• Title/Summary/Keyword: Introduction to Medicine

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Impact of antimicrobial resistance in the $21^{st}$ century

  • Song, Jae-Hoon
    • Proceedings of the Korean Society for Applied Microbiology Conference
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    • 2000.04a
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    • pp.3-6
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    • 2000
  • Antimicrobial resistance has been a well-recognized problem ever since the introduction of penicillin into clinical use. History of antimicrobial development can be categorized based on the major antibiotics that had been developed against emerging resistant $pathogens^1$. In the first period from 1940 to 1960, penicillin was a dominating antibiotic called as a "magic bullet", although S.aureus armed with penicillinase led antimicrobial era to the second period in 1960s and 1970s. The second stage was characterized by broad-spectrum penicillins and early generation cephalosporins. During this period, nosocomial infections due to gram-negative bacilli became more prevalent, while those caused by S.aureus declined. A variety of new antimicrobial agents with distinct mechanism of action including new generation cephalosporins, monobactams, carbapenems, ${\beta}$-lactamase inhibitors, and quinolones characterized the third period from 1980s to 1990s. However, extensive use of wide variety of antibiotics in the community and hospitals has fueled the crisis in emerging antimicrobial resistance. Newly appeared drug-resistant Streptococcus pneumoniae (DRSP), vancomycin-resistant enterococci (VRE), extended-spectrum ${\beta}$-lactamase-producing Klebsiella, and VRSA have posed a serious threat in many parts of the world. Given the recent epidemiology of antimicrobial resistance and its clinical impact, there is no greater challenge related to emerging infections than the emergence of antibiotic resistance. Problems of antimicrobial resistance can be amplified by the fact that resistant clones or genes can spread within or between the species as well as to geographically distant areas which leads to a global concern$^2$. Antimicrobial resistance is primarily generated and promoted by increased use of antimicrobial agents. Unfortunately, as many as 50 % of prescriptions for antibiotics are reported to be inappropriate$^3$. Injudicious use of antibiotics even for viral upper respiratory infections is a universal phenomenon in every part of the world. The use of large quantities of antibiotics in the animal health industry and farming is another major factor contributing to selection of antibiotic resistance. In addition to these background factors, the tremendous increase in the immunocompromised hosts, popular use of invasive medical interventions, and increase in travel and mixing of human populations are contributing to the resurgence and spread of antimicrobial resistance$^4$. Antimicrobial resistance has critical impact on modem medicine both in clinical and economic aspect. Patients with previously treatable infections may have fatal outcome due to therapeutic failure that is unusual event no more. The potential economic impact of antimicrobial resistance is actually uncountable. With the increase in the problems of resistant organisms in the 21st century, however, additional health care costs for this problem must be enormously increasing.

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Legislation Status and Legal Issues of Non-Face-to-Face Treatment (비대면진료 관련 입법 현황과 법적 쟁점)

  • Jinsuk, Kim;Eol, Lee
    • The Korean Society of Law and Medicine
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    • v.24 no.4
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    • pp.131-160
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    • 2023
  • An amendment to Medical Law allowing permanent face-to-face treatment has been proposed in the 21st National Assembly, with five different bills introduced. However, each proposed amendment focuses on different aspects, and the issue is currently in a state of 'ongoing review' due to factors such as opposition from the medical profession and political considerations. However, from the perspective that the introduction of non-face-to-face treatment should be institutionalized and legislated prioritizing patient safety, certain directions are proposed. These include focusing on returning patients as the primary target, chronic diseases as the focal conditions, outpatient medical institutions as the implementing agencies, restricting non-face-to-face means primarily to video systems, and legally exempting healthcare professionals from responsibility for incidents beyond their control. The proposed directions also emphasize establishing the right to demand face-to-face treatment. It is suggested to legislate initial standards that ensure a minimum level of safety and gradually expand the scope of non-face-to-face treatment through future research, evaluation, and similar step-by-step approaches.

