Age and body weight adjusted warfarin initiation program for ischaemic stroke patients

Yoo, S.-H.,Nah, H.-W.,Jo, M.-W.,Kang, D.-W.,Kim, J. S.,Koh, J.-Y.,Kwon, S. U. Blackwell Publishing Ltd 2009 European Journal of Neurology Vol.16 No.10

<P>Background: </P><P>Despite its proven effect, anticoagulation is not recommended to the acute ischaemic stroke due to the risk of bleeding complications. The purpose of this study is development of individualized warfarin initiation program for acute or subacute stroke patients.</P><P>Methods: </P><P>Among stroke patients who regularly visited out-patient clinics, we included patients who have continuously taken the same dose of warfarin as the prothrombin time remained at target International Nomarlized Ratio (INR). We assessed potential variables that affect the maintenance dose of warfarin. Using these variables, we developed an individualized warfarin initiation program.</P><P>Results: </P><P>The median warfarin maintenance dose (interquartile range) in the 321 included patients was 4 (3–5) mg per day. Age (adjusted <I>R</I><SUP>2</SUP> = 0.221, <I>P </I><<I> </I>0.001) and body weight (added to age, adjusted <I>R</I><SUP>2</SUP> = 0.238, <I>P </I>=<I> </I>0.008) were significant predicting factors of the dose. We classified the maintenance doses into high (HG), standard, and low group (LG) based on the distribution of maintenance doses. Decision tree analysis categorized younger (≤55 years old) and heavier (≥55 kg) patients into HG, and very old (≥80 years old) or low body weight (<55 kg among those >56 years old) patients into LG. We recommend 7 mg of warfarin as a standard initial dose, but 10 mg was recommended for HG patients and 5 mg for LG.</P><P>Conclusion: </P><P>We expect that this individualized program may reduce the time to target INR without excessive anticoagulation. Further prospective studies are needed to reveal the efficacy and safety of applying this program for acute stroke patients.</P>

증기발생기 수실 노즐댐 설치 및 제거작업의 피폭선량 저감에 영향을 주는 관리요인에 관한 연구

이동하,Lee, Dhong Ha 대한인간공학회 2017 大韓人間工學會誌 Vol.36 No.5

Objective: The aim of this study is to investigate the effective managerial factors influencing dose reduction of the nozzle dam installation and removal tasks ranking within top 3 in viewpoint of average collective dose of nuclear power plant maintenance job. Background: International Commission on Radiation Protection (ICRP) recommended to reduce unnecessary dose and to minimize the necessary dose on the participants of maintenance job in radiation fields. Method: Seven sessions of nozzle dam installation and removal task logs yielded a multiple regression model with collective dose as a dependent variable and work time, number of participants, space doses before and after shield as independent variables. From the sessions in which a significant reduction in collective dose occurred, the effective managerial factors were elicited. Results: Work time was the most important factor contributing to collective dose reduction of nozzle dam installation and removal task. Introduction of new technology in nozzle dam design or maintenance job is the most important factor for work time reduction. Conclusion: With extended task logs and big data processing technique, the more accurate prediction model illustrating the relationship between collective dose reduction and effective managerial factors would be developed. Application: The effective managerial factors will be useful to reduce collective dose of decommissioning tasks as well as regular preventive maintenance tasks for a nuclear power plant.

