Background/Aims: We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL). Methods: We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse-free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up. Results: The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10-year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis. Conclusions Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.

BACKGROUND AND OBJECTIVES: Proficient differentiation of human pluripotent stem cells (hPSCs) into specific lineages is required for applications in regenerative medicine. A growing amount of evidences had implicated hormones and hormone-like molecules as critical regulators of proliferation and lineage specification during in vivo development. Therefore, a deeper understanding of the hormones and hormone-like molecules involved in cell fate decisions is critical for efficient and controlled differentiation of hPSCs into specific lineages. Thus, we functionally and quantitatively compared the effects of diverse hormones (estradiol 17-β (E2), progesterone (P4), and dexamethasone (DM)) and a hormone-like molecule (retinoic acid (RA)) on the regulation of hematopoietic and neural lineage specification. METHODS AND RESULTS: We used 10 nM E2, 3 μM P4, 10 nM DM, and 10 nM RA based on their functional in vivo developmental potential. The sex hormone E2 enhanced functional activity of hematopoietic progenitors compared to P4 and DM, whereas RA impaired hematopoietic differentiation. In addition, E2 increased CD34⁺CD45⁺ cells with progenitor functions, even in the CD43⁻ population, a well-known hemogenic marker. RA exhibited lineage-biased potential, preferentially committing hPSCs toward the neural lineage while restricting the hematopoietic fate decision. CONCLUSIONS: Our findings reveal unique cell fate potentials of E2 and RA treatment and provide valuable differentiation information that is essential for hPSC applications.
Dexamethasone ; Humans ; Induced Pluripotent Stem Cells ; Pluripotent Stem Cells ; Progesterone ; Regenerative Medicine ; Tretinoin

BACKGROUND: The clinical practice examination (CPX) was introduced in 2010, and the Seoul-Gyeonggi CPX Consortium developed the patient-physician interaction (PPI) assessment tool in 2004. Both institutions use rating scales on classified sections of PPI but differ in their scoring of key components. This study investigated the accuracy of standardized patient scores across rating scales by comparing checklist methods and verified the concurrent validity of two comparable PPI rating tools. METHODS: An educational CPX module dyspepsia case was administered to 116 fourth-year medical students at Hanyang University College of Medicine. One experienced standardized patient rated exams using two different PPI scales. She scored checklists composed of 43 items related to the two original PPI scales through video clips of the same students. From these checklists, we calculated Pearson's correlation coefficient. RESULTS: The correlations of total PPI score between the checklist and rating scale methods were 0.29 for the Korean Medical Licensing Examination (KMLE) tool and 0.30 for the consortium tool. The correlations between the KMLE and consortium tools were 0.74 for checklists and 0.83 for rating scales. In terms of section scores, the consortium tool showed only three significant correlations between the two methods out of seven sections and the KMLE tool showed only two statistically significant correlations out of five sections. CONCLUSION: The rating scale and checklist methods exhibited a weak relationship in the PPI assessment, but a high correlation between assessment tools using the same method. However, the current rating scale requires modification by reorganizing key scoring components through factor analysis.
Behavior Rating Scale ; Checklist* ; Dyspepsia ; Education, Medical ; Educational Measurement ; Humans ; Licensure ; Methods ; Physician-Patient Relations ; Students, Medical ; Weights and Measures

BACKGROUND: After introduction of clinical skills assessment in the Korean Medical Licensing Examination, medical schools have reinforced both experiential learning with real patients and preparatory programs. This study was conducted to investigate whether a clinical practice examination (CPX) preparation program improves students' CPX score in terms of case specificity. METHODS: One hundred and thirteen senior students in a medical school participated in this study. During the fourth-year clerkship, 28 students (24.8%) from three rotation groups took a 3-day CPX preparation course consisting of module development, role play, and comprehensive physical exam skills training. Eleven rotation groups (n=85) were compared as control. Both the intervention and control group took two comprehensive CPXs before and after the clerkship was completed. RESULTS: There was no significant difference in age, sex, and school type between the two groups. On pre-test CPX, there was no significant difference in total and sectional scores between the two groups. On post-test CPX, total scores of the intervention group were higher than those of the control groups (69.5±4.3 vs. 67.5±4.4, P < 0.05). History taking scores were higher in intervention groups (70.0±6.0 vs. 66.0±6.6, P=0.01). The station scores of vaginal discharge with case similarity were higher in the intervention groups (73.0±6.3 vs. 68.9±9.3, P=0.03). CONCLUSION: A short CPX preparation course improved history taking ability, but its effect was greater only in a specific case, similar to the pre-course case. Whether this effect was due to the test experience or true improvement in competency requires further investigation.
Clinical Clerkship ; Clinical Competence ; Education, Medical, Undergraduate ; Humans ; Licensure ; Outcome Assessment (Health Care) ; Patient Simulation ; Problem-Based Learning ; Role Playing ; Schools, Medical ; Sensitivity and Specificity ; Simulation Training ; Vaginal Discharge

