PURPOSE: The purpose of this study was to analyze the opinions of students and tutors about the use of reflective journals in Problem Based Learning performed in Seoul National University College of Medicine over a period of 4 weeks, and to determine the possible applications of such journals as an evaluation tool. METHODS & RESULTS: The writing of a reflective journal helps students to achieve some of the important PBL goals, for example, keeping such a journal encourages students to reflect on their learning experiences, and fosters problem solving skills. All students were asked to complete the same questionnaire every weeks for the four week period. Most students thought of a reflective journal as a tool for personal reflection, rather than as a tool for fostering problem solving skills. The questionnaire was rated on 5 point scale: from 'very important' to 'not important at all'. Fifty eight percent of tutors and 20% of students replied that the journal writing was 'very important'. CONCLUSION: We suggest the following items for the future application of the reflective journal as an evaluation tool. First, intimate trust should be developed between students and tutors, as a reflective journal can include private matters. Second, tutors should give feedback for the student's reflective journal. Finally, comprehensive direction should be given to students and tutors to allow them to use their reflective journals effectively.
Foster Home Care ; Humans ; Learning ; Problem Solving ; Problem-Based Learning* ; Seoul ; Writing ; Surveys and Questionnaires

The inflammasome is a multi-protein complex that induces maturation of inflammatory cytokines interleukin (IL)-1beta and IL-18 through activation of caspase-1. Several nucleotide binding oligomerization domain-like receptor family members, including NLRP3, recognize unique microbial and danger components and play a central role in inflammasome activation. The NLRP3 inflammasome is critical for maintenance of homeostasis against pathogenic infections. However, inflammasome activation acts as a double-edged sword for various bacterial infections. When the IL-1 family of cytokines is secreted excessively, they cause tissue damage and extensive inflammatory responses that are potentially hazardous for the host. Emerging evidence has shown that diverse bacterial pathogens or their components negatively regulate inflammasome activation to escape the immune response. In this review, we discuss the current knowledge of the roles and regulation of the NLRP3 inflammasome during bacterial infections. Activation and regulation of the NLRP3 inflammasome should be tightly controlled to prevent virulence and pathology during infections. Understanding the roles and regulatory mechanisms of the NLRP3 inflammasome is essential for developing potential treatment approaches against pathogenic infections.
Bacterial Infections/immunology/metabolism/pathology/prevention & control ; Carrier Proteins/*metabolism ; Caspase 1/metabolism ; Humans ; Inflammasomes/immunology/*metabolism ; Interleukin-1beta/metabolism ; Signal Transduction

