• Journal of Yeungnam Medical Science
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• 제37권4호
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• pp.277-285
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• 2020

Tuberculosis (TB) is still a major health problem worldwide. Especially, multidrug-resistant TB (MDR-TB), which is defined as TB that shows resistance to both isoniazid and rifampicin, is a barrier in the treatment of TB. Globally, approximately 3.4% of new TB patients and 20% of the patients with a history of previous treatment for TB were diagnosed with MDR-TB. The treatment of MDR-TB requires medications for a long duration (up to 20-24 months) with less effective and toxic second-line drugs and has unfavorable outcomes. However, treatment outcomes are expected to improve due to the introduction of a new agent (bedaquiline), repurposed drugs (linezolid, clofazimine, and cycloserine), and technological advancement in rapid drug sensitivity testing. The World Health Organization (WHO) released a rapid communication in 2018, followed by consolidated guidelines for the treatment of MDR-TB in 2019 based on clinical trials and an individual patient data meta-analysis. In these guidelines, the WHO suggested reclassification of second-line anti-TB drugs and recommended oral treatment regimens that included the new and repurposed agents. The aims of this article are to review the treatment strategies of MDR-TB based on the 2019 WHO guidelines regarding the management of MDR-TB and the diagnostic techniques for detecting resistance, including phenotypic and molecular drug sensitivity tests.

• 보건행정학회지
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• 제16권4호
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• pp.147-168
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• 2006

Technological innovation has been regarded as the core competence for the economic growth of individual, as well as organization and country. Pharmaceutical innovation, what we call new medicines, influence people's longevity and productivity by increasing output per hour worked. Therefore, using claims data on virtually all the drugs and diseases of over 550,000 people enrolled in National Health Insurance Program in Korea, we examined the impact of the vintage (original FDA and KFDA approval year) of drugs used to treat a patients from July 1st to December 31st in 2002 on the patient's mortality at the end of 2004, controlling for demographic characteristics(age and sex), utilization of medical services, and the nature and complexity of illness. We found that people using newer drugs are less likely to die at the end of 2004, conditional on covariates. The estimated mortality rates were declining with respect to drug vintage for 1970s, 1980s and 1990s and highly significant. In addition to estimating the model for the entire sample, we estimated the model separately for several disease categories classified by Korean Classification of Disease. Estimates of three drug vintage variables for subgroups of people with (1)neoplasms, (2)endocrine, nutritional and metabolic diseases, and (3)the diseases of circulatory system displayed similar patterns.

• Clinical and Experimental Pediatrics
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• 제53권11호
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• pp.936-941
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• 2010

The systematic approach to pharmacologic treatment is typically to begin with the safest, simplest, and most conservative measures. It has been realized that the more rapidly inflammation is under control, the less likely it is that there will be permanent sequelae. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of initial treatment for inflammation. In addition, the slow-acting antirheumatic drugs (SAARDs) and disease-modifying antirheumatic drugs (DMARDs) have efficacy of anti-inflammatory action in children with chronic arthritis. New therapeutic modalities for inflammation, such as etanercept and infliximab, promise even further improvements in the risk/benefit ratio of treatment. It is not typically possible at the onset of the disease to predict which children will recover and which will go on to have unremitting disease with lingering disability or enter adulthood with serious functional impairment. Therefore, the initial therapeutic approach must be vigorous in all children.

• Archives of Pharmacal Research
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• 제22권6호
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• pp.533-541
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• 1999

Many conventional anticancer drugs display relatively poor selectivity for neoplastic cells, in particular for solid tumors. Furthermore, expression or development of drug resistance, increased glutathione transferases as well as enhanced DNA repair decrease the efficacy of these drugs. Research efforts continue to overcome these problems by understanding these mechanisms and by developing more effective anticancer drugs. Cyclophosphamide is one of the most widely used alkylating anticancer agents. Because of its unique activation mechanism, numerous bioreversible prodrugs of phosphramide mustard, the active species of cyclophosphamide, have been investigated in an attempt to improve the therapeutic index. Solid tumors are particularly resistant to radiation and chemotherapy. There has been considerable interest in designing drugs selective for hypoxic environments prevalent in solid tumors. Much of the work had been centered on nitroheterocyclics that utilize nitroreductase enzyme systems for their activation. In this article, recent developments of anticancer prodrug design are described with a particular emphasis on exploitation of selective metabolic processes for their activation.