A Study on the Rational Improvement of the Regulation and System about Embryo Preservation (배아 보존에 관한 합리적 제도 개선을 위한 연구)

  • Baik, Sujin;Moon, Hannah;Park, Inkyoung;Cha, Seunghyun;Park, Joonseok;Lee, Gyeonghun;Park, Chun-seon;Cho, Heesoo;Kim, Myung-Hee
    • The Korean Society of Law and Medicine
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    • v.22 no.3
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    • pp.57-95
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    • 2021
  • Korea's period for preservation of embryos is up to five years (the Bioethics Act). However, the study reviewed domestic and foreign laws and drew issues due to the recent demand that the development of related science and technology and the period limitation limit the rights of consent holder for embryo production. the first issue is that preserved embryos are intended for pregnancy, and it is important to ensure that the autonomy of the consent holder is protected through careful consideration based on information such as scientific evidence. the second is that regulations regarding the obligation to manage embryonic preservation institutions are needed. the third is to create a social atmosphere in which embryo creation, preservation, and disposal take place in a minimum range, considering the special status of embryos. based on this issue, the first of the proposals for rational improvement of the regulation and system about embryo preservation is the introduction of an environment in which sufficient explanation and appropriate consent can be exercised and to extend the reasons for the extension of the period, rather than specifying the specific period in law. the second is that institutionalization is necessary considering not only the obligation to manage preservation institutions but also the overall site, such as concerns that may arise as a result. lastly, we propose the introduction of a management method considering the future use of embryos, such as transfer to provide research purposes and donation of pregnancy purposes by others. this process should be a method of sufficient social discussion and consensus, as well as a general consideration of the family relationship with the born child.

Introduction of Whidam's Su-Gi therapy - Focused on Cervical spine (휘담식 수기요법의 소개 - 경추부를 중심으로)

  • Beag, Ji You;Cho, Min Gun;Bae, Jae Ryong;Kang, Han Joo;Kim, Jun Chul;Lee, Jae Heung;Jang, Sang Chul;Ahn, Hun Mo
    • Journal of Korean Medical Ki-Gong Academy
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    • v.17 no.1
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    • pp.24-51
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    • 2017
  • Objective : The purpose of this study is to introduce Whidam's Su-Gi therapy(WST.) as a remarkable traditional manual therapy. Main subject : WST. is a traditional manual therapy from Do-In(導引) An-Kyo(按蹻) that treats disease by controlling Gi(Gi-Gong therapy). It makes treatment effects by pushing Sa-Gi(邪氣) which becomes aggregation-accumulation(積聚) to right places by using pointillage, stroking, and rubbing with doctor's focused intention(意念). The cervical spine connects body and brain, so treating cervical spine could be a foundation of all treatment. Discussion : WST. is a manual therapy that treats not only muscles, nerves, vessels, joints but also Oriental medicine concept-meridian, acupoint and Gi(氣). Conclusions: 1) WST. is a traditional manual therapy using Gi-Gong, 2) WST. changes Sa-Gi(邪氣) into Jung-Gi(正氣), which means curing aggregation-accumulation(積聚), 3) Cervical WST. treats a passage that connects upper and lower parts of human body; heart and brain, and 4) Cervical WST. is a treatment to activate So-Ju-Cheon(小周天), which controls human body immunity.

Pathology of Glomerulonephritis - Specimen Preparation and Basic Pathologic Changes - (사구체신염의 병리 - 표본제작 및 기본병변 -)

  • Kim, Yong-Jin
    • Childhood Kidney Diseases
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    • v.15 no.1
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    • pp.29-37
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    • 2011
  • To understand the course of renal diseases well, we must have basic knowledges of histologic procedures of renal biopsy samples as well as basic pathologic changes. This article describes the method of dividing the biopsy samples, fixatives for various pathologic examinations and basic pathologic changes of glomerular diseases. For light microscopic examination, color changes of glomerular structures in PAS, trichrome and PAM stains, normal glomerular patterns compared to various glomerulopathies are introduced. While describing typical staining patterns and intensities of fluorescence in membranous glomerulopathy and IgA nephropathy, basic interpretation of immunofluorescent microscopic examination is described. To understand electron microscopic pictures of renal diseases, preference locations of electron dense deposits in various glomerulonephrites are described with schema. This article is the introduction part of the renal pathology and for the further detail changes of specific entities, we should reference the renal pathology textbooks or articles.

