나환자에 있어서 혈청내 면역복합체,백혈구 이동 억제인자 및 HLA-DR항원에 관한 연구

박주영,최인홍,김세종,유준,김주덕 大韓癩學會 1984 癩學 會誌 Vol.17 No.1

임부(姙婦)의 산전위험요인평가연구(産前危險要因評價硏究): 일선(一線) 보건요원(保健要員)을 위한 산전관리용(産前管理用) 위험요인적용모형(危險要因適用模型) 개발(開發)

박인화 ( In-hwa Park ),주신일 ( Shyn Ii Joo ) 한국보건사회연구원 1985 保健社會硏究 Vol.5 No.1

1. Background and Purpose of Study The purpose of this study is to develop a risk factor assessment chart that is simple to use by health workers at grass-root level and predictive enough to screen and allocate limited resources to high-risk pregnancy. A risk scoring chart, currently in use by the government sector in the field of maternal and child health in Korea, is based on arbitrary criteria for selection and scoring of risk factors. Therefore this chart has considerable limitations in the statistical sense including the validity of scoring system. Against this backstop, development of a risk factor assessment chart that is valid on statistical consideration is critically indicated for manpower situation as unique in Korea where nurse-aids account for the predominant work-force engaged in the maternal and child health care service at the grass-root level in the public sector. 2. Design of Study Materials: The current study, which is the second phase one, relates to the 3,838 pregnant women reviewed and edited out of the original 4,012 women observed in the first phase of the study (Joo et al., 1982) and is intended to attempt further in-depth analysis of the information on pregnancy and labour of the population. Information on the medical charts of pregnant women who were consecutively delivered at the Busan II Shin Hospital during the first six months in 1981 are the main data source. Relevant information on these medical charts were collected in standardized questionaire that was developed by a Korea Institute for Population and Health research team. Analysis of Data: In principle, four main analyses were undertaken. First, the significance of association between maternal variables and a defined outcome variable which relates to unwanted pregnancy complications and labor/delivery outcomes, was assessed by means of the adjusted chi-square test. A list of variables that were shown statistically significant on chi-square test were selected as risk factors. Therefore, pregnancies with risk factors were categorized as high-risk pregnancy, and those without any were grouped as non-risk pregnancy which, however, were subject to further analysis of next stage. In short, all those non-risk pregnancies found without risk factors under· went analysis of each succeeding stage up 10 final one, fourth stage. Second, odds ratio as an approximation to the relative risk, was calculated to assess the potency of different risk factors associated with the defined outcome variable. Third, validity of each stage of screening scheme was tested. interms 01 sensitivity, specificity and predictability. Finally, a revised risk assessment chart to screen high-risk pregnancy was developed for the use of health workers at grass-root level. 3, Findings First stage of analysis: Six maternal variables including obstetric danger signals identified over chief complaints of the pregnant were examined in relation to the unwanted pregnancy complications and labour/delivery outcomes. The first stage analysis showed that there were significant associat ion between four danger signals of edema, blurred visionf headache, convulsion and bleeding, and the adverse outcome. Risk factors with the highest association are convulsion and edema that are highly correlated with hypertensive disorder 01 pregnancy. The prevalence of the pregnancy with single or more of the four risk factors is found to be 16.3 percent and corresponding odds ralio is 4.59, as shown in Table 8. Second stage of analysis: Non-risk pregnancies that were not exposed to anyone of the statistically Significant danger signals of the first stage of analysis were further divided into two groups, ie., primiparas and multiparas. Six independent variables including age for the group of primiparas and 15 variables for multiparas including the former six for the primiparas were examined in relation to the adverse outcomes. For primipara, age and height are found to be risk factors and for multipara, age, height