Purpose: Autonomic dysfunction is a common but frequently underrecognized feature of many neurological disorders. It may present as orthostatic hypotension (OH), supine hypertension, bladder and gastrointestinal dysfunction, sudomotor abnormalities, or sexual dysfunction, and it contributes substantially to morbidity and reduced quality of life. This review provides a clinically oriented overview of autonomic dysfunction across major neurological disorders, outlines a practical diagnostic framework, and summarizes current management principles for general physicians and neurologists.Current concepts: The spectrum of neurological diseases associated with autonomic involvement is broad, ranging from peripheral neuropathies—such as diabetic autonomic neuropathy, Guillain-Barré syndrome, and hereditary transthyretin amyloidosis—to central neurodegenerative disorders, including Parkinson disease, multiple system atrophy, dementia with Lewy bodies, and pure autonomic failure. Motor neuron disease and autoimmune autonomic ganglionopathy represent additional important categories. Clinical evaluation of autonomic dysfunction relies on careful history taking, bedside orthostatic blood pressure measurement, and standardized autonomic function tests, including the Valsalva maneuver, deep breathing, tilt-table testing, and sudomotor assessment. Distinguishing neurogenic from non-neurogenic causes of OH is critical because it determines both prognosis and management. Management requires a multifaceted approach that includes treatment of the underlying disease, nonpharmacologic interventions, and targeted pharmacotherapy for specific autonomic manifestations. The coexistence of OH and supine hypertension in patients with autonomic failure presents a particularly challenging therapeutic dilemma.Discussion and conclusion: Autonomic dysfunction spans diverse neurological diseases, impairing quality of life and survival. Systematic evaluation enables early detection, while multifaceted management—combining nonpharmacologic measures and pharmacotherapy—improves outcomes. Greater awareness will enhance diagnostic accuracy and care for affected patients.
Purpose: Anesthesiology has evolved from a discipline focused primarily on ensuring intraoperative survival to one that promotes recovery, minimizes complications, and improves long-term outcomes. Drug choice is central to this shift, as it directly affects both immediate and long-term patient results. This review summarizes current evidence on anesthetic drug selection and its clinical implications.Current concepts: Enhanced recovery after surgery (ERAS) emphasizes opioid-sparing strategies and multimodal analgesia, with agents such as propofol, dexmedetomidine, and lidocaine supporting early mobilization and recovery. Sugammadex enables rapid and reliable reversal of neuromuscular blockade, reducing residual paralysis and associated respiratory complications. Remimazolam offers predictable recovery and hemodynamic stability, making it particularly valuable in older or high-risk patients. Beyond perioperative outcomes, precision anesthesia integrates factors such as frailty, sarcopenia, pharmacogenomics, and oncological considerations, suggesting that anesthetic management may influence long-term survival and quality of life.Discussion and conclusion: Anesthetic drug selection should be recognized as a key determinant of patient recovery and prognosis. Integrating ERAS principles, neuromuscular monitoring with sugammadex, and emerging agents such as remimazolam within a precision anesthesia framework can guide safer and more individualized clinical practice.
Purpose: Attributable fraction (AF) measures, including AF and population attributable fraction (PAF), quantify the potential reductions in disease burden if specific risk factors were eliminated. Although relative risk describes the strength of association, it does not directly address the clinically and policy-relevant question of how much disease is preventable. This article presents an integrated framework for interpreting AF and PAF across clinical and population contexts, focusing on applications to cancer prevention.Current concepts: AF, defined at the level of exposed individuals, helps explain causal contribution and the preventable proportion in clinical settings. PAF that is based on exposure prevalence among those with the disease (Pc) reflects the causal composition of disease among patients, whereas PAF based on exposure prevalence in the population (Pe) estimates potential impacts of population-level interventions. These measures are grounded in a counterfactual framework and require causal interpretation. This review presents key formulations, including Levin’s and Miettinen’s approaches, together with their underlying assumptions. By distinguishing target populations and question types—causation, prevention, and prioritization—AF and PAF provide complementary insights at the individual, patient group, and population levels.Discussion and conclusion: AF measures offer a unified framework linking causal inference with clinical decision-making and public health policy. AF supports patient-level counseling and intervention prioritization, whereas PAF informs population-level prevention and resource allocation. Appropriate interpretation requires careful consideration of causal assumptions, target populations, and the presence of multiple risk factors. Overall, AF and PAF are essential tools for translating epidemiologic evidence into actionable clinical and policy decisions.
