Ki Hong Chang

Endometrium from women with endometriosis shows increased proliferation activity

Examination of 631 infertile women, including 434 women with endometriosis and 197 without endometriosis, revealed an increasing incidence of endometrial polyps, especially in the test subjects with endometriosis, and advanced stages of endometriosis. Expression of Ki-67 and Bcl-2 proteins and MTT assay results were significantly higher in endometrium of patients with endometriosis than in patients without endometriosis. These showed increased proliferation activity and cell proliferation markers not only clinically but also pathologically.

Comparison of laparoscopic versus conventional open surgical staging procedure for endometrial cancer

OBJECTIVE The aim of this study was to compare the surgical outcomes of laparoscopic surgery and conventional laparotomy for endometrial cancer. METHODS A total of 104 consecutive patients were non-randomly assigned to either laparoscopic surgery or laparotomy. All patients underwent comprehensive surgical staging procedures including total hysterectomy, bilateral salpingo-oophorectomy, and pelvic/para-aortic lymphadenectomy. The safety, morbidity, and survival rates of the two groups were compared, and the data was retrospectively analyzed. RESULTS Thirty-four patients received laparoscopic surgery and 70 underwent laparotomy. Operation time for the laparoscopic procedure was 227.0+/-28.8 minutes, which showed significant difference from the 208.1+/-46.4 minutes (p=0.032) of the laparotomy group. The estimated blood loss of patients undergoing laparoscopic surgery was 230.3+/-92.4 mL. This was significantly less than that of the laparotomy group (301.9+/-156.3 mL, p=0.015). The laparoscopic group had an average of 20.8 pelvic and 9.1 para-aortic nodes retrieved, as compared to 17.2 pelvic and 8.5 para-aortic nodes retrieved in the laparotomy group. There was no significant difference (p=0.062, p=0.554). The mean hospitalization duration was significantly greater in the laparotomy group than the laparoscopic group (23.3 and 16.4 days, p<0.001). The incidence of postoperative complications was 15.7% and 11.8% in the laparotomy and laparoscopic groups respectively. No statistically significant difference was found between the two groups in the survival rate. CONCLUSION Laparoscopic surgical staging operation is a safe and effective therapeutic procedure for management of endometrial cancer with an acceptable morbidity compared to the laparotomic approach, and is characterized by far less blood loss and shorter postoperative hospitalization.

Significance of postoperative CA-125 decline after cytoreductive surgery in stage IIIC/IV ovarian cancer

OBJECTIVE The purpose of this study was to evaluate whether the decline in serum CA-125 levels following primary cytoreductive surgery prior to starting adjuvant chemotherapy has a prognostic value in patients with stage IIIC/IV ovarian carcinoma. METHODS A retrospective review was conducted of all patients with stage IIIC/IV ovarian carcinoma who underwent primary cytoreductive surgery followed by platinum-based chemotherapy from 1994 to 2007. Demographic, pathologic, treatment, and survival data were collected. Patients were included if serum CA-125 levels were drawn preoperatively and within one week prior to their first chemotherapy cycle, and whose postoperative CA-125 level declined. Percentage decline was calculated, and was compared with standard statistical tests in groups by 25% declination intervals. RESULTS Of the 112 stage IIIC/IV patients, 81 (72.3%) met the above inclusion criteria. The median time from surgery to postoperative CA-125 sampling was 16 days (range: 7-42). A >/=75% decline was associated with a median progression-free survival (PFS) of 25 months (95% CI=0-63). This was significantly longer when compared with each of the other 25% interval groups. After multivariate analysis, independent prognostic factors included a >/=75% decline in CA-125 levels after surgery and the presence of residual tumor. Age, grade, histology, and preoperative CA-125 levels were not statistically significant factors. CONCLUSION A >/=75% decline in serum CA-125 serum levels from primary cytoreductive surgery to the start of adjuvant chemotherapy has independent prognostic value for PFS in patients with stage IIIC/IV ovarian carcinoma.

