Background: Developmental trajectories of clinical skills in training physicians vary among tasks and show interindividual differences. This study examined the predictors of medical internship performance and residency entrance and found subtypes of performance trajectory in training physicians. Methods: This retrospective cohort study involved 888 training physicians who completed a medical internship between 2015 and 2019. After the internship, 627 physicians applied for residency training between 2016 and 2020. Finally, 160 of them completed their first-year residency in internal medicine, surgery, pediatrics, and psychiatry departments between 2016 and 2020. Pearson’s correlation coefficients of internship performance and first year-residency performance (n = 160) were calculated. Latent profile analysis identified performance trajectory subtypes according to medical school grade point average (GPA), internship performance, English proficiency, and residency selection procedures. Multivariate logistic regression models of residency acceptance (n = 627) and performance in the top 30%/lower 10% in the first year of residency were also constructed. Results: Medical internship performance showed a significant positive correlation with the medical school GPA (r = 0.194) and the written score for the medical licensing examination (r = 0.125). Higher scores in the interview (adjusted odds ratio [aOR], 2.57) and written examination (aOR, 1.45) of residency selection procedures and higher medical internship performance (aOR, 1.19) were associated with a higher chance of residency acceptance. The latent profile analyses identified three training physician subgroups: average performance, consistently high performance (top 30%), and adaptation to changes (lowest 10%). Higher scores in the interview for residency selection (aOR, 1.35) and lower scores for medical internship performance (aOR, 0.79) were associated with a higher chance of performing in the top 30% or lowest 10% in the first year of residency, respectively. Conclusion Performance in the interview and medical internship predicted being among the top 30% and lowest 10% of performers in the first year of residency training, respectively.Individualized educational programs to enhance the prospect of trainees becoming highfunctioning physicians are needed.

Purpose: To evaluate the safety, efficiency, and size-dependency of the ‘Inverted omega En-bloc (Ʊ)’ holmium laser enucleation of the prostate (HoLEP) in benign prostate hyperplasia (BPH) with lower urinary tract symptoms. Materials and Methods: A retrospective analysis of 716 consecutive patients who underwent HoLEP under the care of a single surgeon from 2014–2021. These patients were treated using the ‘Inverted omega En-bloc’ HoLEP technique for BPH. The patients were divided into 3 groups: Group 1 (<40 mL, n=328), Group 2 (40–60 mL, n=221), and Group 3 (≤60 mL, n=167). Perioperative parameters, safety, and functional outcomes were assessed and analyzed. Results: The perioperative parameters, like enucleation time (45.8±26.9 min), morcellation time (13.2±47.5 min), and catheterization duration (1.6±1.2 d) significantly differed to favor smaller prostate sizes (p<0.01). Significant improvements in the IPSS (total, voiding, storage, and quality of life), post-void residual urine, and maximum flow rate were observed 3 months post-HoLEP and continued during the 1-year follow-up period in all groups (p<0.01). The postoperative complications included urethral stricture in 11 patients (1.5%), bladder neck contracture in 12 (1.7%), urinary incontinence in 14 (2.0%), and bladder injuries in 4 (0.6%). Bladder neck contractures occurred only in Group 1. The postoperative surgical management for complications included urethral sounding (n=9, 1.3%), endoscopic internal urethrotomy (n=2, 0.3%), and re-HoLEP for bladder neck contractures in (n=12, 1.7%). The rate of re-HoLEP for regrowing adenomas was 15 (2.1%). Postoperative medications exceeding 6 months were α-blocker (n=22, 3.1%), cholinergics (n=16, 2.2%), anticholinergics (n=58, 8.1%), antidiuretics (n=18, 2.5%), and daily PDE5 inhibitor (n=38, 5.3%). Thirty-four patients (4.7%) had postoperative incidental prostate cancer. Conclusions The inverted omega En-bloc HoLEP technique is safe and effective for the treatment of BPH. Moreover, ‘Inverted omega En-bloc’ HoLEP is a size-independent and effective method for all prostate sizes.

