Seoul National University College Research Articles

Abstract Su806: Enhancing Cardiac Arrest Registries and Research – A Framework for Handling Defibrillator Data

Background: Cardiac arrest is the most time-sensitive medical condition, and survival probability is highly dependent on early, high-quality cardiopulmonary resuscitation (CPR) measures. Resuscitation registries are established tools for continuous quality improvement and serve as a source for research. Yet they lack comprehensive information on the quality of CPR measures themselves—such as the depth, rate, and release of chest compressions—and are limited in the temporal resolution of these measures. However, data on both are contained in the recordings of defibrillators. Aims: To develop a framework for healthcare providers to gain immediate case-specific feedback, reduce documentation efforts and make fine-grained information accessible for research. Approach: An open-source Python module named CPRDAT (Kern et al. Zenodo, https://doi.org/10.5281/zenodo.10057964) was designed. This module is capable of importing and extracting data from various defibrillators as well as data recorded by VitalRecorder ( VitalDB , Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea) into a uniform data object. Methods were implemented to automatically process, analyze, and aggregate these time-series of physiological signals, with particular attention to CPR. To reduce manual annotation workload, classification algorithms were developed. Plotting routines were developed to display the signals interactively in web applications, allowing healthcare providers to interact with the data through zooming, scaling, shifting, concatenating, merging and labelling. Results: The module was implemented into the German Resuscitation Registry, offering users a manufacturer-agnostic, data-driven, case-specific debriefing tool. Extracted information on CPR measures is stored in the registry. The framework, able to manage multiple time-series data sources, was further implemented in other settings, such as the analysis of laboratory data of a CPR swine model. Conclusions: The new module dramatically enhances the accessibility of physiologic time-series recordings. More fine-grained data will provide deeper insights into processes and CPR physiology. Finally, the open-source Python module abolishes barriers in research.

A Standardized Education Program on Deceased Organ and Tissue Donation for Premedical and Medial Students in Korea.

As the imbalance in organ demand and supply is getting worse, <1000 patients waiting for organ transplants die each year in South Korea. To enhance positive attitudes to deceased organ-tissue donation through systematic education, we developed an educational program with delivery pathways for premedical and medical students. Online and offline self-learning educational materials on deceased organ-tissue donation were generated and posted on the Vitallink Academy YouTube site. Thirty-two pre- and 15 posteducation questionnaires were developed using a web-based survey platform, and conducted before and immediately after the education process. The education proceeded in 3 steps: (1) group study sessions on selected topics, (2) poster submissions by each group and the selection of excellent poster by the organizing committee, and (3) excellent poster presentation and questions and answers. A total of 141 students in the first year of premedical classes at the Seoul National University College of Medicine participated in this program. Only 24.2% of responders agreed that anyone who was diagnosed with brain death should donate. The proportion of students with positive attitudes toward organ-tissue donation increased from 74.7% to 97.7% (P < 0.001) with our education. Likewise, interest in deceased organ-tissue donation-related issues increased from 33.3% to 84.9% (P < 0.001). The expressed willingness for organ-tissue donation also increased from 76.8% to 96.5% (P < 0.001). The proportion of accepting brain death as the determination of death increased from 61.6% to 89.5% (P < 0.001). Moreover, 81.4% changed their approach and planned to register with an organ donor card. In this study, significant improvements were observed in knowledge, awareness, and attitude toward organ-tissue donation with our newly developed co-participatory education program for premedical students. Hence, target-specific education can be regarded as a valuable approach to enhancing public awareness of deceased organ-tissue donation.

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*Department of Ophthalmology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea; †Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea; ‡Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, South Korea; and §Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea. This work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT) (2020R1F1A1072264). None of the authors has any financial/conflicting interests to disclose.

The international quest for the imaging diagnosis of liver cancer.

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Jugular Venous Reflux as an Indicator of Innominate Vein Occlusion Responsible for Superior Ophthalmic Vein Thrombosis.

