• 보험의학회지
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• 제29권1호
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• pp.16-21
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• 2010

The measurement of prostate specific antigen (PSA) in screening for prostate cancer is recently performed as a routine check-up in clinical medicine and insurance medicine. Several factors may affect serum PSA levels. As prostate size increases with increasing age, the PSA concentration also rises. Increasing body mass index (BMI) is associated with a lower mean PSA concentration. Inhibitors of 5-alpha-reductase such as finasteride and dutasteride produce a 50 percent or greater decrease in serum PSA during the first three months of therapy, which persists as long as the drug is continued. Men who are regularly taking non-steroidal antiinflammatory drugs (NSAIDs) or acetaminophen have lower PSA levels. Emerging concepts regarding PSA testing that may help refine the interpretation of an elevated concentration include: PSA density, PSA velocity, and Free versus complexed or bound PSA. With many insurance companies, PSA level has become part of a standard battery of blood tests, along with HIV, cholesterol, liver enzymes, and other predictors of premature death. But, there is no clear proof of benefit, so we have to monitor the value of PSA test as a prostate cancer screening test in insurance medicine.

• 대한임상독성학회지
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• 제16권2호
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• pp.165-171
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• 2018

An overdose of antihypertensive agents, such calcium channel blockers (CCBs) and angiotensin II receptor blocker (ARBs), and the antihyperglycemic agent, metformin, leads to hypotension and lactic acidosis, respectively. A 40-year-old hypertensive and diabetic man with hyperlipidemia and a weight of 110 kg presented to the emergency room with vomiting, dizziness, and hypotension following an attempted drug overdose suicide with combined CCBs, ARBs, 3-hydroxy-3-methylglutaryl-coemzyme A reductase inhibitors, and metformins. A conventional medical treatment initially administered proved ineffective. The treatment was then changed to simultaneous extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), which was effective. This shows that simultaneous ECMO and CRRT can be an effective treatment protocol in cases of ineffective conventional medical therapy for hypotension and lactic acidosis due to an overdose of antihypertensive agents and metformin, respectively.

• The Korean Journal of Physiology and Pharmacology
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• 제3권4호
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• pp.447-454
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• 1999

The production of nitric oxide (NO) and the expression of inducible nitric oxide synthase (iNOS) are known to be modulated by a variety of factors. Recent study showed that endotoxin-induced NO synthesis and iNOS expression were greatly enhanced by elevation of extracellular glucose concentration in murine macrophages. Although this was suggested to be due to the activation of protein kinase C (PKC) via sorbitol pathway, there was lack of evidence for this speculation. This study was performed to delineate the underlying intracellular mechanisms of glucose-enhancing effect on endotoxin-induced NO production in Raw264.7 macrophages. The levels of NO release induced by lipopolysaccharide (LPS) significantly increased by the treatment of glucose in a concentration dependent manner and also, this effect was observed in LPS-preprimed cells. Concurrent incubation of cells with PKC inhibitors, H-7 or chelerythrine, and LPS resulted in the diminution of NO production regardless of glucose concentration but this was not in the case of LPS-prepriming, that is, chelerythrine showed a minimal effect on the glucose- enhancing effect. PMA, a PKC activator, did not show any significant effect on glucose-associated NO production. Modulation of sorbitol pathway with zopolrestat, an aldose reductase inhibitor, did not affect LPS-induced NO production and iNOS expression under high glucose condition. And also, sodium pyruvate, which is expected to normalize cytosolic $NADH/NAD^+$ ratio, did not show any significant effect at concentrations of up to 10 mM. Glucosamine marginally increased the endotoxin-induced nitrite release in both control and high glucose treated group. 6-diazo-5-oxonorleucine (L-DON) and azaserine, glutamine: fructose- 6-phosphate amidotransferase (GFAT) inhibitors, significantly diminished the augmentation effect of high glucose on endotoxin-induced NO production. On the other hand, negative modulation of GFAT inhibitors was not reversed by the treatment of glucosamine, suggesting the minimal involvement, if any, of glucosamine pathway in glucose-enhancing effect. In summary, these results strongly suggest that the hexosamine biosynthesis pathway and the activation of PKC via sorbitol pathway do not contribute to the augmenting effect of high glucose on endotoxin induced NO production in macrophage-like Raw264.7 cells.

