The Efficacy and Safety of Cynanchum atratum Root Extract with Containing Moisturizer on Skin Barrier Function and Itch Relief / 대한피부과학회지

Background@#Patients with skin barrier dysfunction often coincides with pruritus, creating a ‘vicious cycle’ of dry skin and itching. Recently, Cynanchum atratum (CA) extract and its constituents have demonstrated effects on atopic dermatitis both in vivo and in vitro. @*Objective@#This study aimed to assess the safety and efficacy of a moisturizer infused with CA extract in enhancing epidermal barrier function and reducing pruritus. @*Methods@#A total 36 participants with skin barrier dysfunction with pruritus (mean age: 46.22±12.48 years) applied the CA-containing moisturizer topically twice daily for up to 4 weeks. Treatment efficacy was assessed by the investigator using the erythema scaling induration fissuring (ESIF) scale, transepidermal water loss (TEWL), skin hydration, visual analogue scale (VAS) for pruritus, and overall patient satisfaction assessed via questionnaire. @*Results@#The CA-containing moisturizer demonstrated favorable tolerability, and yielded significant pruritus relief as evidenced by VAS scores after 2 and 4 weeks of application (p＜0.05). Significant decreases in TEWL (p＜0.05) and skin hydration (p＜0.05) were observed after 2 and 4 weeks, indicating enhanced skin barrier function. Moreover, significant relief from pruritus and reductions in ESIF were observed at 2 and 4 weeks of application (p ＜0.05), aligning with the high levels of patient satisfaction was high. @*Conclusion@#The CA-infused moisturizer emerged as a safe and effective intervention for restoring skin barrier function and providing itch relief.

Lymph Node Stations of Pancreas Which Are Identified in Real Color Sectioned Images of a Cadaver With Pancreatic Cancer

Background@#In pancreatic cancer surgery, anatomical understanding of lymph node metastases is required. Distinguishing lymph nodes in computed tomography or magnetic resonance imaging is challenging for novice doctors and medical students because of their small size and similar color to surrounding tissues. This study aimed to enhance our understanding of the clinical anatomy of lymph node stations relevant to pancreatic cancer using newly sectioned images of a cadaver with true color and high resolution and their three-dimensional (3D) models. @*Methods@#An 88-year-old female cadaver who died of pancreatic cancer was serially sectioned.Among the sectioned images of the whole body (0.05 mm-sized pixel, 48 bits color), images of the abdomen were selected, and examined to identify lymph nodes and nearby structures.34 structures (9 in digestive system; 1 in urinary system; 2 in cardiovascular system; 22 in lymphatic system) were segmented on the sectioned images. Based on the sectioned and segmented images, volume and surface models were produced. @*Results@#Among the known 28 lymph node stations, 21 stations were identified through location, size, and color of normal and abnormal structures in the sectioned images and 3D models. Two near the splenic artery could not be separated from the cancer tissue, and the remaining five were not clearly identified. In the surface models, the shape and location of lymph node stations could be confirmed with nearby structures. @*Conclusion@#The lymph node stations relevant to pancreatic cancer can be anatomically understood by using the sectioned images and 3D models which contain true color and high resolution.

The Prognosis of Post-Scabetic Itch / 대한피부과학회지

Background@#The primary goal of scabies treatment is to eliminate mites; however, but post-scabetic itch persists in many patients. Since long-standing itching can lead to the development of other comorbidities, appropriate interventions are necessary. @*Objective@#This study aimed to investigate the effects of inappropriate (continuous or prolonged) scabicide use and oral steroids on the duration of pruritus in patients with scabies. @*Methods@#The duration of pruritus, use of oral corticosteroids, total immunoglobulin E (IgE) levels, specific IgE levels for house dust mites, and eosinophil counts were evaluated. Post-scabetic itch was defined as itching that persisted for more than 3 weeks, although scabies was no longer detected; 208 participants with post-scabetic itch were included. @*Results@#We recruited 265 participants with confirmatory diagnosis of scabies and 116 with clinical diagnosis. We treated 124 participants with scabicides based on the guidelines, whereas 257 participants were not. The type of scabicide did not affect the duration of pruritus. Scabicide overuse did not shorten the duration of pruritus; however, its prolonged use lengthened the treatment period. Although oral corticosteroids did not shorten the duration of pruritus in the patients, they were effective when the patient had post-scabetic itch. In addition, a positive correlation between the total IgE level and duration of pruritus was observed. @*Conclusion@#This study investigated the effect of treatment modality on the clinical course of scabies. Our findings suggest that overuse of scabicides might be associated with post-scabetic itch, and short-term use of oral corticosteroids may be effective in reducing its duration.

