Relationship of Peer- and Self Assessments in the Anatomy Laboratory and Academic Performance of Gross Anatomy / 체질인류학회지

Gross anatomy, with cadaver laboratory dissection, is in a unique position to preside over a rich number of activities such as the team work, integrity, active learning, communication in the small group-all aspects of professional conduct. The purposes of this study are to investigate the correlation of professionalism with academic performance and the characteristics of groups of students in the performance variables. First-year Pusan National University School of Medicine students (n=108) from the Class of 2015 taking the gross anatomy course were required to do the self- and peer assessment about the professional behaviors of each of the six members of their dissecting group. The students were classified into one of four subgroups based on their deviation from the self- and peer assessment medians, such as high peer/high self (HP/HS), high peer/low self (HP/LS), low peer/high self (LP/HS), low peer/low self (LP/LS). There were significant higher scores in the high peer groups (HP/HS, HP/LS) in comparison with low peer groups (LP/HS, LP/LS) in the academic performance of end-of-term (F=3.24), credit (F=3.54), pre-Lab (F=3.94), practical examination (F=3.60) scores. Significant correlations among academic performance variables were observed generally. There were some differences in the correlation in the practical examination and other variables. The relatively high correlation between practical examination and other variables is HP/HS, followed by LP/LS, LP/HS and then HP/LS. In conclusion, peer- and self assessment subgroups showed a significant differences in the academic performance. This assignment would be available to evaluate work habits of professionalism in the gross anatomy laboratory. It is suggested that HP/HS group was more adaptable in the contextual leaning the gross anatomy course.

Structured Assessment to Evaluate a Family Medicine Clerkship Program / 의학교육논단

This correction is being published to revise the acknowledgements of the above article.

Structured Assessment to Evaluate a Family Medicine Clerkship Program / 의학교육논단

This study was conducted to analyze the strengths and weaknesses of a 3-week family medicine clerkship program based on the results of an online survey taken by the students (N=127) and a structured interview with a focus group (n=10), aimed to improve the quality of the clerkship program. The online survey contained questions pertaining to goals, schedule, contents, arrangement, atmosphere, environment, evaluation, and satisfaction regarding the clerkship. The focus group interview addressed the schedule and achievements of the program. Scores were reported on a 5-point Likert scale. Most students were highly satisfied with the overall quality of the clerkship. The structured interview results showed that 97.6% of the clerkship program was executed according to the schedule. The focus group reported a perfect score of 5 points on several measures including: accomplishment of the educational goals of the family medicine clerkship, providing many chances to obtain medical histories and perform physical examinations on real patients, experience with various symptoms and diseases, positive attitudes of faculty members when teaching, notification of the guidelines for evaluation beforehand, well-constructed and effective clerkship schedule, and reflection of student feedback. However, the focus group gave low scores on: support for health accidents of students, access to patient information, enough opportunities to practice clinical skills, appropriate rest facilities for students, and fairness of clerkship evaluation process. In conclusion, the structured evaluation performed after the 3-week clerkship program motivated students and helped them ensure an efficient clerkship. This structured evaluation also suggested basic data to make the professor who is subject of the assessment. This study shows that structured assessment is an effective method which can be used to improve the quality of clerkships.

Morphometric Analysis of Distances between Sacral Hiatus and Conus Medullaris Using Magnetic Resonance Image in Korean Adult / 체질인류학회지