• Journal of Yeungnam Medical Science
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• 제20권2호
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• pp.152-159
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• 2003

고지혈증이 관상동맥 죽상 동맥경화증의 가장 중요한 위험 인자이며 또한 고지혈증을 치료할 경우 관상동맥 질환의 발생이 감소한다고 인정되고 있다. 이러한 고지혈증 치료제로 새로 개발된 simvastatin($Zocor^{(R)}$)의 단기사용 시 효과와 안정성을 알아보기 위해 저자들은 simvastatin을 12주 사용하여 연구를 시행하였다. 대상 환자는 원발성 고콜레스테롤 혈증으로 진단받은 환자로서 첫(0주)방문일 기준으로 측정한 혈중 콜레스테롤 농도가 240 mg/dl이상이거나 220 mg/dl이상이면서 병력이 있는 환자를 대상으로 하였으며 HMG-CoA reductase 억제제인 simvastatin을 저녁에 1일 20 mg씩 경구투여하였다. 12주 후 시행한 혈액검사소견상 혈청 총 콜레스테롤치, 저비중 지단백 콜레스테롤치 및 중성지방은 치료전에 비하여 치료후에 의미있게 감소하였고(p<0.05) 고비중 지단백 콜레스테롤치는 변화가 없었으며 simvastatin 투여기간중 약물 부작용은 없었다. 이상의 결과로 보아 simvastatin은 고지혈증 환자의 치료에 단기간 사용할 경우 그 효과가 확실하고 안전한 치료제라 생각된다.

• 한국임상약학회지
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• 제21권2호
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• pp.90-99
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• 2011

Health Insurance Review & Assessment Service (HIRA) claims database has a high potential to detect signals of new drug interactions. The aim of this study was to evaluate the usefulness of information component (IC) and relative risk (RR) as a tool for signal detection, and to analyze the possible drug interactions caused by clopidogrel using HIRA claims database. This study was performed in elderly patients over 65 years of age who administered clopidogrel from January 2005 to June 2006 in South Korea. Serious Adverse Events (SAEs) as drug interactions of clopidogrel were defined as any ambulatory hospitalization for ischemic diseases within comcomitant medication period of clopidogrel. Information Component (IC) and Relative Risk (RR) were calculated to compare the proportion of drug-SAE pairs in order to select drug specific SAEs. IC and RR signals of clopidogrel drug interaction were screened when IC's 95% confidence interval was greater than 0 and RR's 95% confidence interval was greater than 1 respectively. All detected signals were compared to references such as $Micromedex^{(R)}$ and 2010 Drug Interaction $Facts^{TM}$. Sensitivity, specificity, positive predicted value and negative predicted value were used to evaluate usefulness of this method. Among 13,252,930 cases of elderly patients who co-administered clopidogrel and other drugs, 47,485 cases were detected as SAE. Of these, one-hundred nine cases were detected by the IC-based data-mining approach and ninety one cases were detected by the RR-based data-mining approach. Total One-hundred sixty three unrecognized signals were detected by IC or RR. Twelve signals from IC-based data-mining (57.1%) were corresponded with drug interactions from references and eight signals from RR-based data-mining (38.1%) were corresponded with drug interactions from references. These signals include proton pump inhibitors, calcium channel blockers and HMG CoA reductase Inhibitors, which were known to affect CYP450 metabolism. Further studies using HIRA claims database are necessary to develop appropriate data-mining measure.

