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The Epidemiology of Antidepressant Prescriptions in South Korea from the Viewpoint of Medical Providers : A Nationwide Register-Based Study (정신과 의사와 비정신과 의사의 항우울제 처방에 대한 연구 : 건강보험심사평가원 청구 데이터 중심으로)

  • Kim, Min Ji;Kim, Namwoo;Shin, Daun;Rhee, Sang Jin;Park, C. Hyung Keun;Kim, Hyeyoung;Yang, Boram;Ahn, Yong Min
    • Korean Journal of Biological Psychiatry
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    • v.26 no.2
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    • pp.39-46
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    • 2019
  • Antidepressants are widely used to treat depression in Korea, however, only a few studies have focused on the provider of the treatment. The aim of the study is to compare the differences between patients who were prescribed antidepressants by psychiatrists and those who were prescribed antidepressants by non-psychiatrists in South Korea. Patients with a diagnosis of depressive disorder who had been newly prescribed antidepressants in 2012 were selected from the Health Insurance Review and Assessment Service database. They were classified into two groups depending on whether they received the antidepressant prescription from a psychiatrist or non-psychiatrist. Sociodemographic, clinical, and depression related cost has been investigated. Treatment resistant depression, which is defined as a failure of two antidepressant regimens to alleviate symptoms, was also investigated. Prescription adequacy was assessed based on whether a regimen was maintained for at least 4 weeks. Among the 834694 patients with pharmaceutically treated depression (PTD) examined in this study, 326122 (39.1%) were treated by psychiatrists. Patients who were treated by psychiatrists were younger and had more psychiatric comorbidities than those treated by non-psychiatrists. They had longer PTD duration (229.3 days vs. 103.0 days, p < 0.05) and a larger proportion of treatment resistant depression (9.3% of PTD) when compared to those patients treated by non-psychiatrists. The patients treated by psychiatrists had a smaller proportion of inadequate antidepressant use compared to those patients in the non-psychiatrist group (44.5% vs. 65.1%, p < 0.05). The costs related to depression corrected with PTD duration were higher in the non-psychiatrist group (32214 won vs. 56001 won, p < 0.05). Patients who receive antidepressants from psychiatrists are patients with more severe, treatment-resistant depression. Psychiatrists prescribe antidepressants more adequately and cost- effectively than non-psychiatrists.

Beneficial Effect of Ginseng Extract on Sudden Sensorineural Hearing Loss (돌발성난청에서 홍삼추출물의 추가적인 치료효과)

  • Im, Gi-Jung;Cinn, Young-Gi;Chang, Ji-Won;Choi, Joan;Chae, Sung-Won;Jung, Hak-Hyun
    • Journal of Ginseng Research
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    • v.33 no.2
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    • pp.155-159
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    • 2009
  • Sudden idiopathic sensorineural hearing loss is a disease that develops within several hours to several days. Its etiology has not yet been verified, but the disturbance of the circulation of blood in the inner ear, inner-ear hydrops, and viral infection are considered possible causes of the disease. This study was conducted to evaluate the effect of Panax ginseng extract, which is known to have a vasodilatory effect, on sudden sensorineural hearing loss. Sixty-nine patients suffering from sudden sensorineural hearing loss were admitted to Korea University Anam Hospital from March to December 2008. They were divided into the experimental (30 ears) and control (39 ears) groups. Ginseng extract (2700 mg/day, 4 weeks) was added to the therapeutic regimen in the experimental group. The effect of ginseng extract therapy was analyzed according to the factors relating to the prognosis. A considerable hearing improvement was documented in both groups (32.2 dB in the experimental group and 25.8 dB in the control group). However, there was little beneficial effect of ginseng extract on additional hearing improvement compared with control. The total recovery rate of the experimental group (80.0%) was better than that of the control group (58.9%), and the experimental group's high-tone hearing gain at 3 kHz (29.7 dB) was better than that of the control group (21.7 dB). The results of the study suggest that the effects of ginseng therapy tend to be superior to those of the conventional therapy, but the difference between the two is not statistically significant. The hearing gains tend to be in the higher frequencies and may be due to the promotion of cellular differentiation from the supporting cells.

