Journal of The Korean Medical Association最新文献

{"title":"Endoscopic treatment of colorectal polyps and early colorectal cancer","authors":"Yunho Jung","doi":"10.5124/jkma.2023.66.11.642","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.11.642","url":null,"abstract":"Background: Colonoscopy offers higher diagnostic sensitivity than other colorectal cancer screening methods and provides the advantage of both diagnostic tissue sampling and polyp removal. Since the majority of colorectal cancers evolve from adenomatous polyps, polyp resection through colonoscopy is widely considered an effective method of preventing colorectal cancer and reducing mortality rates.Current Concepts: Determining colorectal polyp size and shape requires comprehensive endoscopy with enhanced imaging techniques to choose treatment directions and the appropriate colorectal polypectomy method. The selection of the polypectomy method is contingent upon the polyp’s attributes and possible malignancy according to US Multi-Society Task Force on Colorectal Cancer and European gastrointestinal endoscopy guidelines. This article examines eight polypectomy procedures: cold forceps polypectomy, hot biopsy polypectomy, cold snare polypectomy, hot snare polypectomy, endoscopic mucosal resection (EMR), and modified EMR techniques. Each method has unique benefits and is suitable for particular polyp types and sizes. Piecemeal EMR and endoscopic submucosal dissection offer alternatives for larger or challenging lesions that require careful planning and follow-up. After endoscopic resection of early colorectal cancer, further surgery may be necessary depending on the risk of lymph node metastasis as determined by specific histologic findings following Korean and Japanese guidelines.Discussion and Conclusion: The choice of endoscopic resection technique, which depends on factors such as polyp shape, size, and location as well as endoscopist skill, is crucial for ensuring complete polyp removal.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":" 97","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculosis and chest radiology","authors":"Eun-Young Kang","doi":"10.5124/jkma.2023.66.11.667","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.11.667","url":null,"abstract":"Background: Tuberculosis is still a major public health problem, although it is decreasing worldwide. The World Health Organization is working to reduce the incidence and deaths of tuberculosis globally and aims to eradicate tuberculosis.Current Concepts: The world’s gradual eradication of tuberculosis would be virtually inconceivable without the outstanding scientific works of Robert Koch and Wilhelm Conrad Röntgen. In 1882, Koch’s discovery of the tuberculosis bacillus was the most important first step towards controlling and ending this deadly disease. In 1895, Röntgen’s discovery of the X-ray revolutionized humanity as it became the first technology used to create images of the human body. X-ray images became an essential tool in modern medicine within a short period.Discussion and Conclusion: Chest radiology plays a crucial role in tuberculosis screening, diagnosis, and management. Chest radiology has contributed to the control of tuberculosis, which has plagued humanity for a long time, and will continue to contribute to eradicating tuberculosis in the world.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":" 95","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatricians’ perspectives on telemedicine for pediatric patients","authors":"Jin Suk Kim","doi":"10.5124/jkma.2023.66.11.688","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.11.688","url":null,"abstract":"Background: This study examined the characteristics of pediatric patients through surveys and in-depth interviews with pediatricians who have experience in telemedicine, and analyzed the current status of telemedicine in pediatrics and the perception of telemedicine among pediatric patients. We also evaluated the associated risks and unsuitability of telemedicine for pediatric patients and presented pertinent policy recommendations.Methods: A questionnaire survey was conducted using the Doctor Survey by the Korean Medical Association. The survey was distributed via email and was open from July 24, 2023 to August 6, 2023. Of the 643 responses, 42 were used for analysis in this study. We examined the perception about providing telemedicine, and the reasons for not providing telemedicine to pediatric patients. In terms of perceptions about telemedicine for pediatric patients, we examined opinions on (1) whether pediatric patients are appropriate candidates for telemedicine, and (2) whether telemedicine could be administered to first-time pediatric patients (including medical consultation) during holidays and at night.Results: Pediatric patients constitute a patient group with distinct characteristics, entailing more careful attention than adult patients. According to the survey results, 42.9% of respondents were not providing telemedicine for pediatric patients. Furthermore, the respondents perceived telemedicine for pediatric patients as unsafe (61.1%), unrealistic (73.8%), and unsuitable (69.0%).Conclusion: Telemedicine for pediatric patients can be viewed as risky and inappropriate. Therefore, the government needs to involve pediatricians in the policy development process for telemedicine aimed at pediatric patients.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":" 98","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135191811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological treatment of Ménière disease","authors":"Beom Sik Park, Byung Hong Kang, Michelle J. Suh","doi":"10.5124/jkma.2023.66.10.581","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.10.581","url":null,"abstract":"Background: Despite significant progress in audiology, there is no definitive treatment option for Ménière disease due to its multifactorial etiology.Current Concepts: The primary treatment goal for Ménière disease is first, to decrease the frequency of symptoms and, second, to minimize the severity of vertigo and hearing loss. Concurrently, the preservation of vestibular and auditory functions should be prioritized. The protection of vestibular and auditory functions should also be considered. Treatment options for Ménière disease include lifestyle modifications, medical treatment, and surgical intervention. Recent treatment algorithms aim to gradually escalate the invasiveness of the treatment to assist in developing a more uniform treatment approach.Nanomaterials, including nanoparticles and nanocarriers, offer an array of novel diagnostic and therapeutic applications for achieving effective drug delivery into the inner ear of patients with Ménière disease. New treatment drugs, such as SPI-1005 (Sound Pharmaceuticals) are currently under clinical trial. Furthermore, drugs are also being repurposed and investigated for their potential in treating Ménière disease.Discussion and Conclusion: Developing new drugs and investigating the pathophysiology of Ménière disease for subtyping is emerging. These may direct the future diagnosis and treatment of the disease and facilitate a better understanding of disease mechanisms. Patients with different subtypes of Ménière disease may require different treatment strategies, which can be achieved by personalized therapy, accurate prognosis prediction, and even, disease prevention.