OBJECTIVE: Endotracheal intubation (ETI) is the most reliable way to manage the airway. Stepwise deliberate practice and mastery training is essential in maintaining and promoting the skill of intubation. This study was conducted to identify differences in examiners' expectations regarding competent skill performance and to develop learner-adjusted assessment tools with appropriate levels according to student and resident learners based on the expectations and limited observation of performance by examiners. METHODS: This was an exploratory, psychometric study using a simple airway part task trainer. The draft ETI assessment tool from the literatures, previous tools, and the preliminary learner-adjusted assessment tool for students and residents were developed and analyzed. Knowledge-based and competence-based items for each learner group were identified based on experts' expectations. The final learner-adjusted tools were refined through analyzing the content validity, internal consistency, and interrater reliability based on assessing the observed performance of 14 students and 12 residents by ten experts. RESULTS: The preliminary student-adjusted assessment tool and resident-adjusted assessment tool had 12 items on the checklist with a ternary scoring system and a ternary scoring checklist including 15 items, and an overall Global Rating Scale. The final student-adjusted assessment tool was composed of a ternary scoring checklist including 9 items (total CVI, 86.6%; Cronbach's α, 0.83; interrater reliability, 0.64). The resident-adjusted assessment, on the other hand, was also composed of a ternary scoring checklist including 12 items (total CVI, 86.4%; Cronbach's α, 0.7; interrater reliability, 0.78), in addition to global rating scale including ‘rating of the overall process’. CONCLUSION: The experts had different expectations regarding the level of competence in each step according to learner groups with different levels of difficulty. Understanding the factors influencing assessments can provide a guide for teaching and objectively assessing to the examiner.
Checklist ; Hand ; Humans ; Intubation ; Intubation, Intratracheal ; Mental Competency ; Psychometrics

BACKGROUND: Studies on factors which may predict the risk of diabetes are scarce. This prospective cohort study was conducted to determine the association between adiponectin and type 2 diabetes among Korean men and women. METHODS: A total of 42,845 participants who visited one of seven health examination centers located in Seoul and Gyeonggi province, Republic of Korea between 2004 and 2008 were included in this study. The incidence rates of diabetes were determined through December 2011. To evaluate the effects of adiponectin on type 2 diabetes, the Cox proportional hazard model was used. RESULTS: Of the 40,005 participants, 959 developed type 2 diabetes during a 6-year follow-up. After the adjustment for age, body mass index (BMI), and waist circumference, the risks for type 2 diabetes in participants with normoglycemia had a 1.70-fold (95% confidence interval [CI], 1.21 to 2.38) increase in men and a 1.83-fold (95% CI, 1.17 to 2.86) increase in women with the lowest tertile of adiponectin when compared to the highest tertile of adiponectin. For participants with impaired fasting glucose (IFG), the risk for type 2 diabetes had a 1.46-fold (95% CI, 1.17 to 1.83) increase in men and a 2.52-fold (95% CI, 1.57 to 4.06) increase in women with the lowest tertile of adiponectin. Except for female participants with normoglycemia, all the risks remained significant after the adjustment for fasting glucose and other confounding variables. Surprisingly, BMI and waist circumference were not predictors of type 2 diabetes in men or women with IFG after adjustment for fasting glucose and other confounders. CONCLUSION: A strong association between adiponectin and diabetes was observed. The use of adiponectin as a predictor of type 2 diabetes is considered to be useful.
Adiponectin ; Body Mass Index ; Cohort Studies ; Confounding Factors (Epidemiology) ; Diabetes Mellitus ; Fasting ; Female ; Follow-Up Studies ; Glucose ; Humans ; Incidence ; Male ; Proportional Hazards Models ; Prospective Studies ; Republic of Korea ; Waist Circumference

