임신과 수유기의 적정약물요법

임영채 全南大醫大 2001 전남의대학술지 Vol.37 No.2

The Effects of Weight Control Behaviors among Korean Obese Adults

강리리,김하늬,정영아,황환식,박훈기,박기영 대한가정의학회 2018 Korean Journal of Family Medicine Vol.39 No.4

Background: This study aimed to identify and examine the effects of weight control behaviors correlated withweight loss in obese individuals who attempted to lose weight within the past year. Methods: In this cross-sectional study, data from 9,461 obese individuals were collected from the fifth and sixth KoreanNational Health and Nutrition Examination Survey (2010–2014). Three of nine verified methods of weightcontrol suggested in the survey were selected: diet therapy (reduced food intake), exercise therapy (exercise), andmedication therapy (prescribed weight loss medications). Participants were divided into one of seven groups (diettherapy alone; exercise therapy alone; drug therapy alone; combined diet and exercise therapy; combined exerciseand drug therapy; combined diet and drug therapy; or combined diet, exercise, and drug therapy). Logistic regressionanalysis was used to determine whether the group that tried to lose weight in the past year had indeed lostweight compared to the group that did not. Results: The odds ratios for weight loss (≥3 but <6 kg vs. ≥6 but <10 kg) for the combined therapies were 2.05 (95%confidence interval, 1.23–3.41) for combined diet and exercise therapy and 5.43 (1.74–16.92) for combined diet, exercise,and drug therapy. Conclusion: All levels of weight loss were significantly associated with combined diet and exercise therapy. Weightloss ≥6 kg but <10 kg was significantly associated with combined diet and exercise therapy as well as with combineddiet, exercise, and medication therapy among individuals who tried to lose weight in the past year.

Reviews : Invited Review ; Strategies and Advancement in Antibody-Drug Conjugate Optimization for Targeted Cancer Therapeutics

( Eunhee G Kim ),( Kristine M Kim ) 한국응용약물학회 2015 Biomolecules & Therapeutics(구 응용약물학회지) Vol.23 No.6

Antibody-drug conjugates utilize the antibody as a delivery vehicle for highly potent cytotoxic molecules with specificity for tumor-associated antigens for cancer therapy. Critical parameters that govern successful antibody-drug conjugate development for clinical use include the selection of the tumor target antigen, the antibody against the target, the cytotoxic molecule, the linker bridging the cytotoxic molecule and the antibody, and the conjugation chemistry used for the attachment of the cytotoxic molecule to the antibody. Advancements in these core antibody-drug conjugate technology are reflected by recent approval of Adectris® (anti-CD30-drug conjugate) and Kadcyla® (anti-HER2 drug conjugate). The potential approval of an anti-CD22 conjugate and promising new clinical data for anti-CD19 and anti-CD33 conjugates are additional advancements. Enrichment of antibody-drug conjugates with newly developed potent cytotoxic molecules and linkers are also in the pipeline for various tumor targets. However, the complexity of antibody-drug conjugate components, conjugation methods, and off-target toxicities still pose challenges for the strategic design of antibody-drug conjugates to achieve their fullest therapeutic potential. This review will discuss the emergence of clinical antibody-drug conjugates, current trends in optimization strategies, and recent study results for antibody-drug conjugates that have incorporated the latest optimization strategies. Future challenges and perspectives toward making antibody-drug conjugates more amendable for broader disease indications are also discussed.

Antiepileptic Drug Therapy for Status Epilepticus

김대영,김재문,조용원,양광익,김동욱,이순태,노영주,서종근,변정익,김근태 대한신경과학회 2021 Journal of Clinical Neurology Vol.17 No.1

Status epilepticus (SE) is one of the most serious neurologic emergencies. SE is a condition that encompasses a broad range of semiologic subtypes and heterogeneous etiologies. The treatment of SE primarily involves the management of the underlying etiology and the use of antiepileptic drug therapy to rapidly terminate seizure activities. The Drug Committee of the Korean Epilepsy Society performed a review of existing guidelines and literature with the aim of providing practical recommendations for antiepileptic drug therapy. This article is one of a series of review articles by the Drug Committee and it summarizes staged antiepileptic drug therapy for SE. While evidence of good quality supports the use of benzodiazepines as the first-line treatment of SE, such evidence informing the administration of second- or third-line treatments is lacking; hence, the recommendations presented herein concerning the treatment of established and refractory SE are based on case series and expert opinions. The choice of antiepileptic drugs in each stage should consider the characteristics and circumstances of each patient, as well as their estimated benefit and risk to them. In tandem with the antiepileptic drug therapy, careful searching for and treatment of the underlying etiology are required.