and seven va riables related to previous obstet ric history are proved to be risk factors. Each prevalence of primiparas and multipa ras who are exposed to single or more of risk factors in each defined group are 4.5 percent and 50.0 percent respectively. Corresponding odds ratios for primipara and multipara thus exposed to risk factors are 4.41 and 3.45 respectively, as shown in Table 11. Third stage of analysis: Those non-risk pregnancies that were continuously left out over the process of first and second stage of analysis underwent further examination. Seven maternal variables that can be easily identified over simple clinical check-up were examined of their effect on the defined outcome variable. Statistically significant are two factors of blood pressure (140/90 mmHg or higher) and presence of pre-eclampsia/eclampsia. The prevalence of pregnancies with single or both of the two risk factors is 5.5 percent with corresponding odds ratio of 1.57, as shown in Table 13. It is comparatively weaker association in contrast with those found in the preceding stages of analysis. Fourth stage or analysis: Those non-risk pregnancies continuously left out over the three stages of analysis were further examined to find out what statistically significant risk factors were out of the 14 selected maternal variables during pregnancy of third trimester. These variables are divided into two groups. ie., one group of nine variables that are easily identifiable during clinical check-up and another group of five variables that would require examination of more skilled health personnel. Significant among the former group are found to be five risk factors including excessive weight gain and among the latter, three risk factors including abnormal size on abdominal examination. The prevalence of pregnancies with one or more of five risk factors in the former group accounts for 11.9 percent with corresponding odds ratio of 2.44, whereas the prevalence of pregnancies with single or more of the lauer`s three risk factors is 20.2 percent with corresponding odds ratio of 3.73. Thus, risk factors that would require expert examination seem to have higher degree of association, as shown in Table 15. Consequently the prevalance of pregnancies with single or more of the above eight risk factors combined. is 29.4 percent with corresponding odds ratio of 3. 19. 4. Conclusion and Recommendation Among the total of 48 maternal variables initially employed for analysis, 26 variables were selected as risk factors. Accordingly study pregnancies were screened at each stage of analysis, depending on the occurrence of the relevant risk factors. In this study, all those classified as high-risk pregnancy account for 41.5 percent-47.6 percent according to the type of screening scheme applied at fourth stage. The predictability of this screening scheme has, at all stages of screening, positive predictive power between 41.7 percent and 69.3 percent, and negative predictive power between 67.0 percent and 89.3 percent. Total correct classification which accounts for the percentage of true positive and negative cases combined among the cases observed, ranges from 67.3 percent to 73.8 percent, as shown in Table 19. High predictability is found of the fourth stage scheme with more complicated risk factors, and lower one, of the second stage scheme with risk factors of age, height, and previous obstetric histories. Positive predictive power of this screening scheme, by and large, is lower than negative predictive power. In conclusion, a risk factor assessment chart proposed in this study for the use of health workers at grass-root level is illustrated in Table 20. This revised scheme is modified out of study results in terms of statistical consideration between risk factors and the outcome variable, logical validation, and practical utility. In the future efforts, selection of risk factors and their cut-off points will be defined in view of balance between the seriousness of the false negative mistakes and the damage done to individuals by the needless use of resources on the false positives. This in turn raises a critical issue in the public health activities; how many and what kind of "mistakes" can be accomodated when resources are limited?

