No abstract available.
Humans

Background: Breaking the chain of disease transmission from overseas is necessary to control new infectious diseases such as coronavirus disease 2019 effectively. In this study, we developed a mobile app called Self-Symptom Checker (SSC) to monitor the health of inbound travelers. Methods: SSC was developed for general users and administrators. The functions of SSC include non-repudiation using QR (quick response) codes, monitoring fever and respiratory symptoms, and requiring persons showing symptoms to undergo polymerase chain reaction tests at nearby screening stations following a review of reported symptoms by the Korea Disease Control and Prevention Agency, as well as making phone calls, via artificial intelligence or public health personnel, to individuals who have not entered symptoms to provide the necessary information. Results: From February 12 to March 27, 2020, 165,000 people who were subjected to the special entry procedure installed SSC. The expected number of public health officers and related resources needed per day would be 800 if only the phone was used to perform symptom monitoring during the above period. Conclusion By applying SSC, more effective symptom monitoring was possible. The daily average number of health officers decreased to 100, or 13% of the initial estimate. SSC reduces the work burden on public healthcare personnel. SSC is an electronic solution conceived in response to health questionnaires completed by inbound travelers specified in the World Health Organization International Health Regulations as a requirement in the event of a pandemic.

BACKGROUND: OSCE was conducted to measure the immediate outcome of ICM. The measurement focused on basic clinical skills. METHODS: The subject of study was 115 third year medical students who took ICM course. The examination consisted of ten 5-minute stations with nine cases that represented commonly encountered problems in primary care. OSCE stations were duplicated into two sites. Therefore, same OSCE was performed six times in each sites. We evaluated the reliability of OSCE scores and compared the mean scores according to the examination sites and time sequences. Also, we got feedback from all participants by questionnaires. RESULTS: Mean of total OSCE score was 52.1. Cronbach alpha of total station was 0.559. For blood pressure check, lung physical examination, and neck mass physical examination station, there was a significant difference in mean scores as the time sequences(p<0.05). Both students and examiners evaluated the OSCE positively, and felt that OSCE was meaningful experience to prepare clinical skills. CONCLUSION: We can confirm that OSCE is a reasonable evaluation tool for ICM. However, further trials to develop the more reliable and valid examinations will be warranted.
Blood Pressure ; Clinical Competence ; Clinical Medicine* ; Humans ; Lung ; Neck ; Physical Examination ; Primary Health Care ; Students, Medical ; Surveys and Questionnaires

With the class of 2000, the College of Medicine at Korea University instituted a revised curriculum. The new revision combined the traditional, and discipline-oriented, curriculums into a newly integrated curriculum. The purpose of this study is to identify the problems of the newly introduced integrated lectures, and how to find ways to improve this curriculum. Overloaded lecture hours and content, insufficient functional integration between disciplines, unstructured handout, deficiency in reference material and lack of motivation were identified as problems for students. Most of the participants urged a more effective collaboration between the faculty members of individual disciplines. Basic and clinical disciplines must be integrated as thoroughly as possible to improve and stabilize the new curriculum. Also, overall lecture time should be diminished, thereby allowing students to actively pursue their own learning.
Cooperative Behavior ; Curriculum ; Humans ; Korea* ; Learning ; Lectures* ; Motivation

BACKGROUND: Transforming growth factor (TGF)- has a large variety of biological functions, including the modulation of inflammation and the immune system, and is presumed to play important roles in repairing wounds and reducing scarring. The objective of this study is to examine the effects of TGF-1 on healing wounds and reducing scarring. We have also analysed the ability of the hemagglutinating virus of Japan (HVJ) liposome mediated antisense oligodeoxynucleotides (ODNs) to specifically inhibit wound-induced expressions of TGF-1 proteins and mRNA in the rat skin. METHODS: Skin wounds were created on the backs of 80 anesthetized rats. The first group of wounds, as the controls, was unmanipulated. The second group of wounds, as positive controls or an excessive scarring model, was injected with TGF-1 subcutaneously. The third group of wounds was injected with anti-TGF-1 antibody subcutaneously. The fourth group of wounds was injected with HVJ liposome mediated antisense ODNs for TGF-1 subcutaneously. The wounds of all groups were bisected and analysed histologically 5, 10, 15, 30, and 50 days after the wounds were made. RESULTS: All control wounds (TGF-1 or no injection) healed with scarring, whereas the wounds treated with the antibody or antisense ODNs healed with less scar formation compared to the control group. The wounds treated with the antibody or antisense ODNs had fewer macrophages, less collagen and fibronectin contents than the other wounds. Northern blotting and in situ hybridization analysis showed that wound sites treated with HVJ liposome mediated antisense ODNs for TGF-1 exhibited decreased levels of TGF-1 mRNA after injury. CONCLUSIONS: These findings suggest an important new approach to controlling scarring in normal wound healing, complementing the practice of adding exogenous growth factors to chronic wounds in the attempt to inhibit collagen deposition.
Animals ; Blotting, Northern ; Cicatrix* ; Collagen ; Complement System Proteins ; Fibronectins ; Genetic Therapy* ; Immune System ; In Situ Hybridization ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Liposomes ; Macrophages ; Oligodeoxyribonucleotides ; Oligoribonucleotides ; Rats ; RNA, Messenger ; Sendai virus ; Skin ; Transforming Growth Factor beta ; Transforming Growth Factors ; Wound Healing ; Wounds and Injuries