A Novel Human Brainstem Map Based on True-Color Sectioned Images

Background@#Existing atlases for the human brainstem were generated from magnetic resonance images or traditional histologically stained slides, but both are insufficient for the identification of detailed brainstem structures at uniform intervals. @*Methods@#A total of 319 sectioned images of the brainstem were selected from whole-body axial sectioned images, then coronal and sagittal sectioned images were reconstructed from the horizontal images. The fine and detailed structures were annotated in PowerPoint slides, then the volume model was produced and some white matter fibers were traced using MRIcroGL. @*Results@#In this study, a novel brainstem atlas based on sectioned images was generated that shows the true color and shape, as well as the accurate location of the nuclei and tracts;it reveals the striking contrast between gray and white matter, as well as fine structures.In total, 212 structures, including nuclei and tracts, were annotated in axial, coronal, and sagittal plane views of sectioned images (48-bit true color; 0.2 mm intervals, 0.06 mm × 0.06 mm pixel size). To verify the accuracy of the annotations, a volume model of the brainstem was constructed for independent observations of the three planes. @*Conclusion@#In this paper, we describe several interesting structures included in the atlas. By depicting the fine structures of the human brainstem in detail, this atlas allows comprehensive understanding of the complicated topographies of the brainstem. As such, it will be of value for neuroanatomy education and research, in addition to enriching the literature on the human brain.

Identification of cranial nerve ganglia using sectioned images and three-dimensional models of a cadaver

Background@#Cranial nerve ganglia, which are prone to viral infections and tumors, are located deep in the head, so their detailed anatomy is difficult to understand using conventional cadaver dissection. For locating the small ganglia in medical images, their sectional anatomy should be learned by medical students and doctors.The purpose of this study is to elucidate cranial ganglia anatomy using sectioned images and three-dimensional (3D) models of a cadaver. @*Methods@#One thousand two hundred and forty-six sectioned images of a male cadaver were examined to identify the cranial nerve ganglia. Using the real color sectioned images, real color volume model having a voxel size of 0.4 × 0.4 × 0.4 mm was produced. @*Results@#The sectioned images and 3D models can be downloaded for free from a webpage, anatomy.dongguk.ac.kr/ganglia. On the images and model, all the cranial nerve ganglia and their whole course were identified. In case of the facial nerve, the geniculate, pterygopalatine, and submandibular ganglia were clearly identified.In case of the glossopharyngeal nerve, the superior, inferior, and otic ganglia were found. Thanks to the high resolution and real color of the sectioned images and volume models, detailed observation of the ganglia was possible. Since the volume models can be cut both in orthogonal planes and oblique planes, advanced sectional anatomy of the ganglia can be explained concretely. @*Conclusions@#The sectioned images and 3D models will be helpful resources for understanding cranial nerve ganglia anatomy, for performing related surgical procedures.

Portable Document Format File Containing the Schematics and Operable Surface Models of the Head Structures

Background@#A book entitled “Visually Memorable Regional Anatomy (VMRA)” consists of extremely schematic figures as well as concise anatomic knowledge. On the other hand, in the Visible Korean (VK) project, three-dimensional surface models of 297 head structures have been reconstructed. The study's objective was to verify how the coexistence of the schematic figures and realistic surface models affected anatomy learning. @*Methods@#In the portable document format (PDF) file of VMRA, 19 pages of the surface models of the head from the PDF file of VK were embedded. The resultant PDF file was utilized as a learning tool of the medical students in two universities. @*Results@#The PDF file could be downloaded free of charge from anatomy.co.kr. The PDF file has been accessed by users from multiple countries including Korea, United States, and Hungary. In the PDF file, the surface models could be selected in any combinations, magnified, freely rotated, and compared to the corresponding schematics. The number of hours that the PDF file was used by medical students and the scores of written examination on the PDF file showed a low positive correlation in a university. The students replied that the combined PDF file was helpful for understanding anatomy and for doing cadaver dissection. They were also satisfied with the convenience of comparing the surface models and schematics. @*Conclusion@#The freely obtainable PDF file would be a beneficial tool to help students learn anatomy easily, interactively, and accurately.

