• Title/Summary/Keyword: First-line treatment

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Antibiotics for bacterial pneumonia in children (세균성 폐렴과 항생제 선택)

  • Yum, Hye-yung
    • Clinical and Experimental Pediatrics
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    • v.52 no.3
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    • pp.283-288
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    • 2009
  • Pneumonia remains the leading cause of mortality in children. Diagnosis depends on a combination of factors, including clinical assessment, radiological and laboratory findings. Although Streptococcus pneumoniae remains the most important cause of childhood bacterial pneumonia, the great majority of cases of community-acquired pneumonia (CAP) are of viral etiology. A new, rapid, and inexpensive test that differentiates viral from bacterial pneumonia is needed to decide empiric antibiotic treatment. Antibiotics effective against the expected bacterial pathogens should be instituted where necessary. The role of emerging pathogens and the effect of pneumococcal resistance and heptavalent conjugate pneumococcal vaccines are to be considered in practice. There are reports supporting the valid and highly efficacious use of penicillin as a first-line drug for treating CAP. This review raises the issue of the overuse of unnecessary antibiotics in viral CAPs and the use of second or third-line antibiotics for non-complicated pneumonias in most clinical settings.

Gene expression profiling after ochratoxin A treatment in small intestinal epithelial cells from pigs

  • Jung Woong, Yoon;Sang In, Lee
    • Journal of Animal Science and Technology
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    • v.64 no.5
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    • pp.842-853
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    • 2022
  • Ochratoxin A (OTA) is a well-known mycotoxin that causes disease through the ingestion of contaminated food or feed, for example, in the porcine industry. The intestinal epithelium acts as the first barrier against food contamination. We conducted a study on the exposure of the porcine intestinal epithelium to OTA. We used the intestinal porcine epithelial cell line IPEC-J2 as an in vitro model to evaluate the altered molecular mechanisms following OTA exposure. Gene expression profiling revealed that OTA upregulated 782 genes and downregulated 896, totalling 1678 differentially expressed genes. Furthermore, immunofluorescence, quantitative real-time polymerase chain reaction, and western blotting confirmed that OTA damages the tight junction protein ZO-1. Moreover, OTA activated the expression of inflammatory genes (IL-6, IL-8, IL-10, NF-kB, TLR4, and TNF-α). In summary, this study confirmed that OTA alters various molecular mechanisms and has several adverse effects on IPEC-J2 cells.

Korean Medication Algorithm for Bipolar Disorder 2018 : The Elderly (한국형 양극성 장애 약물치료 알고리듬 2018 : 노인)

  • Jung, Young-Eun;Kim, Moon-Doo;Bahk, Won-Myong;Yoon, Bo-Hyun;Jon, Duk-In;Seo, Jeong Seok;Kim, Won;Lee, Jung Goo;Woo, Young Sup;Jeong, Jong-Hyun;Sohn, InKi;Shim, Se-Hoon;Song, Hoo-Rim;Min, Kyung Joon
    • Mood & Emotion
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    • v.16 no.3
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    • pp.123-128
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    • 2018
  • Objectives : The fourth revision of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was performed to provide more proper guidelines for clinicians. In this study, we evaluated treatment strategies of elderly patients with bipolar disorders of KMAP-BP 2018. Methods : Sixty-one psychiatrists of the review committee with vast clinical experiences in treating bipolar disorders, completed the survey. An expert consensus was obtained, on pharmacological treatment strategies for elderly patients with bipolar disorder. The executive committee analyzed results, and discussed the results to produce the final algorithm. Results : In elderly patients with bipolar disorder, first-line treatment option for acute manic episode is monotherapy, with atypical antipsychotics or mood stabilizer, and a combination of mood stabilizer and atypical antipsychotics. First-line treatment option for acute depressive episode, was a combination of mood stabilizer and atypical antipsychotics, monotherapy with atypical antipsychotic or mood stabilizer, and atypical antipsychotics with lamotrigine. Conclusion : In KMAP-BP 2018, the recommendation for treatment option in elderly patients with bipolar disorder, was newly introduced. We expect this algorithm may provide valuable information, and facilitate treatment of elderly patients with bipolar disorder.

