Validation of the Korean Version of the Undergraduate Clinical Education Environment Measure / 의학교육논단

In light of the need for a tool to evaluate the clinical practice education environment as perceived by medical and nursing students, this study is was conducted to develop and validate the Korean version of the Undergraduate Clinical Education Environment Measure (K-UCEEM) as a measurement tool for managing the clinical practice education climate and quality of education. For validation, the UCEEM consisting of 25 items developed by Pia Strand in 2013 was adapted according to standard translation procedures. The K-UCEEM questionnaire was administered to 73 medical students and 135 nursing students who participated in clinical practice at one medical institution. Exploratory factor analysis and confirmatory factor analysis were conducted to confirm the validity of the instrument’s structure. In order to determine referential validity, the relationships among stresses in clinical practice were examined, and differences in factor scores were compared by gender and college. It was confirmed that the scale of 24 items and five factors showed a moderate model fitness index. The reliability of the factors ranged from 0.786 to 0.867. In addition, all five factors were found to have negative correlations with the clinical practice stress sub-factor, and there were statistically significant differences by gender and college. Through this study, the validity and reliability of the K-UCEEM were verified. In the future, it is expected that further verification of the scale, as well as evaluation and improvement of the clinical practice education environment based on this scale, will occur.

Academic burnout and selection-optimization-compensation strategy in medical students / 한국의학교육

PURPOSE: This study was conducted to examine the relationship between academic demand, academic burnout, and the selection-optimization-compensation (SOC) strategy in medical students. METHODS: A total of 317 students at Yeungnam University, comprising 90 premedical course students, 114 medical course students, and 113 graduate course students, completed a survey that addressed the factors of academic burnout and the selection-optimization-compensation strategy. We analyzed variances of burnout and SOC strategy use by group, and stepwise multiple regression analysis was conducted. RESULTS: There were significant differences in emotional exhaustion and cynicism between groups and year in school. In the SOC strategy, there were no significant differences between groups except for elective selection. The second-year medical and graduate students experienced significantly greater exhaustion (p<0.001), and first-year premedical students experienced significantly higher cynicism (p<0.001). By multiple regression analysis, subfactors of academic burnout and emotional exhaustion were significantly affected by academic demand (p<0.001), and 46% of the variance was explained. Cynicism was significantly affected by elective selection (p<0.05), and inefficacy was significantly influenced by optimization (p<0.001). CONCLUSION: To improve adaptation, prescriptive strategies and preventive support should be implemented with regard to academic burnout in medical school. Longitudinal and qualitative studies on burnout must be conducted.

Asthma Development Partially Linked to Adiponectin and Leptin in Overweight Children / 소아알레르기및호흡기학회지

PURPOSE: The prevalence of asthma and obesity is increasing concomitantly, but the link between asthma and obesity is unclear. We sought to address possible roles of leptin and adiponectin in the development of asthma, and changes in pulmonary function in overweight children. METHODS: Four study groups of 61 children aged 6 to 18 years (mean age, 9.69+/-2.16) were enrolled: (1) 14 mild-to-moderate asthmatics with overweight, (2) 16 mild-to-moderate asthmatics with normal weight, (3) 16 obese subjects without asthma, and (4) 15 healthy controls. We measured biomarkers in blood, including total and allergen-specific IgE, eosinophil, eosinophilc cationic protein (ECP), leptin, adiponectin, interleukin (IL)-6, tumor necrosis factor-alpha (TNF-alpha), lipid profiles, insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein 3 (IGF-BP3). Body mass index (BMI), antioxidants and micronutrients in a daily diet were evaluated by the questionnaire. We performed the bronchial challenge test by methacholine inhalation and free running, respectively. RESULTS: The leptin levels was apparently high, and the adiponectin level was low in the over-weight children, as depicting a significant inverse correlation between the 2 variables (R=-0.479; P<0.001). The FEV(1)/FVC ratio was low in the overweight children regardless of the presence of asthma. However, the effect of IL-6, TNF-alpha, nutrients, and other variables on asthma development in the overweight children with asthma was not verified. CONCLUSION: In this study, the levels of leptin, adiponectin or other obesity-related biomarkers were not independently associated with asthma. Therefore, it is concluded that obesity may not be an important factor in pulmonary function impairment.

A Case of Primary Transitional Cell Carcinoma of the Ovary / 대한산부인과학회잡지

Primary ovarian transitional cell carcinoma (TCC) is extremly rare tumor and has been recently classified into the one of the histologic subtypes of ovarian epithelial cell carcinomas. Primary ovarian TCC has been proven to differ from malignant Brenner tumor (MBT) and TCC of the bladder for it's histologic characteristics as well as therapeutic and prognostic implications. TCC of the ovary has been also recognized to have excellent response to chemotherapy and favorable prognosis although it's aggressive properties. We experienced a case of primary ovarian TCC (stage: IIc) in 57 year old woman who presented with low abdominal pain and report this case with a brief review of the concerned literatures.

