Physicians need to be prepared with basic understandings of enuresis and practical tips to diagnose and treat the patients properly. The knowledge about the natural history, epidemiology, and etiology of enuresis, not to mention multiple treatment modalities available, are essential, Medical consultation and treatment of enuresis begins at the age of 5. Evaluation should include history taking, physical examination, and laboratory investigations. A checklist may be provided for quick evaluation in busy clinics. The two main treatment modalities are behavioral modification with an alarm system and pharmacotherapy with desmopressin or imipramine, or oxybutinin. The response to treatment is evaluated after a 1-to 3-months' period of treatment. further evaluation and individualized treatment are needed in poor responders. Normalization of a small functional bladder capacity may help to cure enuresis and treatment of enuresis with antibiotics is effective in children with urinary tract infection, bacteriuria, or cystitis cystica.
Anti-Bacterial Agents ; Bacteriuria ; Checklist ; Child ; Cystitis ; Deamino Arginine Vasopressin ; Drug Therapy ; Enuresis* ; Epidemiology ; Humans ; Imipramine ; Natural History ; Physical Examination ; Urinary Bladder ; Urinary Tract Infections

No abstract available.
Staphylococcus aureus* ; Staphylococcus*

No abstract available.

Cognitive flexibility is a kind of ability to convert mental representation,including reactive flexibility and spontaneous flexibility,and as the vital components of executive function.The experience of the childhood maltreatment may damage both reactive flexibility and spontaneous flexibility and result in cognitive flexibility dysfunction.Prefrontal cortex is the main brain regions of cognitive flexibility,childhood maltreatment experience through injuring the growth of frontal lobe leading to the cognitive flexibility dysfunction.Future research could combine the method of behavioral test and brain damage measurement,to carry on minute research on the two components of cognitive flexibility and brain mechanisms at the same time.

No Abstract available
Cross Infection*

No abstract available.
Mass Screening*

No abstract available.
Mass Screening*

BACKGROUNDS : Infections due to vancomycin-resistant enterococci (VRE) have been reported with increasing frequency in many parts of the world. However, VRE infection is still very rare in Korea. To assess the potential risk of VRE infection in a hospital where such infection is rarely reported, we screened hospitalized patients for fecal colonization with VRE and performed a clinical and epidemiological investigation of VRE colonization. MATERIALS AND METHODS: We screened 405 stool specimens from in- and outpatients for the presence of enterococci using EnterococcoselTM agar (BBLR, USA). Dark-brown or black colonies were tested for enterococci and speciated, followed by confirmation for vancomycin resistance using brain-heart infusion agar containing vancomycin (6microgram/mL). Antimicrobial susceptibilities were determined by agar dilution, disk diffusion, and Vitek GPS-IZ. We also performed pulsed-field gel electrophoresis (PFGE) after SmaI digestion of DNA and polymerase chain reaction for detection of vanA, B and C. To define risk factors for colonization, we reviewed the medical records of patients colonized with VRE or vancomycin- susceptible enterococci (VSE). RESULTS: Twelve (4.1%) of 295 hospitalized patients were colonized with VRE. Six were identified as Enterococcus(E) faecium, 2 each as E. faecalis and E. gallinarum, and 1 each as E. casseliflavus and E. avium. In contrast, only one(0.9%) VRB (E. casseliflavus) was isolated from outpatients. Patients in the intensive careunit (5.4%) and patients whose stool specimens were submitted for Clostridium difficile toxin assay (6.8%) were colonized at higher rate than other inpatients (2.5%), but not at a statistically significant level. Three strains had high-level resistance to van comycin(minimum inhibitory concentration, MIC>256microgram/mL), and the others had low-level resistance (MIC8-16microgram/mL) by agar dilution. But disk diffusion method and Vitek system had problems in detecting some strains with low-level resistance. PFGE patterns of VRE were diverse, suggesting that VRE have been introduced from multiple sources. The vans gene was detected in 3 isolates and vanC gene was found in 9 isolates. Compared with the patients with VSE colonization, patients with VRE had a significantly longer hospital stay, had more frequent invasive procedures or therapeutic interventions such as ventilator, total parenteral nutrition and hemodialysis, showed renal insufficiency more frequently, and were more likely to have received ciprofloxacin or clindamycin therapy. CONCLUSIONS: Although the incidence of VRE infection remains low in Korea, the findings from this study indicate that VRE are not uncommon intestinal colonizers among hospitalized patients. Strict infection control measures including screening for VRE, especially those from patients at risk, close surveillance, judicious use of antibiotics and patient isolation must be implemented to prevent infection and transmission of VRE.
Agar ; Anti-Bacterial Agents ; Ciprofloxacin ; Clindamycin ; Clostridium difficile ; Colon* ; Diffusion ; Digestion ; DNA ; Electrophoresis, Gel, Pulsed-Field ; Humans ; Incidence ; Infection Control ; Inpatients ; Korea ; Length of Stay ; Mass Screening ; Medical Records ; Outpatients ; Parenteral Nutrition, Total ; Patient Isolation ; Polymerase Chain Reaction ; Renal Dialysis ; Renal Insufficiency ; Risk Factors ; Vancomycin ; Vancomycin Resistance ; Ventilators, Mechanical