연령별 적정 와파린 용량 설정에 관한 연구

김희진,박향미,김정미,손기호 한국병원약사회 2006 병원약사회지 Vol.23 No.2

American College of Chest Physicians has recommended reasonable initial dose of warfarin therapy in outpatients, which is at least 5 mg/day for adults and less than 5 mg/day for the elderly. Meanwhile Anti-coagulation Service (ACS) of Samsung Medical Center (SMC) has set up its own guideline in warfarin therapy: warfarin 2 mg/day for over 70-year-old patients, 2.5 mg/day for under 70-year-old patients, followed by checking INR within one week. This was obtained clinically, and its property has not been evaluated. In this context, the purpose of this study is to analyze age-related maintenance dosing pattern and multiple factors of warfarin effect and provide useful information for a standard dose guideline to ACS of SMC. Study I was processed as follows. First, targeted patients were the department of neurology and internal circulatory patients enrolled at ACS. And then, divided into two groups by their specific INR; INR of group I is 1.7 to 2.5 and that of group Ⅱ is 2.0 to 3.0. In study II, patients who had received warfarin therapy in ACS of our out-patient medical center and had indication of atrial fibrillation, at the same time, showing INR 2.0~3.0 were investigated. This study was performed under SAS 3.0 version. For this study, 288 (group Ⅰ) and 220 (group Ⅱ) patients' records were analysed. From the view of age factor, the elderly in both groups needed significantly lower warfarin dose (Ⅰ,Ⅱ: p <0.0001) and the maintenance warfarin dose for male was significantly greater than that of female in group Ⅰ(p<0.05). On the contrary, male did not differ from female in their warfarin requirements in group Ⅱ. In weight respect, there was positive relationship between the body weight and required dose (Ⅰ,Ⅱ: p<0.05), however it did not relate to BMI. In study Ⅱ, under 70-year-old patients needed 33.4 days and over 70-year-old patients needed 28.7 days in order that their INR reaches the target range. In this study, we confirmed that the age of the patient is the most important determinant of warfarin requirement in Korean. We also found required warfarin dose decreased averagely 0.35 mg/week for each additional aged patient and Korean warfarin patients required lower warfarin dose such as 2.2~7 mg/week compared to Caucasian. It means there are ethnic difference. All things considered, this study allowed new guideline for initiating warfarin dose, especially for atrial fibrillation patients whose target INR is 2.0~3.0 and resulted in the age-related maintenance dose like followings; under 50 years old: 3.5 mg/day, 50~59 years old: 3 mg/day, 60~69 years old: 2.5 mg, over 70 years old: 2 mg. Further investigation needs to be conducted to confirm how much the required period to reach INR is shortened when the newly recommended doses are applied.

Aminophylline 클리어런스 및 유지 용량에 영향을 미치는 요인 분석

노주현,정영미,남궁형욱,이병구 한국병원약사회 2006 병원약사회지 Vol.23 No.3

In many clinical cases such as emergency bronchial asthma attack, methylxanthine bronchodilator, aminophylline may have a beneficial role in the management of asthma. However, aminophylline has a narrow therapeutic index. Also individual variability in the rates of metabolism or total clearance has marked an influence on the serum level of the drug. Generally, the overall liver function declines with age, probably as a result of reduced hepatic mass and blood flow. Therefore, we should carefully monitor mode of action and adverse effect of the drug. At present, we don't have a standard guideline for patients on maintenance dose of aminophylline. In practice, initial dose is decided by the clinical experience and maintenance dose is determined from each patient's hepatic clearance. Consequently, in the study, we aimed to analyze the factors of influencing aminophylline maintenance dose in Korean respiratory lung disease patients. From April 2004 to September 2005, the initial treatment of the patients had included constant intravenous aminophylline therapy in Seoul National University Bundang Hospital. Subjects were the adult of over 18 years old and had measured serum level in steady state. Also exclusion were made for patients with altered theophylline metabolism (e.g., smoking), drug interactions (e.g., ciprofloxacin), and concomitant disease states (e.g., congestive heart failure, liver cirrhosis). The subtherapeutic range group had smaller maintenance dose (mg/kg/hr) than the therapeutic range group (0.24 ± 0.06 vs 0.33 ± 0.12, t-test, p 0.05). Mean serum level and maintenance dose of aminophylline in therapeutic range were not influenced by sex and obesity but these were high in young subjects (less than 65 year old). No significant difference between young subjects and geriatric subjects (greater than 65yr) was detected in theophylline clearance. Also, it was found that the clearance of theophylline in obese subjects was similar to that of non-obese subjects. From this study, it is concluded that obesity (actual body weight/ideal body weight) has to be considered as the factor which affect to the clearance. Maintenance dose of the patient group reached therapeutic range was 0.33 ± 0.12 mg/kg/hr, hence dosage guideline can be set by this result.

