검색연산자 | 기능 | 검색시 예 |
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() | 우선순위가 가장 높은 연산자 | 예1) (나노 (기계 | machine)) |
공백 | 두 개의 검색어(식)을 모두 포함하고 있는 문서 검색 | 예1) (나노 기계) 예2) 나노 장영실 |
| | 두 개의 검색어(식) 중 하나 이상 포함하고 있는 문서 검색 | 예1) (줄기세포 | 면역) 예2) 줄기세포 | 장영실 |
! | NOT 이후에 있는 검색어가 포함된 문서는 제외 | 예1) (황금 !백금) 예2) !image |
* | 검색어의 *란에 0개 이상의 임의의 문자가 포함된 문서 검색 | 예) semi* |
"" | 따옴표 내의 구문과 완전히 일치하는 문서만 검색 | 예) "Transform and Quantization" |
Invasive fungal infection is an important cause of morbidity and mortality in granulocytopenic patients receiving cancer chemotherapy or undergoing bone marrow or stem-cell transplantation. The most common pathogens are Candida species and Aspergillus species, and other fungi are also encountered. Empirical antifungal therapy with conventional amphotericin B or liposomal amphotericin B has become the standard of care in reducing invasive fungal infections in patients with neutropenia and persistent fever. Amphotericin B is associated with significant dose-limiting nephrotoxicity and infusion-related reactions. Liposomal amphotericin B is equivalent to conventional amphotericin B as empirical antifungal therapy and significantly reduces proven invasive fungal infections, nephrotoxicity, and infusion-related reactions. The high acquisition cost of liposomal amphotericin B, however, has limited the use of this less toxic formulation of amphotericin B. The lipid formulations of amphotericin B and triazoles (fluconazole, itraconazole, voriconazole), were found to be a suitable alternative to amphotericin B preparations as empirical antifungal agents in patients with persistent fever and neutropenia. However, these agents may be associated with toxicity and adverse drug interactions and have a limited spectrum of activity, erratic bioavailability, unpredictable pharmacokinetics, and limited efficacy. Caspofungin is a relatively new class of antifungal agents that non-competitively inhibit the synthesis of fungal cell-wall 1, 3-beta-D-glucan. Caspofungin is a suitable alternative to liposomal amphotericin B as empirical therapy and offered the advantages of safety, improved survival, and improved response rates in patients with invasive fungal infections. However, caspofungin has a drug interactions with dexamethasone, cyclosporine, tacrolimus and is expensive. Numerous antifungal agents could represent potential alternatives to amphotericin B, a difficult drug to administer. The optimal empiric antifungal therapy remains a matter of controversy. Clinicians ultimately have to select the optimal antifungal agents after considering the cost as well as efficacy, toxicity of the drugs.
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