Recently, the prevalence of prostate cancer has been increased with the screening of prostate-specific antigen and the increase in the elderly population. In particular, the diagnosis of the low-risk prostate cancer has increased greatly, and social interest for overtreatment has been heightened in Korea. Therefore, this review aimed to provide evidence-based treatment guidelines in low-risk prostate cancer based on Korean population. The literature provides evidence on treatment options, such as watchful waiting, active surveillance, radical prostatectomy, and radiation therapy according to the life expectancy of patients with low-risk prostate cancer. Furthermore, this review provides information on the efficacy of pelvic lymph node dissection and adjuvant radiation therapy during/after radical prostatectomy in low-risk prostate cancer.
Aged ; Diagnosis ; Evidence-Based Medicine ; Humans ; Korea ; Life Expectancy ; Lymph Node Excision ; Mass Screening ; Medical Overuse ; Neoplasms, Second Primary ; Prevalence ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Watchful Waiting

Patients with lysosomal acid lipase (LAL) deficiency and glycogen storage disease (GSD) demonstrated hepatomegaly and dyslipidemia. In our case, a 6-year-old boy presented with hepatosplenomegaly. At 3 years of age, GSD had been diagnosed by liver biopsy at another hospital. He showed elevated serum liver enzymes and dyslipidemia. Liver biopsy revealed diffuse microvesicular fatty changes in hepatocytes, septal fibrosis and foamy macrophages. Ultrastructural examination demonstrated numerous lysosomes that contained lipid material and intracytoplasmic cholesterol clefts. A dried blood spot test revealed markedly decreased activity of LAL. LIPA gene sequencing identified the presence of a novel homozygous mutation (p.Thr177Ile). The patient's elevated liver enzymes and dyslipidemia improved with enzyme replacement therapy. This is the first report of a Korean child with LAL deficiency, and our findings suggest that this condition should be considered in the differential diagnosis of children with hepatosplenomegaly and dyslipidemia.
Biopsy ; Child* ; Cholesterol ; Diagnosis, Differential ; Dyslipidemias ; Enzyme Replacement Therapy ; Fibrosis ; Glycogen Storage Disease ; Hepatocytes ; Hepatomegaly ; Humans ; Liver ; Lysosomes ; Macrophages ; Male ; Sterol Esterase*

Patients with lysosomal acid lipase (LAL) deficiency and glycogen storage disease (GSD) demonstrated hepatomegaly and dyslipidemia. In our case, a 6-year-old boy presented with hepatosplenomegaly. At 3 years of age, GSD had been diagnosed by liver biopsy at another hospital. He showed elevated serum liver enzymes and dyslipidemia. Liver biopsy revealed diffuse microvesicular fatty changes in hepatocytes, septal fibrosis and foamy macrophages. Ultrastructural examination demonstrated numerous lysosomes that contained lipid material and intracytoplasmic cholesterol clefts. A dried blood spot test revealed markedly decreased activity of LAL. LIPA gene sequencing identified the presence of a novel homozygous mutation (p.Thr177Ile). The patient's elevated liver enzymes and dyslipidemia improved with enzyme replacement therapy. This is the first report of a Korean child with LAL deficiency, and our findings suggest that this condition should be considered in the differential diagnosis of children with hepatosplenomegaly and dyslipidemia.
Biopsy ; Child* ; Cholesterol ; Diagnosis, Differential ; Dyslipidemias ; Enzyme Replacement Therapy ; Fibrosis ; Glycogen Storage Disease ; Hepatocytes ; Hepatomegaly ; Humans ; Liver ; Lysosomes ; Macrophages ; Male ; Sterol Esterase*

