OBJECTIVE: The purpose of this study was to evaluate the validity of midsagittal reference (MSR) planes constructed in maxillofacial 3D images. METHODS: Maxillofacial computed tomography (CT) images were obtained in 36 normal occlusion individuals who did not have apparent facial asymmetry, and 3D images were reconstructed using a computer software. Six MSR planes (Cg-ANS-Ba, Cg-ANS-Op, Cg-PNS-Ba, Cg- PNS-Op, FH perpendicular (Cg, Ba), FH perpendicular (Cg, Op)) were constructed using the landmarks located in the midsagittal area of the maxillofacial structure, such as Cg, ANS, PNS, Ba and Op, and FH plane constructed with Po and Or. The six pairs of landmarks (Z, Fr, Fs, Zy, Mx, Ms), which represent right and left symmetry in the maxillofacial structure, were selected. Statistically significant differences of the right and the left measurements were examined through t-test, and the difference of the right and the left measurement was compared among the six MSR planes. RESULTS: The distances from the right and the left landmarks in each pair to each MSR plane did not show a statistically significant difference. The reproducibility of the landmark identification was excellent. CONCLUSION: All the six planes constructed in this study can be used as a MSR plane in maxillofacial 3D analysis, particularly, the planes including Cg and ANS.
Facial Asymmetry

Patients undergoing insertion of cardiac implantable electronic devices often exhibit perioperative hemorrhagic complications. Perioperative antithrombotic management, which balances the risk of acute thrombosis and postoperative bleeding, is therefore important for these patients. In this case report, we present three cases of cardiovascular implantable electronic device (CIED) insertion. While the three patients each had different reasons for not discontinuing antithrombotic medications, they all needed CIEDs. During the CIED implantation procedures, a small incision was made on the pectoralis muscle region to obtain a small subcutaneous pocket, and Tachosil, a fibrin sealant patch, was inserted below and above the inserted device. The patients showed no pocket hematoma formation or any hemorrhagic complications. We thus concluded the application of a fibrin sealant patch could be an option for perioperative anticoagulation management without interruption of anticoagulants and antiplatelets.

Background: Povidone-iodine (PVP-I) is an antiseptic that is commonly used as an alternative to alcohol in clinical settings, including for perioperative skin disinfection. However, the presence of iodine in PVP-I can result it adverse effects on thyroid function. This study explored the effect of PVP-I on thyroid function and assessed its safety profile. Methods: We assessed thyroid function in patients before and after treatment with Repigel (topical liposomal hydrogel with 3% PVP-I) between January 2017 and January 2023, for a period of at least 2 weeks. Patients were stratified by age, sex, and previous history. Results: No significant changes in thyroid function were observed in the 61 patients enrolled until 2 weeks after application of Repigel. Significant increases in T3, T4, and free T4 levels were detected 4 weeks after Repigel application. A comparison of the initial thyroid function test (TFT) and TFT 4 weeks post-application found that the mean T3 levels were 71.12 ± 17.55 ng/dL and 59.84 ± 18.60 ng/dL and mean T4 levels were 6.48 ± 1.49 µg/dL and 5.50 ± 1.36 µg/dL, respectively. The mean free T4 levels were 1.08 ± 0.39 ng/dL and 0.90 ± 0.19 ng/dL, respectively. Conclusion Changes in thyroid function during the application of Repigel were observed. We conclude that thyroid function should be examined at regular intervals before and after topical application of Repigel. Additionally, clinicians should exercise caution when administering iodine-containing substances such as Repigel to patients with abnormal thyroid function, and schedule follow-up TFTs at 4 weeks.

Identifying tumors or wounds on the scalp is difficult because hair blocks the vision during surgery and suturing. In the meantime, we have commonly used hairpins to hold the hair for a clearer view; however, we would like to suggest a new method, a “hair-fixing sheet,” consisting of hook-like surface. We applied the two methods, hair-fixing sheets and hairpins, assuming several situations. In these situations, it was possible to fix a wider range or various shapes more conveniently using a hair-fixing sheet than using several hairpins at a similarly low cost. In addition, it was easy to change the hair to be fixed, remove it postoperatively, and prevent the hair from being pulled out, thereby preventing additional postoperative pain.

