PURPOSE: This study aims to explore the improvement of medical curriculums by examining the relationship between attributes of the Korean physicians and their needs for specialized departments and professionals for enhancing Korean physicians' social competence. METHODS: The uniqueness of this study is in its conduction a survey about the Korean physicians' needs of specialized departments and professionals for physicians' social competence or not, unlikely that previous studies focused on reviews. Subjects of this study are 288 physicians among the members of the Korean Society of Medical Education and The Korea Intern Resident Association. The hierarchical regression analyses are conducted. RESULTS: The authors present the results. First, the needs of specialized departments decline if physicians have ever majored on basic medical and learned professionalism ethics. Second, the older physicians are, the much more learned professionalism ethics and the needs of leadership competence physicians have, the necessities of specialized professionals are reduced. Finally, the physicians' needs of patient-oriented communication and sympathy of human in society as well as professionalism ethics increase recognitions of the importance of specialized professionals. CONCLUSION: These results show that strengthening systemic and educators' individual capacity for successful social competence curriculums is important.
Curriculum ; Education* ; Education, Medical ; Ethics ; Humans ; Korea ; Leadership ; Mental Competency

It has been reported that a change in the cellular redox state may be involved in the regulation of vascular tone, but the underlying mechanism is not fully understood. The present study was designed to investigate the cellular effect of sulfhydryl modifying agents in the coronary artery of rabbit using the tension measurement and whole cell clamping method. The application of diamide, a sulfhydryl oxidizing agent, relaxed the endothelium denuded coronary arteries in a dose dependent manner. The fact that this diamide-induced relaxation was significantly attenuated by a pretreatment of 4-AP, and the coronary arteries precontracted with 100 mM K+ instead of histamine, suggests the involvement of 4-AP sensitive K+ channels in the diamide-induced relaxation of coronary arteries. Whole cell patch clamp studies revealed that the 4-AP sensitive IdK was significantly enhanced by the membrane permeant oxidizing agents, diamide and DTDP, and were reversed by subsequent exposure to the reducing agent, DTT. Neither the membrane impermeant oxidizing or reducing agents, GSSG or GSH, had any effect on the activity of IdK, indicating that intracellular sulfhydryl modification is critical for modulating IdK activity. The Diamide failed to significantly alter the voltage dependence of the activation and inactivation parameters, and did not change the inactivation process, suggesting that diamide increases the number of functional channels without altering their gating properties. Since IdK has been believed to play an important role in regulating membrane potential and arterial tone, our results about the effect of sulfhydryl modifying agents on coronary arterial tone and IdK activity should help understand the pathophysiology of the diseases, where oxidative damage has been implicated.
Animal ; Arteries/physiology ; Arteries/drug effects ; Arteries/cytology ; Coronary Vessels/physiology ; Coronary Vessels/drug effects* ; Coronary Vessels/cytology ; Female ; Male ; Oxidants/pharmacology* ; Potassium Channels/physiology ; Rabbits ; Reducing Agents/pharmacology* ; Sulfhydryl Compounds/metabolism*

It has been proposed that Ca(2+)-activated K+ channels play an essential role in maintaining vascular tone during stretch of blood vessel. However, the underlying mechanism of stretch-induced change of Ca(2+)-activated K+ channel activities are still unknown. The present experiment was designed to investigate the effect of membrane stretch on these channels whose activity was measured from rabbit coronary smooth muscle cells using a patch clamp technique. Ca(2+)-activated K+ channel were identified by their Ca2+ and voltage dependencies and its large conductances as in other preparations. Perfusion of cells with a hypotonic solution, which mimics stretching the cell membrane by making a cell swelling, produced an increase in channel activity in cell-attached patch mode. The similar increase was observed when negative pressure was applied into the patch pipette for stretching the cell membrane within a patch area. In inside-out patch, stretch still increased channel activity even under the conditions which exclude the possible involvement of secondary messengers, or of transmembrane Ca2+ influx via stretch-activated cation channels. Pretreatment of arachidonic acid or albumin showed no effect on stretch-induced channel activation, excluding the possibility of fatty acids mediated channel activation during membrane stretch. These results indicate that the stretch may directly increase the activity of Ca(2+)-activated K+ channels in our experimental condition.
Animal ; Arachidonic Acid/pharmacology ; Calcium/pharmacology* ; Calcium/metabolism ; Cell Membrane/physiology ; Coronary Vessels/physiology* ; Hypotonic Solutions/pharmacology ; Membrane Potentials ; Muscle, Smooth, Vascular/physiology* ; Potassium Channels/physiology* ; Rabbits

