Purpose: To evaluate the effects of the non-invasive keratograph break-up time on the repeatability of keratometric measurements derived using the Keratograph 5M in patients with dry eye syndrome. Methods: Thirty-six patients with dry eye and 30 controls were enrolled. We measured keratometric values twice in all subjects and explored whether the two measurements differed by more than 0.5 diopter (D) (the absolute value). We also evaluated the relationship between the absolute difference and the non-invasive keratograph break-up time (NIKBUT). Results: The intraclass correlation coefficients for astigmatism, flat keratometry (K), steep K, and mean K were all higher than 0.95 in patients, thus lower than in controls. The proportion of eyes with absolute differences over 0.5 D between the two keratometric values differed significantly between the dry eye and control groups in terms of the flat K and Kmax values (p = 0.033, 0.037). The average NIKBUT was negatively correlated with the absolute differences in Kmax and astigmatism (p = 0.030, R2 = 0.134 and p = 0.017, R2 = 0.160). Conclusions In patients with dry eye syndrome, keratometric measurements are reliably repeatable, but slightly less so than in normal controls. The proportions of eyes exhibiting absolute keratometric differences over 0.5 D (two measurements) differed in the dry eye and control groups. The lower the non-invasive keratograph break-up time, the poorer the repeatability of keratometric measurements in the dry eye group. Therefore, care is required when obtaining keratometric values for such patients.

Anti-Müllerian hormone (AMH) is now accepted as an important clinical marker of ovarian reserve and is increasingly measured as an initial evaluation at infertility clinics. The aim of this study was to establish reference values for the revised second generation (Gen II) assay using population-based data. In this population-based cohort study, AMH data from unselected infertile women aged 25–45 years from June 2013 to June 2014 (n = 15,801) were collected. The AMH values were measured using the revised Gen II assay. We established and validated 5 AMH-age regression models. Based on the optimal AMH-age model, reference values and centile charts were obtained. The quadratic model (log AMH = 0.410 × age − 0.008 × age²− 3.791) was the most appropriate for describing the age-dependent decrease in AMH measured using the revised Gen II assay. This is the largest population-based study to establish age-specific reference values of AMH using the revised Gen II assay. These reference values may provide more specific information regarding the ovarian reserve estimation of infertile women.
Biomarkers ; Cohort Studies ; Female ; Humans ; Infertility ; Ovarian Reserve ; Reference Values*

Purpose: To analyze the clinical features and visual prognosis of retinal vein occlusion (RVO) in patients under 50 years of age. Methods: A retrospective analysis of medical records of 36 patients under 50 years of age diagnosed with RVO from January 2016 to October 2021. Results: The mean age was 39.53 ± 9.98 years and 50%, 44.4%, and 5.6% had branch, central, and hemi-central RVO, respectively. Before the RVO diagnosis, systemic disease had been diagnosed in 38.9%. Further, 13.89% of the cases had a new systemic disease diagnosed after the diagnosis of RVO. Hypercholesterolemia was observed in 47.6%. The initial visual acuity (VA), best corrected visual acuity (BCVA), and central subfield thickness (CST) showed significant correlations with the final VA, BCVA, and CST. Conclusions In patients with RVO under the age of 50 years, the initial VA and CST can be used as indicators to determine whether treatment is necessary by reflecting the final VA and CST. The initial VA and CST can also be used to predict the visual prognosis. Even at a young age, if complications occur, the visual prognosis of RVO may be poor, so an evaluation of the patient’s general condition is essential, especially the blood cholesterol level.

Purpose: This study aimed to investigate the incidence rate, types and risk factors for delirium in patients admitted to the surgical Step-Down Unit (SDU). Methods: This study was a retrospective study of the electronic medical records of patients admitted to a surgical SDU from February 2020 to July 2020. The delirium assessment was conducted using the short Confusion Assessment Method (a tool that allows quick and easy screening of delirium) and the incidence and risk factors for delirium were determined. Results: Among a total of 227 patients in the study, the incidence rate of delirium was 35 cases (16.7%). It predominantly occurred on the first day (n = 16, 45.7%) and the second day of admission (n = 15, 42.8%). The peak occurrence of delirium was between 14:00 and 22:00 (n = 30, 85.7%). The most common type of delirium was hypoactive (n = 19, 54.3%). The results of multiple logistic regression analysis indicated that the factors influencing the occurrence of delirium in the surgical step down unit (SDU) were age, hypertension, stroke, white blood cell count, and the use of restraints. Conclusion Considering the characteristics of high-risk groups for delirium in the surgical SDU, it is necessary to establish nursing practice guidelines to minimize delirium.