Development of Clinical Practice Guideline by Adaptation: Diabetic Foot Care (수용개작방법을 활용한 당뇨인의 발관리 실무지침 개발)

  • Jeong, Ihn Sook;Park, Kyung Hee;Song, Bok Rye;Sim, Kang Hee;Han, Eun Jin;Hong, Eun-Young;Jung, Young Sun;Lee, Seon Heui;Park, Dong Ah;Jeong, Jae Sim
    • Journal of Korean Clinical Nursing Research
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    • v.21 no.2
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    • pp.196-206
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    • 2015
  • Purpose: This study was done to use a guideline adaptation process to develop a Korean evidence-based diabetic foot care clinical practice guideline for diabetic foot prevention and management. Methods: The guideline adaptation process was conducted according to the guideline adaptation manual developed by the National Evidence-Based Healthcare Collaborating Agency. The process consists of three main phases, with 9 modules including a total of 23 steps. Results: The newly developed diabetic foot care clinical practice guideline consisted of an introduction, description of diabetic foot, summary of recommendations, recommendations, references, appendices, and glossary. There were 165 recommendations in 4 sections (risk assessment for diabetic foot ulcers, prevention of diabetic foot ulcers, wound assessment of diabetic foot ulcers, and management of the diabetic foot). In grading by recommendations, for A there were 30 (18.2%), B, 8 (4.8%), C, 30 (18.2%) D, 97 (58.8%). Conclusion: This guideline can be used as educational material for healthcare workers and diabetic patients. It can also be utilized as a practice guideline for healthcare workers in the hospital and community setting.

Recent Treatment Options for the Clavicle Fracture (쇄골 골절 치료의 최근 경향)

  • Oh, Joo-Han;Choi, Hye-Yeun
    • Clinics in Shoulder and Elbow
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    • v.15 no.1
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    • pp.43-51
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    • 2012
  • Purpose: We sought to determine the appropriate management modality for clavicle fracture through the review of current literature. Materials and Method: This article provides an overview of the knowledge regarding clavicular fracture in adults, including epidemiology, classification, surgical indication, current technique, and results. We also addressed recent debates: the range of the surgical indication for mid-clavicular fracture and the introduction of anatomically precontoured plate as a new treatment modality. Result and Conclusion: Nonsurgical treatment has been regarded as the first choice in the management of clavicle fractures. Quite recently, mounting evidence has shown that adverse outcomes, after a nonsurgical treatment, such as nonunion and malunion, were more prevalent than previously assumed. Accordingly, the indications for surgical fixation appear to be broadening. However, given that the ideal treatment option remains to be determined, the appropriate treatment of clavicle fractures should be tailored based on careful assessment of individual patient's data and preference.

Morphological analysis of maxillary sinus septum using computed tomography (컴퓨터단층촬영을 이용한 상악동 중격의 형태학적 분석)

  • Chae, Jong-Beom;Lee, Sang-Han;Kim, Chin-Soo;Kim, Jong-Bae;Kwon, Tae-Geon
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.37 no.1
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    • pp.36-42
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    • 2011
  • Introduction: The current study examined the morphological characteristics of maxillary sinus septum by computed tomography (CT). Materials and Methods: Two hundred and four patients (408 maxillary sinuses) who visited dental clinic were evaluated. CT were examined. The height of the septum measured from the sinus floor to the apex of the septum more than 3 mm was defined as "sinus septum". Results: The prevalence of sinus septa was 21.3% (87/408), and 31.4% (64/204) of patients had more than 1 sinus septum. Females showed higher and thinner sinus septa than males. The anatomic location of the septa were distributed in the 2nd molar region (43.7%), 1st molar region (31.0%), 2nd premolar region (21.8%) and 1st premolar region (3.5%). In 57 patients with chronic disease, there was no significant difference between sinus disease and the presence of sinus septa. The loss of remaining teeth and teeth adjacent to the sinus septum area was not related to the presence of sinus septa. Older subjects showed a reduced height and length of the septum, and a thicker septum. Conclusion: These results show that the maxillary sinus septum undergoes atrophy with age.

