Analysis of satisfaction and academic achievement of medical students in a flipped class

Purpose The purpose of this study was to examine the satisfaction of medical students in flipped learning and analyzed academic achievement in comparison with lecture class. Methods The subjects were 40 students who participated in flipped learning during neurology course in the second year. After performing flipped learning, formative assessment was conducted and the degree of satisfaction was examined. Questionnaires of satisfaction were developed to identify the perceptions of students on flipped learning. To compare the academic achievement of students, formative assessments were conducted at the end of the flipped learning class and the lecture class. The data was analyzed by frequency and paired t-test method. Results The students showed a high level of frequency in using lecture notes (80.6%) and lecture slides (74.2%) among the pre-class learning resources. The average score (3.89) was higher for the factor of interaction and collaboration in the classroom than for the factor of improving learning (3.62). The average score of the students in the formative assessment was 4.28 points (out of 10 points) in the lecture class, while it was 5.56 points (out of 10 points) in the flipped learning class thus showing a statistically significant difference (t=-4.203, p<0.001). Conclusion It was observed from the responses of the students that flipped learning is helpful for the interaction and collaboration in the classroom. It is expect that this result will be useful as basic data for medical school to try flipped learning in the future

A robust model training strategy using hard negative mining in a weakly labeled dataset for lymphatic invasion in gastric cancer

Abstract Gastric cancer is a significant public health concern, emphasizing the need for accurate evaluation of lymphatic invasion (LI) for determining prognosis and treatment options. However, this task is time‐consuming, labor‐intensive, and prone to intra‐ and interobserver variability. Furthermore, the scarcity of annotated data presents a challenge, particularly in the field of digital pathology. Therefore, there is a demand for an accurate and objective method to detect LI using a small dataset, benefiting pathologists. In this study, we trained convolutional neural networks to classify LI using a four‐step training process: (1) weak model training, (2) identification of false positives, (3) hard negative mining in a weakly labeled dataset, and (4) strong model training. To overcome the lack of annotated datasets, we applied a hard negative mining approach in a weakly labeled dataset, which contained only final diagnostic information, resembling the typical data found in hospital databases, and improved classification performance. Ablation studies were performed to simulate the lack of datasets and severely unbalanced datasets, further confirming the effectiveness of our proposed approach. Notably, our results demonstrated that, despite the small number of annotated datasets, efficient training was achievable, with the potential to extend to other image classification approaches used in medicine

Investigation of the Optimal Operating Position of an Air Cleaner in Terms of Indoor Air Quality in a Four-Bed Hospital Ward

The use of air cleaners indoors has increased with the increase in indoor activities driven by the COVID-19 outbreak. In this study, the indoor air quality was determined at the location of each patient&rsquo;s respirator in a four-bed hospital ward equipped with a ventilation system and curtains, by varying the position of one air cleaner. By operating the air cleaner alone without the ventilation system, it was confirmed that it is better to place the air cleaner close to the center of the ward, regardless of whether curtains are used. It was further identified that the farther away the air cleaner is from the center, the worse the age of air could be, compared to the case of operating it in the center. Moreover, the situation where the ventilation system and air cleaner were operated simultaneously in the hospital ward was considered. It was discovered that operating the air cleaner close to the ventilation inlets in the absence of curtains helps to improve the indoor air quality. Furthermore, it was found that the age of the air is generally low near the location where the air cleaner is operated in the presence of curtains. Selecting an optimal position for the air cleaner can improve the air quality at the location of each bed in a four-bed hospital ward

Comparison of Indoor Air Quality in Summer and Winter According to Four-Way Cassette Fan Coil Unit Operation in a Four-Bed Ward

This study targeted a four-bed ward with a ventilation system and a four-way cassette fan coil unit (4-way FCU) installed on the ceiling. The indoor air quality under summer and winter conditions was comparatively analyzed. The age of air was calculated by conducting tests and simulations under diverse conditions, assuming that the ventilation system and 4-way FCU were continuously operating. The use of an air cleaner and ward curtain was investigated for its impact on the air quality in the breathing zone of a patient lying on the bed, and effects of the airflow and discharge angle of the 4-way FCU were considered. Because the 4-way FCU was installed in the central part of the ceiling, where indoor air is sucked in and subsequently discharged in four directions, the age of air at each bed was found to vary depending on the airflow and discharge angle of the 4-way FCU. When the airflow and discharge angle of the 4-way FCU was fixed, the age of air at each bed appeared to be lower during winter heating than in summer cooling mode. The age of air was significantly lowered at each bed, depending on the use of the curtain and the air cleaner along with the ventilation system and 4-way FCU, and appropriate seasonal operating conditions were identified to maintain a lower age of air at each bed

