No abstract available.

The purpose of this study was to examine professors’ and students’ perceptions of curriculum that fosters character in medical school. ‘Character’ can be defined as a desirable personality and the ability to be a good person. A total of 264 subjects (professors=131, students=133) participated in the study. Survey questions were divided into the three parts (education needs, factors of character, and curriculum management strategy). Data were analyzed by using t-test and one-way analysis of variance. Both professors and students recognized the need for character education. Professors were more aware of the need for education than students (t=4.35, p<0.01), and clinical professors were more aware of the need for education than basic medical science professors (t=3.48, p<0.01). Premedical students were more aware of the need for character-centered education than medical students in the later stages of their education (t=3.41, p<0.01). Professors and students commonly referred to ‘consideration and communication’ as the most important factor in building character. Professors considered ‘self-regulation’ more important than the students recognized, while students perceived ‘wisdom’ as more important than the professors did. There was a difference in preference for curriculum development (creating new subjects vs. revising existing subjects) between the two groups. However, both groups agreed on the teaching and evaluation methods. In conclusion, both groups acknowledged the need for character education. However, there were differences in perception on the major factors of character and preference for curriculum development. The results of this study may assist in designing character education in medical education.

Because of extensive vascular injury, reconstruction of ring avulsion injury is classically believed to be challenging for a hand surgeon. We report a case of ring avulsion injury treated by debridement of the damaged artery and interpositioning vessel graft with a healthy proper palmar digital artery, which lead to successful functional recovery.
Arteries ; Debridement ; Glycosaminoglycans ; Hand ; Transplants ; Vascular System Injuries

BACKGROUND AND OBJECTIVES: This study was to done to determine the value of PROPELLER diffusion-weighted imaging in detecting cholesteatoma. SUBJECTS AND METHOD: Sixty-five patients were evaluated by preoperative magnetic resonance imaging (MRI) with PROPELLER diffusion-weighted imaging. Of 65 patients, 16 patients had chronic otitis media without cholesteatoma and 49 patients with cholesteatoma. Surgical and pathologic findings were compared with the preoperative findings by PROPELLER diffusion-weighted imaging to assess the sensitivity, specificity, positive and negative predictive values. RESULTS: In 49 patients with cholesteatoma, high signal intensity compatible with cholesteatoma was found in 46 patients, whereas in 16 patients without cholesteatoma, high signal intensity was not detected in any of them. The sensitivity, specificity, positive and negative predictive values for PROPELLER diffusion-weighted imaging were 94.1%, 100%, 100%, and 84.2%, respectively. CONCLUSION: PROPELLER diffusion-weighted imaging can be a useful tool in detecting cholesteatoma.
Cholesteatoma* ; Diffusion Magnetic Resonance Imaging ; Humans ; Magnetic Resonance Imaging ; Methods ; Otitis Media ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVES: Ultrasonography is the most useful tool for detecting extrathyroidal extension, which is the deciding factor in surgical extension of papillary thyroid carcinoma. However, there are few studies on pre-operative ultrasonographic findings about extrathyroidal extension. This research thus evaluates a predictive sonographic index of extrathyroidal extension. SUBJECTS AND METHOD: 265 patients with papillary thyroid carcinoma who underwent preoperative sonography and surgery were respectively reviewed. Sonographic findings were compared with pathological results. RESULTS: There were no differences among the patents in terms of calcification and echo texture, whereas significant differences were observed in terms of mass size, lymph node metastasis, capsule contact, and degree of capsule contact. These four factors were weighted according to the degree of severity and defined the extrathyroidal index as the total of these scores. The index had high sensitivity, specificity and predictability. CONCLUSION: We suggest that the extrathyroidal extension index with sonography is helpful for drawing pre-operative sonographic diagnosis.
Diagnosis ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms* ; Ultrasonography*

Increasing importance of vaccination during coronavirus disease 2019 (COVID-19) pandemic, several vaccines were developed. Messenger RNA (mRNA) vaccines including BNT162b2 (Pfizer, New York, NY, USA; BioNTech, Mainz, Germany), mRNA-1273 (Moderna, Cambridge, MA, USA) have been disclosed side effects such as thrombocytopenia, myocarditis and headache in general. In addition, adverse effects due to autoimmune responses induced by spike glycoproteins of mRNA vaccines are rarely reported such as the Guillain-Barre syndrome, autoimmune encephalitis and so on. Herein, we report a rare case of encephalitis with new-onset refractory status epilepticus after BNT162b2 mRNA COVID-19 vaccination improved with immune therapy.