The purpose of this study was to provide basic biometric data on Korean adults through magnetic resonance imaging (MRI)-based measurements of the distances between the apex of sacral hiatus (SH) and the termination of dural sac (DS), and between SH and conus medullaris (CM) because they are critical to the performance of epidural neuroplasty. A total of 200 patients (88 males and 112 females) with back pain, who had no spine fracture, significant spinal deformity, and spondyloisthesis were selected for this study. The subjects were of mean age 54.3 (20~84) years and mean height 161.3 cm (135~187). T2-weighted MRI images were used for correlation analysis to evaluate the relationships between the distances, and variables such as sex and height. In all patients, the mean distance between SH and DS was 62.8±9.4 mm and the mean distance between SH and CM was 232.2±21.8 mm. The minimum distance and the maximum distance between SH and DS were 34.8 mm and 93.9 mm respectively, and the minimum distance and the maximum distance between SH and CM were 155.0 mm and 284.0 mm respectively. In female patients, both the distances between the SH and DS, and between SH and CM were shorter when compared to those of the male patients (p<0.05). Both the distances between SH and DS and between SH and CM showed a significant correlation with height (p<0.01). The results of this study will provide a useful biometric data on the distances between SH and DS and between SH and CM in Korean in ensuring clinical safety and in the development of more effective catheterization techniques for epidural neuroplasty in Korean.

Expression and Characterization of Genes by Expressed Sequence Tag Analysis in the Rat Thymus during Regeneration following Acute Thymic Involution Induced by Cyclophosphamide / 체질인류학회지

The thymus is the central lymphoid organ for the development of bone marrow-derived precursor cells into mature T-cells. Understanding the molecular mechanism of thymic involution and regeneration is critical to develop methods to normalize or improve host immunity from the decreased immune function caused by thymic involution. In this study, the regenerating thymus cDNA library was constructed in the rat from a model of thymic involution and regeneration induced by cyclophosphamide. Expressed sequence tags (ESTs) were obtained by partial sequencing of 700 randomly selected insert-containing clones. A total of 630 ESTs were analyzed, of which 486 ESTs (78%) matched to known genes and 125 ESTs (19%) matched to other ESTs (unknown genes). The 19 ESTs (3%) did not match with any known sequences. The ESTs were grouped into six main functional categories: metabolism (44%), signaling components (20%), membrane transport (7%), cytoskeleton (2%), cell division (2%) and defense (2%). As a result of RT-PCR analysis, expression of putative gene 01, putative E2IG2 gene, musculin and osteoactivin significantly increased in rat thymus during regeneration. The putative gene 01 showed complete homology with mitochondrial ribosomal protein S4 by homology search and multiple alignment of amino acid. These results provide the extensive molecular information on thymus regeneration and will be useful source to identify various genes which may play an important role in the thymus regeneration as well as to clone novel genes. Furthermore, the availability of these data will serve as a basis for further research to understand the molecular mechanism of thymus regeneration.

Study of Clinical Medical Teachers' Attitudes to the Knowledge of Gross Anatomy of Medical Students / 체질인류학회지

There is concerns about the perceived decline in the knowledge of gross anatomy of the medical students and postgraduate trainees. It is partly caused by the introduction of integrated medical curriculum and the shortage of basic medical science program and the extension of clinical clerkship consequently. There is widespread variability in the teaching style and anatomical curricular content at the medical school in Korea. Despite these changes in the anatomical education, there have been few attempts to assess the opinions of senior clinical teachers on the state of anatomical knowledge of students and the place of anatomy teaching within the curriculum. We sought the views of the clinical teachers on the adequacy of the anatomical knowledge of current students and recent graduates of 5 medical schools in Pusan and Gyeongsang-Nam do areas. Most of the clinical teachers were of the opinion that current medical students have an insufficient anatomical knowledge. They indicated the causes of decline were the clinical irrelevant anatomical teaching content and weakness of identity of anatomy by the introduction of the integrated medical education program. There was widespread support for both the concepts of spreading anatomy teaching throughout the medical course, and an optional, clinically related final year student project in the anatomy.

