PURPOSE: Hypothetico-deductive reasoning (HDR) is an essential learning activity and a learning outcome in problem-based learning (PBL). It is important for medical students to engage in the HDR process through argumentation during their small group discussions in PBL. This study aimed to analyze the quality of preclinical medical students' argumentation according to each phase of HDR in PBL. METHODS: Participants were 15 first-year preclinical students divided into two small groups. A set of three 2-hour discussion sessions from each of the two groups during a 1-week-long PBL unit on the cardiovascular system was audio-recorded. The arguments constructed by the students were analyzed using a coding scheme, which included four types of argumentation (Type 0: incomplete, Type 1: claim only, Type 2: claim with data, and Type 3: claim with data and warrant). The mean frequency of each type of argumentation according to each HDR phase across the two small groups was calculated. RESULTS: During small group discussions, Type 1 arguments were generated most often (frequency=120.5, 43%), whereas the least common were Type 3 arguments (frequency=24.5, 8.7%) among the four types of arguments. CONCLUSION: The results of this study revealed that the students predominantly made claims without proper justifications; they often omitted data for supporting their claims or did not provide warrants to connect the claims and data. The findings suggest instructional interventions to enhance the quality of medical students' arguments in PBL, including promoting students' comprehension of the structure of argumentation for HDR processes and questioning.
Cardiovascular System ; Clinical Coding ; Comprehension ; Humans ; Learning ; Problem-Based Learning* ; Students, Medical*

OBJECTIVES: This study was to investigate the psychiatric diagnoses of survivors of traumatic stress, i.e. torture, as a part of a large research project of a human rights survey of torture survivors. METHODS: Participants were 24 torture survivors who consented to participate, who had experienced torture during the period of 1970 through the 2000's. Participants were recruited from human rights support groups and government agencies using the snowballing technique. Data was collected by a psychiatrist and two psychologists using the MINI-International Neuropsychiatric Interview PLUS. RESULTS: The prevalence of past psychiatric diagnoses which occurred during a post-victimization period included post-traumatic stress disorder (PTSD, 37.5%), depressive disorders (45.8%), panic disorder (16.6%), substance related disorders (24.9%), psychotic disorder (4.1%), and adjustment disorder (16.6%). The prevalence of current diagnoses at interview period included PTSD (33.3%), depressive disorders (41.6%), panic disorder (8.2%), generalized anxiety disorder (4.1%), substance related disorders (20.8%), psychotic disorder (4.1%), adjustment disorder (12.5%), and suicidal tendency of above mid-level (16.6%). The co-morbidity rate was 37.5% in the past, and 33.3% at present. CONCLUSION: It was revealed that torture survivors were suffering from high rates of chronic psychiatric disorders. Appropriate psychiatric treatment may be in need to support the sufferings of the survivors.
Adjustment Disorders ; Anxiety Disorders ; Depressive Disorder ; Government Agencies ; Human Rights ; Humans ; Mental Disorders ; Panic Disorder ; Prevalence ; Psychiatry ; Psychotic Disorders ; Self-Help Groups ; Stress Disorders, Post-Traumatic ; Stress, Psychological ; Survivors ; Torture

The purpose of this study was to investigate the cause of eruption disturbance in the maxillary central incisor and establish the effective treatment plan by analyzing the vertical distance, angulation of long axis and root development of the tooth with eruption disturbance using the cone-beam CT.The average age of 134 patients diagnosed with unilaterally impacted maxillary central incisor was 7.9 years old and the male was 2.1 times higher than the female. The most common cause of eruption disorder was physical obstruction, especially mesiodens and odontoma. Of the teeth with unilateral eruption disorder, 78 cases erupted spontaneously and 56 cases erupted non-spontaneously after removal of physical obstruction.The possibility of spontaneous or non-spontaneous eruption in the unilaterally impacted maxillary central incisor depended on several factors, such as vertical distance, angulation of long axis and root development of unerupted tooth. The spontaneous eruption of the impacted maxillary cental incisor was most frequent at the angulation of long axis of 50 to 90 degrees, which is similar to the angulation of long axis of the normally erupted maxillary central incisor. In addition, the spontaneous eruption period of impacted maxillary central incisor was more influenced by the vertical distance than the angulation of long axis and the root development. Most of the teeth that showed non-spontaneous eruption had orthodontic traction, and these teeth were usually erupted within about 12 months. The period treated with orthodontic traction was no statistical significance with the vertical distance, the angulation of long axis, and the root development.This study will provide information on the cause of unilaterally impacted maxillary cental incisor and help to establish the future treatment plan.
Cone-Beam Computed Tomography ; Female ; Humans ; Incisor ; Male ; Odontoma ; Tooth ; Tooth, Impacted ; Tooth, Unerupted ; Traction

