• Title/Summary/Keyword: Clinical pathways

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Clinical features and molecular mechanism of muscle wasting in end stage renal disease

  • Sang Hyeon Ju;Hyon-Seung Yi
    • BMB Reports
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    • v.56 no.8
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    • pp.426-438
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    • 2023
  • Muscle wasting in end-stage renal disease (ESRD) is an escalating issue due to the increasing global prevalence of ESRD and its significant clinical impact, including a close association with elevated mortality risk. The phenomenon of muscle wasting in ESRD, which exceeds the rate of muscle loss observed in the normal aging process, arises from multifactorial processes. This review paper aims to provide a comprehensive understanding of muscle wasting in ESRD, covering its epidemiology, underlying molecular mechanisms, and current and emerging therapeutic interventions. It delves into the assessment techniques for muscle mass and function, before exploring the intricate metabolic and molecular pathways that lead to muscle atrophy in ESRD patients. We further discuss various strategies to mitigate muscle wasting, including nutritional, pharmacological, exercise, and physical modalities intervention. This review seeks to provide a solid foundation for future research in this area, fostering a deeper understanding of muscle wasting in ESRD, and paving the way for the development of novel strategies to improve patient outcomes.

Inherited Metabolic Disorders Involving the Nervous System (신경계 이상을 동반하는 선천성 대사 질환)

  • Jeesuk Yu
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.23 no.2
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    • pp.21-30
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    • 2023
  • Inherited metabolic disorders (IMD) are a group of disorders caused by defects in specific biochemical pathways. Up to 85% of IMD display predominantly neurological manifestations by affecting neurodevelopment or causing neurodegeneration. These neurometabolic disorders present with a variety of neurological and non-neurological manifestations. Early diagnosis of IMD is important because some disorders can be treated or improved with specific treatment if detected early. For prompt diagnosis and treatment, it is important to suspect IMD by being familiar with the clinical characteristics, biochemical abnormalities, and characteristic neuroimaging patterns that appear in IMD. Genetic testing, including next-generation sequencing, is also important in diagnosing IMD. During the follow-up of patients with IMD, it is necessary to conduct regular physical and neurological examinations in addition to disease-specific management.

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Effect of Cimetidine on Theophylline Disposition and Metabolic Pathways (Cimetidine의 Theophylline 약동학 및 대사과정에 미치는 효과에 관한 연구)

  • Jang, In-Jin;Lee, Sun-Hee;Shin, Jae-Gook;Shin, Sang-Goo;Park, Chan-Woong
    • The Korean Journal of Pharmacology
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    • v.26 no.1
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    • pp.83-90
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    • 1990
  • The effect of cimetidine on theophylline metabolism was examined in dogs. Single dose intravenous theophylline kinetic studies were performed in cross-over manner before and after one week intravenous cimetidine (30 mg/kg/day) treatment. Cimetidine decreased theophylline clearance by an average of 31% (p<0.05) and prolonged theophylline half-li fe by an average of 29% (p<0.01) compared to those in control peirods. However, steady-state volume of distribution and protein binding of theophylline were not changed significantly. Twenty-four hours urinary excretion of 3-methylxanthine, 1-methyluric acid and 1,3-dimethyluric acid, which are the major metabolites of theophylline, were all decreased after cimetidine treatment, whereas the excreted fractions of individual metabolites were unchanged by cimetidine. From the above data, it could be susggested that cimetidine decreases theophylline clearance and prolongs the half-life by non-specific inhibition of the demethylations and 8-hydroxylation pathways.

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DNA Repair Gene Associated with Clinical Outcome of Epithelial Ovarian Cancer Treated with Platinum-based Chemotherapy

  • Kang, Shan;Sun, Hai-Yan;Zhou, Rong-Miao;Wang, Na;Hu, Pei;Li, Yan
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.2
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    • pp.941-946
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    • 2013
  • Objective: The nucleotide excision repair (NER) and base excision repair (BER) pathways, two DNA repair pathways, are related to platinum resistance in cancer treatment. In this paper, we studied the association between single nucleotide polymorphisms (SNPs) of involved genes and response to platinum-based chemotherapy in epithelial ovarian cancer. Method: Eight SNPs in XRCC1 (BER), XPC and XPD (NER) were assessed in 213 patients with epithelial ovarian cancer using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and primer-introduced restriction analysis-polymerase chain reaction (PIRA-PCR) techniques. Results: The median progression-free survival (PFS) of patients carrying the Lys/Lys and Lys/Gln+Gln/Gln genotype of the XPC Lys/Gln polymorphism were 25 and 12 months, respectively (P=0.039); and the mean overall survival (OS) of patients was 31.1 and 27.8 months, respectively (P=0.048). Cox's multivariate analysis suggested that patients with epithelial ovarian cancer with the Gln allele had an increased risk of death (HR=1.75; 95% CI=1.06-2.91) compared to those with the Lys/Lys genotype. There are no associations between the XPC PAT+/-, XRCC1 Arg194Trp, Arg280His, Arg399Gln, and XPD Asp312Asn, Lys751Gln polymorphisms and the survival of patients with epithelial ovarian cancer when treated with platinum-based chemotherapy. Conclusion: Our results indicated that the XPC Lys939Gln polymorphism may correlate with clinical outcome of patients with epithelial ovarian cancer when treated with platinum-based chemotherapy in Northern China.

