BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) with acquired metallo β-lactamase (MBL) resistance have been increasingly reported worldwide and associated with significant mortality and morbidity. Here, an outbreak of genetically related strains of Klebsiella pneumoniae producing the imipenemase (IMP)-1 MBL in a medical intensive care unit (MICU) in Korea is reported. METHODS: Since isolating carbapenem-resistant K. pneumoniae (CRKP) at the MICU of the hospital on August 10, 2011, surveillance cultures for CRE in 31 hospitalized patients were performed from August to September 2011. Carbapenem resistance was determined based on the disk diffusion method outlined in the Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction (PCR) was performed for genes coding for β-lactamase. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). In addition, a surveillance study of environmental cultures and health-care workers (HCWs) was conducted in the MICU during the same time frame. RESULTS: During the study period, non-duplicated CRKP specimens were discovered in four patients in the MICU, suggestive of an outbreak. On August 10, 2011, CRKP was isolated from the sputum of a 79-year-old male patient who was admitted to the MICU. A surveillance study to detect additional CRE carriers by rectal swab revealed an additional three CRKP isolates. PCR and sequencing of the four isolates identified the presence of the IMP-1 gene. In addition, PFGE showed that the four isolated strains were genetically related. CRE was not identified in specimens taken from the hands of HCWs or other environmental sources during surveillance following the outbreak. Transmission of the carbapenemase-producing Enterobacteriaceae strain was controlled by isolation of the patients and strict contact precautions. CONCLUSIONS: This study shows that rapid and systemic detection of CRE and strict infection controls are important steps in preventing nosocomial transmission.
Aged ; Clinical Coding ; Critical Care* ; Diffusion ; Disease Outbreaks ; Drug Resistance, Bacterial ; Electrophoresis, Gel, Pulsed-Field ; Enterobacteriaceae ; Hand ; Humans ; Infection Control ; Intensive Care Units* ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Male ; Methods ; Mortality ; Pneumonia ; Polymerase Chain Reaction ; Sputum

PURPOSE: This study was conducted to examine the degrees of depression and activities of daily living (ADLs), and to identify factors that predict depression in elderly patients. METHODS: The sample was149 patients (80% female; mean age 79.1) from three geriatric hospitals located in small cities and who agreed to participate in the study. Data were collected by staff nurses involved in direct patient care from October to September 2009. The level of depression was measured on a daily basis for seven days using a 13-item scale. Patients' ADLs was measured using a modified 10-item Bathel ADLs scale. Data were analyzed using SPSS/WIN 17.0. RESULTS: Mean depression score was 10.05+/-4.77 out of 26 points and about 27% was assessed as depressed with more than 13 points. Multiple regression analysis showed that low educational level, absence of spouse and fewer family visits predict depression. In addition, low ADLs and sleep disturbance predict depression. CONCLUSION: Nursing care providers need to be concerned about ADLs of older patients and should develop nursing activity programs to increase their in-hospital physical activities. It is also important care for older patients' sleep and encourages family visits to decrease their depression.
Activities of Daily Living ; Aged ; Depression ; Humans ; Motor Activity ; Nursing Care ; Patient Care ; Spouses

No abstract available.
Ciliary Motility Disorders*

PURPOSE: The purpose of this study was to construct and test a structural equation modeling on the reproductive health behavior of single women with sexual experiences. This study employed Ajzen's Theory of Planned Behavior (TPB). METHODS: The data were collected after receipt of consent from 250 single women with sexual experiences, and analyzed using SPSS 18.0 and AMOS 18.0. RESULTS: Model fit indices for the hypothetical model were suitable for the recommended level: x²=362.407, RMR=0.065, RMSEA=0.070, GFI=0.867. TLI=0.927, CFI=0.938, IFI=0.939, and x²/dF=2.237. Intention showed direct effect with the biggest effect being on reproductive health behavior. Attitude, subjective norm and perceived behavioral control were found to have a direct effect on intention. Among them, perceived behavioral control revealed the largest influence. CONCLUSION: This study suggests that the TPB is a suitable model in explaining the reproductive health behavior of single women with sexual experience. Strategic plans for educational and intervention programs should be aimed to encourage single women to engage in reproductive health behavior.
Female ; Humans ; Intention ; Reproductive Health* ; Single Person*