The relationship between the level of testosterone and the incidence of coronary heart disease is still controversial in the view of the results of clinical and epidemiologic studies. This uncertainty might be partly due to relatively small number of experimental studies undertaken to investigate the cellular mechanism underlying the vascular responses to testosterone. To further investigate the cellular mechanisms of testosterone with respect to vascular response, we investigated the effect of testosterone on contractility and intracellular Ca2+ regulation in a rabbit coronary artery and evaluated the underlying mechanism of testosterone-induced changes of coronary vascular tone by using various pharmacological blockers. Testosterone was found to relax rabbit coronary arteries in a dose-dependent manner, and no significant difference was found in the relaxation response to testosterone with or without endothelium. Similar results were obtained in male and non-pregnant female rabbit coronary arteries. The relaxation response of rabbit coronary arteries to testosterone was greater for PGF2alpha-contracted rings than for KCl contracted rings, which suggest the involvement of K+ channels. Furthermore, the relaxation response to testosterone was significantly reduced by 4-aminopyridine, a sensitive blocker of voltage dependent K+ channels, but not by low doses of tetraethylammonium or iberiotoxin, a Ca2+ activated K+ channel blocker. Testosterone simultaneously reduced the intracellular Ca2+ concentration ([Ca2+]i) and tension, and 4-AP effectively antagonized the testosterone-induced change of [Ca2+]i and tension. Therefore, it may be concluded that the stimulation of voltage dependent K channels is responsible, at least in part, for the testosterone-induced relaxation of rabbit coronary arteries.
Androgens/*pharmacology ; Animals ; Arteries/drug effects ; Calcium/*metabolism ; Coronary Vessels/*drug effects ; Female ; Intracellular Membranes/*metabolism ; Male ; Osmolar Concentration ; Potassium Channels, Voltage-Gated/drug effects/*metabolism ; Rabbits ; Support, Non-U.S. Gov't ; Testosterone/*pharmacology ; *Vasodilation

Neuromuscular choristoma is a rare benign tumor of the peripheral nerves. To the best of our knowledge, 21 cases have been reported to date. We describe here a 20-day-old female infant who presented with a buttock mass (4.5 x 4.1 x 3.2 cm on MRI) arising from the left sciatic nerve. Microscopically, it was characterized by an intimately disorganized mixture of nerve fibers and striated muscle fibers that were occasionally surrounded by the perineurium and separated by fibrous bands of varying thickness. In some areas, there appeared to be some cells in transitional forms between nerve fibers and muscle fibers, revealing variously positive expressions for S-100 protein in the muscular components. These findings are consistent with the hypothesis that neuroectodermal-derived Schwann cells can give rise to mature skeletal muscle. It appears that the fibrosis may be related to the degeneration of the neural components. The size of the mass on MRI has been unchanged during the 3-year follow-up period.
Buttocks ; Choristoma* ; Female ; Fibrosis ; Follow-Up Studies ; Humans ; Infant ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Muscle, Striated ; Nerve Fibers ; Peripheral Nerves ; S100 Proteins ; Schwann Cells ; Sciatic Nerve*

