• 제목/요약/키워드: First-line treatment

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Treatment of steroid-resistant pediatric nephrotic syndrome

  • Kang, Hee-Gyung
    • Clinical and Experimental Pediatrics
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    • 제54권8호
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    • pp.317-321
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    • 2011
  • Children who suffer from steroid-resistant nephrotic syndrome (SRNS) require aggressive treatment to achieve remission. When intravenous high-dose methylprednisolone fails, calcineurin inhibitors, such as cyclosporine and tacrolimus, are used as the first line of treatment. A significant number of patients with SRNS progress to end-stage renal disease if remission is not achieved. For these children, renal replacement therapy can also be problematic; peritoneal dialysis may be accompanied by significant protein loss through the peritoneal membrane, and kidney allograft transplantation may be complicated by recurrence of SRNS. Plasmapheresis and rituximab were initially used for treatment of recurrent SRNS after transplantation; these are now under consideration as rescue therapies for refractory SRNS. Although the prognosis of SRNS is complicated and unfavorable, intensive treatment in the early stages of the disease may achieve remission in more than half of the patients. Therefore, timely referral of pediatric SRNS patients to pediatric nephrology specialists for histological and genetic diagnosis and treatment is highly recommended.

Delayed treatment-free response after romiplostim discontinuation in pediatric chronic immune thrombocytopenia

  • Lim, Hyun Ji;Lim, Young Tae;Hah, Jeong Ok;Lee, Jae Min
    • Journal of Yeungnam Medical Science
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    • 제38권2호
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    • pp.165-168
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    • 2021
  • We report the case of a 16-month-old patient with chronic immune thrombocytopenia (ITP) patient who experienced delayed treatment-free response (TFR) after romiplostim treatment. He received intravenous immunoglobulin every month to maintain a platelet count above 20,000/µL for 2 years. Thereafter, he received rituximab and cyclosporine as second-line therapy, with no response, followed by romiplostim. After 4 weeks of treatment, the platelet count was maintained above 50,000/µL. Following 7 months of treatment, he discontinued romiplostim, and the platelet count decreased. His platelet counts remained above 50,000/µL, without any bleeding symptoms, 2 years after romiplostim discontinuation. This is the first report of TFR after romiplostim treatment in pediatric chronic ITP.

Carbapenemase-Producing Enterobacterales: Epidemiology, Detection, and Treatment

  • Yun Hee Baek;Kyeong Seob Shin
    • 대한의생명과학회지
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    • 제29권3호
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    • pp.109-120
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    • 2023
  • Recently, the explosive increase of carbapenemase-producing Enterobacterales (CPE) in the worldwide poses a serious threat. The purpose of this study is to investigate epidemiology, detection, and treatment of CPE. Three main carbapenemase are reported worldwide, which were KPC, NDM, and OXA-48-like. KPC type are mostly found in USA, China, Europe, and Latin America. NDM type are mostly found in South Asia. OXA-48-like are often seen in the Mediterranean and Northern Africa. In Korea, CPE have increased explosively since 2015. In 2021, 18,099 CPE were isolated, which were Klebsiella pneumoniae, Escherichia coli, and Enterobacter cloacae in order. The CPE genotype was distributed with KPC, NDM, OXA type in order. Phenotypic detection methods include carbapenemase production tests (CPT) and differential tests of CPE. CPTs include modified Hodge test, modified carbapenem inactivation method (mCIM), Carba NP test, among which mCIM is the most widely used due to easy accessibility and accuracy. A lot of genotypic methods are being done for quick results, and commercialized kits using multiplex real-time PCR and microarray are widely used. Colistin and tigecycline are used as the first line of CPE treatment and are used in combination with second line drugs such as meropenem and fosfomycin.

