The Development of Evaluation Methods for Outcomes in Medical Humanities Curriculum of a Medical School / 계명의대학술지

This study was performed to select the proper assessing methods for learning outcomes in undergraduate education of medical humanities (MH), and to evaluate whether student assessments in MH curricula are related to the graduate outcomes (GO)and/or periodic phase outcomes (PO). We searched the reasonable assessing methods for GO and PO of MH curricula of Keimyung University School of Medicine (KUSM). The outcomes are composed of six competencies including patient care, communication, patient support, professionalism, problem solving and research, and self-development. Then, we analyzed whether student assessments carried out during formal MH curricula properly achieved their PO, furthermore their GO. Four competencies including communication, patient support, professionalism, self-development were lightened to be closely related to outcomes for MH. Only the component of problem solving was settled to be related to MH in the competency of problem solving and research. The competency of patient care was excluded from the relationship with MH. The assessing methods for the GO and three PO recommended from educational experts, and there were various available assessing methods based on medical situations and clinical contexts including direct observation of clinical skills, 360 degree feedback, peer review, self-assessment, project-based assessment, portfolio-based assessment, discussion & presentation-based assessment, log-based assessment. For the outcome-achieving from formal MH curricula, the MH programs of phase-1 (1st and 2nd grades) almost accomplished the PO of communication, patient supporting and professionalism, and considerably accomplished the PO of problem solving and self-development. The MH programs of phase-2 (3rd and 4th grades) accomplished considerably their PO as the competencies of professionalism and problem solving, and partially as communication, patient supporting and self-development. However, as only one program, public health law, was provided for MH program in phase-3 (5th and 6th grades), the extra methods to evaluate their MH outcomes are needed. Many assessing methods can be available for the most MH competencies consisting of the GO of KUSM, and the proper assessing methods for each MH competency should be selected based on programs and learning contexts in MH education. While formal MH curricula of the school variously accomplished the MH competencies of GO according to periodic phases of curricula, it is recommended to enhance the feasibility and effectiveness of evaluation for GO in MH curricula of the school.

Optimization of scan delay for multi-phase computed tomography by using bolus tracking in normal canine kidney

This study was performed to optimize scan delays for canine kidney by using a bolus-tracking technique. In six beagle dogs, computed tomography (CT) of the kidney was performed three times in each dog with different scan delays after a bolus-tracking trigger of 100 Hounsfield units (HU) of aortic enhancement. Delays were 5, 20, 35, and 50 sec for the first scan, 10, 25, 40, and 55 sec for the second scan, and 15, 30, 45, and 60 sec for the third scan. The renal artery-to-vein contrast difference peaked at 5 sec, and the renal cortex-to-medulla contrast difference peaked at 10 sec. The renal cortex-to-medulla contrast difference approached zero at a scan delay of 30 sec after the bolus trigger. For the injection protocol used in this study, the optimal scan delay times for renal arterial, corticomedullary, and nephrographic phases were 5, 10, and 30 sec after triggering at 100 HU of aortic enhancement using the bolus-tracking technique. The bolus-tracking technique is useful in multi-phase renal CT study as it compensates for different transit times to the kidney among different animals, requires a small dose of contrast media, and does not require additional patient radiation exposure.

Cerebral air embolism during endoscopic band ligation with liver cirrhosis

Cerebral air embolism is an uncommon disorder, but it can result in significant morbidity and even mortality. Cerebral air embolism during esophago-gastro-duodenoscopy is also rare, but has in recent years been repeatedly reported. We report here a patient with cerebral infarction due to air embolism during endoscopic variceal ligation in liver cirrhosis. The patient was later confirmed to have patent foramen ovale. To our knowledge, this is the first report of such a complication with underlying patent foramen ovale and portal hypertension, who did no have underlying malignancy

Dependence of RIG-I Nucleic Acid-Binding and ATP Hydrolysis on Activation of Type I Interferon Response

Exogenous nucleic acids induce an innate immune response in mammalian host cells through activation of the retinoic acid-inducible gene I (RIG-I). We evaluated RIG-I protein for RNA binding and ATPase stimulation with RNA ligands to investigate the correlation with the extent of immune response through RIG-I activation in cells. RIG-I protein favored blunt-ended, double-stranded RNA (dsRNA) ligands over sticky-ended dsRNA. Moreover, the presence of the 5'-triphosphate (5'-ppp) moiety in dsRNA further enhanced binding affinity to RIG-I. Two structural motifs in RNA, blunt ends in dsRNA and 5'-ppp, stimulated the ATP hydrolysis activity of RIG-I. These structural motifs also strongly induced IFN expression as an innate immune response in cells. Therefore, we suggest that IFN induction through RIG-I activation is mainly determined by structural motifs in dsRNA that increase its affinity for RIG-I protein and stimulate ATPase activity in RIG-I.