The relationship among self-efficacy, perfectionism and academic burnout in medical school students

Purpose: The purpose of this study was to examine the relationship among academic self-efficacy, socially-prescribed perfectionism, and academic burnout in medical school students and to determine whether academic self-efficacy had a mediating role in the relationship between perfectionism and academic burnout. Methods: A total of 244 first-year and second-year premed medical students and first- to fourth-year medical students were enrolled in this study. As study tools, socially-prescribed perfectionism, academic self-efficacy, and academic burnout scales were utilized. For data analysis, correlation analysis, multiple regression analysis, and hierarchical multiple regression analyses were conducted. Results: Academic burnout had correlation with socially-prescribed perfectionism. It had negative correlation with academic self-efficacy. Socially-prescribed perfectionism and academic self-efficacy had 54% explanatory power for academic burnout. When socially-prescribed perfectionism and academic self-efficacy were simultaneously used as input, academic self-efficacy partially mediated the relationship between socially-prescribed perfectionism and academic burnout. Conclusion: Socially-prescribed perfectionism had a negative effect on academic self-efficacy, ultimately triggering academic burnout. This suggests that it is important to have educational and counseling interventions to improve academic self-efficacy by relieving academic burnout of medical school students.

Reappraisal of Neonatal Greenstick Skull Fractures Caused by Birth Injuries: Comparison of 3-Dimensional Reconstructed Computed Tomography and Simple Skull Radiographs

OBJECTIVE The most common birth-associated head injuries during vaginal delivery are cephalhematomas and subgaleal hematomas. Cranial injuries are rarely encountered. The neonate cranium is soft and pliable, and greenstick skull fractures (GSFs) are expected to be more frequent than linear or depressed fractures, but they are extremely difficult to detect with simple skull radiography. As a result, no reports have been issued on this topic to date. Recent reports suggest that technological advances in 3-dimensional (3D) computed tomography (CT) have successfully enhanced the diagnostic accuracy for cranial fractures. The authors researched the types and characteristics of GSFs and the diagnostic accuracy of 3D CT for cranial fractures in neonates. METHODS The simple skull radiographs and 3D CT images of 101 neonates were retrospectively evaluated and compared with respect to diagnosis of cranial fractures, and skull GSFs were classified on the basis of 3D CT findings into 5 types depending on multiplicity and location. RESULTS 3D CT detected 88 cases of cranial fractures, that is, 89 GSFs, 4 combined GSFs and linear fractures, and 3 combined GSFs and depressed fractures. The diagnostic rate of 3DCT was 91% and this was significantly higher than the 13% rate of simple skull radiographs (P < 0.001). CONCLUSIONS GSFs rather than linear fractures were found to account for most cranial injuries among neonates. The diagnostic accuracy of 3D CT was considerably superior than simple skull radiography, but the high radiation exposure levels of 3D CT warrant the need for development of a modality with lower radiation exposure.

Longitudinal analysis of the effect of academic failure tolerance on academic achievement fluctuation in medical school students.

Purpose: Academic failure tolerance (AFT) is one of the important psychological concepts in education, but its applications in medical education are rare. Thus, the purpose of this study was to investigate the effect of academic failure tolerance on academic achievement fluctuation among medical school students using a longitudinal research design. Methods: The subjects were 43 medical students who responded to the AFT test. This study analyzed the longitudinal data of achievement scores up to the 2nd academic year (2012–2013) among students who were divided into academic achievement improvement and decline groups. Results: Comparing the improvement and decline groups’ mean academic achievement fluctuation scores demonstrated that behavior and preferred task difficulty showed high scores whereas feeling scores were lower in the improvement group (p<0.05). Conclusion: In the improvement group, despite the higher negative feeling scores during academic failure, the students favored the more difficult subjects and were more assiduous in their studies. This will form an important basis for enhancing academic achievement among medical students.