Dawn of the Visible Monkey: Segmentation of the Rhesus Monkey for 2D and 3D Applications

Background@#To properly utilize the sectioned images in a Visible Monkey dataset, it is essential to segment the images into distinct structures. This segmentation allows the sectioned images to be compiled into two-dimensional or three-dimensional software packages to facilitate anatomy and radiology education, and allows them to be used in experiments involving electromagnetic radiation. The purpose of the present study was to demonstrate the potential of the sectioned images using the segmented images. @*Methods@#Using sectioned images of a monkey's entire body, 167 structures were segmented using Adobe Photoshop. The segmented images and sectioned images were packaged into the browsing software. Surface models were made from the segmented images using Mimics. Volume models were made from the sectioned images and segmented images using MRIcroGL. @*Results@#In total, 839 segmented images of 167 structures in the entire body of a monkey were produced at 0.5-mm intervals (pixel size, 0.024 mm; resolution, 8,688 × 5,792; color depth, 24-bit color; BMP format). Using the browsing software, the sectioned images and segmented images were able to be observed continuously and magnified along with the names of the structures. The surface models of PDF file were able to be handled freely using Adobe Reader. In the surface models, the space information of all segmented structures was able to be identified using Sim4Life. On MRIcroGL, the volume model was able to be browsed and sectioned at any angle with real color. @*Conclusion@#Browsing software, surface models, and volume models are able to be produced based on the segmentation of the sectioned images. These will be helpful for students and researchers studying monkey anatomy and radiology, as well as for biophysicists examining the effects of electromagnetic radiation.

Effects of Reading a Free Electronic Book on Regional Anatomy with Schematics and Mnemonics on Student Learning

BACKGROUND: To help medical students learn anatomy effectively in limited hours, a regional anatomy book enhancing students' memorization was developed.METHODS: Only anatomical terms essential for basic cadaver dissection are included along with schematic figures which enable memorization of complicated anatomical structures. Learning comics and comic strips that depict anatomy mnemonics and jokes were appended and sentences were written to be comfortably readable. The electronic book titled “Visually Memorable Regional Anatomy” has been distributed without payment or registration. With the help of 246 volunteer students from three Korean medical schools, the book's learning effects were evaluated.RESULTS: These students' book reading led to increase in their anatomy scores, including written examination scores and tag examination scores. It was an encouraging result that almost 20% of students spontaneously read the book no matter who presented their lecture or examination. A webpage version of the book was visited by thousands of users.CONCLUSION: The book with unique features may suggest a new perspective in the field of anatomy learning. After having acquaintance with essential structures from reading the book, students are able to and willing to study more from other resources.

Virtual Anatomical and Endoscopic Exploration Method of Internal Human Body for Training Simulator

BACKGROUND: Virtual environments have brought the use of realistic training closer to many different fields of education. In medical education, several visualization methods for studying inside the human body have been introduced as a way to verify the structure of internal organs. However, these methods are insufficient for realistic training simulators because they do not provide photorealistic scenes or offer an intuitive perception to the user. In addition, they are used in limited environments within a classroom setting.METHODS: We have developed a virtual dissection exploration system that provides realistic three-dimensional images and a virtual endoscopic experience. This system enables the user to manipulate a virtual camera through a human organ, using gesture-sensing technology. We can make a virtual dissection image of the human body using a virtual dissection simulator and then navigate inside an organ using a virtual endoscope. To improve the navigation performance during virtual endoscopy, our system warns the user about any potential collisions that may occur against the organ's wall by taking the virtual control sphere at the virtual camera position into consideration.RESULTS: Experimental results show that our system efficiently provides high-quality anatomical visualization. We can simulate anatomic training using virtual dissection and endoscopic images.CONCLUSION: Our training simulator would be helpful in training medical students because it provides an immersive environment.

