• Journal of Pharmacopuncture
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• v.6 no.1
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• pp.14-15
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• 2003

중의학은 서양의 의료 다원주의의 한 부분이 되었다. 특히 침과 같이 서양의 개념과는 분명히 다른 의료 기법에 있어서는 두드러진다. 그밖에 뜸, 안마, 기공, 중약 및 복합 처방들도 있다. 서양에서 전문직업인화는 보건의료 관련분야에서 중심적인 인력양성 방법이 되었다. 이는 대학이 기반을 다진 중세까지 거슬러 올라가는데, 19세기에는 법인들이 전문직업인 모임으로 바뀌어 가면서 개인적 환경을 변화시키고 직업의 체계를 개발하였다. 변호사, 교사, 사제, 의사가 그 예이다. 의료에 있어서 학교교육을 통해 수련된 의사들이 조산사나 안마사들을 지배하게 되었는데 이런 경향은 1950-60년대에 극에 달한다. 그러다가 이들의 지배는 대중매체, 환자, 다른 주변 의료 보조인력들에 의해 도전을 받는다. 이와 비슷한 양상을 이단적인 의료에서도 관찰할 수 있다. 전문직업인의 우세와 시점이 비슷한 생물의학의 우월적 지배는 많은 다양한 의료에 의해 도전을 받는다. 그러나 생물의학의 우월함의 약세가 시술자들의 전문직업인화 까지를 포함하지는 않았다. 실제로 침술과 같은 치료술들을 전문직업인인 의사나 의사가 아닌 시술자들이 함께 쓰고 있기 때문이다. 이는 직능간의 분쟁을 야기할 가능성이 높다. 이단적 개념을 기존 의료계로 통합하는 것이 전문직업인들인 의사들의 노력으로 이해되었다. 이 견해는 두 가지 문제를 내포하고 있는데, 첫째 의사들을 단일한 속성으로 보고 있다는 것인데, 실제로 현대의학을 배우고 가르치는 나라들 사이에도 매우 다양한 차이가 있음을 간과하고 있다. 둘째로 의료인이 아닌 시술자들도 다양한 분야로 통합되었는데, 통합은 어쩌면 하급의 전문인들의 노력의 결과로 설명되어야 하는 것이 더 알맞을 수 있다. 그러나 이들도 전문직업인의 조직구조를 가져야 만 하고, 그렇지 않으면 파편으로 남을 것이다. 전문직업인주의는 언제나 과학과 연계하고 있는데, 독일 정부와 직업인 조직은 의료과학 집단에게 이단적 시술들의 임상효과를 검증하게 하였다. 이것은 이단 의료계에 우호적인 단체나 적대적인 단체 모두에게 적용되었다. 매우 강한 힘을 가진 냉소적인 조직 가운데 하나는 National Committee of SHI-Physicians and Sickness Funds(Bundesausschuss der Arzte und Krankenkassen).2 인데, 2001년에, 이 단체에서 출판한 자료에는 침의 효용성은 침을 시술하는 사람에 달린 것 일뿐 시술자의 수련이나 침 시술의 배경 개념에 달려있는 것이 아니다. 그러므로 침은 무작위 표본추출 대조군 실험을 통해 효과를 검증받지 못한 다른 치료법들의 범주에 머물러 있다.(cf. Bundesausschuss 2001: 8). 1990년대, 무작위 표본추출 대조군 실험은 생물의학이 아닌 의료의 효과를 검증하는데 알맞지 않고 비윤리적이라고 강한 비판을 받았다. 한편 1995년에 WHO는 침의 유효성 평가를 위해 이 실험기법을 추천하며, 이어 2001년에, the International Council of Medical Acupuncture and Related Techniques(ICMART)는 침연구와 시술을 위한 헌장(Acupuncture Charter Berlin an Evidence Based Medicine (EBM)3 for acupuncture)을 채택 공표한다. 독일 보험 회사들도 침의 효과와 효율성을 검증하기 위해 대규모 실험을 시작했다. 100,000 명이 넘는 환자들이 무작위 표본추출 대조군 실험을 통해 평가되고 있는데 이 실험은 병원이나 일차의료기관의 외래에서 진행되고 있다. 영국에서는 이 분야의 유력한 Edzard Ernst가 위의 개념과 비슷한 구도를 설정 공표하는데 보완의학 분야의 많은 다른 전문가들의 견해를 무릎 쓰고, 그는 증거기반 의학에 대한 그의 신념을 표방한다. "무작위 표본추출 대조군 실험이 보환의학 분야의 시술을 검증하기 위한 알맞은 방법이 아니라고 끝없이 주장하지만 우리는 거의 모든 치료법을 포괄하는 분야에 이들 실험을 발견하였으니, 이는 보완의학도 엄정한 방법으로 검증할 수 있다는 것을 보여준다고 할 수 있다."(Ernst et al. 2001: xiii). 적어도 독일에서 진행중인 효과 검증 연구가 향후 아시아 의학의 기반 마련에 중요한 역할을 하게 될 것이다. 영국에서는 이에 대한 정치적 수렴이 전문 직업인화에 달려 있을 것이다. 여기에서 나는 아시아에서 유래한 의료의 서양에서 어떻게 사회학적 관찰의 대상으로 분류되고 정의되는지 소개하고자 한다.