Nano carriers that enable co-delivery of chemotherapy and RNAi agents for treatment of drug-resistant cancers

Tsouris, V.,Joo, M.K.,Kim, S.H.,Kwon, I.C.,Won, Y.Y. Pergamon Press ; Elsevier Science Ltd 2014 BIOTECHNOLOGY ADVANCES Vol.32 No.5

Tumor cells exhibit drug resistant phenotypes that decrease the efficacy of chemotherapeutic treatments. The drug resistance has a genetic basis that is caused by an abnormal gene expression. There are several types of drug resistance: efflux pumps reducing the cellular concentration of the drug, alterations in membrane lipids that reduce cellular uptake, increased or altered drug targets, metabolic alteration of the drug, inhibition of apoptosis, repair of the damaged DNA, and alteration of the cell cycle checkpoints (Gottesman et al., 2002; Holohan et al., 2013). siRNA is used to silence the drug resistant phenotype and prevent this drug resistance response. Of the listed types of drug resistance, pump-type resistance (e.g., high expression of ATP-binding cassette transporter proteins such as P-glycoproteins (Pgp; also known as multi-drug resistance protein 1 or MDR1, encoded by the ATP-Binding Cassette Sub-Family B Member 1 (ABCB1) gene)) and apoptosis inhibition (e.g., expression of anti-apoptotic proteins such as Bcl-2) are the most frequently targeted for gene silencing. The co-delivery of siRNA and chemotherapeutic drugs has a synergistic effect, but many of the current projects do not control the drug release from the nanocarrier. This means that the drug payload is released before the drug resistance proteins have degraded and the drug resistance phenotype has been silenced. Current research focuses on cross-linking the carrier's polymers to prevent premature drug release, but these carriers still rely on environmental cues to release the drug payload, and the drug may be released too early. In this review, we studied the release kinetics of siRNA and chemotherapeutic drugs from a broad range of carriers. We also give examples of carriers used to co-deliver siRNA and drugs to drug-resistant tumor cells, and we examine how modifications to the carrier affect the delivery. Lastly, we give our recommendations for the future directions of the co-delivery of siRNA and chemotherapeutic drug treatments.

Nanoparticle-Mediated Combination Therapy: Two-in-One Approach for Cancer

Gurunathan, Sangiliyandi,Kang, Min-Hee,Qasim, Muhammad,Kim, Jin-Hoi MDPI 2018 INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES Vol.19 No.10

<P>Cancer represents a group of heterogeneous diseases characterized by uncontrolled growth and spread of abnormal cells, ultimately leading to death. Nanomedicine plays a significant role in the development of nanodrugs, nanodevices, drug delivery systems and nanocarriers. Some of the major issues in the treatment of cancer are multidrug resistance (MDR), narrow therapeutic window and undesired side effects of available anticancer drugs and the limitations of anticancer drugs. Several nanosystems being utilized for detection, diagnosis and treatment such as theranostic carriers, liposomes, carbon nanotubes, quantum dots, polymeric micelles, dendrimers and metallic nanoparticles. However, nonbiodegradable nanoparticles causes high tissue accumulation and leads to toxicity. MDR is considered a major impediment to cancer treatment due to metastatic tumors that develop resistance to chemotherapy. MDR contributes to the failure of chemotherapies in various cancers, including breast, ovarian, lung, gastrointestinal and hematological malignancies. Moreover, the therapeutic efficiency of anticancer drugs or nanoparticles (NPs) used alone is less than that of the combination of NPs and anticancer drugs. Combination therapy has long been adopted as the standard first-line treatment of several malignancies to improve the clinical outcome. Combination therapy with anticancer drugs has been shown to generally induce synergistic drug actions and deter the onset of drug resistance. Therefore, this review is designed to report and analyze the recent progress made to address combination therapy using NPs and anticancer drugs. We first provide a comprehensive overview of the angiogenesis and of the different types of NPs currently used in treatments of cancer; those emphasized in this review are liposomes, polymeric NPs, polymeric micelles (PMs), dendrimers, carbon NPs, nanodiamond (ND), fullerenes, carbon nanotubes (CNTs), graphene oxide (GO), GO nanocomposites and metallic NPs used for combination therapy with various anticancer agents. Nanotechnology has provided the convenient tools for combination therapy. However, for clinical translation, we need continued improvements in the field of nanotechnology.</P>