Virtual Anatomical and Endoscopic Exploration Method of Internal Human Body for Training Simulator

BACKGROUND@#Virtual environments have brought the use of realistic training closer to many different fields of education. In medical education, several visualization methods for studying inside the human body have been introduced as a way to verify the structure of internal organs. However, these methods are insufficient for realistic training simulators because they do not provide photorealistic scenes or offer an intuitive perception to the user. In addition, they are used in limited environments within a classroom setting.@*METHODS@#We have developed a virtual dissection exploration system that provides realistic three-dimensional images and a virtual endoscopic experience. This system enables the user to manipulate a virtual camera through a human organ, using gesture-sensing technology. We can make a virtual dissection image of the human body using a virtual dissection simulator and then navigate inside an organ using a virtual endoscope. To improve the navigation performance during virtual endoscopy, our system warns the user about any potential collisions that may occur against the organ's wall by taking the virtual control sphere at the virtual camera position into consideration.@*RESULTS@#Experimental results show that our system efficiently provides high-quality anatomical visualization. We can simulate anatomic training using virtual dissection and endoscopic images.@*CONCLUSION@#Our training simulator would be helpful in training medical students because it provides an immersive environment.

Effects of Reading a Free Electronic Book on Regional Anatomy with Schematics and Mnemonics on Student Learning

BACKGROUND@#To help medical students learn anatomy effectively in limited hours, a regional anatomy book enhancing students' memorization was developed.@*METHODS@#Only anatomical terms essential for basic cadaver dissection are included along with schematic figures which enable memorization of complicated anatomical structures. Learning comics and comic strips that depict anatomy mnemonics and jokes were appended and sentences were written to be comfortably readable. The electronic book titled “Visually Memorable Regional Anatomy” has been distributed without payment or registration. With the help of 246 volunteer students from three Korean medical schools, the book's learning effects were evaluated.@*RESULTS@#These students' book reading led to increase in their anatomy scores, including written examination scores and tag examination scores. It was an encouraging result that almost 20% of students spontaneously read the book no matter who presented their lecture or examination. A webpage version of the book was visited by thousands of users.@*CONCLUSION@#The book with unique features may suggest a new perspective in the field of anatomy learning. After having acquaintance with essential structures from reading the book, students are able to and willing to study more from other resources.

Virtual Anatomical and Endoscopic Exploration Method of Internal Human Body for Training Simulator

BACKGROUND@#Virtual environments have brought the use of realistic training closer to many different fields of education. In medical education, several visualization methods for studying inside the human body have been introduced as a way to verify the structure of internal organs. However, these methods are insufficient for realistic training simulators because they do not provide photorealistic scenes or offer an intuitive perception to the user. In addition, they are used in limited environments within a classroom setting.@*METHODS@#We have developed a virtual dissection exploration system that provides realistic three-dimensional images and a virtual endoscopic experience. This system enables the user to manipulate a virtual camera through a human organ, using gesture-sensing technology. We can make a virtual dissection image of the human body using a virtual dissection simulator and then navigate inside an organ using a virtual endoscope. To improve the navigation performance during virtual endoscopy, our system warns the user about any potential collisions that may occur against the organ's wall by taking the virtual control sphere at the virtual camera position into consideration.@*RESULTS@#Experimental results show that our system efficiently provides high-quality anatomical visualization. We can simulate anatomic training using virtual dissection and endoscopic images.@*CONCLUSION@#Our training simulator would be helpful in training medical students because it provides an immersive environment.

