PURPOSE: This study aims at to make intermediate-term evaluations of a curriculum by investigating its development, operation and outcomes 2 years after its revision. METHODS: A survey using 5-point-Lickert scale questionnaires was given to the group of directors who developed the curriculum, instructors who only used it in their classes, and a student group from the first and second grades. Focus group interviews were performed in the professor groups. RESULTS: Curricular reform was evaluated as being systematic, democratic, and positive in general. Both groups answered questions positively about the relevance of the integrated curriculum and introduction of clinical medicine (ICM), graded as 3.4 (professor) and 3.5 (student). As for problem-based learning (PBL) and the patient-doctor-society (PDS), the professor group responded more positively than students. The 'web-based learning center' was recognized positively by many more students (4.01) than professors (2.75). With regard to the education outcome, professors gave 3.3 points and students 3.5 to an item that asked 'whether students attained the learning goal or not?' Professors, through interviews, showed their satisfaction with the attempt to reform the curriculum, but they pointed out that long-term evaluations should be performed. CONCLUSION: The interim evaluation of the revised curriculum, from its planning to its effects, affirmed by several suggestions to be successful in the long run through 1) enhancement of systematic participation and communication, 2) further integration, 3) steady evaluation, 4) greater effort on professional development, and 5) active interaction between professors and students.
Clinical Medicine ; Curriculum ; Evaluation Studies as Topic ; Focus Groups ; Humans ; Learning ; Problem-Based Learning ; Schools, Medical ; Surveys and Questionnaires

BACKGROUND: In this study, we present a case of unicystic ameloblastoma (UA) treated by marsupialization followed by surgical enucleation as a conservative approach. UA is a rare, benign, less aggressive, and less invasive variant of ameloblastoma that is observed quite often in younger patients. Radical approaches have effects on the physical and psychological development of a growing young patient; therefore, conservative approaches are widely used for UA management in children. CASE PRESENTATION: This report described a case of an 11-year-old girl with UA of the mandibular molar–ramus area, which also involved impaction of the second and third molars. The lesion was marsupialized, and 31 months after marsupialization, surgical enucleation was performed with extraction of the impacted third molar. The second molar, which was preserved, spontaneously and completely erupted. No recurrence was observed during a 49-month follow-up. CONCLUSIONS: Conservative treatments for UA in young patients have more advantages. Our results provide evidence that marsupialization is effective in regressing the lesion size to ease complete removal, preserving mandibular growth, maintaining involved second molar, and promoting the eruption of the tooth.
Ameloblastoma* ; Child ; Female ; Follow-Up Studies ; Humans ; Molar ; Molar, Third ; Recurrence ; Tooth ; Tooth Eruption

This paper reviews the global effect of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of children and adolescents in South Korea, the U.S., Japan, and China. We reviewed research on deteriorated mental health, including increased suicide, suicidal thoughts, and self-harm. Various studies have shown that students’ mental health issues, such as depression and anxiety, have worsened during the COVID-19 pandemic. Furthermore, the number of students who committed suicide has significantly increased in the U.S. and Japan. Factors such as prior mental health status, change in daily routine, reduced physical activity, excessive screen time, overuse of electronic devices, and reduced social support have been reported to have a significant effect. The chain of deteriorating mental health among the youth began at the onset of COVID-19, social distancing, and school closure. As youths began to stay at home instead of going to school, they lost opportunities to connect with their friends or teachers, who could provide support outside of their homes. Young people spent less time on physical activity and more time online, which damaged their sleeping schedule and daily routine. In preparing for the post-pandemic phase, we should thoroughly analyze the long-term effects of the pandemic on youth mental health, while simultaneously tackling current imminent issues.

Background and Objectives: Human mesenchymal stem cell-conditioned medium (MSC-CM) is produced using mesenchymal stem cell culture technology and has various benefits for the skin, including wrinkle removal, skin regeneration, and increased antioxidant activity. Its popularity is thus increasing in the field of functional cosmetics. Methods: and Results: In this study, we analyzed the effects of fetal bovine serum-supplemented MSC-CM (FBSMSC-CM) and human platelet lysate-supplemented MSC-CM (hPL-MSC-CM) on skin rejuvenation characteristics.We found that the concentrations of important growth factors (VEGF, TGF-β1, and HGF) and secretory proteins for skin regeneration were significantly higher in hPL-MSC-CM than in FBS-MSC-CM. Furthermore, the capacity for inducing proliferation of human dermal fibroblast (HDF) and keratinocytes, the migration ability of HDF, extracellular matrix (ECM) production such as collagen and elastin was higher in hPL-MSC-CM than that in FBSMSC-CM. Conclusions These results support the usefulness and high economic value of hPL-MSC-CM as an alternative source of FBS-MSC-CM in the cosmetic industry for skin rejuvenation.