Effect of low intensity pulsed ultrasound in activating the mitogen-activated protein kinase signaling pathway and inhibition inflammation cytokine synthesis in chondrocytes

  • Kim, Eun-Jung;Kim, Gye-Yeop
    • Physical Therapy Rehabilitation Science
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    • v.3 no.1
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    • pp.33-37
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    • 2014
  • Objective: Low intensity pulsed ultrasound (LIPUS) has been shown to accelerate cell proliferation and tissue healing in both animal models and clinical trials. However, details of the clinical effects of LIPUS have not been well characterized. The aim of this study was to investigate the effect of LIPUS on mitogen-activated protein kinase (MAPK) activation in rat articular chondrocytes. Design: Cross-sectional study. Methods: Chondrocyte were cultured in six well cell culture plates for 72 hours at $37^{\circ}C$ with 5% $CO_2$, and then exposed to LIPUS at 1.5 MHz frequency and $30-mW/cm^2$ power. Changes in chondrocyte activities were evaluated in response to oxydative stress in dose-dependent (0 and 300 uM) and time-dependent (0-24 hr) manner. The cell viability were analyzed using MTT [3-(4.5-dimethylthiazol-2-yl)-2.5 diphenyltetrazolium bromide]. The expression of p38 MAPK was measured using western blotting. Results: Oxidative stress was induced in rat chondrocytes using hydrogen peroxide ($H_2O_2$). The cell viability was decreased in chondrocytes after the $H_2O_2$ dose and time-dependent treatment. The p38 MAPK phosphorylation occurred at a significantly increased rate after $H_2O_2$ treated (p<0.05). Expression of p38 MAPK was decreased in the p38 inhibitor groups compared with the oxidative stress-induced chondrocyte damage via the p38 MAPK signaling pathways (p<0.05). Conclusions: It could be concluded that LIPUS can inhibit oxidative stress-induced chondrocyte damage via the p38 MAPK signaling pathways.

Decision-Tree Analysis to Predict Blood Pressure Control Status Among Hypertension Patients Taking Antihypertensive Medications (약물복용 중인 고혈압 환자의 혈압관리양상 예측을 위한 의사결정나무분석)

  • Kim, Hee Sun;Jeong, Seok Hee;Park, Sook Kyoung
    • Journal of Korean Biological Nursing Science
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    • v.21 no.1
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    • pp.85-97
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    • 2019
  • Purpose: This study was performed to analyze the levels of blood pressure and to identify good or poor blood pressure control (BPC) groups among hypertension patients. The study was based on the Korea National Health and Nutrition Examination Survey (KNHANES VI and VII) conducted from 2013 to 2016. Methods: The sociodemographic and clinical data of 4,151 Korean hypertension patients aged 20-79 years and who were taking antihypertensive medications was extracted from the KNHANES VI and VII database. Descriptive statistics for complex samples and a decision-tree analysis were performed using the SPSS WIN 24.0 program. Results: The mean age was $62.46{\pm}0.21years$. The mean systolic blood pressure (SBP) was $128.07{\pm}0.28mmHg$, and the diastolic blood pressure (DBP) was $76.99{\pm}0.21mmHg$. 71.9% of participants showed normal blood pressure (SBP < 140mmHg and DBP < 90mmHg). From the decisiontrees analysis, the characteristics of participants related to good BPC group were presented with 9 different pathways same as those from the poor BPC group. Good or poor BPC groups were classified according to the patients' characteristics such as age, living status, occupation, education, hypertension diagnosis period, numbers of comorbidity, perceived health status, total cholesterol, high density lipoprotein-cholesterol, alcohol drinking per month, and depressive mood. Total cholesterol level (< 201mg/dL or ${\geq}201mg/dL$ cutoff point) was the most significant predictor of the participants' BPC group. Conclusion: This decision-tree model with the 18 different pathways can form a basis for the screening of hypertension patients with good or poor BPC in either clinical or community settings.

Status of the Development and Utilization of Critical Pathways in Medical Institutions in South Korea (국내 의료기관의 표준진료지침 개발 및 운영 현황)

