• Title/Summary/Keyword: First-line treatment

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The Effects of Electrical Stimulation Therapy with Microchip for the Treatment of Bladder Irritability Symptoms in Stress Urinary Incontinent Women (방광 자극증상을 호소하는 복압성 요실금 환자에서 마이크로칩을 이용한 전기자극치료의 효과)

  • Jung, Hee-Chang;Chung, Yeun-Ho;Shin, Hyoun-Jin
    • Journal of Yeungnam Medical Science
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    • v.21 no.2
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    • pp.207-214
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    • 2004
  • Purpose: This study was carried out to evaluate the efficacy of intravaginal pelvic floor electrical stimulation (FES) therapy on bladder irritability symptoms in stress urinary incontinent women. Materials and Methods: The evaluation before and after treatment included the Blaivas's female Bladder Questionnaire, the quality of life questionnaires and the overall satisfaction with present voiding state using visual analogue test (VAT). All patient were treated for 20 minutes, twice a week for 6 weeks, using a new intravaginal electrical stimulator with microchip (PIC16C74). Results: After the FES therapy, the overall success rate of the SUI was 50.4.% at 9 months. The bladder irritability symptoms such as frequency, nocturia, urgency, residual urine sensation and lower abdominal discomfort were improved. In particular, the symptoms of frequency, urge incontinence, dysuria were significantly improved after the FES therapy at 9 months. The VAT score of the overall satisfaction with the present voiding state was significantly lower after the FES therapy. 73.7% of patients were satisfied with the FES therapy and complications such as hemorrhage, vaginitis, urinary tract infection and pain were not encountered. Conclusion: These results suggest that FES therapy with microchip improves some bladder irritability in SUI women. Therefore, electrical stimulation therapy should be considered as a first line therapy in SUI women with bladder irritability symptoms.

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Treatment with a Small Synthetic Compound, KMU-193, induces Apoptosis in A549 Human Lung Carcinoma Cells through p53 Up-Regulation

  • Choi, Eun Young;Shin, Kyeong-Cheol;Lee, Jinho;Kwon, Taeg Kyu;Kim, Shin;Park, Jong-Wook
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.14
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    • pp.5883-5887
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    • 2015
  • Despite recent advances in therapeutic strategies for lung cancer, mortality still is increasing. In the present study, we investigated the anti-cancer effects of KMU-193, 2-(4-Ethoxy-phenyl)-N-{5-[2-fluoro-4-(4-methylpiperazine-1-carbonyl)-phenylamino]-1H-indazol-3-yl}-acetamide in a human non-small cell lung cancer cell line A549. KMU-193 strongly inhibited the proliferation of A549 cells, but it did not have anti-proliferative effect in other types of cancer cell lines. KMU-193 further induced apoptosis in association with activation of caspase-3 and cleavage of PLC-${\gamma}1$. However, KMU-193 had no apoptotic effect in untransformed cells such as TMCK-1 and BEAS-2B. Interestingly, pretreatment with z-VAD-fmk, a pan-caspase inhibitor, strongly abrogated KMU-193-induced apoptosis. KMU-193 treatment enhanced the expression levels of p53 and PUMA. Importantly, p53 siRNA transfection attenuated KMU-193-induced apoptosis. Collectively, these results for the first time demonstrate that KMU-193 has strong apoptotic effects on A549 cells and these are largely mediated through caspase-3- and p53-dependent pathways.

Radio-Sensitization by Piper longumine of Human Breast Adenoma MDA-MB-231 Cells in Vitro