BACKGROUND: The purpose of this study was to evaluate serum lipid levels in Korean adults after consumption of different types of yogurt. METHODS: Study subjects were 3,038 individuals (≥19 years of age) who participated in the 2012 Korean National Health and Nutrition Examination Survey. Yogurt intake was assessed with a food frequency questionnaire by using the 24-hour recall method. We conducted complex samples general linear analysis with adjustment for covariates. RESULTS: The serum triglyceride levels in the group consuming viscous yogurt were lower than those in the group consuming non-viscous yogurt. CONCLUSION: Consumption of viscous yogurt is associated with low serum triglyceride levels in Korean adults.
Adult ; Cholesterol ; Humans ; Korea* ; Methods ; Nutrition Surveys* ; Triglycerides ; Yogurt*

We report on a case of ischemic dysfunction of the sinus node as a complication after percutaneous transluminal coronary angioplasty of the distal left circumflex artery. After local thrombolytic therapy in the sinus node artery, sinus node arterial flow was re-established and sinus node function normalized over the period of a week. Our experience suggests that immediate reperfusion of a totally occluded nodal artery can be re-established. Ischemic dysfunction of the sinus node, as a complication of angioplasty, is generally transient and requires a prolonged period for recovery. Therefore the decision to implant a permanent pacemaker should be delayed for at least one week after the ischemic insult.
Urinary Plasminogen Activator/administration & dosage/*therapeutic use ; Thrombolytic Therapy/*methods ; Sinoatrial Node/*physiopathology ; Myocardial Ischemia/*complications/radiography/therapy ; Middle Aged ; Male ; Infusions, Intravenous ; Humans ; Follow-Up Studies ; Fibrinolytic Agents/administration & dosage/*therapeutic use ; Electrocardiography ; Coronary Angiography ; Arrhythmia/diagnosis/*drug therapy/etiology ; Angioplasty, Transluminal, Percutaneous Coronary/adverse effects

PURPOSE: To find out the differences in eating habits between poor feeding and non-poor feeding children. METHODS: We performed questionnaires on 504 children under four years of age who visited hospitals in Gwangju city and JaollaNamdo from May to August, 2002. RESULTS: 138 (27.4%) children were included in poor feeding group, and 366 (72.%) children were in non-poor feeding group. Breast feeding rate was 18.8% in the poor feeding group and 20.3% in the non-poor feeding group. Duration of breast feeding for less than six months were noted in 70.5% of poor feeding group, and 58.5% of non-poor feeding group. The time at starting solid food in the poor feeding group was as follows; 15.9% of infants started on solid food when they were 2~4 months old, 32.7% during 4~6 months, 38.1% during 6~8 months and 18.8% over one year of age. Solid food was given in wrongly manners in both groups by nursing bottles, including 80.4% in poor feeding group and 66.6% in non-poor feeding group. CONCLUSION: This study demonstrated close relationships among poor feeding children under four years of age with history of low rate and short duration of breast feeding, inappropriate time to start on solid food, less interest in food during mealtime, and unbalanced diet. Pediatricians should make an effort to play an important role in nutritional education and treatment in children.
Breast Feeding ; Child* ; Diet ; Eating* ; Education ; Gwangju ; Humans ; Infant ; Meals ; Nursing ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Prolonged atrial conduction time and inhomogeneous electrical atrial activity have been known to be important electrophysiologic characteristics in patients with paroxysmal atrial fibrillation (PAF). Filtered P wave duration dispersion (Pdisp) is defined as the difference between the maximal and minimal filtered P wave duration of the three X, Y, Z leads of P wave signal averaged ECG (PSAECG). The purpose of this study was to determine and compare conventional PSAECG parameters with this newly developed parameter, Pdisp, for the prediction of PAF risk. SUBJECTS AND METHODS: The study population, consisting of 65 patients with PAF (Group 1) and 56 age and sex matched controls (Group 2), was further subgrouped by the presence (Group A) and absence (Group B)of organic heart disease. The PSAECG was recorded using P wave triggered SAECG and the following parameters were measured: total filtered P wave duration (TFPD), vector magnitude, RMS10, RMS20, RMS30 and Pdisp. These parameter values were compared between groups. RESULTS: TFPD and Pdisp were significantly longer in the PAF group than in the control group (121.2+/-9.7 msec versus 108.5+/-12.7 msec, p=0.005:25.2+/-11.5 msec versus 14.7+/-7.9 msec, p<0.001, respectively). The presence of organic heart disease and the size of the left atrium did not affect the result. The designation of Pdisp greater than 15 msec as the cut-off value for predicting PAF produced a sensitivity of 85% and a specificity of 75%, and was more accurate than TFPD (sensitivity 72%, specificity 66%). CONCLUSION: Pdisp might be a more accurate SAECG parameter for predicting the PAF risk than other conventional parameters.
Atrial Fibrillation* ; Electrocardiography ; Heart Atria ; Heart Diseases ; Humans ; Risk Assessment ; Sensitivity and Specificity