• Journal of Pharmaceutical Investigation
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• 제40권spc호
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• pp.1-7
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• 2010

Since the introduction of the biopharmaceutics classification system (BCS) in 1995, it has viewed as an effective tool to categorize drugs in terms of prediction for bioavailability (BA) and bioequivalence (BE). The BCS consist of four drug categories: class I (highly soluble and highly permeable), class II (low soluble and highly permeable), class III (highly soluble and low permeable) and class IV (low soluble and low permeable), and almost all drugs belong to one of these categories. Likewise, classifying drugs into four categories according to their solubility and permeability is simple and relatively not controversial, and thus the FDA adopted the BCS as a science-based approach in establishing a series of regulatory guidance for the industry. Actually, many pharmaceutical companies have gained a lot of benefits, which directly connect to cost loss and failure decrease in the early stage of drug development. Recently, instead of solubility, using dissolution characteristics (e.g. intrinsic dissolution rate) have provided an improvement in the classification in correlating more closely with in vivo drug dissolution rather than solubility by itself. Furthermore, a newly modified-version of BCS, biopharmaceutics drug disposition classification system (BDDCS), which classify drugs into four categories according to solubility and metabolism, has been introduced and gained much attention as a new insight in respect with the drug classification. This report gives a brief overview of the BCS and its implication, and also introduces the recent new trend of drug classification.

• 한국식품위생안전성학회지
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• 제11권4호
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• pp.315-321
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• 1996

Various antimicrobial drug screen tests have been used in order to ensure food safety. However, the conventional screen tests, the Swab Test on Premises(STOP, USA), the Calf Antibiotic and Sulfa Test(CAST, USA) and the European Economic Community 4-plate Test(FPT, EU) are not sufficiently rapid or sensitive enough to detect low levels of sulfa drugs in meat. We developed a new screen test kit for the determination of the antimicrobial residues in meat called the Bacillus megaterium Disk Assay(BmDA). A comparison of BmDA with the older screen tests showed BmDA was as good as the older ones with several advantages. The new test kit is faster-it can be read in 4∼6 hours instead of 16∼18 hours. Moreover, BmDA can discriminate sulfa drugs from other antimicrobial drugs because p-aminobenzoic acid countacts the inhibiting action of sulfa drugs. Minimum detectable levels of sulfa drugs were significantly improved at the lever of 0.025*0.1 pp, compared with the level of 1.0 ppm in FPT. A comparison of BmDA with the older screen tests in HPLC confirmed meat samples exceeded the Korean tolerance value of 0.1 ppm showed BmDA was the most sensitive in the microbiological screen tests. As the microbiological screen tests have already known, a person familiar with simple laboratory techniques should have no difficulty in using it to detect antimicrobial residues in meat. This would be a simple, economic method of antimicrobial residues detection which might be succesfully used by many laboratories.

• 혜화의학회지
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• 제4권2호
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• pp.333-333
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• 1996

Chinese medicine is a precious treasure inherited from ancient ancestors. It is accredited for the prosperous growth of the Chinese nations. However, the descriptions of the herbs in the ancient herbal are not in detail and the great numbers of herbs used which grows in wide geographic areas together with various local folk names, new substitutes and new folk medicines had increased, many Chinese herbs are composed of herbs that are labeled with identical names but actually are of different origins and different grades. Similar situation had occurred in China, japan and Korea In Taiwan, misused Chinese crude drugs are also very common in the past. This phenomenon had caused a lot of confusion and had great influence the clinical efficacy of the treatment. In the past, Professor Hong Yen Hsu, Na Chi, Woei Song Kan and Kung Yin Yen had studied the origins of Chinese crude drugs in Taiwan based on the morphological identification and found that the origins of Ma-Tou-Ling, Pu-Kung-Yin, Tu-Chung, Wang-Pu-Liu-Hsing, Pan-lan-Ken, Niu-Chi, Fang-Chi, Huang-Chi, PienHsiu and Sha Wan-Tzi are different from that of the species used in mainland China. In order to assure the quality and clinical efficacy of the crude drugs, besides the traditional morphological methods, we bad recently combined modem chemical and pharma-cological methods to assess drug quality. Drugs that have been evaluated without effects should be abandoned. The species of those commonly misued crude drugs used in compound formula preparations are also identified Based on the pharmacological results, a suitable species is recommended so as to improve the clinical efficacy of those preparations. In this paper, we like to report our recent studies on Niu Chi(Achyranthis Bidentatae Radix, Cyathulae Radix and Strobilanthis Radix). Fang-Chi(Arstolochiae Fangchi Radix, Stephaniae Tetrandrae Radix and Cocculus Radix) and Huang-Chi(Astragali Radix and Hedysari Radix) using comparative pharmacognosy methods.

