• Title/Summary/Keyword: 제4군

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Therapeutic Endoscopy-related Gastrointestinal Bleeding and Thromboembolic Events in Patients Using Warfarin or Direct Oral Anticoagulant (와파린 및 새로운 경구용 항응고제를 복용하는 환자에서의 치료 내시경과 관련된 위장관 출혈 및 혈전색전증의 위험)

  • Na, Hee Kyong
    • The Korean Journal of Gastroenterology
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    • v.72 no.5
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    • pp.271-273
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    • 2018
  • 내시경 시술 전 일시적으로 항응고제를 중단하는 것은 위장관 출혈의 위험과 혈전색전증의 위험 사이에 적절한 균형을 잡기 어렵기 때문에 논란의 여지가 많다. 와파린은 새로운 경구용 항응고제(direct oral anticoagulant agent, DOAC)보다 임상의에게 더 친숙하고, 효과를 쉽고 빠르게 전환시킬 수 있다는 장점이 있지만 복잡한 약역동학 특징과 좁은 치료적 범위 때문에 관리가 어렵다. 반면, DOAC는 약물의 모니터링 및 용량 조절 없이 정해진 용량으로 처방이 가능하며, 빠르게 작용하고, 반감기가 짧아 관리가 쉽지만 해독제가 없다는 단점이 있다. 이전 연구들에서 DOAC를 복용한 환자들은 와파린을 복용한 환자들보다 시술과 관련되지 않은 위장관 출혈의 위험이 높았다고 보고한 바 있다. 하지만 시술과 관련된 위장관 출혈 위험에 대하여는 알려진 바가 없는 실정이다. 미국이나 유럽 내시경 가이드라인들에서는 저위험 내시경 시술을 받는 환자들에서는 와파린과 DOAC를 유지하도록 권고하고 있으며, 고위험 시술의 경우에는 와파린를 사용하는 환자들에서 헤파린 교량 요법(heparin bridging)을 시행하도록 권고하고 있다. 임상적으로 DOAC를 사용하는 환자들 또한 혈전색전증을 예방하기 위하여 헤파린 교량 요법을 시행해볼 수 있는데, 와파린 및 DOAC의 헤파린 교량 요법과 관련된 출혈 및 혈전색전증 위험의 차이 또한 명확하지 않다. 따라서 저자들은 1) 와파린과 DOAC 치료를 받는 환자들에서의 출혈, 혈전색전증 및 사망의 위험을 비교하고자 하였으며, 2) 13종류의 고위험 내시경 시술 중에서 시술별 위험을 비교하고, 3) 헤파린 교량 요법이 합병증의 발생을 증가시키지 않는지 확인하고자 본 연구를 진행하였다. 일본 대규모 국가 입원 환자 데이터베이스를 이용하여 2014년 4월부터 2015년 5월까지 시술 전 와파린 또는 DOAC(rivaroxaban, apixaban, dabigatran, edoxaban)를 복용하고, 13종류의 고위험 내시경 시술을 시행받은 20세 이상의 성인 환자 총 16,977명을 확인하였다. 고위험 시술은 용종 절제술, 내시경 점막절제술, 내시경 점막하박리술, 협착 부위의 풍선확장술, 내시경 지혈술, 내시경 정맥결찰술, 내시경 주사 경화요법, 내시경 괄약근절개술, 내시경 초음파 유도하 미세침 흡인 검사, 경피적 위루술을 포함하였다. 일대일 성향 점수 매칭 분석(propensity score matching, 나이, 성별, 체질량 지수, 기저 질환, 병원의 규모, 시술의 종류, 약물의 종류를 매칭)을 시행하여 와파린군과 DOAC군에서 시술 위장관 출혈 및 혈전색전증, 사망의 발생을 비교하였다. 또한 경구항혈전제와 헤파린 교량 치료 시행 유무에 따라, DOAC 단독군, 와파린 단독군, DOAC와 헤파린 교량 요법군, 와파린과 헤파린 교량요법군으로 나누어, 하위군(subgroup) 분석을 시행하였다. 5,046쌍이 성향 점수 매칭 분석에 포함되었으며, 와파린군에서 DOAC군보다 통계적으로 의미 있게 위장관 출혈의 비율이 높았다(12.0% vs. 9.9% p=0.02). 혈전색전증 발생률(5.4% vs. 4.7%)과 입원중 사망률(5.4% vs. 4.7%)은 양 군에서 의미 있는 차이는 없었다. DOAC 종류별로 나누어 하위군 분석을 시행하였을 때, 와파린군은 rivaroxaban군에 비하여 위장관 출혈의 비율이 높았으며, rivaroxaban군, dabigatran군에 비하여 혈전색전증의 비율이 높았고, 입원 중 사망률에서는 의미 있는 차이는 없었다. 내시경 시술의 종류로 보정하였을 때 위장관 출혈 및 혈전색전증, 사망률은 DOAC 단독으로 치료한 환자에서보다 와파린과 헤파린 교량 요법(bridging) 또는 DOAC과 헤파린 교량 요법을 시행한 환자에서 높았다. 시술 종류 중에서는 위루관 삽입술에 비하여 내시경 점막하박리술, 내시경 점막절제술 및 내시경 정맥류결찰술, 내시경 주사경화요법을 시행한 환자에서 위장관 출혈의 위험이 가장 높았으며, 하부 내시경 점막절제술, 하부 용종 절제술, 내시경적 유두괄약근절제술 또는 내시경 초음파 유도하 미세침 흡인 검사는 중등도 위험을 보였다.

