A lack of ongoing diabetes is an important factor in preserving eyes from late or suboptimally treated endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess

AbstractPurposeThe purpose of this study is to identify the possible factors for preserving the eyes after late or suboptimally treated endogenous endophthalmitis secondary to Klebsiella pneumoniae (KP) liver abscess.MethodsA retrospective chart review was conducted for patients admitted with KP liver abscess from January 1991 to June 2012.ResultsSix hundred and ninety-three patients with KP liver abscess were recorded, in which endophthalmitis was identified in 53 cases (65 eyes, 8.29%). Diabetes was significantly associated with the development of endophthalmitis (p = 0.014). Eleven eyes received their last ocular treatment ≥10 days and final vision ≥ counting fingers, and were defined as benign type KP endophthalmitis. The absence of diabetes was the only consistent candidate factor for benign type KP endophthalmitis.ConclusionA lack of ongoing diabetes is an important factor in preserving eyes with late or suboptimally treated endogenous endophthalmitis second to KP liver abscess

Expression Profiles of Phosphoenolpyruvate Carboxylase and Phosphoenolpyruvate Carboxylase Kinase Genes in Phalaenopsis, Implications for Regulating the Performance of Crassulacean Acid Metabolism

Phalaenopsis is one of the most important potted plants in the ornamental market of the world. Previous reports implied that crassulacean acid metabolism (CAM) orchids at their young seedling stages might perform C3 or weak CAM photosynthetic pathways, but the detailed molecular evidence is still lacking. In this study, we used a key species in white Phalaenopsis breeding line, Phalaenopsis aphrodite subsp. formosana, to study the ontogenetical changes of CAM performance in Phalaenopsis. Based on the investigations of rhythms of day/night CO2 exchange, malate contents and phosphoenolpyruvate carboxylase (PEPC) activities, it is suggested that a progressive shift from C3 to CAM occurred as the protocorms differentiated the first leaf. To understand the role of phosphoenolpyruvate carboxylase kinase (PEPC kinase) in relation to its target PEPC in CAM performance in Phalaenopsis, the expression profiles of the genes encoding PEPC (PPC) and PEPC kinase (PPCK) were measured in different developmental stages. In Phalaenopsis, two PPC isogenes were constitutively expressed over a 24-h cycle similar to the housekeeping genes in all stages, whereas the significant day/night difference in PaPPCK expression corresponds to the day/night fluctuations in PEPC activity and malate level. These results suggest that the PaPPCK gene product is most likely involved in regulation of CAM performance in different developmental stages of Phalaenopsis seedlings

Evaluation of the In Vivo

Background. Radix Paeoniae Rubra (Chi Shao) contains several phytochemicals with hypoglycemic actions. Current research aims to explore potential insulinotropic effects and long-term therapeutic efficacy of such herb against type 2 diabetes. Methods. Composition analysis for the ethanol extract (PRExt) was executed by high performance liquid chromatography. Polyphenol-enriched fraction was characterized by high pressure size exclusion chromatography. Multiple cell platforms were employed to evaluate hypoglycemic bioactivities. In animal experiments, blood glucose, the homeostasis model assessment (HOMA)-index assessment, glucose tolerance test, and in vivo glucose uptake were all measured. Additional effects of PRExt on obesity and hepatic steatosis were evaluated by serum and histological analysis. Results. PRExt provides multiple hypoglycemic effects including the enhancement of glucose-mediated insulin secretion. Pentagalloylglucose and polyphenol-enriched fraction are two insulinotropic constituents. Moreover, PRExt intraperitoneal injection causes acute hypoglycemic effects on fasted db/db mice. Oral administration of PRExt (200 mg/kg b.w.) gradually reduces blood glucose in db/db mice to the level similar to that in C57J/B6 mice after 30 days. The improvement of glucose intolerance, HOMA-index, and in vivo glucose uptake is evident in addition to the weight loss effect and attenuation of hepatic steatosis. Conclusion. PRExt is an effective antidiabetic herbal extract with multiple hypoglycemic bioactivities

The Efficacy of Endoscopic Papillary Balloon Dilation for Patients with Acute Biliary Pancreatitis

