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Incidence of Adverse Effects and Discontinuation Rate between Patients Receiving 250 Micrograms and 500 Micrograms of Roflumilast: A Comparative Study

  • Joo, Hyonsoo;Han, Deokjae;Lee, Jae Ha;Rhee, Chin Kook
    • Tuberculosis and Respiratory Diseases
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    • v.81 no.4
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    • pp.299-304
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    • 2018
  • Background: Roflumilast is the only approved oral phosphodiesterase-4 inhibitor for the treatment of severe chronic obstructive pulmonary disease (COPD) in patients with chronic bronchitis and a history of frequent exacerbations. The purpose of this study was to examine the incidence of adverse effects associated with roflumilast treatment in a real-world setting. Further, we compared the incidence of adverse effects and the discontinuation rate among patients receiving different doses. Methods: We identified all outpatients diagnosed with COPD at Seoul St. Mary's Hospital between May 2011 and September 2016 and retrospectively reviewed their medical records. Roflumilast was prescribed to patients in doses of $500{\mu}g$ and $250{\mu}g$. Results: A total of 269 COPD patients were prescribed roflumilast in our hospital during the study period. Among them, 178 patients were treated with $500{\mu}g$ and 91 patients were treated with $250{\mu}g$. The incidence of adverse effects was 38.2% in the $500{\mu}g$ group and 25.3% in the $250{\mu}g$ group (p=0.034). The discontinuation rate of roflumilast was 41.6% (n=74) in the $500{\mu}g$ group and 23.1% (n=21) in the $250{\mu}g$ group (p=0.003). When adjusted by age, sex, smoking status, and lung function, $500{\mu}g$ dose was significantly associated with the discontinuation of roflumilast (odds ratio, 2.87; p<0.001). Conclusion: There was a lower incidence of adverse effects and discontinuation among patients treated with $250{\mu}g$ compared with $500{\mu}g$ dose. Further studies regarding the optimal dose of roflumilast are required.

Clinical characteristics and outcomes among pediatric patients hospitalized with pandemic influenza A/H1N1 2009 infection

  • Lee, Eun;Seo, Ju-Hee;Kim, Hyung-Young;Na, Shin;Kim, Sung-Han;Kwon, Ji-Won;Kim, Byoung-Ju;Hong, Soo-Jong
    • Clinical and Experimental Pediatrics
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    • v.54 no.8
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    • pp.329-334
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    • 2011
  • Purpose: The purpose of this article is to describe the clinical and epidemiologic features and outcomes among children hospitalized with pandemic influenza A/H1N1 2009 infection. Methods: We retrospectively reviewed the charts of hospitalized pediatric patients (<18 years) diagnosed with pandemic influenza A/H1N1 2009 infection by reverse-transcriptase polymerase chain reaction at a tertiary hospital in Seoul, Korea, between September 2009 and February 2010. Results: A total of 72 children were hospitalized with pandemic influenza A/H1N1 2009 infection (median age, 6.0 years; range, 2 months to 18 years). A total of 40% had at least 1 underlying medical condition, including asthma (17%), malignancies (19%), and heart diseases (17%). Of the 72 patients, 54 (76%) children admitted with H1N1 infection showed radiographic alterations compatible with pneumonia. There was no significant difference in pre-existing conditions between pandemic influenza A/H1N1 infected patients with or without pneumonia. Children with pandemic influenza A/H1N1 pneumonia were more likely to have a lower lymphocyte ratio (P=0.02), higher platelet count (P=0.02), and higher level of serum glucose (P=0.003), and more commonly presented with dyspnea than did those without pneumonia (P=0.04). Conclusions: No significant differences in age, sex, or presence of preexisting conditions were found between children hospitalized with pandemic influenza A/H1N1 H1N1 influenza infection with pneumonia and those without pneumonia. Higher leukocyte count, higher glucose level, and a lower lymphocyte ratio were associated with the development of pandemic A/H1N1 2009 influenza pneumonia.