Update on the Evidence Regarding Maintenance Therapy

  • Lee, Jeong Eun;Chung, Chae-Uk
    • Tuberculosis and Respiratory Diseases
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    • 제76권1호
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    • pp.1-7
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    • 2014
  • Maintenance therapy has emerged as a novel therapeutic paradigm for advanced non-small-cell lung cancer (NSCLC). Maintenance therapy that aims to sustain a clinically favorable state after first-line chemotherapy has two strategies. Switch maintenance therapy entails switching to a new and non-cross-resistant agent in an alternating or sequential manner, on completion of first-line chemotherapy. Continuous maintenance therapy keeps ongoing administration of a component of the current regimen after four to six cycles of chemotherapy, if there is a stable disease, or better response. Both maintenance therapies can be continued, until disease progression. The potential evidence regarding maintenance therapy includes providing the opportunity to receive additional treatment, through sustaining tumor shrinkage, and delayed emergence of tumor-related symptom. Thus far, debates over the parameters used to predict the effectiveness of maintenance therapy, financial burden, and uncertainty of improving the quality of life exist. Despite many debates, maintenance therapy, which is currently recommended, has been disclosed to be beneficial.

Power line interference noise elimination method based on independent component analysis in wavelet domain for magnetotelluric signal

  • Cao, Xiaoling;Yan, Liangjun
    • Geosystem Engineering
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    • 제21권5호
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    • pp.251-261
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    • 2018
  • With the urbanization in recent years, the power line interference noise in electromagnetic signal is increasing day by day, and has gradually become an unavoidable component of noises in magnetotelluric signal detection. Therefore, a kind of power line interference noise elimination method based on independent component analysis in wavelet domain for magnetotelluric signal is put forward in this paper. The method first uses wavelet decomposition to change single-channel signal into multi-channel signal, and then takes advantage of blind source separation principle of independent component analysis to eliminate power line interference noise. There is no need to choose the layer number of wavelet decomposition and the wavelet base of wavelet decomposition according to the observed signal. On the treatment effect, it is better than the previous power line interference removal method based on independent component analysis. Through the de-noising processing to actual magnetotelluric measuring data, it is shown that this method makes both the apparent resistivity curve near 50 Hz and the phase curve near 50 Hz become smoother and steadier than before processing, i.e., it effectively eliminates the power line interference noise.

Phase II Study on Voriconazole for Treatment of Chinese Patients with Malignant Hematological Disorders and Invasive Aspergillosis

  • Zhang, Xue-Zhong;Huang, Xin-En;Xu, Yan-Li;Zhang, Xiu-Qun;Su, Ai-ling;Shen, Zheng-Shan
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권5호
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    • pp.2415-2418
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    • 2012
  • Objective: To investigate the efficacy and safety of voriconazole in treating Chinese patients with hematological malignancies and invasive aspergillosis. Methods: From March 2007 to April 2012, patients with diagnoses confirmed by CT, GM test and/or PCR assays, were recruited into this study. Aspergillosis of all patients were treated with voriconazole 6 mg/kg intravenous infusion (iv) every 12 h for 1 day, followed by 4 mg/kg IV every 12 h for 10-15 days; Then, switch to oral administration that was 200mg every 12h for 4-12 weeks. Efficacy and safety were evaluated according to Practice Guideline of Infectious Diseases Society of America. Results: The overall response rate of 38 patients after voriconazole treatment was 81.6%. The median time to pyretolysis was 4.5 days. Treatment related side effects were mild and found in only 15.8% of cases. No treatment related deaths occurred. Conclusions: Voriconazole can considered to be a safe and effective front-line therapy to treat patients with hematological malignancies and invasive aspergillosis. Alternatively it could be used as a remedial treatment when other antifungal therapies are ineffective.

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.

한국형 양극성 장애 약물치료 알고리듬 2018 : 소아/청소년 (Korean Medication Algorithm for Bipolar Disorder 2018 : Children and Adolescents)

