Acute-Onset Vitreous Hemorrhage of Unknown Origin before Vitrectomy: Causes and Prognosis

Purpose. To analyze causes and prognosis of acute-onset preoperatively unknown origin vitreous hemorrhage (VH). Methods. This study included patients who underwent vitrectomy for acute-onset preoperatively unknown origin VH. The underlying causes of VH, which were identified after vitrectomy, were analyzed. And overall visual prognosis of unknown origin VH was analyzed. Risk scoring system was developed to predict visual prognosis after vitrectomy. Results. 169 eyes were included. Among these, retinal vein occlusion (RVO), retinal break, and age-related macular degeneration (AMD) were identified in 74 (43.8%), 50 (29.6%), and 21 (12.4%) patients, respectively. After vitrectomy, logMAR BCVA significantly improved from 1.93±0.59 to 0.47±0.71. However, postoperative BCVA in AMD eyes were significantly poorer than others. Poor visual prognosis after vitrectomy was associated with old age, poor preoperative vision in both eyes, and drusen in the fellow eye. Conclusions. RVO, retinal break, and AMD are the most common causes of acute-onset preoperatively unknown origin VH and the most common causes of VH change with age. The visual prognosis of unknown origin VH is relatively good, except among AMD patients. Older patients with poor preoperative BCVA in both eyes and patients with AMD in the fellow eye are at a higher risk of poor visual prognosis following vitrectomy

The BDNF Val66Met Polymorphism Affects the Vulnerability of the Brain Structural Network

Val66Met, a naturally occurring polymorphism in the human brain-derived neurotrophic factor (BDNF) gene resulting in a valine (Val) to methionine (Met) substitution at codon 66, plays an important role in neuroplasticity. While the effect of the BDNF Val66Met polymorphism on local brain structures has previously been examined, its impact on the configuration of the graph-based white matter structural networks is yet to be investigated. In the current study, we assessed the effect of the BDNF polymorphism on the network properties and robustness of the graph-based white matter structural networks. Graph theory was employed to investigate the structural connectivity derived from white matter tractography in two groups, Val homozygotes (n = 18) and Met-allele carriers (n = 55). Although there were no differences in the global network measures including global efficiency, local efficiency, and modularity between the two genotype groups, we found the effect of the BDNF Val66Met polymorphism on the robustness properties of the white matter structural networks. Specifically, the white matter structural networks of the Met-allele carrier group showed higher vulnerability to targeted removal of central nodes as compared with those of the Val homozygote group. These findings suggest that the central role of the BDNF Val66Met polymorphism in regards to neuroplasticity may be associated with inherent differences in the robustness of the white matter structural network according to the genetic variants. Furthermore, greater susceptibility to brain disorders in Met-allele carriers may be understood as being due to their limited stability in white matter structural connectivity

Evaluation of an international faculty development program for developing countries in Asia: the Seoul Intensive Course for Medical Educators

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Abstract Background The issue of collaboration in medical education is becoming prominent. Some faculty development programs have suggested an approach for promoting collaboration on a global level. However, non-English-speaking developing countries in Asia, especially in Southeast Asia, do not take advantage of them due to their unique context, such as language and culture. To address these issues, Seoul National University College of Medicine initiated a 6-week international faculty development program called the Seoul Intensive Course for Medical Educators for 16 fellows from five Asian countries (Cambodia, Laos, Mongolia, Myanmar, and Vietnam). The aim of this study is to report the evaluation results of the outcome of the program and discuss better ways of collaborating with developing countries. Methods Three levels of collaboration—intraorganizational, intranational, and international—were central initiatives of the program. Prior to setting up the program details, we first established four design principles, following which the contents, materials, and facilitators were determined to maintain consistency with the design principles. The evaluation of the program was done with Kirkpatricks four-level model. Most of the evaluation data for level 1 were collected by two questionnaires, the post-module survey and the post-program survey. Portfolios and progress reports were mainly used to collect outcome data for levels 2 and 3, respectively. Results The reaction was generally positive throughout the program and there was a significant correlation between satisfaction and relevance to ones job or needs. Despite the fellows propensity for overestimating themselves, both the evaluators and fellows reported that there was significant improvement in learning. Opinions on the impact or urgency of the topics were slightly different from country to country; however, the answers regarding feasibility were fairly similar. Moreover, we could observe from the post-program progress reports that the transfer of learning was actively in progress, mainly for topics that were highly feasible. Conclusions These results show that the program was successful in terms of its effectiveness. Consistent and timely support is essential for the sustainable development of the medical education systems in these countries. Further understanding of the underlying factors on transfer (level 3) could improve the effectiveness of faculty development programs for developing countries