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"1522 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136360126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between age-related hearing loss and cognitive decline","authors":"Jiwon Seo","doi":"10.5124/jkma.2023.66.10.568","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.10.568","url":null,"abstract":"Background: Presbycusis, or age-related hearing loss, is a prevalent condition characterized by the gradual deterioration of hearing with age. The resulting impairments in auditory function lead to reduced speech perception in noisy environments and often have a negative impact on cognitive, behavioral, and psychosocial functions in the elderly population.Current Concepts: The proposed etiological mechanisms linking presbycusis to cognitive decline or dementia include the common-cause hypothesis, cognitive load hypothesis, cascade hypothesis, and overdiagnosis or harbinger hypothesis. Moreover, the challenges posed by the rapidly aging population in several countries, including Korea, highlight the increasing social impact of hearing loss and dementia. Consequently, interventions for hearing rehabilitation, such as the use of hearing aids and implantable hearing devices, have paramount importance in mitigating the adverse effects of hearing loss on cognitive impairment and dementia.Discussion and Conclusion: The implementation of prevention and rehabilitation programs for hearing loss in the elderly is crucial for alleviating the socioeconomic burden associated with the welfare of the aging population. However, many economically vulnerable elderly individuals reportedly do not use hearing aids, even though they experience considerable inconvenience resulting from hearing loss, primarily due to inadequate financial support. Therefore, implementing a comprehensive national policy to support hearing aid usage among elderly individuals with moderate hearing loss holds significant potential for reducing their risk of cognitive impairment and dementia.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136360123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-pharmacological therapy for tinnitus","authors":"Chae Dong Yim","doi":"10.5124/jkma.2023.66.10.597","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.10.597","url":null,"abstract":"Background: Tinnitus is often difficult to treat because it is closely related to hearing loss, central nervous system disorders, and emotional problems. Although various drug treatments have been attempted for patients with tinnitus, there is no drug that has been clearly proven to be effective. On the other hand, there are some studies showing the effectiveness of various non-pharmacological treatments for tinnitus.Current Concepts: Tinnitus is classified into subjective and objective tinnitus. Representative non-pharmacological treatments for chronic subjective tinnitus include sound therapy, hearing aids or implantable hearing rehabilitation devices, tinnitus retraining therapy, neuropsychiatric therapy, and neuromodulatory treatment. When objective tinnitus does not improve with conservative treatment, surgical treatment can be selected depending on the cause. Acupuncture treatment for tinnitus is not recommended due to lack of evidence on its effectiveness and safety.Discussion and Conclusion: Despite many studies, the mechanisms of tinnitus remain unknown. Thus, it is difficult to cure the cause of tinnitus. Because subjective responses to tinnitus vary according to the patient’s psychological state, a variety of approaches would be needed for the treatment of tinnitus.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136360122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical applications of next-generation sequencing in the diagnosis of genetic disorders in Korea: a narrative review","authors":"Jihoon G. Yoon, Man Jin Kim, Yong Jin Kwon, Jong-Hee Chae","doi":"10.5124/jkma.2023.66.10.613","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.10.613","url":null,"abstract":"Background: Next-generation sequencing (NGS) technologies have revolutionized genetic testing and enabled efficient screening of various genetic conditions in clinical settings. However, the clinical application of genetic test results presents numerous significant challenges. This review aims to provide a comprehensive overview of key concepts for the clinical application of NGS, including (1) technical aspects and limitations, (2) variant classification, (3) clinical interpretation, (4) familial testing and genetic counseling, and (5) ethical considerations.Current Concepts: In short-read-based NGS, several limitations exist in detecting genomic variations, including repetitive sequences or complex structural variations. The variant classification process can be influenced by suspected genomic conditions and the accessibility of genomic databases. Therefore, the final genetic diagnosis depends on the physician’s discretion, which relies on the genotype-phenotype correlations and reverse phenotyping through additional evaluations. Familial testing can help trace the origin of variants and allele segregation and aid in variant interpretation, risk assessment, disease prevention, and family planning. In addition to addressing the clinical impact of genetic results, genetic counselors should also consider potential consequences related to ethical, legal, and social issues, including family dynamics.Discussion and Conclusion: NGS-based genetic testing is a promising diagnostic tool for genetic disorders, but proper variant interpretation and clinical evaluation are crucial for optimal clinical practice. Notably, ethical considerations and regulatory measures are required to prepare for the next era of genomic medicine.