WordNet

provide with an index; "index the book"
a numerical scale used to compare variables with one another or with some reference number
the finger next to the thumb (同)index_finger, forefinger
a number or ratio (a value on a scale of measurement) derived from a series of observed facts; can reveal relative changes as a function of time (同)index_number, indicant, indicator
an alphabetical listing of names and topics along with page numbers where they are discussed
adjust through indexation; "The government indexes wages and prices"
list in an index
relating to or involved in therapy; "therapeutic approach to criminality" (同)therapeutical
branch of medicine concerned with the treatment of disease
the act of classifying and providing an index in order to make items easier to retrieve

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(本・雑誌などの)『索引』;図書目録 / 指し示すもの,印 / (計器などの)指針 / 指数・虜 / 《the I-》(カトック教会の)禁所目録 / 〈本など〉‘に'索引をつける / 〈語など〉‘を'索引に載せる
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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/03/10 13:40:17」(JST)

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The therapeutic index (also known as therapeutic ratio) is a comparison of the amount of a therapeutic agent that causes the therapeutic effect to the amount that causes death (in animal studies) or toxicity (in human studies).^[1]

Quantitatively, it is the ratio given by the lethal or toxic dose divided by the therapeutic dose.

In animal studies, the therapeutic index is the lethal dose of a drug for 50% of the population (LD₅₀) divided by the minimum effective dose for 50% of the population (ED₅₀).

Lethality is not determined in human clinical trials; instead, the dose that produces a toxicity in 50% of the population (TD₅₀) is used to calculate the therapeutic index.

While the lethal dose is important to determine in animal studies, there are usually severe toxicities that occur at sublethal doses in humans, and these toxicities often limit the maximum dose of a drug. A higher therapeutic index is preferable to a lower one: a patient would have to take a much higher dose of such a drug to reach the lethal/toxic threshold than the dose taken to elicit the therapeutic effect.

in animal studies, or for humans,

Generally, a drug or other therapeutic agent with a narrow therapeutic range (i.e. having little difference between toxic and therapeutic doses) may have its dosage adjusted according to measurements of the actual blood levels achieved in the person taking it. This may be achieved through therapeutic drug monitoring (TDM) protocols.

The therapeutic index varies widely among substances: most forgiving among the opioid analgesics is remifentanyl, which offers a therapeutic index of 33,000:1; tetrahydrocannabinol, a sedative and analgesic of herbal origin (cannabis), has a safe therapeutic index of 1000:1, while diazepam, a benzodiazepine sedative-hypnotic and skeletal muscle relaxant has a less-forgiving index of 100:1 and morphine, a sedative, antidepressant, and analgesic also of herbal origin (genus Papaver) has an index of 70:1^[2] (which, however, is still considered very safe).

Less safe are cocaine, a stimulant and local anaesthetic; ethanol (colloquially, the "alcohol" in alcoholic beverages), a widely available sedative consumed world-wide: the therapeutic indices for these substances are 15:1 and 10:1 respectively. Even less-safe are drugs such as digoxin, a cardiac glycoside; its therapeutic index is approximately 2:1.^[3] Other examples of drugs with a narrow therapeutic range, which may require drug monitoring both to achieve therapeutic levels and to minimize toxicity, include: paracetamol (acetaminophen), dimercaprol, theophylline, warfarin and lithium carbonate. Some antibiotics require monitoring to balance efficacy with minimizing adverse effects, including: gentamicin, vancomycin, amphotericin B (nicknamed 'amphoterrible' for this very reason), and polymyxin B.

The effective therapeutic index can be affected by targeting, in which the therapeutic agent is concentrated in its area of effect. For example, in radiation therapy for cancerous tumors, shaping the radiation beam precisely to the profile of a tumor in the "beam's eye view" can increase the delivered dose without increasing toxic effects, though such shaping might not change the therapeutic index. Similarly, chemotherapy or radiotherapy with infused or injected agents can be made more efficacious by attaching the agent to an oncophilic substance, as is done in peptide receptor radionuclide therapy for neuroendocrine tumors and in chemoembolization or radioactive microspheres therapy for liver tumors and metastases. This concentrates the agent in the targeted tissues and lowers its concentration in others, increasing efficacy and lowering toxicity.