Purpose: This opinion argues that the proposed legislative amendment in Korea—prohibiting physicians’ collective resignation and suspension of practice under criminal penalty—undermines medical professionalism, infringes on fundamental rights in a democratic society, and exacerbates the breakdown of the social contract between physicians and the government that has characterized recurrent physician–government conflict in Korea.Current concepts: Medical professionalism is grounded in a social contract balancing physician autonomy with responsibilities to patients and society. Although governments may regulate healthcare to protect public welfare, excessive state control risks undermining this balance. The proposed amendment extends beyond the provisions of the Medical Service Act, which already authorize work-resumption orders during collective practice suspension. While directly equating this bill with the Soviet Semashko model would be an overstatement, criminalizing individual resignation conceptually parallels the treatment of physicians as state-managed human resources rather than autonomous professionals. In East Asian healthcare systems, including Korea, where licensure authority is centralized, such punitive legislation risks constraining professional autonomy. In contrast, the United Kingdom, despite offering healthcare as a public entitlement, preserves physicians’ rights to collective action through the British Medical Association.Discussion and conclusion: The proposed amendment should be withdrawn. Efforts to strengthen the public character of healthcare should not infringe physicians’ fundamental rights. Rather than relying on coercive legislation, sustainable solutions require the establishment of independent medical regulatory bodies, improvements in working conditions for essential healthcare workers, and constructive dialogue between physicians and the government—approaches that uphold both professional autonomy and public accountability.
Purpose: Extravasation is the unintentional leakage of vesicant or irritant drugs, contrast media, or other infused fluids into surrounding tissue into the surrounding tissue. Extravasation causes injuries ranging from mild irritation to severe necrosis. Incidence ranges from 0.1%–6% in adults and up to 58% in neonates. This review summarizes evidence-based guidelines for diagnosis, management, and prevention.Current concepts: Risk factors include patient-related (fragile veins, older age, neonates, and patients with cancer), procedure- or device-related (inexperienced staff, multiple cannulation attempts, inappropriate catheter selection or fixation, and high infusion pressure), and drug- or product-related (vesicant drugs, high osmolarity or viscosity, and extreme pH) factors. Drugs are classified as vesicants, irritants, or nonvesicants. Diagnosis is primarily clinical, presenting with pain, swelling, and erythema. Differential diagnoses include flare reaction, venous irritation, and venous spasm. Immediate intervention is crucial: stop the infusion, leave the needle in situ for aspiration, then remove the cannula, mark the area, and notify a physician. Management includes elevating the limb, administering specific antidotes, and thermal therapy. Cold compresses are used for DNA-binding vesicants and contrast media, while warm compresses are indicated for non-DNA-binding vesicants. Each session should last 15–20 minutes every 4–6 hours for 24–48 hours.Discussion and conclusion: Surgical referral depends on clinical severity rather than volume alone. Prevention requires standardized protocols, appropriate device selection, and continuous staff training. Adherence to evidence-based guidelines significantly reduces the incidence of extravasation and associated morbidity.
Purpose: Remimazolam is a novel, ultra–short-acting benzodiazepine. Developed as a “soft drug,” it is rapidly metabolized by tissue esterases into an inactive metabolite. This metabolism enables fast onset, predictable offset, and straightforward reversibility with flumazenil, distinguishing it from non-benzodiazepine hypnotics.Current concepts: Pharmacokinetically, remimazolam exhibits high clearance, a small steady-state volume of distribution, and a short context-sensitive half-time, which help minimize accumulation during prolonged infusions. Pharmacodynamically, it produces dose-dependent sedation by modulating the GABAA receptor and demonstrates consistent concentration–response relationships. Clinically, randomized and observational studies support its efficacy in procedural sedation and general anesthesia. Remimazolam is associated with stable hemodynamics, reduced vasopressor requirements, and minimal respiratory compromise. Older adults and high-risk patients often experience favorable recovery profiles, and remimazolam shows promise in neurosurgery, where rapid neurological assessment is essential.Discussion and conclusion: Several challenges remain, presenting opportunities for innovation. Sporadic cases of reported anaphylaxis may involve remimazolam itself or the dextran-40 excipient, necessitate careful administration and warrant research into optimized infusion strategies. Reports of resedation after flumazenil antagonism underscore the need for extended recovery monitoring and highlight areas for clinical refinement. Limited pediatric data emphasize the importance of establishing standardized dosing regimens. Discrepancies between bispectral index values and actual hypnotic depth indicate the need to identify drug-specific electroencephalography (EEG) markers. Overall, remimazolam represents a promising alternative to conventional sedative-hypnotics, especially when hemodynamic stability and rapid, reversible hypnosis are priorities. Future studies should prioritize refining dosing strategies for special populations, validating EEG markers, and evaluating long-term cognitive outcomes and cost-effectiveness.