INTRODUCTION: In today's society, the rapid and appropriate care of the dental emergency patients is much more important. So, a retrospective study on the characteristics of emergency dental injuries and diseases will be very meaningful. MATERIALS AND METHODS: This retrospective clinical study was carried by reviewing the radiographic films and emergency chart of 11,493 patients who had visited the emergency room of Hallym Sacred heart Hospital and were treated in the Department of Oral and Maxillofacial Surgery from January 2006 to December 2010. RESULTS: The male to female ratio was 1.9:1. The highest monthly incidence was observed in May (10.4%) and June (8.9%) and the peak age distribution was the first decade (56.0%), followed by the second decade (16.0%). Trauma was the most common cause in dental emergency patients, followed in order by toothache, odontogenic infection, temporomandibular joint (TMJ) disorder and oral hemorrhage. Soft tissue injury was most prevalent in the trauma group, followed by tooth injury and facial bone fractures. In the tooth injury group, tooth fracture (56.7%) showed the highest incidence followed in order by tooth subluxation (18.2%), tooth concussion (16.9%), tooth avulsion (11.5%) and alveolar bone fractures (3.7%). In the facial bone fracture group, mandibular fractures (81.8%) showed the highest incidence followed in order by maxilla fractures (15.7%), nasal bone fractures (9.0%), zygomaticomaxillary complex fractures (5.4%), orbital bone fractures (2.5%). In mandibular bone fractures, the most common location was the symphysis (70.1%), followed in order by the mandibular angle (33.0%), mandibular condyle (22.8%) and mandibular body (13.6%). In the infection group, a submandibular space abscess (46.2%) was most common followed in order by a buccal space abscess (17.4%), canine space abscess (16.9%) and submental space abscess (12.3%). TMJ dislocation (89.3%) showed the highest incidence in the TMJ disorder group, followed by TMJ derangement (10.7%). In the other group, a range of specific symptoms due to post operation complications, trigeminal neuralgia, chemical burns and foreign body aspiration were reported. CONCLUSION: For the rapid and appropriate care of the dental emergency patients, well-organized system should be presented in oral and maxillofacial surgery. And it is possible under analysis of pattern and the variation of the dental emergency patients.
Abscess ; Age Distribution ; Burns, Chemical ; Dislocations ; Emergencies ; Facial Bones ; Female ; Foreign Bodies ; Fractures, Bone ; Heart ; Humans ; Incidence ; Male ; Mandibular Condyle ; Mandibular Fractures ; Maxilla ; Nasal Bone ; Oral Hemorrhage ; Orbit ; Retrospective Studies ; Soft Tissue Injuries ; Surgery, Oral ; Temporomandibular Joint ; Temporomandibular Joint Disorders ; Tooth ; Tooth Avulsion ; Tooth Fractures ; Tooth Injuries ; Toothache ; Trigeminal Neuralgia ; X-Ray Film

BACKGROUND/AIMS: Osteoprotegerin (OPG) and fetuin-A are vascular calcification regulators that may be related to high cardiovascular (CV) mortality in hemodialysis (HD) patients. We evaluated the relationship between OPG, fetuin-A, and pulse wave velocity (PWV), a marker of vascular stiffness, and determined whether OPG and fetuin-A were independent predictors of CV events in HD patients. METHODS: We conducted a prospective observational study in 97 HD patients. OPG and fetuin-A were measured at baseline and arterial stiffness was evaluated by PWV. All patients were stratified into tertiles according to serum OPG levels. RESULTS: A significant trend was observed across increasing serum OPG concentration tertiles for age, HD duration, systolic blood pressure, cholesterol, triglycerides, and PWV. Multiple linear regression analysis revealed that diabetes (beta = 0.430, p = 0.000) and OPG levels (beta = 0.308, p = 0.003) were independently associated with PWV. The frequency of new CV events was significantly higher in the upper OPG tertiles compared with those in the lower OPG tertiles. In Cox proportional hazards analysis, upper tertiles of OPG levels were significantly associated with CV events (hazard ratio = 4.536, p = 0.011). CONCLUSIONS: Serum OPG, but not fetuin-A, levels were closely associated with increased vascular stiffness, and higher OPG levels may be independent predictors of new CV events in HD patients.
Adult ; Aged ; Biological Markers/blood ; Cardiovascular Diseases/blood/diagnosis/*etiology/mortality/physiopathology ; Female ; Humans ; Kaplan-Meier Estimate ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Osteoprotegerin/*blood ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Pulse Wave Analysis ; *Renal Dialysis/adverse effects/mortality ; Renal Insufficiency, Chronic/complications/diagnosis/mortality/*therapy ; Risk Factors ; Up-Regulation ; *Vascular Stiffness ; alpha-2-HS-Glycoprotein/analysis