  • Yao, Jian-Xin;Yao, Zhi-Feng;Li, Zhan-Feng;Liu, Yong-Biao
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.7
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    • pp.3211-3217
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    • 2014
  • Background: The current study investigated the effects of Piper longumine on radio-sensitization of human breast cancer MDA-MB-231 cells and underlying mechanisms. Materials and Methods: Human breast cancer MDA-MB-231 cells were cultured in vitro and those in logarithmic growth phase were selected for experiments divided into four groups: control, X-ray exposed, Piper longumine, and Piper longumine combined with X-rays. Conogenic assays were performed to determine the radio-sensitizing effects. Cell survival curves were fitted by single-hit multi-target model and then the survival fraction (SF), average lethal dose ($D_0$), quasi-threshold dose ($D_q$) and sensitive enhancement ratio (SER) were calculated. Cell apoptosis was analyzed by flow cytometry (FCM). Western blot assays were employed for expression of apoptosis-related proteins (Bc1-2 and Bax) after treatment with Piper longumine and/or X-ray radiation. The intracellular reactive oxygen species (ROS) level was detected by FCM with a DCFH-DA probe. Results: The cloning formation capacity was decreased in the group of piperlongumine plus radiation, which displayed the values of SF2, D0, Dq significantly lower than those of radiation alone group and the sensitive enhancement ratio (SER) of D0 was1.22 and 1.29, respectively. The cell apoptosis rate was increased by the combination treatment of Piper longumine and radiation. Piper longumine increased the radiation-induced intracellular levels of ROS. Compared with the control group and individual group, the combination group demonstrated significantly decreased expression of Bcl-2 with increased Bax. Conclusions: Piper longumine at a non-cytotoxic concentration can enhance the radio-sensitivity of MDA-MB-231cells, which may be related to its regulation of apoptosis-related protein expression and the increase of intracellular ROS level, thus increasing radiation-induced apoptosis.

Survival Analysis in Advanced Non Small Cell Lung Cancer Treated with Platinum Based Chemotherapy in Combination with Paclitaxel, Gemcitabine and Etoposide

  • Natukula, Kirmani;Jamil, Kaiser;Pingali, Usha Rani;Attili, Venkata Satya Suresh;Madireddy, Umamaheshwar Rao Naidu
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.8
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    • pp.4661-4666
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    • 2013
  • Background: The wide spectrum of clinical features in advanced stages of non-small cell lung cancer (NSCLC) probably contributes to disparities in outcomes because of different prognostic variables significant for stage IIIB/IV patients. Hence the aim of this study was to check for favorable response of patients to various chemotherapeutic combinations with respect to patient survival in stage IIIB and stage IV NSCLC disease. We selected those patients for our study who were receiving treatment with paclitaxel, gemcitabine or etoposide in combination with platinum based drugs. Materials and Methods: Seventy-two patients who visited the hospital from June 2009 to November 2012 with confirmed diagnosis of lung cancer were included, and data were collected for follow up and classified according to treatment received with respect to patients' regimen and response, and overall survival. This study analyzed tumor variables that were associated with clinical outcome in advanced NSCLC patients who were undergoing first-line chemotherapy for stage IIIB/IV NSCLC. Results: Comparative data on various parameters like age, gender, stage, histology, site of disease, metastatic site and chemo-regimens was analyzed; these parameters predicted variable significant improvement for overall survival ($p{\geq}0.05$). One and two year survival rates were 20.8% and 15.3%. Conclusions: In this study we found slight improvement in survival rates in NSCLC and clinical outcomes with one combination (carboplatin+paclitaxel). Overall there were only marginal differences in survival rates for other chemo-regimens evaluated in this study.

Concurrency of Guillain-Barre syndrome and acute transverse myelitis: a case report and review of literature

  • Tolunay, Orkun;Celik, Tamer;Celik, Umit;Komur, Mustafa;Tanyeli, Zeynep;Sonmezler, Abdurrahman
    • Clinical and Experimental Pediatrics
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    • v.59 no.sup1
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    • pp.161-164
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    • 2016
  • Guillain-$Barr{\acute{e}}$ syndrome and acute transverse myelitis manifest as demyelinating diseases of the peripheral and central nervous system. Concurrency of these two disorders is rarely documented in literature. A 4-year-old girl presenting with cough, fever, and an impaired walking ability was admitted to hospital. She had no previous complaints in her medical history. A physical examination revealed lack of muscle strength of the lower extremities and deep tendon reflexes. MRI could not be carried out due to technical problems; therefore, both Guillain-$Barr{\acute{e}}$ syndrome and acute transverse myelitis were considered for the diagnosis. Intravenous immunoglobulin treatment was started as first line therapy. Because this treatment did not relieve the patient's symptoms, spinal MRI was carried out on the fourth day of admission and demyelinating areas were identified. Based on the new findings, the patient was diagnosed with acute transverse myelitis, and high dose intravenous methylprednisolone therapy was started. Electromyography findings were consistent with acute polyneuropathy affecting both motor and sensory fibers. Therefore, the patient was diagnosed with concurrency of Guillain-$Barr{\acute{e}}$ syndrome and acute transverse myelitis. Interestingly, while concurrency of these 2 disorders is rare, this association has been demonstrated in various recent publications. Progress in diagnostic tests (magnetic resonance imaging and electrophysiological examination studies) has enabled clinicians to establish the right diagnosis. The possibility of concurrent Guillain-$Barr{\acute{e}}$ syndrome and acute transverse myelitis should be considered if recovery takes longer than anticipated.

