• 제목/요약/키워드: second-line treatment

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거골 골연골 병변 치료에 대한 최신 지견 (Current Updates in Treatment of Osteochondral Lesions of the Talus)

  • 박영환;김재영;김학준
    • 대한족부족관절학회지
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    • 제23권2호
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    • pp.43-51
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    • 2019
  • Despite the increasing number of osteochondral lesions of the talus, there are a lack of definite evidence-based treatment protocols. Several types of treatments are available, each having their advantages and disadvantages. First-line therapy consists of well-conducted conservative treatment. Surgical treatment is the second choice. Treatments are chosen based on the size of the lesion, location, chronicity, and the condition of the neighboring cartilage. This article reviews the current updates in the treatment of osteochondral lesions of the talus to help clinicians use the available treatment strategies more efficiently.

2018 한국형 공황장애 치료지침서 : 정신사회적 치료전략 (Korean Guidelines for the Treatment of Panic Disorder 2018 : Psychosocial Treatment Strategies)

  • 김민숙;김민경;이재헌;김원;문은수;서호준;구본훈;양종철;이강수;이상혁;김찬형;유범희;서호석
    • 대한불안의학회지
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    • 제15권1호
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    • pp.13-19
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    • 2019
  • Objective : The purpose of this study was to investigate consensus relative to treatment strategies for psychosocial treatment in panic disorder, that represents one subject addressed by the Korean guidelines for treatment of panic disorder 2018. Methods : The executive committee developed questionnaires relative to treatment strategies for patients with panic disorder based on guidelines, algorithms, and clinical trials previously published in foreign countries and Korea. Seventy-two (61.0%) of 112 experts on a committee reviewing panic disorder responded to the questionnaires. We classified the consensus of expert opinions into three categories (first-line, second-line, and third-line treatment strategies), and identified treatment of choice using the Chi-square test and 95% confidence intervals. Results : For psychosocial treatment of panic disorder, individual and group cognitive behavior therapy (CBT) were recommended treatments of choice, and mindfulness based cognitive therapy (MBCT) was recommended as first line strategy. There was statistically significant consensus among experts regarding usefulness of each component of CBT and MBCT, for treatment of patients with panic disorder. Conclusion : Results, that reflect recent studies and clinical experiences, may provide the guideline for psychosocial treatment strategies for panic disorder.

원발성 온난자가면역용혈빈혈의 치료에 대한 후향적 분석 (Retrospective Clinical Analysis of Treatment for Primary Warm Autoimmune Hemolytic Anemia)

  • 문홍섭;박치영
    • 한국임상약학회지
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    • 제25권3호
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    • pp.166-170
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    • 2015
  • Background: Primary warm autoimmune hemolytic anemia (AIHA) is a relatively rare hematologic disorder resulting from autoantibody production against red blood cells. There has been very few studies about primary warm AIHA in South Korea because of its low incidence. We retrospectively analyzed the treatment outcome of primary warm AIHA. Method: We reviewed retrospectively the medical records of 9 primary warm AIHA patients from December 2002 to January 2015. We analyzed the causes and clinical characteristics of primary warm AIHA patients. We retrospectively analyzed the clinical data in electronic medical records for 9 Korean patients with AIHA patients who were diagnosed during the period from December 2002 to January 2015 at the Regional University Hospital in Korea. The study protocol was approved by the Institutional Review Board (IRB #2015-08-007, Chosun University Hospital IRB). Results: The mean age was 52 years (range 27~78), the mean hemoglobin level was 5.0 g/dL (range 2.5~6.4 g/dL). All patients received steroids at therapeutic dosages (corticosteroid 1 mg/Kg) as first line treatment. Eight of them showed complete response (5/8, 62.5%) and partial response (3/8, 37.5%), one patient required second-line treatment with rituximab. Two patients who responded first line treatment were relapsed at 86 weeks and 24 weeks after response, respectively. Only one patient of them was retreated with corticosteroid because of anemic symptoms. Conclusion: This study indicates that oral corticosteroid is an effective therapy for primary warm AIHA.

침습성 아스페르길루스증의 치료 목적으로 voriconazole을 단독으로 투여받는 폐이식 환자에서 voriconazole 약물혈중농도 모니터링의 유효성 검증 (Validation of Voriconazole Therapeutic Drug Monitoring in Lung Transplant Recipients Receiving Voriconazole alone for Treatment of Invasive Aspergillosis)