Background. No study investigated the efficacy and safety of endoscopic papillary balloon dilation (EPBD) for the treatment of acute biliary pancreatitis (ABP). Method. We retrospectively reviewed the effects of EPBD on patients with ABP from February 2003 to December 2012. The general data, findings of image studies, details of the procedure, and outcomes after EPBD were analyzed. Result. Total 183 patients (male/female: 110/73) were enrolled. The mean age was 65.9 years. Among them, 155 patients had mild pancreatitis. The meantime from admission to EPBD was 3.3 days. Cholangiogram revealed filling defects inside the common bile duct (CBD) in 149 patients. The mean dilating balloon size was 10.5 mm and mean duration of the dilating procedure was 4.3 minutes. Overall, 124 patients had gross stones retrieved from CBD. Four (2.2%) adverse events and 2 (1.1%) intraprocedure bleeding incidents but no procedure-related mortality were noted. Bilirubin and amylase levels significantly decreased after EPBD. On average, patients resumed oral intake within 1.4 days. The clinical parameters and outcomes were similar in patients with different severity of pancreatitis. Conclusion. EPBD can be effective and safe for the treatment of ABP, even in patients presenting with severe disease

Buffering effect of coping style on the stress-depression relationship among Taiwanese ICU nurses: A multi-group structural equation model with two-factor Nurse Stress Checklist

Learning Objective 1: The learners, including ICU nurses, nursing educators, and nursing managers will be able to understand the importance of coping style on the stress-depression relationship. Learning Objective 2: The learners, in particular ICU nurses will be able to benefit from the recommendations to understand some methods to reduce depression in ICU nurses. Purpose: The purposes of this study were (1) to investigate the buffering effect of coping style on the “overall job stress”-depression relationship among ICU nurses, and (2) further to explicate paths associated with an interaction effect of coping style on the stress-depression relationship among ICU nurses. Methods: A sample of 509 ICU nurses who were female and status below vice-head-nurse was recruited from 18 hospitals in Taiwan. The instrument adopted was a structured questionnaire. Multi-stage multiple linear regression analyses and a multi-group structural equation model based on refactoring structure of the Nurse Stress Checklist were used to investigate the buffering effects of coping style on the job stress-depression relationship. Results: Coping style did not have a buffering effect on the “overall stress”-depression relationship among ICU nurses, but there was support for the buffering effect of coping style on the “competency stress”-depression relationship. However, “competency” stress had significant and positive association with depression only for avoidant coping group. On the other hand, the direct effects of “work adaptation” stress on depression were significant in both coping groups and the effect strength did not significantly differ. Conclusions: Death education should be included in the cultivating education of nursing students. The nursing manager should endeavor to increase his/her observational skills in order to detect increased signs of depression among his/her personnel in the early stages; and nurses should be encouraged to take advantage of available therapies early to assure safety of patients’ care. Preparing programs such as effective coping with stress and continuing professional training should be taken into account in hospital training. It is important to develop systems for effective two-way communication, especially communication between nurses and physicians, as well as communication between nurses and patients’ family. Additionally reducing workload may be more effective than stress management

Early improvement in HAMD-17 and HAMD-6 scores predicts ultimate response and remission for depressed patients treated with fluoxetine or ECT

Background : HAMD-6 is derived from the 17-item Hamilton Rating Scale for Depression (HAMD-17).We explore whether HAMD-6 is a reliable, valid, and sensitive to change measure, and whether early improvement using HAMD-6 can predict ultimate response/remission for inpatients with major depressive disorder (MDD) receiving either fluoxetine or electroconvulsive therapy (ECT). Methods : Data were from 2 trials for 126 MDD inpatients receiving fluoxetine, and 116 inpatients receiving ECT. Internal consistency, validity, and sensitivity to change using HAMD-17 and HAMD-6 at each assessment were examined and compared. Early improvement was defined as an at least 20% reduction of HAMD-17 or HAMD-6 scores at week 2 for patients receiving fluoxetine, or after 6 treatments for patients receiving ECT. Response was defined as ??50% HAMD-17 score improvement from baseline, and remission was defined as a total HAMD-17 score of ??7 at endpoint. Receiver operating characteristic analysis was used to determine which rating scale had better discriminative capacity. Results : HAMD-6 is a reliable, valid, and sensitive to change measure. Early improvement using HAMD-6 had comparable predictive values with that of HAMD-17 for response/remission for patients receiving either fluoxetine or ECT. Limitations : Samples were taken from 2 open-label trials with limited sample sizes. Conclusions : HAMD-6 is a clinically useful measure. Those patients without early improvement, however, have a minimal chance of reaching ultimate response/remission, regardless of whether HAMD-17 or HAMD-6 was use

Retinal Nerve Fiber Layer Thickness Measured by Optical Coherence Tomography in Non-glaucomatous Taiwanese