Enhancement of Cytotoxicity by the Combination of Anticancer Drugs in Human Lung Adenocarcinoma Cell Line (PC-14) (폐암세포주 (PC-14)에서 복합항암제 처치시 암세포살해능의 증강에 관한 연구)

  • Lee, Choon-Taek
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.3
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    • pp.525-533
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    • 1997
  • Background : No ideal combination chemotherapy for lung cancer has been established even though lots of combination anticancer chemotherapies have been tried. For the combination of anticancer drugs, the interaction of anticancer drugs is very important but unpredictable factor. In this experiment, we designed and tested new experiment to measure the interaction of two anticancer drugs using MIT assay in an attempt to predict clinical response of the combination regimen. Methods : With human lung adenocarcinoma cell line (PC-14), the cytotoxic effect of cisplatin, adriamycin, mitomycin C and etoposide were measured by in vitro chemosensitivity test (MIT assay). The combined cytotoxic effects of combination of two drugs were also measured in every combination of the drug concentrations and analyzed the interaction by Anava analysis of two way factorial design. Results : Four individual drugs showed cytotoxic effects on PC-14 by dose dependent fashion. Comparison of two drug combinations revealed that mitomycin C + cisplatin and adriamycin + cisplatin combinations showed stronger synergistic cytotoxic effects. Conclusion : From this experiment, we suggest two combinations of mitomycin C + cisplatin and adriamycin + cisplatin as chemotherapeutic regimens for unresectable non-small cell lung cancer. Furthermore, this experimental design could be applied to other types of cancer requiring combination anticancer chemotherapy.

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Chest-wall Surface Dose During Post-mastectomy Radiation Therapy, with and without Nonmagnetic Bolus: A Phantom Study

  • Choi, Cheon Woong;Hong, Joo Wan;Park, Cheol Soo;Ahn, Jae Ouk
    • Journal of Magnetics
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    • v.21 no.2
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    • pp.293-297
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    • 2016
  • For mastectomy patients, sufficient doses of radiation should be delivered to the surface of the chest wall to prevent recurrence. A bolus is used to increase the surface dose on the chest wall, whereby the surface dose is confirmed with the use of a virtual bolus during the computerized treatment-planning process. The purpose of this study is an examination of the difference between the dose of the computerized treatment plan and the dose that is measured on the bolus. Part of the left breast of an Anderson Rando phantom was removed, followed by the attainment of computed tomography (CT) images that were used as the basis for computerized treatment plans that were established with no bolus, a 3 mm-thick bolus, a 5 mm-thick bolus, and a 10 mm-thick bolus. For the computerized treatment plan, a prescribed dose regimen was dispensed daily and planning target volume (PTV) coverage was applied according to the RTOG 1304 guidelines. Using each of the established computerized treatment plans, chest-wall doses of 5 points were measured; this chest-wall dose was used as the standard for the analysis of this study, while the level of significance was set at P < 0.05. The measurement of the chest-wall dose with no bolus is 1.6 % to 10.3 % higher, and the differences of the minimum average and the maximum average of the five measurement points are -13.8 and -1.9, respectively (P < 0.05); however, when the bolus was used, the dosage was measured as 3.7 % to 9.2 % lower, and the differences of the minimum average and the maximum average are 7.4 and 9.0, -1.2 and 17.4, and 8.1 and 19.8 for 3 mm, 5 mm, and 10 mm, respectively (P < 0.05). As the thickness of the bolus is increased, the differences of the average surface dose are further increased. There are a variety of factors that affect the surface dose on the chest wall during post-mastectomy radiation therapy, for which verification is required; in particular, a consideration of the appropriate thickness and the number of uses when a bolus is used, and which has the greatest effect on the surface dose on the chest wall, is considered necessary.

Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture(STRICTA) : Extending the CONSORT Statement (STRICTA(침 임상연구에서 중재 보고를 위한 표준) 개정판: CONSORT Statement의 확충안)