INTRODUCTION: The placement of a single miniplate is not sufficient to achieve rigid fixation in mandibular angle fractures. It often causes difficulties in reducing the intermaxillary fixation (IMF) period. Consequently, the placement of 2 miniplates is preferable. The intraoral approach in an open reduction and internal fixation (ORIF) of a mandibular angle fracture with 2 miniplates is often challenging. Accordingly, an alternative of transbuccal approach is performed. However, this method leaves a scar on the face and can result in facial nerve injury. This clinical study suggests a protocol that can maintain rigid fixation without a transbuccal approach in mandibular angle fractures. MATERIALS AND METHODS: The subjects were 7 patients who sustained fractures of the mandibular angle and treated at Department of Oral and maxillofacial surgery, Sacred Heart Hospital, Hallym University. ORIF under general anesthesia was done using the intraoral approach. One miniplate was inserted on external oblique ridge of the mandible, and the other was placed on lateral surface of the mandibular body with contra-angle drill and driver. A radiographic assessment and occlusal contact point examination was carried out before surgery, and 2, 4 and 6 weeks after surgery. RESULTS: The mean operation time was 80 minutes. Regarding the occlusion state, the number of contact points increased after surgery. Paresthesia and infection were reported to be complications before surgery. CONCLUSION: The placement of 2 miniplates using contra-angle drill for ORIF of mandibular angle fractures allows early movement of the mandible without IMF. We propose this approach to reduce the patients' discomfort and simplify the surgical procedure.
Anesthesia, General ; Cicatrix ; Facial Nerve Injuries ; Heart ; Humans ; Mandible ; Mandrillus ; Paresthesia ; Prospective Studies ; Surgery, Oral

BACKGROUND/AIMS: Spontaneous HBeAg seroconversion occurs frequently in the immune reactive phase in HBeAg-positive chronic hepatitis B (CHB). Therefore, observation for 3-6 months before commencing antiviral therapy is recommended in patients with alanine aminotransferase (ALT) levels that exceed twice the upper limit of normal (ULN). However, HBeAg seroconversion occurs infrequently in patients infected with hepatitis B virus (HBV) genotype C. The aim of the present study was to determine whether the waiting policy is necessary in endemic areas of HBV genotype C infection. METHODS: Ninety patients with HBeAg-positive CHB were followed prospectively without administering antiviral therapy for 6 months. Antiviral therapy was initiated promptly at any time if there was any evidence of biochemical (i.e., acute exacerbation of HBV infection or aggravation of jaundice) or symptomatic deterioration. After 6 months of observation, antiviral therapy was initiated according to the patient's ALT and HBV DNA levels. RESULTS: Only one patient (1.1%) achieved spontaneous HBeAg seroconversion. Biochemical and symptomatic deterioration occurred before 6 months in 17 patients (18.9%) and 5 patients, respectively. High ALT and HBV DNA levels were both independent risk factors for biochemical deterioration. Of 15 patients with HBV DNA > or =5.1x107 IU/mL and ALT > or =5xULN, biochemical deterioration occurred in 7 (46.7%), including 1 patient receiving liver transplantation due to liver failure. CONCLUSIONS: Spontaneous HBeAg seroconversion in patients with HBeAg-positive CHB is rare within 6 months. Biochemical deterioration was common and may lead to liver failure. Immediate antiviral therapy should be considered, especially in patients with high ALT and HBV DNA levels in endemic areas of genotype C infection.
Adult ; Alanine Transaminase/blood ; Antiviral Agents/*therapeutic use ; DNA, Viral/blood ; Female ; Follow-Up Studies ; Genotype ; Guanine/analogs & derivatives/therapeutic use ; Hepatitis B e Antigens/*blood ; Hepatitis B virus/*genetics ; Hepatitis B, Chronic/*drug therapy ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk Factors

The incidence of aspergillosis infections in the maxillary sinus has increased recently, because of overuse of antibiotics, steroids, anticancer agents, immunosuppressant, antimetabollites, and uncontrolled diabetes mellitus. The clinical features of maxillary sinus aspergillosis include pain, swelling and foul odor nasal excretion. This needs to be differentiated from bacterial maxillary sinusitis, and surgical treatment with antifungal agents are suggested. Recently, we treated two patients with maxillary sinus aspergillosis surgically (Caldwell Luc operation) and with antifungal agents(itraconazole). The results were satisfactory so we report these cases with literature review.
Anti-Bacterial Agents ; Antifungal Agents ; Antineoplastic Agents ; Aspergillosis ; Diabetes Mellitus ; Humans ; Incidence ; Itraconazole ; Maxillary Sinus ; Maxillary Sinusitis ; Odors ; Steroids