조현병에서 인지행동치료의 적용

이동은 대한신경정신의학회 2012 신경정신의학 Vol.51 No.6

Objectives Cognitive behavioral therapy for treatment of schizophrenia was designed as a psychological therapy for treatment of drug resistant patients with schizophrenia. This therapy is currently being widely applied from early psychosis to chronic condition. The aim of this article is to review the main results of research articles on cognitive behavioral therapy of schizophrenia and prompt practicing the therapy in Korean mental health services. Methods The important original and review articles were referred in order to understand the main results of research from published international books, and the English website Pubmed was searched in order to update recent findings. This article reviewed the results of four areas of different phases and types of cognitive behavioral therapy for treatment of schizophrenia: drug resistant chronic patients, acute psychotic state, prodromal phase, and group cognitive behavioral therapy. Results Cognitive behavioral therapy for treatment of drug resistant patients with schizophrenia can attenuate the positive and general symptoms more than that for patients who receive supportive psychotherapy or treatment as usual. However, the effect appears to be less than previously expected, small to moderate. Cognitive behavioral therapy for patients of acute psychotic state can reduce the time of recovery from acute psychotic symptoms by approximately 25%. The result of cognitive behavioral therapy for patients of prodromal phase shows that the therapy can reduce the rate of transition to schizophrenia by up to one third. Group behavioral therapy has recently been tested. Group therapists have suggested that the therapy should be applied through the way of groups with relatively homogenous symptoms. However, whether the therapy can reduce the severity of hallucination in the voice hearer group is inconclusive. Conclusion Alongside pharmacotherapy for treatment of schizophrenia, cognitive behavioral therapy is a distinct psychological therapy for attenuation of psychotic symptoms. The effect of cognitive behavioral therapy appears to last for one year and requires additional therapeutic sessions after one year. The effect is not still clear in group cognitive behavioral therapy for treatment of schizophrenia. Cognitive behavioral therapy for treatment of schizophrenia should be practiced widely in the Korean mental health system. 조현병의 인지행동치료는 약물치료와 더불어 정신병적증상을 효과적으로 다룰 수 있는 가장 체계적인 심리학적 치료 방법이다. 조현병의 인지행동치료를 통하여 전구기 정신증 환자부터 약물저항성 만성 환자까지 망상과 환청과 같은정신병적 증상에 일정 부분 호전을 가져올 수 있으며 사회적기능 회복에도 도움이 될 수 있다. 인지행동치료의 효과는 약1년 정도 지속되는 것으로 보이며 이후에는 부가적인 치료가필요하다. 집단 인지행동치료의 정신병적 증상에 대한 효과는 명확하지 않지만 비교적 동질적인 증상 집단을 대상으로치료를 시도하였을 때, 사회적 기능 회복에 대한 효과는 있는것으로 보인다. 조현병의 인지행동치료는 국내의 임상과 지역사회에서 활발하게 적용되어야 할 것이다.

