BACKGROUND: Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP. METHODS: Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed. RESULTS: Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality. CONCLUSIONS: High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.
Acinetobacter baumannii* ; Acinetobacter* ; Anti-Bacterial Agents ; APACHE ; Diagnosis ; Humans ; Medical Records ; Mortality ; Pneumonia, Ventilator-Associated* ; Sulbactam*

Purpose: To assess the prevalence and progression of a stage 0 macular hole in the fellow eye of patients with an idiopathic full-thickness macular hole.
Methods: The fellow eyes of 189 patients who underwent idiopathic full-thickness macular hole surgery were examined by biomicroscopy and spectral domain-optical coherence tomography (SD-OCT). A subset of 21 fellow eyes with a stage 0 macular hole was observed. Changes in the macular hole were evaluated by biomicroscopy and SD-OCT for an average of 29 months.
Results: Among the 21 eyes, 15 showed no change in perifoveal vitreous detachment (71.4%). Two eyes (9.5%) developed complete vitreofoveal separation, and one of the two developed a separation after progression to stage 1A. Among 21 eyes, 5 (23.8%) developed above stage 1A, and one of the five progressed to stage 1B after five years, which was successfully treated with vitrectomy and gas tamponade.
Conclusions Perifoveal vitreous detachment in the fellow eye on SD-OCT, defined as a stage 0 macular hole, occurred at an earlier phase than stage 1A macular holes and may progress to an advanced stage. Therefore, patients who undergo macular hole surgery and have a stage 0 macular hole or perifoveal vitreous detachment in the fellow eye should be followed closely.

Purpose: To assess the prevalence and progression of a stage 0 macular hole in the fellow eye of patients with an idiopathic full-thickness macular hole.
Methods: The fellow eyes of 189 patients who underwent idiopathic full-thickness macular hole surgery were examined by biomicroscopy and spectral domain-optical coherence tomography (SD-OCT). A subset of 21 fellow eyes with a stage 0 macular hole was observed. Changes in the macular hole were evaluated by biomicroscopy and SD-OCT for an average of 29 months.
Results: Among the 21 eyes, 15 showed no change in perifoveal vitreous detachment (71.4%). Two eyes (9.5%) developed complete vitreofoveal separation, and one of the two developed a separation after progression to stage 1A. Among 21 eyes, 5 (23.8%) developed above stage 1A, and one of the five progressed to stage 1B after five years, which was successfully treated with vitrectomy and gas tamponade.
Conclusions Perifoveal vitreous detachment in the fellow eye on SD-OCT, defined as a stage 0 macular hole, occurred at an earlier phase than stage 1A macular holes and may progress to an advanced stage. Therefore, patients who undergo macular hole surgery and have a stage 0 macular hole or perifoveal vitreous detachment in the fellow eye should be followed closely.

Purpose: This study compared the radiologic and clinical outcomes of metacarpal fractures treated with two minimally invasive surgical techniques: Kirschner wire (K-wire) fixation and headless screw fixation. Materials and Methods: This study included 52 patients (46 males and 6 females; age 18-55 years) with distal metacarpal fractures (middle and distal shaft, including the neck) who had undergone K-wire fixation or headless screw fixation. All subjects were followed up for at least six months. The radiologic assessments were performed to evaluate the angular deformity and shortenings. The total active motion (TAM), grip strength, and patients’ subjective functional assessment were measured to evaluatethe hand function. The time taken to return to work (RTW) and adverse events were analyzed. Results: Of the 52 cases, metacarpal fractures treated with headless screw fixation and K-wire fixation showed a significant difference associated with early RTW (p<0.05). There were no significant differences between the subjects treated with K-wire fixation and those with headless screw fixation in terms of the radiologic measurement, hand function examinations, complications, and adverse events (p>0.05). Conclusion After a six-month follow-up, minimally invasive K-wire fixation and headless screw fixation produced similar clinical and radiologic outcomes in subjects with metacarpal fractures. Compared to K-wire fixation, however, headless screw fixation led to earlier functional recovery and might be a better option for treating metacarpal fractures in this regard.