Clinical Characteristics of REM-Dependent Obstructive Sleep Apnea in Korean Adults

BACKGROUND: Rapid-eye-movement-sleep-dependent obstructive sleep apnea (REM-OSA) is a sleep breathing abnormality in which apneas/hypopneas occur mainly during REM sleep periods. However, the clinical significance of REM-OSA compared to sleep-stage-non-dependent OSA (SND-OSA) has been controversial. This study evaluated differences in the clinical features, polysomnography (PSG) characteristics, and subjective symptoms between REM-OSA and SND-OSA. METHODS: In total, 136 consecutive patients with mild-to-moderate OSA were enrolled. REM-OSA was defined as a rapid eye movement (REM):non-REM apnea-hypopnea index (AHI) ratio of >2 and a total duration of REM sleep exceeding 30 minutes. We compared the demographic, clinical, and PSG characteristics, and subject symptoms between REM-OSA and SND-OSA. RESULTS: The REM-OSA group comprised 45 (33%) of the 136 subjects. The mean age and total AHI did not differ between the groups, but there was a significant female predominance (35.6% vs. 16.5%) in the REM-OSA group. In terms of PSG parameters, subjects with REM-OSA showed a lower percentage of light sleep and a lower AHI in a supine position despite spending more sleep time in that position. Subjective sleep complaints, depression, anxiety, and health-related quality of life did not differ between the two study groups. CONCLUSIONS: The female predominance and sleep architecture differed between REM-OSA and SND-OSA in this study. The AHI in subjects with SND-OSA was dependent on sleep position rather than sleep stage. Further study is needed to elucidate the pathomechanism and clinical significance of REM-OSA.

The Relations between Diabetic Dietary Compliance, Dietary Intake, and Physical Activity and the Prevalence of Metabolic Syndrome (MS) in Type 2 Diabetic Patients / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to investigate the relations between diabetic dietary compliance and dietary intake, physical activity and prevalence of metabolic syndrome (MS) in type 2 diabetic patients. METHODS: Seventy five subjects diagnosed with type 2 diabetes visiting the D hospital in Dongducheon from May 2014 to Dec 2014 were included in this study. The subjects were divided into two groups according to their diabetic dietary compliance score (median 39); low diabetic dietary compliance (LDDC) group (n=44) and high diabetic dietary compliance (HDDC) group (n=31). Survey data collection was carried out by direct interview method. The nutrient intake, food intake and KDDS (Korean's dietary diversity score), DVS (dietary variety score) and GMVDF (grain, meat, vegetable, dairy and fruit) were analyzed using data from the 24-recall method. Metabolic parameters were obtained from the hospital records. Data was analyzed using Chi-square test and general linear model adjusted for sex. RESULTS: The prevalence of MS was 59.7% in the participating diabetic patients. The prevalence of MS of the HDDC (39.3%) was significantly lower than that of the LDDC (72.7%). The distribution of physical activity showed a significant difference between the groups (p=0.006). The intakes of seeds and nuts of the HDDC were significantly lower than those of the LDDC. Fat and vegetable fat intakes and % fat of energy in the HDDC were significantly lower than those in the LDDC. But, carbohydrate (CHO) and potassium intake and %CHO of energy in the HDDC were significantly higher than those in the LDDC. KDDS and GMVDF showed significant differences between groups (p=0.033; p=0.012). CONCLUSIONS: Continuous intervention by specialized nutritionists for long-term self-regulation is needed for diabetic patients, and the high compliance to diabetic diet and increasing physical activity may be effective in the prevention of metabolic syndrome.