Hypoglycemic Effects of Korean Wild Vegetables (한국산 야생식용물의 혈당강하효과)

  • Sook Ja Lim
    • Journal of Nutrition and Health
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    • v.25 no.6
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    • pp.511-517
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    • 1992
  • The hypoglycemic effects of Korean wild vegetables : Capsella bursa-pastoris Medicus(CBM) Commelina communis L. (CCL) Calystegics japonica Choisy(CJC) Discorea japonica Thunb(DJT) and Persicaria perfolidata Gross(PPG) in diabetic rats were determined. Sixty male Sprague-Dawley diabetic rats(130~180g) induced by the streptozotocin (45mg/kg) injection into the tail vein were fed either a control or experimental diets for four weeks. The plasma levels of glucose and cholesterol were measured. The urinary glucose levels were monitored. Crude fiber mineral(Ca, Fe, Zn and Cr) and ascorbic acid contents of the wild vegetables were analyzed. The extents of blood glucose decrement in CCL. DJT or PPG fed rats were greater than that in the control group. This extents of decrement in CBM or CJC fed rats were not significan-tly different from that in the control group. The urinary glucose was shown to be negative to Band reagent strip in CCL or DJT group at the 4th week. The plasma cholesterol levels of all the groups including control group were not essentially different. It is suggested that the intakes of CCL or DJT could be useful for prevetive and therapeutic approches to alleviate the hyperglycemic status in diabetes mellitus.

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Effects of Serum and Gonadotropins in In-Vitro Maturation Medium on Nuclear Maturation, Development and Cell Numbers of Korean Native Cow Embryos (체외성숙용 배지에 혈청과 호르몬의 첨가가 한우 난포란의 핵성숙과 배발달 및 배반포의 세포수에 미치는 영향)

  • Park Y. S.;Kim J. M.;Park H. D.
    • Journal of Embryo Transfer
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    • v.19 no.3
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    • pp.229-237
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    • 2004
  • The main objective of this study was to examine the effects of serum and gonadotropins supplement during in vitro maturation(IVM) of bovine oocytes on nuclear maturation and embryo development, and we also examine the cell number. 1 . The first polar body(PB) extrusion rates of Korean native cow(KNC) oocytes matured in medium with FBS or gonadotropins were similar among treatment groups. The development rate to the blastocyst stage was significantly higher in the group of both supplement FBS and gonadotropins(26.0%) than in the group of non-supplement(9.9%) and gonadotropins (12.0%). The numbers of inner cell mass (ICM) and trophectoderm (TE) cells and total cell numbers of blastocysts were highest in the group of both supplement FBS and gonadotropins, and the number of ICM cells was increased by FBS supplementation (p<0.05). 2. The PB extrusion rates of KNC oocytes matured in medium with FBS in the different duration of IVM was significantly higher in the 0-18hr(63.1%) and in the 9-18hr(63.4%) group than in the 0-9hr.(37.4%) group (p<0.05). The embryo development rates did not differ among treatment groups. The numbers of TE cells and total cell numbers of blastocysts were similar among treatment groups, but the number of ICM cells of the 0-18h. group were significantly higher than the other treatment groups (p<0.05). The results indicate that although TCM199 alone can support bovine oocyte maturation and development to the blastocyst stage, a high quality of blastocysts can be produced from oocytes matured in medium containing serum and gonadotropins.

