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Management of Non-pain Symptoms in Terminally Ill Cancer Patients: Based on National Comprehensive Cancer Network Guidelines (말기암환자에서 통증 외 증상의 관리: 최신 NCCN(National Comprehensive Cancer Netweork) 권고안을 중심으로)

  • Lee, Hye Ran
    • Journal of Hospice and Palliative Care
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    • v.16 no.4
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    • pp.205-215
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    • 2013
  • Most terminally ill cancer patients experience various physical and psychological symptoms during their illness. In addition to pain, they commonly suffer from fatigue, anorexia-cachexia syndrome, nausea, vomiting and dyspnea. In this paper, I reviewed some of the common non-pain symptoms in terminally ill cancer patients, based on the National Comprehensive Cancer Network (NCCN) guidelines to better understand and treat cancer patients. Cancer-related fatigue (CRF) is a common symptom in terminally ill cancer patients. There are reversible causes of fatigue, which include anemia, sleep disturbance, malnutrition, pain, depression and anxiety, medical comorbidities, hyperthyroidism and hypogonadism. Energy conservation and education are recommended as central management for CRF. Corticosteroid and psychostimulants can be used as well. The anorexia and cachexia syndrome has reversible causes and should be managed. It includes stomatitis, constipation and uncontrolled severe symptoms such as pain or dyspnea, delirium, nausea/vomiting, depression and gastroparesis. To manage the syndrome, it is important to provide emotional support and inform the patient and family of the natural history of the disease. Megesteol acetate, dronabinol and corticosteroid can be helpful. Nausea and vomiting will occur by potentially reversible causes including drug consumption, uremia, infection, anxiety, constipation, gastric irritation and proximal gastrointestinal obstruction. Metoclopramide, haloperidol, olanzapine and ondansetron can be used to manage nausea and vomiting. Dyspnea is common even in terminally ill cancer patients without lung disease. Opioids are effective for symptomatic management of dyspnea. To improve the quality of life for terminally ill cancer patients, we should try to ameliorate these symptoms by paying more attention to patients and understanding of management principles.

Microbiological Quality and Growth and Survival of Foodborne Pathogens in Ready-To-Eat Egg Products (즉석섭취 알 가공품의 미생물학적 품질 및 주요 식중독 균의 증식·생존 분석)

  • Jo, Hye Jin;Choi, Beom Geun;Wu, Yan;Moon, Jin San;Kim, Young Jo;Yoon, Ki Sun
    • Journal of Food Hygiene and Safety
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    • v.30 no.2
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    • pp.178-188
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    • 2015
  • Microbial quality of baked egg products was evaluated by counting the levels of sanitary indicative bacteria (aerobic plate counts, coliforms, and E. coli), L. monocytogenes and Salmonella spp. at the critical control points (CCPs) of manufacturing process. In addition, the survival and growth of foodborne pathogens in various egg products (cheese, tuna, tteokgalbi, pizza omelets, baked egg, and steamed egg) were investigated at 4, 10, and $15^{\circ}C$. The contamination level of aerobic plate counts decreased from 4.67 log CFU/g at CCP 1 to 0.56 log CFU/g at CCP 3 in baked egg products. No coliforms and E. coli were detected at all CCPs. Although L. innocua and Salmonella spp. were identified at CCP 1, no L. monocytogenes and Salmonella spp. were detected in the final products. The contamination levels of aerobic plate counts and coliforms in egg strips and number of aerobic plate counts in Tteokgalbi omelet are higher than the microbiological standard of processed egg products. At $10^{\circ}C$, the growth of all pathogens was not prevented in omelet and baked egg, but the populations of S. Typhimurium and E. coli were reduced in steamed egg at $10^{\circ}C$, regardless of the presence of other pathogens. The growth of L. monocytogenes was faster than that of S. Typhimurium and E. coli in omelet. More rapid growth of S. Enteritidis than S. Typhimurium was observed in egg products, indicating the greater risk of S. Enteritidis than S. Typhimurium in egg products.