Single Photon Emission Computerized Tomography and Neuropsychological Tests That Predict a Good Response to Donepezil Therapy for Alzheimer's Disease

BACKGROUND AND PURPOSE: Cholinesterase inhibitors (ChEIs) are effective in Alzheimer's disease (AD) treatment. The aim of this study is 1) to find neuropsychological factors that affect the functional response to ChEI therapy and 2) to determine whether regional cerebral blood flow (rCBF) pretreatment predicts a cognitive change in response to ChEI. METHODS: We prospectively recruited 32 patients diagnosed with probable AD and treated them with donepezil, a ChEI, over one year. The patients were divided into stable (s-AD) and declined (d-AD) AD groups, based on changes in Korean version of Mini-Mental State Examination (K-MMSE) scores. Patients were assessed using the Alzheimer's Disease Co-operative Study-Activities of Daily Living (ADCS-ADL) and Seoul Neuropsychologic Screening Battery, as well as brain single photon emission computerized tomography (SPECT) at baseline and last medical evaluations. The predictors of therapeutic responses were analyzed using general linear models. RESULTS: Based on their cognitive function changes, AD patients were classified into two groups: s-AD (n=14, annual change in K-MMSE score or =0.9). The s-AD at baseline showed significantly better ADCS-ADL function (p=0.04) and had a tendency to preserve frontal function compared to the d-AD group. Global Statistical Parametric Mapping analysis revealed no significant decrease of rCBF between baseline and follow-up SPECT, in either the s-AD or the d-AD groups. However, on regional perfusion analysis of baseline SPECT, the d-AD group demonstrated perfusion deficits in the supramarginal gyrus, inferior occipital gyrus, and rolandic operculum compared with the s-AD group. CONCLUSIONS: Highly preserved ADCS-ADLs predicted a better improvement in MMSE scores in response to ChEI therapy and a more positive functional response in the group with preserved frontal function. rCBF provided hints to the variable response to donepezil therapy with ChEI treatment.

Transient Parkinsonism Associated with Scrub Typhus

No abstract available.

Myelopathy in a Patient with Low-Voltage Electrical Burn

No abstract available.

Relationship Between Findings on Brain MRI and Prognosis in Patients With Spontaneous Intracranial Hypotension

BACKGROUND: The outcome of spontaneous intracranial hypotension (SIH) is unpredictable and some patients have persistent and often incapacitating symptoms. This study was aimed to investigate whether abnormalities on initial magnetic resonance imaging (MRI) can predict the outcome in patients with SIH. METHODS: We retrospectively included 44 patients with SIH. Brain MRI was available for all patients. Treatment consisted of conservative treatment and/or high-volume epidural blood patching. Patients were divided into two groups: favorable or non-favorable group. Favorable group was defined as clinical improvement by conservative therapy or one trial of autologous epidural blood patching; non-favorable group as more than two week of admission, two or more trials of autologous epidural blood patching, or relapse of orthostatic headache. RESULTS: Twenty-one (48%) of 44 patients were classified as the favorable group. The non-favorable group had several abnormal findings on brain MRI (16 cases vs. 5 cases in favorable group, p<0.003), including platybasia (1), skull base tumor (1), Chiari I malformation (1), diffuse mild thickening and enhancement of dural and epidural layer of thoracic spine (1), pituitary enlargement (3), sagging brain (3) and subdural hemorrhage (4). In the non-favorable group, 13 out of 23 patients (57%) showed pachymeningeal enhancement in brain MRI (2 patients in favorable group, p<0.001). CONCLUSIONS: Brain MRI abnormalities were more frequently related with non-favorable outcomes in SIH. Pachymeningeal enhancement in particular could suggest an unfortunate prognosis.

Quality of Life in Korean Patients with Obstructive Sleep Apnea

BACKGROUND: Obstructive sleep apnea (OSA) is a common disease, but there are few studies about the quality of life (QOL) of Korean patients with OSA. The aims of the present study were compare the QOL of patients with OSA and healthy controls, and to determine the factors that influence the QOL in these patients. METHODS: This was a casecontrol study comparing the QOL of 136 OSA patients and 126 healthy controls. For all of the subjects, QOL and the severity of subjective symptoms were evaluated using various questionnaires, including the Korean versions of the Medical Outcome Study Short Form-36 (SF-36), the Pittsburg Sleep Quality Index (PSQI-K), the Epworth Sleepiness Scale (KESS), the Insomnia Severity Index (ISI), the Beck Depression Inventory (KBDI)-2, and the Hospital Anxiety Scale (HAS). RESULTS: The QOL was worse in patients with OSA than in the controls, but there was no association between the severity of OSA and the degree of worsening of QOL. Multiple stepwise regression analysis revealed that the strongest associations were found between QOL and HAS, ISI and BDI-2 scoring in OSA patients. CONCLUSIONS: These findings demonstrate that OSA represents a considerable burden on the QOL of Koreans, and suggest that the impairment in QOL of Koreans with OSA is related to the degree of anxiety, insomnia and depression that they suffer.