PURPOSE: Currently, in treatment of symptomatic common bile duct (CBD) stone, the endoscopic retrograde cholagiopancreatography (ERCP) is usually carried out as an initial evaluation and removal of CBD stones. But, many cases necessitate surgical exploration of CBD and stone removal. Recently, laparoscopic CBD exploration (LCBDE) procedure is increasing due to the high success rate of stone clearance with the easy use of a choledochoscope and the advantage of less aggressive laparoscopic procedure properties. We reviewed the long-term results and efficacy of LCBDE in relation to traditional open CBDE results to demonstrate the superiority of LCBDE. METHODS: From July 1997 until July 2007, 189 consecutive patients with CBD stones were enrolled in a retrospective study. Those patients were divided into two-groups: Laparoscopic CBDE (group L) and Open CBDE (group O), and compared the patients' clinical characteristics, postoperative outcomes and follow up data. RESULTS: Of 189 patients who underwent successful CBD exploration, 66 (34.9%) were open group and 123 (65.1%) were laparoscopic group. Stone clearance rate was 100% in both groups. The mean operation time, incidence of postoperative complications and hospital days had no significant difference between the two groups (P>0.05). The cases of T-tube insertion and recurrence of CBD stone were significantly more in open group (P<0.05). CONCLUSION: On investigation of long-term follow up data of the two groups, CBD stone recurrence cases were significantly fewer in laparoscopic group. The lower incidence of complication and stone recurrence is evidence of the superiority of laparoscopic procedure in CBD exploration and removal of CBD stones.
Choledocholithiasis ; Common Bile Duct ; Follow-Up Studies ; Humans ; Imidazoles ; Incidence ; Nitro Compounds ; Postoperative Complications ; Recurrence ; Retrospective Studies

Purpose: This study aims to design that using formative assessment as an instructional strategy in real-time online classes, and to explore the application of Bloom’s taxonomy in the development of formative assessment items. Methods: We designed the instruction using formative assessment in real-time online classes, developed the items of formative assessment, analyzed the items statistically, and investigated students' perceptions of formative assessment through a survey. Results: It is designed to consist of 2–3 learning outcomes per hour of class and to conduct the formative assessment with 1–2 items after the lecture for each learning outcome. Formative assessment was 31 times in the physiology classes (total 48 hours) of three basic medicine integrated. There were nine “knowledge” items, 40 “comprehension” items, and 55 “application” items. There were 33 items (31.7%) with a correct rate of 80% or higher, which the instructor thought was appropriate. As a result of the survey on students’ perceptions of formative assessment, they answered that it was able to concentrate on the class and that it was helpful in achieving learning outcomes. Conclusion The students focused during class because they had to take formative assessment immediately after the learning outcome lecture. “Integration of lesson and assessments” was maximized by solving the assessment items as well as through the instructor’s immediate explanation of answers. Through formative assessment, the students were able to utilize metacognition by learning what content they understood or did not understand. Items that consider Bloom’s taxonomy allow students to remember, understand, and apply to clinical contexts.

Objective: This study aimed to evaluate the correlation between obesity and pelvic organ prolapse (POP), both anatomically and symptomatically, in Korean women. Methods: We retrospectively reviewed 476 women who visited the urogynecology clinic between January 2013 and December 2016. All the enrolled women were Korean. We sought to evaluate the relationship between obesity and POP, both anatomically and symptomatically, by using a validated tool. Anatomic assessment was performed by a standardized Pelvic Organ Prolapse Quantification (POP-Q) system and symptomatic assessment was performed by a Pelvic Floor Distress Inventory (PFDI)-20 questionnaire. Obesity measurement was performed by measuring body mass index (BMI). Results: We enrolled 476 women in our study. There was no statistically significant correlation between BMI and POP-Q or PFDI-20 scores: Ba (P=0.633), Bp (P=0.363), C (P=0.277), Pelvic Organ Prolapse Distress Inventory-6 (P=0.286), Colorectal Anal Distress Inventory-8 (P=0.960), Urinary Distress Inventory-6 (P=0.355), and PFDI-20 (P=0.355). In addition, there was no statistically significant correlation between BMI and POP-Q or PFDI-20 in patients with severe (greater than stage III) POP. We also separately analyzed the differences in the POP-Q points and PFDI-20 scores between the obese and non-obese groups. There was no statistically significant difference between the groups. Conclusion We evaluated the correlation between obesity and POP using a validated tool. The present study revealed no significant correlation between obesity and POP severity anatomically or symptomatically in Korean women. This contrasts the results of most studies of Western women. Further studies in Asian women are required in order to confirm our results.