A 46-year-old male presented with skin lesion on the tip of penis, occurring a month ago. Erythematous macules and grouped vesicles on the glans penis and upper side of prepuce area were noticed. In addition, scales were noticed on the tip of glans penis. The lesion was first diagnosed as herpes genitalis based on the clinical manifestation, but had failed to improve with systemic and topical antiviral and topical antibiotics. KOH examinations were performed on his upper glans penis, and we detected pseudo hyphae and spores. Fungal culture and polymerase chain reaction (PCR) study were revealed as Candida albicans. He was successfully treated with topical isoconazole cream twice a day. Candida balanitis refers to candida infections of glans penis. Infectious balanitis presented various clinical presentations, it is not easy to diagnose with clinical presentation only. Therefore, it is essential to include other examination such as KOH examination, microorganism exam, and/or biopsy in the differential diagnosis when cutaneous lesions are noticed in patients. Herein, we present a candida balanitis with atypical features that clinically mimicked herpes genitalis.
Anti-Bacterial Agents ; Balanitis* ; Biopsy ; Candida albicans ; Candida* ; Diagnosis, Differential ; Herpes Genitalis* ; Humans ; Hyphae ; Male ; Middle Aged ; Penis ; Polymerase Chain Reaction ; Skin ; Spores ; Weights and Measures

BACKGROUND: Although cisatracurium has many advantages in anesthetic practices, the best choice of a nondepolarizing neuromuscular blocking agent that can replace succinylcholine is rocuronium. However, it is reported that remifentanil with propofol might provide reliable intubating condition, even without a neuromuscular blocking agent; therefore, it might improve the intubating condition with cisatracurium. This study examined intubating conditions after administering rocuronium or cisatracurium in a rapid sequence induction with remifentanil-propofol. METHODS: Fifty two ASA physical status 1 or 2 adult patients scheduled for an elective surgery were enrolled in a randomized double-blinded trial. Anesthesia was induced in all patients with propofol 2.0 mg/kg and remifentanil 0.5 microgram/kg, administered over 60 seconds. Rocuronium 0.9 mg/kg (3 x ED95, R group, n = 23) or cisatracurium 0.15 mg/kg (3 x ED95, C group, n = 29) was administered after the induction sequence. Laryngoscopy was attempted when the anesthesiologist thought it was 90 seconds after drug administration and appropriate time for intubation. The examiner, another anesthesiologist, recorded the exact time to intubation and suppression of maximal T1 on TOF. The intubating condition was assessed by the first anesthesiologist, as excellent, good, poor or not possible. RESULTS: The best time to laryngoscopy was predicted by measuring TOF and was found to be significantly longer in the C group (197 +/- 53 s) than in the R group (102 +/- 49 s) (P value < 0.05). However, time to larygoscopy, intubating condition during the laryngoscopy, and hemodynamic changes after intubation was similar in both groups. CONCLUSIONS: Despite fundamentally slower onset time, cisatracurium can provide quite good intubating conditions, which were comparable to those achieved with equipotent doses of rocuronium, which is more expensive in anesthesia inducted with remifentanil and propofol.
Adult ; Androstanols ; Anesthesia ; Atracurium ; Hemodynamics ; Humans ; Intubation ; Laryngoscopy ; Neuromuscular Blockade ; Piperidines ; Propofol ; Succinylcholine

OBJECTIVE: Under estrogen deficiency, blastocysts cannot initiate implantation and enter dormancy. Dormant blastocysts live longer in utero than normal blastocysts, and autophagy has been suggested as a mechanism underlying the sustained survival of dormant blastocysts during delayed implantation. Autophagy is a cellular degradation pathway and a central component of the integrated stress response. Reactive oxygen species (ROS) are produced within cells during normal metabolism, but their levels increase dramatically under stressful conditions. We investigated whether heightened autophagy in dormant blastocysts is associated with the increased oxidative stress under the unfavorable condition of delayed implantation. METHODS: To visualize ROS production, day 8 (short-term dormancy) and day 20 (long-term dormancy) dormant blastocysts were loaded with 1-microM 5-(and-6)-chloromethyl-2', 7'-dichlorodihydrofluorescein diacetate, acetyl ester (CM-H2DCFDA). To block autophagic activation, 3-methyladenine (3-MA) and wortmannin were used in vivo and in vitro, respectively. RESULTS: We observed that ROS production was not significantly affected by the status of dormancy; in other words, both dormant and activated blastocysts showed high levels of ROS. However, ROS production was higher in the dormant blastocysts of the long-term dormancy group than in those of the short-term group. The addition of wortmannin to dormant blastocysts in vitro and 3-MA injection in vivo significantly increased ROS production in the short-term dormant blastocysts. In the long-term dormant blastocysts, ROS levels were not significantly affected by the treatment of the autophagy inhibitor. CONCLUSION: During delayed implantation, heightened autophagy in dormant blastocysts may be operative as a potential mechanism to reduce oxidative stress. Further, ROS may be one of the potential causes of compromised developmental competence of long-term dormant blastocysts after implantation.
Animals ; Autophagy* ; Blastocyst* ; Estrogens ; Mental Competency ; Metabolism ; Mice* ; Oxidative Stress ; Reactive Oxygen Species*

