10
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• 2004

Studies of oxaliplatin, 5-fluorouracil and leucovorin in pretreated metastatic colorectal cancer showed that oxaliplatin dose intensity is important prognostic factor for objective response rates and progression-free-survival (PFS). To evaluate response rates, PFS and toxicity according to oxaliplatin dose intensity, we retrospectively analyzed data from patients with metastatic colorectal cancer received oxaliplatin,5-fluorouracil, leucovorin regimens. Sixty-three patients were reviewed in this study, 42 patients received low dose intensity oxaliplatin (LDI: $\leq85\;mg/m^2/2wks$) and 21 patients high dose intensity oxaliplatin (HDI: $>85\;mg/m^2/2wks$). Objective responses occurred in 10 $(47.7\%)$ HDI patients and 9 $(21.4\%)$ LDI patients (p = 0.014). Median PFS was 24.7 weeks in HDI group, with $45.1\%$ of HDI patients progression free at 6 months, and 20.5 weeks in LDI group, with $33.5\%$ of LDI patients progression free at 6 months (p = 0.344). Increased oxaliplatin dose intensity was not associated with neutropenia, thrombocytopenia, neuropathy, nausea and vomiting. This study showed that oxaliplatin dose intensification significantly improves objective response rate in pretreated metastatic colorectal cancer without increasing severe toxicity.

• Journal of Radiation Protection and Research
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• v.37 no.4
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• pp.231-236
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• 2012

This study derived measures to reduce exposure doses by identifying factors which affect the external radiation dose rate of patients treated with radiopharmaceuticals for PET-CT tests. The external radiation dose rates were measured on three parts of head, thorax and abdomen at a distance of 50cm from the surface of 60 PET-CT patients. It showed there are changes in factors affecting the external radiation dose rate over time after the administration of F-18 FDG. The external radiation dose rate was lower in the patients with more water intake than those with less water intake before the injection of radiopharmaceuticals at all three points: right after the injection of radiopharmaceuticals (average 4.17 mins), after the pre-PEET-CT urination step (average 77.47 mins), and right after the PET-CT test (average 114.15 mins). The study also found there is a need to increase the amount of water intake before the injection of radiopharmaceuticals in order to maintain a low external radiation dose rate in patients. This strategy is only possible under the assumption that the quality of the video has not changed after conducting this study on the relations between the image and quality. This study also found a need to use radiopharmaceuticals with the minimum amount needed for each patient because F-FDG doses affects the external radiation dose rate at the point right after the injection of radiopharmaceuticals. Urination frequency was the most significant factor to affect the external radiation dose rates at the point right after the PET-CT test and the point after the pre-PET-CT urination step. There is a need to realize the strategy to increase the urination frequency of patients to maintain the external radiation dose rate low (average 77.47 mins) before and after the injection of radiopharmaceuticals. In addition, at this point, there is a need to take advantage of personal strategies because the external radiation dose rate is lower if the fasting time is shorter, the contrast medium is used, and the amount of water intake is increased after the administration of radiopharmaceuticals. Finally this study found the need to be able to generalize these findings through an in-depth research on the factors affecting the external radiation dose rate, which includes radiopharmaceutical dose, urination frequency, the amount of water intake, fasting time and the use of contrast medium.