In the rabbit renal artery, acetylcholine (ACh, 1 nM ~ 10 micrometer) induced endothelium-dependent relaxation of arterial rings precontracted with norepinephrine (NE, 1 micrometer) in a dose-dependent manner. NG-nitro-L-arginine (L-NAME, 0.1 mM), an inhibitor of NO synthase, or ODQ (1 micrometer), a soluble guanylate cyclase inhibitor, partially inhibited the ACh-induced endothelium-dependent relaxation. The ACh-induced relaxation was abolished in the presence of 25 mM KCl and L-NAME. The cytochrome P450 inhibitors, 7-ethoxyresorufin (7-ER, 10 micrometer), miconazole (10 micrometer), or 17-octadecynoic acid (17-ODYA, 10 micrometer), failed to inhibit the ACh-induced relaxation in the presence of L-NAME. 11,12-epoxyeicosatrienoic acid (11,12-EET, 10 micrometer) had no relaxant effect. The ACh-induced relaxation observed in the presence of L-NAME was significantly reduced by a combination of iberiotoxin (0.3 micrometer) and apamin (1 micrometer), and almost completely blocked by 4-aminopyridine (5 mM). The ACh-induced relaxation was antagonized by P2Y receptor antagonist, cibacron blue (10 and 100 micrometer), in a dose-dependent manner. Furthermore, 2-methylthio-ATP (2MeSATP), a potent P2Y agonist, induced the endothelium-dependent relaxation, and this relaxation was markedly reduced by either the combination of iberiotoxin and apamin or by cibacron blue. In conclusion, in renal arteries isolated from rabbit, ACh produced non-NO relaxation that is mediated by an EDHF. The results also suggest that ACh may activate the release of ATP from endothelial cells, which in turn activates P2Y receptor on the endothelial cells. Activation of endothelial P2Y receptors induces a release of EDHF resulting in a vasorelaxation via a mechanism that involves activation of both the voltage-gated K+ channels and the Ca2+-activated K+ channels. The results further suggest that EDHF does not appear to be a cytochrome P450 metabolite.
4-Aminopyridine ; Acetylcholine* ; Adenosine Triphosphate ; Apamin ; Cytochrome P-450 Enzyme System ; Endothelial Cells ; Guanylate Cyclase ; Miconazole ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase ; Nitroarginine ; Norepinephrine ; Potassium Channels, Calcium-Activated ; Potassium Channels, Voltage-Gated ; Relaxation* ; Renal Artery* ; Vasodilation

Lysophosphatidylcholine (LPC), which accumulates in atherosclerotic arteries, has been reported to inhibit endothelium-dependent relaxation (EDR) in many different species. However, the underlying mechanism of LPC-induced inhibition of EDR is still uncertain. In the present study, we measured simultaneously both isometric tension and cytosolic free Ca2+ ([Ca2+]i) in rabbit carotid strips, and examined the effect of LPC on tension and [Ca2+]i. In carotid strips with intact-endothelium, high K+ (70 mM) increased both tension and [Ca2+]i, and cumulative addition of acetylcholine (ACh) from 0.1 to 10microM induced dose dependent increase of [Ca2+]i with concomitant relaxation. In the presence of L-NAME (0.1 mM), ACh increased [Ca2+]i without affecting the amplitude of high K+-induced tension. These ACh-induced change of [Ca2+]i and tension was abolished by removal of endothelium or 10 nM 4-DAMP (muscarinic receptor antagonist) pretreatment. Pretreatment of LPC (10microM) inhibited ACh (10microM)-induced change of tension and [Ca2+]i in endothelium-intact carotid artery. On the other hand, LPC had no effect on ACh-induced change of tension and [Ca2+]i in endothelium denuded artery. In Ca2+-free external solution, ACh transiently increased [Ca2+]i, and pretreatment of LPC significantly inhibited ACh-induced transient [Ca2+]i change. Based on the above results, it may be concluded that LPC inhibits the ACh-induced [Ca2+]i change through inhibition of Ca2+ mobilization in vascular endothelial cells, resulting in decreased production of NO and concomitant inhibition of endothelium-dependent vascular relaxation.
Acetylcholine ; Arteries ; Carotid Arteries ; Cytosol ; Endothelial Cells ; Endothelium ; Endothelium, Vascular ; Hand ; Lysophosphatidylcholines* ; NG-Nitroarginine Methyl Ester ; Relaxation*

