- 作者列表："Kwon HY","Kim HL","Kim J
: Background: South Korea is the first Asian country to adopt health technology assessment (HTA) as a tool to support decision-making concerning pricing and reimbursement of drugs in 2007. Korean traditional medicines have been continuously marginalized in the modern paradigm of evidence-based medicine. To nurture Korean medicines, clinical practice guidelines for Korean medicines have been developed through government-led initiatives, and HTAs have been applied for the National Health Insurance coverage of Korean medicines. In this study, 27 diseases were selected for analyzing the evidence development of both clinical and economic values of Korean medicines. Methods: To investigate the status quo in application of HTA in Korean medicines, reports on the cost-effectiveness analysis project comprising 27 Korean medical interventions were reviewed. Results: All the selected studies were trial-based economic appraisals and their effectiveness was estimated with a subjective judgment tool, such as the quality of life measurement or visual analog scale. This study reconfirmed the limitations of Korean medicines, which included a short observation period, nonrandomized controlled trials, small sample size, subjective assessment for efficacy, selection bias, large uncertainty, and lack of evidence. Conclusions: Priorities should be placed on establishing the clinical evidence of Korean medicines, which will serve as the base for expanding the health coverage of Korean medicines and improving satisfaction and reliability of oriental medicines in Korea's health care system. Furthermore, the need to nurture the institutional environment in which both oriental and Western medicines can collaborate in Korea should be emphasized.
: 背景: 2007年，韩国是第一个采用卫生技术评估 (HTA) 作为支持药品定价和报销决策的工具的亚洲国家。韩国传统药物在循证医学的现代范式中不断被边缘化。为了培育韩国药品，通过政府主导的举措制定了韩国药品的临床实践指南，并将HTAs应用于韩国药品的国家健康保险覆盖范围。在这项研究中，选择了27种疾病来分析韩国药物的临床和经济价值的证据发展。 方法: 为了调查HTA在韩国药品中的应用现状，回顾了包括27项韩国医疗干预措施的成本-效果分析项目的报告。 结果: 所有选定的研究都是基于试验的经济评估，其有效性是用主观判断工具估计的，如生活质量测量或视觉模拟量表。这项研究再次证实了韩国药物的局限性，包括观察期短，非随机对照试验，样本量小，疗效主观评估，选择偏倚，不确定性大，缺乏证据。 结论: 应优先考虑建立韩国药品的临床证据，这将成为扩大韩国药品健康覆盖面和提高东方药品在韩国医疗保健系统中的满意度和可靠性的基础。此外，应强调需要培育东方和西方药物可以在韩国合作的体制环境。
METHODS::The ATP binding-cassette superfamily corresponds the mostly transmembrane transporters family found in humans. These proteins actively transport endogenous and exogenous substrates through biological membranes in body tissues, so they have an important role in the regulation of many physiological functions necessary for human homeostasis, as well as in response regulation to several pharmacological substrates. The development of multidrug resistance has become one of the main troubles in conventional chemotherapy in different illnesses including cancer, being the increased efflux of antineoplastic drugs the main reason for this multidrug resistance, with a key role of the ABC superfamily. Likely, the interindividual variability in the pharmacological response among patients is well known, and may be due to intrinsically factors of the disease, genetic and environmental ones. Thus, the understanding of this variability, especially the genetic variability associated with the efficacy and toxicity of drugs, can provide a safer and more effective pharmacological treatment, so ABC genes are considered as important regulators due to their relationship with the reduction in pharmacological response. In this review, updated information about transporters belonging to this superfamily was collected, the possible role of these transporters in cancer, the role of genetic variability in their genes, as well as some therapeutic tools that have been tried to raise against main transporters associated with chemoresistance in cancer.
METHODS:BACKGROUND:Cholinergic neurotransmission regulates neuroinflammation in Parkinson disease (PD). RESEARCH DESIGN AND METHODS:The authors conducted a delayed-start study of donepezil for cognitive decline in non-demented PD patients. The study consisted of a 96-week randomized placebo-controlled double-blind phase 1, followed by a 24-week donepezil extension phase 2. The primary outcome measure was a change in the Mini-Mental State Examination (MMSE) at week 120. RESULTS:A total of 98 patients were randomly allocated to the early-start (donepezil-to-donepezil) and delayed-start (placebo-to-donepezil) groups. Mean (SD) of the baseline MMSE was 27.6 (2.0) and 28.0 (2.1), respectively. MMSE change at week 120 was better in the early-start group than in the delayed-start group, but the difference was not significant. The MMSE declined in apolipoprotein ε4 carriers, but not in non-carriers, and the factor interaction (intervention × ε4 genotype) was highly significant (P < 0.001). Analyzed with the interaction, the difference was significant (group difference 1.95 [0.33 to 3.57], P = 0.018). The MMSE decline slope in phase 1 was significantly better in the early-start group than in the delayed-start group (P = 0.048). CONCLUSIONS:Cognitive function deteriorated in ε4 carriers, but not in non-carriers, and early-start donepezil may postpone cognitive decline in the former.
METHODS::Since the discovery of dental pulp stem cells, a lot of teams have expressed an interest in dental pulp regeneration. Many approaches, experimental models and biological explorations have been developed, each including the use of stem cells and scaffolds with the final goal being clinical application in humans. In this review, the authors' objective was to compare the experimental models and strategies used for the development of biomaterials for tissue engineering of dental pulp with stem cells. Electronic queries were conducted on PubMed using the following terms: pulp regeneration, scaffold, stem cells, tissue engineering and biomaterial. The extracted data included the following information: the strategy envisaged, the type of stem cells, the experimental models, the exploration or analysis methods, the cytotoxicity or viability or proliferation cellular tests, the tests of scaffold antibacterial properties and take into account the vascularization of the regenerated dental pulp. From the 71 selected articles, 59% focused on the "cell-transplantation" strategy, 82% used in vitro experimentation, 58% in vivo animal models and only one described an in vivo in situ human clinical study. 87% used dental pulp stem cells. A majority of the studies reported histology (75%) and immunohistochemistry explorations (66%). 73% mentioned the use of cytotoxicity, proliferation or viability tests. 48% took vascularization into account but only 6% studied the antibacterial properties of the scaffolds. This article gives an overview of the methods used to regenerate dental pulp from stem cells and should help researchers create the best development strategies for research in this field.