Purpose: This study aimed to identify the factors that influence the wellness of bus drivers by examining the relationships between job stress, physical activity, subjective happiness, and wellness. Methods: Self-report questionnaires were distributed during October 2017. Results: Based on a multiple regression analysis, the significant factors found to affect the wellness of bus drivers were physical activity (β=.48,p<.001), subjective happiness (β=.25, p=.001), and job stress (β=-.17, p=.025). The total explanatory power of the study variables for wellness was 45.7% (F=33.04, p<.001). Conclusion These findings highlight a need to develop workplace wellness programs to reduce job stress and improve physical activity and subjective happiness among bus drivers.

BACKGROUND: Pretreatment or addition of lidocaine or ketamine have been reported to reduce pain on injection. However, the stability of propofol following the addition of lidocaine or ketamine is not yet known. Therefore, we checked compatibility and stability of propofol-lidocaine or propofol-ketamine mixtures. METHODS: After mixing 9 ml of 1% propofol and 0, 5, 10, 15, or 20 mg of 2% lidocaine or 10, 20 mg of ketamine, the samples (0.9 ml) were divided into 10 glass vials and stored at room temperature. Macroscopic and microscopic changes, and propofol concentrations were measured at 0, 1/4, 1/2, 1, 2, 3, 4, 5, 6, and 24 hours after mixing. Premedicated 100 ASA classification I or II patients scheduled for elective surgery were randomly allocated into one of three groups(Group 1: propofol only, Group 2: propofol + lidociane 20 mg, Group 3: propofol + ketamine 10 mg). Intensity and frequency of injection pain was checked during induction (150 ml/hr). Intensity of injection pain was evaluated with a pain score (1: no pain, 2: mild, 3: moderate 4: severe). RESULTS: Macroscopic and microscopic changes were only seen in propofol-lidocaine mixtures (more than 15 mg after 1 hour) in a time-dependent manner. In the mixtures with lidocaine 15 or 20 mg, the propofol concentration decreased linearly and significantly compared to the control (time 0) in a time-dependent manner from 1 hour to 24 hours. However, the propofol concentration was not changed in the propofol-ketamine mixtures. The pain score at 20 mg of lidocaine or 10 mg of ketamine were significantly lower than propofol only group and there was no difference in pain score between group 2 and group 3. CONCLUSIONS: Lidocaine (more than 15 mg), but not ketamine, added to 90 mg of propofol reduced the propofol concentration linearly in a time-dependent manner and showed microscopic changes from l hour after mixing. Therefore, this mixture seems to be inappropriate for long-standing storage and thus propofol-ketamine mixtures are more appropriate for this purpose.
Classification ; Glass ; Humans ; Ketamine ; Lidocaine ; Propofol*

Hemosiderosis is a disorder characterized by deposits of hemosicerin in multiple organs without organ dysfunction or injury. The color of the skin becomes brown, espeially on sun exposured areas. Mucous mernbranes are also affected in up to 5-25% of cases. A 43-year-old woman visited our clinic due to generalized brown colotation of her skin, including conjunct we and oral mucous mernbrane which she had had for 10 months. She had been treated with multiple he nodialysis combined with periodic transfusion for renal failure 3 times a month during the last 5 yeadrs Her plasma ferrit in level was elevated markedly and TIBC decreased, but cortisol and ACTH levels were within normal limits, Histopathologic findings of the neck skin showed hyperpigmentation of basal layer and deposition of brown pigment wrthin and around the sweat glands. In Fontana-Masson stain, the lower epidermis showed a massive deposition of melanin. Prussian blue stain revealei hemosiderin within snd around, the sweat glands. Hemosiderin could also be noticed on specirnens of thliver biopsy. The patient improved progressively after the rstriction of trasnfusion and treatment of renal failure.
Adrenocorticotropic Hormone ; Adult ; Biopsy ; Epidermis ; Female ; Hemosiderin ; Hemosiderosis* ; Humans ; Hydrocortisone ; Hyperpigmentation ; Melanins ; Neck ; Plasma ; Renal Insufficiency ; Skin ; Solar System ; Sweat Glands

