The birth of the scientific revolution, brought forth by Vesalius and Copernicus in 1543, marked the beginning of a new age. However, the changes such as treatment effectiveness, survival rate, prevalence of specific diseases, etc. had not yet become clear during the 16th century. In the early 17th century, Boerhaave emphasized bedside teaching and practice. His attitude influenced numerous students and educators, so many medical students visited hospital wards where he worked. From the late 18th to 19th centuries, Jenner's smallpox vaccination, Pasteur's anthrax and rabies vaccinations, and Koch's four postulates used to detect pathogens were developed using the scientific research method, which initiated big changes for medicine. Flexner, credited for reporting the new medical education system, adopted scientific medicine. He believed medical students must study basic medical science since it could be the foundation of clinical medicine and lead to a revolution in the field. He proposed a new medical curriculum composed of two-years of basic medicine and two-years of clinical medicine, which has been used more than 100 years. During the late 20th century, bedside teaching rounds decreased gradually as scientific medicine has become popular. Many medical educators in many articles have proposed bedside education as an effective method for medical learning. Despite the advent of the age of artificial intelligence and the changing of medical environments in the near future, bedside education will be more useful and important for medical students, educators, and patients as it is a traditional method and essential for patients who desire a more personal approach.
Three hundred and seventy-three steers (approximately 7 mo of age and $247{\pm}19.4\;kg$) were utilized to determine the effects of trace mineral (TM) source and growth implants on trace mineral status. Steers were blocked by ranch, post-weaning treatment within ranch, stratified by initial body weight, and randomly assigned to one of 36 pens (9-12 head/pen). Treatment consisted of: I) control (no supplemental Cu, Zn, Mn, and Co), ii) inorganic trace minerals, and iii) organic trace minerals. Six pens of steers per treatment received a growth implant at the beginning of the experiment and were re-implanted during the finishing phase. The remaining steers received no growth implants. Steers were fed a corn silage-based growing diet for 56 d then were gradually switched to a high concentrate finishing diet. Treatments during the finishing phase consisted of: i) control (no supplemental Zn); ii) inorganic Zn (30 mg of Zn/kg DM from $ZnSO_4$); and iii) organic Zn (iso-amounts of organic Zn). By the end of the growing and finishing phases, implanted steers had greater (p<0.01) plasma Cu concentrations than non-implanted steers. During the growing phase, liver Cu concentrations (p<0.01) and plasma Zn concentrations (p<0.02) were greater in steers supplemented with TM compared to control steers. Steers supplemented with inorganic minerals had greater liver Cu concentrations than steers supplemented with organic minerals at the beginning (p<0.01) and end (p = 0.02) of the growing phase. During both the growing (p = 0.02) and finishing phases (p = 0.05), nonimplanted control steers had greater plasma Cu concentrations than non-implanted steers supplemented with TM, whereas, implanted control steers had similar plasma Cu concentrations than implanted steers supplemented with TM. Non-implanted steers that received inorganic TM had lower plasma Cu concentrations (p = 0.03) during the growing phase and ceruloplasmin activity (p<0.04) during the finishing phase than non-implanted steers that received organic TM, whereas, implanted steers supplemented with either organic or inorganic TM had similar plasma Cu concentrations.
The precipitates of $L2_1$-type $Ni_2AlHf$ phase in B2-ordered NiAl system has been observed by using transmission electron microscope (TEM). The hardness of as-quenched NiAl-Hf alloys is high due to the larger strengthening. However, age hardening of this alloy is not main effect to increase hardness compared to the large microstructural variations during aging. At the beginning of aging, the $L2_1$-type $Ni_2AlHf$ precipitates keep a lattice coherency with the NiAl matrix. The orientation relationship between the $Ni_2 AlHf$ precipitate and the NiAl matrix is <100>$_{Ni2AlHf}$//<100>$_{NiAl}$, {001}$_{Ni2AlHf}$//{001}$_{NiAl}$. By aging treatment for long time $Ni_2AlHf$ precipitates lost their coherency and change their morphology to the spherical ones surrounded by misfit dislocations. The orientation relationship between the NiAl matrix and the $Ni_2AlHf$ precipitates, however, has been kept even after longer aging time. The lattice misfit between the $Ni_2AlHf$ precipitate and the NiAl matrix has been calculated by the selected electron diffraction patterns, and the spacings of misfit dislocations is about 4.5% at 1173 K.