Transventricular Biopsy of Brain Tumor without Hydrocephalus Using Neuroendoscopy with Navigation

  • Song, Ji-Hye;Kong, Doo-Sik;Seol, Ho-Jun;Shin, Hyung-Jin
    • Journal of Korean Neurosurgical Society
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    • v.47 no.6
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    • pp.415-419
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    • 2010
  • Objective : It is usually difficult to perform the neuroendoscopic procedure in patients without hydrocephalus due to difficulties with ventricular cannulation. The purpose of this study was to find out the value of navigation guided neuroendoscopic biopsy in patients with peri- or intraventricular tumors without hydrocephalus. Methods : Six patients with brain tumors without hydrocephalus underwent navigation-guided neuroendoscopic biopsy. The procedure was indicated for verification of the histological diagnosis of the neoplasm, which was planned to be treated by chemotherapy and/or radiotherapy as the first line treatment, or establishment of the pathological diagnosis for further choice of the most appropriate treatment strategy. Results : Under the guidance of navigation, targeted lesion was successfully approached in all patients. Navigational tracking was especially helpful in entering small ventricles and in approaching the third ventricle through narrow foramen Monro. The histopathologic diagnosis was established in all of 6 patients : 2 germinomas, 2 astrocytomas, 1 dysembryoplastic neuroepithelial tumor and 1 pineocytoma. The tumor biopsy sites were pineal gland (n = 2), suprasellar area (n = 2), subcallosal area (n = 1) and thalamus (n = 1). There were no operative complications related to the endoscopic procedure. Conclusion : Endoscopic biopsy or resection of peri- or intraventricular tumors in patients without hydrocephalus is feasible. Image-guided neuroendoscopic procedure improved the accuracy of the endoscopic approach and minimized brain trauma. The absence of ventriculomegaly in patients with brain tumor may not be served as a contraindication to endoscopic tumor biopsy.

Drug Interaction in New Antipsychotics (새로운 항정신병약물의 약물상호작용)

  • Kim, Yong Sik;Kang, Ung Gu;Roh, Myoung Sun
    • Korean Journal of Biological Psychiatry
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    • v.7 no.1
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    • pp.14-20
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    • 2000
  • Recently atypical antipsychotics have been used as first line agent in the treatment of schizophrenia, and also played a significant role in the treatment of many kinds of psychiatric disorders. The pharmacokinetic and pharmacodynamic properties of these newer antipsychotics are well known through preclinical and early clinical trials. However, it is important to note the limitations of the results due to its relatively short experience. Clozapine is eliminated principally by the hepatic P450 1A2 and 3A4 cytochrome enzymes. 1A2 inducers such as carbamazepine and smoking can reduce its half-life, while 1A2 inhibitors such as SSRIs, especially fluvoxamine can increase its duration of action. Carbamazepine should be avoided in a patient on clozapine because of carbamazepine's potential effects on bone marrow. Benzodiazepines tend to increase the chances of sedation, delirium and respiratory depression. Risperidone is metabolized to 9-hydroxyriperidone by the hepatic P450 2D6 cytochrome enzymes. Fluoxetine and paroxetine, 2D6 inhibitors interfere with metabolism, but 9-hydroxyrisperidone has similar biological activity as parental drug, so it has little affect on the outcome. Olanzapine shows minimal capacity to inhibit cytochrome P450 isoenzymes and shows minimal chance of drug interaction. It is eliminated principally by the hepatic P450 1A2 and 2D6 cytochrome enzymes.

