PURPOSE: To compare the corneal first surface higher-order aberrations (HOAs) of normal subjects and patients with dry eye using KR-1W(R) (Topcon Corp., Tokyo, Japan) and Pentacam(R) HR (Oculus Inc., Dutenhofen, Germany). We analyzed the relationship between the aberrations and the diagnostic parameters of dry eye. METHODS: We evaluated anterior corneal HOAs in 71 normal eyes and 71 dry eyes using KR-1W(R) and Pentacam(R). Dry eye patients were examined for fluorescein staining, tear break-up time (TBUT), and Schirmer I test. Ocular Surface Disease Index (OSDI) was used for assessment of subjective symptoms in dry eye patients. RESULTS: HOAs measured by both instruments were greater in the dry eye group than in the control group, although HOAs using KR-1W(R) only achieved statistical significance. The anterior corneal HOAs measured by the 2 instruments were significantly correlated with superficial punctate keratitis. Moreover, TBUT and the Shirmer I test negatively correlated, and OSDI positively correlated, with anterior corneal HOAs. CONCLUSIONS: The HOAs in patients with dry eye were significantly different from controls and tended to increase with disease severity. KR-1W(R) might be more useful than Pentacam(R) to detect tear film instabilities.
Fluorescein ; Humans ; Keratitis ; Tears

Leigh's disease is a rare progressive neurological disorder that is characterized light microscopically by focal spongy necrosis in the brain and electron microscopically by mitochondriopathy. We report an autopsy case of Leigh's disease that showed abnormalities in the liver, kidney and skeletal muscle as well as the central nervous system. The patient was an 18-month-old girl who has carried a diagnosis of cerebral palsy ever since her birth to a 20-year-old mother. The baby was generally hypertonic and mentally retarded. She died of severe metabolic acidosis. Postmortem examination showed growth retardation, fatty liver, fatty kidney and soft brain. Brain section showed multifocal softenings in the brainstem, basal ganglia and periventricular areas. Microscopically increased capillaries with endothelial proliferation, vacuolar degeneration and mild gliosis were seen in the brain. The axons were relatively preserved. Liver and kidneys showed microvesicular fatty change. Myofiber degeneration of the skeletal muscle was also noted. Electron microscopic examination showed markedly increased mitochondria in the parenchymal cells of the brain, liver and kidney. The mitochondria showed round to ovoid ballooned appearance including electron-dense core-like structures and pseudoinclusions of glycogen granules.
Brain/pathology/ultrastructure ; Female ; Humans ; Infant ; Kidney/pathology/ultrastructure ; Leigh Disease/*pathology ; Liver/pathology/ultrastructure ; Mitochondrial Encephalomyopathies/pathology ; Muscles/pathology

Panic disorder is one of the chronic and disabling anxiety disorders. There has been evidence for either genetic heterogeneity or complex inheritance, with environmental factor interactions and multiple single genes, in panic disorder's etiology. Linkage studies have implicated several chromosomal regions, but no research has replicated evidence for major genes involved in panic disorder. Researchers have suggested several neurotransmitter systems are related to panic disorder. However, to date no candidate gene association studies have established specific loci. Recently, researchers have emphasized genome-wide association studies. Results of two genome-wide association studies on panic disorder failed to show significant associations. Evidence exists for differences regarding gender and ethnicity in panic disorder. Increasing evidence suggests genes underlying panic disorder overlap, transcending current diagnostic boundaries. In addition, an anxious temperament and anxiety-related personality traits may represent intermediate phenotypes that predispose to panic disorder. Future research should focus on broad phenotypes, defined by comorbidity or intermediate phenotypes. Genome-wide association studies in large samples, studies of gene-gene and gene-environment interactions, and pharmacogenetic studies are needed.
Catechol O-Methyltransferase/genetics ; Cholecystokinin/genetics ; Genetic Loci ; *Genome-Wide Association Study ; Humans ; Monoamine Oxidase/genetics ; Panic Disorder/*genetics