The Importance of low dose steroid maintenance therapy after rituximab treatment in a recalcitrant pemphigus vulgaris patient

( Tae Hoon Kim ),( Seung Hwan Choi ),( Seung Min Ha ),( Ki Hoon Song ),( Ki Ho Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.1

Pemphigus is a severe blistering disorder caused by autoantibodies to desmogleins 1 and 3. Some patients with pemphigus never enter into remission with conventional therapy of high-dose corticosteroid. These patients need steroid-sparing agents such as conventional immunosuppressants or immunobiologics. Rituximab is an anti CD20, chimeric monoclonal antibody binding to the CD20 antigen on B cells, which proved to be effective in recalcitrant pemphigus. A 54-year-old Korean woman presented with recurrent episodes of multiple erythematous bullae and macules with ulcerations on trunk, upper extremities and oral mucosa and her disease did not respond so effectively to systemic corticosteroid or cyclosporin. The patients were treated with four weekly infusions of 375 mg/m2 of rituximab but lesions did not improve for a while. After low dose steroid maintenance therapy was added to the rituximab treatment, the skin lesions improved rapidly and subsided without any recurrence. Now she is administered mycofenolate mofetil 500mg /d. Herein, we report a case of recalcitrant pemphigus vulagris, which was successfully treated with Retuximab and low dose steroid maintenance therapy.

방사성물질과 접촉하는 작업의 손 · 발이 받는 피폭방사선량 평가에 대한 고찰

김희근,공태영,동경래,최은진 (사)한국방사선산업학회 2017 방사선산업학회지 Vol.11 No.3

Concerns about high radiation exposure to the hands of radiation workers who may contact with radioactive contamination on surfaces in a nuclear power plant (NPP) had been raised, and the Korean regulatory body required the extremity dose estimation during contact tasks with radioactive materials. Korean NPPs conducted field tests to identify the incident radiation to the hands of radiation workers who may contact with radioactive contamination during maintenance periods. The results showed that the radiation fields for contact tasks are dominated by high energy photons. It was also found that the radiation doses to the hands of radiation workers in Korean NPPs were much less than the annual dose limits for extremities. This approach can be applicable to measure and estimate the extremity dose to the hands of medical workers who handle the radioactive materials in a hospital.

One-Year Follow-Up of Serum Prolactin Level in Schizophrenia Patients Treated with Blonanserin: A Case Series

Sakae Takahashi,Masahiro Suzuki,Makoto Uchiyama 대한신경정신의학회 2015 PSYCHIATRY INVESTIGATION Vol.12 No.4

In our previous study, a prolactin elevation was more frequently in risperidone than in blonanserin; however, it was more often in blonanserin than in olanzapine. Therefore, while a rate of PRL rising is low to moderate, hyperprolactinemia is a considerable adverse effect in the blonanserin treatment. In this study, to examine detailed characteristics of hyperprolactinemia of blonanserin, we analyzed the prolactin data in six schizophrenic patients who were switched to blonanserin from other antipsychotics and followed for one year. As a result, blonanserin dose was clearly associated with serum prolactin level. The average prolactin level was almost normal when the mean blonanserin dosage was 8.0 mg/day. Regardless of the dose decrease of blonanserin, there were no remarkable changes in symptoms and social functions. Based on our findings, we conclude that low dose blonanserin medication may be useful for schizophrenia maintenance treatment without hyperprolactinemia and a high rate of relapse.