O-047 Conservative therapy of adnexal torsion employing color doppler sonography

Study Objective. To ascertain i f color Doppler sonography (CDS) can detect viability of adnexa in torsion. Design. Concurrent, nonrandomized study (Canadian Task Force classification 11-2). Setting. Tertiary medical care center in a university hospital. Patients, Twenty-seven women suspected of having torsion of the ovary in which a benign tumor was present. Interventions. Color Doppler sonography of the ovarian pedicle suggested torsion. Laparoscopy or laparotomy was performed in 19 patients and confirmed the diagnosis. Measurements and Main Results. We identifed a twisted vascular pedicle of the ovarian tumor by CDS in 24 (88%) of 27 women. Pedicle arterial and venous blood f low was observed in 10 women; pathology specimens revealed normal tissue, edema with congestion, or early hemorrhage. In all nine in whom only arterial blood f low or no blood f low was observed, pathology revealed hemorrhagic necrosis. In five women with arterial and venous blood f low the tumor was managed conservatively, either by detorsion or cystectomy, after which no embolism or tumor recurrence was seen at follow-up ultrasonography. Normal follicular development and ovulation occurred in these patients. Conclusion. For women of childbearing age in whom torsion of benign adnexal tumors is suspected, CDS should be performed to confirm the diagnosis and ascertain whether or not pedic/e arterial and venous/~/ood f low is present. I f such blood f low is detected, the adnexa is considered to be viable and detorsion or cystectomy may be performed, thus preservin~ the ovary. It is recommended that further studies with a larger group be undertaken to provide a basis for statistical analysis. (l Am Assoc Gynecol Laparosc 5(1):13-17, 1998) Tors ion of uter ine adnexa accounts for approximate ly 2.7% of all gyneco log ic emergenc ie s and may be a rare but impor tant e t io logy of acute a b d o m i n a l pain ~ as first reported by J, B land Sut ton in 1890. In adnexal torsion the ovary and ipsilateral fal lopian tube twist with the pedicle as the axis, thereby b lock ing From the Departments of Obstetrics and Gynecology (Drs. Chang, Hwang, Kwon. Yoo, Ryu, and Oh) and Radiology (Dr. Lee), Ajou University School of Medicine. Suwon, Korea. Address reprint requests to Ki-Hong Chang, M.D., Department of Obstetrics and Gynecology, Ajou University School of Medicine, 5 Wonchon dong, Paldal-ku, Suwon, Korea 112-749; fax 082 331 219 5250. CTF II-2: Evidence obtained from well-designed cohort or case control studies, preferably from more than one center or research group.

Potential bias factors that affect the course evaluation of students in preclinical courses

Purpose We aim to identify what potential bias factors affected students’ overall course evaluation, and to observe what factors should be considered in the curriculum evaluation system of medical schools. Methods This study analyzed students’ ratings of preclinical instructions at the Ajou University School of Medicine. The ratings of instructions involved 41 first-year and 45 second-year medical students. Results There was a statistically significant difference between years of study and ratings’ scoring. Learning difficulty, learning amount, student assessment, and teacher preparation from second-year students were significantly higher than first-year students (p<0.05). The analysis results revealed that student assessment was the predictor of ratings from first-year students, while teacher preparation was the predictor of ratings from second-year students. Conclusion We found significant interactions between year of study and the students’ rating results. We were able to confirm that satisfaction of instructions factors perceived by medical students were different for the characteristics of courses. Our results may be an important resource for evaluating preclinical curriculums.

Can disclosure of scoring rubric for basic clinical skills improve objective structured clinical examination

Purpose: To determine whether disclosure of scoring rubric for objective basic clinical skills can improve the scores on the objective structured clinical examination (OSCE) in medical students. Methods: Clinical performance score results of one university medical students (study group, n=345) were compared to those of another university (control group, n=1,847). Both groups took identical OSCE exam. OSCE rubric was not revealed to the study group until they were in the last 2 years of medical school. Results: There was no significant difference between before and after disclosure of rubric. However, history taking and physical examination scores of the study group were lower than those of the control group before the disclosure of rubric. After disclosure of rubric, the scores were either unchanged or slightly increased in the control group. Trend analysis of scores demonstrated that history taking and physical examination scores after the disclosure were significantly increased in the study group for 2 years. Conclusion: This study revealed that disclosure of basic clinical skills rubric to medical students could enhance their clinical performance, particularly in history taking and physical examination scores.