Pneumatosis intestinalis is an uncommon condition that is characterized by the presence of gas within the bowel wall. We experienced a case of pneumatosis intestinalis after cession of chemotherapy and we herein report on this case. A 58-year old man was admitted to our hospital for the evaluation of incidentally recognized pneumatosis intestinalis. He was diagnosed as having non small cell lung cancer in August 2006 and he received radiation therapy for concomitant brain metastasis and SVC syndrome in September 2006. He achieved a partial response after completing 6 cycles of chemotherapy with gemcitabine and cisplatin. Newly enlarged lymph nodes were observed on the follow-up CT, and chemotherapy with paclitaxel and carboplatin was started in July 2007. Due to the lack of a response, the therapeutic regimen was switched to oral erlotinib. After 1 month of treatment, the follow-up CT for response evaluation revealed pneumatosis intestinalis in the ascending colon without any subjective symptoms such as fever or abdominal pain. The laboratory results were within the normal range except for a slight increase of leukocytes. He underwent right hemicolectomy, but he didn't survive his postoperative acute renal failure and pneumonia
Abdominal Pain ; Acute Kidney Injury ; Brain ; Carboplatin ; Cisplatin ; Colon, Ascending ; Deoxycytidine ; Fever ; Follow-Up Studies ; Humans ; Leukocytes ; Lung ; Lung Neoplasms ; Lymph Nodes ; Neoplasm Metastasis ; Paclitaxel ; Pneumonia ; Quinazolines ; Reference Values ; Small Cell Lung Carcinoma ; Erlotinib Hydrochloride

Objective: Semantic verbal fluency (SVF) engages cognitive functions such as executive function, mental flexibility, and semantic memory. Left frontal and temporal lobes, particularly the left inferior frontal gyrus (IFG), are crucial for SVF. This study investigates SVF and associated neural processing in older adults with mild SVF impairment and the relationship between structural abnormalities in the left IFG and functional activation during SVF in those individuals. Methods: Fifty-four elderly individuals with modest level of mild cognitive impairment whose global cognition were preserved to normal but exhibited mild SVF impairment were participated. Prefrontal oxyhemoglobin (HbO2) activation and frontal cortical thickness were collected from the participants using functional near-infrared spectroscopy (fNIRS) and brain MRI, respectively. We calculated the β coefficient of HbO2 activation induced by tasks, and performed correlation analysis between SVF induced HbO2 activation and cortical thickness in frontal areas. Results: We observed increased prefrontal activation during SVF task compared to the resting and control task. The activation distinct to SVF was identified in the midline superior and left superior prefrontal regions (p<0.05). Correlation analysis revealed an inverse relationship between SVF-specific activation and cortical thickness in the left IFG, particularly in pars triangularis (r(54)=-0.304, p=0.025). Conclusion The study contributes to understanding the relationship between reduced cortical thickness in left IFG and increased functional activity in cognitively normal individuals with mild SVF impairment, providing implications on potential compensatory mechanisms for cognitive preservation.

OBJECTIVES: Recently, Interest has been increase on the cognitive and emotional effects of bilateral eye movement. However, there is little research related to the subject in Korea. In this study, we evaluated the effects of bilateral eye movement to memory. METHODS: There were a total of 24 subjects between the ages of 18 and 45. All were right-handed. The subjects first studied words, and then performed recognition memory task about the words after bilateral eye movement and eye fixation. The results (recognition accuracy, response bias, mean response to hits) were compared and analyzed. In addition, We evaluated whether the results differ according to the type of word. Repeated measure analysis of variance was performed for statistical analysis. RESULTS: The main effects on condition [F(1, 23)=9.39, p<0.05] and word type [F(1, 23)=33.727, p<0.05] in recognition accuracy were statistically significant. Also main effect of mean response time to hits was observed [F(1, 23)=66.482, p<0.05]. CONCLUSION: These results suggest that bilateral eye movement enhance recognition accuracy than eye fixation. In this study, bilateral eye movement that affects cognition were investigated.
Bias (Epidemiology) ; Cognition ; Eye ; Eye Movements ; Korea ; Memory ; Reaction Time ; Task Performance and Analysis