Purpose: To report a case of late opacification of a hydrophilic acrylic monofocal intraocular lens (IOL) with a hydrophobic surface (CT SPHERIS® 204) after a second vitrectomy in a patient with proliferative diabetic retinopathy.Case summary: A 50-year-old male with diabetes presented with decreased visual acuity in the right eye. He had undergone phacoemulsification and IOL (CT SPHERIS® 204) implantation, vitrectomy, endolaser photocoagulation, and intravitreal bevacizumab (Avastin®) injection due to vitreous hemorrhage in the right eye about 43 months prior. Four months after the surgery, presenting with recurrent vitreous hemorrhage and neovascularization of the angle, he underwent partial vitrectomy and intravitreal and intracameral bevacizumab (Avastin®) injection. The best-corrected visual acuity was 0.1 in the right eye when he presented with decreased visual acuity. Slit lamp examination of the right eye showed diffuse whitish granular opacity on the surface of the IOL. The IOL was explanted, together with the capsular bag, and examined using scanning electron microscopy and energy-dispersive X-ray spectroscopy. Conclusions This case is the first to report late opacification of a hydrophilic, acrylic monofocal IOL with a hydrophobic surface, the CT SPHERIS® 204. It is necessary to be cautious in using this type of lens in patients with diabetic retinopathy.

Purpose: To investigate the clinical outcomes of refixation of a dislocated intraocular lens (IOL) and IOL exchange with intrascleral fixation. Methods: We performed a retrospective study of 90 patients (91 eyes) who underwent refixation or exchange of IOLs from January 2014 to April 2019. The patients were divided into an ab externo scleral refixation group (group 1), an intrascleral refixation group (group 2), and an exchange with intrascleral fixation group (group 3). We evaluated the best-corrected visual acuity (BCVA), spherical equivalent, cylindrical power, intraocular pressure, and postoperative complications. Results: The BCVA was 0.10 ± 0.17 (group 1), 0.15 ± 0.29 (group 2), and 0.31 ± 0.52 (group 3) at 6 months after surgery. The BCVA change in group 3 was significantly greater than that in groups 1 and 2 (p = 0.018 and p = 0.046, respectively). The final BCVA was not significantly different among the groups (p = 0.422). The spherical equivalent was -1.26 ± 1.72 diopters (D) (group 1), -1.32 ± 2.09 D (group 2), and -0.17 ± 1.58 D (group 3) at 6 months after surgery, showing that group 1 and group 2 were more myopic than group 3 (p = 0.004 and p = 0.001, respectively). Haptic slippage was the most common complication. Conclusions Refixation of dislocated IOLs and IOL exchange with intrascleral fixation did not differ significantly in terms of the final visual outcomes. Refixation was associated with more myopia and a higher risk of IOL dislocation or haptic slippage than exchange.

Purpose: To report a case of delayed symptoms after intralenticular dexamethasone implant (Ozurdex ® ; Allergan, Irvine, CA, USA).Case summary: A 65-year-old male was referred for myodesopsia and decreased visual acuity. A dexamethasone implant was located in the crystalline lens, and the lens showed mild nucleus opacity. The patient had been treated with multiple intravitreal injections of anti-vascular endothelial growth factor and had received an injection of dexamethasone implant about seven weeks before symptom onset. Based on the symptoms, phacoemulsification was performed and an intraocular lens was placed within the capsular bag. After surgery, symptoms improved. One month after surgery, as cystoid macular edema worsened, the patient was treated with an intravitreal injection of triamcinolone acetonide (MaQaid ® ; Wakamoto Pharmaceutical Co., Ltd., Tokyo, Japan). After intravitreal injection, cystoid macular edema improved. Conclusions Intralenticular injection of the dexamethasone implant is very rare; however, great care should be taken during the procedure. It should be noted that the onset of symptoms by intralenticular dexamethasone implant may not occur immediately following the procedure. Thus, close follow-up is necessary, with the possibility of surgical intervention depending on visual acuity and underlying complications.

Purpose: To report a case of late opacification of a hydrophilic acrylic monofocal intraocular lens (IOL) with a hydrophobic surface (CT SPHERIS® 204) after a second vitrectomy in a patient with proliferative diabetic retinopathy.Case summary: A 50-year-old male with diabetes presented with decreased visual acuity in the right eye. He had undergone phacoemulsification and IOL (CT SPHERIS® 204) implantation, vitrectomy, endolaser photocoagulation, and intravitreal bevacizumab (Avastin®) injection due to vitreous hemorrhage in the right eye about 43 months prior. Four months after the surgery, presenting with recurrent vitreous hemorrhage and neovascularization of the angle, he underwent partial vitrectomy and intravitreal and intracameral bevacizumab (Avastin®) injection. The best-corrected visual acuity was 0.1 in the right eye when he presented with decreased visual acuity. Slit lamp examination of the right eye showed diffuse whitish granular opacity on the surface of the IOL. The IOL was explanted, together with the capsular bag, and examined using scanning electron microscopy and energy-dispersive X-ray spectroscopy. Conclusions This case is the first to report late opacification of a hydrophilic, acrylic monofocal IOL with a hydrophobic surface, the CT SPHERIS® 204. It is necessary to be cautious in using this type of lens in patients with diabetic retinopathy.