Effects of Magnoliae Cortex and Zizyphi Fructus Extract Mixtures on the Progression of Experimental Periodontitis in Beagle Dogs (후박 및 대조 추출혼합물이 치주질환유발 성견의 치주질환억제에 미치는 효과)

  • Shin, Seung-Yun;Lee, Yong-Moo;Ku, Young;Rhyu, In-Chul;Han, Soo-Boo;Choi, Sang-Mook;Bae, Ki-Hwan;Chung, Chong-Pyoung
    • Journal of Periodontal and Implant Science
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    • v.29 no.2
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    • pp.289-297
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    • 1999
  • 최근 생약 추출물의 항균, 항염효과에 관한 관심이 증대되고 있으며 이를 이용한 치주질환의 예방 및 억제효과에 관한 연구들이진행되고 있다. 이 연구의 목적은 시험관 실험을 통하여 이미 밝혀진 후박 및 대조추출물의 치주질환 원인 균에 대한 항균, 항염효과를 성견에서 인위적으로 치주질환을 일으킨 후 실험 약제의 경구투여를 통하여 질환의 진행에 미치는 영향을 알아보는 것이다. 실험동물은 생후 18개월된 비글견 6마리를 이용하였다. 상악은 제2,3 소구치 및 제4소구치에 하악은 제2, 3, 4 소구치 및 제1 대구치를 실험대상 치아로 하였으며 교정용 철사와 봉합사를 이용하여 치경부주위에 결찰하여 인위적 치주질환을 일으켰다. 염증 유발 8주 후에 결찰을 풀고 실험동물을 아무 것도 투여하지 않은 군(음성대조군, 3마리), 후박 및 대조 추출혼합물 투여군(실험군, 3마리)으로 나누었다. 실험 시작 (-8주), 약제 투여 시작(0주), 투여 후 2, 4, 6, 8주째에 치태지수, 치은지수, Florida Probe를 이용한 치주낭깊이 및 치은열구액 등의 임상지수를 측정하였다. 염증유발 8주동안에 치태지수, 치은지수, 치주낭깊이, 치은열구액은 급속히 증가하였다. 결찰은 제거하고, 약제를 투여한 이후 실험군에서 치은지수, 치주낭깊이, 치은열구액은 가장 높은 값을 나타내고 있었다. 실험군에서는 8주가 될때까지 임상지수 수치가 낮아지고 있었으며, 8주째에는 대부분의 지수에서 음성대조군과 유의성 있는 차이를 보이고 있었다. 양성대조군에서 비해서 실험군은 대부분의 경우에 임상지수가 나이지고 있었지만 6주 또는 8주째의 치은지수, 치주낭깊이 중 일부만을 제외하고는 유의성 있는 차이를 보이지는 않았다. 이 연구결과 후박 및 대조 추출혼합물이 in vitro뿐만 아니라 in vivo 상태에서도 치주염의 치료 및 골재생의 효과가 있음을 알 수 있었으며, 이와 같은 동물실험의 결과를 바탕으로 임상시험을 거쳐 향후 사람에게 유용한 치주염치료제로 개발, 사용될 수 있을 것으로 여겨진다.