Nuclear factor I-C가 치근발생 과정에서 Hertwig's 상피초 형성에 미치는 영향

신인철,박주철,정문진,오현주,박선화,이창섭,김흥중,Shin, In-Cheol,Park, Joo-Cheol,Jeong, Moon-Jin,Oh, Hyun-Ju,Park, Sun-Hwa,Lee, Chang-Seop,Kim, Heung-Joong 대한소아치과학회 2005 大韓小兒齒科學會誌 Vol.32 No.3

치아의 형성은 상피-간엽간의 상호작용을 통해 조절되어지는 복잡한 발생과정이다. 지금까지 치관의 발생에 관여하는 유전자 및 그들의 신호전달경로에 관한 연구는 다수 진행되어 왔지만 치근의 발생을 조절하는 기전에 대해서는 별로 알려진 것이 없다. 최근에 NFI-C knock out 생쥐에서 정상치관에 비정상적인 치근을 가지는 치아가 보고되었다. 본 연구의 목적은 NFI-C가 어떻게 치근의 형태와 상아모세포의 분화에 관여하는지를 규명하는 것이다. NFI-C knock out 생쥐의 치근 발생동안에 HERS의 역할을 연구하고자 cytokeratin 면역조직화학적방법과 치근상아질의 특성을 규명하기 위해 DSPP mRNA in-situ hybrydization법을 수행하였다. 1. NFI-C knock out 생쥐의 치근형성시 HERS의 역할 Wild type과 knock out type 모두에서 cytokeratin은 모든 HERS 세포들과 반응하였고, HERS와 법랑상피 사이의 양성반응세포들의 연속성은 치경부 부위에서 소실되었다. Knock out type에서 치근상아질이 침착된 후, cytokeratin 양성-HERS 세포들은 치경부에서 불규칙한 배열과 극성의 상실을 보였다. 2. NFI-C knock out 생쥐의 치근상아질의 특성 DSPP mRNA의 발현은 wild type에서 치관과 치근상아질의 상아모세포 모두에서 강한 발현을 보인 반면, knock out type에서는 치관부위 상아질의 상아모세포에서만 강한 발현을 보였다. 3. NFI-C knock out 생쥐의 치근 발생과정에서 HERS는 치관으로부터 정상적인 확장을 보인 반면, 치근부위에서의 상아 모세포 분화는 실패하였다. 위의 결과들로 보아 NFI-C는 치근형성 과정에서 상아모세포 분화에 중요한 역할을 하는 것으로 사료된다. Tooth formation is a complex developmental process that is mediated through a series of reciprocal epithelial-mesenchymal interactions. Several signal pathways and transcription factors have been implicated in regulating molar crown development, but relatively little is known about the regulation of root development. It was reported that NFI-C knockout mice showed abnormal root formation with normal crown. The aims of this study are to elucidate how the NFI-C regulate the determine of root shape and odontoblasts differentiation. We carried out immunohistochemistry using cytokeratin to investigate the role of Hertwig's epithelial root sheath and DSPP mRNA in-situ hybridization to conform the nature of root dentin during root development in NFI-C knockout mice. Cytokeratin reacted with all the HERS cells and the continuity of cytokeratin positive cells between the HERS cells and enamel epithelium was lost in the cervical region both wild and K/O types. After root dentin deposition cytokeratin positive-HERS cells showed irregularity and loss of polarity in the cervical region in K/O type. DSPP mRNA was strongly expressed in odontoblasts of crown and root dentin in wild type mice, whereas expression of DSPP mRNA was restricted in odontoblast of crown dentin in the K/O type. During root formation in NFI-C knockout mice, HERS normally grow out of the crown but fail to induce odontoblast differentiation in root portion. These results suggest that NFI-C may play important roles in odontoblast differentiation during root dentin formation.