Purpose: This study aims to design that using formative assessment as an instructional strategy in real-time online classes, and to explore the application of Bloom’s taxonomy in the development of formative assessment items. Methods: We designed the instruction using formative assessment in real-time online classes, developed the items of formative assessment, analyzed the items statistically, and investigated students' perceptions of formative assessment through a survey. Results: It is designed to consist of 2–3 learning outcomes per hour of class and to conduct the formative assessment with 1–2 items after the lecture for each learning outcome. Formative assessment was 31 times in the physiology classes (total 48 hours) of three basic medicine integrated. There were nine “knowledge” items, 40 “comprehension” items, and 55 “application” items. There were 33 items (31.7%) with a correct rate of 80% or higher, which the instructor thought was appropriate. As a result of the survey on students’ perceptions of formative assessment, they answered that it was able to concentrate on the class and that it was helpful in achieving learning outcomes. Conclusion The students focused during class because they had to take formative assessment immediately after the learning outcome lecture. “Integration of lesson and assessments” was maximized by solving the assessment items as well as through the instructor’s immediate explanation of answers. Through formative assessment, the students were able to utilize metacognition by learning what content they understood or did not understand. Items that consider Bloom’s taxonomy allow students to remember, understand, and apply to clinical contexts.

Objective: This study aimed to evaluate the correlation between obesity and pelvic organ prolapse (POP), both anatomically and symptomatically, in Korean women. Methods: We retrospectively reviewed 476 women who visited the urogynecology clinic between January 2013 and December 2016. All the enrolled women were Korean. We sought to evaluate the relationship between obesity and POP, both anatomically and symptomatically, by using a validated tool. Anatomic assessment was performed by a standardized Pelvic Organ Prolapse Quantification (POP-Q) system and symptomatic assessment was performed by a Pelvic Floor Distress Inventory (PFDI)-20 questionnaire. Obesity measurement was performed by measuring body mass index (BMI). Results: We enrolled 476 women in our study. There was no statistically significant correlation between BMI and POP-Q or PFDI-20 scores: Ba (P=0.633), Bp (P=0.363), C (P=0.277), Pelvic Organ Prolapse Distress Inventory-6 (P=0.286), Colorectal Anal Distress Inventory-8 (P=0.960), Urinary Distress Inventory-6 (P=0.355), and PFDI-20 (P=0.355). In addition, there was no statistically significant correlation between BMI and POP-Q or PFDI-20 in patients with severe (greater than stage III) POP. We also separately analyzed the differences in the POP-Q points and PFDI-20 scores between the obese and non-obese groups. There was no statistically significant difference between the groups. Conclusion We evaluated the correlation between obesity and POP using a validated tool. The present study revealed no significant correlation between obesity and POP severity anatomically or symptomatically in Korean women. This contrasts the results of most studies of Western women. Further studies in Asian women are required in order to confirm our results.

Bronchopulmonary sequestration (BPS) is a rare congenital abnormality of the lower airway, generally characterized by blood supply received from the systemic circulation. We present a rare case of a 19-year-old man with incidentally detected BPS supplied by a branch of a pulmonary artery, rather than a systemic artery. Computed tomography showed a sequestered segment supplied by a branch of the left pulmonary artery and containing an ectopic bronchus. As chest computed tomography revealed necrosis in the sequestered tissue, infection was presumed, and the tissue was surgically removed. This may represent a very unusual occurrence, as such cases have yet to be reported in the literature.