BACKGROUNDS : Infections due to vancomycin-resistant enterococci (VRE) have been reported with increasing frequency in many parts of the world. However, VRE infection is still very rare in Korea. To assess the potential risk of VRE infection in a hospital where such infection is rarely reported, we screened hospitalized patients for fecal colonization with VRE and performed a clinical and epidemiological investigation of VRE colonization. MATERIALS AND METHODS: We screened 405 stool specimens from in- and outpatients for the presence of enterococci using EnterococcoselTM agar (BBLR, USA). Dark-brown or black colonies were tested for enterococci and speciated, followed by confirmation for vancomycin resistance using brain-heart infusion agar containing vancomycin (6microgram/mL). Antimicrobial susceptibilities were determined by agar dilution, disk diffusion, and Vitek GPS-IZ. We also performed pulsed-field gel electrophoresis (PFGE) after SmaI digestion of DNA and polymerase chain reaction for detection of vanA, B and C. To define risk factors for colonization, we reviewed the medical records of patients colonized with VRE or vancomycin- susceptible enterococci (VSE). RESULTS: Twelve (4.1%) of 295 hospitalized patients were colonized with VRE. Six were identified as Enterococcus(E) faecium, 2 each as E. faecalis and E. gallinarum, and 1 each as E. casseliflavus and E. avium. In contrast, only one(0.9%) VRB (E. casseliflavus) was isolated from outpatients. Patients in the intensive careunit (5.4%) and patients whose stool specimens were submitted for Clostridium difficile toxin assay (6.8%) were colonized at higher rate than other inpatients (2.5%), but not at a statistically significant level. Three strains had high-level resistance to van comycin(minimum inhibitory concentration, MIC>256microgram/mL), and the others had low-level resistance (MIC8-16microgram/mL) by agar dilution. But disk diffusion method and Vitek system had problems in detecting some strains with low-level resistance. PFGE patterns of VRE were diverse, suggesting that VRE have been introduced from multiple sources. The vans gene was detected in 3 isolates and vanC gene was found in 9 isolates. Compared with the patients with VSE colonization, patients with VRE had a significantly longer hospital stay, had more frequent invasive procedures or therapeutic interventions such as ventilator, total parenteral nutrition and hemodialysis, showed renal insufficiency more frequently, and were more likely to have received ciprofloxacin or clindamycin therapy. CONCLUSIONS: Although the incidence of VRE infection remains low in Korea, the findings from this study indicate that VRE are not uncommon intestinal colonizers among hospitalized patients. Strict infection control measures including screening for VRE, especially those from patients at risk, close surveillance, judicious use of antibiotics and patient isolation must be implemented to prevent infection and transmission of VRE.
Agar ; Anti-Bacterial Agents ; Ciprofloxacin ; Clindamycin ; Clostridium difficile ; Colon* ; Diffusion ; Digestion ; DNA ; Electrophoresis, Gel, Pulsed-Field ; Humans ; Incidence ; Infection Control ; Inpatients ; Korea ; Length of Stay ; Mass Screening ; Medical Records ; Outpatients ; Parenteral Nutrition, Total ; Patient Isolation ; Polymerase Chain Reaction ; Renal Dialysis ; Renal Insufficiency ; Risk Factors ; Vancomycin ; Vancomycin Resistance ; Ventilators, Mechanical

No abstract available.