PURPOSE: To investigate the influence of corneal biomechanical factors on ocular pulse amplitude measured using dynamic contour tonometry in normal subjects. METHODS: The study population consisted of normal subjects who visited the outpatient clinic from January, 2014 to July, 2014. Ocular pulse amplitude was measured using dynamic contour tonometry and corneal hysteresis (CH) and corneal resistance factor (CRF) were measured using an ocular response analyzer. We applied univariate and multivariate linear regressions to investigate the relationship between ocular pulse amplitude and corneal biomechanical factors and other ocular factors. RESULTS: Fifty eyes of 50 patients (average age 52.8 +/- 17.2 years) were examined. The average ocular pulse amplitude was 2.90 +/- 1.04 mm Hg and the CH and CRF were 10.44 +/- 1.96 mm Hg and 11.03 +/- 2.21 mm Hg, respectively. In univariate linear regression, factors influencing ocular pulse amplitude were ocular pressure based on CRF (beta = 0.280, p = 0.049), Goldmann applanation tonometry (beta = 0.293, p = 0.039), and spherical equivalent (beta = 0.283, p = 0.047), while in multivariate linear regression the only factor influencing ocular pulse amplitude was CRF (beta = 0.686, p = 0.042). CONCLUSIONS: A positive correlation between ocular pulse amplitude reflecting ocular perfusion pressure and CRF reflecting corneal elasticity was observed. Correlations between the 2 factors will be an important aspect in future studies regarding the influences of corneal biomechanical factors on ocular perfusion pressure in glaucoma patients.
Ambulatory Care Facilities ; Elasticity ; Glaucoma ; Humans ; Linear Models ; Manometry ; Perfusion

PURPOSE: To investigate the changes in corneal higher-order aberration (HOA) during amblyopia treatment and the correlation between HOA and astigmatism in hyperopic amblyopia children. METHODS: In this retrospective study, a total of 72 eyes from 72 patients ranging in age from 38 to 161 months were included. Patients were divided into two groups based on the degree of astigmatism. Corneal HOA was measured using a KR-1W aberrometer at the initial visit and at 3-, 6-, and 12-month follow-ups. Correlation analysis was performed to assess the association between HOA and astigmatism. RESULTS: A total of 72 patients were enrolled in this study, 37 of which were classified as belonging to the higher astigmatism group, while 35 were assigned to the lower astigmatism group. There was a statistically significant difference in success rate between the higher and lower astigmatism groups. In both groups, all corneal HOAs were significantly reduced during amblyopia treatment. When comparing the two groups, a significant difference in coma HOA at the 12-month follow-up was detected (p = 0.043). In the Pearson correlation test, coma HOA at the 12-month follow-up demonstrated a statistically significant correlation with astigmatism and a stronger correlation with astigmatism in the higher astigmatism group than in the lower astigmatism group (coefficient values, 0.383 and 0.284 as well as p = 0.021 and p = 0.038, respectively). CONCLUSIONS: HOA, particularly coma HOA, correlated with astigmatism and could exert effects in cases involving hyperopic amblyopia.
Aberrometry ; Adolescent ; Amblyopia/*physiopathology ; Astigmatism/*physiopathology ; Child ; Child, Preschool ; Corneal Topography ; Corneal Wavefront Aberration/diagnosis/*physiopathology ; Eyeglasses ; Follow-Up Studies ; Humans ; Hyperopia/*physiopathology/therapy ; Retrospective Studies ; Visual Acuity/physiology

Pyogenic vertebral osteomyelitis (PVO) may result in neurological deficits and sequelae, so early diagnosis and appropriate treatment are critical. Many previous studies on PVO exist, but our paper has aimed to comprehensively summarize the clinical aspects of PVO. Through review of the vast literature on the clinical research of PVO an overview of the clinical characteristics, diagnostic methods, treatment and prognosis is provided.
Diagnosis* ; Early Diagnosis ; Osteomyelitis* ; Prognosis