Alveolar soft-part sarcoma of the female genital tract are extremely rare. Fewer than 30 cases have been described in the literature. We experienced a case of alveolar soft-part sarcoma of the female genital tract which was diagnosed by routine light microscopic study using ultrastructural and immunohistochemical stain. We report this case with a brief review of the literature.
Female* ; Humans ; Sarcoma, Alveolar Soft Part*

PURPOSE: To determine whether retinal nerve fiber layer (RNFL), macula and macular ganglion cell layer (mGCL)-inner plexiform layer (IPL) thickness differ in the amblyopic and normal fellow eyes of unilateral amblyopic patients using spectral domain optical coherence tomography (SD-OCT). METHODS: 80 patients with 160 eyes were included in this study; the distribution of patients was 17 patients with strabismic amblyopia, 17 patients with strabismic non-amblyopia, 23 patients with anisometropic amblyopia, and 23 patients with anisometropic non-amblyopia. Macular, RNFL, and mGCL-IPL thickness were obtained by SD-OCT, and the interocular thickness differences of each group were analyzed. After treatment, the changes of OCT parameters were evaluated in amblyopic patients. RESULTS: Average macular, average RNFL, and average mGCL-IPL thickness of amblyopic eyes were thicker than for normal fellow eyes in amblyopic patients (40 patients total; p < 0.001, p < 0.001, p = 0.002, respectively). In 23 patients with anisometropic amblyopia, average macular, average RNFL, and average mGCL-IPL thickness of amblyopic eyes were thicker than the normal fellow eye (p = 0.008, p < 0.001, p = 0.002). In the 17 patients with strabismic amblyopia, average macular and average RNFL thickness of amblyopic eyes were thicker than the normal fellow eye (p=0.016, p < 0.006, respectively). No interocular thickness differences were observed in the control groups. Interocular differences between amblyopic and normal eyes remained unchanged after the amblyopic eyes were treated. CONCLUSIONS: Average RNFL and average mGCL-IPL thickness of amblyopic eyes were thicker than normal fellow eyes, but no differences were observed for macular in amblyopic patients. There was no change in the OCT parameter in amblyopic eyes after treatment.
Amblyopia* ; Ganglion Cysts* ; Humans ; Nerve Fibers ; Retinaldehyde ; Tomography, Optical Coherence

Heat shock protein 27 (HSP27) and alpha B crystallin (aBC) belong to the small heat shock protein (sHSP) family and have similar amino acid sequences. However, no study has compared the distributional patterns of these two sHSPs in the retina and optic nerve. In this study, we compared the spatiotemporal distributions of the expressions of HSP27 and aBC in the developing chick retina and optic nerve. Both HSP27 and aBC were first expressed in the retina and optic nerve at embryonic day 16 (E16). At E20 the expressions of the two proteins were increased in the retina and optic nerve. Double immunofluorescence demonstrated that HSP27 and aBC were expressed in oligodendrocytes of the retina and optic nerve. In addition, HSP27 was also found to be expressed in ganglion cells in the retina. The findings of this study suggest that HSP27 and aBC act to protect ganglion cells and oligodendrocytes during late development of the chick retina and optic nerve.
alpha-Crystallin B Chain* ; Amino Acid Sequence ; Animals ; Chick Embryo* ; Fluorescent Antibody Technique ; Ganglion Cysts ; Heat-Shock Proteins ; HSP27 Heat-Shock Proteins* ; Humans ; Oligodendroglia ; Optic Nerve* ; Retina*