Plasma Levels of High Molecular Weight Adiponectin are Associated with Cardiometabolic Risks in Patients with Hypertension (고혈압 환자에서 혈장 고분자량 아디포넥틴 농도와 심장-대사위험인자와의 관련성 연구)

  • Chung, Hye-Kyung;Shin, Min-Jeong
    • Journal of Nutrition and Health
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    • v.41 no.8
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    • pp.733-741
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    • 2008
  • In the present study, we comprehensively examined the associations of plasma levels of total adiponectin and high molecular weight (HMW) adiponectin with the features of cardiometabolic risks including body fat distribution, dyslipidemia, insulin resistance and inflammatory markers in a cross-sectional study of 110 treated hypertensive patients. Blood lipid profiles, high sensitivity C-reactive protein (hsCRP) and homeostasis model assessment of insulin resistance (HOMA- IR) derived from fasting glucose and insulin concentrations were determined. Plasma levels of tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$), interleukin-6 (IL-6) and intercellular adhesion molecule-1 (ICAM-1) were analyzed using ELISA. The results showed that plasma levels of HMW-adiponectin were negatively associated with body mass index (BMI, r = - 0.203, p < 0.05) and waist circumference (r = -0.307, p < 0.01), which was not shown in total adiponectin. Plasma levels of HMW-adiponectin were negatively associated with triglyceride (r = -0.223, p < 0.05) and positively associated with HDL-cholesterol (r = 0.228, p < 0.05). Plasma levels of adiponectin were positively associated with HDL-cholesterol (r = 0.224, p < 0.05). Plasma levels of HMW-adiponectin were negatively associated with hsCRP (r = -0.276, p < 0.01) and IL-6 (r = -0.272, p < 0.01). In addition, there were weak associations between plasma levels of HMWadiponectin and TNF-${\alpha}$ (r = -0.163, p = 0.07) and ICAM-1 (r = -0.158, p = 0.09). However, there were no significant associations of total adiponectin with inflammatory markers except hsCRP (r = -0.203, p < 0.05). Stepwise multiple linear regression analysis showed that only plasma levels of HMW-adiponectin was an independent factor influencing serum levels of hsCRP, a marker of systemic low grade inflammation, after adjusting for age, gender, BMI, waist circumference, alcohol intake, smoking status, blood lipids, total adiponectin and drug use (p < 0.01). These results suggest that HMW-adiponectin, rather than total adiponectin, is likely to be closely associated with the features of cardiometabolic risks in treated hypertensive patients and might be effective biomarker for the prediction of cardiovascular disease.

Medicinal Herb Extracts Attenuate 1-Chloro-2,4dinitrobenzene-induced Development of Atopic Dermatitis-like Skin Lesions (한약재 단일 추출물 및 복합 추출물을 이용한 아토피성 피부염 억제 효과)

  • Lee, Moon Hee;Han, Min Ho;Yoon, Jung Jeh;Song, Myung Kyu;Kim, Min Ju;Hong, Su Hyun;Choi, Byung Tae;Kim, Byung Woo;Hwang, Hye Jin;Choi, Yung Hyun
    • Journal of Life Science
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    • v.24 no.8
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    • pp.851-859
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    • 2014
  • The present study was designed to investigate whether ethanol extracts of Sophora flavescens (GS), Glycyrrhiza uralensis (GC), Dictamnus dasycarpus (BSP), and their mixtures (GGB-1, -2, -3, and -4) inhibit 1-chloro-2,4-dinitrobenzene (DNCB)-induced atopic dermatitis (AD) in a mouse model. DNCB was topically applied on the dorsal surface of Balb/c mice to induce AD-like skin lesions. The pathological phenotypes of AD, such as erythema, ear thickness, edema, scabs, and discharge, were significantly decreased in the GGB (DNCB + GS:GC:BSP = 3:1:1 mixture)-1-treated groups compared with the other treated groups. The weight of the spleen in immune organs was significantly decreased in the GGB-1-treated groups, whereas the weight of the liver in a control group was similar to that of the groups treated with the samples. Furthermore, toluidine blue staining analysis, a method used to specifically identify mast cells, showed that master cell infiltration into the dermis of the GGB-1-treated group was significantly decreased. The immunoglobulin E concentration was lower in the GGB-1-treated group. In addition, the levels of inflammatory cytokines (interferon-${\gamma}$, interleukin-1, 4, 5, 6, and 13, $1{\beta}$, and tumor necrosis factor-${\alpha}$) were also significantly reduced in the GGB-1-treated group. Taken together, these results suggest that a mixture of GS, GC, and BSP in a proportion of 3:1:1 (GGB-1) may contribute to the relief of AD symptoms and may be considered an excellent candidate for an AD therapeutic drug.