NSAID Activated Gene (NAG-1), a Modulator of Tumorigenesis

  • Eling, Thomas E.;Baek, Seung-Joon;Shim, Min-sub;Lee, Chang-Ho
    • BMB Reports
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    • v.39 no.6
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    • pp.649-655
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    • 2006
  • The NSAID activated gene (NAG-1), a member of the TGF-$\beta$ superfamily, is involved in tumor progression and development. The over-expression of NAG-1 in cancer cells results in growth arrest and increase in apoptosis, suggesting that NAG-1 has anti-tumorigenic activity. This conclusion is further supported by results of experiments with transgenic mice that ubiquitously express human NAG-1. These transgenic mice are resistant to the development of intestinal tumors following treatment with azoxymethane or by introduction of a mutant APC gene. In contrast, other data suggest a pro-tumorigenic role for NAG-1, for example, high expression of NAG-1 is frequently observed in tumors. NAG-1 may be like other members of the TGF-$\beta$ superfamily, acting as a tumor suppressor in the early stages, but acting pro-tumorigenic at the later stages of tumor progression. The expression of NAG-1 can be increased by treatment with drugs and chemicals documented to prevent tumor formation and development. Most notable is the increase in NAG-1 expression by the inhibitors of cyclooxygenases that prevent human colorectal cancer development. The regulation of NAG-1 is complex, but these agents act through either p53 or EGR-1 related pathways. In addition, an increase in NAG-1 is observed in inhibition of the AKT/GSK-$3{\beta}$ pathway, suggesting NAG-1 alters cell survival. Thus, NAG-1 expression is regulated by tumor suppressor pathways and appears to modulate tumor progression.

The Wound Healing Effects of Alginate- crosslinked Collagen Dermal Substitute of Artificial Skin (콜라겐을 알긴산으로 교차 결합시킨 인공진피의 창상치유 효과)

  • Chang, Jae Hoon;Park, Dae Hwan;Shin, Jeong Im;Ahn, Ki Young;Song, Chul Hong
    • Archives of Plastic Surgery
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    • v.33 no.1
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    • pp.13-20
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    • 2006
  • Alginate, which is isolated from brown seaweed, is a bioabsorbable long chain polysaccharides, ${\beta}$-D-mannuronic acid and ${\alpha}$-L-guluronic acid. The authors produced alginates and alginate-colllagen as a disc form. Then, to evaluate the efficacy of alginate and alginate-collagen complex as a wound healing material, three full-thickness skin defects of 2 cm in diameter were made at the back of the New Zealand white rabbits. Three groups of dressing materials-alginate, alginate-collagen complex and vaseline gauze as control group - were applied on the wound and the results were evaluated grossly and histopathologically. The authors compared gross findings of sizes of healed wound, wound epithelization and wound contraction by tracing the remaining wound area at 5th, 10th, 15th, 20th, 25th day after wound introduction, and wound biopsy was performed at 3rd, 7th, 14th, 21st day, respectively. Alginate and alginate-collagen complex showed statistically higher percentage of wound contraction and wound healing compared to control group(p<0.05). Alginate-collagen complex showed statistically higher percentage of wound contraction, epithelization and wound healing compared to alginate alone. In conclusion, the result suggests that alginate has a good effect of wound healing and that alginate-collagen complex is more effective in wound healing than alginate alone.