Effects of Reading a Free Electronic Book on Regional Anatomy with Schematics and Mnemonics on Student Learning

BACKGROUND@#To help medical students learn anatomy effectively in limited hours, a regional anatomy book enhancing students' memorization was developed.@*METHODS@#Only anatomical terms essential for basic cadaver dissection are included along with schematic figures which enable memorization of complicated anatomical structures. Learning comics and comic strips that depict anatomy mnemonics and jokes were appended and sentences were written to be comfortably readable. The electronic book titled “Visually Memorable Regional Anatomy” has been distributed without payment or registration. With the help of 246 volunteer students from three Korean medical schools, the book's learning effects were evaluated.@*RESULTS@#These students' book reading led to increase in their anatomy scores, including written examination scores and tag examination scores. It was an encouraging result that almost 20% of students spontaneously read the book no matter who presented their lecture or examination. A webpage version of the book was visited by thousands of users.@*CONCLUSION@#The book with unique features may suggest a new perspective in the field of anatomy learning. After having acquaintance with essential structures from reading the book, students are able to and willing to study more from other resources.

Rise of the Visible Monkey: Sectioned Images of Rhesus Monkey

BACKGROUND: Gross anatomy and sectional anatomy of a monkey should be known by students and researchers of veterinary medicine and medical research. However, materials to learn the anatomy of a monkey are scarce. Thus, the objective of this study was to produce a Visible Monkey data set containing cross sectional images, computed tomographs (CTs), and magnetic resonance images (MRIs) of a monkey whole body. METHODS: Before and after sacrifice, a female rhesus monkey was used for 3 Tesla MRI and CT scanning. The monkey was frozen and sectioned at 0.05 mm intervals for the head region and at 0.5 mm intervals for the rest of the body using a cryomacrotome. Each sectioned surface was photographed using a digital camera to obtain horizontal sectioned images. Segmentation of sectioned images was performed to elaborate three-dimensional (3D) models of the skin and brain. RESULTS: A total of 1,612 horizontal sectioned images of the head and 1,355 images of the remaining region were obtained. The small pixel size (0.024 mm × 0.024 mm) and real color (48 bits color) of these images enabled observations of minute structures. CONCLUSION: Due to small intervals of these images, continuous structures could be traced completely. Moreover, 3D models of the skin and brain could be used for virtual dissections. Sectioned images of this study will enhance the understanding of monkey anatomy and foster further studies. These images will be provided to any requesting researcher free of charge.

Advanced Sectioned Images of a Cadaver Head with Voxel Size of 0.04 mm

BACKGROUND: The sectioned images of a cadaver head made from the Visible Korean project have been used for research and educational purposes. However, the image resolution is insufficient to observe detailed structures suitable for experts. In this study, advanced sectioned images with higher resolution were produced for the identification of more detailed structures. METHODS: The head of a donated female cadaver was scanned for 3 Tesla magnetic resonance images and diffusion tensor images (DTIs). After the head was frozen, the head was sectioned serially at 0.04-mm intervals and photographed repeatedly using a digital camera. RESULTS: On the resulting 4,000 sectioned images (intervals and pixel size, 0.04 mm³; color depth, 48 bits color; a file size, 288 Mbytes), minute brain structures, which can be observed not on previous sectioned images but on microscopic slides, were observed. The voxel size of this study (0.04 mm³) was very minute compared to our previous study (0.1 mm³; resolution, 4,368 × 2,912) and Visible Human Project of the USA (0.33 mm³; resolution, 2,048 × 2,048). Furthermore, the sectioned images were combined with tractography of the DTIs to elucidate the white matter with high resolution and the actual color of the tissue. CONCLUSION: The sectioned images will be used for diverse research, including the applications for the cross sectional anatomy and three-dimensional models for virtual experiments.

Real-Color Volume Models Made from Real-Color Sectioned Images of Visible Korean

BACKGROUND: Volume models made from magnetic resonance images on computed tomographs can produce horizontal, coronal, sagittal, and oblique planes that are used widely in clinics, although detailed structures cannot be identified. Existing real color volume models are mostly commercial and their production methods have not been released. The aim of this study was to distribute free of charge, real-color volume models produced from sectioned images with the production method. METHODS: The original voxel size of sectioned images was increased appropriately so that the volume model could be handled by typical personal computers. By using Dicom Browser and MRIcroGL, the sectioned images were processed to become the volume models. RESULTS: On the MRIcroGL, the resultant volume model with the voxel size of 0.5 × 0.5 × 0.5 mm3 could be displayed and freely rotated. By adjusting variables of the software, desired oblique planes could be produced instantly. With overlay function, a model of segmented structure can be overlapped to the entire volume models. The sectioned images with high quality and the segmentation data of Visible Korean enabled the identification of detailed anatomical structures on the planes. CONCLUSION: The volume models can be used by medical students and doctors for learning sectional anatomy. Other researchers can utilize the method of this study to produce volume models from their own sectioned images.