외과계 감염증에 대한 Sulperazon(Sulbactam/cefoperazone) 및 Cefoperazone의 임상효과 비교연구

박규주,노동영,김상준,권오중,정중기,홍인규 대한화학요법학회 1990 대한화학요법학회지 Vol.8 No.2

Despite recent advances in development of antibiotics and antiseptic techniques, infection still remains to be one of the major problems in the surgical field. Due to development of bacterial resistance to commonly used antibiotics, there is always a need to develop a new antimicrobial agent which would overcome such resistance. Sulperazon (Sulbactam/Cefoperazone) is a combination drug of potent β-lactamase inhigitor, sulbactam, and cefoperazone which has broad antibacterial spectrum, which was developed to combat against β-lactamase producing microorganisms. In an effort to evaluate the efficacy and safety of sulperazone, we have randomly divided 40 patients (12 with perforated appendicitis, 10 with peritionitis, 6 with GB empyema, 6 with periproctal abscess, 3 with wound infection, 1 liver abscess, 1 pancreatic abscess, and 1 acute cholangitis) into 2 groups (20 patients in each group). One group received daily dose of 2 to 3 grams of sulperazon and the other group received daily dose of 2 to 3 grams of cefoperazone. Following results were obtained : 1. Clinical effect of sulperazon was cure in 16 patients (80%), improvement in 3 patients (15%), compaired to cure in 14 patients (70%), improvement in 4 patients (20%) for the cefoperazone group. 2. Using disc diffusion method, sulperazon was sensitive to all of the isolated microorganisms except β-hemolytic streptococci, which was moderately sensitive. Cefoperazone was sensitive to only E. coli, Pseudomonas aeruginosa and Serratia. 3. Microbiological effect of sulperazon was eradication of offending microorganisms in 16 patients (80%), compared to 14 patients (70%) in Cefoperazone group. 4. Overall clinical efficacy of sulperazon was 95%, compared to 80% for cefoperazone. 5. Adverse effects due to sulperazon was nausea and diarrhea which occurred in 1 patient respectively. 2 patients receiving cefoperazone experienced diarrhea. It can be concluded that sulperazon is a safe and effective antibiotic agent which can be used in surgical infection patients.

장시간 불가피한 공복(fasting)후 인체의 내분비 변화 : 삼풍백화점 붕괴 사고후 구조된 3인의 증례 THREE CASES IN COLLAPSE OF SAMPOONG DEPARTMENT STORE

박규남,황주일,박조현,오동렬,이원재,오승택,김세경,김인철 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

The interactions between nutrition and the endocrine system are more intimate and complex that previously thought. Nutrition modulates secretion and activity of many hormones, as part of the stress adaptation process. Fasting, in particular, produces a number of important changes in the endocrine system, with teleological purpose of helping the body tolerate the lack of food ingestion. These changes are therefore beneficial and protective, although at times they may not appear to be that way. The endocrine changes of fasting mediate the metabolic response. We must emphasize that these changes are completely reversible when appropriate nutrition is established. These changes are as followes: 1) decreased insulin and increased glucagon levels, 2) decreased thyroid effect, 3) decreased sympathetic activity, 4) hypothalamic hypogonadism, 5) decreased growth, 6) altered glucocorticoid secretion and metabolism, 7) impaired mineralocorticoid response, 8) decreased ADH secretion and effect. We experienced three cases of involuntary prolonged fasting after collapse of Sampoong department store. They were released from collapsed field after 11(case Ⅰ), 13(case Ⅱ), 17days(case Ⅲ) respectively. In each case, the endocrine changes of plasma levels were as followes: decrease of cortisol in case Ⅰ, increase of GH in case Ⅱ, decrease of free T3, T3, cortisol and increase of reverse T3, insulin in case Ⅲ. Each one did not show the same endocrine changes of plasma levels. But we think these changes of fasting are beneficial in metabolic response of human.

법랑모세포 분화와 법랑질 형성과정에서 OD314, Apin protein의 발현 및 기능

박종태,최용석,김흥중,정문진,오현주,신인철,박주철,손호현 대한치과보존학회 2006 Restorative Dentistry & Endodontics Vol.31 No.6

