No abstract available.
DNA* ; Immunophenotyping*

In this paper, we present some results from an experimental web-based Problem-Based Learning(PBL) course, which was offered to 64 medical students in the first grade at Konkuk university for 7 weeks. For the course, we developed a web-based PBL module, which is composed of three sections. The first section includes the 8 stages of problem probing and solving in patient's care. In every stage, the students can browse all the data for the problem solving. The second section contains some problems for evaluating the academic achievement of the students who successfully passed in the first section. In the third section, some questionnaires are presented to survey the students response. The followings are the results. 1. Average score of the first section was 64.1+/-13.2. Most students participated in the course with integrity, and especially seven students(11%) were remarkable in their clinical reasoning. 2.The student's computer skill did not largely affect their academic achievements. However, it is desirable for the students to learn basic computer usage in advance. 3.A few students attended to the discussion through bulletin board facilities. Considering the importance of discussion in PBL, we need to devise a new way of attracting students in the discussion. 4. The survey showed that sixty five percent of the students thought that the lecture was effective and ninety one percent of them that it would be better if it is offered as a regular course during summer or winter vacations. Seventy five percent of students became to realize the importance of basic sciences such as biochemistry and physiology after this course. 5. There were many students who complained about the malfunctioning of the system. The system should be modified to be more reliable and robust. In conclusion, the web-based PBL course provided an effective way of learning in medical education. It also turned out to be used as an alternative of traditional PBL and especially useful for self study.
Biochemistry ; Education, Medical ; Humans ; Learning ; Physiology ; Problem Solving ; Problem-Based Learning* ; Students, Medical ; Surveys and Questionnaires

BACKGROUND: Currently the most common treatment modality of refractory ascites in patients with liver cirrhosis was large volume paracentesis, but this procedure usually needed albumin infusion and occasionally developed unwanted complications. By reason of albumin shortage in Korea and occasional unfavorable complications, we studied the usefulness of dialytic ultrafiltration as an another treatment modality of refractory ascites. METHODS: Dialytic ultrafiltration was done in 10 patients (total 48 times) with liver cirrhosis or hepatocellular carcinoma. Two drainage conduit (via 16 gauge angio-catheter) of input and output were made by puncture of patient's right and left lower quadrant abdomen. The initial ultrafiltration rate of dialyser was 250mL/min. Ascitic fluid was removed continuously until the filtration rate down at 50mL/min. After ultrafiltration, ascitic fluid contained concentrated albumin and large molecules was reinfused via input conduit. Pre-treatment and post-treatment level of blood chemistry, plasma renin concentration, aldosterone, and electrolytes in serum; total protein and albumin in ascites were measured. During the ultrafiltration, we closely observed the change of blood pressure, heart rates and mental status. RESULTS: The mean ultrafiltration time was 231+/-28min, ultrafiltrated volume was 5.15+/-1.41 L. During dialytic ultrafiltration, patient's blood pressure and heart rate were stable and there was no change of mental status. After dialytic ultrafiltration, blood urea nitrogen level significantly decreased from 30.5+/-23.7mg/dL to 25.7+/-20.2mg/dL; serum aldosterone level decreased from 807.3+/-301.1pg/ml to 431.1+/-187.2pg/ml in serum (P<0.01). The albumin level in the ascitic fluid significantly increased from 0.67+/-0.28g/dL to 1.90+/-1.16g/dL (P<0.01). Plasma renin concentration level tend to decreased (P=0.06). The patient's serum total protein, albumin, electrolytes, and creatinine were not changed. Complications of dialytic ultrafiltration were peritonitis (one case) and hypotension (one case). But these unwanted complications were readily managed by adequate antibiotics and intravenous fluid therapy. CONCLUSION: The dialytic ultrafiltration can be used effectively without albumin infusion in the treatment of refrartory ascites in patients with advanced liver cirrhosis.
Abdomen ; Aldosterone ; Anti-Bacterial Agents ; Ascites* ; Ascitic Fluid ; Blood Pressure ; Blood Urea Nitrogen ; Carcinoma, Hepatocellular ; Chemistry ; Creatinine ; Drainage ; Electrolytes ; Filtration ; Fluid Therapy ; Heart Rate ; Humans ; Hypotension ; Korea ; Liver Cirrhosis* ; Liver* ; Paracentesis ; Patient Rights ; Peritonitis ; Plasma ; Punctures ; Renin ; Ultrafiltration*