HomeStrokeVol. 54, No. 4Jugular Venous Reflux as an Indicator of Innominate Vein Occlusion Responsible for Superior Ophthalmic Vein Thrombosis No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessFull TextJugular Venous Reflux as an Indicator of Innominate Vein Occlusion Responsible for Superior Ophthalmic Vein Thrombosis Jiyeon Ha, Seondeuk Kim, Han-Sang Lee and Keun-Hwa Jung Jiyeon HaJiyeon Ha https://orcid.org/0000-0002-5133-759X Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, South Korea. Search for more papers by this author , Seondeuk KimSeondeuk Kim https://orcid.org/0000-0003-1791-1815 Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, South Korea. Search for more papers by this author , Han-Sang LeeHan-Sang Lee Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, South Korea. Search for more papers by this author and Keun-Hwa JungKeun-Hwa Jung Correspondence to: Keun-Hwa Jung, MD, PhD, Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea. Email E-mail Address: [email protected] https://orcid.org/0000-0003-1433-8005 Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, South Korea. Search for more papers by this author Originally published7 Feb 2023https://doi.org/10.1161/STROKEAHA.122.042062Stroke. 2023;54:e161–e162"Jugular Venous Reflux as an Indicator of Innominate Vein Occlusion Responsible for Superior Ophthalmic Vein Thrombosis." Stroke, 54(4), pp. e161–e162FootnotesFor Sources of Funding and Disclosures, see page e162.Correspondence to: Keun-Hwa Jung, MD, PhD, Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea. Email [email protected]com

P5.13: Developing a Standardized Education Program on Deceased Organ Donation for Pre-medical Students

Introduction: It is necessary to deliver essential knowledge on deceased organ donation to medical and premedical students who will play an important role in the field of deceased organ donation in the future. To increase awareness and knowledge on deceased organ donation through a systemic education, we developed educational content and contents delivery pathways for pre-medical and medical students and evaluated its educational effect. Method: On- and off-line self-learning aids materials on 7 topics on deceased organ donation were generated and posted on the Vitallink Academy YouTube site. Pre- and post-education questionnaires (32 and 15 questions, respectively) were developed using a web-based survey platform. The survey consisted of items related to awareness, knowledge, and attitude to deceased organ donation. These surveys were conducted before and immediately after the education process. The education was proceeded according to the following 3 steps (1) Group study sessions on selected topics, (2) Poster submission on the given topic by each group and excellent poster selection by the organizing committee, and (3) Excellent poster presentation and Q&A. Results: A total of 141 students in the first grade at the premedical course at the Seoul National University College of Medicine participated in this program. Even though 96% of students had heard about deceased organ-tissue donation, only 2.1% said that they know about it well. 33.3% of students showed interest in the deceased organ-tissue donation-related issues. 24.2% agreed that anyone who was diagnosed with brain death should donate. Students will agree to donate if their family member had registered (88.9%) or if the person had expressed wishes to donate while alive (63.6%). Most students (83.8%) said that courtesy for deceased donors is necessary or very necessary through funeral support services (35.4%), and the establishment of the memorial park or memorable monument (22.2%). Interest in deceased organ-tissue donation-related issues increased from 33.3% to 84.9% by education (P<0.001). The proportion of students with a positive attitude toward organ-tissue donation was increased from 74.7% to 97.7% (P<0.001). Their attitude toward deceased donation evaluated by expressing willingness to organ-tissue donation also increased from 76.8% to 96.5% (P<0.001). The proportion of accepting brain death as a death increased from 61.6% to 89.5% (P<0.001). Moreover, 81.4% of students had changed in minds and planned to sign up for brain death organ donation registration. Conclusion: Among many avenues of improving public awareness in deceased organ and tissue donation, target-specific education could be the best way in increasing family agreement in countries adapting the Opt-in system. Significant improvements were observed in knowledge and awareness which is enough to bring changes in attitude when we applied our newly developed education program to a group of premedical students.

Abstract 1800: Novel NSDHL inhibitor (Compound 9) exerts anti-proliferative and cytotoxic activity in breast cancer cells