• Journal of Veterinary Clinics
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• v.30 no.4
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• pp.258-263
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• 2013

The primary goal of this study was to compute sample sizes required to achieve the each aim of a variety of foot-and-mouth disease (FMD) surveillance programs, using a statistically valid technique that takes the following factors into account: sensitivity (Se) and specificity (Sp) of diagnostic test system, desired minimum detectable prevalence, precision, population size, and desired power of the survey. In addition, sample sizes to detect FMD if the disease is present and also as proof of freedom were computed. The current FMD active surveillance programs consist of clinical, virological, and serological surveillance. For the 2012 serological surveillance, annual sample sizes (n = 265,065) are planned at four separate levels: statistical (n = 60,884) and targeted (n = 115,232) at breeding pig farms and slaughter house, in together with the detection of structural proteins (SP) antibodies against FMD (n = 88,949). Overall, the sample size was not designed taking the specific aims of each surveillance stream into account. The sample sizes for statistical surveillance, assuming stratified two-stage sampling technique, was based to detect at least one FMD-infected case in the general population. The resulting sample size can be used to obtain evidence of freedom from FMD infection, not for detecting animals that have antibodies against FMD virus non-structural proteins (NSP). Additionally, sample sizes for targeted surveillance were not aimed for the population at risk, and also without consideration of statistical point of view. To at least the author's knowledge, sampling plan for targeted, breeding pig farms and slaughter house is not necessary and need to be included in the part of statistical surveillance. Assuming design prevalence of 10% in an infinite population, a total of 29 animals are required to detect at least one positive with probability of 95%, using perfect diagnostic test system (Se = Sp = 100%). A total of 57,211 animals needed to be sampled to give 95% confidence of estimating SP prevalence of 80% at the individual animal-level with a precision of ${\pm}5%$, assuming 800 herds with an average 200 heads per farm, within-farm variance of 0.2, between-farm variance of 0.05, cost ratio of 100:1 of farm against animals. Furthermore, 779,736 animals were required to demonstrate FMD freedom, and the sample size can further be reduced depending on the parameters assumed.

• Proceedings of the Korean Society for Emotion and Sensibility Conference
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• 2009.05a
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• pp.101-104
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• 2009

This study investigated compensatory mechanisms in the brain during a verbal working memory task among people with Alcohol Use Disorders (AUD). A total of 21 college male students participated in the study: eleven AUD participants and 10 normal controls. Study participants were asked to complete the Korean version of the Wechsler Adult Intelligence Scale-III (K-WAIS-III) prior to the fMRI experiment. Verbal 0-back and 2-back tasks were used to assess brain activities of the participants' verbal working memory. Brain scanning was performed on Siemens SONATA 1.5T Scanner while participants were performing the 0-back and 2-back tasks. Within the AUD group, participants with greater dependency to alcohol (based on DSM-IV criteria) in the past 1 year showed lower mean score on the 'Similarities' of the K-WAIS-III (r=-0.63, p<0.05, N=11). The more participants experienced alcohol withdrawal symptoms in the past 1 year, the lower the score they received on the K-WAIS-III 'Picture Arrangement' (r=-0.69, p<0.05, n=11). The fMRI regression results showed that individuals who present greater degree of alcohol dependency symptoms are likely to show greater brain activation in the bilateral middle frontal gyri (BA 9) during the verbal working memory task. The degree of alcohol withdrawal symptoms were associated with increased brain activation in the left superior and middle frontal gyri (BA8), left precentral gyrus (BA 6), and left inferior parietal lobule (BA 40). The study findings showed that the degree of alcohol abuse/dependence and withdrawal symptoms were associated with decreased cognitive function and increased activations in brain regions particularly important for abstract reasoning (BA 9), central executive (BA 9), or spatial storage (BA 40) during a working memory task. Therefore, these results could support previous studies suggesting that the neural system of people with ADD may adopt a brain compensatory mechanism to maintain normal level of cognitive functions.

