PURPOSE: This study explored the interrelationships between perfectionism, achievement goals, and academic efficacy, hypothesizing that perfectionism and achievement goals affected academic efficacy in medical students. Of the 400 medical students surveyed from three universities in Seoul, 228 completed and returned the questionnaires yielding a total response rate of 57%. Their average age was 23.28 years. METHODS: Measures of students' perfectionism, achievement goals, and academic efficacy were obtained. Exploratory factor analyses were used to measure dimensions of perfectionism (adaptive and maladaptive) and achievement goals (mastery, performance-approach, and performanceavoidance). Both scales confirmed the three subscales of achievement goals and two subscales of perfectionism through Principal Component Analyses and internal consistency testing. Structural equation modelling techniques were used to test the relationships among the variables. RESULTS: It was found that adaptive perfectionism positively influenced students' academic efficacy directly and indirectly via their mastery and performance-approach goals. Moreover, maladaptive perfectionism influenced their academic efficacy indirectly via their performanceapproach goals. However, maladaptive perfectionism did not influence their academic efficacy directly or indirectly via performance-avoidance goal. CONCLUSION: Medical educators need to be aware that encouraging students toward adaptive perfectionism, which is psychologically less stressful, is valuable given these findings. Perhaps learning environments could be developed to enhance students' adaptive perfectionism, mastery and performance-approach goals, and subsequently academic efficacy.
Humans ; Learning ; Principal Component Analysis ; Seoul ; Students, Medical* ; Weights and Measures ; Surveys and Questionnaires

This is a case report of the provocative discographic findings before and after focal selective coagulation of the major annular fissure using intradiscal navigable catheter. A 46-year-old woman had a 30-month history of axial low back pain and magnetic resonance imaging findings suspicious for painful L4/5 disc. The provocative discography confirmed painful disc before coagulation. The final electrode tip position in the coagulation procedure was at the largest fissure within the outer annular margin identified through the discography. Six months after the successful coagulation therapy, inadvertently performed discography resulted in decreased pressure rise over time. Neither evoked pain nor change in the integrity of outer annulus as compared with the previous results was reported. Such an interventional method has not been reported previously, and the analytic results suggest that it may be possible to relocate the pressure of the entire nucleus pulposus only by focal selective coagulation of the fissure.
Catheters ; Electrodes ; Female ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Methods ; Middle Aged

Purpose: Although protein-induced vitamin K absence or antagonist II (PIVKA-II) has been used as a diagnostic tool for hepatocellular carcinoma (HCC), its prognostic value remains unclear. Methods: This was a nationwide multicenter study using the database of the Korean Liver Cancer Association. Patients with hepatitis B-related HCC who underwent liver resection as the first treatment after initial diagnosis (2008–2014) were selected randomly. Propensity score matching (1:1) was performed for comparative analysis between those with low and high preoperative PIVKA-II. Univariable and multivariable Cox proportional-hazards regression were used to identify prognostic factors for HCC-specific survival. Results: Among 6,770 patients, 956 patients were included in this study. After propensity score matching, the 2 groups (n = 245, each) were well balanced. The HCC-specific 5-year survival rate was 80.9% in the low PIVKA-II group and 78.7% in the high PIVKA-II group (P = 0.605). In univariable analysis, high PIVKA-II (>106.0 mAU/mL) was not a significant predictor for worse HCC-specific survival (hazard ratio [HR], 1.183; 95% confidence interval [CI], 0.76–1.85; P = 0.461). In multivariable analysis, hyponatremia of <135 mEq/L (HR, 4.855; 95% CI, 1.67–14.12; P = 0.004), preoperative ascites (HR, 4.072; 95% CI, 1.59–10.43; P = 0.003), microvascular invasion (HR, 3.112; 95% CI, 1.69–5.74; P < 0.001), and largest tumor size of ≥5.0 cm (HR, 2.665; 95% CI, 1.65–4.31; P < 0.001), but not preoperative high PIVKA-II, were independent predictors for worse HCCspecific survival. Conclusion Preoperative PIVKA-II is not an independent prognostic factor for HCC-specific survival after liver resection for hepatitis B-related HCC.