Differences among Endophytic Fungal Communities Isolated from the Roots of Cephalanthera longibracteata Collected from Different Sites in Korea

Orchidaceous plants have symbiotic relationships with endophytic fungi, including mycorrhizal fungi, which play important roles in the seed germination and growth of the host plants. In this study, endophytic fungal communities isolated from the roots of Cephalanthera longibracteata collected from three different sites in Korea were analyzed, and it was determined whether fungal communities were preferentially correlated with the sites. The fungal isolates were identified by sequence analysis of the internal transcribed spacer regions of rDNA. In total, 30 species of endophytic fungi, including two species of mycorrhizal fungi belonging to the genus Tulasnella, were identified. Leptodontidium orchidicola showed the highest frequency and was isolated from all root samples. Species diversity and richness were not significantly different among sites. However, the community structure of the endophytic fungi significantly differed among sites, suggesting that the site characteristics affected the community composition of the endophytic fungi colonizing the roots of C. longibracteata. Our findings will aid in developing methods involving the use of symbiotic fungi for orchid conservation and restoration in native habitats.

Improved Software to Browse the Serial Medical Images for Learning

The thousands of serial images used for medical pedagogy cannot be included in a printed book; they also cannot be efficiently handled by ordinary image viewer software. The purpose of this study was to provide browsing software to grasp serial medical images efficiently. The primary function of the newly programmed software was to select images using 3 types of interfaces: buttons or a horizontal scroll bar, a vertical scroll bar, and a checkbox. The secondary function was to show the names of the structures that had been outlined on the images. To confirm the functions of the software, 3 different types of image data of cadavers (sectioned and outlined images, volume models of the stomach, and photos of the dissected knees) were inputted. The browsing software was downloadable for free from the homepage (anatomy.co.kr) and available off-line. The data sets provided could be replaced by any developers for their educational achievements. We anticipate that the software will contribute to medical education by allowing users to browse a variety of images.

Ten Triangles around Cavernous Sinus for Surgical Approach, Described by Schematic Diagram and Three Dimensional Models with the Sectioned Images

For the surgical approach to lesions around the cavernous sinus (CS), triangular spaces around CS have been devised. However, educational materials for learning the triangles were insufficient. The purpose of this study is to present educational materials about the triangles, consisting of a schematic diagram and 3-dimensional (3D) models with sectioned images. To achieve the purposes, other studies were analyzed to establish new definitions and names of the triangular spaces. Learning materials including schematic diagrams and 3D models with cadaver's sectioned images were manufactured. Our new definition was attested by observing the sectioned images and 3D models. The triangles and the four representative surgical approaches were stereoscopically indicated on the 3D models. All materials of this study were put into Portable Document Format file and were distributed freely at our homepage (anatomy.dongguk.ac.kr/triangles). By using our schematic diagram and the 3D models with sectioned images, ten triangles and the related structures could be understood and observed accurately. We expect that our data will contribute to anatomy education, surgery training, and radiologic understanding of the triangles and related structures.

Virtual Endoscopic and Laparoscopic Exploration of Stomach Wall Based on a Cadaver's Sectioned Images

We intended to determine that virtual endoscopy and laparoscopy of the stomach based on serially sectioned cadaver images is beneficial. Therefore, the outlines between the gastric wall and lumen were traced using the new female data of the Visible Korean to build a volume model. While the outlines were expanded at appropriate thicknesses, the stomach was observed endoscopically and laparoscopically in comparison with a chosen sectioned image. Four layers (mucosa, submucosa, muscular layer, and serosa) of the stomach were discernible by their proper colors in the sectioned images. All layers except the submucosa were identified in the endoscopic and laparoscopic views by using consistent colors. The stepwise expansion of the outlines revealed thickness of each layer as well as whether the thickness was uniform. Our ideas and the Visible Korean images could be a robust resource of virtual reality learning for medical students and clinicians.