• 보건행정학회지
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• 제24권2호
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• pp.120-127
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• 2014

Background: Since December 2010, online computerized prospective drug utilization review (pDUR) has been implemented in Korea. pDUR involves the review of each prescription before the medication is dispensed to the individual patient. The pDUR is performed electronically by Health Insurance Review & Assessment Service (HIRA), which is a Korean governmental agency, and then HIRA provides medical institutions and pharmacies with information that can be helpful to them in preventing potential drug problems such as drug/drug interactions or ingredient duplication. The aim of this study was to assess the impact of the Korean pDUR implementation on the proportion of drug-drug interactions (DDIs) using claims data from HIRA. Methods: A before-after comparison of the prevalence of DDIs between prescription was conducted, using HIRA administrative claims data of medical institution from January 2010 to December 2011. The analysis unit was the prescription issued and pairs before and after. The main outcome measures were the proportion of DDIs within- (control group) or between- physician encounters. To examine the difference, a paired t-test was applied. Results: We found that DDIs proportion between prescription decreased significantly (t=3.04, p=0.0026) after the implementation of pDUR, whereas there is no significant reduction within prescription (t=1.15, p=0.2518). With respect to the prevalence of DDIs between drug groups, the most dramatic reduction was occurred between 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors and anti-fungal agents. Conclusion: It seems effective that giving a direct feedback to prescribers by a prospective DUR. Further research is needed to assess the impact of DUR to final outcomes such as hospitalization.

• 혜화의학회지
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• 제18권2호
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• pp.1-12
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• 2009

Most of the cholesterol is synthesized by liver in the body while about one of third is taken via dietary. The main functions of cholesterol is to protect membranes in cell surface, avoid the arterial bleeding by hypertension, and prolong the life of erythrocytes, and so on. However, overload of cholesterol leads to arteriosclerosis associated with leading death cause. Lack of physical activity, emotional and environmental stress, and low intake of protein or vitamin E induce the unbalance between HDL- and LDL-cholesterol so become a basis of ischemic disorders in heart, brain and elsewhere in the body. So far, four major classes of medications for hyperlipidemia are HMG-CoA reductase inhibitors (statins), bile acid sequestrants, nicotinic acid, and fibric acids. The statins can lower LDL and levels triglyceride, but may induce myopathy and an elevation of liver enzyme levels. The bile acid sequestrants lower LDL levels and raise HDL levels with no effect on triglyceride levels but side effects of gastrointestinal (GI) distress, constipation, and a decrease in the absorption of other drugs. Nicotinic acid and fibric acids lower LDL and triglyceride levels with showing flushing, hyperglycemia, hyperuricemia, GI distress, and hepatotoxicity dyspepsia, gallstones, myopathy, and unexplained noncardiac death as adverse effects. Above western drugs lower cholesterol by 15 to 30% while all have notable adverse effects. In traditional medicine, hyperlipidemia is regarded as retention of phlegm and fluid disease. Etiology and pathogenesis of hyperlipidemia is basically based on Spleen-Deficiency and Phlegm-Stagnation, accumulation and stasis of -heat, and Qi & blood stagnation induced by Phlegm-damp, water-dampness, and blood stasis. Thereby, strengthening Spleen and dissolving Phlegm, clearing away heat and diuresis, and supplementing Qi and activating blood circulation are commonly used therapeutic methods for hyperlipidemia. The traditional herbal medicine, have been used for patients with CVA, hypertension or hyperlipidemia in Oriental hospital or Oriental clinic. The lock and key theory is used to develop most of western medicine, however many diseases are caused by mixed factors in body-complex system. We expect that Oriental pharmacological theory could be newborn as a novel drug showing high advantage of blood levels of lipidsand QOL of performance without side effects.

• 한국미생물·생명공학회지
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• 제6권4호
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• pp.155-159
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• 1978