Evaluation of the Usefulness of Differential Diagnosis of Thyroid Nodules using Elasticity Score and Strain Ratio in Elastogpraphy (탄성초음파에서 갑상샘 결절의 감별진단을 위한 탄성도 점수와 변형비의 유용성 평가)

  • Lee, Jin-Soo;Yang, Sung-Hee;Kim, changsoo;An, Hyun
    • Journal of the Korean Society of Radiology
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    • v.11 no.4
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    • pp.227-234
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    • 2017
  • This study evaluated the usefulness of the elasticity score and strain ratio in the differential diagnosis of benign and malignant nodules in thyroid elastography. We performed a retrospective analysis based on the results of fine needle aspiration cytology. The Chi-square test and the Mann-Whitney U test were used to analyze the difference between the five degrees of elasticity score and strain ratio according to the benign and malignant thyroid nodules. ROC curve analysis was used to determine the elasticity score and the best cut-off value of the strain ratio for the prediction of malignant nodules. There was a statistically significant difference (p=0.000) between the homogeneity of the elasticity score and the difference of the strain ratio between the benign and malignant nodule groups. On the ROC curve analysis, the elasticity score and the srain ratio for predicting benign and malignant nodules were determined as AUC 0.842, 0.700, cut-off value 3, 2.49 (p=0.001). Therefore, the elasticity score and strain ratio may be useful in the differential diagnosis of thyroid nodules.

Comparative Analysis of Treatment Planning System and Dose Distribution of Gamma knife PerfexionTM using EBT-3 Film (EBT-3 필름을 사용한 감마나이프 퍼펙션TM의 치료 계획 시스템 및 선량 분포 비교 분석)

  • Jin, Seongjin;Kim, eongjin;Seo, Weonseop;Hur, Beongik
    • Journal of the Korean Society of Radiology
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    • v.11 no.6
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    • pp.509-515
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    • 2017
  • The purpose of this study is to measure the 3 dimensional dose distribution of Gamma knife $Perfection^{TM}$, make a comparative analysis of the result and establish the measurement method for the procedures using EBT3 film. The dose distributions of the Gamma knife $Perfection^{TM}$ installed in two hospitals were evaluated in accuracy and precision. For accuracy, the difference between the mechanical center axis and the dose center axis was assessed on a 4 mm collimator. The allowed difference in accuracy is within 0.3 mm and it was measured as 0.098 mm, 0.195 mm for A hospital and 0.229 mm, and 0.223 mm for B hospital. For precision the difference between the FWHM(Full Width at Half Maximum) of Gamma Plan and measurement in the 4, 8, and 16 mm collimators was calculated. The allowed difference in precision is less than ${\pm}1mm$. The value of the hospital A was -0.283 ~ 0.583 mm, and the hospital B was -0.857 ~ 0.810 mm. When analyzing the dose distributions using the image-j program, it is necessary to establish a clearer reference point of the measurement point, and it is considered that the comparison of the dose distribution should be performed in actual treatment irradiation dose with a high dose usable film.

Evaluation of Magnetic Resonance Imaging using Image Co-registration in Stereotactic Radiosurgery (정위방사선수술시 영상공동등록을 이용한 자기공명영상 유용성 평가)

  • Jin, Seongjin;Cho, Jihwan;Park, Cheolwoo
    • Journal of the Korean Society of Radiology
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    • v.11 no.4
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    • pp.235-240
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    • 2017
  • The purpose of this study is to confirm the safety of the clinical application of image co - registration in steteotactic radiosurgery by evaluating the 3D positioning of magnetic resonance imaging using image co-registration. We performed a retrospective study using three-dimensional coordinate measurement of 32 patients who underwent stereotactic radiosurgery and performed magnetic resonance imaging follow-up using image co-registration. The 3 dimensional coordinate errors were $1.0443{\pm}0.5724mm$ (0.10 ~ 1.89) in anterior commissure and $1.0348{\pm}0.5473mm$ (0.36 ~ 2.24) in posterior commissure. The mean error of MR1 (3.0 T) was lower than that of MR2 (1.5 T). It is necessary to minimize the error of magnetic resonance imaging in the treatment planning using the image co - registration technique and to confirm it.