Significance of 8-OHdG Expression as a Predictor of Survival in Colorectal Cancer

The incidence of colorectal cancer (CRC) is increasing worldwide. 8-hydroxy-2′-deoxyguanosine (8-OHdG), one of the most prevalent DNA alterations, is known to be upregulated in several carcinomas; however, 8-OHdG has not been used to predict the prognosis of patients with CRC. We aimed to determine 8-OHdG levels in patients with CRC using immunohistochemistry and conducted a survival analysis according to the pathological stage. The 5-year event-free survival (EFS) and disease-specific survival (DSS) hazard ratios (HRs) of the low 8-OHdG subgroup were 1.41 (95% confidence interval (CI): 1.01–1.98, p = 0.04) and 1.60 (95% CI: 1.12–2.28, p = 0.01), respectively. When tumor node metastasis (TNM) staging and 8-OHdG expression were combined, the 5-year EFS and DSS HRs of patients with CRC with low 8-OHdG expression cancer at the same TNM stage (stage Ⅲ/Ⅳ) were 1.51 (95% CI: 1.02–2.22, p = 0.04) and 1.64 (95% CI: 1.09–2.48, p = 0.02), respectively, compared to those with high 8-OHdG expression cancer, indicating a poor prognosis. Therefore, low 8-OHdG expression is a significant predictive factor for 5-year EFS and DSS in patients with CRC, and it can serve as an essential biomarker of CRC

A case of Cowden syndrome diagnosed from multiple gastric polyposis

Cowden syndrome is a rare autosomal dominant disorder that is characterized by multiple hamartomas in a variety of tissues and this is associated with germline mutations in the phosphatase and tensin homologue (PTEN) gene, which is the tumor suppressor gene located on chromosome 10q23.3. It is characterized by multiple hamartomatous neoplasms of the skin, oral mucosa, gastrointestinal (GI) tract, bones, central nervous system, eyes, and genitourinary tract. Cowden syndrome does not have increased risk of GI malignancy; however, it has an increased risk of breast, thyroid and endometrial cancer development. Here the authors report a rare case of Cowden syndrome incidentally diagnosed from multiple gastric polyposis. A 29-year-old woman presented with multiple gastric polyps. The laboratory results were normal except for mild anemia, with a hemoglobin level of 11.9 g/dL. Esophagogastroduodenoscopy revealed multiple gastric, duodenal polyps and esophageal acanthosis. Colonoscopy revealed possible hamartomatous polyps in the rectum. Under the suspicion of Cowden syndrome, sonography of the thyroid and breasts was carried out, which revealed multiple thyroid masses. Subsequent fine-needle aspiration biopsy revealed the presence of clusters of follicular epithelial cells, and due to the possibility of malignancy, the patient underwent total thyroidectomy. The pathology was reported as invasive follicular carcinoma. A gene study by direct sequencing showed the presence of a PTEN mutation (c.633C > A /p.Cys211*)

Sex-specific differences in risk factors of lymph node metastasis in patients with early gastric cancer.

Accurate prediction of lymph node status is of crucial importance in the appropriate treatment planning for patients with early gastric cancer (EGC). Some studies have examined factors predicting lymph node metastasis (LNM) in EGC; however, these studies did not consider sex-specific differences. This study aimed to investigate sex-specific differences in predictive risk factors of LNM in EGC based on surgical specimens. Patients who underwent surgical treatment for EGC between January 2003 and February 2016 were retrospectively evaluated. Patients who underwent previous gastric surgery or treatment for gastric neoplasms were excluded. Finally, 1076 patients treated for EGC were included in the analysis. We analyzed risk factors of LNM by dividing patients into male and female groups. Of 1076 patients (mean age 59.6 years), 69% were men. The overall LNM rate was 9.4%. The LNM rate was lower in men (7.8%) than in women (12.9%). Multivariate analysis showed that elevated type (odds ratio [OR], 2.084; 95% confidence interval [CI]: 1.053-4.125; P = 0.035), submucosal invasion (OR, 2.162; 95% CI: 1.018-4.595; P = 0.045), undifferentiated type (OR, 2.044; 95% CI: 1.107-3.772; P = 0.022), and lymphovascular invasion (LVI) (OR, 7.210; 95% CI: 3.835-13.554; P<0.001) were independent predictive risk factors of LNM in EGC in men. However, only submucosal invasion (OR, 8.772; 95% CI: 2.823-27.259; P<0.001) and LVI (OR, 8.877; 95% CI: 3.861-20.410; P<0.001) were independent predictive risk factors of LNM in EGC in women. Submucosal invasion and LVI were risk factors of LNM in both men and women. However, elevated and undifferentiated types were risk factors in men but not in women. Clinicians should consider these sex-specific differences with regard to individualized management