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A Comparative Study of Facemask Therapy with Two Types of Bonded Expander (Bonded expander 형태에 따른 facemask의 치료 효과 비교연구)

  • Lee, Eunha;Park, Kitae
    • Journal of the korean academy of Pediatric Dentistry
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    • v.41 no.4
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    • pp.298-305
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    • 2014
  • The purpose of this study is to evaluate the effects of facemask therapy in patients with Class III malocclusion with two types of bonded expanders covering different numbers of anchored teeth and to compare the anchorage value of two types of bonded expander. Eighteen subjects with Class III malocclusion in early mixed dentition were included in this study, and subjects were divided into two groups based on the number of teeth covered by bonded expander: group 1 (splinting four teeth on each side, 9 subjects) and group 2 (splinting three teeth on each side, 9 subjects). Lateral cephalograms were obtained and assessed before (T1) and after (T2) the treatment. The facemask therapy showed skeletal effects including anterior movement of maxilla and backward rotation of mandible in both groups, with no significant differences between groups. Mesial movement of maxillary molars which indicates anchorage loss of the bonded expander was found in both groups, but significantly larger mesial movement was found in group 2 than in group 1. In conclusion, the value of anchorage was different according to the number of teeth covered by bonded expander as an intraoral anchorage of facemask, but there were no significant differences in skeletal effects.

The Palaeoenvironmental Changes and Macromammal Evolution during the Pleistocene in East Asia (동아시아의 제4기 자연환경의 변화와 젖먹이근동물의 제4기적 진화)

  • Sun Joo, Park
    • The Korean Journal of Quaternary Research
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    • v.2 no.1
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    • pp.51-85
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    • 1988
  • The understanding of the faunal sequence and palaeoenvironment of East Asia since the Late Tertiary depends mainly on the knowledge of Chinese fauna and its environmental changes. The recent Chinese researches including geology, geomorphology, climats fluctuation and loess distribution of this area have provided that the rapid uplifting of Himalayas and Qinghai/Xizang Plateau since the Lower Pleistocene was a main selective factor for the process of environmental changes in this vast territory. Although different concepts of the Plio-Pleistocene boundary have been provided, its boundary can not exceed over 2 mya. Instead of the traditional zoogeographical dicthomy in China, faunal compositions of Pleistocene are divided into three faunal zones. The knowledge of macrofaunal evolution in China are useful to understand the palaeoecology of East Asia. Palaeoenvironment of Korea during the Pleistocene Period can be reconstructed by using the analogy of the current Chinese studies.

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Distribution Pattern of Aquatic Insects in the Upper and Middle Reaches of the Chikuma River in Central Japan (Chikuma 강 상-중류 수역 수서곤충의 분포 양상 (Central Japan))

  • Kimura, Goro;Fukunaga, Yachiyo;Kimio, Hirabayashi
    • Korean Journal of Ecology and Environment
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    • v.37 no.4 s.109
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    • pp.394-399
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    • 2004
  • The species composition and abundance of aquatic insects were investigated by light trap in summer, 2002 at three stations in the Chikuma River, Japan's longest river. A total of 3278 adults/day were collected, the great majority (57.5%) of which were Diptera, followed by Trichoptera (35.4%) and then Ephemeroptera (7.1%). The number of collected aquatic insects and their biomass gradually increased towards downstream, whereas the number of species and species diversity index (H') decreased. 36 species (H'= 4.30) of aquatic insects were collected at St. 1, versus 31 species (H'= 2.81) at St. 3. Moreover, the relative abundance of functional feeding groups changed from St. 1 to St. 3, i.e., 'collectors' increased and 'shredders' decreased.

Effect of Ondansetron Alone and Combination of Naltrexone and Ondansetron on Alcohol Intake in C57BL/6 Mice (Naltrexone과 ondansetron의 병합투여가 C57BL/6형 생쥐의 알코올 섭취량에 미치는 영향)