Prognostic factors and treatment of pediatric acute lymphoblastic leukemia

  • Lee, Jae Wook;Cho, Bin
    • Clinical and Experimental Pediatrics
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    • v.60 no.5
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    • pp.129-137
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    • 2017
  • The event-free survival (EFS) for pediatric acute lymphoblastic leukemia (ALL) has shown remarkable improvement in the past several decades. In Korea also, a recent study showed 10-year EFS of 78.5%. Much of the improved outcome for pediatric ALL stems from the accurate identification of prognostic factors, the designation of risk group based on these factors, and treatment of appropriate duration and intensity according to risk group, done within the setting of cooperative clinical trials. The schema of first-line therapy for ALL remains mostly unchanged, although many groups have now reported on the elimination of cranial irradiation in all patients with low rates of central nervous system relapse. Specific high risk subgroups, such as Philadelphia chromosome-positive (Ph+) ALL and infant ALL continue to have significantly lower survival than other ALL patients. The introduction of tyrosine kinase inhibitors into therapy has led to enhanced outcome for Ph+ ALL patients. Infant ALL patients, particularly those with MLL rearrangements, continue to have poor outcome, despite treatment intensification including allogeneic hematopoietic cell transplantation. Relapsed ALL is a leading cause of mortality in pediatric cancer. Recent advances in immunotherapy targeting the CD19 of the ALL blast have shown remarkable efficacy in some of these relapsed and refractory patients. With improved survival, much of the current focus is on decreasing the long-term toxicities of treatment.

In vivo and in vitro efficacy of florfenicol, terbinafine, and mometasone furoate topical otic solution for the treatment of canine otitis externa

  • Bae, Seulgi;Jin, Yunseok;Oh, Taeho
    • Korean Journal of Veterinary Research
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    • v.61 no.4
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    • pp.37.1-37.6
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    • 2021
  • This study evaluated the efficacy of a new, single-dose otic solution combining florfenicol, terbinafine, and mometasone furoate for the treatment of canine otitis externa (OE) in vitro and in vivo. Forty-one client-owned dogs with OE were included in the study and divided into a treatment group that received the test solution and a negative control group that received a normal saline solution. On day 0, the dogs were treated either with the test or the control solution and evaluated over 30 days. Clinical efficacy was evaluated by clinical signs and cytological organism counts. In vitro antimicrobial susceptibility was evaluated by the minimum inhibitory concentration (MIC). After treatment with the test solution, clinical signs continuously decreased and cytological scores were significantly reduced. The results of MIC testing showed that the test solution was potent against the common pathogenic causes of canine OE. In this study, the most common causative pathogens were Staphylococcus pseudintermedius, Pseudomonas spp. and Malassezia pachydermatis. No issues related to safety were identified. Based on these results, this new ototopical drug can be used as first line treatment for canine OE.

Laryngeal silicone stent as a treatment option for laryngeal paralysis in dogs: a preliminary study of 6 cases

  • Theron, Marie-Laure;Lahuerta-Smith, Tomas
    • Journal of Veterinary Science
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    • v.23 no.4
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    • pp.58.1-58.10
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    • 2022
  • Background: Laryngeal paralysis is a common idiopathic degenerative neurological disease in older medium-to-large breed dogs, with surgical correction of the obstruction being the treatment of choice. Objectives: This study evaluated the use of laryngeal silicone stents to treat canine laryngeal paralysis in dogs where classic surgical treatment was not accepted by the owners. Methods: Dogs diagnosed with laryngeal paralysis, for which the owners refused arytenoid lateralization surgery as a first-line treatment, were treated with laryngeal silicone stents. Results: Six dogs with bilateral laryngeal paralysis were included in the study. All dogs showed improvement in clinical signs immediately after the procedure. No clinical signs or radiographic changes were noted in four out of six dogs in the follow-up visit performed 1 wk later. One dog was suspected of aspirating water while drinking, but the signs disappeared after repositioning the stent. Another dog had a relapse of stridor due to caudal migration of the stent. This dog underwent arytenoid lateralization surgery because larger stents are not commercially available. At the time of writing, between seven and 13 mon after stent placement, no significant incidents have occurred in four dogs, and all owners report a satisfactory quality of life. Conclusions: Laryngeal silicone stenting is an interesting alternative for treating dogs with acquired laryngeal paralysis when the owners refuse classic arytenoid lateralization surgery. Furthermore, stent placement can be a temporary solution to stabilize these dogs until a permanent surgical treatment can be performed.

Gamma Knife Radiosurgery for Trigeminal Neuralgia : Review and Update

  • Lee, Seunghoon;Lee, Jung-Il
    • Journal of Korean Neurosurgical Society
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    • v.65 no.5
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    • pp.633-639
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    • 2022
  • Accurate diagnosis of trigeminal neuralgia (TN) is the starting point for optimal treatment. Gamma knife radiosurgery (GKRS) is currently regarded as one of the first-line treatment options for medically refractory TN. GKRS is a less invasive treatment with a low risk of complications than other surgical procedures that provides a favorable pain control Barrow Neurological Institute (BNI) I-IIIb rate of >75% at short-term follow-up. Drawbacks of GKRS include the latency period before pain relief and higher recurrence rate compared with microvascular decompression. Therefore, repeat treatment is necessary if the initial GKRS was effective but followed by recurrence. The concept of dose rate and the biologically effective dose of radiation has been actively studied in radiation oncology and is also applied in GKRS for TN to achieve high safety and efficacy by prescribing the optimal dose. Recent progress in functional imaging, such as diffusion tensor imaging, enables us to understand the pathophysiology of TN and predict the clinical outcome after GKRS. Here, we review TN, GKRS, and recent updates, especially in the concepts of radiation dose, diffusion tensor imaging studies, and repeat treatment in GKRS for TN.