Acute Effects of Capsaicin on Proopioimelanocortin mRNA Levels in the Arcuate Nucleus of Sprague-Dawley Rats

OBJECTIVE: Capsaicin, a noxious stimulant and main component of the hot flavor of red peppers, has an analgesic effect when administered to humans. We investigated the expression of proopioimelanocortin (POMC) mRNA in the arcuate nucleus of Sprague-Dawley (SD) rats after administering capsaicin, hypothesizing that administering capsaicin activates the central opioid system. METHODS: SD rats were divided randomly into two groups; one group received a saline injection and the other received a capsaicin injection. The POMC mRNA level in the arcuate nucleus of the hypothalamus was measured by the reverse transcription-polymerase chain reaction at 0, 20, 40, 60, and 120 minutes after capsaicin administration. RESULTS: Capsaicin administration resulted in a significantly increased POMC mRNA level, compared to that in saline-treated rats at the 20-minute time point (t=-4.445, p=0.001). However, no significant group differences were observed at other times (t=-1.886, p=0.089; t= -0.973, p=0.353; t=-2.193, p=0.053 for 40, 60, and 120 minutes, respectively). CONCLUSION: The analgesic effect of capsaicin might be associated with increased activity of the cerebral opioid system. This finding suggests that capsaicin acted for nociception and analgesia and could affect alcohol-intake behavior, which might further imply that a food culture could affect drinking behavior.

Expression and roles of NUPR1 in cholangiocarcinoma cells / 대한해부학회지

Nuclear protein-1 (NUPR1) is a small nuclear protein that is responsive to various stress stimuli. Although NUPR1 has been associated with cancer development, its expression and roles in cholangiocarcinoma have not yet been described. In the present study, we found that NUPR1 was over-expressed in human cholangiocarcinoma tissues, using immunohistochemistry. The role of NUPR1 in cholangiocarcinoma was examined by its specific siRNA. NUPR1 siRNA decreased proliferation, migration and invasion of human cholangiocarcinoma cell lines (HuCCT1 and SNU1196 cells). From these results, we conclude that NUPR1 is over-expressed in cholangiocarcinoma and regulates the proliferation and motility of cancer cells.

Characterization of the expression of cytokeratins 5, 8, and 14 in mouse thymic epithelial cells during thymus regeneration following acute thymic involution / 대한해부학회지

The thymus is a central lymphoid organ for T cell development. Thymic epithelial cells (TECs) constitute a major component of the thymic stroma, which provides a specialized microenvironment for survival, proliferation, and differentiation of immature T cells. In this study, subsets of TECs were examined immunohistochemically to investigate their cytokeratin (CK) expression patterns during thymus regeneration following thymic involution induced by cyclophosphamide treatment. The results demonstrated that both normal and regenerating mouse thymuses showed a similar CK expression pattern. The major medullary TECs (mTEC) subset, which is stellate in appearance, exhibited CK5 and CK14 staining, and the minor mTEC subset, which is globular in appearance, exhibited CK8 staining, whereas the vast majority of cortical TECs (cTECs) expressed CK8 during thymus regeneration. Remarkably, the levels of CK5 and CK14 expression were enhanced in mTECs, and CK8 expression was upregulated in cTECs during mouse thymus regeneration after cyclophosphamide-induced acute thymic involution. Of special interest, a relatively high number of CK5+CK8+ TEC progenitors occurred in the thymic cortex during thymus regeneration. Taken together, these findings shed more light on the role of CK5, CK8, and CK14 in the physiology of TECs during mouse thymus regeneration, and on the characterization of TEC progenitors for restoration of the epithelial network and for concomitant regeneration of the adult thymus.

Expression of IL-17A during Thymus Regeneration in the Rat / 체질인류학회지

IL-17A is a pro-inflammatroy cytokine secreted by activated T cells. The IL-17 family consist of IL-17A, IL-17B, IL-17C, IL-17D, IL-17E and IL-17F. IL-17A and IL-17F are produced primarily in activated T cells. In contrast, IL-17B, IL-17C, IL-17D and IL-17E are expressed in a wide assortment of tissues. Their functions partially overlap those of IL-17A, although they have not been as thoroughly investigated. The receptor for IL-17A (IL-17R) is widely expressed in a variety of tissues. IL-17A and IL-17E mRNAs were expressed in only EL4 cells. IL-17C mRNA expression was observed in the thymic subcapsular/cortex epithelial cells (SNEC), cortex or cortical reticular cells (CREC), medullary epithelial cells (MEC), medullary interdigitating-like cells (MDC), thymocytes and EL4 cells. However, IL-17C mRNA was not expressed in RAW 264.7 cells. Immunohistochemical study also demonstrated not only the presence of IL-17A mainly in the thymic epithelial cells, but also the upregulated expression of IL-17A in the thymic epithelial cells of the regenerating thymus. Thus, the results of the present study suggest that IL-17A expressed in the thymocytes and thymic epithelial cells could play an important role in the development of new T cells to replace T cells damaged by cyclophosphamide treatment during thymus regeneration.