Psychometric Properties of the Hypomania Checklist-32 in Korean Patients with Mood Disorders

OBJECTIVE The aim of this study was to examine the validity of the Korean version of the Hypomania Checklist-32, second revision (HCL-32-R2) in mood disorder patients. METHODS A total of 454 patients who diagnosed as mood disorder according to Structured Clinical Interview for DSM-IV Axis I Disorders, clinician version (SCID-CV) (bipolar disorder [BD] I, n=190; BD-II, n=72; and major depressive disorder [MDD], n=192) completed the Korean module of the HCL-32-R2 (KHCL-32-R2). RESULTS The KHCL-32-R2 showed a three-factorial structure (eigenvalue ＞2) that accounted for 43.26% of the total variance. Factor 1 was labeled "active/elated" and included 16 items; factor 2, "irritable/distractible" and included 9 items; and factor 3 was labeled "risk-taking/indulging" and included 9 items. A score of 16 or more on the KHCL-32-R2 total scale score distinguished between BD and MDD, which yielded a sensitivity of 70% and a specificity of 70%. MDD and BD-II also could be differentiated at a cut-off of 15 with maximized sensitivity (0.67) and specificity (0.66). Cronbach's alpha of KHCL-32-R2 and its subsets (factors 1, 2, and 3) were 0.91, 0.89, 0.81 and 0.79, respectively. Correlations between KHCL-32-R2 and Montgomery- Asberg Depression Rating Scale, Young Mania Rating Scale and Korean version of Mood Disorder Questionnaire were -0.66 (p=0.41), -0.14 (p=0.9), and 0.61 (p＜0.001), respectively. CONCLUSION The KHCL-32-R2 may be a useful tool in distinguishing between bipolar and depressive patients in clinical settings

Etiquette for medical students email communication with faculty members: a single-institution study

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Abstract Background Email is widely used as a means of communication between faculty members and students in medical education because of its practical and educational advantages. However, because of the distinctive nature of medical education, students inappropriate email etiquette may adversely affect their learning as well as faculty members perception of them. Little data on medical students competency in professional email writing is available; therefore, this study explored the strengths and weaknesses of medical students email etiquette and factors that contribute to professional email writing. Methods A total of 210 emails from four faculty members at Seoul National University College of Medicine were collected. An evaluation criteria and a scoring rubric were developed based on the various email-writing guidelines. The rubric comprised 10 items, including nine items for evaluation related to the email components and one item for the assessment of global impression of politeness. Three evaluators independently assessed all emails according to the criteria. Results Students were identified as being 61.0 % male and 52.8 % were in the undergraduate-entry program. The sum of each component score was 62.21 out of 100 and the mean value for global impression was 2.6 out of 4. The results demonstrated that students email etiquettes remained low-to-mediocre for most criteria, except for readability and honorifics. Three criteria, salutation (r=0.668), closing (r=0.653), and sign-off (r=0.646), showed a strong positive correlation with the global impression of politeness. Whether a student entered a graduate-entry program or an undergraduate-entry program significantly contributed to professional email writing after other variables were controlled. Conclusions Although students in the graduate-entry program demonstrated a relatively superior level of email etiquette, the majority of medical students did not write emails professionally. Educating all medical students in email etiquette may well contribute to the improvement of student–faculty relationships as well as their email writing

Comparison of Clinico-Physiologic and CT Imaging Risk Factors for COPD Exacerbation

To date, clinico-physiologic indices have not been compared with quantitative CT imaging indices in determining the risk of chronic obstructive pulmonary disease (COPD) exacerbation. We therefore compared clinico-physiologic and CT imaging indices as risk factors for COPD exacerbation in patients with COPD. We retrospectively analyzed 260 COPD patients from pulmonary clinics at 11 hospitals in Korea from June 2005 to November 2009 and followed-up for at least one year. At the time of enrollment, none of these patients had COPD exacerbations for at least 2 months. All underwent clinico-physiologic and radiological evaluation for risk factors of COPD exacerbation. After 1 yr, 106 of the 260 patients had at least one exacerbation of COPD. Multiple logistic regression analysis showed that old age, high Charlson Index, and low FEV1 were significant in a clinico-physiologic model, with C-statistics of 0.69, and that increased age and emphysema index were significant in a radiologic model, with C-statistics of 0.64. The difference between the two models was statistically significant (P = 0.04 by bootstrap analysis). Combinations of clinico-physiologic risk factors may be better than those of imaging risk factors in predicting COPD exacerbation