Effect of Powder of Stevia rebaudiana Leaves against Quality Characteristics during Salting of Rice Bran Danmooji (쌀겨단무지의 절임 중 품질 특성의 변화에 대한 스테비아 잎 분말 첨가의 영향)

  • Kim, Yong-Suk;Lee, Sun-Kyu;Jeong, Do-Yeong;Yang, Eun-Jin;Shin, Dong-Hwa
    • Food Science and Preservation
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    • v.14 no.5
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    • pp.497-503
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    • 2007
  • In order to develop a new rice bran danmooji, changes in physicochemical characteristics and texture of danmooji treated with rice bran, Stevia rebaudiana Bertoni leaf powder, succinic acid, or yeast extract were investigated during salting for 90 days. The PH of rice bran danmooji decreased from PH6.41 initially to pH 4.09 (control group), pH 4.10 (S. rebaudiana treatment S1), pH 3.84 (S. rebaudiana + succinic acid treatment S2), and pH 3.90 (S. rebaudiana+succinic acid+yeast extract treatment S3) after 90 days of salting. At this time, the salinities of rice bran danmooji of the S1, S52, and S3 groups were 2.32%, 1.94% and 2.15% respectively. The hardness of all groups decreased rapidly in the first 30 days of salting, and thereafter showed no changes. After 90 days of salting, the hardness of all groups was $1,186-1,368\;g/cm^2$ with no significant differences between groups. Redness, the a value, of the S2 and S3 groups treated with succinic acid, was lower than that of S3, whereas yellowness, the b value, of S3 treated with succinic acid and yeast extract was the highest of the three groups. Sensory evaluation of rice bran danmooji after 90 days of salting resulted in S3 attaining the highest scores for flavor, taste, texture, and overall acceptability. These results indicate nut high-quality rice bran danmooji may be prepared by addition of S. rebaudiana leaf powder, succinic acid and yeast extract to rice bran.

Quality Characteristics of Jocheong Containing Various Level of Letinus edodes Extracts (표고버섯 추출액을 이용한 조청의 품질특성)

  • Park, Jung-Suk;Na, Hwan-Sik
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.34 no.7
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    • pp.1082-1090
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    • 2005
  • Jocheong was prepared by adding Lentinus edodes extract to improve its quality and to give some functional properties. Contents of crude protein, ash and crude lipid were similar to those of control, while carbohydrate content was decreased. Total mineral content were $1,916.03\~2,674.24mg/kg$ that was no difference between test samples. From HPLC determination of free sugars, Jocheong was found to contain maltose as the highest sugar, followed by glucose and fructose. In amino acid analysis, seventeen amino acid were identified and quantified. Glutamic acid in Jocheong was major amino acid. The major fatty acids in Jocheong $(0\%,\;control)$ were linoleic acid, palmitic acid, oleic acid, myristic acid and caproic acid. There was no significant differences in fatty acid composition, pH and reducing sugar content among the Jocheong samples. The viscosity and solid contents tended to decrease with the addition of Lentinus edodes extract. Increasing the ratio of mushroom extract in Jocheong tended to decrease the lightness, yellowness and redness in Hunter's color value. Although sensory value decreased with increasing Lentinus edodes extracts, use of mushroom extracts (7: 3; saccharification liquids: Lentinus edodes extracts) is recommended for making Jocheong.