Vitamin D3 regulates cell viability in gastric cancer and cholangiocarcinoma / 대한해부학회지

A low serum level of vitamin D has been associated with an increased incidence of gastrointestinal tract cancers. However, the effects of vitamin D3 have not been investigated in gastric cancer and cholangiocarcinoma. In the present study, we found that vitamin D3 treatment significantly suppressed the viability of gastric cancer and cholangiocarcinoma cells. Moreover, vitamin D3 had a synergistic effect with other anti-cancer drugs, such as paclitaxel, adriamycin, and vinblastine, for suppressing cell viability. To determine the underlying mechanism involved in the regulation of viability by vitamin D3, we examined the effects of vitamin D3 on expression of hedgehog signaling target genes, which has been associated with gastric cancer and cholangiocarcinoma. Vitamin D3 treatment decreased the level of mRNA expression of patched1, Gli1, cyclin D1, and Bcl2, suggesting the possibility that vitamin D3 may act through regulation of hedgehog signaling. From the above results, we conclude that vitamin D3 regulates cell viability in gastric cancer and cholangiocarcinoma.

Effects of Differences in Problem-Based Learning Course Length on Academic Motivation and Self-Directed Learning Readiness in Medical School Students / 한국의학교육

PURPOSE: Problem-based learning (PBL) is an educational approach in which complex authentic problems serve as the context and stimulus for learning. PBL is designed to encourage active participation during learning. The goal of this study was to study the effects of PBL on academic motivation and self-directed learning readiness in medical school students. METHODS: The subjects of this study were 190 students in the 1st and 2nd grade of medical school. The period of the PBL course was two weeks for Year 1 and five weeks for Year 2 students. Students completed one module over one week. Academic motivation tests and self-directed learning readiness tests were performed before and after the PBL course. The differences between the two groups were analyzed using paired t-test and repeated measures MANCOVA. RESULTS: PBL had positive effects on academic self-efficacy (self-control efficacy, task-level preference) and academic failure tolerance (behavior, task-difficulty preference) as academic motivation. PBL had a mildly positive effect on self-directed learning readiness. In addition, the five-week PBL course had greater positive effects on academic motivation than the two-week course but not with regard to self-directed learning readiness. CONCLUSION: Medical students engage in academic motivation and self-directed learning readiness during PBL, suggesting that the five-week PBL course has greater positive effects than the two-week course. Future studies are needed to confirm the most effective periods of PBL.

CDH3/P-Cadherin regulates migration of HuCCT1 cholangiocarcinoma cells / 대한해부학회지

Intrahepatic cholangiocarcinoma is the second most common subtype of primary hepatobilliary cancer. Despite advances in surgical and medical therapy, its survival rate remains poor. Compared to hepatocellular carcinoma (HCC), the most common liver malignancy, the underlying mechanisms of cholangiocarcinoma carcinogenesis are poorly characterized. P-cadherin (CDH3) is a cadherin super family member. Although CDH3 is frequently over-expressed in cholangiocarcinoma tissues, its roles have never been characterized. To determine the roles of CDH3 in cholangiocarcinoma, we investigated CDH3 function in HuCCT1 cells using specific siRNA. Transfection with CDH3 siRNA did not affect proliferation of HuCCT1 cells. However, cell migration and invasion were significantly reduced when CDH3 was down-regulated. In addition, expressions of several biomarkers for epithelial-mesenchymal transition (EMT) were not changed by CDH3 down-regulation. These results suggest that CDH3 regulates cell migration independent of EMT in cholangiocarcinoma cells.