Kim, Min-Young;Ha, In-Hyuk;Lee, Jin-Ho;Kim, Jong-Ho;Jung, Boyoung
The Journal of Korean Medicine
/
v.40
no.1
/
pp.86-98
/
2019
Objectives: This study analyzes the electronic medical record (EMR) data of the spine specialist oriental hospital and clinic in various regions, and reports the actual number and used cases of Chuna therapy. Methods: 2,470,772 data was extracted retrospectively from electronic medical records of all inpatients and outpatients who were treated chuna therapy at 21 Korean medicine hospitals and clinics from January 1, 2018 to December 31, 2018. The characteristics of medical treatment using chuna therapy reflect the minimum, maximum and average values of the number of hospitalized patients, length of hospitalization, frequency of hospitalization, number of outpatients, frequency of treatment and frequency of visit. Diseases were classified in the proportion of Chuna treatment according to the KCD, 7th edition. The chuna and blindness charts were derived accordingly from illness and disease of each part of the body. Results: During the study period, a total 1,342,022 inpatients and outpatients visited the study sites. The male proportion was a little higher than the females' (male: 53.7%, female: 46.3%). According to age, the 30s and 40s were more than half the total(30s: 33.0% and 40s: 20.1%). Chuna therapy was treated to more outpatients than hospitalized patients (outpatient: 83.6%, hospitalization: 16.4%), and most treatments were related to musculoskeletal illness(99.06%). Conclusions: As a result of this study, 1,342,389 chuna therapy was performed in 21 hospitals for one year. As highly demanded by the public, we look forward to ensuring national health care options and medical access when health insurance for chuna therapy is applied beginning March 2019.
Background: Despite recent advances in first-line chemotherapy for advanced pancreatic cancer, standard treatment after the failure of initial chemotherapy has not been established. Hence, we aimed to retrospectively analyze the clinical characteristics and outcomes of second-line chemotherapy in patients with advanced pancreatic cancer. Methods: We reviewed the clinical data of patients with advanced pancreatic cancer who underwent palliative chemotherapy at Kosin University Gospel Hospital between January 2013 and October 2020. Results: Among 366 patients with advanced pancreatic cancer who had received palliative chemotherapy, 104 (28.4%) underwent at least one cycle of second-line chemotherapy. The median age of the patients at the time of initiating second-line treatment was 62 years (interquartile range, 57-62 years), and 58.7% (61 patients) of them were male. The common second-line chemotherapy regimens were 5-fluorouracil (FU) plus leucovorin, irinotecan, and oxaliplatin (33 patients, 31.7%); gemcitabine/nab-paclitaxel (29, 27.9%), gemcitabine±erlotinib (13, 12.5%); and oxaliplatin and 5-FU/leucovorin (12, 11.5%). The median overall survival (OS) and progression-free survival were 6.4 months (95% confidence interval [CI], 4.5-8.6 months) and 4.5 months (95% CI, 2.7-6.3 months), respectively. In a multivariate analysis, poor performance status (PS) (hazard ratio [HR], 2.247; p=0.021), metastatic disease (HR, 2.745; p=0.011), and elevated carcinoembryonic antigen (CEA) levels (HR, 1.939; p=0.030) at the beginning of second-line chemotherapy were associated with poor OS. Conclusion: The survival outcome of second-line chemotherapy for advanced pancreatic cancer remains poor. However, PS, disease extent (locally advanced or metastatic), and CEA level may help determine patients who could benefit from second-line treatment.
Raynaud attempted to clarify the situation concerning symmetrical and spontaneous gangrene in a thesis published in 1952. The disease was defined as Raynaud`s phenomenon without associated and contributing conditions or disease, and described as two types, such as, `locale syncope and asphyxia` and `gangrene`. Predilection of Raynaud`s disease for female under 40 years of age wi-thout any vascular occlusive disease beginning in the early decades of life and typical color changes in the skin of the extremities incited by coldness are outstanding features in this disease. One typical case of Raynaud`s disease is presented with relating references. Patient was 24 year old female single patient, who noted pain, numbness, and cyanosis of the finger tips of both hands for 6 years previously in the winter season, and recently such symptoms were aggravated including her both feet for two years even in the summer after exposure to cold water. Physical and laboratory examination revealed nothing specific except slightly glistening tight face and hypertrophy of both finger tips with clammy coldness. FamiliaI and past history revealed nothing specific abnormal contributory factors. Biopsy of skin on the dorsum of right foot one year before this admission revealed no evidence of scleroderma. Treatment was aimed to relieve vasospasmodic reaction to coldness and was very successful with bilateral lumbar and thoracic sympathectomy. Patient is free of symptoms relating to the Raynaud’s phenomenon after sympathectomy for 6 months including winter season.