Radial glia are transdifferentiated into astrocytes within the developing brain and spinal cord. The neural retina contains Muller cells, which are retinal radial glia. Some of the cells that surround the optic nerve head among Muller cells in the chicken retina are called peripapillary glial cells (PPGCs). PPGCs express different molecules compared to typical Muller cells. However, an antigenic PPGC phenotype has not yet been clearly established. In this study, we classified the antigenic PPGC phenotypes and identified the differentiation stages of these cells. At embryonic day (E)8, alphaB-crystallin-positive PPGCs had a bipolar shape with long processes that traversed entire layers of the retina. Pax2 and vimentin were expressed in alphaB-crystallin-positive PPGCs. Glial fibrillary acidic protein (GFAP) immunoreactivity was not observed in PPGCs. At E18, alphaB-crystallin immunoreactivity disappeared from the vitread processes of PPGCs. However, the PPGC cell bodies and ventricular processes contained alphaB-crystallin protein, and the PPGCs retained the same Pax2-positive/vimentin-positive/GFAP-negative profile as that seen at E8. At post-hatch day 120, alphaB-crystallin and Pax2 immunoreactivity was not observed, but vimentin and GFAP expression was clearly observed in the presumptive location of the PPGCs. Furthermore, these two proteins overlapped within that location. Considering that vimentin expression is prolonged until the post-hatching period in chicken brain, these findings suggest that Pax2-negative/vimentin-positive/GFAP-positive PPGCs are phenotypically identical to mature astrocytes in this avian species.
Astrocytes ; Brain ; Chickens ; Glial Fibrillary Acidic Protein ; Neuroglia ; Optic Disk ; Phenotype ; Proteins ; Retina ; Retinaldehyde ; Spinal Cord ; Vimentin

Intracranial pial arteriovenous fistula (AVF) is a rare cerebrovascular lesion that has only recently been recognized as a distinct pathological entity. A 41-year-old woman (Patient 1) presented with the sudden development of an altered mental state. Brain CT showed an acute subdural hematoma. A red sylvian vein was found intraoperatively. A pial AVF was revealed on postoperative angiography, and surgical disconnection of the AVF was performed. A 10-year-old boy (Patient 2) presented with a 10-day history of paraparesis and urinary incontinence. Brain, spinal MRI and angiography revealed an intracranial pial AVF and a spinal perimedullary AVF. Endovascular embolization was performed for both lesions. The AVFs were completely obliterated in both patients. On follow-up, patient 1 reported having no difficulty in performing activities of daily living. Patient 2 is currently able to walk without assistance and voids into a diaper. Intracranial pial AVF is a rare disease entity that can be treated with surgical disconnection or endovascular embolization. It is important for the appropriate treatment strategy to be selected on the basis of patientspecific and lesion-specific factors in order to achieve good outcomes.
Activities of Daily Living ; Adult ; Angiography ; Arteriovenous Fistula ; Brain ; Cerebral Veins ; Child ; Female ; Follow-Up Studies ; Hematoma, Subdural, Acute ; Humans ; Paraparesis ; Rare Diseases ; Urinary Incontinence

In situ hybridization (ISH) using single-stranded DNA probe (ssDNA probe) is a useful method for observing the specific transcripts in cells, since it is convenient to prepare probe which is specific and sensitive. In this study, ssDNA probe for detection of alphaB-crystallin (aBC) mRNA, transcript of a heat shock protein, was prepared and aBC mRNA-expressed cells were spatiotemporally observed in the retina of the developing chick embryos. Single-stranded antisense probe produced by reverse transcription and polymerase chain reaction was identified as a specific probe for aBC mRNA in comparison to negative control using sense probe and immunohistochemistry for aBC protein. In the ISH experiment, aBC mRNA was expressed only in the peripapillary glial cells which are a specific cell type located in the avian retina adjacent to the optic nerve at E12 and E14 retinas. At E16, a small number of aBC mRNA-expressed cells were identified in the nerve fiber layer (NFL) of the retina. At E18, aBC mRNA-expressed cells were observed in the ganglion cell layer (GCL) as well as the NFL. At E20, the number of aBC mRNA-expressed cells was increased in the GCL and the NFL. Based on the same localization of nkx2.2 immunoreactive cells and aBC mRNA-expressed cells, aBC mRNA-expressed cells were identified as oligodendrocytes. These results indicate that ssDNA probe for aBC mRNA detection is very useful tool for oligodendrocyte research such as distribution, migration and differentiation of the cells.
DNA, Single-Stranded ; Ganglion Cysts ; Heat-Shock Proteins ; Immunohistochemistry ; In Situ Hybridization ; Nerve Fibers ; Neuroglia ; Oligodendroglia ; Optic Nerve ; Polymerase Chain Reaction ; Retina ; Reverse Transcription ; RNA, Messenger