Purpose: Orthostatic intolerance is a common condition encountered in primary care and encompasses a range of symptoms triggered by standing. This review aims to provide general physicians with a practical framework for understanding terminology, diagnostic criteria, differential diagnosis, and management of orthostatic intolerance.Current concepts: Hemodynamic orthostatic dizziness/vertigo is defined by the International Classification of Vestibular Disorders as 5 or more episodes of dizziness, unsteadiness, or vertigo triggered by arising or present during the upright position, which improve with sitting or lying down, in the presence of documented orthostatic hypotension (OH), postural orthostatic tachycardia syndrome (POTS), or syncope. Measurement of orthostatic blood pressure and heart rate is essential for screening. The differential diagnosis includes benign paroxysmal positional vertigo, persistent postural-perceptual dizziness, anxiety disorders, bilateral vestibulopathy, primary orthostatic tremor, sensory neuropathy, gait disorders, and cardiac conditions. Evaluation of OH requires a stepwise approach to distinguish neurogenic from non-neurogenic causes. Evaluation of POTS focuses on identifying pathophysiological subtypes, including neuropathic, hyperadrenergic, deconditioning-related, and hypovolemic forms.Discussion and conclusion: Management begins with nonpharmacological strategies, including adequate hydration, increased salt intake, use of compression garments, postural education, and adjustment of contributing medications. When these measures are insufficient, pharmacological treatments for OH include midodrine, droxidopa, fludrocortisone, and pyridostigmine, whereas POTS may be managed with low-dose beta-blockers, ivabradine, or midodrine. A systematic approach incorporating appropriate terminology, standardized diagnostic criteria, and stepwise management is essential for optimizing care in patients with orthostatic intolerance.
Purpose: Diabetic retinopathy is one of the most common complications of diabetes mellitus and remains a leading cause of visual impairment worldwide. Because early-stage diabetic retinopathy is often asymptomatic, diagnosis is frequently delayed, resulting in progression to vision-threatening stages. This education column reviews the importance of screening, summarizes current diagnostic approaches, and outlines contemporary treatment strategies for diabetic retinopathy in routine clinical practice.Current concepts: Regular screening and timely ophthalmic referral are essential for the early detection of diabetic retinopathy. Fundus examination remains the cornerstone of diagnosis, while advances in retinal imaging—including ultra-widefield fundus photography, optical coherence tomography (OCT), fluorescein angiography, and OCT angiography—enable more precise assessment of disease severity, retinal ischemia, and macular involvement. Management strategies are determined according to disease stage and include systemic risk factor control, intravitreal injections, laser photocoagulation, and surgical intervention. Intravitreal anti–vascular endothelial growth factor therapy is the first-line treatment for diabetic macular edema, whereas panretinal photocoagulation remains the standard treatment for proliferative diabetic retinopathy.Discussion and conclusion: Diabetic retinopathy is a progressive disease; however, vision-threatening complications can be substantially reduced through early detection and appropriate management. Regular screening, accurate staging, and timely treatment are key elements in preventing severe visual loss. Close collaboration among primary care physicians, endocrinologists, and ophthalmologists, together with continuous patient education, plays a critical role in improving screening adherence and clinical outcomes. A comprehensive, multidisciplinary approach is essential to reduce the burden of visual impairment caused by diabetic retinopathy.
Purpose: This study aimed to analyze the legal readiness of South Korea's Act on Integrated Support for Community Care using the World Health Organization’s Integrated Care for Older People (ICOPE) framework.Methods: Using the ICOPE action items and system-level enablers as the analytical framework, the provisions of the law were systematically reviewed, and a comparative case study of Singapore’s national strategy was conducted.Results: The analysis showed that while the Korean law establishes a legal foundation for procedural components such as case finding and planning (the Ready phase), it critically lacks operational mechanisms necessary for implementation (the Set phase). In particular, the law does not provide detailed standards for a multidisciplinary workforce, performance-based financial incentives, or a function-oriented data system. The comparison with Singapore further underscored a major governance limitation, specifically the absence of a national-level control tower capable of coordinating fragmented services.Conclusion: Creating a national-level implementation support agency should be a top policy priority. Such an agency is essential to serve as the control tower needed to develop workforce and data standards, align financial incentives, and coordinate a coherent national strategy for integrated care.