PURPOSE: Absorbable bone fixation materials for operation of facial bone fracture are composed of poly- lactic acid(PLA) & poly-glycolic acid(PGA). These materials are absorbed after facial bone healing period. Therefore, these materials are harmless in human body. But because of it's radioopacity, the number and the location of the materials are not checked in follow-up X-ray examination. We studied absorbable bone fixation materials checked radiological examination. So, we made the absorbable plate composed of PLA, Hydroxyapatite (HA) and Gold(Au). METHODS: Plate 1 was consisted of pure PLA. Plate 2 was consisted of PLA(50%) and HA(50%). Plate 3-7 were consisted of PLA(50%), and variable composition of HA & Au. The ratio of Au was as following. From the plate 3 to plate 7, the Au ratio was 1%, 5%, 10%, 17%, and 25%, respectively. Total 3 examinations were used -naked eye examination, simple X-ray examination, and Haunsfield unit of plate in CT examination. RESULTS: Naked eye examination found out that the color of plate 1 was most white. As the Au ratio increases, the color of plate was getting close to khaki color. the radioopacity of plate 2 was similar cortical bone of face in simple X-ray. The Haunsfield unit of cortical bone of face was 1000 HU. Haunsfield unit of titanium plate was 2900 HU. Haunsfield unit of plate 1 through plate 7 were -242, 1489, 1776, 3052, 3092, 3095, and 3095, respectively. CONCLUSION: Radioopacity of plate 2 was similar to cortical bone of face. In CT examination, Hanusfield unit of plate 2 was similar to Hanusfield unit of cortical bone of face. Hanusfield unit of plate 4-7 were similar to Hanusfield unit of titanium plate. So to trace bone fixation materials after facial bone surgery, the best ratio of Au is about 1-5%. If this study is applied to facial bone surgery, radiologic follow up would be easy after facial bone surgery.
Durapatite ; Eye ; Facial Bones ; Follow-Up Studies ; Human Body ; Humans ; Titanium

PURPOSE: This study was undertaken to investigate the osteogenic induction potential of PGA & FBS mixture on a calvarial defect in the rabbit. METHODS: Twenty New zealand white rabbit, weighing from 3.5-4kg were allocated into each of the three groups. Four 8mm sized bone defects were made on the parietal bone by drilling. In group I, the bony defects were implanted with 50 micrometer thickness film containing mixture of PGA and FBS. In group II, with PGA only film, & in group III, the bony defects were left with no implants. Results were evaluated by using morphologic change, radiographic study, biochemical study and histologic examination at 1 week (group I n=7, group II n=7, group III n=14), 2 weeks (group I n=6, group II n=6, group III n=12) and 3 weeks (group I n=7, group II n=7, group III n=14) following implantation. RESULTS: In the morphologic & radiographic study, the formation and corticalization of callus were observed earlier in group I than in groups II and III (p<0.05). In histological examination, group I showed more abundant and faster new bone formation than in group II and III. In biochemical analysis, group I displayed more activity than in group II and III. Group I also showed more abundant osteopontin, osteocalcin than groups II and III. CONCLUSION: In conclusion, the results demonstrate that the mixture of PGA and FBS has an effect on osteoblastic formation in the rabbit model. It is considered that further evaluation of long term results on resorption, immunologic tissue reaction and response of applied mixture in the human model will be needed.
Bony Callus ; Humans ; New Zealand ; Osteoblasts ; Osteocalcin ; Osteogenesis ; Osteopontin ; Parietal Bone

PURPOSE: This study was undertaken to investigate the osteogenic induction potential of PGA & FBS mixture on a calvarial defect in the rabbit. METHODS: Twenty New zealand white rabbit, weighing from 3.5-4kg were allocated into each of the three groups. Four 8mm sized bone defects were made on the parietal bone by drilling. In group I, the bony defects were implanted with 50 micrometer thickness film containing mixture of PGA and FBS. In group II, with PGA only film, & in group III, the bony defects were left with no implants. Results were evaluated by using morphologic change, radiographic study, biochemical study and histologic examination at 1 week (group I n=7, group II n=7, group III n=14), 2 weeks (group I n=6, group II n=6, group III n=12) and 3 weeks (group I n=7, group II n=7, group III n=14) following implantation. RESULTS: In the morphologic & radiographic study, the formation and corticalization of callus were observed earlier in group I than in groups II and III (p<0.05). In histological examination, group I showed more abundant and faster new bone formation than in group II and III. In biochemical analysis, group I displayed more activity than in group II and III. Group I also showed more abundant osteopontin, osteocalcin than groups II and III. CONCLUSION: In conclusion, the results demonstrate that the mixture of PGA and FBS has an effect on osteoblastic formation in the rabbit model. It is considered that further evaluation of long term results on resorption, immunologic tissue reaction and response of applied mixture in the human model will be needed.
Bony Callus ; Humans ; New Zealand ; Osteoblasts ; Osteocalcin ; Osteogenesis ; Osteopontin ; Parietal Bone