  • 손유정;이경아;조주희;김재송;손은선;박무석
    • 한국임상약학회지
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    • 제29권2호
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    • pp.89-100
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    • 2019
  • Background: Invasive aspergillosis (IA) is associated with high morbidity and mortality, particularly among immunocompromised patients, such as lung transplant recipients. Voriconazole, the first-line therapy for IA, shows a non-linear pharmacokinetic profile and has a narrow therapeutic range. Careful and appropriate administration is necessary, primarily because it is used for critically ill patients; however, the clinical usefulness of therapeutic drug monitoring (TDM) has not been sufficiently verified. Therefore, in this study, we validated the safety and efficacy of voriconazole TDM in lung transplant recipients receiving only voriconazole for IA treatment. Methods: The electronic medical records of lung transplant recipients (${\geq}19$ years of age) administered only voriconazole for > 7 days for treatment of IA from June 1, 2013 to May 31, 2018 were analyzed retrospectively. Results: Among the 54 patients, 27 each were allocated to TDM and non-TDM groups, respectively. There were no significant differences in patient characteristics between the two groups except for ICU-hospitalization status. Of the TDM group patients, 81.5% needed adjustment of voriconazole dosage because the levels were out of target range. Comparison of two groups showed that treatment response was higher throughout treatment and switching rates of second-line agents were significantly lower in the TDM group, but it was insufficient to confirm safety improvements through voriconazole TDM. Conclusions: Considering that the treatment response tended to be higher and the rates of switching to second-line antifungal agents were lower in the TDM group, voriconazole TDM may increase the therapeutic effect on IA in lung transplant patients.

2018 한국형 공황장애 치료지침서 : 초기 및 유지 약물치료 전략 (Korean Guidelines for the Treatment of Panic Disorder 2018 : Initial and Maintenance Treatment Strategies for the Pharmacological Treatment of Panic Disorder)

  • 김민경;이재헌;김민숙;김원;문은수;서호준;구본훈;양종철;이강수;이상혁;김찬형;유범희;서호석
    • 대한불안의학회지
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    • 제14권2호
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    • pp.53-62
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    • 2018
  • Objective : The Korean Association of Anxiety Disorders developed Korean guidelines for treatment of panic disorder (PD) 2018. In this paper, we discussed the consensus among psychiatrists, regarding initial and maintenance treatment strategies for pharmacological treatment of PD in Korea. Methods : Based on current treatment guidelines published by the American Psychiatric Association, the National Institute for Clinical Excellence, and the Canadian Psychiatric Association, we developed questionnaires pertinent to initial and maintenance treatment strategies for pharmacological treatment of PD. Seventy-two experts in PD answered questionnaires. We classified expert opinions into three categories, first, second, and third-line treatment strategies, by analyzing the 95% confidence interval. Results : Antidepressants, benzodiazepine anxiolytics, and cognitive-behavioral therapy (CBT) were recommended as treatments of choice (ToC), and first-line strategies for initial treatment of PD. Escitalopram, paroxetine, sertraline, and venlafaxine were preferred from among many anti-panic drugs. Mean starting dose of anti-panic drugs for initial treatment of PD was relatively lower, than that for other psychiatric illnesses such as major depressive disorder. In the case of maintenance treatment of PD, antidepressants and CBT were selected as ToC and first-line strategies. Patients were typically examined every four weeks during treatment, to review effectiveness and side effects of the drug. Pharmacotherapy was generally continued for one year or more. Conclusion : This study provides information about consensus among Korean experts regarding pharmacological treatment strategies for patients with panic disorder.

Continuous-infusion Ifosfamide and Doxorubicin Combination as Second-Line Chemotherapy for Recurrent or Refractory Osteosarcoma Patients in China: a Retrospective Study

  • Huang, Yu-Jing;He, Ai-Na;Sun, Yuan-Jue;Shen, Zan;Min, Da-Liu;Yao, Yang
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권6호
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    • pp.2391-2395
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    • 2015
  • Objective: The aim of this retrospective study was to evaluate the feasibility and efficacy of response to continuous-infusion ifosfamide and doxorubicin combination as second-line chemotherapy for patients with recurrent or refractory osteosarcoma. Materials and Methods: Eighteen recurrent or refractory osteosarcoma patients who were treated with continuous-infusion ifosfamide and doxorubicin combination between May 1999 and April 2011 were included in the analysis. Ifosfamide at $12g/m^2$ was administered by intravenous continuous infusion over 3 days, and doxorubicin $60mg/m^2$ was administered as an intravenous bolus injection on day 1. The combination therapy was repeated every 3 weeks. Treatment was continued until evidence of disease progression or unacceptable toxicity. Results: The patients (ages 7-53 years) received a total of 42 cycles of chemotherapy (median: 2 courses; range: 2-5 courses). The overall response rate was 0% and the disease control rate was 22.3%, with four patients having stable disease. The median time to progression and overall survival time were 2 months (range: 2-5 months) and 9 months (range: 3-29 months), respectively. Major severe toxicities were leucopenia 7 (38.9%), nausea and vomiting 3 (16.7%) and alopecia 9 (50%). There were no treatment-related deaths. Conclusions: In our experience, continuous-infusion ifosfamide and doxorubicin combination therapy at this dosage and schedule was found to be well tolerated and moderate effective, which could be considered as salvage therapy for patients with recurrent or refractory osteosarcoma. Further assessment is necessary to confirm the safety and efficacy of this treatment.