Anti-diabetic effect and mechanism of Korean red ginseng extract in C57BL/KsJ db/db mice

  • Yuan, Hai-Dan;Shin, Eun-Jung;Chung, Sung-Hyun
    • Proceedings of the Ginseng society Conference
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    • 2007.12a
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    • pp.57-58
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    • 2007
  • Purpose: Ginseng is a well-known medical plant used in traditional Oriental medicine. Korean red ginseng (KRG) has been known to have potent biological activities such as radical scavenging, vasodilating, anti-tumor and anti-diabetic activities. However, the mechanism of the beneficial effects of KRG on diabetes is yet to be elucidated. The present study was designed to investigate the anti-diabetic effect and mechanism of KRG extract in C57BL/KsJ db/db mice. Methods: The db/db mice were randomly divided into six groups: diabetic control group (DC), red ginseng extract low dose group (RGL, 100 mg/kg), red ginseng extract high dose group (RGH, 200 mg/kg), metformin group (MET, 300 mg/kg), glipizide group (GPZ, 15 mg/kg) and pioglitazone group (PIO, 30 mg/kg), and treated with drugs once per day for 10 weeks. During the experiment, body weight and blood glucose levels were measured once every week. At the end of treatment, we measured Hemoglobin A1c (HbA1c), blood glucose, insulin, triglyceride (TG), adiponectin, leptin, non-esterified fatty acid (NEFA). Morphological analyses of liver, pancreas and white adipose tissue were done by histological observation through hematoxylin-eosin staining. Pancreatic islet insulin and glucagon levels were detected by double-immunofluorescence staining. To elucidate an action of mechanism of KRG, DNA microarray analyses were performed, and western blot and RT-PCR were conducted for validation. Results: Compared to the DC group mice, body weight gain of PIO treated group mice showed 15.2% increase, but the other group mice did not showed significant differences. Compared to the DC group, fasting blood glucose levels were decreased by 19.8% in RGL, 18.3% in RGH, 67.7% in MET, 52.3% in GPZ, 56.9% in PIO-treated group. With decreased plasma glucose levels, the insulin resistance index of the RGL-treated group was reduced by 27.7% compared to the DC group. Insulin resistance values for positive drugs were all markedly decreased by 80.8%, 41.1% and 68.9%, compared to that of DC group. HbA1c levels in RGL, RGH, MET, GPZ and PIO-treated groups were also decreased by 11.0%, 6.4%, 18.9%, 16.1% and 27.9% compared to that of DC group, and these figure revealed a similar trend shown in plasma glucose levels. Plasma TG and NEFA levels were decreased by 18.8% and 16.8%, respectively, and plasma adiponectin and leptin levels were increased by 20.6% and 12.1%, respectively, in the RGL-treated group compared to those in DC group. Histological analysis of the liver of mice treated with KRG revealed a significantly decreased number of lipid droplets compared to the DC group. The control mice exhibited definitive loss and degeneration of islet, whereas mice treated with KRG preserved islet architecture. Compared to the DC group mice, KRG resulted in significant reduction of adipocytes. From the pancreatic islet double-immunofluorescence staining, we observed KRG has increased insulin production, but decreased glucagon production. KRG treatment resulted in stimulation of AMP-activated protein kinase (AMPK) phosphorylation in the db/db mice liver. To elucidate mechanism of action of KRG extract, microarray analysis was conducted in the liver tissue of mice treated with KRG extract, and results suggest that red ginseng affects on hepatic expression of genes responsible for glycolysis, gluconeogenesis and fatty acid oxidation. In summary, multiple administration of KRG showed the hypoglycemic activity and improved glucose tolerance. In addition, KRG increased glucose utilization and improved insulin sensitivity through inhibition of lipogenesis and activation of fatty acid $\beta$-oxidation in the liver tissue. In view of our present data, we may suggest that KRG could provide a solid basis for the development of new anti-diabetic drug.

