Implementation of Objective Structured Clinical Examination on Diagnostic Musculoskeletal Ultrasonography Training in Undergraduate Traditional Korean Medicine Education: An Action Research.

This study aimed to report the specific methods and investigate the educational effects of diagnostic musculoskeletal ultrasound training and the Objective Structured Clinical Examination (OSCE) for traditional medicine students. Scanning volar wrist and diagnosing carpal tunnel syndrome were selected for musculoskeletal ultrasound to train students to use the basic functions of the ultrasound device and scan various structures including tendons, nerves, and arteries. The students were divided into two groups: one group had 8 weeks of training with mock OSCE experience and received feedback about their scan images, and the other group had 3 weeks of training with flipped learning. The OSCE was implemented on the last day of the training. The subjective learning outcomes were analyzed as students' evaluation with a 5-point scale, and the objective learning outcomes were analyzed using OSCE scores evaluated with a pre-validated checklist. Of the 111 students, 60 (54.1%) responded to the questionnaire. Overall satisfaction with this ultrasound training was high (4.5 ± 0.60). The average OSCE score in the 8-week group was significantly higher than that in the 3-week group. The students' self-assessment showed no significant differences between the two groups. Proficiency in using ultrasound is affected by the practice time and feedback. Ultrasound training should be further expanded as a required curriculum to meet students' needs and achieve learning objectives in the clinical skills education of Korean medicine colleges. Further studies are needed on ultrasound education, especially guided interventions for traditional medicine students.

HIF-1α is required for disturbed flow-induced metabolic reprogramming in human and porcine vascular endothelium.

Hemodynamic forces regulate vascular functions. Disturbed flow (DF) occurs in arterial bifurcations and curvatures, activates endothelial cells (ECs), and results in vascular inflammation and ultimately atherosclerosis. However, how DF alters EC metabolism, and whether resulting metabolic changes induce EC activation, is unknown. Using transcriptomics and bioenergetic analysis, we discovered that DF induces glycolysis and reduces mitochondrial respiratory capacity in human aortic ECs. DF-induced metabolic reprogramming required hypoxia inducible factor-1α (HIF-1α), downstream of NAD(P)H oxidase-4 (NOX4)-derived reactive oxygen species (ROS). HIF-1α increased glycolytic enzymes and pyruvate dehydrogenase kinase-1 (PDK-1), which reduces mitochondrial respiratory capacity. Swine aortic arch endothelia exhibited elevated ROS, NOX4, HIF-1α, and glycolytic enzyme and PDK1 expression, suggesting that DF leads to metabolic reprogramming in vivo. Inhibition of glycolysis reduced inflammation suggesting a causal relationship between flow-induced metabolic changes and EC activation. These findings highlight a previously uncharacterized role for flow-induced metabolic reprogramming and inflammation in ECs.

Clinical test for Attention Enhancement System.

Attention Deficit Hyperactivity Disorder (ADHD) is a childhood syndrome characterized by short attention span, impulsiveness, and hyperactivity, which often leads to learning disabilities and various behavioral problems. The prevalence rates for ADHD varied from a low of 2.0% to a high of 6.3% in 1992 statistics, and it may be higher now. Using Virtual Environments and Neurofeedback, we have developed an Attention Enhancement System for treating ADHD. And we made a clinical test. Classroom-based virtual environments are constructed for intimacy and intensive attention enhancement. In this basic virtual environment, subjects performed some training sessions. There are two kinds of training sessions. One is Virtual Reality Cognitive Training (VRCT) and the other is Virtual Reality Neurofeedback Training (VRNT). In VRNT, we made a change in the virtual environment by Neurofeedback. Namely, if the Beta ratio is greater than the specified threshold level, the change as positive reinforce is created in the virtual environment. 50 subjects, aged 14 to 18, who had committed crimes and had been isolated in a reformatory took part in this study. They were randomly assigned to one of five 10-subject groups: a control Group, two placebo groups, and two experimental groups. The experimental groups and the placebo groups underwent 10 sessions over two weeks. The control group underwent no training session during the same period of time. While the experimental groups used HMD and Head Tracker in each session, the placebo groups used only a computer monitor. Consequently, only the experimental Groups could look around the virtual classroom. Besides that, Placebo Group 1 and Experimental Group 1 performed the same task(Neurofeedback Training), and Placebo Group 2 and Experimental Group 2 also performed the same task(Cognitive Training). All subjects Continuous Performance Task(CPT) before and after all training sessions. In the number of correct answers, omission errors and signal detection index (d'), the subjects' scores from CPT showed significant improvement (p<0.01) after all of the training sessions, while control group indicated no significant change. And experimental groups showed significant difference (p<0.01) with placebo groups. Lastly, the Virtual Reality Neurofeedback training group and the Virtual Reality Cognitive training group indicated not significant difference. Our System is supposed to enhance subjects' attention and lead their behavioral improvement. And also, we can conclude that virtual reality training (both Neurofeedback training and Cognitive training) has an advantage for attention enhancement compared with desk-top training.