BACKGROUND: We investigate the influence of cell surface adhesion receptor integrin alphavbeta3, alpha5beta1 contributes to proliferation and migration of tumor cell in osteosarcoma for carves out a new treatment model by regulation of integrin roles in human osteosarcoma. MATERIALS AND METHODS: We performed proliferation assay, total 11 cell lines including 7 osteosarcoma cell lines established from patients and 4 osteosarcoma standard cell lines. Murine monoclonal anti-alpha5beta1 and anti-alphavbeta3 (Chemicon International Inc. Temecula, CA) were used for growth inhibition assays. We also performed cell motility assay by using the Boyden chamber to evaluate the effect of integrin mediated cell migration. We used the HOS standard osteosarcoma cell lines and each separates contained serum free media with mouse IgG1 negative control antibody, anti-alpha5beta1 antibody and anti-alphavbeta3 antibody. RESULTS: Proliferation of cells decreased significantly in 10 out of 11 cell lines when blocking with alphavbeta3 or alpha5beta1 respectively. Blocking with anti-alphavbeta3 antibody decreased significantly tumor cell proliferation in 10 cell lines. Among the 10 cell lines, 7 cell lines showed significantly more decrease of proliferation with anti-alphavbeta3 antibody than with anti-alpha5beta1antibody. Blocking with anti-alpha5beta1 antibody decreased significantly tumor cell proliferation in 10 cell lines. Among the 10 cell lines, 3 cell lines showed significantly more decrease of proliferation with anti-alpha5beta1 antibody than with anti-alphavbeta3 antibody. Including statistically not significant 2 cell lines the growth inhibition of osteosarcoma cell lines was more obvious (10 out of 11) in blocking with anti-alphavbeta3 antibody. The migration of cells was significantly decreased when blocked with anti-alpha5beta1 antibody and anti-alphavbeta3 antibody. CONCLUSION: Under the based on the integrin alphavbeta3, alpha5 beta1 are central role on proliferation and migration of osteosarcoma cells, we could be more approach to new therapeutic endeavors with antibody to integrin alphavbeta3, alpha5beta1 molecular target of osteosarcoma.
Animals ; Cell Line ; Cell Migration Assays ; Cell Movement ; Cell Proliferation* ; Culture Media, Serum-Free ; Humans* ; Immunoglobulin G ; Integrin alphaVbeta3* ; Mice ; Osteosarcoma*

Fusarium spp., basically a superficial pathogen, is a newly emerging fungal pathogen of opportunistic infections in immunocompromised patients. At present, although Fusarium spp. are relatively resistant to amphotericin B, the combination of amphotericin B and surgical debridement appear to be optimal treatment for disseminated infection. Recently we experienced a 32-year-old neutropenic patient after induction chemotherapy for acute myelocytic leukemia presented with skin lesions and infiltrations in both lungs. We diagnosed with disseminated fusariosis by skin culture and successfully treated the patient with liposomal amphotericin B. We emphasize a high index of suspicion for skin lesions especially in immunocopromised patients.
Adult ; Amphotericin B* ; Debridement ; Fusariosis* ; Fusarium* ; Humans ; Immunocompromised Host ; Induction Chemotherapy ; Leukemia, Myeloid, Acute ; Lung ; Opportunistic Infections ; Skin