Sometimes the term safety ratio is used instead, particularly when referring to psychoactive drugs used for non-therapeutic (e.g. nonmedical) purposes.^[4] In such cases, the "effective" dose is the amount and frequency that produces the desired effect, which can vary, and can be greater or less than the therapeutically effective dose.

A therapeutic index does not consider drug interactions or synergistic effects. For example, the risk associated with benzodiazepines increases significantly when taken with alcohol, opiates, or stimulants when compared with being taken alone.^{[medical citation needed]} Therapeutic index also does not take into account the ease or difficulty of reaching a toxic or lethal dose. This is more of a consideration for recreational drug users, as the purity can be highly variable.

Protective index is a similar concept, except that it uses TD₅₀ (median toxic dose) in place of LD₅₀. For many substances, toxic effects can occur at levels far below those needed to cause death, and thus the protective index (if toxicity is properly specified) is often more informative about a substance's relative safety. Nevertheless, the therapeutic index is still useful as it can be considered an upper bound for the protective index, and the former also has the advantages of objectivity and easier comprehension.

References[edit]

^ Katzung and Trevor's Pharmacology Examination & Board Review; 9th edition; A.J.Trevor, B.G. Katzung, S.B.Masters, McGraw Hill, 2010, p. 15.
^ Stanley, Theodore H (2000). "Anesthesia for the 21st century". Proc (Bayl Univ Med Cent) 13 (1): 7–10. PMC 1821133. PMID 16389318.
^ Becker, Daniel E (2007 Spring). "Drug Therapy in Dental Practice: General Principles Part 2—Pharmacodynamic Considerations". Anesth Prog. 54 (1): 19–24. doi:10.2344/0003-3006(2007)54[19:DTIDPG]2.0.CO;2. ISSN 0003-3006. PMC 1821133. PMID 17352523. Check date values in: |date= (help)
^ Gable,, Robert S (2004). "Comparison of acute lethal toxicity of commonly abused psychoactive substances" (PDF). Addiction 99 (6): 686–696. doi:10.1111/j.1360-0443.2004.00744.x. PMID 15139867.

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English Journal

A comparative study of low-fluence 1064-nm Q-switched Nd:YAG laser with or without chemical peeling using Jessner's solution in melasma patients.

Lee DB1, Suh HS, Choi YS.Author information 1Department of Dermatology, Ulsan University Hospital , Ulsan , Korea.AbstractBACKGROUND: Although low-fluence 1064-nm Q-switched Nd:YAG laser (QSNYL) is widely used for the treatment of melasma, multiple treatments are necessary for clinical improvement. Superficial chemical peeling using Jessner's solution has been used for treatment of melasma conventionally.
The Journal of dermatological treatment.J Dermatolog Treat.2014 Dec;25(6):523-8. doi: 10.3109/09546634.2013.848261. Epub 2013 Dec 2.
BACKGROUND: Although low-fluence 1064-nm Q-switched Nd:YAG laser (QSNYL) is widely used for the treatment of melasma, multiple treatments are necessary for clinical improvement. Superficial chemical peeling using Jessner's solution has been used for treatment of melasma conventionally.OBJECTIVES: To
PMID 24289244

LRH1 as a driving factor in pancreatic cancer growth.