A squamous odontogenic tumor (SOT) is an epithelial originated benign tumor. It has been rarely reported and most was intramural type. We observed a case of SOT in the mandible. It was associated with the odontogenic cyst. It was shown positive to pancytokeratin and p53. Considering that the case was free from recurrence for 5 years after surgery, p53 positive did not seem to be related to the prognosis of the disease.
Mandible ; Odontogenic Cysts ; Odontogenic Tumor, Squamous* ; Prognosis ; Recurrence

OBJECTIVE: The objective of this international comparative study was to investigate the clinical features and outcome of the treatment of infratemporal fossa abscess (IFA). STUDY DESIGN: This retrospective study was conducted at the Deptartment of Oral and Maxillofacial Surgery of Hallym University and "Iuliu Hatieganu" University of Medicine and Pharmacy. Ten-year records of patients were reviewed in Romania and six-year records were reviewed in Korea. The collected data was then analyzed. RESULTS: A total of 36 cases were found to be IFA (12 males and 24 females: average age; 36.3+/-15.5 yrs: 34 cases from Romania and 2 cases from Korea). The annual frequency of IFA in Romanian and Korean hospitals was 3.40 and 0.33 respectively (P<0.001). The etiology was septic anesthesia (33.3%), infection occurring after extraction (30.6%), periapical lesion (13.9%), impacted third molar (8.3%), post-extraction alveolitis (5.6%), and unknown (8.3%). A successful outcome was seen in 27 patients (75.0%) after initial treatment. The main complication after initial treatment was restricted movement of the mouth (9 cases). CONCLUSION: The etiology of IFA was various and minimal swelling hampered early diagnosis. To prevent IFA, preoperative painting with antiseptic agent must be stressed and proper drainage proved important to relieve pain and to prevent further complications.
Abscess* ; Anesthesia ; Drainage ; Early Diagnosis ; Female ; Humans ; Korea ; Male ; Molar, Third ; Mouth ; Paint ; Paintings ; Pharmacy ; Retrospective Studies ; Romania ; Surgery, Oral

PURPOSE: Silk fibroin (SF) is a new degradable barrier membrane for guided bone regeneration (GBR) that can reduce the risk of pathogen transmission and the high costs associated with the use of collagen membranes. This study compared the efficacy of SF membranes on GBR with collagen membranes (Bio-Gide(R)) using a rat calvarial defect model. MATERIALS AND METHODS: Thirty-six male Sprague Dawley rats with two 5 mm-sized circular defects in the calvarial bone were prepared (n=72). The study groups were divided into a control group (no membrane) and two experimental groups (SF membrane and Bio-Gide(R)). Each group of 24 samples was subdivided at 2, 4, and 8 weeks after implantation. New bone formation was evaluated using microcomputerized tomography and histological examination. RESULTS: Bone regeneration was observed in the SF and Bio-Gide(R)-treated groups to a greater extent than in the control group (mean volume of new bone was 5.49 +/- 1.48 mm3 at 8 weeks). There were different patterns of bone regeneration between the SF membrane and the Bio-Gide(R) samples. However, the absolute volume of new bone in the SF membrane-treated group was not significantly different from that in the collagen membrane-treated group at 8 weeks (8.75 +/- 0.80 vs. 8.47 +/- 0.75 mm3, respectively, P=.592). CONCLUSION: SF membranes successfully enhanced comparable volumes of bone regeneration in calvarial bone defects compared with collagen membranes. Considering the lower cost and lesser risk of infectious transmission from animal tissue, SF membranes are a viable alternative to collagen membranes for GBR.
Animals ; Bone Regeneration* ; Collagen* ; Dental Implants ; Disease Transmission, Infectious ; Fibroins* ; Guided Tissue Regeneration ; Humans ; Male ; Membranes* ; Microcomputers ; Osteogenesis ; Rats* ; Rats, Sprague-Dawley ; Silk*