  • Oh, In-Ohg;Chang, Tae-Ik;Kim, Hyun-Jin;Han, Jung-Mi;Lee, Chun-Kyon
    • Quality Improvement in Health Care
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    • v.28 no.1
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    • pp.2-13
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    • 2022
  • Purpose: This study assessed the status of the Development and Utilization of critical pathways (CP) in South Korea. Methods: We surveyed 195 hospitals obtained on the Korean Hospital Association website. Data were collected using structured questionnaires for staff members in charge of CP management personnel in these hospitals. The questionnaire included CP developed by the institutions, the coverage rates and completion rates of CP in the current year, and management indicators related to CP. The questionnaire also included CP support systems and content within the institutions and questions regarding the advantages of CP utilization and obstacles associated with the CP development process. Results: Analysis of the responses from 70 hospitals (35.9% response rate) showed that a total of 1,370 CP sets were developed. The number of CP related to surgery departments was 365 (26.6%), and CP related to surgery and procedure was 1,093 (79.8%), respectively. The CP coverage rate was the most frequently used indicator to monitor the effect of CP (97.1%), followed by the completion rate (90.0%) and the length of stay in hospital (61.4%). CP managers reported that CP were highly useful for communication (3.39±0.493) and accurate information provision (3.39±0.491). The perception that CP violated doctors' autonomy in treatment was relatively low (2.87±0.645). Conclusion: It is necessary to establish an infrastructure in hospitals for CP. CP can facilitate communication and provide accurate information.

Bambusae Caulis in Taeniam Applicable for Medical Indications Associated with Inflammation

  • Hyo Jae Choi;Yugyeong Gwak;Ji Yeon Lee;Min Jung Kwun;Jun-Yong Choi;Myungsoo Joo
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.37 no.1
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    • pp.14-18
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    • 2023
  • Jukyeo (竹茹; Bambusae Caulis in Taeniam: BCT) is an herbal medicine made from the inner part of the bamboo stem of Phyllostachys nigra Munro var. henonis Stapf ex Rendle or Phyllostachys bambusoides Siebold et Zuccarini. Although medical literature published in China and Korea decades ago introduced BCT as a remedy for reducing vomiting, fever, and hematemesis, decoctions containing BCT as a main herb (君藥) in Korea have been approved only for treating neurologic symptoms. Here, we discuss the anti-inflammatory function of BCT. Combined with the clinical usage of a BCT-containing decoction in treating inflammatory diseases in Japan, we raise the possibility of repurposing the BCT-containing decoctions for treating inflammatory diseases. The anti-inflammatory activity of BCT was mainly assessed by using RAW 264.7 cells. The regulation of NF-κB, Nrf2 and A20 activities was determined by western blot and quantitative RT-PCR. The list of decoctions containing BCT currently approved in Korea was obtained from the Korean Ministry of Food and Drug Safety (KFDA). BCT suppressed the activity of pro-inflammatory factor NF-κB elicited by LPS, activated an anti-inflammatory factor Nrf2, and induced A20 that is known to block several inflammatory pathways simultaneously, suggesting that BCT can suppress inflammation via at least 3 different pathways. KFDA approved 11 decoctions containing BCT as a major herb, including Gamiondam-tang (加味溫膽湯; GOT), for treating neurologic disorders. Interestingly, Jukyeoondam-tang (竹茹溫膽湯; JOT), whose composition is almost identical to GOT except for one herb, has been used to treat inflammatory pulmonary disorders including Covid-19 pulmonary infection in Japan Given the anti-inflammatory function of BCT evidenced by medical literature and experimental results and the clinical usage of JOT in treating inflammatory pulmonary disorders, we suggest a repurposing and extension of the BCT-containing decoctions approved in Korea to treating inflammatory diseases.

The Mechanism of Proteasome Inhibitor-Induced Apoptosis in Lung Cancer Cells (폐암 세포에서 Proteasome Inhibitor에 의한 Apoptosis의 기전)

  • Kim, Cheol Hyeon;Lee, Kyoung-Hee;Lee, Choon-Taek;Kim, Young Whan;Han, Sung Koo;Shim, Young Soo;Yoo, Chul Gyu
    • Tuberculosis and Respiratory Diseases
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    • v.54 no.4
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    • pp.403-414
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    • 2003
  • Background : Proteasome inhibitors can promote either cell survival or programmed cell death, depending on both the specific type and proliferative status of the cell. However, it is not well known whether inhibition of proteasome activity is related to apoptosis in lung cancer cells. In addition, the exact mechanisms responsible for apoptosis induced by proteasome inhibition are not well understood. In the present study, we have examined the effect of proteasome inhibition on lung cancer cells and tried to test the mechanisms that may be associated with the apoptosis of these cells. Methods : We examined the effect of proteasome inhibition with MG132 or PS-341 on cell survival in A549 and NCI-H157 lung cancer cells using MTT assay, and analyzed the cleavage of PARP by Western blot analysis to find evidence of apoptosis. Next, we evaluated the activation of caspase 3 by Western blot analysis and the activity of JNK by immunocomplex kinase assay. We also examined the changes in anti-apoptotic pathways like ERK and cIAP1 by Western blot analysis after inhibition of proteasome function. Results : We demonstrated that MG132 reduced cell survival by inducing apoptosis in A549 and NCI-H157 cells. Proteasome inhibition with MG132 or PS-341 was associated with activation of caspase 3 and JNK, reduced expression of activated ERK, and downregulation of cIAP1. Conclusion : Apoptosis induced by proteasome inhibition may be associated with the activation of pro-apoptotic pathways like caspase 3 and JNK and the inactivation of anti-apoptotic pathways in lung cancer cells.