Journal of The Korea Institute of Healthcare Architecture
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v.12
no.2
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pp.31-39
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2006
Much has changed in the healthcare field since the beginning of the industrial age. In the healthcare field changes are occurring so rapidly and dramatically that yesterday's paradigm will not be tomorrow's paradigm, creating the need above all else to stay fluid and flexible as strategies(included healthcare architecture planning) for the future are developed. The purpose of this study is to analyze the latest architectural trends of general hospital outpatient department based on the healthcare environment changes in Korea. The major healthcare environment change is to change the object of hospital's healthcare services from inpatient to outpatient. In conclusion, the first, medical faculties of outpatient department are subdivided specialized small faculty. The second, clinic systems for medical examination and treatment of specific disease are activated in the most outpatient department. The third, specialized medical centers for chronical disease(Cancer, Cardiac etc.) control are arranged in existed outpatient department or freestanding facility. Specialized medical center for preventive medicine is regionally decentralized for corresponding with the healthcare paradigm shifts.
Craniosynostosis is the premature fusion of calvarial sutures, resulting in deformed craniofacial appearance. Hence, for a long time, it has been considered an aesthetic disorder. Fused sutures restrict growth adjacent to the suture, but compensatory skull growth occurs to accommodate the growing brain. The primary goal for the management of this craniofacial deformity has been to release the constricted skull and reform the distorted shape of the skull vault. However, the intellectual and behavioral prognosis of affected children has also been taken into consideration since the beginning of the modern era of surgical management of craniosynostosis. A growing body of literature indicates that extensive surgery, such as the whole-vault cranioplasty approach, would result in better outcomes. In addition, the age at treatment is becoming a major concern for optimal outcome in terms of cosmetic results as well as neurodevelopment. This review will discuss major concerns regarding neurodevelopmental issues and related factors.
The purpose of this study was to identify clinical characteristics of type 2 diabetic patients with hypertension. The subjects were 209 type 2 diabetic patients who visited at the endocrine center at Kangnam St. Mary's Hospital of Catholic University in Seoul from beginning of March through the end of April in 2001. The patient's clinical laboratory data were assessed at medical record review. The data were analyzed using for t-test, $x^2$ test. The results were as follows: 1) There were no significant differences in age, body mass index, sex, family history of diabetes and oral hypoglycemic agents between hypertensive group and normotensive group, However, percentage of patients receiving insulin treatment was higher significantly in the hypertensive group. 2) Creatinine and microalbuminuria levels were higher significantly in the hypertensive group. However, fasting blood glucose levels were lower significantly in the hypertensive group. There were no significant differences in $HbA_1c$, 2-hour postprandial blood glucose, total cholesterol, triglyceride, high density lipoprotein cholesterol, lipoprotein(a) and blood urea nitrogen between two groups. Our present study supports that Creatinine and microalbuminuria levels were higher significantly in the hypertensive group.
Purpose: This study aimed to investigate the factors of occurrence of amenorrhea and the severity of climacteric symptoms in breast cancer patients who underwent chemotherapy. Method: Women diagnosed with breast cancer without metastasis or recurrence, had surgery followed by chemotherapy, and had menses at the time of surgery were recruited from S hospital located in Seoul. A total of 99 women aged 31 thru 55 years participated and filled out a structured questionnaire including the Functional Assessment Cancer Therapy-Breast plus Endocrine Symptom when they visited the clinic for follow-up. Result: In 88 women amenorrhea occurred within an average of 2 months since beginning chemotherapy, and menstruation was resumed in only 11 women. About 98% of women aged over 40 experienced a cessation in menses thus age was an apparent factor of amenorrhea (Exp(B)=.76, p<.05). Presence of chronic disease (${\beta}=.25$, p<.05) and body weight change (${\beta}=.30$, p<.01) were significant factors influencing the severity of climacteric symptoms. Conclusion: Nurses need to have clinical evidences of menstrual changes due to breast cancer treatment. Information about premature menopause and climacteric symptoms should be provided according to women's health conditions so that they cope better during their survival.
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