The Usefulness of Liver Fibroscan Test Using Ultrasound Image (초음파영상을 이용한 간탄력도 검사의 유용성)

  • An, Hyun;Lee, Jin-Soo;Im, In-Chul;Yang, Sung-Hee
    • Journal of the Korean Society of Radiology
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    • v.11 no.4
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    • pp.205-212
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    • 2017
  • Chronic diffuse hepatopathy is one of the important clinical tasks to reduce mortality and morbidity due to liver cirrhosis, liver failure, and liver cancer. The purpose of this study was to evaluate the criteria for predicting liver and chronic liver disease using Fibroscan based on ultrasound diagnosis. Serum and liver stiffness measurement(kPa) were analyzed in 280 patients and cut-off values of liver stiffness measurement for predicting fatty liver and chronic diffuse hepatopathy were determined using ROC curve analysis. Bilirubin and PT(prothrombin time) were not related to disease prediction(p=0.243, p=0.115). Serum glucose and triglyceride levels were significantly higher in the liver (p<0.05). The cut-off value for predicting chronic diffuse hepatopathy was determined as 10.3 kPa(AUC 0.98, sensitivity 94.94%, specificity 94.93%) in the order of control group, fatty liver and chronic diffuse hepatopathy. Therefore, it will be used as a primary tool for the diagnosis of chronic liver disease patients with quantitative evaluation.

Analysis of Risk Factors Affecting Breast Cancer Incidence : Breast Ultrasonography (유방암 발생에 영향을 미치는 위험인자 분석: 유방초음파 검진자 대상으로)

  • An, Hyun;Yang, Sung-Hee;Im, In-Chul;Lee, Jin-soo
    • Journal of the Korean Society of Radiology
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    • v.11 no.4
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    • pp.289-295
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    • 2017
  • In general, a number of studies have been conducted on factors affecting breast cancer development, but systematic investigations of risk factors are rare. The purpose of this study was to investigate the factors involved in breast cancer screening before breast ultrasound diagnosis and the risk factors associated with breast cancer screening by ultrasound. Self-administered questionnaire was performed on 417 patients who underwent breast ultrasonography and classified as benign and malignant. Breast cancer was associated with age, BMI, and type of medication(p<0.05). Multivariate analysis showed that the odds ratio was 4.93 times higher in the 50s compared to the less than 50s, 2.43 times higher in the obese group than in the normal group, 0.14 times and 0.16 times lower in hormonal replacement therapy(p<0.05). Therefore, as age increases, periodical examination of health and appropriate weight management are needed. So this study is expected to provide basic data for identification of risk factors affecting breast cancer development.

An Analysis into the Dose Rate of Photoneutron Occurring in a Linear Accelerator (선형가속기에서 발생하는 광중성자 선량률 분석)

  • Jang, Howon;Jin, SeongJin;Je, Jaeyong
    • Journal of the Korean Society of Radiology
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    • v.11 no.7
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    • pp.565-569
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    • 2017
  • This research aims at measuring the changes in the dose rate of photoneutron occurring in the process of the investigation into the 10 MV photon beam with a linear accelerator. In addition, the life time of the photoneutron after the end of irradiation was to be analyzed. The photoneutron were measured with a $BF_3$ proportional counter, and the measurement results of the dose rate of the photoneutron were analyzed in 3 parts at intervals of 2 seconds. The measurement results showed that the photoneutron were generated fastest when there was no metal plate inside the radiation field and when there was a lead plate, and that, as for the time that shows the final dose rate at the level of background, the life time was about 1 minute and 40 seconds regardless of the kinds of materials. Therefore, the dose rate according to the time until the photoneutron run out was proved to be different depending on the sorts of the materials and the threshold energy. However, final life time showed similar results regardless of the kinds of the materials, it can be concluded that the kinds of materials don't get involved in the life time of photoneutron.