마약중독의 통합적 치료개입의 함의

류창현 한국중독범죄학회 2024 한국중독범죄학회보 Vol.14 No.1

본 연구의 주요 목적은 마약중독의 통합적 치료개입의 함의에 관련한 문헌을 중심으로 소개하고고찰하는 데 있다. 물질남용문제를 해결하려면 중독자의 재발을 예방하기 위해 사회재통합(social reintegration)이 매우 중요하다. 사회재통합은 주로 가족과 지역사회를 포함한 사회환경에 초점을 맞추고 중독자가 마약을 재사용하려는 충동(urge), 갈망(craving), 기대(anticipation), 기억(memory) 에 저항하도록 조력하는 것을 목표로 한다. 여기에는 건강하고 유익한 대안활동(alternate activities) 에 지속해서 참여하거나 공유적 삶의 질을 향상하는 유용한 새로운 대처기술(coping skills)을 체득함으로써 마약으로 인한 새로운 자극추구(novelty seeking), 쾌락추구(pleasure seeking), 고통회피(pain avoidance), 사적 이득(personal gains)에 익숙해진 뇌 보상회로를 재배선(조성)하는것을 포함한다. 전 세계적으로 알코올과 마약 오남용으로 인한 절망의 죽음(deaths of despair), 이러한 의미 없는 무력한 죽음이 아무 심각한 죄의식과 자각 없이 악순환적으로 계속 반복되고있는 실태이다. 이에 대한 대안으로 최근 마약치료와 재발예방을 위해 개입되고 있는 인지행동치료(CBT)와 더불어 마약중독징후(Signs of Drug Addiction), 마약중독영향(Effects of Drug Addiction), 사회적 영향(Social Effects), 마약중독예방(Prevention from Drug Addiction), 마약중독치료(Drug Addiction Treatment), 중독의 뇌신경생물학적 이해(새로운 자극추구와 도파민), 물질사용장애 예방전략, 중독치료약물, 중독주기의 3단계와 관련된 주요 뇌영역 등과 같이 다양한 효과적인 치료개입을 소개하고 고찰했다. 아울러 향후 물질사용장애(SUDs)를 위한 인지행동치료(CBT)에 관한 추가 연구에 관련해 제시했다. The main purpose of this study is to introduce and review the literature related to the implications of integrated treatment interventions of drug addiction. To solve substance abuse problems, social reintegration is very important to prevent addicts from relapse. Social reintegration focuses primarily on the social environment, including family and community, and aims to help addicts resist urges, cravings, expectations, and memories to reuse drugs. This includes rewiring brain reward circuits accustomed to drug-induced novelty seeking, pleasure seeking, pain avoidance, and personal gains by continuing to participate in healthy and beneficial alternative activities or learning useful new coping skills that improve shared quality of life. Globally, deaths of despair due to alcohol and drug abuse and these meaningless and helpless deaths continue to be repeated in a vicious cycle without any serious guilt feelings or awareness. As an alternative to this, various effective treatment interventions were introduced and considered, including CBT, which has recently been involved in Drug Treatment and Prevention of Relapse, Signs of Drug Addiction, Effects of Drug Addiction, Social Effects, Prevention From Drug Addiction, Drug Addiction Treatment, Understanding the Neurobiology of Addiction (Novelty Seeking and Dopamine), S395-424trategies for Prevention of Substance Use Disorder, Medications for Addiction Treatment, and the Major Brain Regions related to the Three Stages of the Addiction Cycle. Furthermore, further research on CBT for substance use disorders was presented.