• Korean Journal of Veterinary Service
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• v.34 no.4
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• pp.321-331
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• 2011

Mycobacterium bovis, a member of the M. tuberculosis complex (MTC), is the causative agent of bovine tuberculosis. Detection of M. bovis and M. tuberculosis using conventional culture- and biochemical-based assays is time-consuming. Therefore, a simple and sensitive molecular assay for rapid detection would be of great help in specific situations such as faster diagnosis of bovine tuberculosis (bTB) infection in the abattoirs. We developed a novel multiplex real-time PCR assay which was applied directly to biological samples with evidence of bTB and it was allowed to differentiate between M. bovis and M. tuberculosis. The primers and TaqMan probes were designed to target the IS1081 gene, the multi-copy insertion element in the MTC and the 12.7-kb fragment which presents in M. tuberculosis, not in the M. bovis genome. The assay was optimized and validated by testing 10 species of mycobacteria including M. bovis and M. tuberculosis, and 10 other bacterial species such as Escherichia coli, and cattle lymph nodes (n=113). The tests identified 96.4% (27/28) as M. bovis from the MTC-positive bTB samples using conventional PCR for specific insertion elements IS1081. And MTC-negative bTB samples (n=85) were tested using conventional PCR and the real-time PCR. When comparative analyses were conducted on all bovine samples, using conventional PCR as the gold standard, the relative accuracy of real-time PCR was 99.1%, the relative specificity was 100%, and the agreement quotient (kappa) was 0.976. The detection limits of the real-time PCR assays for M. bovis and M. tuberculosis genomic DNA were 10 fg and 0.1 pg per PCR reaction, respectively. Consequently, this multiplex real-time PCR assay is a useful diagnotic tool for the identification of MTC and differentiation of M. bovis and M. tuberculosis, as well as the epidemiologic surveillance of animals slaughtered in abattoir.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.40
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• pp.16.1-16.5
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• 2018

Background: Proliferative verrucous leukoplakia (PVL) is an oral potentially malignant disorder, characterized by multifocal expression, progressive clinical evolution, and a high rate of malignant transformation. Evidence-based information regarding optimal PVL management is lacking, due to the paucity of data. The present report describes a case of PVL associated with HPV-16 infection and epithelial dysplasia treated by diode laser surgery, and the outcome of disease clinical remission over a 2-year follow-up period. Case report: A 61-year-old Caucasian male with oral verrucous hyperkeratosis presented for diagnosis. The lesions were localized on the maxillary gingiva and palatal alveolar ridge. Multiple biopsy specimens have been taken by mapping the keratotic lesion area. Microscopic examination was compatible with a diagnosis of PVL with focal mild dysplasia, localized in the right maxillary gingiva. Polymerase chain reaction (PCR) was done for human papillomavirus (HPV) detection which revealed presence of HPV DNA, and the genotype revealed HPV 16 in the sample. The PVL in the right gingival area was treated on an outpatient basis by excision with a diode laser. This approach resulted in good clinical response and decreased morbidity over a 2-year follow-up period. Conclusions: This case illustrates the benefit of a conservative approach by diode laser treatment than wide surgical excision for management of the PVL lesions associated with mild dysplasia and HPV-16 infection.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.5
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• pp.379-396
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• 2021

Background: Trigeminal neuralgia (TN) is characterized by brief, unilateral, sharp, stabbing, and shooting pain of the fifth cranial nerve. The objective of this systematic review with meta-analysis was to determine the effect of medications compared to placebo in adult patients with TN. Methods: Review authors identified randomized placebo-controlled trials (RCTs) from PubMed, Web of Science, Cochrane, and EMBASE up to February 2021. We assessed the inclusion and exclusion criteria as well as the risk of bias of the studies based on the Cochrane Handbook. A total of 324 unduplicated references were scanned independently and reduced to eight relevant RCTs, with 89 patients included. Medications investigated included oral carbamazepine, subcutaneous sumatriptan, lidocaine (intranasal, 8% spray on the oral mucosa or intravenous), buprenorphine (ganglionic local opioid analgesia), and oral Nav1.7, a selective sodium channel blocker. Results: Meta-analyses showed that overall patients receiving lidocaine reported a significantly lower post-treatment intensity of pain -3.8 points on a 0-10 scale (95% Cl = -4.653 to -2.873; P < 0.001). Patients who received lidocaine were 8.62 times more likely to have pain improvement than patients on placebo (P < 0.001). In one RCT, patients receiving oral carbamazepine showed a significant improvement in pain intensity of -32% compared to the placebo (P < 0.001). In one trial, patients receiving 3 mg subcutaneous sumatriptan had a significantly lower intensity of pain on average -6.1 points on a scale of 0-10 compared to placebo (P < 0.001) and a significant improvement in pain intensity of -75% compared to the improvement in the placebo group (P < 0.001). Patients who received subcutaneous sumatriptan were 10 times more likely to have pain improvement than those who received placebo (P = 0.001) in one study. Due to the unclear/high risk of bias and small sample size, the quality of the evidence for lidocaine in the treatment of TN was low. Conclusion: Further studies are needed for carbamazepine, sumatriptan, buprenorphine, and oral Nav1.7 sodium channel blockers, as only one study reported outcomes.