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Progression of Subdural Effusion after Surgical Treatment (뇌경막하수종의 수술적 치료에 따른 임상 경과)

  • Kim, Jaehyeon
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.14 no.4
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    • pp.1765-1773
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    • 2013
  • The purpose of this study was to contribute to the medical treatment of subdural effusion through clinical sequence analysis of patients who experienced improvement of subdural drainage and had a second operation for subdural drainage or subduroperitoneal shunt. Sixteen cases of the whole patients who have been underwent subdural effusion and subdural drainage were analyzed during the period from 2006 July to 2012 June. The study gave us a result that all of patients, who was taking aspirin, have been under the second operation(p<0.001) and these group have had a subduraoperitoneal shunt(p=0.014)). According to the comparative analysis for the patients group that divided into two; one had subduroperitoneal shunt and the other had no subduroperitoneal shunt, the outcomes of this study were shown as follows. First, their median line deviation was serious in their brain CT. In addition, their subdural effusion increased or did not change with a headache, vomiting, fever and dyspnea. As a result of those symptoms. subduraoperitoneal shunt was carried out(p=0.006). The surgical method for patients who were taken asprin must be cautiously selected and the prevention of sudden disappearance of cerebrospinal fluid and excessive change of intracranial pressure is very important in operation craniectomy.

Botulinum Toxin Therapy versus Anterior Belly of Digastric Transfer in the Management of Marginal Mandibular Branch of the Facial Nerve Palsy: A Patient Satisfaction Survey

  • Butler, Daniel P;Leckenby, Jo I;Miranda, Ben H;Grobbelaar, Adriaan O
    • Archives of Plastic Surgery
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    • v.42 no.6
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    • pp.735-740
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    • 2015
  • Background Botulinum toxin (BT) chemodenervation and anterior belly of digastric muscle (ABD) transfer are both treatment options in the management of an isolated marginal mandibular branch of the facial nerve (MMB) palsy. We compare the patient satisfaction following either BT injections or ABD transfer in the management of their isolated MMB palsy. Methods Patients in the ABD-arm of the study were identified retrospectively from September 2007 to July 2014. The patients in the BT-arm of the study were identified prospectively from those attending the clinic. Both groups of patients completed a validated patient satisfaction survey. Statistical analysis was performed and a P-value <0.05 was considered statistically significant. Results Seven patients were in the ABD-arm and 11 patients in the BT-arm of the study. The patient satisfaction in both groups was high with 45% of ABD-arm patients and 40% of BT-arm patients rating their overall outcome as 'better' or 'much better', which was significantly more than the proportion rating their outcome as 'worse' or 'much worse' (P<0.001), although there was a significant trend towards those in the ABD-arm being more likely to be dissatisfied with their outcome (P=0.01). Conclusions BT therapy is a good first-line intervention in the management of isolated MMB palsy. We have, however, shown that the overall satisfaction in both groups is high. Therefore, in patients who would prefer a more permanent solution to manage their facial asymmetry, ABD transfer remains a satisfactory treatment option with a good level of patient satisfaction.

Can denosumab be a substitute, competitor, or complement to bisphosphonates?

  • Kim, Su Young;Ok, Hwoe Gyeong;Birkenmaier, Christof;Kim, Kyung Hoon
    • The Korean Journal of Pain
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    • v.30 no.2
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    • pp.86-92
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    • 2017
  • Osteoblasts, originating from mesenchymal cells, make the receptor activator of the nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) in order to control differentiation of activated osteoclasts, originating from hematopoietic stem cells. When the RANKL binds to the RANK of the pre-osteoclasts or mature osteoclasts, bone resorption increases. On the contrary, when OPG binds to the RANK, bone resorption decreases. Denosumab (AMG 162), like OPG (a decoy receptor), binds to the RANKL, and reduces binding between the RANK and the RANKL resulting in inhibition of osteoclastogenesis and reduction of bone resorption. Bisphosphonates (BPs), which bind to the bone mineral and occupy the site of resorption performed by activated osteoclasts, are still the drugs of choice to prevent and treat osteoporosis. The merits of denosumab are reversibility targeting the RANKL, lack of adverse gastrointestinal events, improved adherence due to convenient biannual subcutaneous administration, and potential use with impaired renal function. The known adverse reactions are musculoskeletal pain, increased infections with adverse dermatologic reactions, osteonecrosis of the jaw, hypersensitivity reaction, and hypocalcemia. Treatment with 60 mg of denosumab reduces the bone resorption marker, serum type 1 C-telopeptide, by 3 days, with maximum reduction occurring by 1 month. The mean time to maximum denosumab concentration is 10 days with a mean half-life of 25.4 days. In conclusion, the convenient biannual subcutaneous administration of 60 mg of denosumab can be considered as a first-line treatment for osteoporosis in cases of low compliance with BPs due to gastrointestinal trouble and impaired renal function.