Abstract Background: NAD(P) Dependent Steroid Dehydrogenase-Like (NSDHL) is an enzyme involved in post-squalene cholesterol biosynthesis. We recently suggest new insights into the critical role of the NSDHL involved in breast tumor growth and metastasis and its potential for targeted cancer therapy. Compound 9, which is a novel inhibitor of NSDHL, was kindly provided by Dr. Lee B-J in Seoul National University College of Pharmacy. This study aimed to investigate the anti-cancer potential of Compound 9 in breast cancer. Methods: Therapeutic potential of Compound 9 (10~100 μM) was investigated in several human breast cancer cell lines. Total intracellular cholesterol level was measured using Total Cholesterol Assay Kit. Cell cycle analysis using DNA staining with PI, apoptosis analysis using Annexin V/PI-labeling, and transwell migration assay were performed. The Synergistic anticancer effect of compound-9 and paclitaxel was evaluated by crystal violet assay. Western blot and immunofluorescent staining were assessed for investigating the mechanism by which Compound 9 exerts the anti-cancer effect. Results: Time-dependent intracellular uptake of Compound 9 by breast cancer cells was observed. Compound 9 induced cytotoxic, anti-proliferative, and apoptotic effects and cell cycle arrest (G0/G1), and suppressed migration activity on diverse breast cancer cell lines in a time- and dose-dependent manner. Total intracellular cholesterol level was reduced by Compound 9. Combination with Compound-9 and Paclitaxel led to synergistic cytotoxicity. Compound-9 increased the autophagy-related proteins (P62, LC3II) but decreased the anti-apoptotic proteins (XIAP, BCL2). Conclusion: Our data show that Compound 9 exerts strong anti-proliferative and cytotoxic activity in breast cancer cells, suggesting potential additional utility as an anti-cancer drug. Further studies are necessary to validate the potential anti-cancer effect of Compound-9 in breast tumor mice models. Citation Format: So-Hyun Yoon, Hoe Suk Kim, Moonjou Baek, Seungyeon Ryu, Sangeun Lee, Han-Byoel Lee, Bong-Jin Lee, Wonshik Han. Novel NSDHL inhibitor (Compound 9) exerts anti-proliferative and cytotoxic activity in breast cancer cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1800.

The impact of the modified schedules of anatomy education on students' performance and satisfaction: Responding to COVID-19 pandemic in South Korea.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic substantially undermined medical education and healthcare systems. Owing to the pandemic in South Korea, most medical schools needed to be flexible when conducting online and offline classes, but the guidelines did not reflect the specificity of medical schools. This study described the impact of modified anatomy education schedules at the Seoul National University College of Medicine (SNUCM) on students’ academic performance and satisfaction.MethodsAnatomy education in SNUCM is divided into three regional units (the upper and lower limbs, trunk, and head and neck). Owing to the COVID-19 pandemic, the schedule was mixed with simultaneous and rotating schedules. The authors conducted exceptions for online lectures, cadaver dissections, and written and practical examinations in three classes of approximately 50 students each. Furthermore, the authors assessed students’ performance using three sets of written and practical examinations, and students completed a questionnaire regarding modified anatomy laboratory schedules.ResultsDespite the pandemic events in Seoul and South Korea during the laboratory sessions, all sessions were completed without any confirmed COVID-19 cases among the students, faculty, and staff. Most of the scores on the written and practical examinations significantly decreased in 2020 compared to those in 2019. However, in the trunk session that used the virtual anatomy application, the score on the practical examination in 2020 was significantly higher than that in 2019. Over 70% (79 and 77 out of 105 respondents on the upper and lower limbs and trunk, respectively) and 53% (55/105) students reported that there were no significant difficulties in studying anatomy in a face-to-face laboratory.ConclusionsIn conclusion, an adequate education program for cadaver dissection should be developed and provided to overcome the pandemic restrictions. The study findings could serve as a reference for anatomy education during the COVID-19 pandemic.

Establishing Surgical Care Sustainability in Sub-Saharan Africa for Global Child Health: Insights From Pediatric Cardiac Surgical Capacity-Building Programs in Ethiopia and Côte d'Ivoire.

The global surgery research team of the JW LEE Center for Global Medicine, Seoul National University College of Medicine, introduced team-based health workforce training programs for pediatric cardiac surgery in Ethiopia and Côte d'Ivoire. A team-based collaborative capacity-building model was implemented in both countries, and details of the program design and delivery were documented. The research team shared their experiences and identified achievements, lessons, and challenges for cardiac surgical interventions in Sub-Saharan Africa. Future directions were put forward to advance and strengthen the low-and middle-income countries “Safe Surgery.”

Analysis on Students' Career Preparation in One Korean Medical School: Based on the Relationship and Trend Between Career Maturity and Specialty Indecision.