BACKGROUND: Preemptive analgesia may prevent nociceptive inputs generated during surgery from sensitizing central neurons and, therefore, may reduce post-operative pain. But, preemptive analgesia has been shown to decrease postinjury pain in animals, studies in human have provided controversial results. We studied whether intravenous morphine infusion before induction could affect post-operative pain and analgesic demands, when compared with intravenous morphine infusion after the closure of the peritoneum. METHODS: Female patients scheduled for total abdominal hysterectomy were randomly assigned to one of two groups of prospectively studied in a double-blind manner. Group I (n=23) and II (n=20) received intravenous morphine (0.1 mg/kg) before induction of anesthesia and after the closure of the peritoneum, respectively. Either group had continuous infusion of morphine (1.5 mg/hr) immediately after i.v. bolus morphine. Postoperative pain relief was provided with i.v. morphine from a PCA system (Medex Walkmed). Postoperative visual analogue pain scores (VAS), analgesics requirements and side effects were examined and compared between groups for 2 postoperative days. RESULTS: VAS were significantly less in group I (3.3+/-0.4) than in group II (5.3+/-0.5) 2hrs after surgery (p<0.01). Patient-cantrolled morphine cumulative consumption in group I was significantly less than in group II for 24hours (21.9 mg vs 35.3 mg) and 48hours (37.4 mg vs 55.0 mg) after operation (p<0.01). CONCLUSIONS: Preemptive analgesia with intravenous morphine reduces postoperative pain and analgesic requirements. Lower postoperative analgesic requirements in preemptive analgesic group indicate that intravenous morphine prevents development of injury-induced peripheral or central sensitization.
Analgesia* ; Analgesics ; Anesthesia ; Animals ; Central Nervous System Sensitization ; Female ; Humans ; Hysterectomy ; Morphine ; Neurons ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Peritoneum ; Prospective Studies

SV40 large T antigen, a viral oncoprotein, is known to immortalize human diploid fibroblast by soaking up cellular RB and p53, but its frequency is extremely low. Additional genetic alteration is necessary for single-step immortalization. We attempted to find out what this alteration is by overexpressing cellular signal mediator genes; c-myc and cyclin D frequently amplified in many cancer cells. Overexpression of cyclin D did not affect the immortalization, but, overexpression of c-myc along with T antigen could immortalize normal human diploid fibroblast. Several cellular markers tested during immortalization process showed that p21, a cyclin-dependent kinase inhibitor and a marker of cellular senescence, disappeared in the life span-extended cells by T antigen and in the immortalized cells by c-myc. p21 was, however, elevated in the senescent cells and in the cells of crisis. Interestingly, p16 was upregulated whenever T antigen is overexpressed. Telomerase activity was also activated only in the immortalized cells. These results suggest that overexpression of c-myc contributes to immortalization of human diploid fibroblast by activating telomerase activity and suppressing p21 activity.
Antigens, Polyomavirus Transforming/genetics/*metabolism ; Biological Markers ; Cell Aging/*genetics ; Cell Transformation, Viral ; Cells, Cultured ; Cyclins/metabolism ; Diploidy ; Fibroblasts/*metabolism ; Genes, myc/*genetics ; Human ; Protein p16/metabolism ; Simian virus 40/genetics ; Support, Non-U.S. Gov't ; Telomerase/metabolism