Purpose: Obesity is a chronic, complex disease influenced by genetic, biological, and environmental factors, requiring integrated treatment approaches. Since lifestyle modification alone often fails to achieve sustained weight loss, pharmacological interventions are essential for long-term management.Current Concepts: Glucagon-like peptide-1 (GLP-1) receptor agonists and related co-agonists have transformed obesity and type 2 diabetes treatment. Agents including liraglutide and semaglutide, plus the dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonist tirzepatide, induce substantial weight loss (approximately 10% to 25%) through appetite suppression and enhanced satiety while improving glycemic control. Beyond weight reduction, these therapies demonstrate clinically meaningful cardiovascular and renal benefits, some appearing at least partly independent of weight loss, suggesting direct organ-protective effects. The therapeutic scope of GLP-1–based agents has expanded to multiple obesity-related complications, including heart failure with preserved ejection fraction, metabolic dysfunction–associated steatohepatitis, obstructive sleep apnea, osteoarthritis, and peripheral vascular disease. Current success has accelerated development of next-generation therapies targeting greater efficacy, improved tolerability, and novel delivery platforms, including oral formulations and small-molecule nonpeptide agonists.Discussion and Conclusion: This review summarizes established and emerging GLP-1–based therapies for obesity, focusing on mechanisms of action, clinical efficacy from pivotal trials, cardiovascular outcomes, and safety considerations. We discuss strategies to optimize pharmacokinetics and tolerability, advances in multi-receptor agonism, and key safety issues relevant to clinical practice. Four decades after GLP-1 discovery, these therapies represent a major advance in comprehensive metabolic disease management and may redefine obesity treatment and its associated comorbidities beyond original diabetes and weight loss indications.
Purpose: With a focus on novice researchers, it aims to clarify how artificial intelligence (AI) can support research design and may lower barriers to research participation while emphasizing the continuing importance of human judgment in study conception and interpretation.Current concepts: Traditional medical research training has emphasized methodological theory, statistical techniques, and mentor–mentee instruction. However, these approaches often present substantial challenges for novice researchers. Time constraints, limited access to data, and the need to learn unfamiliar methodologies further contribute to these difficulties. Recent advances in AI enable the rapid synthesis of large volumes of information and structured exploration of research questions. AI also facilitates the organization of study frameworks. These tools may help structure research designs that are less dependent on patient-level data. Examples include social media studies, narrative reviews, and qualitative analyses.Discussion and conclusion: AI has the potential to reshape research design education by functioning as a cognitive support tool. It can help novice researchers formulate meaningful questions, select appropriate study designs, and interpret findings. However, responsible use requires explicit attention to explainability, methodological rigor, and ethical standards. Significant limitations include AI’s dependence on available data, its inability to independently verify information, and the risk of generating misleading suggestions when prompts are poorly constructed. Clear guidance regarding the appropriate scope and limitations of AI-assisted research design is essential. When used appropriately, AI may broaden participation in medical research, enhance research literacy, and support the development of sustainable research skills among clinicians and medical trainees.
Purpose: Obesity is closely associated with type 2 diabetes, cardiovascular disease, and other metabolic disorders. Lifestyle modification and pharmacotherapy provide only limited long-term benefits, whereas bariatric and metabolic surgery has become the most effective and durable treatment for severe obesity. This review summarizes current indications, major surgical procedures, clinical outcomes, and recent global and domestic trends.Current Concepts: Current guidelines recommend surgery for patients with a body mass index (BMI) ≥35 kg/m2, or ≥30 kg/m2 with obesity-related comorbidities. In Asian populations, surgery is also indicated for patients with a BMI ≥27.5 kg/m2 who have type 2 diabetes or other metabolic diseases. Sleeve gastrectomy is technically straightforward and safe but is potentially associated with weight regain and gastroesophageal reflux disease. Roux-en-Y gastric bypass achieves durable weight loss and higher remission rates of type 2 diabetes; however, it carries risks of nutritional deficiencies and limits endoscopic access to the bypassed stomach. To address these limitations, sleeve-plus procedures and one-anastomosis gastric bypass have been developed and have shown favorable short- to mid-term outcomes, although long-term evidence remains insufficient.Discussion and Conclusion: In Korea, national insurance coverage and registry-based standardization have improved access and promoted safety, with complication and mortality rates comparable to global data. Bariatric and metabolic surgery is now established as a cornerstone therapy for severe obesity, and optimal outcomes require individualized procedure selection, structured long-term follow-up, and consideration of regional concerns such as gastric cancer surveillance.