The Worker’s External Dose at Maintenance Work Due to Failure During Operation of the Spent Resin Mixed Waste Treatment Facility From Wolseong NPP Unit 1

Ja Yeong Yoon,Hee Reyoung Kim 한국방사성폐기물학회 2024 한국방사성폐기물학회 학술논문요약집 Vol.22 No.1

Impact of ABCB1 C3435T Polymorphism on Treatment Response of Vitamin K Antagonists: A Systematic Review and Meta-analysis

이수연,안숙희 한국임상약학회 2022 한국임상약학회지 Vol.32 No.3

Objective: The aim of this study was to examine the impact of ATP-binding cassette subfamily B member 1 (ABCB1) C3435Tpolymorphism on the treatment response of patients to vitamin K antagonists (VKAs). Methods: In this systematic review and metaanalysis,the PubMed/Medline, Embase, and Cochrane Library databases were searched for eligible articles for the period up toNovember 2020. Articles that reported treatment response to VKAs according to the ABCB1 C3435T polymorphism were includedin this study. Results: A total of 13 and 9 articles were included in the systematic review and meta-analysis, respectively. The weeklymaintenance dose of warfarin was significantly lower in patients with the ABCB1 3435CT or TT polymorphism type than in thosewith the ABCB1 3435CC type (weighted mean difference [WMD], −2.53 mg/week; 95% confidence interval [CI], −3.64 to −1.43,p<0.001). However, the weekly maintenance dose of acenocoumarol was not significantly associated with the ABCB1 C3435Tpolymorphism (WMD, 1.02; 95% CI, −0.61 to 2.65, p=0.22). Conclusion: The ABCB1 C3435T polymorphism was significantlyassociated with the weekly maintenance dose of warfarin. Further research is needed to confirm the association between the ABCB1C3435T polymorphism and the incidence rate of bleeding events.

Randomized Comparison of Adjunctive Cilostazol Versus High Maintenance Dose Clopidogrel in Patients With High Post-Treatment Platelet Reactivity

Jeong, Y.H.,Lee, S.W.,Choi, B.R.,Kim, I.S.,Seo, M.K.,Kwak, C.H.,Hwang, J.Y.,Park, S.W. Elsevier Biomedical 2009 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY - Vol.53 No.13

Objectives: The purpose of this study was to determine the impact of adjunctive cilostazol in patients with high post-treatment platelet reactivity (HPPR) undergoing coronary stenting. Background: Although addition of cilostazol to dual antiplatelet therapy enhances adenosine diphosphate (ADP)-induced platelet inhibition, it is unknown whether adjunctive cilostazol can reduce HPPR. Methods: Sixty patients with HPPR after a 300-mg loading dose of clopidogrel were enrolled. HPPR was defined as maximal platelet aggregation (Agg<SUB>max</SUB>) >50% with 5 μmol/l ADP. Patients were randomly assigned to receive either adjunctive cilostazol (triple group; n = 30) or high maintenance dose (MD) clopidogrel (high-MD group; n = 30). Platelet function was assessed at baseline and after 30 days with conventional aggregometry and the VerifyNow assay. Results: Baseline platelet function measurements were similar in both groups. After 30 days, significantly fewer patients in the triple versus high-MD group had HPPR (3.3% vs. 26.7%, p = 0.012). Percent inhibitions of 5 μmol/l ADP-induced Agg<SUB>max</SUB>and late platelet aggregation (Agg<SUB>late</SUB>) were significantly greater in the triple versus high-MD group (51.1 +/- 22.5% vs. 28.0 +/- 18.5%, p < 0.001, and 70.9 +/- 27.3% vs. 45.3 +/- 23.4%, p < 0.001, respectively). Percent inhibitions of 20 μmol/l ADP-induced Agg<SUB>max</SUB>and Agg<SUB>late</SUB>were consistently greater in the triple versus high-MD group. Percent change of P2Y12 reaction units demonstrated a higher antiplatelet effect in the triple versus high-MD group (39.6 +/- 24.1% vs. 23.1 +/- 29.9%, p = 0.022). Conclusions: Adjunctive cilostazol reduces the rate of HPPR and intensifies platelet inhibition as compared with a high-MD clopidogrel of 150 mg/day.