The Footplate Suture Technique for External Nasal Valve Surgery

BACKGROUND AND OBJECTIVES: To report the preliminary results of the footplate suture technique for narrowing the columellar base to improve nasal respiration and the cosmetic features of the nasal sill. MATERIALS AND METHODS: Patients with nasal obstruction who presented with external nasal valve obstruction were treated with the footplate suture technique. Data on the patient characteristics, operative procedures, and outcomes were gathered from medical records. RESULTS: Five patients were included in this study. The footplate suture technique was used in all patients, together with septoplasty, batten graft and inferior turbinoplasty to improve the nasal valve obstruction as needed. In each case, divergent footplate segments of the medial nasal alar crura were identified and tied to medialize and narrow the columellar base. All patients had satisfactory subjective nasal breathing and cosmetic results. CONCLUSIONS: The footplate suture technique is an adjunctive procedure that improves the nasal obstruction and nasal sill disfiguration caused by external nasal valve obstruction, especially due to the divergent footplate segments of the medial alar crura.

A Case of Takotsubo Cardiomyopathy due to Submucosal Epinephrine Injection during Endoscopic Sinus Surgery / 대한이비인후과학회지

Epinephrine is widely used for hemostasis during endoscopic sinus surgery performed under local and general anesthesia. However, topical epinephrine can cause many adverse effects, such as hypertension, ventricular tachycardia, pulmonary edema and cardiac arrest. Takotsubo cardiomyopathy is a newly described clinical entity characterized by transient left ventricular dysfunction and no significant coronary artery stenosis. We experienced a rare case of reversible Takotsubo cardiomyopathy in a 56-year-old male after submucosal epinephrine injection with an appropriate dose during an endoscopic sinus surgery.

Juxtacortical Spots on Fluid-Attenuated Inversion Recovery Images in Cryptogenic Transient Ischemic Attack

BACKGROUND AND PURPOSE: Juxtacortical spots are detected frequently on fluid-attenuated inversion recovery (FLAIR) images, but have not been extensively researched in patients with transient ischemic attack (TIA). We hypothesized that juxtacortical spots on FLAIR images are partly associated with right-to-left shunt (RLS) in TIA without clear etiology. The possibility of an association between the presence of RLS and juxtacortical spots on FLAIR images in patients with TIA without clear etiology was investigated, and the imaging findings of patients with and without RLS were compared. METHODS: This was a retrospective study of TIA patients who visited our tertiary stroke center consecutively within 72 hours of TIA onset. Cryptogenic TIA was defined as no clear etiology despite a routine diagnostic workup. The presence of RLS was examined by transcranial Doppler with an agitated saline test or transesophageal echocardiography. Juxtacortical spots were defined as small and round hyperintensities in the juxtacortex on FLAIR images, excluding white-matter hyperintensities. RESULTS: Of the 132 patients with cryptogenic TIA examined for this study, 70 (53.0%) had RLS. Juxtacortical spots on FLAIR images were detected more frequently in patients with RLS than in those without. The independent factors for the presence of juxtacortical spots were RLS [odds ratio (OR)=3.802, 95% confidence interval (95% CI)=1.74-8.2; p=0.001] and age (OR=1.058, 95% CI=1.01-1.10; p=0.004) by multivariate analysis. The number of juxtacortical spots was significantly higher among patients with a moderate-to-large RLS than in those with a small or no RLS. CONCLUSIONS: The findings of the present study demonstrate a significant association between the presence of RLS and the occurrence of juxtacortical spots on FLAIR images in patients with cryptogenic TIA.