A Clinical Review of Midtrimester Amniocentesis / 대한산부인과학회잡지

OBJECTIVE: We performed this study to analyze the indications, distributions of maternal age and cytogenetic results of midtrimester amniocentesis and to determine the complications and risks of it. METHODS: This study was retrospectively reviewed 674 cases of midtrimester genetic amniocentesis from January 1997 to October 2001 in Kangdong Sacred Hospital, Hallym University. We analyzed the indications, distributions of maternal and gestational age, chromosomal results, and of which accorded to indications of cytogenetic studies. RESULTS: The indications of amniocentesis were abnormal maternal serum screening (46.2%), advanced maternal age (> OR =35: 44.8%), abnormal ultrasonographic findings (5.9%), familial history of fetal anomaly (2.8%) and previous history of fetal chromosomal abnormalities (0.3%), in order. The overall incidence of chromosomal aberration was 3.6% (24/674), which were composed of 18 cases of numerical aberrations and 6 cases of structural aberrations. In autosomal aberrations, there were 7 cases of Down's syndrome, 6 cases of Edward syndrome, 1 case of Patau syndrome and 3 cases of Mosaicism. In sex chromosomal aberration, there was a case of Turner syndrome. In chromosomal aberrations according to indications, there was 7.5% (3/40) of chromosomal abnormalities in abnormal ultrasonographic findings group, 3.2% (10/311) in abnormal maternal serum screening group and 3.0% (9/302) in advanced maternal age group. There was statistical significance only in abnormal ultrasonographic findings group. There was no significant complication after amniocentesis except 0.3% (2 cases) of fetal loss. CONCLUSION: Maternal serum screening, advanced maternal age and antenatal ultrasonograms should be important screening methods for amniocentesis which is considered to the most effective diagnostic procedure for prenatal cytogenetic studies. The karyotyping analysis of midtrimester amniocentesis is efficacious method for evaluation of chromosomal aberrations and genetic counselling for parents.

Clinical Evaluations of the Classical Intrafascial SEMM Hysterectomy (CISH) / 대한산부인과학회잡지

Objectives: We performed this study to review the clinical availability of the classical intrafascial SEMM hysterectomy (CISH), and report our experience for 2 years restrospectively. METHODS: From March 1999 to February 2001, 100 cases of CISH were performed at the Department of Obstetrics and Gynecology, College of Medicine, Kangdong Sacred Heart Hospital, Hallym university. We performed this procedure by 3 steps. The dissection of uterus was done by classical suture methods (including extracorporeal and intracorporeal suture techniques) to uterine isthmic portion. And then transvaginal cylindrical coring out of the cervical tissue was done using a cervix corer, the Calibrated Uterine Resection Tools (CURT) for resection of cervical tissue especially transformation zone. Finally, the dissected uterus was extracted by using a Serrated Edged Macro-Morcellator (SEMM) without colpotomy. We reviewed the patient's data retrospectively and made phone calls to each patients. RESULTS: The indications for CISH, based on the pre-and intraoperative diagnosis, were leiomyoma, adenomyosis, endometrial hyperplasia and chronic pelvic inflammatory disease or pelvic pain, in order of frequency. The mean operative time was 126 minutes and the mean hemoglobin change was 1.27 gm/dL. The mean hospital days were 5.7 days and the mean age of the patients was 44.6 years old. There were no definite intra- and postoperative complications except for 3 cases of CO2 retentions and 2 cases of delayed bleeding on cervical stump. The mean days to first sexual contact after surgery were 34.5 days. In view of sexual feeling, 86% of the patients didn't feel any difference and only 13% felt worse than before. During postoperative follow-up, the cervical cytologic study were found no endocervical cells at all of 44 checked patients. CONCLUSION: The CISH procedures can be safely performed by well-trained laparoscopists, and this technique minimally alters the anatomy and integrity of the pelvic floor and vagina. Therefore the reductions of surgical morbidity, blood loss, hospitalization and postoperatve discomfort were obtained. Through the preservation of the anatomical relations of the pelvic floor and the function of female sexuality, this technique is the new proposal in gynecologic surgery.

The Effect of Bacterial Lipopolysaccharide on the Lymphokine Production of the T Lymphocytes

It is well known that the murine T helper cell clones are divided by their lymphokine secretory activities. One is the Th-1 cell, producing IL-2 and IFN after stimulation and the other is the Th-2 cell, producing the IL-4 and IL-5. This study was undertaken to evaluate the immunomodulatory properties of the bacterial lipopolysaccharide(LPS) on the lymphokine production in vivo and in vitro. The results were as follows: There were no effects on the lymphokine secretion by the in vitro treatment of the LPS. The in vivo treatment of the LPS decreases the capability of the production of IL-2 and IFN , whereas it increases the capability of IL-4 production. The altered capacity of the lymphokine production was recovered about 2 weeks after the treatment of the LPS. There were no differences on the lymphokine production between E-coli LPS and salmonella LPS. The capacity of the lymphokine production was the same in the treatment of a non-heated LPS or heated-LPS. The lymphokine production of the mice which were desensitized by the long term treatment of the LPS was not different from the control mice. The in vitro treatment of RU486 can block the alterations of the lymphokine production after the treatment of the LPS. In summary, one can tell that the LPS increases the secretion of the IL-4 through the endogenous secretion of the glucocorticoids.