Background/Purpose: Assessment of the peripapillary retinal nerve fiber layer (RNFL) is essential for neuroretinal diseases, especially for early prediction of glaucomatous damage. The purpose of this study wasto measure RNFL thickness by Stratus optical coherence tomography (OCT) in normal Taiwanese subjectsaccording to age group. Methods: The thickness of the RNFL around the disc of normal subjects was obtained, after pupil dilation, by means of 3.4 mm diameter fast mode circle OCT scan. Data for one randomly selected eye of each subjectwere used for statistical analysis. Differences in RNFL thickness were determined by ANOVA. Results: A total of 162 participants were evaluated: 61 male and 101 female, with mean age of 41.3 ± 20years (range, 6–74 years). Mean RNFL thickness was 108.7 ± 9.4 mm (range, 85.5–133.7 mm). The RNFLwas thickest in the inferior (135.8 ± 16.3 mm) and superior (133.9 ± 18.0 mm) quadrants, followed by thenasal (82.6 ± 16.0 mm) and temporal (82.4 ± 17.8 mm) quadrants (F = 551.9, p < 0.001). Conclusion: RNFL thickness was determined by OCT for a normal Taiwanese population aged 6–74 years. The normative data from this study may offer valuable information to enable comparisons of ocular diseasesinvolving RNFL across different populations

Association between Chronic Disease Self-Management, Health Status, and Quality of Life in Older Taiwanese Adults with Chronic Illnesses

Aging is accompanied by many chronic comorbidities and disabilities, and entails medical expenses, which affects the quality of life among older adults. The purpose of this study was to investigate whether the health status of older adults with chronic diseases mediates chronic disease self-management to predict quality of life. Methods: This research adopted a cross-sectional correlation study design. Convenient sampling was performed in outpatient departments commonly visited by older adults in a medical center in Southern Taiwan. The following measures were collected: (1) Physiological measurement: left handgrip, right handgrip, and lower extremities’ muscle strength. (2) Questionnaires: cognitive function was measured by the Alzheimer’s disease (AD)-8 scale, possible frailty with the Kihon Checklist (KCL), functional status with the Barthel Index (BI) and the Lawton and Brody Instrumental Activities of Daily Living (IADL) scales, and self-management for chronic disease and quality of life with the (WHOQOL)-BREF, Taiwan version. Results: Chronic disease self-management is correlated with health status and is directly related to quality of life. Chronic disease self-management also indirectly affects quality of life through health status (cognitive status and risk of frailty), showing that health status partly mediates the correlation between chronic disease self-management and quality of life. Conclusions: A health status feedback system should be introduced in related chronic disease self-management measures for older adults so that they can be aware of their own health status and so that their quality of life is improved. Custom-made nursing interventions are necessary for the reduction in or delay of disability or risk of frailty in older adults, thereby enhancing their quality of life

Acquired paralytic strabismus in Southern Taiwan

Background: Third, fourth, and sixth cranial nerve (CN3, CN4, and CN6) palsies are not uncommon in neuro-ophthalmology. The time and quality of recovery depend on the causes of the cranial nerve palsy. The purpose of our study was to evaluate the causes and outcome of acquired paralytic strabismus (PS) in a southern Taiwan population. Methods: This study involved a retrospective chart review of patients at Kaohsiung Veterans General Hospital from January 2006 through July 2009. A total of 196 patients were enrolled. Outcomes and recovery times were recorded for the patients who exhibited C3, C4, and C6 palsies. The patients were categorized into four etiologic groups: vascular, idiopathic, traumatic, and neoplastic. The onset of PS, its continuing medical management, recovery, and other outcomes were followed up in these patients over a period of up to 10 years. Results: The mean age of the 196 patients enrolled was 58.35 ± 17.60 years (range 11–90 years), and the mean follow-up time was 13.6 months. Seventy-seven patients (39.29%) had CN3 palsy, 38 patients (19.39%) had CN4 palsy, and 81 patients (41.33%) had CN6 palsy. The most common causes were vascular diseases (35.20%), followed by trauma (33.67%), and idiopathic causes (21.94%). About 50% of the patients recovered within 6 months. Among the four etiologic groups of patients, the vascular group showed the best recovery: about half of the patients recovered within 3 months. Longer recovery periods were necessary for patients in the neoplastic group than for those in the traumatic, vascular, and idiopathic groups (p = 0.01; p < 0.001; p < 0.001, respectively). Conclusion: The prognosis for patients with PS depended mostly on the cause of their disease. Patients with PS attributable to a vascular cause had a better prognosis than the other patients, and those in the neoplastic group required the longest time to recover