Changes in the Perception Structure of the Concept of Empathy According to the Educational Experience of Medical Students / 의료커뮤니케이션

Purpose@#: The purpose of this study is to explore changes in the conceptual perception structure of medical students’ empathy according to the educational experience provided at the beginning of the basic medical education. @*Methods@#: The subjects of this study were 116 students in the 2nd year of the pre-medical department of the College of Medicine. @*Results@#: Before and after the basic medical interview class and after the end of the dissection practice, words included in the concept of empathy such as ‘the other person’, ‘emotion’, ‘understanding’, ‘position’, ‘situation’, and ‘thought’ appeared in common. However, these common words appeared mixed before and after the basic medical interview class, but after the end of the dissection practice, they changed to a structure that recognizes the concept of empathy by integrating the core concepts of ‘the other’, ‘understanding’, and ‘emotion’. In particular, after the end of the dissection practice, the word ‘patient’ appeared, expressing the specific object of empathy as a doctor for the first time. @*Conclusion@#: Curriculum related to medical interview within the basic medical education curriculum should be systematically developed so that students can continuously experience practical medical interview situations along with theoretical education.

A New Classification for Cervical Ossification of the Posterior Longitudinal Ligament Based on the Coexistence of Segmental Disc Degeneration

Objective@#: Classification systems for cervical ossification of the posterior longitudinal ligament (OPLL) have traditionally focused on the morphological characteristics of ossification. Although the classification describes many clinical features associated with the shape of the ossification, including the concept of spondylosis seems necessary because of the similarity in age distribution. @*Methods@#: Patients diagnosed with OPLL who presented with increase signal intensity (ISI) on magnetic resonance imaging were surgically treated in our department. The patients were divided into two groups (pure versus degenerative) according to the presence of disc degeneration. @*Results@#: Of 141 patients enrolled in this study, more than half (61%) were classified into the degenerative group. The pure group showed a profound male predominance, early presentation of myelopathy, and a different predilection for ISI compared to the degenerative group. The mean canal compromise ratio (CC) of the ISI was 47% in the degenerative group versus 61% in the pure group (p<0.0000). On the contrary, the global and segment motions were significantly larger in the degenerative group (p<0.0000 and p=0.003, respectively). The canal diameters and global angles did not differ between groups. @*Conclusion@#: Classifying cervical OPLL based on the presence of combined disc degeneration is beneficial for understanding the disorder’s behavior. CC appears to be the main factor in the development of myelopathy in the pure group, whereas additional dynamic factors appear to affect its development in the degenerative group.

Development of Web-Based Cognitive Training Program : Preliminary Study

Effects of medical communication curriculum on perceptions of Korean medical school students / 한국의학교육

PURPOSE: The study examines changes in students' self-assessment of their general communication (GC) and medical communication (MC) competencies, as well as perceptions of MC concepts. METHODS: Participants included 108 second year medical students enrolled at a Korean medical school studying an MC curriculum. It was divided into three sections, and participants responded to questionnaires before and after completing each section. To assess perceived GC and MC competency, items based on a 7-point Likert scale were employed; a single open-ended item was used to examine students' perceptions of MC. Statistical analysis was conducted to gauge GC and MC competency, whereas semantic network analysis was used to investigate students' perceptions of MC. RESULTS: Students perceived their GC competency to be higher than MC. Perceived MC competency differed significantly across the three sections, whereas no differences were found for GC. There were no statistically significant differences after completing the curriculum's second and third sections; however, the vocabulary students used to describe MC concepts became more scholarly and professional. In the semantic networks, the link structure between MC-related words decreased in linearity and looseness, becoming more complex and clustered. The words ‘information’ and ‘transfer’ proved integral to students' perceptions; likewise, ‘empathy’ and ‘communication’ became closely connected in a single community from two independent communities. CONCLUSION: This study differed from prior research by conducting an in-depth analysis of changes in students' perceptions of MC, and its findings can be used to guide curriculum development.