OBJECTIVES: This study was designed to evaluate the relationship between quality of life (QOL) and psycho-socio-spiritual characteristics in male patients with alcohol dependence. METHODS: The sample consisted of 109 men with alcohol dependence defined by DSM-IV criteria. We assessed QOL by the WHO QOL assessment instrument-BREF (WHOQOL) and SmithKline Beecham QOL (SBQOL). Sociodemographic and alcohol related data were collected, and 7 questionnaires were administered: MAST, BDI, STAI, Drinker Inventory of Consequences (DrInC), Scale of Social Support (SSS), Religious Beliefs and Behaviors (RBB) and Spiritual Well-being Scale (SWBS). The correlations between each QOL score and other variables were examined, and stepwise multiple regression analysis was performed. RESULTS: The WHOQOL score positively correlated with education level, SSS (support) and RBB and negatively correlated with MAST, DrInC, BDI, STAI (trait) and SSS (conflict) scores. In stepwise regression analysis, the scores on the STAI and BDI contributed to the score on the WHOQOL. The SBQOL score correlated with the income level, and negatively correlated with BDI and STAI score. STAI score was a weak predictor of SBQOL score. CONCLUSION: The significant predictors of QOL in patients with alcohol dependence were psychological factors such as anxiety and depression.
Alcoholism* ; Anxiety ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Education ; Humans ; Male* ; Psychology ; Quality of Life* ; Surveys and Questionnaires ; Religion

BACKGROUND: This study evaluated the clinical characteristics and risk factors associated with community and hospital onset MRSA isolated from patients admitted to a tertiary care teaching hospital. METHODS: The study was carried out on MRSA isolated from clinical specimens of patients admitted into the wards and the intensive care unit in a 2,200-bed tertiary care teaching hospital from January 1st through December 31st, 2007. In order to identify the risk factors associated with MRSA acquisition, the medical records were reviewed. All statistics were computed using SPSS version 14.0. RESULTS: Of the 835 MRSA isolates, 179 (21.4%) were CO-MRSA and 656 (78.6%) were HO-MRSA. Of the 179 CO-MRSA isolates, 6 (3.4%) were CA-MRSA. Multiple logistic regression analysis showed that a history of using medical device or antibiotics within 1 year before the isolation of MRSA were significant risk factors for HO-MRSA, and a history of hospitalization within 1 year before the isolation of MRSA was a significant risk factor for CO-MRSA. Analysis on the antibiotics administered within 1 year before the isolation of MRSA showed that levofloxacin, macrolides, 1st generation cephalosporins, 3rd generation cephalosporins, 4th generation cephalosporins, vancomycin, metronidazole, and carbapenem were all significant risk factors for HO-MRSA and that TMP/SMX was a significant risk factor for CO-MRSA. Of the 6 (3.4%) CA-MRSA isolates, 1 (16.7%) was the pathogen responsible for soft tissue infection. No patients died from the CA-MRSA infection. CONCLUSION: MRSA isolated from clinical specimens of patients admitted into the wards and the ICU in a tertiary care teaching hospital was usually HO-MRSA, CO-MRSA and HO-MRSA usually had at least one of the risk factors associated with MRSA acquisition, and CO-MRSA was mainly HACO-MRSA.
Anti-Bacterial Agents ; Cephalosporins ; Hospitalization ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Logistic Models ; Macrolides ; Medical Records ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Metronidazole ; Ofloxacin ; Risk Factors ; Soft Tissue Infections ; Tertiary Healthcare ; Vancomycin

PURPOSE: This study aimed to identify multidimensional factors influencing burnout in intensive care unit(ICU) nurses. METHODS: A descriptive cross-sectional design was used. Data were collected during February 2016 from a convenience sample of 222 tertiary hospital ICU nurses and analyzed using t-test, ANOVA, correlation analysis, and multiple regression analysis. RESULTS: Burnout correlated positively with compassion fatigue (CF)(r=.37, p < .001), and negatively with compassion satisfaction (CS)(r=-.66, p < .001). The regression model explained 57% of the variance in burnout. For individual characteristics in the model, perceived health status (β=-.27, p < .001) and gender (β=.14, p=.028) were the most influential factors for ICU nurses' burnout. In the model with added work-related characteristics, nursing environment (β=-.22, p=.001), perceived health status (β=-.20, p=.001), and satisfaction with department (β=-.19, p=.007) were the most influential factors. Finally, for the model with psychological characteristics added, CS (β=-.56, p < .001) and CF (β=.35, p < .001) were the most influential factors. CONCLUSION: Results reveal that most ICU nurses have a moderate level of CF and a moderate to high level of CS and burnout, and that individual, work-related and psychological factors are relevant in ICU nurses' burnout. Programs or interventions to reduce burnout should be developed taking into account these multidimensional factors.
Compassion Fatigue ; Critical Care ; Empathy ; Intensive Care Units ; Nursing ; Personal Satisfaction ; Psychology ; Tertiary Care Centers