• Korean Journal of Clinical Laboratory Science
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• v.50 no.4
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• pp.391-398
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• 2018

Mesenchymal stem cells (MSCs) are an attractive resource for refractory patients because of their anti-inflammatory/immunomodulatory capability and multi-lineage differentiation potential. The transplantation of MSCs has led to positive results in preclinical and clinical application to various diseases, including autoimmune disease, cardiovascular disease, cancer, liver cirrhosis, and ischemic stroke. On the other hand, studies have shown that paracrine factors, not direct cell replacement for damaged cells or tissue, are the main contributors in MSC-based therapy. More recently, evidence has indicated that MSC-derived exosomes play crucial roles in regulating the paracrine factors that can mediate tissue regeneration via transferring nucleic acids, proteins, and lipids to the local microenvironment and cell-to-cell communication. The use of these exosomes is likely to be beneficial for the therapeutic application of MSCs because their use can avoid harmful effects, such as tumor formation involved in cell transplantation. Therefore, therapeutic applications using MSC-derived exosomes might be safe and efficient strategies for regenerative medicine and tissue engineering. This review summarizes the recent advances and provides a comprehensive understanding of the role of MSC-derived exosomes as a therapeutic agent.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.7
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• pp.242-248
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• 2019

This study was conducted to examine the effects of a smart home (electronic control unit, ECU) on the performance and satisfaction of activities of daily living of wheelchair users. A total of 15 wheelchair users (10 patients with spinal cord injury and 5 patients with stroke) were investigated. Smart homes were equipped with ECU technology, which consisted of automation of furniture and products. The products and facilities were integrated and controlled by a smart device or voice. Performance and satisfaction of activities of daily living were measured by the Canadian Occupational Performance Measure (COPM) before and after residence in a smart home. All participants showed a higher COPM (performance score ${\geq}3$, satisfaction score ${\geq}4$) during residence in a smart home compared to residence in the current home. In addition, the COPM scores differed significantly before and after residence in a smart home. These results provide evidence of the applicability of smart homes based on high technology. However, additional studies of more smart home participants should be conducted to improve the quality of the results.

• Therapeutic Science for Rehabilitation
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• v.12 no.2
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• pp.9-23
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• 2023

Objective : Among the studies using neglect interventions in the field of occupational therapy, this study was conducted to confirm the contents and characteristics of literature applying single-subject studies, and to analyze the intervention effect and quality level. Methods : This study is a systematic review, and the single subject study published in academic journals for the last 10 years. Results : As a result of the thesis analysis, it was conducted on stroke, and the removal design with seven studies, and two studies were multiple baseline designs. As a result of analyzing the size of the intervention effect applied to neglect, 'highly effective' was found seven times, 'fairly effective' 18 times, 'questionable effective' five times, and 'unreliable effective' six times. As a result of the quality level, there were no studies with low level, with six high level and three medium level. Conclusion : As a result of the study, various methods were applied to neglect interventions. It is thought that this study will provide basic data for evidence-based interventions.

• Therapeutic Science for Rehabilitation
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• v.12 no.2
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• pp.25-42
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• 2023

Objective : The purpose of this study was to identify the characteristics of a single-subject research study and qualitative levels in which occupational therapy interventions were performed on children with cerebral palsy. Methods : This study targeted papers, published in Research Information Sharing Service (RISS), National Digital Science Library (NDSL), Koreanstudies Information Service System (KISS), and E-article from May 20 to 29, 2022. The search terms were 'cerebral palsy' AND 'single subject research design' OR 'individual subject study'. Eleven papers, were finally selected and analyzed. Results : Most of the studies were medium in methodological quality, and the subjects were pre-school age and spastic hemiplegia. Among the single-subject designs, intervention-removal designs were the most common, and among them, ABA designs were the most common. Interventions included assistive devices, constraint-induced therapy, neurodevelopmental therapy, and sensory integration therapy were 2, and upper extremity exercise, interactive metronome, and CO-OP were 1. Dependent variables were measured with 2 to 4 measurement tools, Significant improvements were found in postural control ability, gait and balance, hand function, and upper extremity function. Conclusion : This study confirmed that it is helpful to apply cerebral palsy occupational therapy by presenting the characteristics of cerebral palsy, intervention sessions and effects, measurement tools and methodological quality levels.