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136361072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic factors of sudden sensorineural hearing loss","authors":"Tae Hoon Kong","doi":"10.5124/jkma.2023.66.10.573","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.10.573","url":null,"abstract":"Background: Sudden sensorineural hearing loss (SSNHL) refers to rapid and often unexplained decline in auditory acuity. Reported recovery rates for SSNHL vary across studies; however, these are usually within the range of 40% to 60%. Although numerous studies have investigated factors that affect auditory restoration, prediction of patients’ hearing recovery remains challenging.Current Concepts: Natural recovery rates for SSNHL range between 32.0% and 65.0%, and treatments commonly include systemic steroid therapy and intratympanic dexamethasone injections. Adjunctive treatments, such as antiviral agents, vasodilators, anticoagulants, hyperbaric oxygen therapy, and stellate ganglion block therapy are also utilized. Recovery typically occurs within 2 weeks, and approximately 66.0% of patients have complete or partial hearing restoration. Recovery predominantly occurs early; approximately 78.2% to 90.0% patients recover within 1 month and >98.0% within 3 months. Age is an important factor associated with recovery; patients aged ≥40 years show low recovery rates. Coexisting dizziness is generally associated with unfavorable outcomes. Hearing loss severity and types (based on the frequency-specific pattern of hearing impairment) are associated with poor prognosis. Additionally, systemic conditions like hypertension and diabetes are implicated as etiopathogenetic contributors. In addition to a variety of audiological assessments to evaluate cochlear function, environmental factors, including particulate matter and air pollution affect outcomes.Discussion and Conclusion: During SSNHL treatment, evaluation of factors known to affect recovery is important to determine patients’ hearing restoration potential. Proactive patient counseling is necessary to guide treatment decision-making, particularly for initiation of auditory rehabilitation following incomplete or lack of recovery. Significant variables that affect hearing recovery are useful prognostic indicators. These studies are expected to provide better understanding of the pathophysiology of SSNHL and offer an evidence-based foundation for therapeutic interventions.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136360125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of post-cardiac arrest syndrome","authors":"Mi-Jin Lee","doi":"10.5124/jkma.2023.66.9.545","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.9.545","url":null,"abstract":"Background: Despite various advances in resuscitation science, the overall survival outcome remains very low in patients who sustain sudden cardiac death. Regardless of the cause of the collapse, multiple organ systems may be injured secondary to post-cardiac arrest syndrome. This column highlights the interventions that can be incorporated as a bundle of post-resuscitation care, to narrow the gap between return of spontaneous circulation (ROSC) and neurologically intact survival.Current Concepts: The post-cardiac arrest care algorithm presents treatment strategies and therapeutic goals to be considered in the initial stabilization stage, followed by investigating the cause of cardiac arrest and intensive care strategies to reduce additional brain damage. Immediately after ROSC, multimodal interventions required for post-ROSC care are bundled into a care regimen (treatment of the reversible cause, adequate seizure management, and glycemic control). It is also essential to establish definitive airway management to maintain normocapnic ventilation, prevent hyperoxia, and optimize hemodynamic management. Targeted temperature management after ROSC confers neuroprotection and leads to improved neurological outcomes.Discussion and Conclusion: Post-cardiac arrest care is also emphasized as a key element in the chain of survival. The interventions outlined could lead to more patients being discharged alive from the hospital, with good neurological function. In addition, continued management planning, such as secondary prevention and social rehabilitation for cardiac arrest survivors and neurological prognostication for patients who do not recover consciousness after a certain period, are included.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136073389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of asthma and eosinophilic allergic diseases using biological products","authors":"Sujeong Kim","doi":"10.5124/jkma.2023.66.9.523","DOIUrl":"https://doi.org/10.5124/jkma.2023.66.9.523","url":null,"abstract":"Background: Asthma and other eosinophilic allergic diseases are heterogeneous syndromes encompassing various endotypes and phenotypic characteristics. The recent development of several targeted biological products has enabled the personalized treatment for heterogeneous pathophysiology in these diseases.Current Concepts: Biological products approved by the US Food and Drug Administration for such diseases primarily comprise monoclonal antibodies that block the pathway of type 2 inflammation, such as immunoglobulin E, interleukin (IL)-5, IL-5 receptor, IL-4α receptor, and thymic stromal lymphopoietin. A practical strategy for selecting the optimal biological products for patients with severe eosinophilic allergic diseases is a shared decision-making process between the patient and physician on the basis of measurable biomarkers, co-morbidity, and patient preferences considering drug characteristics and costs.Discussion and Conclusion: The emergence of biological products in chronic eosinophilic allergic diseases has not only heralded an era of precise treatment but has also improved our understanding of the endogenous types through various treatment responses for each patient. The development of new biological products that affect various pathways and the discovery of novel biomarkers will facilitate the provision of optimized precision medicine to patients with severe uncontrolled diseases.","PeriodicalId":17300,"journal":{"name":"Journal of The Korean Medical Association","volume":"144 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136073391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}