Fusarium spp., basically a superficial pathogen, is a newly emerging fungal pathogen of opportunistic infections in immunocompromised patients. At present, although Fusarium spp. are relatively resistant to amphotericin B, the combination of amphotericin B and surgical debridement appear to be optimal treatment for disseminated infection. Recently we experienced a 32-year-old neutropenic patient after induction chemotherapy for acute myelocytic leukemia presented with skin lesions and infiltrations in both lungs. We diagnosed with disseminated fusariosis by skin culture and successfully treated the patient with liposomal amphotericin B. We emphasize a high index of suspicion for skin lesions especially in immunocopromised patients.
Adult ; Amphotericin B* ; Debridement ; Fusariosis* ; Fusarium* ; Humans ; Immunocompromised Host ; Induction Chemotherapy ; Leukemia, Myeloid, Acute ; Lung ; Opportunistic Infections ; Skin

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is known to be frequently associated with obesity, type 2 diabetes and dyslipidemia. Recently, the diagnosis of fatty liver disease, based on ultrasonographic findings, has increased. Therefore, we examined the association between NAFLD and various metabolic diseases, such as obesity, glucose intolerance, dyslipidemia, and hypertension or metabolic syndrome, and tried to find out whether NAFLD was independently related to insulin resistance. METHODS: From April to June 2000, 262 subjects, attending for routine physical check-ups, were screened. Of these, 115 one hundred fifteen subjects were studied, with the other 147 excluded due to significant alcohol consumption, evidence of viral or toxic hepatitis, significant liver or renal dysfunction, and overt thyroid disease. Fatty liver was diagnosed if the subject had a "bright" liver on ultrasonographic examination. All diagnoses were made by a single experienced radiologist. RESULTS: Of the 115 subjects. 30 (26%) showed NAFLD. 1. Systolic and diastolic blood pressures, body weight, serum total cholesterol, triglyceride, fasting insulin levels and HOMA IR (homeostasis model assessment insulin resistance index) were higher in the subjects with NAFLD than in the controls. 2. Multiple logistic regression analysis, including age, sex, BMI, waist to hip ratio, fasting serum glucose, lipids and insulin levels, HOMA IR, and hypertension showed that BMI, total cholesterol and HOMA IR were independently related with NAFLD. 3. 27% of the subjects with NAFLD showed metabolic syndrome, and 53% of subjects with metabolic syndrome had NAFLD. 4. The percentage of subjects who had more than two factors of metabolic syndrome was three times higher in the subjects with NAFLD compared to the controls. CONCLUSION: These results suggest that NAFLD may be independently related with insulin resistance. Metabolic diseases, such as glucose intolerance, obesity, dyslipidemia and hypertension, were more prevalent in the subjects with NAFLD than in the controls. Therefore, we should try to assess the status of the metabolic diseases, and treat them in patients with NAFLD.
Alcohol Drinking ; Blood Glucose ; Body Weight ; Cholesterol ; Diagnosis ; Drug-Induced Liver Injury ; Dyslipidemias ; Fasting ; Fatty Liver* ; Glucose Intolerance ; Humans ; Hypertension ; Insulin ; Insulin Resistance ; Liver ; Logistic Models ; Metabolic Diseases* ; Obesity ; Thyroid Diseases ; Triglycerides ; Waist-Hip Ratio

Craniopharyngioma accounts for 3% to 5% of intracranial tumors and is the second most common neoplasm in the sellar region. Panhypopituitarism associated with craniopharyngioma has been reported in 7% of all patients with craniopharyngioma. Slipped capital femoral epiphysis is the condition in which the femoral head slips downward and backward on the femoral neck at the epiphyseal plate due to growth disturbance of capital physis, the actual cause of which is unknown. It is a disease of adolescence, during which many physiologic hormonal changes occur. The clinical association between slipped capital femoral epiphysis and endocrine disease is well known. There have been four cases of slipped capital femoral epiphysis associated with endocrine disorders in Korea. This is the first Korean case report of slipped capital femoral epiphysis combined with craniopharyngioma caused by hypopituitarism
Adolescent ; Craniopharyngioma* ; Endocrine System Diseases ; Epiphyses* ; Femur Neck ; Growth Plate ; Head ; Humans ; Hypopituitarism ; Korea ; Slipped Capital Femoral Epiphyses