Lin Q1, Aihara A2, Chung W2, Li Y3, Huang Z1, Chen X4, Weng S5, Carlson RI2, Wands JR2, Dong X6.Author information 1Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, The University of Rhode Island, Pharmacy Building, 7 Greenhouse Road, Kingston, RI 02881, United States.2Division of Gastroenterology and Liver Research Center, Rhode Island Hospital, Warren Alpert Medical School, Brown University, United States.3Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, The University of Rhode Island, Pharmacy Building, 7 Greenhouse Road, Kingston, RI 02881, United States; Bacteriologic Laboratory, Harbin Center for Disease Control and Prevention, Harbin 150056, Heilongjiang Province, China.4Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, The University of Rhode Island, Pharmacy Building, 7 Greenhouse Road, Kingston, RI 02881, United States; Department of Internal Medical Oncology, The Third Affiliated Hospital of Harbin Medical University, Harbin 150040, Heilongjiang Province, China.5Department of Occupational Health Assessment, Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen 518001, Guangdong Province, China.6Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, The University of Rhode Island, Pharmacy Building, 7 Greenhouse Road, Kingston, RI 02881, United States. Electronic address: xiaoqun_dong@mail.uri.edu.AbstractLiver receptor homolog 1 (LRH1), directs the development and differentiation of embryonic pancreas, and is overexpressed in pancreatic cancer (PC). We hypothesized that LRH1 promotes PC growth. Cell proliferation and tumorigenicity in nude mice were compared between empty vector-transfected (control) and stable LRH1-overexpressed PC cell lines. The subsequent tumor burden, vasculature development, and histologic features were evaluated. LRH1 overexpression enhanced the expression of downstream target genes (cyclin D1/E1) and stimulated cell proliferation in PC cell lines. LRH1 upregulated cyclin E1 truncated T1/T2 isoforms expression which may occur through ERα-calpain1 signaling. Compared with the control, LRH1 overexpressing stable cells generated tumors with increased weight, proliferation index and enhanced angiogenesis. Cyclin D1/E1 and calpain1 were overexpressed in human PC tumors compared to adjacent normal pancreas. These observations demonstrate that LRH1 promotes PC growth and angiogenesis, suggesting that LRH1 is a driving factor in tumorigenesis and may serve as a potential therapeutic target.
Cancer letters.Cancer Lett.2014 Apr 1;345(1):85-90. doi: 10.1016/j.canlet.2013.11.014. Epub 2013 Dec 11.
Liver receptor homolog 1 (LRH1), directs the development and differentiation of embryonic pancreas, and is overexpressed in pancreatic cancer (PC). We hypothesized that LRH1 promotes PC growth. Cell proliferation and tumorigenicity in nude mice were compared between empty vector-transfected (control
PMID 24333731

Reconstruction of a neurocutaneous defect of the proximal phalanx with a heterodigital arterialised nerve pedicle flap.

Chen C1, Tang P2, Zhang X3.Author information 1The Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, PR China. Electronic address: ts_chenchao@163.com.2The Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, PR China. Electronic address: tangpeifubeijing@163.com.3Hand Surgery Department, The Second Hospital of Qinhuangdao, Changli, Qinhuangdao, Hebei, 066600, PR China; Chengde Medical College, Chengde, Hebei, 067000, PR China.AbstractBACKGROUND: Complex digital injuries involving soft-tissue loss and digital nerve defect pose a challenging problem for hand surgeons. The purpose of this study was to evaluate the efficacy of transferring the heterodigital arterialised nerve pedicle flap for reconstructing the digital neurocutaneous defects and to compare the results with those of transferring the cross-finger flap and secondary nerve grafting.
Injury.Injury.2014 Apr;45(4):799-804. doi: 10.1016/j.injury.2013.09.034. Epub 2013 Sep 27.
BACKGROUND: Complex digital injuries involving soft-tissue loss and digital nerve defect pose a challenging problem for hand surgeons. The purpose of this study was to evaluate the efficacy of transferring the heterodigital arterialised nerve pedicle flap for reconstructing the digital neurocutaneou
PMID 24125537

Japanese Journal

Effect of Existence of Red Blood Cells in Trapping Performance of Microbubbles by Acoustic Radiation Force

Masuda Kohji,Nakamoto Ryusuke,Watarai Nobuyuki,Koda Ren,Taguchi Yuto,Kozuka Teruyuki,Miyamoto Yoshitaka,Kakimoto Takashi,Enosawa Shin,Chiba Toshio
Jpn J Appl Phys 50(7), 07HF11-07HF11-6, 2011-07-25
… We have proposed a method to control microbubbles by making use of acoustic radiation force, which is generated with acoustic propagation, to correspond to therapeutic applications of ultrasound. … By defining the trapping index to evaluate the amount of trapped microbubbles, we have confirmed that the trapping performance was enhanced according to the concentration of RBCs and the sound pressure, but not according to the central frequency of ultrasound. …
NAID 150000057680

心肺停止蘇生後患者に対する脳低温療法中の鎮静の指標に bispectral index (BIS) を用いた2症例

高木俊介,岩下眞之,大川卓巳,大井康史,松崎昇一,下山哲,田原良雄,鈴木範行
日本集中治療医学会雑誌 = Journal of the Japanese Society of Intensive Care Medicine 18(3), 387-392, 2011-07-01
NAID 10029383338