BACKGROUND: Anesthesia induction time is related to speed of injection, injected volume, and Keo. In the case of target controlled infusion, induction time can be controlled by adjusting the induction time mode. The aim of this study was to estimate the effect of induction time mode on variable parameters and vital signs during anesthesia induction with propofol using a target controlled infusion (TCI). METHODS: Sixty unpremedicated adult patients (ASA class I or II, 18 55 yrs) scheduled for elective surgery were randomly allocated to four groups according to induction mode. Group 1 was assigned a flash induction mode, and groups 2, 3 and 4 were assigned 2, 3 and 4min respectively. The end point of anesthesia induction was loss of eyelash reflex. Various parameters including induction time, infused volume, current/effect concentration at induction, and vital signs were compared. RESULTS: As the induction time mode was prolonged, induction time was delayed, but there was no difference in infused volume. Also, the current concentration decreased gradually, but the effect concentration did not show any difference. The vital signs were more stable in groups 3 and 4 compared with groups 1 and 2. CONCLUSIONS: For anesthesia induction, a rapid induction mode showed more rapid induction and low current concentration, but vital signs were relatively unstable and the effect concentration at induction showed no difference. For critically ill patients or patients with unstable hemodynamics, a more gradual induction mode for anesthesia induction in propofol TCI is recommended.
Adult ; Anesthesia* ; Critical Illness ; Hemodynamics ; Humans ; Propofol* ; Reflex ; Vital Signs*

The nasal ala is a challenging area for surgical reconstruction, with thick sebaceous skin, the lack of an ample tissue reservoir, and an adjacent free margin. Numerous flaps have been reported for the repair of alae defects. A 71-year-old woman with simultaneous basal cell carcinomas involving both nasal alae was treated by Mohs micrographic surgery. The surgical defects measured 1.5x1.5 cm on the center of the right nasal ala and 1.0x1.0 cm on the left nasal ala, including the alar crease and rim. The right nasal ala was used as a nasolabial transposition flap and the left nasal ala was reconstructed by an island pedicle flap. The final shape and texture were satisfactory. The flaps survived and nasal symmetry was preserved. Combined nasolabial transposition and island pedicle flaps thus offer a superior esthetic and functional result owing to minimized tension. This may be a valuable reconstructive option in the repair of bilateral nasal alae defects.
Aged ; Carcinoma, Basal Cell ; Female ; Humans ; Mohs Surgery ; Skin ; Succinates

Sirtuins (SIRTs) are involved in multiple cellular processes including those related to aging, cancer, and a variety of cellular functions including cell cycle progression, DNA repair, and cellular proliferation. SIRTs have been shown to extend the yeast life span, although there is presently little known about SIRT expression in the organs of mice. In the present study, we were especially interested in identifying differences in SIRT expression between young mice and aged mice. Specifically, we investigated the expression of SIRT1 and SIRT3 in the kidney, lung, skin, adipose tissue, and spleens of 6-month-old and 24-month-old mice using immunohistochemical staining. Compared with that in younger mice, the expression of SIRT1 in 24-month-old rats was increased in kidney, lung, and spleen tissue, while that of SIRT3 was decreased in adipose, kidney, and lung tissue. The results of our study suggest that aging is associated with altered patterns of expression of SIRT1 and SIRT3. In addition, we noted that the expression patterns of SIRT1 and SIRT3 varied by organ. Taken together, the results of this study suggest the possibility that SIRTs may be involved in diseases associated with aging.
Adipose Tissue ; Aging ; Animals ; Cell Cycle ; Cell Proliferation ; Child, Preschool ; DNA Repair ; Humans ; Immunohistochemistry ; Infant ; Kidney ; Lung ; Mice* ; Rats ; Sirtuins ; Skin ; Spleen ; Yeasts