Modulation of Severity of Relaxation in the Isolated Rat Aortic Tissue Model of Ischemia / 대한마취과학회지

The purpose of this study was undertaken to test if alteration of calcium flux across the sarcolemma or sarcoplasmic reticulum change subsequent relaxation of rat aorta in tissue model of ischemia. Thoracic aorta ring segments(2-3mm wide) were studied with solution that mimicked real ischemia condition(hypoxia, acidosis, elevated lactate levels and zero sub strate). During ischemic condition, the effect of treatments thought to decrease cytosolic cal cium were tested. Half time(t(1/2)) and degree of stabilized relaxation were 2.4+/-0.9 minutes and 17.6+/-12.1%(NE 10-7 M precontraction as 100%) for verapamil(10-6 M), 3.3+/-0.7 min- utes, 22.2+/-3.9% for low Ca2+(0.75mM) in ischemic solution. Interventions aimed to elevat- ing cytosolic calcium were also tested. 3.8+/-0.9 minutes and 68.6+/-8.1% for high (10.0 mM) Ca2+ in ischemic solution, 3.7+/-0.7 minutes, 72.8+/-3.9/. for ryanodine(3X10-9 M). 3.8+/-0.5 minutes, 53.4+/-2.6% for isoproterenol. Without any treatment or agents during ischemia, hlaf time and degree of relaxation were 4.0+/-1.7 minutes, 74.6+/-13.2%, enothelium and time independent. These data support that treatment or agent thought to reduce influx of cytosolic calcium levels exaggerated the severity of relaxation. The mechanism of relaxation in ischsmia is not completely clear, but it is suggested that a reduction of calcium influx may involved and directly related.

Histopathological Study for Chronic Photic Retinal injury After Atropinization for a Long Time

The damaging effect of radiant energy to retina as observed in eclipse retinopathy, photocoagulation and laser burn was always considered the result of thermal coagulation. Pnly recently was it suspected that chronic exposure to radiant energy of low intensity may also damage the retina by mechanisms that may differ from simple transformation of light energy into heat. We suspected that long exposure to natural light through the atropinized pupil at penalisation treatment may damage the retina. So, atropinized rabbits will be exposed to more amount of light through dilated pubil and such a possibility led to speculation that some of maculopathy observed in atropinized man may be related to photic damage produced by chronic exposure to light of relatively low intensity. Therefore, we studied the changes in postesior pole histopathologically by light and electron microscopy after long exposure to natural light through dilated pupil.

A Histological Study of a Congenital Glaucoma

A pair of eyes of a 18 year-old girl with advanced congenital glaucoma was examined by light and electron microscopy. Results were as follows: 1. Trabecular meshwork and iris root showed fibrosis. 2. Schlemm's canal was absent. 3. Endothelium of the trabecular meshwork was degenerated. 4. Ciliary body was atrophied. 5. Inner layer of retina showed degeneration with the loss of nerve fiber layer and ganglion cell layer, which was replaced by Mueller cells. 6. Optic nerve showed atrophy from a loss of nerve fibers and there was proli feration of collagen tissue.

A Case of Subretinal Cysticercosis Associated with Subcutaneous Nodules

A new case of the recently experienced intraocular cysticercosis associated with multiple skin lesions (subcutaneous nodules) is presented. Clinical picture of this case was characteristic with bizarre shape retinal hemorrhage, and clinical diagnosis was possible by the fluorescein angiography of fundus. Trans-scleral extraction of the subretinal cysticercus was performed successfully without rupture of a cyst-capsule through the infero-temporal quadrant of sclera near to the equator of right eye. Diagnosis of ocular cysticercosis was confirmed by histo-parasitological examination on the extracted cyst of 5 x 7 mm in size. Oral medication is generally not amenable treatment for the intraocular cysticercosis, and less traumatic surgical removal is the only effective method for the improvement of visual function or preservation of the eye itself. The immense review of literatures on the ocular cysticercosis including the subretinal invas ion was attempted.

The Change of the Curneal Curvature Before and After Cataract Operation

1. In total 33 cases of cataract, measurements of the corneal curvature(radius) were performed preoperatively and postoperatively. 2. Among 6 cases of below 40 year old, extracapsular cataract extraction were 5 cases. While 23 cases were done in intracapsular extraction among 27 cases of more than 40 year. 3. At two month after the operation, vertical and horizontal curvatures are closer to that of preoperative condition than in 1 month after the operation. 4. 2 month after the operation, vertical curvatures are getting flat in 66 %, while more cases showed tight horizontal curvatures than flat one.