PURPOSE: Thiazide diuretics exert their hypotensive efficacy through a combined vasodilator and diuretic effect. The present study was conducted to assess the inhibitory effect of thiazide diuretic, hydrochlorothiazide, and the thiazide-like diuretics, indapamide and chlorthalidone on contractile responses to norepinephrine and arginine vasopressin in aortic rings from 2K1C renal hypertensive and sham-clipped normotensive rats. METHODS: 2K1C hypertension was made by clipping the left renal artery and age-matched control rats received a sham treatment. Changes in the tension of aortic ring preparations were measured isometrically. RESULTS: Indapamide inhibits the contractile responses to norepinephrine and vasopressin in aortic rings from 2K1C rats, while it did not modify in control rats. The inhibitory effect of indapamide was abolished by endothelium removal. Hydrochlorothiazide or chlorthalidone did not affect the vasoconstriction induced by norepinephrine and vasopressin either in sham or in 2K1C hypertensive rats. CONCLUSION: These results suggest that indapamide inhibits the contractile responses to norepinephrine and vasopressin via an endothelium-dependent mechanism in 2K1C renal hypertension.
Animals ; Aorta ; Arginine Vasopressin ; Chlorthalidone ; Diuretics ; Endothelium ; Hydrochlorothiazide ; Hypertension ; Hypertension, Renal ; Indapamide ; Norepinephrine ; Placebos ; Rats ; Renal Artery ; Salicylamides ; Sodium Chloride Symporter Inhibitors ; Vasoconstriction ; Vasodilation ; Vasopressins

PURPOSE: Evidence has emerged that oxygen-derived free radicals may induce vascular relaxations via ATP-sensitive K+ (K(ATP)) channels and the level of free radicals is increased in animal models of hypertension. The present study was conducted to determine whether relaxations to an K(ATP) channel opener, pinacidil, are increased in the aorta from two-kidney, one clip (2K1C) hypertensive rats and whether free radial scavengers reduce these relaxations. METHODS: 2K1C hypertension was induced by clipping the left renal artery and age-matched control rats received a sham treatment. Rings of aortae without endothelium were suspended for isometric force recording. RESULTS: Relaxations to pinacidil (10(-8) to 10(-5) M), which are abolished by glibenclamide (10(-5) M), were augmented in the aorta from 2K1C rats, compared to those from control rats. In the aorta from 2K1C rats, catalase (1,200 U/mL), but neither superoxide dismutase (150 U/mL) nor deferoxamine (10(-4) M), reduced relaxations to pinacidil, whereas in the aorta from control rats, the free radical scavengers did not affect these relaxations. CONCLUSION: These results suggest that in 2K1C hypertension, vasorelaxation to an KATP channel opener is augmented and that hydrogen peroxide in smooth muscle cells may partly contribute to these relaxations.
Animals ; Aorta ; Catalase ; Deferoxamine ; Endothelium ; Free Radical Scavengers ; Free Radicals ; Glyburide ; Hydrogen Peroxide ; Hypertension ; Hypertension, Renal ; Models, Animal ; Myocytes, Smooth Muscle ; Pinacidil ; Placebos ; Rats ; Relaxation ; Renal Artery ; Salicylamides ; Superoxide Dismutase ; Vasodilation

PURPOSE: Baroreceptor reflex regulation has been shown to reset towards a higher blood pressure level. This study was designed to assess alterations of chronotropic baroreflexes in two-kidney, one clip (2K1C) and deoxycorticosterone acetate (DOCA)-salt hypertensive rats. METHODS: Arterial pressure and heart rate (HR) were monitored continuously during intravenous infusions of phenylephrine or sodium nitroprusside. Ensuing reflex HR responses during each drug infusion were determined in two ways: (a) at 10 s intervals (time analysis), and (b) with every 10 mmHg change in pressure (pressure analysis). RESULTS: Both pressor and depressor responses produced by phenylephrine or sodium nitroprusside were comparable between normotensive and hypertensive rats. Both reflex tachycardia and bradycardia were attenuated in 2K1C hypertensive rats as compared with normotensive rats, whereas no significant differences were shown in DOCA-salt hypertensive rats. CONCLUSION: These results indicate that chronotropic baroreflexes are impaired in 2K1C hypertensive rats, but not in DOCA-salt hypertensive rats.
Animals ; Arterial Pressure ; Baroreflex ; Blood Pressure ; Bradycardia ; Desoxycorticosterone ; Dihydrotachysterol ; Heart Rate ; Hypertension ; Infusions, Intravenous ; Nitroprusside ; Phenylephrine ; Rats ; Reflex ; Tachycardia