Purpose: This article reviews recent dietary strategies for obesity management, with particular attention to low-calorie diets (LCDs), low-carbohydrate diets, intermittent fasting (IF), and structured dietary patterns.Current Concepts: Dietary intervention remains a cornerstone of non-pharmacological obesity treatment. A LCD, defined as a daily caloric reduction of 500 to 1,000 kcal from baseline, typically produces weight loss of approximately 0.5 to 1.0 kg per week and is considered both safe and practical. IF has demonstrated comparable weight loss efficacy to LCDs and may be an option depending on individual characteristics and medical status. However, evidence is still limited, and because of the risk of hypoglycemia, IF is generally not recommended for patients with type 2 diabetes. Additional approaches, such as low-carbohydrate diets and Mediterranean-style dietary patterns, have shown variable metabolic benefits. Meta-analyses suggest that the degree of carbohydrate restriction alone does not yield additional cardiovascular benefits, with outcomes depending largely on the quality of macronutrient substitutions.Discussion and Conclusion: Ultimately, rather than promoting any single dietary strategy, reducing overall caloric intake remains the fundamental principle of obesity treatment. Within traditional Korean diets, a modest reduction in carbohydrate intake may also enhance metabolic outcomes.
Purpose: This paper discusses current publication ethics issues related to the use of generative artificial intelligence (AI)—defined as AI systems capable of producing original text, images, or other content—in the writing of academic papers.Current concepts: As the performance of generative AI has improved significantly, it has increasingly been used in the writing of academic papers. In some instances, generative AI has been listed as an author and has been used in various ways to modify manuscript text. Journal editors began issuing policies regarding its use. Based on a shared perspective, editorial organizations proposed several principles, stating that generative AI cannot be an author and that authors and editors must be transparent about its use. They further emphasized that human authors bear responsibility for the integrity of their work. Despite these recommendations, controversy persists, particularly regarding the specific circumstances under which generative AI may or may not be used.Discussion and conclusion: The rapid development of generative AI compels the scientific community to make new ethical judgments within the publication process, which has traditionally been shaped by human consensus. Stakeholders must continuously review and reevaluate publication ethics issues related to generative AI, including authorship, liability, and disclosure of use.
Purpose: Metabolic dysfunction–associated steatotic liver disease (MASLD) is one of the most prevalent chronic liver diseases worldwide, with a rising incidence driven by obesity and type 2 diabetes. Because progression to advanced fibrosis is the primary determinant of long-term outcomes, there is an increasing need for effective pharmacological therapies. This review summarizes current pharmacological treatment strategies for MASLD and emerging therapeutic approaches.Current concepts: Management of MASLD is based on risk stratification according to fibrosis stage and metabolic risk factors. Although lifestyle modification remains the cornerstone of treatment, pharmacological therapy is considered in patients with metabolic dysfunction–associated steatohepatitis (MASH) and/or significant fibrosis. Conventional agents, such as pioglitazone and vitamin E, improve hepatic steatosis and inflammation; however, their antifibrotic effects remain limited. More recently, disease-modifying therapies such as resmetirom have demonstrated improvements in both MASH resolution and fibrosis. Incretin-based therapies, including glucagon-like peptide-1 receptor agonists, have also shown favorable metabolic and histological effects and have gained regulatory attention based on surrogate endpoints.Discussion and conclusion: Despite recent advances, most available therapies have limited antifibrotic efficacy, underscoring the need for more effective treatment strategies. Emerging agents targeting diverse pathways—including fibroblast growth factor 21 analogs, dual incretin agonists, and pan–peroxisome proliferator–activated receptor agonists—are under active investigation. Future management of MASLD is expected to evolve toward a personalized approach based on fibrosis stage and metabolic risk, with increasing emphasis on combination therapies and antifibrotic strategies to modify disease progression.