Explanatory Study of Medical Students' Perception of Life Concept / 의학교육논단

This study surveyed 506 medical students on their perception of life concept using an open-ended questionnaire. A constant comparative analysis of participants' written responses was conducted. The results revealed 3 main types and several sub-types of life concept. The main types included: humanities & sociology type, scientific type, and humanities · sociology & science mixed type. The humanities & sociology type had 6 sub-types: religious values, ethical values, limited time, social characteristics, consciousness · spirit · soul, and mixed type. The scientific type had 4 sub-types as follows: respiration & metabolism, genetic & reproduction, homeostasis & emergent property, and mixed type. The most prevalent type was the perception that life concept, ethical values in humanities & sociology type. The understanding of the concept of life is essential to medical students' learning and improvement of professional competence. These results may suggest a meaningful direction for medical education regarding the concept of life.

Cortical Thickness of Resting State Networks in the Brain of Male Patients with Alcohol Dependence

OBJECTIVES: It is well known that problem drinking is associated with alterations of brain structures and functions. Brain functions related to alcohol consumption can be determined by the resting state functional connectivity in various resting state networks (RSNs). This study aims to ascertain the alcohol effect on the structures forming predetermined RSNs by assessing their cortical thickness. METHODS: Twenty-six abstinent male patients with alcohol dependence and the same number of age-matched healthy control were recruited from an inpatient mental hospital and community. All participants underwent a 3T MRI scan. Averaged cortical thickness of areas constituting 7 RSNs were determined by using FreeSurfer with Yeo atlas derived from cortical parcellation estimated by intrinsic functional connectivity. RESULTS: There were significant group differences of mean cortical thicknesses (Cohen's d, corrected p) in ventral attention (1.01, < 0.01), dorsal attention (0.93, 0.01), somatomotor (0.90, 0.01), and visual (0.88, 0.02) networks. We could not find significant group differences in the default mode network. There were also significant group differences of gray matter volumes corrected by head size across the all networks. However, there were no group differences of surface area in each network. CONCLUSIONS: There are differences in degree and pattern of structural recovery after abstinence across areas forming RSNs. Considering the previous observation that group differences of functional connectivity were significant only in networks related to taskpositive networks such as dorsal attention and cognitive control networks, we can explain recovery pattern of cognition and emotion related to the default mode network and the mechanisms for craving and relapse associated with task-positive networks.

Perceptual comparison of the "good doctor" image between faculty and students in medical school / 한국의학교육

PURPOSE: The purpose of this study is to analyze the differences in the perception of the "good doctor" image between faculty and students, based on the competencies of the "Korean doctor's role." METHODS: The study sample comprised 418 students and 49 faculty members in medical school. They were asked to draw images of a "good doctor," and the competencies were then analyzed using the Draw-A-Scientist test and the social network program Netminer 4.0. RESULTS: Of the competency areas, "communication and collaboration with patient" and "medical knowledge and clinical skills" were the most frequently expressed, and "education and research," "professionalism," and "social accountability" were less commonly expressed. Images of a good doctor by the faculty focused on competencies that were directly related to current clinical doctors. Conversely, those by the students expressed various competencies equally. CONCLUSION: We have provided basic data for faculties and schools to plan various education strategies to help students establish the image of a good doctor and develop the necessary competencies as physicians.

Brain Activation Evoked by Sensory Stimulation in Patients with Spinal Cord Injury : Functional Magnetic Resonance Imaging Correlations with Clinical Features

OBJECTIVE: The purpose of this study is to determine whether the changes of contralateral sensorimotor cortical activation on functional magnetic resonance imaging (fMRI) can predict the neurological outcome among spinal cord injury (SCI) patients when the great toes are stimulated without notice. METHODS: This study enrolled a total of 49 patients with SCI and investigated each patient's preoperative fMRI, postoperative fMRI, American Spinal Injury Association (ASIA) score, and neuropathic pain occurrence. Patients were classified into 3 groups according to the change of blood oxygenation level dependent (BOLD) response on perioperative fMRI during proprioceptive stimulation with repetitive passive toe movements : 1) patients with a response of contralateral sensorimotor cortical activation in fMRI were categorized; 2) patients with a response in other regions; and 3) patients with no response. Correlation between the result of fMRI and each parameter was analyzed. RESULTS: In fMRI data, ASIA score was likely to show greater improvement in patients in group A compared to those belonging to group B or C (p<0.001). No statistical significance was observed between the result of fMRI and neuropathic pain (p=0.709). However, increase in neuropathic pain in response to the signal change of the ipsilateral frontal lobe on fMRI was statistically significant (p=0.030). CONCLUSION: When there was change of BOLD response at the contralateral sensorimotor cortex on perioperative fMRI after surgery, relief of neurological symptoms was highly likely for traumatic SCI patients. In addition, development of neuropathic pain was likely to occur when there was change of BOLD response at ipsilateral frontal lobe.