OBJECTIVE: A defense mechanism is an automatic psychological process necessary for successful adaptation. It reflects adaptive capacity. The purpose of this study is to explore the relationship between the adaptation ability of individuals who face mandatory military service and the pattern of defense mechanisms. METHODS: The subjects were 69 men (21.4±2.2 years) who expressed psychological difficulties in three military service situations. Control group was 36 men (24.0±1.4 years) who had successfully completed military service. We examined psychiatric history, the pattern of defense mechanisms, and depression and anxiety levels. Defense mechanisms were compared between two groups. RESULTS: The maladjusted group used immature defenses more frequently than the control group did. There were no differences in the defense patterns according to diagnosis. The control group used more identification and rationalization, classified as immature defenses. The temporarily maladjusted group used more somatization, regression, and avoidance. CONCLUSION: Using mature defense mechanisms helped young adults to adapt to a particular situation. The maturity of the defense is more valuable than the psychiatric diagnosis. Some immature defenses are also helpful to adapt. We cautiously assume that some defenses can be protective or risk factors in adapting to stressful situations by young adults.
Anxiety ; Defense Mechanisms ; Depression ; Diagnosis ; Humans ; Korea ; Male ; Mental Disorders ; Military Personnel ; Rationalization ; Risk Factors ; Social Adjustment ; Young Adult

PURPOSE: To compare the evaluation results of faculties to those of Standardized Patients (SP) participating in a Clinical Performance Examination (CPX) administered at Ewha Womans University College of Medicine. METHODS: The CPX was taken by 77 fourth year medical students. Cases and checklist were developed by the medical school consortium in capital area. Six cases were used and 24 SPs participated and evaluated the students' performances. The whole session was recorded on videotapes so that 6 medical school faculties could analyze and evaluate the students' performances as well. The results were compared and analyzed by SPSS package. RESULTS: The agreement between the faculties and the SPs was relatively good (r=0.79), but not good enough. In every case, SPs gave higher marks than did the faculties. Clear disease entity cases like "hepatitis" and "anemia" showed better agreement than obscure clinical contexts such as "bad news delivery". Better agreement was seen in the items of physical exam category (r=0.91), but the agreement was very poor in the items of doctor-patient (Dr-Pt) relationship category (r=0.54). The construction of checklist and the character of each evaluation item should influence the differences. CONCLUSION: More detailed guidelines and clear/specific evaluating items are necessary to improve the agreement rate. In certain categories like physical exam and brief history taking, the SP' s evaluation can replace the faculties', but for complex contexts like Dr-Pt relationship.
Checklist ; Female ; Humans ; Schools, Medical ; Students, Medical ; Videotape Recording

PURPOSE: Clinical performance examination(CPX) using standardized patients(SPs) is an acceptable method of testing medical professionals, but there has been some concerns about security. The objective of this work is to examine whether the day of the examination influences the scores of examinees of different medical schools at different times throughout the examination period. METHODS: Six medical schools, which had participated in the Seoul-Gyeonggi CPX Consortium 2005, were enrolled. Each station, controlled by the same regulations, included 12 minutes of SP encounter and 5 minutes of writing a short essay. We compared the mean scores using ANOVA and linear trends with multiple regression analyses and SPSS version 11.0. RESULTS: The mean score of examinees from all 6 medical schools was 63.2+/-.9. There was no difference in total mean scores among the medical schools according to the period when CPX was conducted. Classified by their examination day, there was no difference among the mean scores of the 1st, 2nd, and 3rd day, but in one school where the examination was performed for 5days, the mean scores of the 4th day was higher than the others(p<0.05). There were trends of linear increases over the five days for the 'physical examination'question, but not for 'physician-patient interaction'and 'patient education'. CONCLUSION: The changes in scores according to the examination day in this study did not show consistent results. However, the variable results seen according to school, test question, and examination day need further analysis for test security issues.
Clinical Competence ; Humans ; Schools, Medical* ; Social Control, Formal ; Writing