Sendai F/HN Viroplexes for Efficient Transfection of Leukemic T Cells

PURPOSE: Most chemical transfection reagents are ineffective for the transfection of cells in suspension, such as leukemic cell and stem cell lineages. We developed two different types of viroplexes, cationic Sendai F/HN viroplexes (CSVs) and protamine sulfate-condensed cationic Sendai F/HN viroplexes (PCSVs) for the efficient transfection of T-leukemic cells. MATERIALS AND METHODS: The viroplex systems were prepared by reconstitution of fusogenic Sendai F/HN proteins in DMKE (O,O'-dimyristyl-N-lysyl glutamate) cationic liposomes. The viroplexes were further optimized for plasmid DNA and siRNA delivery to suspension cells. The particle size and surface charge of the viroplexes were analyzed with a zeta-sizer. Transfection of plasmid DNA (pDNA) and small interfering RNA (siRNA) by CSVs or PCSV was evaluated by measurement of transgene expression, confocal microscopy, FACS, and RT-PCR. RESULTS: The optimized CSVs and PCSVs exhibited enhanced gene and siRNA delivery in the tested suspension cell lines (Jurkat cells and CEM cells), compared with conventional cationic liposomes. In the case of pDNA transfection, the CSVs and PCSVs show at least 10-fold and 100-fold higher transgene expression compared with DMKE lipoplexes (or lipofectamine 2000), respectively. The CSVs showed more effective siRNA delivery to the suspension cells than cationic liposomes, as assessed by confocal microscopy, FACS, and RT-PCR. The effective transfection by the CSVs and PCSVs is presumably due to fusogenic activity of F/HN proteins resulting in facilitated internalization of pDNA and siRNA. CONCLUSION: This study suggests that Sendai F/HN viroplexes can be widely applicable for the transfection of pDNA and siRNA to suspension cell lines.

Syncope Associated With Glossopharyngeal Neuralgia in B-Cell Lymphoma

No abstract available.

Hyperperfusion Syndrome after Carotid Stent-Supported Angioplasty in Patients with Autonomic Dysfunction

Cerebral hyperperfusion syndrome (CHS) is a rare, serious complication of carotid revascularization either after carotid endarterectomy or carotid stent placement. Although extensive effort has been devoted to reducing the incidence of CHS, little is known about the prevention. Postprocedural hypertension is very rare due to autoregulation of carotid baroreceptors but may occur if presented with autonomic dysfunction. We present two cases of CHS after cerebral revascularization that presented autonomic dysfunction.

Hyperintense Vessel Signs on FLAIR MRI as a Predictor of Early Neurological Deterioration in Patients with Acute Posterior Circulation Infarction

BACKGROUND: Hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery imaging (FLAIR) is an indicator of slow flow and early ischemia. This study tested the hypothesis that HVS in the posterior circulation is associated with a worse outcome. METHODS: We retrospectively included 64 stroke patients with posterior circulation steno-occlusion within 6 hours of symptom onset and reviewed early neurological deterioration (END). END was defined as an increase in National Institutes of Health Stroke Scale (NIHSS) score of 4 or more from baseline during the first week. We analyzed demographic and laboratory information followed by an assessment of the magnetic resonance images. In addition, we assessed the posterior circulation Albert Stroke Program Early CT Score (pc-ASPECTS) on diffusion-weighted imaging (DWI). RESULTS: Among the 64 patients who met the inclusion criteria, END was seen in 17 patients. On univariate analysis, these END patients had higher baseline NIHSS scores and elevated initial systolic blood pressure (iSBP). Multiple logistic regression analysis revealed pc-ASPECTS (p=0.007), HVS on FLAIR (p=0.011), and iSBP (p=0.016) as independent predictors of END. CONCLUSIONS: The presence of HVS on FLAIR in the posterior circulation might indicate the presence of more severe ischemic penumbrae and END. pc-ASPECTS may also be an independent predictor of functional outcome.

Two Cases of Congenital Vallecular Cyst with Respiratory Distress and Feeding Problems in Young Infant / 대한이비인후과학회지

Congenital vallecular cyst (VC) is a rare cause of stridor and respiratory distress in neonates and infants. Due to the anatomical location of the cyst, an infant with a VC is at risk of life-threatening upper airway obstruction and eventual death. The cyst sits in the vallecular space and can cause significant retroflexion of the epiglottis. It may also present with feeding problems resulting in failure to grow. Endoscopic laryngoscopy is necessary to visualize it and mar-supialization of the cyst is the preferred treatment. We present 2 successfully treated cases of congenital VC in young infants with symptoms of upper respiratory obstruction and feeding problems.

A Case of Bilateral Nasolabial Cysts / 대한이비인후과학회지

Nasolabial cyst is a rare non-odontogenic, developmental cyst that occurs in sublabial and premaxillary area. This cyst is usually unilateral, but it occurs bilaterally about 10% of cases. A 55-year-old woman visited our clinic with asymptomatic bilateral nasolabial swelling. Evaluation of history, physical examination and CT scan led to the diagnosis of a nasolabial cyst, and surgical excision was performed via sublabial approach. In intraoperative finding, two nasolabial cysts of similar size that entirely divided by anterior nasal spine were identified. The pathologic findings were consistent with nasolabial cysts. We herein report a rare case of bilateral occurrence of nasolabial cysts with a review of literatures.