BackgroundFor medical school students, specialty choice after graduation significantly impacts their future doctor life. Several Korean medical schools have made efforts to prepare career development programs. However, career support programs based on the systematic analysis of medical school students’ first to the final year are still lacking. Therefore, this study aims to analyze the students’ career preparation of one medical school in Korea using the Career Maturity Inventory (CMI) and Specialty Indecision Scale (SIS) and to explore the relationship between CMI and SIS variables.MethodsFrom December 2020 to July 2021, we conducted an online survey of 600 students in years 1 to 4 at Seoul National University College of Medicine. We analyzed the differences between the years of the students through one-way analysis of variance of the CMI and SIS and the relationship between the two instruments by correlation analysis and multiple regression analysis.ResultsA total of 198 students completed the survey. The average scores of the CMI variables tended to increase as the year of study went up, and the confidence score of the 1st year students was significantly lower than that of the 2nd and 4th year students. Although there was almost no consistent decrease by year in the SIS variables, 3rd and 4th year students showed significantly lower readiness scores than 1st year students. Additionally, we found that the CMI variables mostly had a negative effect on the SIS variables.ConclusionThere is an increasing tendency for career maturity by year of study in Korean medical school students. However, looking at the SIS results, the career concerns vary among the students. Therefore, medical schools can effectively use the SIS to identify the career concerns of students.

Minimally Invasive Living Donor Liver Transplantation: Pure Laparoscopic Explant Hepatectomy and Graft Implantation Using Upper Midline Incision.

Liver TransplantationVolume 27, Issue 10 p. 1493-1497 Brief Report Minimally Invasive Living Donor Liver Transplantation: Pure Laparoscopic Explant Hepatectomy and Graft Implantation Using Upper Midline Incision Kyung-Suk Suh M.D., Ph.D., Corresponding Author Kyung-Suk Suh M.D., Ph.D. kssuh2000@gmail.com Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea These authors contributed equally to this work as first authors. Address reprint requests to Kyung-Suk Suh, M.D., Ph.D., Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongnogu, Seoul 03080, Korea. Telephone: +82-2-2072-3789; FAX: +82-2-766-3975; E-mail: kssuh2000@gmail.comSearch for more papers by this authorSuk Kyun Hong M.D., Suk Kyun Hong M.D. orcid.org/0000-0002-0020-6215 Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea These authors contributed equally to this work as first authors.Search for more papers by this authorKwangpyo Hong M.D., Kwangpyo Hong M.D. Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorEui Soo Han M.D., Ph.D., Eui Soo Han M.D., Ph.D. Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorSu Young Hong M.D., Su Young Hong M.D. Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorSanggyun Suh M.D., Sanggyun Suh M.D. Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorJeong-Moo Lee M.D., Jeong-Moo Lee M.D. orcid.org/0000-0001-7806-8759 Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorYoungRok Choi M.D., YoungRok Choi M.D. orcid.org/0000-0003-2408-7086 Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorNam-Joon Yi M.D., Ph.D., Nam-Joon Yi M.D., Ph.D. Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorKwang-Woong Lee M.D., Ph.D., Kwang-Woong Lee M.D., Ph.D. Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this author Kyung-Suk Suh M.D., Ph.D., Corresponding Author Kyung-Suk Suh M.D., Ph.D. kssuh2000@gmail.com Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea These authors contributed equally to this work as first authors. Address reprint requests to Kyung-Suk Suh, M.D., Ph.D., Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongnogu, Seoul 03080, Korea. Telephone: +82-2-2072-3789; FAX: +82-2-766-3975; E-mail: kssuh2000@gmail.comSearch for more papers by this authorSuk Kyun Hong M.D., Suk Kyun Hong M.D. orcid.org/0000-0002-0020-6215 Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea These authors contributed equally to this work as first authors.Search for more papers by this authorKwangpyo Hong M.D., Kwangpyo Hong M.D. Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorEui Soo Han M.D., Ph.D., Eui Soo Han M.D., Ph.D. Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorSu Young Hong M.D., Su Young Hong M.D. Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorSanggyun Suh M.D., Sanggyun Suh M.D. Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorJeong-Moo Lee M.D., Jeong-Moo Lee M.D. orcid.org/0000-0001-7806-8759 Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorYoungRok Choi M.D., YoungRok Choi M.D. orcid.org/0000-0003-2408-7086 Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorNam-Joon Yi M.D., Ph.D., Nam-Joon Yi M.D., Ph.D. Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this authorKwang-Woong Lee M.D., Ph.D., Kwang-Woong Lee M.D., Ph.D. Department of Surgery, Seoul National University College of Medicine, Seoul, South KoreaSearch for more papers by this author First published: 10 April 2021 https://doi.org/10.1002/lt.26066Citations: 3 Potential conflict of interest: Nothing to report. SEE EDITORIAL ON PAGE 1378 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume27, Issue10October 2021Pages 1493-1497 RelatedInformation