Effect of morphology and diameter of implant fixture-abutment connection on mechanical failure of implants (임플랜트 고정체-지대주 연결부의 형태와 직경이 임플랜트의 기계적 실패에 미치는 영향)

  • Yun, Bo-Hyeok;Shin, Hyon-Mo;Yun, Mi-Jung;Huh, Jung-Bo;Jeong, Chang-Mo;Kang, Eun-Sook
    • The Journal of the Korean dental association
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    • v.53 no.9
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    • pp.644-655
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    • 2015
  • Purpose: This study was conducted to evaluate the effect of the fixture abutment connection type and diameter on the screw joint stability in external butt joint for 2nd surgery and internal cone connected type implant system for 1st and 2nd surgery using ultimate fracture strength. Materials and Methods: USII system, SSII system and GSII system of Osstem Implant were used. Each system used the fixture with two different diameters and cement-retained abutments, and tungsten carbide / carbon coated abutment screws were used. Disc shaped stainless steel metal tube was attached using resin-based temporary cement. The experimental group was divided into seven subgroups, including the platform switching shaped specimen that uses a regular abutment in the fixture with a wide diameter in USII system. A static load was increased to the metal tube at 5mm deviated point from the implant central axis until it reached the compression bending strength at a rate of 1mm/min. Then the deformations and patterns of fracture in threaded connection were compared. Results and Conclusion: 1. In the comparison between the Regular diameter, compression bending strength of SSII system was higher than USII system and GSII system. There was no significant difference between USII system and GSII system. 2. In the comparison between wide diameter, compression bending strength was increased in the order of GSII system, USII system, and SSII system. 3. In comparison between the implant diameter, compression bending strength of the wide diameter was greater than the regular diameter in any system(P<0.05). 4. There was no significant difference between the platform switching (III group) and the regular diameter (I group) in USII system. 5. In USII system, fracture of abutment screw and deformation of both fixture and abutment were observed in I, II and III subgroups. 6. Failure pattern of SSII system, which was the fracture of abutment screw and deformation of the abutment and fixture, was observed in both IV and V subgroups. Fracture of some fixtures was observed in subgroup V. 7. Failure pattern of GSII system, which was the fracture of the abutment screw and deformation of the fixture and the abutment, was observed in both VI and VII subgroups. Apart from other subgroups, subgroup VII demonstrated no bending neither the fracture at the top of the fixture. The compressive deformation of internal slope in the fixture was the only thing observed in subgroup VII.

Randomized clinical trial on the efficacy of Escherichia coli-derived rhBMP-2 with ${\beta}$-TCP/HA in extraction socket

  • Huh, Jung-Bo;Lee, Hyo-Jung;Jang, Ji-Woong;Kim, Myung-Jin;Yun, Pil-Young;Kim, Su-Hong;Choi, Kyung-Hee;Kim, Young-Kyun;Cho, Kyoo-Sung;Shin, Sang-Wan
    • The Journal of Advanced Prosthodontics
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    • v.3 no.3
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    • pp.161-165
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    • 2011
  • PURPOSE. This randomized clinical trial was conducted to assess the safety and effectiveness of the ErhBMP-2 in alveolar bone regeneration as well as preservation of the ${\beta}$-TCP bone graft material that contains ErhBMP-2. MATERIALS AND METHODS. This study involved 72 patients at the 3 study centers. The patients, who were divided into 2 groups: the experiment group who had ErhBMP-2 coated TCP/HA and the control group who had TCP/HA graft material alone transplanted immediately after tooth extraction. CT was taken before and 3 months after the transplantation and healing status was compared between the two groups. The efficacy endpoints that were used to measure the degree of bone induction included alveolar bone height and 3 measurements of bone width. The paired t test was used to determine the significance of the changes (P<.05). RESULTS. Changes in alveolar bone height were $-1.087{\pm}1.413$ mm in the control group and $-.059{\pm}0.960$ mm in the experimental group (P<.01). At 25% extraction socket length [ESL], the changes were $0.006{\pm}1.149$ mm in the control group and $1.279{\pm}1.387$ mm in the experimental group. At 50% ESL, the changes were $0.542{\pm}1.157$ mm and $1.239{\pm}1.249$ mm, respectively (P<.01 for 25% ESL, and P<.05 for 50% ESL). During the experiment, no adverse reactions to the graft material were observed. CONCLUSION. ErhBMP-2 coated ${\beta}$-TCP/HA were found to be more effective in preserving alveolar bone than conventional ${\beta}$-TCP/HA alloplastic bone graft materials.