OBJECTIVE: This study aimed to examine the associations between depression and both coronary artery disease (CAD) and cardiovascular risk factors (CVRs) in Korean women. Furthermore, this study sought to determine whether depression was associated with use of healthcare services in women with CAD or CVRs. METHODS: This cross-sectional study was conducted on 26,335 women who were aged 19 years or older, and who participated in the Korean National Health and Nutrition Examination Survey (2007–2014). Associations of prior diagnosis of depression with CAD and CVRs and with nonutilization of healthcare services were investigated. RESULTS: Women with depression had a higher prevalence of CAD and CVRs including obesity, hypertension, dyslipidemia, and metabolic syndrome than those without depression. In addition, depression was significantly associated with nonutilization of healthcare services in women with most CVRs. CONCLUSION: Considering the high rate of comorbid depression with CAD or CVRs and the low lvels of health service utilization in depressed patients, screening for common CVRs, such as obesity, hypertension, and dyslipidemia, should be provided for patients with depression in mental health care settings.
Coronary Artery Disease ; Cross-Sectional Studies ; Delivery of Health Care* ; Depression* ; Diagnosis ; Dyslipidemias ; Female ; Health Services ; Humans ; Hypertension ; Mass Screening ; Mental Health ; Nutrition Surveys ; Obesity ; Prevalence ; Risk Factors

BACKGROUND: Dipeptidyl peptidase-4 (DPP-4) inhibitor add-on therapy is a new option for patients with inadequately controlled type 2 diabetes who are taking combined metformin and sulfonylurea (SU). We evaluated the efficacy and safety of this triple therapy and the characteristics of rapid responders and hypoglycemia-prone patients. METHODS: We included 807 patients with type 2 diabetes who were prescribed a newly added DPP-4 inhibitor to ongoing metformin and SU in 2009 to 2011. Glycemia and other metabolic parameters at baseline, 12, 24, and 52 weeks, as well as episodes of hypoglycemia were analyzed. Rapid responders were defined as patients with > or =25% reduction in glycosylated hemoglobin (HbA1c) within 12 weeks. RESULTS: At baseline, while on the submaximal metformin and SU combination, the mean HbA1c level was 8.4%. Twelve weeks after initiation of DPP-4 inhibitor add-on, 269 patients (34.4%) achieved an HbA1c level < or =7%. Sixty-six patients (8.2%, 47 men) were rapid responders. The duration of diabetes was shorter in rapid responders, and their baseline fasting plasma glucose (FPG), HbA1c, C-peptide, and homeostasis model assessment of insulin resistance were significantly higher. Patients who experienced hypoglycemia after taking DPP-4 inhibitor add-on were more likely to be female, to have a lower body weight and lower triglyceride and FPG levels, and to have higher homeostasis model assessment of beta-cells. CONCLUSION: An oral hypoglycemic triple agent combination including a DPP-4 inhibitor was effective in patients with uncontrolled diabetes. Proactive dose reduction of SU should be considered when a DPP-4 inhibitor is added for rapid responders and hypoglycemia-prone patients.
Blood Glucose ; Body Weight ; C-Peptide ; Diabetes Mellitus, Type 2 ; Dipeptidyl-Peptidase IV Inhibitors ; Fasting ; Female ; Hemoglobin A, Glycosylated ; Homeostasis ; Humans ; Hypoglycemia ; Insulin Resistance ; Metformin* ; Sulfonylurea Compounds ; Triglycerides

Recombinant human parathyroid hormone 1-34 (rHPTH; 1-34, teriparatide) increases bone mass and increases osteoporotic fracture by stimulating new bone formation. It was approved in the United States for treatment of osteoporosis in men and women, and its effectiveness and safety was proved. Mild hypercalcemia was observed, but persistent and severe hypercalcemia was not observed in the studies of teriparatide. In this case, severe hypercalcemia was developed from patient having gait disturbance who was treated with vitamin D, calcium and teripartide for two months to treat osteoporosis after subtrochanteric fracture. Hypercalcemia was resolved with discontinuation of teriparatide. Severe hypercalcemia is not a common complication of teriparatide and monitoring of serum calcium level is routinely not recommended. But it is necessary to pay close attention to patients who were treated with teriparatide, especially in immobilized patients.
Calcium ; Female ; Gait ; Humans ; Hypercalcemia ; Male ; Osteogenesis ; Osteoporosis ; Osteoporotic Fractures ; Parathyroid Hormone ; Teriparatide ; United States ; Vitamin D

Recombinant human parathyroid hormone 1-34 (rHPTH; 1-34, teriparatide) increases bone mass and increases osteoporotic fracture by stimulating new bone formation. It was approved in the United States for treatment of osteoporosis in men and women, and its effectiveness and safety was proved. Mild hypercalcemia was observed, but persistent and severe hypercalcemia was not observed in the studies of teriparatide. In this case, severe hypercalcemia was developed from patient having gait disturbance who was treated with vitamin D, calcium and teripartide for two months to treat osteoporosis after subtrochanteric fracture. Hypercalcemia was resolved with discontinuation of teriparatide. Severe hypercalcemia is not a common complication of teriparatide and monitoring of serum calcium level is routinely not recommended. But it is necessary to pay close attention to patients who were treated with teriparatide, especially in immobilized patients.
Calcium ; Female ; Gait ; Humans ; Hypercalcemia ; Male ; Osteogenesis ; Osteoporosis ; Osteoporotic Fractures ; Parathyroid Hormone ; Teriparatide ; United States ; Vitamin D