BACKGROUND: This study is intended to propose not only to introduce and evaluate the 2 years Clinical Research Coordinator (CRC) professional on-the-job training program that has been implemented in Samsung Medical Center on September of 2009, but also to develop the CRC future education program. METHODS: It is surveyed with self-report type for the 53 trainees, 18 non-trainees, and 17 investigators, the participants worked in Samsung Medical Center, and the major contents of the survey were general characteristics, training program evaluations, CRC qualification evaluation, and job satisfaction. The collected data was analyzed at the 0.05 level of significance by using SAS 9.1 version. RESULTS: The training program is conducted as 4 phases, each phase assessed separately. The Professional A course got the highest satisfaction, and it was deal with quality control (Mean=4.11 ~ 4.33). Most of the investigators answered that the trainees have high priority to be hired in the future (very much=82.45). The non-trainees answered that the training program would be helpful to improve the job competency and qualification (very much=22.2 %, somewhat=55.6 %) and 88.9 % of them answered that they have intention to participate in the training program. Finally, compared to non-trainees, the trainees have more job attachment (P=0.0036) and intention to continue CRC (P=0.0045). CONCLUSION: The CRC professional training program in Samsung Medical Center, as on the job training for 2 years, satisfies the investigators and trainees with positive effect on CRC job satisfaction and job stability. Based on this study, the education program with good quality should be developed considering the characteristics for each institution and close research field.
Humans ; Inservice Training ; Intention ; Job Satisfaction ; Korea ; Phenothiazines ; Quality Control ; Research Personnel

OBJECTIVES: This study examined the association between socioeconomic factors and asthma symptoms. METHODS: A total of 6,919 elementary school children in Seoul were enrolled in the study. Data were obtained from a web-based questionnaire survey. The questionnaire was based on the International Study of Asthma and Allergies in Childhood core module. The prevalence of wheeze in the past 12 months and severe asthma symptoms were obtained. The potential risk factors for asthma symptoms included household income and the number of siblings. A multiple logistic regression analysis was used to calculate the odds ratios (OR) and 95% confidence interval (CI) for the risk factors of asthma symptoms. RESULTS: The prevalence of current wheeze (wheeze in the past 12 months) was 5.2%. Household income and asthma symptoms were inversely associated after adjusting for other potential risk factors (p for trend=0.03). This association was modified by the number of siblings. With two or more siblings, the effect of household income on asthma symptoms was not significant. However, low household income was still a significant variable for patients with fewer than two siblings (OR 1.41; 95% CI, 1.09-1.81). CONCLUSIONS: It appears that childhood asthma disparity is dependent on household income. Therefore, policies to improve childhood health inequities should be emphasized.
Asthma ; Child ; Family Characteristics ; Humans ; Hypersensitivity ; Logistic Models ; Odds Ratio ; Prevalence ; Risk Factors ; Siblings ; Socioeconomic Factors ; Surveys and Questionnaires

Phaeohyphomycosis is an infection of humans and other animals caused by a number of phaeoid fungi. It is characterized by the development of dark-colored hyphae and other types of fungal elements in invaded tissues. Phaeohyphomycosis caused by Exophiala species is an unusual infection, but it has been reported with increasing frequency as laboratory methods for diagnosis have improved. A 68-year-old woman presented with yellowish round crusted plaque which is similar to actinic keratosis or keratoacanthoma on her right cheek. Histopathologic examination showed mononuclear cell infiltrate and dark-brown hyphae. The nucleotide sequence of internal transcribed spacer-2 was identical to that of Exophiala species. We report a case of phaeohyphomycosis mimicking skin cancer.
Aged ; Animals ; Base Sequence ; Cheek ; Diagnosis ; Exophiala* ; Female ; Fungi ; Humans ; Hyphae ; Keratoacanthoma ; Keratosis, Actinic ; Phaeohyphomycosis* ; Skin Neoplasms

Although vitamin C supplements were consumed for health maintenance and fatigue recovery, the effects of high doses of vitamin C supplement remains controversial. Our study performed the effects of 100 mg and 2,000 mg vitamin C supplements on plasma and urinary vitamin C concentration in Korean women. Twenty-four women completed the 4 weeks intervention. Anthropometric data, plasma and urinary vitamin C concentrations, superoxide dismutase activity, thiobarbituric acid reactive substance (TBARS) level, and fatigue severity scale (FSS) were collected, and the statistical analyses compared between- and within-group findings at pre- and post-intervention. Concentrations of vitamin C in plasma and urinary excretion were significantly increased with 100 mg and 2,000 mg of vitamin C supplementation (p < 0.050). TBARS level was decreased significantly with 2,000 mg of vitamin C supplementation (p < 0.050). In addition, FSS was declined significantly in 100 mg of vitamin C supplementation group (p < 0.050). Our result showed that vitamin C supplementation of either 100 mg or 2,000 mg led to an increase in vitamin C concentrations in plasma and vitamin urinary excretion but not statistically significant among groups. TBARS level was decreased in 2,000 mg and FSS was decreased in 100 mg of vitamin C supplementation in Korean women. We suppose that additional clinical trial is needed to examine the effects of vitamin C supplements for a wide range of doses on plasma and urinary vitamin C concentrations in Korean.
Ascorbic Acid* ; Fatigue ; Female ; Humans ; Plasma* ; Superoxide Dismutase ; Thiobarbituric Acid Reactive Substances ; Vitamins*