  • Kim, Hyeun-Kyeung;Kim, Sung-Gon;Kang, Cheol-Joong;Park, Sang-Ick;Kim, Won-Ho
    • Journal of Life Science
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    • v.17 no.11
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    • pp.1576-1581
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    • 2007
  • Dopamine reward pathway projecting from ventral tegmental area to nucleus accumbens is well known as playing an important role in alcohol dependence. It is supposed that this dopamine pathway is modulated by $5-HT_3$ nervous system, and it was reported that ondansetron (OND), $5-HT_3$ receptor antagonist, reduced drinking amount and increased abstinence rate in alcohol-dependent patients. The purpose of this study is to investigate the effect of combination of OND and naltrexone (NTX), non-specific opioid receptor antagonist, on alcohol intake in C57BL/6 mice. In 40 C57BL/6 mice in the state of alcohol dependence, vehicle, while OND 0.01 mg/kg, or NTX 1.0 mg/kg administrated respectively, or OND 0.01 mg/kg and NTX 1.0 mg/kg administrated simultaneously for ten days, medication effects on 2-hr alcohol, 22-hr water, 24-hr food intake and body weight were studied. When vehicle group was compared with 3 medication groups respectively, using a repeated measure ANOVA, NTX alone and vehicle groups showed a significant medication by time interaction (p=0.042) in 2-hr alcohol intake, but in the other 2 groups, OND and NTX combination group and OND alone group, there was no significant interaction with vehicle group in 2-hr alcohol intake. From these results, it is suggested that there is no effect on alcohol intake in mice treating with OND, and naltrexone#s suppression effect on alcohol intake in mice is attenuated when treating with OND and NTX simultaneously. It is supposed that a further study looking at the interactions of serotonin, dopamine and opioid nerves systems will be needed.

EFFECT OF BISCOVER ON THE MARGINAL MICROLEAKAGE OF COMPOSITE RESIN RESTORATION (복합레진 수복물의 변연 미세누출에 관한 BiscoverTM 전색제의 효과)

  • Cho, Young-Gon;Choi, Hee-Young
    • Restorative Dentistry and Endodontics
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    • v.30 no.5
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    • pp.355-362
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    • 2005
  • The purpose of this study was to compare the effect on marginal leakage of a resin surface sealant (Biscover) applied before or after polymerization of composite resin to unsealed composite restorations. Thirty Class V cavities with the occlusal margin in enamel and cervical margin in dentin or cementum were prepared on the buccal surfaces of sound extracted molars and restored with a microfilled light-cured composite resin (Micronew). Restorations were randomly assigned into one of three equal groups (n = 10): a control group - no surface sealing, group 1 - applied Biscover after polymerization of the composite resin. and group 2 - applied Biscover before polymerization of the composite resin. Specimens were thermocycled, immersed in a $20\%$ methylene blue solution for 4 hoots, sectioned longitudinally, and analyzed for leakage at the occlusal and gingival margins. The results of this study were as follows 1. In sealed group, group 2 showed higher microleakage than group 1 at both occlusal and gingival margins. but there was no significant difference between two groups (p > 0.05). 2. Unsealed control group showed a little higher microleakage than sealed group at occlusal margins, and a little Higher or similar microleakage than sealed group at gingival margins (p > 0.05) 3. Control group and group 2 showed significantly less microleakage at the occlusal margins, but group 1 showed no significantly difference between microleakage at the occlusal and gingival margins.

Effects of Estrogen Receptor $\alpha$-Selective Agonist Propyl Pyrazole Triol on the Morphology of Accessory Genital Glands of Male Mouse (수컷 생쥐 부속 생식샘의 형태에 미치는 에스트로겐 수용체 $\alpha$의 선택적 효능제 propyl pyrazole triol의 영향)

  • Han, Ji-Yeon;Cho, Hyun-Wook
    • Applied Microscopy
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    • v.39 no.1
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    • pp.17-25
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    • 2009
  • This study investigated that exposure of male mice to estrogen receptor $\alpha$-selective agonist, 4,4',4"-(4-propyl-[1H]-pyrazole-1,3,5-triyl)tris-phenol (PPT) induce morphological changes of accessory genital glands. The male reproductive organs were fixed and processed for light microscopy. The PPT induced decreases of ventral prostates, seminal vesicles and preputial glands weights with experimental time. The glandular lumen of ventral prostate was atrophied compared with control group. Type of epithelial tissues in the prostate was changed from simple columnar epithelium to stratified cuboidal or squamous epithelium. Treated group with the agonist showed that increased connective tissue underlying epithelium in the prostate and seminal vesicle. Especially, the glandular lumen of the seminal vesicle was contracted when PPT-treated animals were compared with control group. Secretion cells of preputial gland were smaller than that of control group. On week 8, PPT treatment caused decrease of epithelial cell height lining the lumen of preputial gland. These results provide information useful in researching the physiological function of estrogen mediated by estrogen receptor $\alpha$ in male accessory genital gland.