본 연구에서는 법랑모세포 분화와 법랑질 형성에 연관이 있는 OD314 일명 Apin protein의 기능을 밝힐 목적으로, in-situ hybridization에 의한 OD314 mRNA 발현과 법랑모세포 세포주에서 OD314 enamel matrix protein의 발현, 그리고 OD314 유전자를 과발현/억제시킬 수 있는 construct를 제작한 후 법랑질 형성 중에 OD314의 기능을 알아보고자 RT-PCR를 시행하여 다음과 같은 결과를 얻었다. 1. OD314 mRNA는 발생중인 상아모세포보다 법랑모세포에서 강하게 발현되었다. 2. Tuftelin은 석회화 결정이 형성되는 14일까지 발현이 지속되고, 그 이후부터 점차 감소하였다. Amelogenin과enamelin은 7일부터 그 발현이 점점 감소하였다. 3. U6-OD314 siRNA construct를 이용하여 transfection한 법랑모세포 세포주는 OD314와 tuftelin,MMP2 mRNA 발현이 감소하였으며, CM-OD314를 transfection하여 OD314의 과발현을 유도한 경우에는 OD314와 MMP20 mRNA의 발현이 뚜렷이 증대되었다. 이 결과는 OD314가 법랑모세포의 분화와 법랑질의 형성 그리고 석회화 과정에 중요한 역할을 하는 새로운 인자임을 시사한다. This study was aimed to elucidate the biological function of OD314 (Apin protein), which is related to ameloblast differentiation and amelogenesis. Apin protein, calcifying epithelial odontogenic (pindborg) tumors (CEOTs)-associated amyloid, were isolated from CEOTs, and has similar nucleotide sequences to OD314. We examined expression of the OD314 mRNA using in-situ hybridization during tooth development in mice. Expression of OD314 and several enamel matrix proteins were examined in the cultured ameloblast cell line up to 28 days by reverse transcription-polymerase chain reaction (RT-PCR) amplification. After inactivation and over-expression of the OD314 gene in ameloblast cell lines using U6 vector-driven RNA interference and CMV-OD314 construct, RT-PCR were performed to evaluate the effect of the OD314 during amelogenesis. The results were as follows: 1. In in-situ hybridization, OD314 mRNAs were more strongly expressed in ameloblast than odontoblast. 2. When ameloblast cells were cultured in the differentiation and mineralization medium for 28 days, the tuftelin mRNA expression was maintained from the beginning to day 14, and then gradually decreased to day 28. The expressions of amelogenin and enamelin were gradually decreased according to the ameloblast differentiation. 3. Inactivation of OD314 by U6-OD314 siRNA construct down-regulated the expression of OD314, MMP-20, and tuftelin, whereas over-expression of OD314 by CMV-OD314 construct up-regulated the expression of OD314 and MMP-20 without change in tuftelin. These results suggest that OD314 is considered as an ameloblast-enriched gene and may play the important roles in ameloblast differentiation and mineralization.

Synergistic effects of codecoration of oxide nanoparticles on the gas sensing performance of In₂O₃ nanorods

Park, Sunghoon,Sun, Gun-Joo,Kheel, Hyejoon,Lee, Wan In,Lee, Sangmin,Choi, Seung-Bok,Lee, Chongmu Elsevier 2016 Sensors and actuators. B Chemical Vol.227 No.-

<P><B>Abstract</B></P> <P>n-In<SUB>2</SUB>O<SUB>3</SUB> nanorods codecorated with n-Fe<SUB>2</SUB>O<SUB>3</SUB> and p-Co<SUB>3</SUB>O<SUB>4</SUB> nanoparticles were synthesized by the thermal evaporation of In<SUB>2</SUB>S<SUB>3</SUB> powders in an oxidizing atmosphere followed by the solvothermal deposition of Fe<SUB>2</SUB>O<SUB>3</SUB> and Co<SUB>3</SUB>O<SUB>4</SUB> nanoparticles, and their ethanol gas sensing properties were examined. The p-Co<SUB>3</SUB>O<SUB>4</SUB>-decorated n-In<SUB>2</SUB>O<SUB>3</SUB> nanorods exhibited stronger and faster response to ethanol gas than the n-Fe<SUB>2</SUB>O<SUB>3</SUB>-decorated n-In<SUB>2</SUB>O<SUB>3</SUB> nanorods due to the larger modulation of the conduction channel width and interfacial potential barrier height, and stronger catalytic activity of p-Co<SUB>3</SUB>O<SUB>4</SUB> than n-Fe<SUB>2</SUB>O<SUB>3</SUB>. Furthermore, the codecorated In<SUB>2</SUB>O<SUB>3</SUB> nanorod sensor exhibited significantly stronger and faster response to ethanol gas than its mono-oxide nanoparticle-decorated counterparts under the condition of the same total amount of the decorating nanoparticles. The origin of the synergistic effects of codecoration on the ethanol sensing properties of the In<SUB>2</SUB>O<SUB>3</SUB> nanorod sensor is not the formation of compounds or nanoalloys between the oxides but the formation of a large number of the p–n junctions between the two different types of decorating oxides, i.e., Fe<SUB>2</SUB>O<SUB>3</SUB>–Co<SUB>3</SUB>O<SUB>4</SUB> p–n junctions in addition to the Co<SUB>3</SUB>O<SUB>4</SUB>–In<SUB>2</SUB>O<SUB>3</SUB> p–n junctions.</P>