Purpose: To investigate the effect of order of examination on the results of noninvasive keratograph tear film evaluation using Keratograph5M in dry eye patients. Methods: One hundred and four patients with dry eye symptoms were analyzed retrospectively. All patients underwent bilateral noninvasive tear film evaluation using measurements of tear meniscus height (TMH) and noninvasive keratograph break-up time (NIKBUT) obtained using Keratograph5M. Measurements were performed sequentially in the order of right TMH, left TMH, right NIKBUT, and left NIKBUT. Results: There was no statistically significant difference in TMH values between the right and left eyes (0.24 ± 0.08 and 0.23 ± 0.08 mm, respectively). Mean NIKBUT-first (time at first tear film break-up) and mean NIKBUT-average (the mean of all tear film break-up time over the entire cornea) were 6.17 ± 3.28 and 10.00 ± 3.97 seconds, respectively, for right, and 7.43 ± 3.86 and 11.57 ± 4.34 seconds, respectively, for left eyes. In addition, mean NIKBUT-first between right and left eyes, and mean NIKBUT-average between them were statistically significant (p = 0.013 and p = 0.007, respectively). Mean NIKBUT and mean TMH differences were not significantly influenced by right or left eyes, age, or sex (all p > 0.050). Spearman correlation analyses of TMH, NIKBUT-first, and NIKBUT-average results showed moderate positive correlations between right and left eyes (r = 0.470, r = 0.322, and r = 0.576, respectively; p < 0.001). Conclusions TMH evaluation was not affected by test order; however, NIKBUT measurement was affected by test order, because of reflex tearing due to forced eye opening during the examination. Therefore, TMH should be evaluated before NIKBUT, and sufficient time interval and caution should be needed between NIKBUT measurements on both eyes.

The typical life cycle of filamentous fungi commonly involves asexual sporulation after vegetative growth in response to environmental factors. The production of asexual spores is critical in the life cycle of most filamentous fungi. Normally, conidia are produced from vegetative hyphae (termed mycelia). However, fungal species subjected to stress conditions exhibit an extremely simplified asexual life cycle, in which the conidia that germinate directly generate further conidia, without forming mycelia. This phenomenon has been termed as microcycle conidiation, and to date has been reported in more than 100 fungal species. In this review, first, we present the morphological properties of fungi during microcycle conidiation, and divide microcycle conidiation into four simple categories, even though fungal species exhibit a wide variety of morphological differences during microcycle conidiogenesis. Second, we describe the factors that influence microcycle conidiation in various fungal species, and present recent genetic studies that have identified the genes responsible for this process. Finally, we discuss the biological meaning and application of microcycle conidiation.
Fungi* ; Germination ; Hyphae ; Life Cycle Stages ; Spores ; Spores, Fungal

PURPOSE: The study aimed to develop a play toolkit to facilitate infants' and toddlers' symbolic thought and fine motor development. METHODS: This study used a methodological study design including two phases of development and evaluation. After reviewing the play culture and developmental health issues in Kyrgyzstan through a literature review and interviews with local experts and parents, the toolkit was developed and evaluated using content validity and utilization tests. RESULTS: The toolkit was based on Westby's symbolic play and the fine motor milestones in the Bright Futures Guidelines. The Toolkits were composed of an overall suggested play schedule according to the child's age, four kinds of play props, and a utilization guidebook for parents. The play props were a felt book, sorting and assembling blocks, cup blocks, and a tangram. The guidebook contained age-appropriate operating methods and alternative ways to use the materials. CONCLUSION: A play toolkit was developed to enhance nurturing practices among parents of infants and toddlers. The findings may help facilitate effective interactions between parents and their children. Considering that nurturing care is critical for achieving better child health outcomes, enhancing parenting resources and parent-child relations could function as an effective strategy for promoting child health.
Appointments and Schedules ; Child ; Child Development ; Child Health ; Humans ; Infant ; Kyrgyzstan ; Methods ; Parent-Child Relations ; Parenting ; Parents ; Play and Playthings