  • Lee, Hyang-Sook;Cha, Su-Jin;Park, Hi-Joon;Seo, Jung-Chul;Park, Jong-Bae J.;Lee, Hye-Jung
    • Korean Journal of Acupuncture
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    • v.27 no.3
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    • pp.1-23
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    • 2010
  • Objectives and methods : The Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) were published in five journals in 2001 and 2002. These guidelines, in the form of a checklist and explanations for use by authors and journal editors, were designed to improve reporting of acupuncture trials, particularly the interventions, thereby facilitating their interpretation and replication. Subsequent reviews of the application and impact of STRICTA have highlighted the value of STRICTA as well as scope for improvements and revision. To manage the revision process a collaboration between the STRICTA Group, the CONSORT Group, and the Chinese Cochrane Centre was developed in 2008. An expert panel with 47 participants was convened that provided electronic feedback on a revised draft of the checklist. At a subsequent face-to-face meeting in Freiburg, a group of 21 participants further revised the STRICTA checklist and planned dissemination. Results : The new STRICTA checklist, which is an official extension of CONSORT, includes six items and 17 sub-items. These set out reporting guidelines for the acupuncture rationale, the details of needling, the treatment regimen, other components of treatment, the practitioner background, and the control or comparator interventions. In addition, and as part of this revision process, the explanations for each item have been elaborated, and examples of good reporting for each item are provided. In addition, the word "controlled" in STRICTA is replaced by "clinical", to indicate that STRICTA is applicable to a broad range of clinical evaluation designs, including uncontrolled outcome studies and case reports. Conclusions : It is intended that the revised STRICTA, in conjunction with both the main CONSORT Statement and extension for nonpharmacologic treatment, will raise the quality of reporting of clinical trials of acupuncture.

Clinical Pharmacokinetics of Vancomycin in Ovarian Cancer Patients (난소암 환자에서 반코마이신의 임상약물동태)

  • Kim, Yang Woo;Choi, Jun Shik;Lee, Jin Hwan;Park, Jae Young;Choi, Byong Chul;Burm, Jin Pil
    • Korean Journal of Clinical Pharmacy
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    • v.8 no.1
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    • pp.13-18
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    • 1998
  • The purpose of this study was to determine pharmacokinetic parameters of vancomycin using the compartment model dependent and compartment model independent analysis in 6 Korean normal volunteers and 8 ovarian cancer patients. Vancomycin was administered 1.0 g bolus by IV infusion over 60 minutes. The elimination rate constant ($\beta$), volume of distribution (Vd), total body clearance (CLt), and area under the plasma level-time curve (AUC) of vancomycin in normal volunteers using the compartment model dependent analysis were $0.150\pm0.030\;hr^{-1},\;32.9\pm2.81\;L/kg,\;5.36\pm0.63\;L/hr,\;and\;186.5\pm20.5\;{\mu}g/ml{\cdot}hr$, respectively. The $\beta$, Vd, CLt, and AUC of vancomycin in ovarian cancer patients using the compartment model dependent analysis were $0.109\;0.008\;hr^{-1},\;41.5\pm3.01\;L/kg,\;4.58\pm0.57\;L/hr\;and\;218.3\pm22.9\;{\mu}g/ml{\cdot}hr$, respectively. There were significant differences (p<0.05,\;p<0.01) in $\beta$, Vd, CLt, and AUC between normal volunteers and ovarian cancer patients. The elimination rate constant (Kel), CLt, and AUC of vancomycin in normal volunteers using the compartment model independent analysis were $0.152\pm0.022\;hr^{-1},\;5.77\pm0.75\;L/hr,\;and\;173.2\pm22.5;{\mu}g/ml{\cdot}hr$, respectively. The Kel, CLt, and AUC of vancomycin in ovarian cancer patients using the compartment model independent analysis were $0.126\pm0.012\;hr^{-1},\;4.96\pm0.55\;L/hr,\;and\;201.7\pm25.6;{\mu}g/ml{\cdot}hr$, respectively. There were significant differences (p<0.05, p<0.01) in Kel, CLt, and AUC between normal volunteers and ovarian cancer patients. And also, there was significant difference (p<0.05) in Kel of vancomycin in ovarian cancer patients between the compartment model dependent and independen analysis. It is necessary for effective dosage regimen of vancomycin in ovarian cancer patient to use these population parameters.