법랑모세포 분화와 성숙과정에서 OD314의 발현

박주철,안성민,김흥중,정문진,박민주,신인철,손호현 大韓齒科保存學會 2005 Restorative Dentistry & Endodontics Vol.30 No.5

법랑모세포는 법랑질을 형성하고 유지하는 세포로, 법랑질의 유기기질을 분비하고 법랑질 석회화 과정에도 관여한다. 치아 발생과정에서 법랑모세포의 분화는 순차적인 상피-간엽 상호작용에 의하여 조절되나, 분화나 성숙과정의 정확한 기전은 아직까지 잘 알려져 있지 않다. 최근에 상아모세포에서 처음 발견된 OD314가 치아 발생과정에서 상아질을 형성하는 상아모세포 뿐 아니라 법랑모세포에도 발현된다고 하였다. 이에 본 연구에서는 생쥐 하악 전치의 다양한 시기의 법랑모세포를 이용하여, 형태학적 분석과 in-situ hybridization에 의한 OD314 mRNA의 발현 그리고 OD314 항체를 이용한 면역조직화학적 분석을 통하여 OD314 유전자의 법랑 모세포 분화와 성숙과정에서의 역할을 연구하여 다음과 같은 결과를 얻었다. 1. 형태학적으로 법랑모세포는 분화 단계에 따라 분비 전단계 법랑모세포, 분비기 법랑모세포, 성숙기의 평탄끝 법랑모세포와 성숙기의 주름끝 법랑모세포로 구분되었다. 2. OD314 mRNA는 분비기의 법랑모세포에서부터 발현되기 시작하여 법랑모세포가 성숙해갈 수록 그 발현이 증가하였다. 3. OD314 단백질은 분비 전단계의 법랑모세포에서는 발현되지 않고, 분비기의 법랑모세포에서는 세포질에 전체적으로 발현되었다. 성숙기의 평탄끝 법랑모세포와 주름끝 법랑모세포에서는 세포의 근심과 원심끝단에 OD314 단백질이 강하게 발현되었다. 이상의 결과를 종합하여 OD314는 법랑모세포의 분화와 성숙과정에서 세포질 내부에서 특징적인 역할을 하는 것으로 사료된다. Ameloblasts are responsible for the formation and maintenance of enamel which is an epithelially derived protective covering for teeth. Ameloblast differentiation is controlled by sequential epithelial-mesenchymal interactions. However, little is known about the differentiation and maturation mechanisms. OD314 was firstly identifled from odontoblasts by subtraction between odontoblast/pulp cells and osteoblast/dental papilla cells, even though OD314 protein was also expressed in ameloblast during tooth formation. In this study, to better understand the biologcal function of OD314 during amelogenesis, we examined expression of the OD314 mRNA and protein in various stages of ameloblast differentiation using in-situ hybridization and immunohistochemistry. The results were as follows : 1. The ameloblast showed 4 main morphological and functional stages referred to as the presecretory, secretory, smooth-ended, and ruffle-ended. 2. ○D314 mRNA was expressed in secretory ameloblast and increased according to the maturation of the cells. 3. OD314 protein was not expressed in presecretory ameloblast but expressed in secretory ameloblast and maturative ameloblast. OD314 protein was distributed in entire cytoplasm of secretory ameloblast. However, OD314 was localized at the proxiamal and distal portion of the cytoplasm of smooth- ended and ruffle-ended ameloblast. These results suggest that ○D314 may play important roles in the ameloblast differentiation and maturation.