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A Study on Heavy Metal Concentrations of Oxidized Hair Coloring Products in Korea Market (한국에서 유통 중인 산화형 염모제의 중금속 농도에 관한 연구)

  • Choi, Chae Man;Hong, Mi Sun;Lee, Yun Jung;Kim, Hwa Soon;Kim, Hyun Jung;Kim, Jung Hun;Chae, Young Zoo
    • Journal of the Society of Cosmetic Scientists of Korea
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    • v.39 no.3
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    • pp.241-249
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    • 2013
  • This study was aimed to provide the fundamental data about oxidized hair color products. For this reason, we collected 125 oxidized hair color products, which were distributed in domestic market from January to October, 2012, and measured the heavy metal concentrations of lead, arsenic, cadmium, chromium, manganese, nickel, copper in the samples. Results were compared by domestic, foreign, henna, type and color. The average metal concentrations were as follows; 0.211 ${\mu}g/g$ for lead, 0.008 ${\mu}g/g$ for cadmium, 0.051 ${\mu}g/g$ for arsenic, 0.954 ${\mu}g/g$ for chromium, 6.250 ${\mu}g/g$ for manganese, 0.591 ${\mu}g/g$ for nickel and 0.544 ${\mu}g/g$ for copper. In case of lead and arsenic, the concentrations were much less than the regulated amount (20 ${\mu}g/g$ and 10 ${\mu}g/g$, respectively) suggested by MFDS (Ministry of Food and Drug Safety). In henna (p < 0.05), the concentrations were significantly higher than those of other domestic and foreign oxidized hair color products as follows; 1.264 ${\mu}g/g$ for lead, 0.267 ${\mu}g/g$ for arsenic, 0.025 ${\mu}g/g$ for cadmium, 4.055 ${\mu}g/g$ for chromium, 72.044 ${\mu}g/g$ for manganese, 3.076 ${\mu}g/g$ for nickel and 4.640 ${\mu}g/g$ for copper. Statistically, it showed that the heavy metal concentrations were quite different for the different types of hair color products. The cream and liquid type products had the highest average concentration in chromium (0.708 ${\mu}g/g$, 0.478 ${\mu}g/g$, respectively). On the other hand, powder type products showed the highest concentration in manganese (60.041 ${\mu}g/g$). In addition, the concentrations of heavy metals and the color of products are not quite correlated. It was shown that average concentrations of lead and chromium were higher for yellow, chromium for red and pink, manganese for brown and black, and nickel for green.

Study on IL -8 Expression in Peripheral Blood Monocytes (말초 혈액 단핵구에서 IL-8 발현에 관한 연구)