Despite of the improved water purification system, the decreased use of aluminum based phosphate binding gels and periodic determination of serum aluminum levels, aluminum accumulation cannot be eliminated. We experienced a case of acute encephalopathy in aluminum intoxication with subdural hematoma presenting myoclonic jerk and mental change in a end stage renal failure. She was treated succesfully with low dose DFO treatment for 3 month.
Aluminum* ; Gels ; Hematoma, Subdural* ; Myoclonus ; Renal Insufficiency* ; Water Purification

A 66-year-old female who had undergone surgery for a herniated disc at the L5-S1 level at another hospital 3 months earlier was admitted with persistent back and leg pain. She was diagnosed with spondylodiscitis at the L5-S1 level by magnetic resonance imaging. A biopsy was performed, and Candida parapsilosis and Enterococcus faecium were isolated from the excised material. We report herein a case of successful treatment of polymicrobial spondylodiscitis in accordance with accurate microbiological diagnosis. Based on this case, we hope to encourage physicians to perform biopsies more aggressively or repeatedly to improve the diagnostic yield.
Aged ; Biopsy ; Candida ; Coinfection ; Diagnosis ; Discitis* ; Enterococcus faecium ; Female ; Hope ; Humans ; Intervertebral Disc Displacement ; Leg ; Magnetic Resonance Imaging

Viruses present in the blood or blood products serve important infection source to transfusion patients or users of blood products. Human parvovirus B19 has been recognized as a new viral pathogen in human mainly transmitted via blood. Thus, detection of human parvovirus B19 has become an urgent problem to be solved. This study was intended to develop methods to detect human parvovirus B19 in the blood or blood products by nucleic acid amplification technique (NAT) or polymerase chain reaction (PCR). Five sets of primer DNAs were tested for the detection of human parvovirus B19 by PCR. A primer set amplifying 258 nucleotides corresponding Vp1 gene of human parvovirus B19 was chosen and further studies were done to determine the optimum condition to detect human parvovirus B19 from human blood or blood products. PCR detection of human parvovirus B19 was almost 1,000 times more sensitive than the receptor-mediated hemagglutination assay developed by the Japanese Red Cross Center. Although direct PCR of B19 virus without DNA extraction could detect B19 virus from PBS buffer, attempts to detect the virus from whole blood or plasma failed. PCR after DNA extraction from blood or plasma samples could detect B19 virus as little as 104 PFU/ml. Our results can further be applied for developing routine methods to identify human parvovirus B19 in human blood or commercial blood products.
Asian Continental Ancestry Group ; DNA ; Hemagglutination ; Humans* ; Nucleotides ; Parvovirus B19, Human* ; Plasma ; Polymerase Chain Reaction* ; Red Cross

The purpose of this study was to investigate the prevalence, clinical characteristics, and management of functional constipation at pediatric gastroenterology clinics. A prospective survey using the Rome III criteria was distributed to a group of parents of children with a constipation history and its control group in May 2008. The mean prevalence of constipation was 6.4%, which was similar to those in other countries. Statistically significant variables for children without constipation were that more children had a body mass index of below the 10th percentile even though they received more mother's care and ate balanced meals compared to the constipation group. Meanwhile, the constipation group frequently showed a history of constipation in infancy, picky-eating, lack of exercise, and retentive posturing. When analyzed with the Rome III criteria, the children showed greater than 60% rate of hard stools, painful stools, a history of large fecal mass in rectum, and its disappearance of constipation symptoms after passing a large stool. Our study found different approaches amongst pediatric gastroenterologists like rectal examinations, disimpaction, or drug treatment. Several factors addressed in our study can provide better guidelines for clinicians treating constipation and its future research.
Adolescent ; Body Mass Index ; Child ; Child, Preschool ; Constipation/*diagnosis/drug therapy/epidemiology ; Female ; Hospitals ; Humans ; Infant ; Laxatives/therapeutic use ; Male ; Prevalence ; Prospective Studies ; Rectum/physiopathology ; Severity of Illness Index