PURPOSE: To examine the prevalence of obesity in elementary school-aged children in Gwangju, and long term courses of those obese children. METHODS: We examined children aged 7 to 12 in the total number of 3,028 elementary school students consisting of 1,579 boys and 1,449 girls between 1994 and 1999. Obesity was defined as weight that exceeded the standard weight for height and sex by more than 20%(relative weight >120%). RESULTS: The prevalence of obesity was 3.4% at age 7 and 6.2% at age 12. The prevalence of obesity increased with age in both sexes. In boys, 5.7% of normal weight children at age 7 became obese at age 12. Sixty percent of mild obese children and sixty four point three percent of moderately obese children at age 7 remained obese at age 12. One hundred percent of severely obese children at age 7 remained obese at age 12. In girls, 3.1% of normal weight children at age 7 became obese at age 12. Forty seven percent of mildly obese children and fifty six point three percent of moderately obese children at age 7 remained obese at age 12. Sixty six point seven percent of severely obese children at age 7 remained obese at age 12. Above half of the obese children at age 7 remained obese at age 12. CONCLUSION: Our results suggest that prevention and treatment of obesity in elementary school children is required as early as possible.
Child ; Female ; Follow-Up Studies* ; Gwangju ; Humans ; Obesity ; Pediatric Obesity* ; Prevalence

BACKGROUND: This study was designed to evaluate the role of KATP channel activation and change of monophasic action potential duration on cardioprotective effect of ischemic preconditioning in cat. METHODS: 34 cats were divided into 4 groups: control (n=10), ischemic preconditioning(n=8), glibenclamide pre-treated(n=8) and nicorandil pre-treated group(n=8). Ischemic preconditioning was done in ischemic preconditioning and glibenclamide pre-treated groups by 3 episodes of 5 min ischemia and 10 min reperfusion. All subjects underwent 40 min of ischemia and 40 min reperfusion. The KATP channel antagonist glibenclamide was given as intravenous bolus (0.5mg/kg) 10 min before ischemic precondtioning and infused (5 microgram/min) during ischemic preconditioning. Nicorandil, a KATP channel opener was injected as intravenous bolus (0.5mg/kg) before 40 min ischemic procedure. Monophasic action potential duration at 50% repolarization(MAP50) was measured in the ischemic and non-ischemic area respectively by epicardial probe throughout the experiment. The effects of ischemic preconditioning were determined by infarct size (% area at risk). RESULTS: Ischemic preconditioning or pretreatment with nicorandil prior to 40 min ischemia demonstrated a significant reduction in infarct size(26.6+/-7%, 33+/-8% infarction of the risk zone, respectively, p<0.01, p<0.05 vs. control) with respect to control(42+/-7% infarction of the risk zone). Pretreatment with glibenclamide abolished the effect of ischemic preconditioning(40+/-8% infarction of the risk zone, p=NS vs. control) Ischemic preconditioning group exhibited a significant reduction of ischemic area MAP50 duration in the ischemic area during preconditioning; at first preconditioning 123+/-9msec vs. 137+/-19msec control(p=NS), at second preconditioning 105+/-16msec vs. 140+/-19msec control(p<0.01), at third preconditioning 109+/-15msec vs. 138+/-19msec control(p<0.05). Pretreatment with glibenclamide prevented the reduction of MAP50 in the ischemic area during ischemic preconditioning. During 40 minutes ischemia, MAP50 shortening was more pronounced in the preconditioned group than in control group; at 10 min 85+/-22 msec vs. 131+/-31msec control(p<0.05), at 20 min 88+/-21msec vs. 130+/-32msec control(p<0.05), and at 30 min 103+/-24msec vs. 136+/-30msec control(p<0.05). This shortening effect was prevented by glibenclamide pretreatment. Nicorandil pretreatment pronounced the ischemic shortening of MAP50 in ischemic area and the nicorandil effect was most significant during early ischemic period; at 10 min 97+/-21msec(p<0.05 vs. control), at 20 min 104+/-32msec (p=NS vs. control), and at 30 min 134+/-28msec(p=NS vs. control). MAP50 measured in non-ischemic area was not significantly different between groups. CONCLUSION: We conclude that KATP channel activation and monophasic action potential duration shortening play a important role in myocardial protection during ischemic injury.
Action Potentials* ; Animals ; Cats* ; Glyburide ; Infarction ; Ischemia ; Ischemic Preconditioning* ; Nicorandil ; Reperfusion