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Oxaliplatin-induced Peripheral Neuropathy in Patients with Advanced or Metastatic Gastric Cancer (진행성 또는 전이성 위암 환자에 있어서 Oxaliplatin 투여로 인한 말초신경통증 분석)

  • Park, Ae-Ryoung;Kim, Soon-Joo;Bang, Joon-Seok;La, Hyen-Oh
    • Korean Journal of Clinical Pharmacy
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    • v.19 no.1
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    • pp.18-22
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    • 2009
  • Oxaliplatin is a tolerable and effective drug of choice in the treatment of advanced or metastatic gastric cancer. However, it has many dose-limiting neurotoxicities. This study was performed to assess the incidence and types of oxaliplatin-related neurotoxicities. Sixty-four patients receiving oxaliplatin-involved regimen as salvage therapy on metastatic gastric cancer or as the first-line therapy on advanced gastric cancer were evaluated during the period between September 1, 2006 and February 29, 2008. The patients were treated with oxaliplatin 100 $mg/m^2$ and leucovorin 100 $mg/m^2$ simultaneously as 2-hour-lasting infusion on Day-1 followed by 5-FU 1200 $mg/m^2$ as a 22-hour-lasting continuous infusion both on Day-1 and Day-2 by every other week. We developed questionnaires to evaluate patient-recognized neurotoxic symptoms rather than the observer-described events. Surveys were completed at bedside or via telephone interview. Acute and chronic neurotoxicities were graded according to the National Cancer Institute Common Toxicity Criteria (NCI-CTC, version 3) as well as the Oxaliplatin-specific Neurotoxicity Scale. The Grade-3 neuropathy was reported in 19% of the patients (n=12) and grade-1/2 neuropathy occurred in 70% (n=45). The most common symptom was cold-related dysesthesia (83%) regarded as nociperception by the patients. Some patients (19%) experienced functional impairment affecting activities of daily living such as writing, buttoning, and walking. Even though 74% of the patients (42/57) were prescribed with gabapentin to reduce these peripheral symptoms, it did not appear to derive any benefit from this medication. It is suggested that notify the patients about their oxaliplatin-associated, debilitating symptoms, and educate them any self-care strategy at the initiating phase of the chemotherapy. Moreover, it needs to design the intervention studies regarding the prevention and management of the peripheral neuropathy.

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The Results of the ATP Based Chemotherapy Response Assay in Gastric Cancer Tissues (ATP-CRA 방법을 이용한 위암조직의 항암제 감수성 검사결과)

  • Lee, Je-Hyung
    • Journal of Gastric Cancer
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    • v.7 no.3
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    • pp.160-166
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    • 2007
  • Purpose: Recently, chemosensitivity tests have become widely used for the selection of effective drugs in gastric cancer patients. In this study, a chemosensitivity test was performed to select agents to increase the effectiveness of adjuvant chemotherapy. Materials and Methods: Chemosensitivity testing was performed in 81 gastric cancer patients that received a gastrectomy at the Yeungnam University Hospital. An ATP (adenosine triphosphate) based chemotherapy response assay was used. Clinicopatholgical factors such as sex, age, expression of tumor markers (CEA and CA19-9 levels), location of the tumor, morphology of advanced cancer, histological type, cell differentiation, depth of invasion, Lauren classification, Ming classification, lymphatic invasion, vascular invasion, neural invasion, lymph node metastasis and TNM stage were used to correlate the chemosensitivity and clinicopathological factors. Results: The most effective antitumor agents in gastric cancer patients were (in order of effectiveness) 5-FU, Epirubicin, lrinotecan and Oxaliplatin in our series. The chemosensitivity test showed a significant difference in susceptibility according to clinicopathological factors. Conclusion: Further studies on multidrug therapy are needed to evaluate synergistic effects of drugs. Therefore, for effective chemotherapy, it is more efficacious to select a chemosensitive drug than continue to use the same drug regimen.

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Superovulation Response after Follicular Wave Synchronization with Follicular Aspiration by Ultrasonography in HanWoo I. Effect of Follicular Aspiration on Ovarian Response Following Superovulation (과배란 처치시 우세난포 조절에 의한 한우 수정란 생산성 향상에 관한 연구 I. 우세난포 처리에 따른 난소반응)