Adenotonsillectomy may increase the risk of alopecia areata in childhood: A nationwide population-based cohort study

Adenotonsillectomy may increase the risk of alopecia areata in childhood: A nationwide population-based cohort study

The impact of writing on academic performance for medical students

BackgroundWriting is a useful learning activity that promotes higher-order thinking, but there are limited studies that prove its effectiveness. In previous research, researchers tested the effect of summary writing on students’ comprehension and found no significant difference from that of re-studying texts. The purpose of this study, therefore, is to expand previous findings and investigate the effect of two types of writing tasks on medical students’ academic performance, specifically in the transfer of knowledge.MethodsAn experiment was conducted with 139 medical students from Seoul National University College of Medicine. They were randomly assigned to three study conditions: self-study (SS), expository writing (EW), and argumentative writing (AW) group. Each group studied the given material by the method they were assigned, and they were tested on their comprehension and transfer of knowledge using rote-memory type items and transfer type items respectively.ResultsThe results showed that the two writing groups displayed better performance than the SS group in transfer type items, while there was no difference in scores between the EW and AW group. However, the three groups showed no significant difference in their scores for rote-memory type items. Also, there was a positive correlation between the writing scores and transfer type item scores in the AW group.ConclusionsThis study provides empirical evidence for writing to be adopted in medical education for greater educational benefits. Our findings indicate that writing can enhance learning and higher-order thinking, which are critical for medical students.

Nasal Symbiont &lt;i&gt;Staphylococcus Epidermidis&lt;/i&gt; Promotes the Cellular Environment Lacking Airway Proteases to Restrict the Cellular Entry of Influenza a Virus in the Nasal Epithelium

Background: Our recent study presented that human nasal commensal Staphylococcus Epidermidis could potentiate antiviral immunity in the nasal mucosa through interferon-related innate responses. Here, we found that human nasal commensal S. epidermidis promoted protease–protease inhibitor balance in favor of the host and prevented influenza A virus (IAV) replication in the nasal mucosa and lungs. Methods: We examined the contribution of intranasal administration of human nasal S. epidermidis in controlling IAV infection using murine model and culture nasal epithelial cells. IAV mRNA, viral titer, nucleoprotein levels, and histopathologic findings were evaluated. The induction of S. epidermidis-regulated serine protease inhibitors and correlation of serine proteases were also determined. Findings: A relatively higher induction of Serpine1 exhibited in S. epidermidis-inoculated nasal epithelium and S. epidermidis-induced Serpine1 significantly decreased the expression of serine proteases. Furthermore, the transcription of urokinase plasminogen activator (uPA) and Serpine1 was biologically relevant in S. epidermidis-inoculated nasal epithelium, and the induction of uPA might be related with the sequential increase of Serpine1 in human nasal epithelium. Interpretation: Our findings reveal that human nasal commensal S. epidermidismanipulates the cellular environment lacking serine proteases in the nasal epithelium through Serpine1 induction and disturbs IAV spread to the lungs at the level of the nasal mucosa. Funding: This work was supported by the Basic Science Research Program through the National Research Foundation of Korea, funded by the Ministry of Education 2016R1D1A1B01014116, 2019M3C9A6091945, 2017M3A9F3041233) and was also supported by a grant from the Korean Health Technology R&D Project through the Korean Health Industry Development Institute, funded by the Ministry of Health & Welfare of the Republic of Korea (HI20C0546). Declaration of Interest: None to declare. Ethical Approval: The institutional review board (IRB) of the Seoul National University College of Medicine approved the protocol for this study (IRB #C2012248 [943]). In vivo experiments with C57BL/6J mice were carried out according to guidelines approved by the IRB of the Seoul National University College of Medicine (IACUC #2016-0093).