약물중독예방을 위한 NGO 발전방향 - 「한국마약퇴치운동본부」를 중심으로 -

박성수 한국중독범죄학회 2020 한국중독범죄학회보 Vol.10 No.4

현재의 악화되고 있는 마약류 문제를 해결하기 위해 보다 전문화된 치료재활프로그램과 전 문 인력이 필요한 상황이다. 마약이라는 물질도 잘 알아야 하지만, 사람, 특히 중독된 사람의 회복에 대해서도 전문성을 확보해야 된다. 이를 위해서는 마약중독예방사업의 범위를 포괄적 으로 바라볼 필요가 있으며, 이를 통해 일반 국민대상의 예방교육의 내용도 지금까지 폐해 정 보 전달 중심에서 벗어나 인지적 극복기술, 의사결정 및 문제해결능력을 키우는 정서교육과 연계하여 청소년들이 가정, 친구, 학교에서 느끼는 사회적 압력을 잘 극복할 수 있는 훈련과 친구의 약물권유를 거절할 수 있는 힘을 기를 수 있는 교육으로 나아갈 수 있을 것이다. (재) 한국마약퇴치운동본부가 지금까지 우리나라가 마약 없는 밝은 사회로 나아갈 수 있도록 많은 기여를 한 것은 사실이다. 그러나 (재)한국마약퇴치운동본부의 마약퇴치활동 또 다르게 말해 서 우리나라의 사람중심 마약중독예방사업은 최근 상당기간 동안 현상유지에 머무르고 있어 보인다. 마약류중독예방센터가 주간입소시설로 전환하여 전문적인 활동의 폭을 넓혀나가면 서 한편으로 중독자 및 가족들의 쉼터역할을 강화해 나가고 있고, 기소유예 교육 등 재활교육 이 내실있게 발전하고 있는 등 몇몇 가시적인 진전이 있는 것도 사실이다. 그러나, 마약중독 예방사업이 국가적으로 체계적으로 수행되기 위해서는 앞에서 살펴본 대로 물질관리 중심 법 적 환경과 그에 따른 행정기관들의 업무분장 등의 문제 등에 대하여 범정부적으로 깊이있게 들여다보고 개선책을 마련하는 것이 필요하다. A more specialized rehabilitation program and professional manpower are needed to solve the current worsening drug problem. The substance of drugs should also be well known, but it should also have expertise in the recovery of people, especially those who are addicted. To this end, it is necessary to look at the scope of the drug addiction prevention project comprehensively, and through this, the contents of preventive education for the general public will move away from the focus of the information on harmful effects so far, along with emotional education that develops cognitive coping skills, decision-making and problem-solving skills, training for teenagers to overcome social pressures at home, friends, and to develop the power to reject drug recommendations from their friends. It is true that the Korean Association Against Drug Abuse has so far contributed much to helping the nation move toward a bright, drug-free society. However, in other words, the Korean Association Against Drug Abuse's anti-drug activities, the nation's human-centered anti-drug program, has remained in the status quo for quite some time. It is also true that the Drug Addiction Prevention Center has expanded its professional activities by converting it to a weekly admission facility, strengthening the role of shelter for addicts and their families, and developing rehabilitation education such as suspension of indictment. However, in order for the drug addiction prevention project to be carried out systematically nationwide, it is necessary to take a deep look into the legal environment centered on material management and the problems such as the division of duties of administrative agencies.

Salvage Regimens after Failure of Previous Helicobacter pylori Eradication Therapy: A Systematic Review and Meta-analysis

Hyo-Joon Yang,정혜경,Seung Joo Kang,이용찬,Seon-Young Park,Cheol Min Shin,Sung Eun Kim,임현철,Jie-Hyun Kim,Su Youn Nam,Woon Geon Shin,Jae Myung Park,Il Ju Choi,김재규,Miyoung Choi,Korean College of Helicobacter a 대한상부위장관ㆍ헬리코박터학회 2021 Korean Journal of Helicobacter Upper Gastrointesti Vol.21 No.1

Background/Aims: As antibiotic resistance increases and new first-line therapies emerge, salvage therapies for Helicobacter pylori (H. pylori) eradication failures are becoming more common and complicated. This study aimed to systematically review overall salvage regimens after previous failure of H. pylori eradication. Materials and Methods: A systematic review of randomized clinical trials evaluating salvage therapies after previous H. pylori eradication failure was performed. A meta-analysis was conducted when an adequate number of studies suitable for grouping was found. Results: Overall, 36 studies with 77 treatment arms were identified, and they were highly heterogeneous regarding previously failed regimens and salvage regimens under comparison. Bismuth quadruple therapy after failure of standard triple therapy showed a pooled intention-to-treat (ITT) eradication rate of 75.5% (95% CI, 71.6~79.1%), and the rates were significantly higher with 14-day therapy than 7-day therapy by 9% (95% CI, 2~15%). Levofloxacin triple therapy after failure of standard triple therapy demonstrated a pooled ITT eradication rate of 73.3% (95% CI, 68.4~77.3%). In direct comparison, the two regimens were not significantly different in eradication rates. No study evaluated salvage regimens after the failure of bismuth or non-bismuth quadruple therapy. Conclusions: The current studies regarding salvage regimens are highly heterogeneous. Bismuth quadruple therapy and levofloxacin triple therapy may be a reliable option after failure of standard triple therapy, but the regional profile of antibiotic resistance should be considered. Further studies are needed for salvage regimens after failure of non-bismuth or bismuth quadruple therapy.