인지처리치료: 외상후 스트레스 장애의 일차 치료 (Cognitive Processing Therapy as a First-line Treatment for Post-Traumatic Stress Disorder)

  • 최진희;소형석;황순조;석지우;최하연;이승훈;이은영
    • 정신신체의학
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    • 제30권2호
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    • pp.80-98
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    • 2022
  • 외상후 스트레스 장애는 다양한 치료들에 대한 치료반응이 좋지 않아, 많은 임상가들에게 큰 도전이 되고 있다. 최근 발간된 여러 임상 진료지침들은 인지처리치료 및 지연노출치료를 포함한 트라우마 초점 정신치료들을 일차 치료로 공통적으로 권고하고 있다. 환자에게 근거에 기반한 치료적 선택지들에 대하여 정보를 제공함으로써 환자와 임상가가 함께 최선의 치료방법을 선택할 수 있도록 하는 것이 중요하며, 이를 위해 인지처리치료의 내용과 근거를 소개하는 것이 본 종설의 목적이다. 인지처리치료의 회기 구성과 내용을 요약하여 소개하고, 외상후 스트레스 장애에 대한 인지처리치료의 효과를 알아본 다양한 연구들을 민간인 집단과 재향군인/현역군인 집단으로 구분하여 제시하였다. 인지처리치료의 탈락율을 낮추고 치료성적을 올리며 치료접근도를 높일 수 있는 방법들 및 외상후 스트레스 장애에 대한 근거중심치료의 활성화를 위한 방안을 토의한다.

개에서 외부고정법을 이용한 양측성 하악골절의 치유 일례 (A Case of External Skeletal Fixation for Treatment of Bilateral Mandibular Fracture in a Dog)

  • 구자민;김현희;박대식;장홍희;이효종;이후장;송해룡;이용훈;정종태
    • 한국임상수의학회지
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    • 제20권1호
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    • pp.134-137
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    • 2003
  • A 5-year-old, male mixed breed dog was presented to Gyeongsang National University Animal Hospital for bilateral mandibular open fracture by bite. The dog had loss of the teeth and injury of the oral mucosa. Radio-graphic and blood examinations were conducted. Fracture lines were observed between first premolar and second premolar, but temporomandibular luxation was not observed on radiographs. In serum analysis, elevated levels of CPK and LDH were found. The dog was anesthetized and prepared for aseptic surgery. Acrylic external skeletal fixator with Kirschiner wire was applied. Pin loosening and malalignment of the right fracture line was observed at 7 weeks after surgery. We applied Kirschner-Ehmer fixator and half pins during the second surgical procedure. At 4 weeks after a second surgical procedure, the fixator and pins were removed from mandible. The fractures were healed with no complications.

Annexin I Stimulates Insulin Secretion through Regulation of Cytoskeleton and PKC Activity

  • Kang, Na-Na;Won, Jong-Hak;Park, Young-Min
    • Animal cells and systems
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    • 제13권1호
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    • pp.17-23
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    • 2009
  • In previous studies, we found that Annexin I (Anx I) was co-secreted with insulin in response to glucose, and that extracellular Anx I stimulated the release of insulin via the Anx I binding site in rat pancreatic islets and the &-cell line. However, the role that Anx I plays in the insulin secretion was not established. Therefore, in this study, we evaluated the insulin secretion pattern in response to Anx I and the involvement of the cytoskeleton or PKC in Anx Istimulated insulin secretion in MIN6N8a cells. The peak time of insulin secretion in response to Anx I treatment corresponded with the second phase insulin secretion by glucose in the perifused pseudoislets. In addition, Anx I-stimulated insulin secretion was not affect by readily releasable pool depletion. Taken together, these findings indicate that Anx I treatment was associated with movement of the reserve pool of insulin. Furthermore, Anx I-stimulated insulin secretion was attenuated by treatment with a microfilament inhibitor, cytochalasin B, as well as by PKC down regulation. These results indicate that Anx I may be a regulator of second phase insulin secretion.

DTP(Digital Textile Printing)에서 미디어의 원사꼬임 및 편성구조가 프린팅 Quality에 미치는 영향(I) (Effects on Printing Quality according to Yarn Twist and Knitting Structure of Media in Digital Textile Printing(I))

  • 박순영;전동원;박윤철;이범수
    • 한국염색가공학회지
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    • 제22권3호
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    • pp.282-291
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    • 2010
  • Digital textile printing(DTP) is becoming more important because the production trend of textile printing goods is adapting to small-lot multiple items. Recently enhanced use of DTP is closely connected with production of high value-added products in fashion industry, which is also appropriate for quick response system(QRS). Quality of DTP depends on pre-treatment, after-treatment, ink, media, printer, etc. One of these parameters, Selection of good media is very important to obtain high quality of DTP products. Especially, the effects of media on printing quality of DTP according to yarn twist and structure of knitting fabric were examined in this study. Two types of yarn twist of 830 t.p.m and 1630 t.p.m for cotton knit were used and five types of media structures were knitted with single circular knitting machine. First, MIU, MMD, SMD's values are closely related with surface roughness of sample as well as printing quality. The hard twist samples were higher values than normal twist samples in the same media structure. In case of SMD, the values increased from plain to corduroy types. Second, aspect of line sharpness, line area, and line width values of hard twist samples decreased from plain to corduroy than those of normal twist samples. Third, line deviation values of hard twist samples, blurriness of line, also decreased than those of normal twist samples.