Evaluation of Patients’ Adverse Events Associated With Contact Isolation: Matched Cohort Study With Propensity Score

Background: Contact isolation (ie, patient isolation with contact precautions) has been frequently used for preventing healthcare-associated infections caused by epidemiologically important pathogens (eg, vancomycin-resistant enterococcus [VRE]) via direct or indirect contact with patients. Based on ineffective components of routine contact isolations (eg, fewer healthcare provider visits), some studies have reported an association between the likelihood of adverse events and contact isolation. Objective: Given no strong evidence for this association due to most studies’ invalid study designs and systematic misclassification, we compared adverse events between a VRE isolation cohort and a matched comparison cohort, using a propensity score matching cohort study design. Methods: This study was conducted at a 1,337-bed, tertiary-care, university-affiliated, Korean hospital equipped with a full electronic medical record (EMR) system for all patient records. With institutional review board approval, all relevant EMR records were extracted for the study period 2015–2017. All contact isolation information of VRE patients were confirmed through EMR manual review by 1 trained research nurse. For propensity score matching, risk factors for adverse events (ie, decubitus ulcer, fall, and cardiopulmonary resuscitation [CPR]) were selected based on literature reviews: length of stay, age, gender, diabetes mellitus, hypertension, albumin, Charlson comorbidity index, Braden scale score, and Hendrich II fall risk. For each VRE case, the 1:1 matched case was selected through the nearest neighbor matching with calculated propensity scores. The retrospective observation period was from the cohort entry date (ie, contact isolation start date) to the cohort exit date (ie, discharge or discontinue of contact isolation). A time-to-event analysis with a Cox proportional hazard model was conducted using SAS version 9.4 software. Results: Among the 98,527 inpatients (323 VRE positive; 98,204 VRE negative), the VRE cohort (N = 141 of 216, 65% of total VRE patients admitted to general wards without adverse event history before contact isolation) and the matched comparison (no isolation) cohort (N = 141, 0.1%) showed no differences in characteristic comparisons (Table 1). The Cox proportional hazard model was not applicable for CPR because no CPR case was available in the matched comparison cohort. The hazard ratios for adverse events showed no statistically significant difference for both cohorts: decubitus ulcer (hazard ratio [HR], 1.049; 95% CI, 0.328–3.352; fall (HR, 0.418; 95% CI, 0.051–3.349) (Table 2). Conclusions: Based on the full EMR records for 3 years, our propensity-score–matched cohort study reported no association between the likelihoods of adverse events and contact isolation.Funding: This work was supported by the Collaborative Research Program of Medical Science and Nursing Science from Seoul National University College of Medicine (Grant no. 800-20180001 &amp; 810-20180001).Disclosures: None.

Effect of bevel direction on the tracheal tube pathway during nasotracheal intubation: A randomised trial.

For nasotracheal intubation, the nasal pathway between the inferior turbinate and hard palate (lower pathway) is preferred for patient safety. However, selecting the lower pathway can be challenging because passage of the tube through the nasal pathway is usually performed blindly. We investigated whether facing the bevel of the tracheal tube in the cephalad direction of the patient could help in advancing the tracheal tube through the lower pathway during nasotracheal intubation. A randomised, blinded trial. SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea from January 2019 to March 2020. Sixty-eight adult patients undergoing oromaxillary surgeries were enrolled in this study. Patients were randomly allocated to undergo nasotracheal intubation with the bevel of the tube facing the cephalad direction (intervention group) or to the left (conventional group). The effects of bevel direction on the pathway of the tube in the nasal cavity, and the incidence of epistaxis were evaluated by fibreoptic bronchoscopy. The success rate of the tracheal tube passing through the lower pathway was significantly higher in the intervention group than the conventional group (79.4 vs. 55.9%, relative risk 1.421, 95% CI 1.007 to 2.005, P = 0.038). The incidence of epistaxis was also lower in the intervention group than in the conventional group (41.2 vs. 73.5%, relative risk 0.560, 95% CI 0.357 to 0.878, P = 0.007). Facing the bevel of the tracheal tube in the cephalad direction of the patient facilitated selection of the lower pathway and reduced the incidence of epistaxis during nasotracheal intubation in patients undergoing oromaxillary surgery. ClinicalTrial.gov, NCT03740620.

Teaching cardiac excitation-contraction coupling using a mathematical computer simulation model of human ventricular myocytes.