• 한국임상약학회지
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• 제23권2호
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• pp.89-96
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• 2013

This article aimed to introduce 'risk sharing' schemes for pharmaceuticals between drug manufacturers and healthcare payer. Published literature review was undertaken to summarize risk sharing concepts and collect information on existing scheme examples in other countries focusing on new anticancer drugs. Risk sharing schemes could be categorized into health outcomes-based and non-outcomes (financial) based ones. Outcome-based schemes could be broken down into performance-linked reimbursement and conditional coverage. Performance-linked reimbursement can be further broken into outcomes guarantee and pattern or process of care and conditional coverage included coverage with evidence development and conditional treatment continuation schemes. Non-outcome based schemes included market share and price volume at population level, and utilization caps and manufacturer funded treatment initiation at patient level. We reviewed the fifteen examples for anticancer drugs that risk sharing agreements in response to the inherent uncertainties and increased costs of eleven anticancer drugs. Of them, eight cases were coverage with evidence development schemes. The anticancer drugs except bevacizumab and cetuximab were all listed on the national health insurance formulary in Korea, with reimbursement criteria defined on the basis of approved indications and administrations. Risk sharing approach may be a useful tool to ensure values for drug expenditure, but there are a number of concerns such as high administration costs, lack of transparency and conflicts of interest, especially for performance-based health outcomes reimbursement schemes.

• 한국병원경영학회지
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• 제14권4호
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• pp.52-70
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• 2009

This study is to analyse the reimbursement prices of drugs in Japan. Japan has the world's second-largest pharmaceutical market, and the world's largest price-controlled pharmaceutical market. The reimbursement prices of new drugs in Japan are determined by confidential negotiations between the manufacturer and the Japanese Ministry of Health, Labor, and Welfare. Pharmaceuticals account for a larger share of total healthcare expenditures in Japan than in most other major pharmaceutical markets such as France, Germany, United Kingdom and United States. Prescription drugs' share of total healthcare spending has slightly increased in recent years, from 20.2% in 2000 to 21.5% in 2004, the most recent year for which data are currently available. This trend is attributable to the effect of the Japanese rapidly aging population that stimulates demand for healthcare services. There are several method of price setting for drugs as below. First, on the initial pricing of branded drugs, is the similar-efficacy pricing method and cost calculation method. Second is postmarketing price changes which are biennial price revisions under the rule of National Health Insurance. Third is the rule of the generics price. Recently, the generics market is expanded because there are increasing numbers of hospitals by DPCs(Diagnosis-procedure Combinations).

• Natural Product Sciences
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• 제8권2호
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• pp.66-70
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• 2002

The in vitro anticoagulant and fibrinolytic activities of crude extracts from insects were evaluated in order to find effective therapeutic drugs for the treatment of myocardial and cerebral thrombosis. We prepared three types of extracts (water, methanol and ethylacetate) from 28 insects for use as raw materials for the activity assays. The fibrinolytic activity was tested using the fibrin plate method and the activated partial thromboplastin time and thrombin time were measured for blood clotting activity. With regards to the fibrinolytic system, water extracts of six kinds of insects displayed a remarkable level of activity with a plasmin-like action. The water extracts of [Catharsius molossus, Eupolyphaga sinensis, Huechys sanguinea, Mantidis $o\ddot{o}theca$, Mimela splendens, and Polistes mandarinus (Vespae Nidus)] exhibited the activity. On the other hand, the methanol extracts did not display any fibrinolytic activity. In terms of the coagulation system, an aqueous extract of silkworm Tongchunghacho (Paecilomyces japonica), Oxya japonica japonica and Buthus martensi (Scorpion) increased the clotting time significantly longer (181 times) than the control. These results suggest that crude drugs from insects are useful sources for the development of new drugs for use in treatments involving blood coagulation and fibrinolysis.