  • 심세훈;박원명;윤보현;전덕인;서정석;김원;이정구;우영섭;정종현;김문두;손인기;송후림;민경준
    • 우울조울병
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    • 제16권3호
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    • pp.109-122
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    • 2018
  • Objectives : The objective of this study was to revise the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2014: Children and Adolescents. Methods : We performed the survey, using a questionnaire comprising 22 questions according to each situation, in children and adolescents with bipolar disorder. Results : First-line pharmacotherapeutic strategies for manic episode in children with bipolar disorder were a combination of mood stabilizer (MS) and an atypical antipsychotics (AAP), monotherapy with an AAP, risperidone, and aripiprazole. Aripiprazole was selected as first-line medication for depressive episode in children with bipolar disorder, and aripiprazole, and risperidone were selected as first-line at high-risk children. First-line pharmacotherapeutic strategies for manic episode in adolescents were a combination of MS and an AAP, monotherapy with an AAP valproate, lithium, risperidone (Treatment of Choice, TOC), aripiprazole, and quetiapine. First-line pharmacotherapeutic strategies for depressive episode in adolescents, were a combination of an atypical antipsychotics and lamotrigine, valproate, aripiprazole (TOC), risperidone, and quetiapine. For depressive episodes in adolescents at high risk for bipolar disorder, valproate, aripiprazole (TOC), and risperidone were selected as first-line medication. Conclusion : We expect that the present KMAP-BP 2018-children and adolescents, is useful for clinicians to treat children and adolescents with bipolar disorder.

고식적 항암화학요법 후에 Capecitabine 단독치료에 반응을 보인 전이성 대장암 환자 1례 (Response to Capecitabine Treatment Following Palliative Chemotherapy for Metastatic Colorectal Cancer: A Case Report)

  • 박대화;김주석;강선형;문희석;성재규;정현용
    • Journal of Digestive Cancer Research
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    • 제5권1호
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    • pp.66-69
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    • 2017
  • 대장암의 치료에 여러 약물이 사용되지만, 5-FU는 오랫동안 대장암의 항암치료의 근간이 되고 있다. Capecitabine은 경구 복용하는 5-FU의 전구체로서, 최근 전이성 대장암의 치료에 사용이 증가되고 있는 약물이다. 저자들은 전이성 대장암 환자에서 고식적인 항암화학요법으로 1차 치료로서 FOLFOX에 좋은 반응을 보였으나, 부작용으로 중단 후 2차 치료로서 Capecitabine 단독요법만을 시행하였음에도 지속적으로 좋은 반응을 보이며 추적관찰하고 있는 사례를 문헌고찰과 함께 보고하는 바이다.

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Modified Docetaxel and Cisplatin in Combination with Capecitabine (DCX) as a First-Line Treatment in HER2-Negative Advanced Gastric Cancer

  • Bilici, Ahmet;Selcukbiricik, Fatih;Demir, Nazan;Ustaalioglu, Bala Basak Oven;Dikilitas, Mustafa;Yildiz, Ozcan
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권20호
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    • pp.8661-8666
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    • 2014
  • Background: Docetaxel and cisplatin in combination with fluorouracil (DCF) regimen is accepted to be one of the standard regimens in the treatment of advanced gastric cancer. However, substantial toxicity has limited its use in daily clinical practice. Therefore, modification of DCF regimens, including introduction of capecitabine has been investigated to improve the safety profiles. In the present study, the efficacy and toxicity of a regimen with a modified dose of docetaxel and cisplatin in combination with oral capecitabine (DCX) was evaluated in untreated patients with HER2-negative advanced gastric cancer. Materials and Methods: Fifty-four patients with HER2-negative locally advanced or metastatic gastric cancer were included in this cohort. Patients received docetaxel $60mg/m^2$ plus cisplatin $60mg/m^2$ (day 1) combined with capecitabine $1650mg/m^2$ (days 1-14) every 3 weeks. Treatment response, survival, and toxicity were retrospectively analyzed. Results: The median age was 54 years (range: 24-76). The majority of patients (70%) had metastatic disease, while 11 patients (21%) had recurrent disease and underwent curative gastrectomy, and 5 patients (9%) had locally advanced disease (LAD). The median number of DCX cycles was 4. There were 28 partial responses and 11 complete responses, with an overall response rate of 72%. Curative surgery could be performed in four patients among five with LAD. At the median follow-up of 10 months, the median progression-free survival (PFS) and overall survival (OS) of the entire cohort of patients were 7.4 and 12.1 months, respectively. Dose modification was done in 12 patients due to toxicity in 8 and noncompliance in 4 patients. The most common hematological toxicity was neutropenia, which occurred at grade 3-4 intensity in 10 of 54 patients (27.7%). Febrile neutropenia was diagnosed only in two cases. Conclusions: DCX regimen offers prominent anti-tumor activity and considered to be effective first-line treatment with manageable toxicity for patients with HER2-negative advanced gastric cancer.