Expression of the p75NTR Neurotrophin Receptor in the Thymic Medullary Epithelial Cells and Interdigitating Dendritic Cells during Rat Thymus Regeneration Following Acute Thymic Involution / 대한해부학회지

The existence of a functional link between the nervous and immune systems has been well established. The present study was to characterize the expression of p75NTR during thymus regeneration from acute involution induced by cyclophosphamide in the rat. Immunohistochemical and double immunofluorescence analyses demonstrated that expression of the p75NTR was decreased in the thymic medullary epithelial cells and interdigitating dendritic cells during thymus regeneration. The presence of p75NTR protein in extracts from the control and regenerating rat thymus was confirmed by western blot. Furthermore, RT-PCR analysis supported these results by demonstrating that thymic extracts contain p75NTR mRNA at lower levels during thymus regeneration. Thus, our results suggest that the p75NTR located on the thymic medullary epithelial cells and interdigitating dendritic cells could play a role in the development of new T cells to replace the thymocytes damaged during thymus regeneration

Effects of Nicotine on MPTP-induced Parkinson's Disease Animal Model / 대한해부학회지

Parkinson's disease (PD) is a progressive neurological disorder characterized by selective loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc). Despite extensive researches, the etiology of this disease is still unknown; however, the prevalence of PD is lower in the population of cigarette smokers. In this study, the effects of nicotine were investigated on 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced Parkinson's disease animal model and the spontaneous locomotor activity was analyzed. In comparison with MPTP-induced PD animals, nicotine-treated PD animals exhibited significant improvement in the number of dopaminergic neurons in the SNpc, the relative density of dopaminergic axon terminals in the striatum, and locomotor activity. Also, MPTP-induced astrogliosis was prevented by nicotine treatment. These results suggest that the dopamine depletion in the SNpc and striatum and the decreased spontaneous locomotor activity were prevented by nicotine treatment in the MPTP-induced PD animal model.

Effects of retinoic acid on ischemic brain injury-induced eurogenesis

Neurogenesis can be induced by pathological conditions such as cerebral ischemia. However the molecular mechanisms or modulating reagents of the reactive neurogenesis after the cerebral ischemia are poorly characterized. Retinoic acid (RA) has been shown to increase neurogenesis by enhancing the proliferation and neuronal differentiation of forebrain neuroblasts. Here, we examined whether RA can modulate the reactive neurogenesis after the cerebral ischemia. In contrast to our expectation, RA treatment decreased the reactive neurogenesis in subventricular zone (SVZ), subgranular zone (SGZ) and penumbral region. Furthermore, RA treatment also decreased the angiogenesis and gliosis in penumbral region.

Anatomic Motor Point Localization of the Biceps Brachii and Brachialis Muscles

Injection of the neurolytic agents into motor points of the biceps brachii or brachialis muscles is an effective treatment of spasticity of the elbow flexors in many stroke survivors. Accurate localization of the motor points of each muscle is necessary for enhancing the efficacy of motor point blocks. To identify the precise locations of the motor points (terminal nerve endings) of the biceps brachii and brachialis muscles in relation to anatomic surface landmarks for motor point blocks, we dissected 23 limbs from 12 cadavers. A reference line was defined as a line connecting the coracoid process with the lateral epicondyle of the humerus. The location of the motor points of the biceps brachii and brachialis muscles was identified in reference to the reference line. The motor point of the biceps brachii muscle was found to be approximately half of the reference line. In the brachialis muscle, the location of the motor point was 70% of the reference line from the coracoid process and 2 cm medial to the line. The results are expected to facilitate effective localization of the motor point block of these muscles in selective motor nerve block.

