To conduct a comparative study of children’s health in South Korea versus North Korea focusing on air pollution.

We used annual mortality rate, prevalence, and environmental indicators data from the World Bank and World Health Organizations (WHO). Trend analysis of the two Koreas was conducted to evaluate changes in health status over time. Spearman’s correlation analysis was used to find out the correlation between environmental indicators and children’s health status.

We found a distinct gap in children’s health status between the two Koreas. While North Korea reported a higher death rate of children than South Korea, both showed a decreasing trend with the gap narrowing from 2000 to 2017. The prevalence of overweight and obesity increased and that of thinness decreased in both Koreas. Except PM_2.5 exposure, South Korea reported higher figures in most indicators of air pollutant emissions (South Korea, mean (SD)=28.3 (2.0); North Korea, mean (SD)=36.5 (2.8), P-value=0.002).

This study empirically discovered the gaps and patterns of children’s health between South Korea and North Korea. North Korean children experienced more severe health outcomes than children in South Korea. These findings imply that epigenetic modification caused by environmental stressors affect children’s health in the two Koreas despite similar genetic characteristics. Considering the gaps in children’s health between the two Koreas, more attention and resources need to be directed towards North Korea because the necessary commodities and services to improve children’s health are lacking in North Korea.

This paper aims to describe an outcome-based curriculum development process at a medical school that has difficulty in advancement from the higher stage outcomes to the individual lesson outcomes, and to propose a way to implement it practically.

We reviewed the objectives, strategies and previous products of the school's taskforce activities and suggested the principle of bidirectional approaches of outcome based curriculum development.

The developing strategy identified such as firstly, the evaluation of present curriculum and then, the review of the outcomes developed previously with considering the nation-wide environmental change in medical education. Then, we selected one example course which was focused the resources of the school to, and finally the product of the example course was propagated to the other courses with central monitoring.

Bidirectional model of ‘Top-down’ plus ‘Bottom-up’ approaches could be an efficient way to develop the outcome-based curriculum in a medical school, which has difficulties to advance the developing process due to various reasons including limited resources.

Increasing interest and use of arterial conduits is based on the better patency of left internal thoracic artery(LITA) than that of saphenous vein(SV) graft. We compared the early result of coronary artery bypass grafting(CABG) using LITA and radial artery(RA group) with CABG using LITA and SV only(SV group).

We compared the early operative results of 6 cases in RA group with 18 cases in SV group selected from 24 cases that had CABG between January 2006 and December 2006. We analyzed each group on the preoperative risk factors and operative results.

We can't find significant differences in clinical and hemodynamic characteristics before surgery. There were no statically significant difference between two groups in operative mortality and each morbidities(postoperative intraaortic balloon pump insertion, bleeding, stroke, perioperative myocardial infarction, wound dehiscence), respectively. However, the overall incidence of conventional CABG using cardiopulmonary bypass was higher in RA group compared to SV group(p=0.016). Accordingly, RA group had longer duration of ventilation time(p=0.004) and ICU stay(p=0.003) than SV group with statically significant difference between two groups in hospital stay. The graft patency on postoperative coronary angiography or computerized tomographic angiography at 7-14 days after operation in both group patients were 100%(includeing LITA, RA and SV).

We had early good operative results in RA group and SV group.

Comparing with the traditional curriculum which provides mainly basic medical science training in the first 2 years, the early exposure to clinical medicine is a major trend of medical education through recent decades. However the timing, extent, content and methods of the 'early clinical education' are not defined clearly and the application is various. Preparing the transformation of the curriculum from undergraduate to graduate entry at Ewha medical school, the concepts of 'early clinical exposure' into our new curriculum needs to be clear. We want to decide how early and how deep and what contents of clinical knowledge and skills are to be introduced in the new curriculum.

Literature review. Interview with a developer and the participants of the 'early clinical education' curricula which has been applied in the Carver College of Medicine, University of lowa since 1998.

The early exposure of clinical knowledge and skills has been introduced world widely and many curricula have it as early as the very week of entrance. Problem based learning, standardized patient program, clinical skill labs and clinical mentoring, etc. are being used with various modification. Early clinical education enhanced the loaming interest and professional minds to the medical students as well as their achievements.

The early clinical education will be applied to the new curriculum of the graduate school of medicine starting 2007 in Ewha Medical School.

There have been many parameters that determined the results of radiocephalic ffisutla. However, few reliable intraoperative parameters have been suggested until now. The purpose of this study was to find the correlation between intra-operative blood flow and early patency of radiocephalic fistula.

Between March 1998 and October 1999, 45 radiocephalic arteriovenous fistulas were constructed in 38 patients. Intra-operative blood flow measurements were made 10 minutes after complection of the vascular anastomoses with 3-4mm handheld flow probes. Patients were followed until failure of fistula or 3months after first hemodialysis with these fistulas. Intraoperative blood flow as well as age, sex, presence of diabetes, size of cephalic vein, thrill on the fistula and flow of radial artery were correlated with early patency.

The mean intraoperative blood flow was 195.9±16.7 mL/min ranged from 50 to 500 mL/min, and it was the only significant parameter that determined early patency of radiocephalic fistula. Fistulas with flow less than 150 ml/min(10 of 18) revealed higher failure rate than those of flow more than 150 ml/min(1 of 27), which was statistically significant(p<0.01). All of the patients with flow less than 70 ml/min(5 of 5) failed in maintaining patency within a month. However, the other variables were not correlated with early patency.

In conclusion intra-operative blood flow measurements can be performed with ease and intraoperative blood flow in radiocephalic fistula is well correlated with early patency of the fistula. And we rocommend that radio-cephalic fistula of flow less than 150mL/min should be observed carefully and that of flow less than 70mL/min must be abandoned intraoperatively.

Inflammatory reaction is the one of deteriorating causes of pulmonary function after cardiopulmonary bypass. And leukocytes play a major role in inflammatory reaction by producing cytotoxic oxygen free radicals, initiating complement cascade, and so on. We tested the hypothesis that reducing the circulating leukocyte by using leukocyte poor RBC(LPR) in priming solution, and low-dose aprotinin which reduces whole body inflammatory response can reduce inflammatory reaction and results in less release of cytokines and preserving better pulmonary function after cardiopulmonary bypass.

In a prospective, randomized study, 23 children undergoing open heart surgery were investigated. LPR was used in 8 patients(group 1), 8 patients received low-dose aprotinin(50,000 KIU per body weight in priming solution, group 2) and 7 patients were control group (group 3). Patients with complex heart diseases, body weight over 10kg, palliative surgery, and residual defect after surgery were excluded from this study. CBC, interleukin 6, and granulocyte elastase were analyzed after 60 minutes of cardiopulmonary bypass, and (A-a)DO₂(alveolar arterial oxygen difference) was measured postoperatively.

There was no statistically significant difference in interleukin 6 level, granulocyte elastase level, (A-a)DO₂, intubation period, mortality, pulmonary complication, and WBC count at postoperative 1st day.

Our results suggested that LPR in priming solution and low-dose aprotinin have little influence on the inflammatory reaction and pulmonary function deterioration caused by cardiopulmonary bypass. Although LPR in priming solution can reduce circulatory leukocyte, the leukocytes increase rapidly after initiation of cardiopulmonary bypass, so that reducing leukocytes by LPR use has little influence on the inflammatory reaction.