To understand the excitation-contraction (E-C) coupling of cardiomyocytes, including the electrophysiological mechanism of their characteristically long action potential duration, is one of the major learning goals in medical physiology. However, the integrative interpretation of the responses occurring during the contraction-relaxation cycle is challenging due to the dynamic interaction of underlying factors. Starting in 2017, we adopted the mathematical computer simulation model of human ventricular myocyte (Cardiac E-C_Sim), hypothesizing that this educational technology may facilitate students' learning of cardiac physiology. Here, we describe the overall process for the educational application of Cardiac E-C_Sim in the human physiology practicum of Seoul National University College of Medicine. We also report the results from questionnaires covering detailed assessment of the practicum class. The analysis of results and feedback opinions enabled us to understand how the students had approached the problem-solving process. As a whole, the students could better accomplish the learning goals using Cardiac E-C_Sim, followed by constructive discussions on the complex and dynamic mechanisms of cardiac E-C coupling. We suggest that the combined approach of lecture-based teaching and computer simulations guided by a manual containing clinical context would be broadly applicable in physiology education.

Evaluation of a Ten-Year Team-Based Collaborative Capacity-Building Program for Pediatric Cardiac Surgery in Uzbekistan: Lessons and Implications.

Background:Most children who have congenital heart disease in low- and middle-income countries (LMICs), including Uzbekistan, do not receive adequate and timely pediatric cardiac surgical care. To strengthen the surgical capacity of a local pediatric cardiac surgery team in Tashkent, Uzbekistan, the JW LEE Center for Global Medicine at Seoul National University College of Medicine has developed a team-based training program and has been collaboratively conducting surgeries and care in order to transfer on-site knowledge and skills from 2009 to 2019.Objectives:To evaluate the long-term effects of the collaborative program on the cardiac surgical capacity of medical staff (teamwork, surgical complexity, and patients’ pre-surgical weights) as well as changes in the lives of the patients and their families. To derive lessons and challenges for other pediatric cardiac surgical programs in LMICs.Methods:To assess the effects of this ten-year long program, a mixed-methods design was developed to examine the trend of surgical complexity measured by Risk Adjustment for Congenital Heart Surgery 1 score (RACHS-1) and patients’ pre-surgical weights via medical record review (surgical cases: n = 107) during the decade. Qualitative data was analyzed from in-depth interviews (n = 31) with Uzbek and Korean medical staff (n = 10; n = 4) and caregivers (n = 17).Findings:During the decade, the average RACHS-1 of the cases increased from 1.9 in 2010 to 2.78 in 2019. The average weight of patients decreased by 2.8 kg from 13 kg to 10.2 kg during the decade. Qualitative findings show that the surgical capacity, as well as attitudes toward patients and colleagues of the Uzbek medical staff, improved through the effective collaboration between the Uzbek and Korean teams. Changes in the lives of patients and their families were also found following successful surgery.Conclusions:Team-based training of the workforce in Uzbekistan was effective in improving the surgical skills, teamwork, and attitudes of medical staff, in addition, a positive impact on the life of patients and their families was demonstrated. It can be an effective solution to facilitate improvements in pediatric cardiovascular disease in LMICs if training is sustained over a long period.

Perceptions and attitudes of medical students regarding artificial intelligence in dermatology.

Background: Artificial intelligence (AI) is progressing rapidly, and its application in the field of medicine is increasing. AI algorithms have been shown to be as accurate as dermatologists in classifying various skin diseases based on clinical images. Objectives: To investigate the attitudes of medical students towards the application of AI in dermatology Methods: Between January and February 2020, we performed a survey to medical students from Seoul National University College of Medicine with approval by the Institutional Review Board of Seoul National University Hospital. Results: One hundred students (male/female: 53/47) completed the survey. The median age was 22.5 years. Only 10% stated that they know AI well, whereas 42% stated they do not. Thirty-one percent expressed interest in AI, and 51% declared that they have received AI-related education. Regarding the source of AI-related knowledge, students responded that they mostly received this information from newspapers and television (82/100, 82%), followed by social networking services (41%), lectures (32%), friends or family (29%), and academic papers or books (22%). Most students (83%) agreed that AI education is necessary in medical school curricula. Conclusion: The discrepancy between the degree of interest among medical students and their level of AI education requires a resolution. Medical school curricula should equip students with the skills and knowledge required to understand and apply AI.

Severe Bilateral Optic Neuropathy in a Patient With Behçet Disease.

From the Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea. The authors declare no conflict of interest. Correspondence: Haeng-Jin Lee, MD, PhD, Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea. E-mail: [email protected].