Effects of Indomethacin on Ischemia-induced Brain Injury / 대한해부학회지

Cerebral ischemia can have severe results and disrupt quality of life. Current medicine is not effective at overcoming these problems. To find out more effective therapies, it is necessary to understand the microenvironment of cerebral injury after the ischemia. In the present study, to investigate the effects of inflammatory reaction, indomethacin, an anti-inflammatory drug, was used in a photothrombotic focal infarction rat model. It was revealed that cerebral ischemia increased neurogenesis in the subventricular (SVZ) and subgranular zones (SGZ), and in the penumbral region. Indomethacin treatment reduced the cerebral ischemia-induced neurogenesis by 86.2%, 53.8%, and 52.8% respectively. Cerebral ischemia increased gliosis and angiogenesis in the penumbral region and indomethacin reduced gliosis and angiogenesis by 48.2% and 58.1%, respectively. These results suggest that indomethacin treatment after the cerebral ischemia can reduce neurogenesis, angiogenesis, and gliosis in the penumbral region.

Morphological Changes of Anterior Horn Cells of Lumbar Spinal Cord after Anterior Root Avulsion in Adult Rat / 대한해부학회지

The morphological changes in the anterior horn of the L4 and L5 spinal segments were observed following anterior root avulsion in the adult male Sprague-Dawley rat (300~350 gm) at 5 days, 1 week, 2 weeks and 3 weeks postlesion. The animals were perfused with 4% paraformaldehyde, 0.15% picric acid in 0.1 M phosphate buffer solution and cryostat sections were prepared. Immunohistochemistry was used to identify changes of the phenotype in the anterior horn cells. Primary antibodies, goat anti-choline acetyltransferase (ChaT, 1 : 500, Chemicon), mouse antirat ED-1 (1 : 200, Serotec), rabbit anti-glial fibrillary acidic protein (GFAP, 1 : 200, DAKO) and rabbit anti-vascular endothelial growth factor (VEGF, 1 : 500, Santa Cruz Biotechnology) were used. Avidin-Biotin complex method was performed for immunohistochemical reaction and color reaction was developed with DAB-H2O2. Following results were observed in the anterior horn of lumbar spinal cord; 1. The number of ChaT-immunoreactive (ir) cells were reduced 20% level of control animals at 3 weeks after avulsion. 2. ED-1-ir microglia were significantly increased at 1 week and processes of ED-1-ir microglia surrounded around the axotomized neuronal cell bodies. 3. Gliosis defined by extensive GFAP immunoreactivity was observed both ipsilateral and contralateral side of lesion but the VEGF-ir cells were significantly increased in the ipsilateral side of lesion. Therefore, this study suggested that the majority of axotomized motor neurons were degenerated and the cellular proliferation and phenotype changes including glial cell activation were observed in the lumbar spinal cord after anterior root avulsion of adult rats.

Comparison of Three Different Techniques in Cervical Transpedicular Screw Insertion

OBJECTIVE: This is a cadaver study to assess the accuracy of three cervical screw insertion techniques: the blind technique (Group I), the laminotomy technique (Group II), and the funnel technique (Group III). METHODS: Ten human cadavers embalmed with formaldehyde were prepared. After exposing the spinous processes, the laminas and the lateral masses, titanium alloy transpedicular screws were inserted from C3 to C7. A total of 100 pedicles were ramdomly assigned to one of three techniques (the blind technique: 31 screws, the laminotomy technique: 51 screws, the funnel technique: 18 screws). Axial computed tomography with 1-mm slices, and sagittal and coronal reformation were performed to identify the accuracy of the screw insertion and the anatomic relationships. RESULTS: In Group I, 9 screws (29%) were either contained within or penetrated less than 1mm, which were rated as successful. In Group II, 24 screws (47%) were successful. In Group III, 16 screws (89%) were successful. In the multiple comparison, there was a statistically significant difference between Groups I and III and between Groups II and III (chi-square test and Bonfenoni test). CONCLUSION: The funnel technique can help a surgeon's understanding about the cervical pedicle more precisely than the other two techniques. The funnel technique is less dependent on lateral soft tissue retraction state.