  • 이병천;이동원;신수정;박종임;황우석
    • Journal of Embryo Transfer
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    • v.14 no.3
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    • pp.203-210
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    • 1999
  • In this stuyd, the effect of the dominant follicle aspiration for the superovulatory response in HanWoo was investigated. The criterion for the presence or absence of a dominant follicle based on their morphological examination. The dominant follicle was aspirated 48hr before the onset of superovulation treatment by 6.5MHz convex probe connected with a carrier and superovulation induced by FSH (Super-Ov Tyrer, Texas, U.S.A) adminstered twic a day s.c. over 4 day in a decreasing regimen. From 13 HanWoo scanned daily to determine the presence and growth of the dominant follicle, its an average diameter of 15.4mm was measured and an average diameter of corpora lutea was 18.7mm on day of follicular aspiration. In the experiment, a follicular remove by ultrasound-guided aspiration, the ovarian response was significantly enhanced when animals were superovulated in the aspiation of a dominant follicle compare with animals superovulated non-aspiration of a dominat follicle. In the aspiration of a dominant follicle donors yieleded more corpora lutea(14.4$\pm$4.7 vs 8.6$\pm$3.4) and transferable embryos(8.9$\pm$4.2 vs 5.4$\pm$2.7) than control. In cows in which the dominant follicle had been aspirated under sonographical control 2 days before superovuation, the number of corpus lutea and transferable embryos were significantly enhanced compared with animals superovulated in the presence of a dominant follicle (14.4$\pm$4.7 vs 6.9$\pm$2.7, ; 8.9$\pm$4.2 vs 3.3$\pm$1.6). After 7 days of artificial insemination, the embryos at 7 days were cllected by uterine flushing after dominant follicle insemination, the embryos at 7 days were collected by uterine flushing after dominant follicle aspiration and superovulation treatment, and evaluated their quality by morphological criteria. Sixteen embryos with excellent and good grade were transferred into 8 recipient cows. Six pregnancies were identified at 60 and 120 days of gestation by rectal palpations. In conclusion, the present study showed that 1) the presence or absence of a dominant follicle signficicnatly affects superovulatory responses, and 2) ultrasound-guided follicular aspiration of the dominant follicle and superovuation treatment provides an accurate and procedure to increase ovarian responses in HanWoo.

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Studies on Artificial Contorl of Parturition in Korean Native Goats III. The Effects of Prostaglandin $F_2\alpha$ and Estradiol-Benezoate (한국 재래산양 분만의 인위적 조절에 관한 연구 III. Prostaglandin $F_2\alpha$와 Estradiol-Benzoate 병용투여에 의한 분만수기 효과)

  • 윤창현;민관식;장규태;오석두
    • Korean Journal of Animal Reproduction
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    • v.16 no.2
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    • pp.109-116
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    • 1992
  • The present study was carried out to establish a practical regimen for artificial parturition induction using prostaglandin F2$\alpha$(PGF2$\alpha$) and estradiol-benezoate in Korean native goats. The effect of parturition induction and the time intervals to induced parturition after injection were investigated. The birth weight and body weight of kids at 15 days of age were measured. A total of 24 pluriparous goats were offered for this experiment. The animals were divided into 4 goats per treatment by the injection time(142, 145 or 148 day of pregnancy) and dosage(5.0$\times$10 or 7.5$\times$7.5mg). The results obtained were summarized as follows : A total of 24 pregnant goats were intramusculary treated with 5.0$\times$10 or 7.5$\times$7.5mg of PGF2$\alpha$ and estradiol-benzoate for parturition induction of Day 142, 145 or 148 of gestation. Parturition was induced in all of the goats(100%) treated. The kids produced from induced parturition were all healthy. The time intervals to induced parturition after PGF2$\alpha$ and estradiol-benezoate injection of 5.0$\times$10 or 7.5$\times$7.5mg to pregnant goats on Day 148(23.22$\pm$0.51~23.40$\pm$1.26hrs) were significantly(P<.01) shorter than those of the 142 days of the gestation(26.34$\pm$2.22~28.39$\pm$3.02hrs). No significant difference was found in the time intervals between the doses(5.0$\times$10 or 7.5$\times$7.5mg) treated for parturition induction. The birth weight of kids from induced parturition was no significant difference between on Day 148 and on Day 142 of gestation. However, the birth weight of kids from parturition induced on Day 148 was found significantly(P<.01) heavier than that of the 142 days of gestation. The body weight of kids at 15 days old was also significantly(P<.01) lighter in the parturition induced on day 142 than those on Day 142. The birth weight and body weight of kids at 15 days old were not affected by 5.0$\times$10 or 7.5$\times$7.5mg injection of PGF2$\alpha$ and estradiol-benzoate for inducing parturition. From the above results, it was concluded that the parturition induction by PGF2$\alpha$ and estradiol-benezoate injection of 5.0$\times$10 or 7.5$\times$7.5mg on Day 142 of gestation, which was correspondent to 8 days before expected spontaneous parturition, was available without any significant troubles.

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