PURPOSE: To evaluate the efficacy of unenhanced MR imaging compared to the diagnostic accuracy, advantage, and limitations of abdominal ultrasonography in the diagnosis of acute appendicitis. MATERIALS AND METHODS: The study included 40 patients suspected of having acute appendicitis and who were subjected to an unenhanced MR image, as well as an abdominal ultrasonography. A T1 FLASH in an axial image, a chemical shift-selective fat suppressed T2 HASTE in an axial image, as well as a T2 HASTE in an axial and coronal image were obtained as unenhanced MR images. The diagnosis was established based on a surgical or clinical follow-up of the unenhanced MR results, which were then statistically compared to the ultrasonographic results. RESULTS: The surgical or clinical follow-up results revealed that 25 patients were positively diagnosed with appendicitis. Of these, 7 patients had symptoms of acute appendicitis with no pathologic diagnoses, whereas the 8 remaining patients were diagnosed with another condition. The sensitivity and accuracy of the unenhanced MR imaging was 92% and 90%, compared to ultrasonography which was 68% and 72.5% accurate, respectively. The differences in sensitivity and accuracy between the two methods were found to be statistically significant (p < .05, chi-square test). Based on these results, unenhanced MR imaging was superior to sonography for the diagnosis of appendicitis. CONCLUSION: Unenhanced MR imaging may be a useful modality for the diagnosis of acute appendicitis, especially for suboptimal or nondiagnostic sonographies, as well as patients that are particularly sensitive to radiation exposure.
Acute Disease ; Appendicitis ; Appendix ; Follow-Up Studies ; Humans ; Imidazoles ; Nitro Compounds

PURPOSE: Hypertension may be involved an alteration of intrinsic basal tone in vascular smooth muscle. The purpose of this study was to investigate the vasorelaxant effect of atrial natriuretic peptide (ANP) on isolated non-contracted aorta from two-kidney, one clip (2K1C) renovascular hypertensive rats. METHODS: 2K1C hypertension was induced by clipping the left renal artery and were used 6 weeks later. Age-matched rats receiving a sham treatment, which served as controls. The thoracic aortae were mounted in tissue baths to measure the isometric tension. RESULTS: ANP diminished basal tone in previously unstimulated thoracic aortic rings from 2K1C hypertensive rats, while it had no effect in the control rats. Endothelial destruction potentiated the vasorelaxant effect of ANP on basal tone in 2K1C rats. A similar potentiation of the ANP response was observed by pre-treatment with N omega-nitro-L-arginine methyl ester (L-NAME) or methylene blue in aortic rings with endothelium. Treatment with calcium-free Krebs decreased basal tone and abolished ANPresponse. These effects were observed only in aortic rings from 2K1C rats. Similarly, staurosporine and calphostin C, inhibitors of protein kinase C (PKC), lowered basal tone and abolished ANP-response in hypertensive rats. CONCLUSION: These results demonstrate that ANP has a vasorelaxant effect on basal tone in 2K1C renovascular hypertension. Inhibition of ANP effects on basal tone by calcium-free Krebs and PKC antagonists suggests that altered Ca2+ -active tone is involved in hypertension, that modifies the response of vascular smooth muscle to the ANP.
Animals ; Aorta ; Aorta, Thoracic ; Atrial Natriuretic Factor ; Baths ; Endothelium ; Hypertension ; Hypertension, Renovascular ; Methylene Blue ; Muscle, Smooth, Vascular ; Naphthalenes ; NG-Nitroarginine Methyl Ester ; Placebos ; Protein Kinase C ; Rats ; Renal Artery ; Salicylamides ; Staurosporine