The objective of this study was to investigate national surgical trends for distal radius fractures (DRFs) in Korea and analyze healthcare institution type-specific surgical trends. We analyzed a nationwide database acquired from the Korean Health Insurance Review and Assessment Service (HIRA) from 2011 to 2015. International Classification of Diseases, 10th revision (ICD-10) codes and procedure codes were used to identify patients aged ≥ 20 years with newly diagnosed DRFs. A total of 459,388 DRFs occurred from 2011 to 2015. The proportion of DRF cases treated by surgery tended to increase over time, from 32.6% in 2011 to 38.3% in 2015 (P < 0.001). Open reduction with internal fixation (ORIF) using a plate steadily gained in popularity each year, increasing from 39.2% of overall surgeries in 2011 to 60.9% in 2015. The type of surgery for DRFs differed depending on the type of healthcare institution. ORIF (91%) was the most popular procedure in tertiary hospitals, whereas percutaneous pinning (58%) was most popular in clinics. In addition, general hospitals and hospitals with 30–100 beds used external fixation more frequently than tertiary hospitals and clinics did. Overall, our findings indicate that surgical treatment of DRF, particularly ORIF, continues to increase, and that the component ratio of operation codes differed according to the healthcare institution type.
Delivery of Health Care ; Epidemiology ; Hospitals, General ; Humans ; Insurance, Health ; International Classification of Diseases ; Korea* ; Radius Fractures* ; Radius* ; Tertiary Care Centers

Usual presentations of bilateral vestibular loss are ataxia and oscillopsia. However, fluctuating dizziness is also observed in bilateral vestibulopathy patient. Fluctuating vestibular function in bilateral vestibular loss patients may suggest asymmetric progression of functional loss after compensation is partially accomplished. Because labyrinthine lesion causing vestibular loss is a predisposing factor of benign paroxysmal positional vertigo (BPPV), secondary BPPV can also be developed in bilateral vestibular loss patients. However, BPPV has been hardly noticed in bilateral vestibulopathy patients as a cause of fluctuating dizziness. Authors experienced two cases of BPPV developed in bilateral vestibular loss, one of which showed complete dead labyrinth on ice water caloric test and no significant vestibule-ocular reflex on rotation test. These cases show recurrent BPPV can be the cause of recurrent vertigo in bilateral vestibular loss patients.
Ataxia ; Caloric Tests ; Causality ; Compensation and Redress ; Dizziness ; Ear, Inner ; Humans ; Ice ; Reflex ; Vertigo* ; Vestibular Diseases ; Vestibular Function Tests ; Water

BACKGROUND: Some chemotherapeutic drugs induce NF-κB activation by degrading the IκBα protein in cancer cells which contributes to anticancer drug resistance. We hypothesized that inhibiting IκBα degradation would block NF-κB activation and result in increased tumor cell mortality in response to chemotherapy. METHODS: The "superrepressor" form of the NF-κB inhibitor was transferred by an adenoviral vector (Ad-IκBα-SR) to the human lung cancer cell lines (NCI H157 and NCI H460). With a MTT assay, the level of sensitization to cisplatin and paclitaxel were measured. To confirm the mechanism, an EMSA and Annexin V assay were performed. RESULTS: EMSA showed that IκBα-SR effectively blocked the NF-κB activation induced by cisplatin. Transduction with Ad-IκBα-SR resulted in an increased sensitivity of the lung cancer cell lines to cisplatin and paclitaxel by a factor of 2~3 in terms of IC50. Annexin-V analysis suggests that this increment in chemosensitivity to cisplatin probably occurs through the induction of apoptosis. CONCLUSION: The blockade of chemotherapeutics induced NF-κB activation by inducing Ad-IκBα-SR, increased apoptosis and increasing the chemosensitivity of the lung cancer cell lines tested, subsequently. Gene transfer of IκBα-SR appears to be a new therapeutic strategy of chemosensitization in lung cancer.
Adenoviridae ; Annexin A5 ; Apoptosis ; Cell Line* ; Cisplatin ; Drug Resistance ; Drug Therapy ; Humans* ; Inhibitory Concentration 50 ; Lung Neoplasms* ; Lung* ; Mortality ; Paclitaxel*