분리된 효모에 의한 aromatic ring compound의 전환반응 실험에 앞서 phenol 자화능에 대한 환경 인자의 영향을 조사하기 위하여 phenol을 유일한 탄소원으로 사용하여 분리된 효모균을 30시간, 3$0^{\circ}C$에서 진탕배양하여 균체증식량을 측정하였다. 1) pH3.5~4.5 온도 35$^{\circ}C$에서 가장 자화능이 우수하였으며 phenol의 처음 농도 1000ppm 까지 는 쉽게 이용할 수 있었고 2000ppm에서는 5 일간 배양시켰을 때 비로소 균체증식이 나타났다. 2) pH 5.0, 배양온도 3$0^{\circ}C$에서 본 균의 maximum specific growth rate는 0.27hr-1 이었으며, phenol 을 1000ppm씩 단계적으로 첨가하면서 phenol 소비율에 대한 균체수율 정수 Y값을 구한 결과 Y=3.2였다. 3) Yeast extract를 필수영양원으로 첨가할 때 0.005~0.01% 농도에서 가장 효과적이었으며, 또 산화환원소 효소 조해제인 HgCl$_2$, phenylhydrazine 을 명명 $10^{-5}$M, $10^{-3}$M을 배지내에 첨가하면 분리된 효모균의 증식을 거의 볼 수 없었다. 4) Phenol의 자화에 명종 실소원의 효과를 비교 해 본 결과 urea가 가장 효과적이었고, 이 효모균은 phenol 외에 catechol, resorcinol, benzidine 을 자화할 수 있다

• Genomics & Informatics
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• 제8권1호
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• pp.41-49
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• 2010

Statins are competitive inhibitors of hydroxy-3-methyl glutaryl coenzyme A (HMG-CoA) reductase and used most frequently to reduce plasma cholesterol levels and to decrease cardiovascular events. However, statins also have been reported to have undesirable side effects such as myotoxicity and hepatotoxicity associated with their intrinsic efficacy mechanisms. Clinical studies recurrently reported that statin therapy elevated the level of liver enzymes such as ALT and AST in patients suggesting possible liver toxicity due to statins. This observation has been drawn great attention since statins are the most prescribed drugs and statin-therapy was extended to a larger number of high-risk patients. Here we employed rat primary hepatocytes and microarray technique to understand underlying mechanism responsible for statin-induced liver toxicity on cell level. We isolated genes whose expressions were commonly modulated by statin treatments and examined their biological functions. It is of interest that those genes have function related to response to stress in particular immunity and defense in cells. Our study provided the basic information on cellular mechanism of statin-induced cytotoxicity and may serve for finding indicator genes of statin -induced toxicity in rat primary hepatocytes.

• 한국식물병리학회:학술대회논문집
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• 한국식물병리학회 1995년도 Proceedings of special lectures on Molecular Biological Approaches to Plant Disease National Agricultural Science and Technology Institute Suwon, Korea
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• pp.55-75
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• 1995

Induction of HMG-Co A reductase (HMGR) is essential for the biosynthesis of sesquiterpenoid phytoalexins and steroid derivatives in Solanaceous plants following wounding and pathogen infection. To better understand this complex step in stress-responsive isoprenoid synthesis, three classes of cDNAs for HMGR (hmg1, hmg2, and hmg3) were isolated from a potato tuber library. The potato cDNAs had extensive homology in open reading frames but had low homology in the 3'-untranslated regions. RNA gel blot analysis using gene-specific probes revealed that hmg1 is induced by wounding but wound induction is strongly suppressed by arachidonic acid or by inoculation with Phytophthora infestants. In contrast, hmg2 and hmg3 are slightly induced by wounding and strongly enhanced by arachidonic acid or inoculation. The induction and suppression of HMGR genes parallel the suppression of steroid and stimulation of sesquiterpenoid accumulations observed in earlier investigations. Treatment of the tuber disks with a low concentration of methyl-jasmonate doubled the wound induced accumulation of hmg1 transcripts and steroid-glycoalkaloid accumulation, but did not affect the abundance of transcripts for hmg2 or hmg3 nor induce phytoalexins. High concentration of methyl-jasmonate suppressed hmg1 mRNA and steroid-glycoalkaloid accumulation, induced hmg3 mRNA, and did not elicit phytoalexins. Lipoxygenase inhibitors suppressed the accumulation of of hmg1 transcripts and steroid-glycoalkaloids, which were restored by exogeneous methyl-jasmonate. Methyl-jasmonate applied together with arachidonic acid enhanced the elicitor induced accumulation of sesquiterpenes and sustained steroid-glycoalkaloid levels with transcript levels for the various HMGR mRNAs equal to or greater than wound-only treatment. These results domonstrate that the consequences of wound- and pathogen-responses of plants are different at the levels of gene expression and associated secondary metabolism.