Grisel's Syndrome Induced by Mycobacterium tuberculosis

Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joints, which is caused by an inflammatory process in the upper neck. It is rare to find literary reports of Grisel's syndrome with an evident pathogen in a lesion. For the first time in Korea, we report a 36-year-old female with Grisel's syndrome having an atlantoaxial subluxation, which was caused by a retropharyngeal abscess secondary to pulmonary Mycobacterium tuberculosis. The patient was treated with an anti-tuberculosis regimen and was prescribed a Philadelphia collar for the control of torticollis. The result of magnetic resonance imaging (MRI) showed an improved atlantoaxial alignment, after drug treatment and immobilization. This patient was neurologically intact and free from symptomatic complaints at follow-up visit. Dynamic cervical radiograph confirmed that the atlantoaxial joints had been stable. The pathophysiology of Grisel's syndrome, along with anatomical attributes, was explained on the basis of the patient's clinical course.

Comparison of Wave V Latencies of Auditory Brainstem Responses by Bone Conduction and Air Conduction in Normal Hearing Infants and Toddlers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Bone conduction (BC) auditory brainstem response (ABR) is an important factor in determining the type of hearing loss especially in infants and other difficult-to-test populations. However, multiple constraints including technical difficulties make evaluating BC ABR less feasible in the clinic, and there is also lack of information that guides clinicians how to evaluate it. The purpose of this study is to compare the latency of wave V in BC and air conduction (AC) ABR in normal hearing infants and gather reference values for wave V latency of BC ABR. SUBJECTS AND METHOD: A total of 210 ears of normal hearing, of those not belong to the hearing loss risk group, were included. All the infants underwent ABR evoked by clicks via AC (3A insert phone) and BC (Radioear B-71, vibrator positioned on the mastoid) under sedation. The latency of wave V at 30 dB nHL by BC and AC was compared and analyzed according to age. RESULTS: The results revealed that in every age group in the study, wave V latency at 30 dB nHL of BC ABR was shorter than that of AC ABR. There was a significant decrease in BC and AC latencies with age, but among each consecutive age group, significant latency change was not identified after 6 months old. CONCLUSION: The latency of BC ABR in young children was shorter than that of AC ABR, and it decreased significantly as age increased. However, the reference data should be considered by taking each laboratory's test parameter into consideration.

A Case of Polymorphous Low Grade Adenocarcinoma in Submandibular Gland / 대한이비인후과학회지

Polymorphous low-grade adenocarcinoma (PLGA) is a distinctive salivary gland neoplasm with a propensity to arise from minor salivary glands, particularly of the palate. Reports of PLGA have increased with the establishment of specific histopathological criteria characterizing the PLGA, but there are only a few reports of major salivary gland origin. PLGA shares histological features with adenoid cystic carcinoma, so histopathologic diagnosis is essential and immunohistochemistry is an important tool when making differential diagnosis. The treatment of choice is wide surgical excision, and long-term follow up is necessary to evaluate local recurrences. We herein report a case of PLGA arising in a submandibular gland with a review of the relevant literature.

Langerhans cell protein 1 (LCP1) binds to PNUTS in the nucleus: implications for this complex in transcriptional regulation

Protein phosphatase-1 (PP1) nuclear targeting subunit (PNUTS), also called PP1R10, p99, or CAT 53 was originally isolated as a mammalian nuclear PP1-binding protein. In this study, we performed yeast two-hybrid screens to identify PNUTS-interacting proteins. Here, we report that LCP1 (epidermal Langerhans cell protein 1), a novel member of the HMG-box protein family, binds tightly to PNUTS. Co-immunoprecipitation of deletion constructs revealed that the C-terminus of LCP1 is sufficient for the interaction with an N-terminal region of PNUTS that is distinct from its PP1-binding domain. Furthermore, immunofluorescence studies showed that a subpopulation of LCP1 co-localizes with PNUTS in nuclear speckles. Importantly, we found that the N-terminus of LCP1 has a strong trans-activation activity in a GAL4-based heterologous transcription assay. The transcriptional activity of LCP1 is markedly suppressed by its interaction with PNUTS, in a PP1-independent manner. These findings suggest that the coordinated spatial and temporal regulation of LCP1 and PNUTS may be a novel mechanism to control the expression of genes that are critical for certain physiological and pathological processes.