H type of congenital tracheoesophageal fistula (TEF) is rare, occurring approximately once in 100,000 births. The presentation of this anomaly in adults is indeed uncommon. We report a case of a 47-year-old male with congenital TEF dectected during epidural hematoma removal under general anesthesia. Intermittent disappearance of normal capnography, bubbling sound at substernal area, and air leakage at oral cavity observed during manually assisted ventilation, especially during inspiration. We observed a H-type of TEF and tracheal intubation via esophagus in chest CT after operation.
Adult ; Anesthesia, General ; Capnography ; Esophagus ; Hematoma ; Humans ; Intubation ; Male ; Middle Aged ; Mouth ; Parturition ; Thorax ; Tracheoesophageal Fistula ; Ventilation

BACKGROUND: Bisphosphonate is used in osteoporosis treatment to repress osteoclast activity, which then decreases levels of osteocalcin (OC). OC, a protein secreted by osteoblasts and released from the bone matrix during osteoclastic bone resorption, has been found to control blood glucose levels by increasing insulin production and sensitivity. The question addressed in this study is whether decreasing OC through bisphosphonate treatment will provoke a change in glucose homeostasis. METHODS: Eighty-four patients with osteoporosis were treated with once-weekly risedronate 35 mg and cholecalciferol 5,600 IU. We measured fasting plasma glucose (FPG), insulin, and undercarboxylated (Glu) and carboxylated (Gla) OC levels at baseline and after 16 weeks. To estimate insulin resistance (IR) and beta-cell function (B)%, homeostasis model assessment (HOMA)-IR and HOMA-B% were also calculated, respectively. RESULTS: The mean FPG level in total subjects increased significantly from 5.3 to 5.5 mmol/L, but no changes in blood glucose were noted in the 24 subjects with impaired fasting glucose. Glu and Gla OC levels declined significantly after treatment. No correlations were observed between changes in OC and changes in glucose, however. CONCLUSIONS: Bisphosphonate treatment for osteoporosis reduced OC, but this change was not associated with changes in glucose metabolism.
Blood Glucose ; Bone Matrix ; Bone Resorption ; Cholecalciferol ; Etidronic Acid ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin ; Insulin Resistance ; Osteoblasts ; Osteocalcin ; Osteoclasts ; Osteoporosis ; Plasma ; Risedronate Sodium

PURPOSE: To evaluate the availability of magnetic resonance (MR) voiding cystography for the diagnosis of vesicoureteral reflux (VUR) and to compare the sensitivity of MR voiding cystography (MRVC) with that of radiographic voiding cystourethrography (VCUG) in the detection of VUR. MATERIALS AND METHODS: MRVC was performed upon 20 children referred for investigation of VUR. Either coronal T1-weighted spin-echo or spoiled gradient-echo images were obtained before and after transurethral administration of a mixture of normal saline and gadopentetate dimeglumine, and immediately after voiding. The findings of MRVC were compared with those of VCUG performed within 6 months of MRVC. RESULTS: VUR was detected in 23 ureterorenal units (16 VUR's by both methods, five VUR's by VCUG, and two VUR's by MRVC). The sensitivity of VCUG and MRVC in detecting VUR was 91.3% (21/23) and 78.3% (18/23), respectively. MRVC detected renal scarring in 15 out of 17 kidneys with scintigraphically detected renal scarring. CONCLUSION: Although MRVC is slightly less sensitive than VCUG in the detection of VUR, it can be used for the diagnosis of VUR and renal scarring simultaneously, and thus will reduce the radiation hazard.
Child ; Cicatrix ; Diagnosis* ; Gadolinium DTPA ; Humans ; Kidney ; Ureter ; Vesico-Ureteral Reflux*

Facial nerve palsy due to the benign parotid tumor is extremely rare. The authors experienced a case of pleomorphic adenoma in parotid gland, showing retrograde extension to mastoid bone along the facial nerve, resulting facial nerve palsy. An 82-year-old woman with facial nerve palsy for six years was revealed to have a solid mass in the close proximity to mastoid tip with contrast enhancement on computed tomography (CT). The mass extended into the air cells of temporal bone at the exiting site of the facial nerve through stylomastoid foramen. Based on the CT findings and her facial nerve palsy, initial diagnosis was facial nerve schwannoma. Mass was removed via transmastoid approach. The pathology was pleomorphic adenoma and direct nerve invasion was not observed.
Adenoma ; Adenoma, Pleomorphic ; Aged, 80 and over ; Facial Nerve ; Female ; Humans ; Mastoid ; Neurilemmoma ; Paralysis ; Parotid Gland ; Temporal Bone