  • Kim, Jae-Yeol;Lee, Jae-Cheol;Kang, Min-Jong;Park, Jae-Seok;Yoo, Chul-Gyu;Kim, Young-Whan;Han, Sung-Koo;Shim, Young-Soo;Lee, Jae-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.5
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    • pp.703-712
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    • 1995
  • Background: Peripheral blood monocytes are important immune effector cells that play a fundamental role in cellular immunity. In addition to their antigen-presenting and phagocytic activities, monocytes/macrophage produce a vast array of regulatory and chemotactic cytokines. Interleukin-8(IL-8), a potent neutrophil-activating and chemotactic peptide, is produced in large quantities by mononuclear phagocytes and may be an important mediator of local and systemic inflammation. Overexpression by IL-8 of such inflammation may be an important step of tissue injury frequently seen in inflammatory reaction. So it could be hypothesized that the agents which block the production of IL-8 can decrease the inflammatory reaction and tissue injury. To evaluate this, we described the effect of Dexamethasone, $PGE_2$, Indomethacin and Interferon-$\gamma$(IFN-$\gamma$) on IL-8 mRNA and protein expression from LPS-stimulated human peripheral blood monocytes(PBMC). Method: PBMC was isolated from healthy volunteers. To evaluate the effect of Dexamethasone, $PGE_2$ & Indomethacin, these drug were treated for 1 hour before and after LPS stimulation and IFN-$\gamma$ was only treated I hour before the LPS stimulation. Northern blot analysis for IL-8 mRNA and ELISA for immunoreactive IL-8 protein in culture supernatant were performed. We repeated above experiment three times for Northern blot analysis and two times for ELISA and got the same result. Results: 1) Pre- and post-treatment of Dexamethasone suppressed both the LPS stimulated IL-8 mRNA expression and IL-8 protein release in PBMC. 2) IFN-$\gamma$ pre-treatment suppressed the IL-8 mRNA expression and IL-8 protein release in unstimulated cells. 3) In LPS stimulated cells, IFN-$\gamma$ suppressed the IL-8 mRNA expression but IL-8 protein release suppression was not observed. 4) $PGE_2$ and Indomethacin exert no effect on the LPS-stimulated IL-8 mRNA and protein expression in concentration used in this experiment ($PGE_2;10^{-6}M$, Indomethacin; $10{\mu}M$). Conclusion: One of the mechanism of antiinflammatory action of Dexamethasone can be explained by the suppressing effect of IL-8 production in some extent and by this antiinflammatory effect, dexamethasone can be used to suppress local and systemic inflammation mediated by IL-8.

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Pharmacokinetics of ofloxacin in Patients with Multidrug-Resistant Tuberculosis (다제내성결핵 환자에서 ofloxacin의 약동학적 분석)

  • Park, Seung-Kyu;Yoon, Young-Ran;Lee, Woo-Chul;Jun, Hyung-Min;Shon, Ji-Hong;Kim, Kyoung-Ah;Park, Ji-Young;Shin, Jae-Gook
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.2
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    • pp.128-136
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    • 2002
  • Background: There are few studies that have reported on the pharmacokinetic(PK) disposition of fluoroquinolones in patients with multi-drug resistant tuberculosis(MDR-Tb), even though fluoroquinolones are frequently co-prescribed to those patients. In this study, the PK disposition of ofloxacin, a fluoroquinolone, was evaluated in patients with MD R -Tb. Methods: Twenty patients with MDR-Tb were given 2nd line Tb drugs including ofloxacin (300mg twice a day), prothionamide, cycloserine, para-aminosalicylic acid, kanamycin, and streptomycin. The patients were grouped according to their body mass index(BMI) as an index of emaciation (group A : 18.5$\leq$BMI <23, group B : BMI < 18.5). Blood samples were serially drawn and urine samples were collected upto 24 hours after the last dose of those drugs at steady state (over 1 month). The ofloxacin concentrations were determined using HPLC (High Performance Liquid Chromatography). Results: The AUC of ofloxacin in group B was greater than that in group A ($31.4{\pm}8.9{\mu}g/ml{\cdot}h$ vs. $24.1{\pm}6.2{\mu}g/ml{\cdot}h$)(Check the symbols), (p<0.05). The total clearance(Cl/F) of ofloxacin was $0.16{\pm}0.03$ L/h/kg in group A, and $0.14{\pm}0.03$ L/h/kg in group B. The half-lives of ofloxacin in two groups were similar (group A : $5.3{\pm}0.8$ hours, group B : $5.7{\pm}0.9$ hours). In addition, the other PK parameters in two groups were also similar. Conclusions: The pharmacokinetics of ofloxacin in patients with MDR-Tb appears to be comparable with those of normal subjects, and the extent of emaciation appears to have an influence on the pharmacokinetics of ofloxaicn in chronic debilitated MDR-Tb patients.