Identification of Arbuscular Mycorrhizal Fungi from Botrychium ternatum Native in Korea

Arbuscular mycorrhizal fungi were observed in Botrychium ternatum native in Korea. The partial small subunit (SSU) of ribosomal DNA gene from the fern roots was amplified with primers AM1/NS31. Nucleotides sequence analysis of the clones revealed that two fragments were close to Glomus proliferum and G. sinuosum. The other three DNA fragments were close to those of G. proliferum with the relatively low similarities (92~95%) and speculated to be originated from three different species of Glomus (GLA006, GLA016, and GLA032). Five different nucleotide sequences close to three AM fungal species were found in the roots of B. ternatum native in Korea.

Three Dimensional Analysis of the Medial Longitudinal Arch of Foot

OBJECTIVE: To evaluate and quantify the medial longitudinal arch of foot using a 3-D foot scanner and 3-D arch measurement program. METHOD: 997 subjects (363 men and 634 women) were selected. The foot length, width, girth and medial longitudinal arch parameters were measured with a 3-D foot scanner (Nexcan(r), K&I, Korea), analysis software (EnFOOT(R), K&I, Korea) and 3-D measurement program of the medial longitudinal arch. RESULTS: The mean arch lengths were 100.3 mm for men, 90.4 mm for women. The mean arch height and arch volume in both genders were 14.7 mm, 12.1 mm and 10.3 cm3, 6.0 cm3, respectively. We compared the arch parameters of both genders by univariate analysis of variance and in most cases the parameters of men were larger than those of women. Moderate positive relationships were found between foot length and arch width of talonavicular joint in cases of men, foot length and length from heel point to distal arch point in both genders (Pearson correlation coefficient > 0.3, p<0.01). CONCLUSION: We evaluated the medial longitudinal arch of Korean feet three dimensionally. These data sould be a useful reference for making shoes, insoles, and orthoses.

Interactions of Newly Isolated Orchid Mycorrhizal Fungi with Korean Cymbidium kanran Hybrid 'Chungsu'

Two fungal isolates obtained from roots of Cymbidium goeriingii in Jeju island were confirmed to be symbiotic with orchid plantlets, and were compared with other orchid mycorrhizal (OM) fungi previously isolated. The two isolates differed in their peloton structures formed in the roots of Cymbidium kanran hybrid 'Chungsu' and in responses of orchid plant. These two isolates differed from the additionally tested OM fungi in some features, and from root damaging species of Rhizoctonia and Fusarium as based on cluster analysis after PCR-RAPD with the primers, Bioneer-28 and OPO-2. With this simple and fast technique, it was possible to distinguish OM fungi from the plant root pathogenic fungi based on calculation of their polymorphic bands. This technique can therefore be helpful to distinguish the OM fungi from the root pathogens. Particularly, the new isolates are considered as new resource of symbiotic fungi for horticultural industries.

Salicylate Regulates Cyclooxygenase-2 Expression through ERK and Subsequent NF-kappaB Activation in Osteoblasts

The expression of cyclooxygenase-2 (COX-2) is a characteristic response to inflammation and can be inhibited with sodium salicylate. TNF-alpha plus IFN-gamma can induce extracellular signal-regulated kinase (ERK), IKK, IkappaB degradation and NF-kappaB activation. The inhibition of the ERK pathway with selective inhibitor, PD098059, blocked cytokine-induced COX-2 expression and PGE2 release. Salicylate treatment inhibited COX-2 expression induced by TNF-alpha/IFN-gamma and regulated the activation of ERK, IKK and I kappaB degradation and subsequent NF-kappaB activation in MC3T3E1 osteoblasts. Furthermore, antioxidants such as catalase, N-acetyl-cysteine or reduced glutathione attenuated COX-2 expression in combined cytokines-treated cells, and also inhibited the activation of ERK, IKK and NF-kappaB in MC3T3E1 osteoblasts. In addition, TNF-alpha/IFN-gamma stimulated ROS release in the osteoblasts. However, salicylate had no obvious effect on ROS release in DCFDA assay. The results showed that salicylate inhibited the activation of ERK and IKK, IkappaB degradation and NF-kappaB activation independent of ROS release and suggested that salicylate exerts its anti-inflammatory action in part through inhibition of ERK, IKK, IkappaB, NF-kappaB and resultant COX-2 expression pathway.

