Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/m2. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 microIU/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 *0602 type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatment, and the cataplexy not supported by HLA DQB1 *0602 should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.
Adolescent ; Benzhydryl Compounds ; Blood Pressure ; Body Mass Index ; Cataplexy ; Clonazepam ; Cyclohexanols ; Extremities ; Hallucinations ; Heart Rate ; HLA-DQ beta-Chains ; Humans ; Hypersomnolence, Idiopathic ; Intracellular Signaling Peptides and Proteins ; Male ; Methimazole ; Narcolepsy ; Nervous System Diseases ; Neuropeptides ; Polysomnography ; Propranolol ; Reference Values ; Sleep Deprivation ; Sleep Paralysis ; Sleep, REM ; Thyroid Gland ; Thyrotoxicosis ; Vital Signs ; Orexins ; Venlafaxine Hydrochloride

No abstract available.
Child* ; Humans ; Tachycardia, Supraventricular*

PURPOSE: To explore the relationship between problem-based learning (PBL) evaluations and clinical performance. METHODS: The study included 117 third-year medical students at Chonnam National University Medical School. The students' first-, second-, and third-year PBL evaluations were compared with their clinical performance examination (CPX) scores in third year. The PBL evaluations were composed of three subscales: tutors' evaluation (students' professional behavior, contribution to group process, and contribution to group content), a report, and a written examination. The CPX assessed four performance categories: history taking, physical examination, information sharing, and patient-physician interaction. RESULTS: No significant correlation was found between the first-year PBL evaluations and CPX scores; however, the second-year PBL evaluations were significantly correlated with history taking (r=0.186, p=0.044) and patient-physician interaction (r=0.213, p=0.021) of CPX. The third-year PBL evaluations were significantly correlated with physical examination (r=0.248, p=0.007), and patient-physician interaction (r=0.283, p=0.002) of CPX. Several significant correlations between the PBL evaluations subscales and CPX scores were revealed. The PBL tutors' evaluation (r=0.343, p=0.000) and report scores (r=0.210, p=0.023) were significantly correlated with patient-physician interaction of CPX. The contribution to group process of tutors' evaluation was significantly correlated with patient-physician interaction (r=0.186, p=0.045), and the contribution to group content of tutors' evaluation was significantly correlated with physical examination (r=0.187, p=0.044). CONCLUSION: We found a significant association between PBL evaluations and CPX scores.
*Clinical Competence ; *Education, Medical, Undergraduate ; *Educational Measurement ; Group Processes ; Humans ; *Problem-Based Learning ; Republic of Korea ; Schools, Medical ; *Students, Medical ; Universities

No abstract available.
Cerebral Palsy* ; Clubfoot* ; Congenital Abnormalities* ; Muscle Spasticity*

No abstract available.
Exostoses*

This study was undertaken to analyze the displacement and stress distribution in the mandible according to the pulling directions during mandibular first molar cervical traction after mandibular second molar extraction. The 3-dimensional finite element method(FEM) was used for a mathematical model composed of 594 elements and 1019 nodes. An orthodontic force, 450gm, was applied to the each mandibular first molar in parallel, and below the occlusal plane by 7degrees and 25degrees and meet the midsagittal plane by 40degrees toward posterior direction. The results were as follows: 1. Mandibular teeth were displaced in more downward, posterior and lateral direction. Especially high stress was noted in case of parallel pull than in case of below the occlusal plane by 7degrees and 25degrees. 2. Mandibular first molar was moved bodily. 3. Generally, alveolar bone, mandibular body, ascending ramus and mandibular angle portion were displaced in downward, posterior and lateral direction. But coronoid process was displaced in downward, forward and lateral direction, and anterior and inner middle portion of condyle head and neck were displaced in downward, forward and medial direction, and posterior and outer middle portion of condyle head and neck were displaced in upward, forward and medial direction. 4. Maximum stress was observed at the condyle head and neck portion. With steeper direction of force, condyle head and neck showed more stress than parallel relation to the occlusal plane.
Dental Occlusion ; Finite Element Analysis* ; Head ; Humans* ; Mandible* ; Models, Theoretical ; Molar* ; Neck ; Tooth ; Traction*

Purpose: This study investigated the perceptions of medical residents and faculty members before the implementation of the duty hour regulation in December 2017. Methods: A survey was administered to 263 residents and 358 faculty members in the Chonnam National University Hospital. The subjects were given a self-administered structured questionnaire designed to measure their perspectives on duty hour regulation. They were also asked to answer an open-ended question regarding their expectations or concerns regarding duty hour regulation. The response rates were 50.2% for residents and 24.0% for faculty members. Results: Residents and faculty members regarded the improvement of junior residents’ well-being favorably, but had conflicting views regarding senior residents. Residents expressed difficulty in completing unchanged workloads within the limited time, while faculty members were more concerned about worsening patient safety due to the discontinuity of care and insufficient resident education. Conclusion Medical residents and faculty members had differing concerns regarding duty hour regulation. Further studies and the development of future policies should be considered to improve resident education and patient safety within the limited duty hour regulation.

The aim of this study was to systematically collect data for evaluating short- and long-term outcomes using Kirkpatrick’s four-level evaluation model, Chonnam National Medical School has established plans for developing and managing a database of student and graduate cohorts. The Education Evaluation Committee, with assistance from the Medical Education Office, manages the development and maintenance of cohort data. Data collection began in the 2022 academic year with first- through fourth-year medical students and graduates of the year 2022. The collected data include sociodemographic characteristics, admission information, psychological test results, academic performance data, extracurricular activity data, scholarship records, national medical licensing exam results, and post-graduation career paths. The Education Evaluation Committee and the Medical Education Office analyze the annually updated student and graduate cohort data and report the results to the dean and relevant committees. These results are used for admissions processes, curriculum improvement, and the development of educational programs. Applicants interested in using the student and graduate cohort data to evaluate the curriculum or conduct academic research must undergo review by the Educational Evaluation Committee before being granted access to the data. It is expected that the collected data from student and graduate cohorts will provide a sound and scientific basis for evaluating short- and long-term achievements based on student, school, and other characteristics, thereby supporting medical education policies, innovation, and implementation.

Despite current regulations requiring social distancing due to coronavirus disease 2019, problem-based learning (PBL) requires student interaction to achieve common goals and enhance critical thinking and deep learning abilities. Social presence in the online education environment reduces both perceptions of physical distance and psychological distance in interactions. This study aimed to compare PBL activities between in-person and videoconferencing classes, and to investigate social presence and learning satisfaction in a videoconferencing PBL environment. The PBL consisted of six modules for both the first and second years of Chonnam National University Medical School. As social distancing was strengthened, the second class of the fifth module in both years was converted to an online format and the fifth module was excluded. The first four PBL modules were conducted as in-person classes, but the last PBL module was administered via videoconferencing. After the final PBL module, 100 (81.3%) first-year medical students and 90 (79.6%) second-year students were asked to complete a self-administered questionnaire on social presence and learning satisfaction. There were no significant differences in the small group activities of tutorial sessions between in-person and videoconferencing classes. In the online videoconferencing class, students who had favorable attitudes toward the tutors’ social role and interactions with peers showed high satisfaction with their learning. In conclusion, online videoconferencing allows students to simultaneously perceive their interactions with others and social presence, even at a distance. Tutors can enhance a sense of online community and collaborative learning as facilitators of online PBL.