Emerging Trends in the Treatment of Advanced Hepatocellular Carcinoma: A Radiological Perspective

  • Gun Ha Kim;Jin Hyoung Kim;Pyeong Hwa Kim;Hee Ho Chu;Dong Il Gwon;Heung-Kyu Ko
    • Korean Journal of Radiology
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    • v.22 no.11
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    • pp.1822-1833
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    • 2021
  • This is a narrative review of various treatment modalities for advanced hepatocellular carcinoma (HCC), with a focus on recent updates in radiological treatments, as well as novel treatment concepts related to immune checkpoint inhibitors and combination therapies with locoregional treatments. Interventional radiologists have made efforts toward developing alternative and/or combination treatments for first-line systemic treatment of patients with advanced HCC. Locoregional treatments with or without systemic therapy may be considered in the selected patients. Various treatment modalities for advanced HCC are emerging, and several randomized controlled trials, including those of combination treatments with immunotherapy, are ongoing.

A Phase II Study on Continuous Infusional Paclitaxel and 5-Fu as First-line Chemotherapy for Patients with Advanced Esophageal Cancer

  • Gu, Ming;Li, Su-Yi;Huang, Xin-En;Lin, Yan;Cheng, Hong-Yan;Liu, Lin
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.11
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    • pp.5587-5591
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    • 2012
  • Objective: This study was performed to evaluated the efficacy and safety of continuous infusional paclitaxel and 5-Fu as first-line chemotherapy in patients with advanced esophageal squamous cell cancer (ESCC). Methods: A total of 22 patients with advanced esophageal squamous cell cancer with no indications for surgery and radiation therapy, or recurrent patients were enrolled from October 2008 to November 2010. All were treated with PTX 20 $mg/m^2$ was administered through a 16 hours continuous intravenous infusion on days 1 to 3, 8 and 9. DDP 3.75 $mg/m^2$ was given on days 1 to 4 and 8 to 11, continuous infusional 5-FU over 24-hours on days 1 to 5 and 8 to 12 at a dose of 375 $mg/m^2$, and folacin 60 mg orally synchronized with 5-Fu. The treatment was repeated every 21 days for at least two cycles. Results: 22 cases of all enrolled patients could be evaluated for the effect of treatment: 2 cases were CR, 9 cases PR, 5 cases SD and 2 cases PD, giving an overall response rate of 68.2%(15/22). The median time to progression was 7.0 months. The adverse reactions related to chemotherapy were tolerable; the most common toxic effects were marrow depression, alopecia, and fatigue. Conclusion: Low-dose continuous infusional PTX over 16-hours and 5-fu over 24-hours is a promising regimen with good tolerability in treating patients with advanced esophageal squamous cell cancer.

Erlotinib-Related Spontaneous Pneumothorax in Patient with Primary Lung Cancer

  • Nam, Hae-Seong;Lee, Hyeon-Jeong;Kim, Min-Su;Park, Sung-Wook;Jeon, Sang-Hoon;Cho, Jae-Hwa;Kwak, Seung-Min;Lee, Hong-Lyeol;Ryu, Jeong-Seon
    • Tuberculosis and Respiratory Diseases
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    • v.69 no.6
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    • pp.465-468
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    • 2010
  • Spontaneous pneumothorax (SPTx) associated with primary lung cancer is quite rare, but has been reported as the initial presentation or a complication of disease progression. Moreover, chemotherapy-related SPTx in primary lung cancer occurs at a very low frequency, accounting for less than 0.05% of all cases. Here, we report the first case of erlotinib-related SPTx in a patient with advanced lung adenocarcinoma in Korea. After 3 cycles of cisplatin-based chemotherapy as first-line therapy, erlotinib was administered as second-line treatment. Asymptomatic SPTx accompanied by a significant decrease in tumor size was observed in the left lung 7 weeks later. The patient received continuous administration of erlotinib, without additional treatment. This case showed that SPTx can occur in patients with primary lung cancer receiving erlotinib, and asymptomatic chemotherapy-related SPTx in primary lung cancer may not require therapeutic intervention.