Multiple Symbiotic Associations Found in the Roots of Botrychium ternatum

Two types of mycorrhizae, orchid (OM) and arbuscular mycorrhizae (AM), were observed in the cortical cells of Botrychium ternatum roots. The vesicles or arbuscules of AM fungi were examined and the fresh or digestive pelotons by other species of basidiomycetes were also observed in the roots under light microscope. These symbioses were, as the genomic DNAs extracted from roots of B. ternatum reacted with the specific primers, confirmed with PCR technique, being added to more strong evidences. These discoveries were rarely happened in the roots, especially a fern in nature. OM was observed in the roots of B. ternatum collected from the nationwide areas, whereas AM was only in the roots of B. ternatum collected from Chung-Buk areas. It is speculated that OM are associated with the nitrogen cycle in Islands and the growth of B. ternatum in the inland of Central Korea is related to both the phosphate and nitrogen cycle in the nature. The results suggest that B. ternatum is a typical species with two types of mycorrhizae under various growing conditions.

Isolation of the Orchid Mycorrhizal Fungi from the Korean Native Orchids in Cheju

The eleven isolates were isolated from the roots of Cymbidium goeriingii inhabited in the island of Cheju and from Cypripeium calceolus inhabited in the mountains around ChungPuk. The isolates were inoculated to the plantlets of commercial orchids and evaluated to be symbiotic with the orchids. Also, their genomic DNA was extracted from the cultures on the agars and reacted with the primers selected, understanding their biological relations with the pathogenic fungi. Out of eleven isolates, three were observed to stimulate the growth of the orchid plantlets and to be biologically related to the orchid symbiotic fungi, as based on the analyses of PCR-RAPD. Otherwise, the others were observed to decline the growth of orchid plantlet, compared with those of control, and to be grouped with the pathogenic. As based on the results of this work, the roots of C. goeriingii were found to be frequently infected with the pathogenic fungus rather than with symbiotic fungus in natural systems. Further, the infection of the commercial orchid with the pathogens was believed to be abundant without any inoculation of symbiotic fungus under the conditions of greenhouse.

Protective Effect of Melatonin on Neuropathy in Streptozotocin-Induced Diabetic Rats

OBJECTIVE: The purpose of this study is to prove protective action of melatonin on the development of neuropathy in diabetic rat. METHOD: The experimental rats (Sprague-Dawley) were divided into 3 groups: Group 1, streptozotocin-induced diabetic rats with trial of melatonin; Group 2, streptozotocin-induced diabetic rats without trial of melatonin; Group 3, normal control. Streptozotocin was injected intraperitoneally in group 1 and 2. Melatonin was administered per orally in group 1 from 1 week after the injection of streptozotocin. The melatonin effect on diabetic neuropathy was evaluated by the measurement of conduction velocities and amplitudes of rat tail mixed nerve action potentials. The electrophysiologic examinations were performed before and 2, 4, and 6 weeks after administration of streptozotocin. RESULTS: The rat tail mixed nerve conduction velocities were decreased at 4 weeks in group 1 and 2, and showed significant improvement at 6 weeks in group 1 as compared with those of group 2 (p<0.05). The amplitudes of the compound nerve action potentials did not show difference before and after streptozotocin and melatonin trials, neither among groups. CONCLUSION: In this experimental study, we observed the inhibitory effect of melatonin on the progression of polyneuropathy in early stage of diabetic rat. For the clinical application to human beings, further study is required.

A Case of Mononeuritis Multiplex in Churg-Strauss Syndrome: A case report

OBJECTIVE: We report a case of Churg-Strauss syndrome (CSS) which accompanied a mononeuritis multiplex. CASE SUMMARY: A 46-year-old woman began to suffer from an allergic rhinitis since 1985, and was diagnosed as a bronchial asthma in 1995. She also complained numbness of the upper and lower extremities, which eventually lead to a weakness and edema of both upper and lower extremities. Electrophysiologic study findings were compatible with a mononeuritis multiplex. The skin biopsy revealed a necrosis of the vessels with infiltration of a large number of neutrocytes and lymphocytes. CONCLUSION: Based on the patient's clinical characteristic, skin biopsy findings and electrophysiologic study findings, we have concluded that the case fit well for CSS.