Calcium Regulation of EGF-Induced ERK5 Activation: Role of Lad1-MEKK2 Interaction

The ERK5 cascade is a MAPK pathway that transmits both mitogenic and stress signals, yet its mechanism of activation is not fully understood. Using intracellular calcium modifiers, we found that ERK5 activation by EGF is inhibited both by the depletion and elevation of intracellular calcium levels. This calcium effect was found to occur upstream of MEKK2, which is the MAP3K of the ERK5 cascade. Co-immunoprecipitation revealed that EGF increases MEKK2 binding to the adaptor protein Lad1, and this interaction was reduced by the intracellular calcium modifiers, indicating that a proper calcium concentration is required for the interactions and transmission of EGF signals to ERK5. In vitro binding assays revealed that the proper calcium concentration is required for a direct binding of MEKK2 to Lad1. The binding of these proteins is not affected by c-Src-mediated phosphorylation on Lad1, but slightly affects the Tyr phosphorylation of MEKK2, suggesting that the interaction with Lad1 is necessary for full Tyr phosphorylation of MEKK2. In addition, we found that changes in calcium levels affect the EGF-induced nuclear translocation of MEKK2 and thereby its effect on the nuclear ERK5 activity. Taken together, these findings suggest that calcium is required for EGF-induced ERK5 activation, and this effect is probably mediated by securing proper interaction of MEKK2 with the upstream adaptor protein Lad1

Adults’ Perception of Children’s Vowel Production

The study examined the link between Korean-speaking children’s vowel production and its perception by inexperienced adults and also observed whether ongoing vowel changes in mid-back vowels affect adults’ perceptions when the vowels are produced by children. This study analyzed vowels in monosyllabic words produced by 20 children, ranging from 2 to 6 years old, with a focus on gender distinction, and used them as perceptual stimuli for word perception by 20 inexperienced adult listeners. Acoustic analyses indicated that F0 was not a reliable cue for distinguishing gender, but the first two formants served as reliable cues for gender distinction. The results confirmed that the spacing of the two low formants is linguistically and para-linguistically important in identifying vowel types and gender. However, a pair of non-low back vowels caused difficulties in correct vowel identification. Proximal distance between the vowels could be interpreted to result in the highest mismatch between children’s production and adults’ perception of the two non-low back vowels in the Korean language. We attribute the source of the highest mismatch of the two non-low back vowels to the ongoing sound change observed in high and mid-back vowels in adult speech. The ongoing vowel change is also observed in the children’s vowel space, which may well be shaped after the caregivers whose non-low back vowels are close to each other

Acute-Onset Vitreous Hemorrhage of Unknown Origin before Vitrectomy: Causes and Prognosis

Purpose. To analyze causes and prognosis of acute-onset preoperatively unknown origin vitreous hemorrhage (VH). Methods. This study included patients who underwent vitrectomy for acute-onset preoperatively unknown origin VH. The underlying causes of VH, which were identified after vitrectomy, were analyzed. And overall visual prognosis of unknown origin VH was analyzed. Risk scoring system was developed to predict visual prognosis after vitrectomy. Results. 169 eyes were included. Among these, retinal vein occlusion (RVO), retinal break, and age-related macular degeneration (AMD) were identified in 74 (43.8%), 50 (29.6%), and 21 (12.4%) patients, respectively. After vitrectomy, logMAR BCVA significantly improved from 1.93±0.59 to 0.47±0.71. However, postoperative BCVA in AMD eyes were significantly poorer than others. Poor visual prognosis after vitrectomy was associated with old age, poor preoperative vision in both eyes, and drusen in the fellow eye. Conclusions. RVO, retinal break, and AMD are the most common causes of acute-onset preoperatively unknown origin VH and the most common causes of VH change with age. The visual prognosis of unknown origin VH is relatively good, except among AMD patients. Older patients with poor preoperative BCVA in both eyes and patients with AMD in the fellow eye are at a higher risk of poor visual prognosis following vitrectomy