OBJECTIVE: To compare the degree of improvement of conduction block in carpal tunnel syndrome (CTS) between the patients who received operation and those who received conservative treatment. METHOD: Subjects included 33 hands of 27 CTS patients who received operation (operation group) and 20 hands of 17 patients who were managed conservatively (non-operation group). Median antidromic sensory responses were recorded with wrist and palm stimulation. The criterion for conduction block was more than 50% drop of baseline to negative peak amplitude of sensory nerve action potential with wrist stimulation compared to palm stimulation. The degree of conduction block was measured before and aftertreatment, and the improvement of conduction block was compared between the two groups. RESULTS: The degrees of conduction block were 59.9+/-14.3% in operation group and 60.5+/-14.5% in the non-operation group at initial evaluation. The improvements of conduction block were 32.1+/-15.1% (5~58.9%) in operation group and 7.8+/-19.8% (-27.3~36.7%) in non-operation group after treatment and the difference was statistically significant. CONCLUSION: The results suggest that operative treatment may be useful even in patients with carpal tunnel syndrome with conduction block.
Action Potentials ; Carpal Tunnel Syndrome* ; Follow-Up Studies* ; Hand ; Humans ; Wrist

Purpose: The efficacy of the Mindful Self-Compassion (MSC) for Healthcare Communities program has not been verified. This study aims to evaluate the feasibility and efficacy of the online MSC for Healthcare Communities program on burnout, stress-related health, and resilience among surgical trainees. Methods: A single-arm pilot study was conducted at a tertiary referral academic hospital in Korea. Surgical trainees were recruited through flyer postings; therefore, a volunteer sample was used. Thus, 15 participants participated, among whom 9 were women and 11 were doctor-residents. The Self-Compassion for Healthcare Communities (SCHC) program was conducted from September to October 2021 via weekly online meetings (1 hour) for 6 weeks. The efficacy of the program was evaluated using validated scales for burnout, stress, anxiety, depression, self-compassion, and resilience before and after the intervention and 1 month later. Results: The results showed significantly reduced burnout, anxiety, and stress scores. After the program, high emotional exhaustion and depersonalization rates decreased, and personal accomplishment increased. Eight participants showed reduced anxiety postintervention, and 9 showed reduced stress. Improvements were observed between pre- and postintervention in resilience, life satisfaction, and common humanity. Changes in self-compassion predicted higher gains in resilience and greater reductions in burnout and stress. Conclusion The SCHC is a feasible and effective program to improve resilience, self-compassion, and life satisfaction and reduce stress, anxiety, depression, and burnout in surgical trainees. This study highlights the need to include specific mental health programs in surgical training to improve trainees’ well-being.

PURPOSE: To assess the usefulness of digital subtraction contrast-enhanced multi-phase magnetic resonance angiography (MRA) for evaluation of the vessels of the gastrointestinal system. MATERIALS AND METHODS: Twenty-five patients who underwent abdominal MRA for evaluation of the vessels of the gastrointestinal system were included in this study. MRA was performed using a 1.5-T scanner and the 3-D turbo-FLASH sequence. Subtraction images of the arterial and portal venous phases were obtained by subtracting arterial phase images from mask images and portal venous phase images from arterial phase images, respectively. Each set of images was processed using a maximum-intensity projection (MIP) algorithm to produce three-dimensional angiograms. We compared overall image quality and the visibility of normal and abnormal vessels between subtraction and non-subtraction MRA. RESULTS: In terms of subjective image quality, subtraction and non-subtraction MRA was similar both the arterial and portal venous phases (p>0.05). During the arterial phase, subtraction MRA visualized more peripheral branches of the left gastric and superior mesenteric arteries than non-subtraction MRA (p<0.05), and during the portal venous phase, subtraction MRA demonstrated more peripheral branches of the superior mesenteric (p<0.01), splenic (p<0.05) and left portal vein (p<0.05) than non-subtraction MRA. In addition, overall visibility of the arterial and portal venous branches was superior with subtraction MRAs than with non-subtraction MRA. Both of these detected all anomalous arterial branching (n=5) and abnormal (encased or obstructed) portal veins (n=5). Subtraction MRA visualized 17 portal venous collaterals in six patients, whereas non-subtraction MRA visualized only seven collateral veins. CONCLUSION: In contrast-enhanced abdominal MRA, the digital subtraction technique permits visualization of more distal branches of the vessels of both the arterial and portal venous systems without significant degradation of image quality. The technique is particularly useful for the detection of portal venous collaterals in patients with portal hypertension.
Angiography* ; Angiography, Digital Subtraction ; Humans ; Hypertension, Portal ; Magnetic Resonance Angiography ; Masks ; Mesenteric Artery, Superior ; Portal Vein ; Subtraction Technique* ; Veins