SV40 large T antigen, a viral oncoprotein, is known to immortalize human diploid fibroblast by soaking up cellular RB and p53, but its frequency is extremely low. Additional genetic alteration is necessary for single-step immortalization. We attempted to find out what this alteration is by overexpressing cellular signal mediator genes; c-myc and cyclin D frequently amplified in many cancer cells. Overexpression of cyclin D did not affect the immortalization, but, overexpression of c-myc along with T antigen could immortalize normal human diploid fibroblast. Several cellular markers tested during immortalization process showed that p21, a cyclin-dependent kinase inhibitor and a marker of cellular senescence, disappeared in the life span-extended cells by T antigen and in the immortalized cells by c-myc. p21 was, however, elevated in the senescent cells and in the cells of crisis. Interestingly, p16 was upregulated whenever T antigen is overexpressed. Telomerase activity was also activated only in the immortalized cells. These results suggest that overexpression of c-myc contributes to immortalization of human diploid fibroblast by activating telomerase activity and suppressing p21 activity.
Antigens, Polyomavirus Transforming/genetics/*metabolism ; Biological Markers ; Cell Aging/*genetics ; Cell Transformation, Viral ; Cells, Cultured ; Cyclins/metabolism ; Diploidy ; Fibroblasts/*metabolism ; Genes, myc/*genetics ; Human ; Protein p16/metabolism ; Simian virus 40/genetics ; Support, Non-U.S. Gov't ; Telomerase/metabolism

BACKGROUND: It is important that proper protocols are in place for trauma patients who require massive transfusion upon arrival at the emergency department. This study is a preliminary analysis of massive transfusion cases at the emergency department of our institution aimed to review the characteristics and situations in which massive transfusion occurs in an effort to better manage trauma patients receiving massive transfusion in the emergency department. METHODS: This study was conducted at the Department of Emergency Medicine in the Korea University Guro Hospital. We retrospectively reviewed the medical charts of trauma-related patients who required massive blood transfusions between January 2013 and December 2015. The inclusion criteria were as follows: patients who were over the age of 18 years and received more than 4 packed RBC (pRBC) units per hour, or 10 or more pRBC units during a period of 24-hours. RESULTS: A total of 669 patients were included in the study. There were significant differences of initial systolic blood pressure (P<0.0001), diastolic blood pressure (P<0.0001), and Injury Severity Score (P<0.0001) between those who survived and those who expired. CONCLUSION: Proper initial resuscitation is essential for the improvement of outcome in trauma patients that require a massive transfusion. The findings from this study may serve as preliminary data in developing proper transfusion protocols for massive transfusion among trauma patients.
Blood Pressure ; Blood Transfusion ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Injury Severity Score ; Korea ; Multiple Trauma ; Resuscitation ; Retrospective Studies ; Transfusion Reaction

OBJECTIVE: The negative symptoms of schizophrenia usually are not responsive to drug therapy to persist and make schizophrenics more difficult in their rehabilitation. The authors investigated the therapeutic effect of token economy(TET) for negative symptoms of schizophrenic patients, and attempted to develop a TET program f3r psychiatric wards in general hospital. METHODS: Negative subscale of PANSS was rated for 35 schizophrenics with negative symptoms as their main problems before and after short-term TET(less than 3 months). Therapeutic factors were identified by comparing patient and program variables between the achieved and the non-achieved group of each level of target behaviors. RESULTS: 1) Subtotal of negative subscale of PANSS was decreased from 31.57+/-4.32 at baseline to 20.66+/-4.63 artier treatment. With TET, symptoms of difficulty in abstract thinking' and 'stereotypic thinking' were less responsive than the other 5 items of the scale Also the dose of antipsychotics prescribed was reduced to 291.21+/-287.74mg/day from 487.58+/-372.79mg/day. 2) The achievement rate of level I (self-help) was 75%, level II (ward-activity) 78%, and level III (social activity/occupation) 68%, resulting in average 74% for all target behaviors. 3) On level II, dose of antipsychotics was lower, and on level III, number of admission was lower and female sex was more frequent in achieving patient group than nonachieving group. The rate of achievement was higher in case of special flood, reception, and outing with family applied as a reinforcer on level I, and reception on level II . CONCLUSION: These results showed that TET was effective for schizophrenic patients with negative symptoms in psychiatric ward. Further investigations to refine the individual program of TET will be needed far enhancement of it s therapeutic efficacy and smart application of it.
Antipsychotic Agents ; Drug Therapy ; Female ; Hospitals, General ; Humans ; Rehabilitation ; Schizophrenia ; Token Economy*