Purpose: To analyze prognostic factors for morphological and functional recovery after vitrectomy in patients with idiopathic epiretinal membrane (ERM). Methods: We conducted a retrospective analysis of patients with ERM who underwent vitrectomy. Postoperative outcomes were evaluated in terms of functional and morphological changes, assessing best-corrected visual acuity (BCVA) and central macular thickness (CMT) after 6 months. Logistic regression was used to identify factors influencing postoperative outcomes. Results: This study included 77 patients (35.1% men). Thirty-eight patients underwent combined vitrectomy and cataract surgery. Logistic regression revealed that better preoperative BCVA was associated with improved postoperative BCVA (p = 0.002). Among the 38 eyes that underwent combined surgery, longer preoperative axial length was linked to better visual outcomes in univariate analysis (p = 0.043), although the association was not statistically significant in multivariate analysis (p = 0.064). Younger age and thinner preoperative CMT were associated with better morphological outcomes (p = 0.034 and p = 0.001, respectively). Conclusions Preoperative BCVA, age, preoperative CMT, and axial length are predictive factors for functional and morphological outcomes after vitrectomy in patients with ERM. These findings may facilitate treatment planning and prognosis prediction before surgery.

Primary aldosteronism (PA) is the most common cause of secondary hypertension and increases the morbidity and mortality associated with cardiovascular diseases. When PA coexists with autonomous cortisol secretion (ACS), the cardiovascular risk increases significantly, especially in cases of bilateral adrenal adenomas with asymmetric hormone secretion, which poses diagnostic and therapeutic challenges. A 50-year-old female presented with hypertension and hypokalemia. PA was diagnosed based on elevated aldosterone levels, suppressed plasma renin activity, and the results of various dynamic endocrine tests. Imaging revealed bilateral adrenal adenomas, and adrenal venous sampling (AVS) confirmed aldosterone hypersecretion from the left adrenal gland and cortisol hypersecretion from both adrenal glands. The patient subsequently underwent left adrenalectomy, which resolved the aldosterone hypersecretion and normalized blood pressure and potassium levels. However, the cortisol hypersecretion persisted. This case highlights the importance of AVS in identifying the sources of hormone secretion and enabling targeted surgical treatment while avoiding bilateral adrenalectomy, which can lead to lifelong adrenal insufficiency. Comprehensive endocrine evaluation, including ACS assessment, in patients with PA is essential to help reduce the cardiovascular risks associated with PA and ACS and thus improve treatment outcomes.

Primary aldosteronism (PA) is the most common cause of secondary hypertension and increases the morbidity and mortality associated with cardiovascular diseases. When PA coexists with autonomous cortisol secretion (ACS), the cardiovascular risk increases significantly, especially in cases of bilateral adrenal adenomas with asymmetric hormone secretion, which poses diagnostic and therapeutic challenges. A 50-year-old female presented with hypertension and hypokalemia. PA was diagnosed based on elevated aldosterone levels, suppressed plasma renin activity, and the results of various dynamic endocrine tests. Imaging revealed bilateral adrenal adenomas, and adrenal venous sampling (AVS) confirmed aldosterone hypersecretion from the left adrenal gland and cortisol hypersecretion from both adrenal glands. The patient subsequently underwent left adrenalectomy, which resolved the aldosterone hypersecretion and normalized blood pressure and potassium levels. However, the cortisol hypersecretion persisted. This case highlights the importance of AVS in identifying the sources of hormone secretion and enabling targeted surgical treatment while avoiding bilateral adrenalectomy, which can lead to lifelong adrenal insufficiency. Comprehensive endocrine evaluation, including ACS assessment, in patients with PA is essential to help reduce the cardiovascular risks associated with PA and ACS and thus improve treatment outcomes.