셀레콕시브 및 그 합성유도체들의 항암활성 스크리닝

박정란,강진형,구효정,노지영,류형철,박상욱,고동현,조일환,이주영,황다니엘,김인경 한국약제학회 2003 Journal of Pharmaceutical Investigation Vol.33 No.2

Selective COX (cyclooxygenase)-2 inhibitors including celecoxib have been shown to induce apoptosis and cell cycle changes in various tumor cells. New inhibitors are recently being developed as chemomodulating agents. We evaluated celecoxib and screened 150 synthetic compounds for anti-proliferative activities in vitro. Effects of celecoxib on COX activity, cell growth, cell cycle distribution, and apoptosis induction were determined in A549 COX-2 overexpressing human non-small cell lung cancer (NSCLC) cells. The COX inhibition of celecoxib increased with concentration up to 82% at 1μM after 24 hr exposure. Forty μM and 50μM of celecoxib induce G_1 arrest, and TUNEL-positive apoptotic cells, respectively. Among 150 compounds, several compounds were selected for having greater COX-2 inhibitory activity and higher selectivity than celecoxib with growth inhibitory activity. Celecoxib showed concentration-dependent COX inhibitory activity, and ability to induce cell cycle arrest and apoptosis in human NSCLC cells in vitro. Among synthetic analogues screened, several compounds showed promising in vitro activity as COX-2 inhibitory anticancer agents, which warrant further evaluation in vitro and in vivo.

Comparison of prasugrel versus clopidogrel in Korean patients with acute myocardial infarction undergoing successful revascularization

Park, Keun-Ho,Jeong, Myung Ho,Kim, Hyun Kuk,Ahn, Tae Hoon,Seung, Ki Bae,Oh, Dong Joo,Choi, Dong-Joo,Kim, Hyo-Soo,Gwon, Hyeon Cheol,Seong, In Whan,Hwang, Kyung Kuk,Chae, Shung Chull,Kim, Kwon-Bae,Kim, Elsevier 2018 Journal of cardiology Vol.71 No.1

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Although there have been several reports that prasugrel can improve clinical outcomes, the efficacy and safety of prasugrel is unknown in Korean patients with acute myocardial infarction (AMI) undergoing successful revascularization.</P> <P><B>Methods</B></P> <P>A total of 4421 patients [637 patients were prescribed prasugrel (60/10 or 5mg, loading/maintenance dose) and 3784 patients clopidogrel (600 or 300/75mg)] with AMI undergoing successful revascularization were enrolled from the core clinical cohort of Korea Acute Myocardial Infarction Registry-National Institute of Health.</P> <P><B>Results</B></P> <P>After propensity score matching (637 pairs), there were no significant differences in baseline clinical and procedural characteristics and in-hospital medications between the two groups. The primary efficacy endpoint, defined as the composite of cardiac death, MI, stroke, or target vessel revascularization at 6 months showed no significant difference between prasugrel and clopidogrel (2.4% vs. 2.9%, <I>p</I> =0.593). Also, no difference was observed in the composite of cardiac death, MI, or stroke during hospitalization between two groups (0.8% vs. 0.9%, <I>p</I> =0.762). However, the incidence of in-hospital Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding was significantly higher in prasugrel compared with clopidogrel (5.3% vs. 2.7%, <I>p</I> =0.015). In multivariate linear regression analysis, trans-femoral intervention, use of glycoprotein IIb/IIIa inhibitors, use of calcium channel blocker, and use of prasugrel were independent predictors of in-hospital TIMI major or minor bleeding [odds ratio (OR)=6.918; 95% confidence interval (CI)=2.453–19.510, OR=2.577; 95% CI=1.406–4.724, OR=4.016; 95% CI=1.382–11.668, OR=2.022; 95% CI=1.101–3.714].</P> <P><B>Conclusions</B></P> <P>Our study shows that the recommended dose of prasugrel had significantly higher in-hospital bleeding complications without reducing ischemic events compared with clopidogrel. However, further large-scale, long-term, randomized clinical trials are required to accurately assess the efficacy and safety of prasgurel and to find out the optimal dose for Korean AMI patients.</P>