BACKGROUND: The p16INK4a gene methylation has been reported to be a major tumorigenic mechanism. METHODS: We evaluated the methylation status of the p16INK4a genes in 231 invasive breast cancer and 90 intraductal carcinoma specimens using a methylation-specific polymerase chain reaction and p16 protein expression using immunohistochemistry. The quantity of cell-free methylated p16INK4a DNA in the plasma samples of 200 patients with invasive breast cancer was also examined using a fluorescence-based real-time polymerase chain reaction assay. RESULTS: The frequencies of p16INK4a methylation in invasive and intraductal tumors were 52.8% (122/231) and 57.8% (52/90), respectively. The p16 protein was overexpressed in 145 of the 231 invasive carcinomas (62.8%) and 63 of the 90 intraductal carcinomas (70%). High p16 expression in invasive carcinomas correlated significantly with a high histologic grade, a negative estrogen receptor and progesterone receptor status, p53 immunoreactivity and high Ki-67 expression with immunohistochemistry. In addition, the methylation index of p16INK4a was significantly higher in the cancer patients than the normal controls (p<0.001). CONCLUSIONS: High p16 immunoreactivity correlated with a loss of differentiation in breast carcinomas and high frequency of p16INK4a promoter methylation in both invasive and intraductal carcinomas, suggesting it may be involved in the pathogenesis of breast cancer.
Breast ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; DNA ; Estrogens ; Genes, p16 ; Genes, Tumor Suppressor ; Humans ; Immunohistochemistry ; Methylation ; Plasma ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Receptors, Progesterone

PURPOSE: Clostridium difficile (C. difficile) is an important cause of nosocomial diarrhea. Diagnostic methods for detection of C. difficile infection (CDI) are shifting to molecular techniques, which are faster and more sensitive than conventional methods. Although recent advances in these methods have been made in terms of their cost-benefit, ease of use, and turnaround time, anaerobic culture remains an important method for detection of CDI. MATERIALS AND METHODS: In efforts to evaluate a novel chromogenic medium for the detection of C. difficile (chromID CD agar), 289 fecal specimens were analyzed using two other culture media of blood agar and cycloserine-cefoxitin-fructose-egg yolk agar while enzyme immunosorbent assay and polymerase chain reaction-based assay were used for toxin detection. RESULTS: ChromID showed the highest detection rate among the three culture media. Both positive rate and sensitivity were higher from chromID than other culture media. ChromID was better at detecting toxin producing C. difficile at 24 h and showed the highest detection rate at both 24 h and 48 h. CONCLUSION: Simultaneous use of toxin assay and anaerobic culture has been considered as the most accurate and sensitive diagnostic approach of CDI. Utilization of a more rapid and sensitive chromogenic medium will aid in the dianogsis of CDI.
Chromogenic Compounds/chemistry ; Clostridium difficile/chemistry/*isolation & purification ; Culture Media/*chemistry

Background: Nationwide research on the association between carbapenem-resistant Enterobacterales (CREs) and antibiotic use is limited. Methods: This nested case-control study analyzed Korean National Health Insurance claims data from April 2017 to April 2019. Based on the occurrence of CRE, hospitalized patients aged ≥ 18 years were classified into CRE (cases) and control groups. Propensity scores based on age, sex, modified Charlson comorbidity score, insurance type, long-term care facility, intensive care unit stay, and acquisition of vancomycin-resistant Enterococci were used to match the case and control groups (1:3). Results: After matching, the study included 6,476 participants (1,619 cases and 4,857 controls).Multivariable logistic regression analysis revealed that the utilization of broad-spectrum antibiotics, such as piperacillin/tazobactam (adjusted odds ratio [aOR], 2.178; 95% confidence interval [CI], 1.829–2.594), third/fourth generation cephalosporins (aOR, 1.764; 95% CI, 1.514–2.056), and carbapenems (aOR, 1.775; 95% CI, 1.454–2.165), as well as the presence of comorbidities (diabetes [aOR, 1.237; 95% CI, 1.061–1.443], hemiplegia or paraplegia [aOR, 1.370; 95% CI, 1.119–1.679], kidney disease [aOR, 1.312; 95% CI, 1.105–1.559], and liver disease [aOR, 1.431; 95% CI, 1.073–1.908]), were significantly associated with the development of CRE.Additionally, the CRE group had higher mortality (8.33 vs. 3.32 incidence rate per 100 personmonths, P < 0.001) and a total cost of healthcare utilization per person-month (15,325,491 ± 23,587,378 vs. 5,263,373 ± 14,070,118 KRW, P < 0.001) than the control group. Conclusion The utilization of broad-spectrum antibiotics and the presence of comorbidities are associated with increasing development of CRE. This study emphasizes the importance of antimicrobial stewardship in reducing broad-spectrum antibiotic use and CRE disease burden in Korea.