5a). In the control strain, approximately 70% of hyphae contained stained Spk 30 min after the initial staining (Fig. 5b and c), which increased to 90% after 60 min (Fig. 5b). In contrast, in the

aipA-overexpressing strain, approximately 35% of hyphae with stained Spk were observed 30 min after the staining (Fig. 5b and c), which only increased to 50% after 60 min (Fig. 5b). Notably, the mutant aipA-overexpressing strains showed nearly identical Spk staining as that of the control Decitabine clinical trial strain (Fig. 5b and c). Taken together, these results suggest that the endocytic recycling of FM4-64 to Spk is both defective and delayed in the aipA-overexpressing strain. However, because the aipA-overexpressing strain also displayed impaired growth, it is possible that the Spk was not present in certain hyphae,

and thus, the relative rate of endocytic recycling was not substantially delayed in this strain. To exclude this possibility, we calculated the half-time required for Spk staining with FM4-64 for each of the strains (Fig. 5d). The half-time for staining in the aipA-overexpressing strain was clearly longer than that in the control and mutant aipA-overexpressing strains, indicating that the selleck kinase inhibitor aipA-overexpressing strain has defects with respect to endocytic recycling; this delay could be caused by the defect of endocytosis, that of trafficking of vesicles to Spk, or both. We also confirmed that there was no significant difference between the control and the ΔaipA strains in this analysis (data not shown). In this study, we discovered a putative

AAA ATPase, AipA, as a binding partner of AoAbp1 by YTH screening. Although the ΔaipA strain did not display growth or endocytic defects, the aipA-overexpressing strain showed impaired growth, abnormal hyphal morphology, and a deficiency in the endocytic recycling of FM4-64, whereas the mutant aipA-overexpressing strains did not. The subsequent localization and functional analyses using the aipA-overexpressing strain suggested that AipA negatively functions only in endocytic recycling at the tip region of A. oryzae. There seems to be one AipA ortholog in filamentous fungi and two in yeasts. Both Sap1p and Yta6p, S. cerevisiae AipA orthologs, are putative AAA ATPases, but their molecular function is unknown. Sap1p was found by the YTH analysis as a binding protein with Sin1p, a transcriptional repressor (Liberzon et al., 1996). Yta6p is one of 12 YTA family proteins and is localized at the cortex in mother cells, but not in daughter cells (Schnall et al., 1994; Beach & Bloom, 2001). Single disruptants of either SAP1 or YTA6 are viable and no remarkable phenotypic alteration has been reported.

, 2007). Currently used surfactants are often petroleum derived, but production of these compounds from renewable substrates is now of considerable interest. Sophorolipids, which consist of the sugar sophorose linked to a long-chain hydroxy fatty acid, are among candidate compounds that can be produced from renewable sources. Interest in sophorolipids is not limited to KU-60019 cost production of surfactants. The unique chemical structure of sophorolipids can serve as the basis for synthesizing certain hydroxy fatty acids and other compounds (Van Bogaert et al., 2007). Perhaps of greater interest are reports that these glycolipids have antimicrobial activity against certain yeasts (Ito et al., 1980), plant pathogenic fungi (Yoo et

al., 2005) and bacteria (Mager et al.,

1987; Lang et al., 1989). Furthermore, Shah et al. (2005) showed inhibition of the HIV virus by sophorolipids, and Chen et al. (2006) provided evidence that the compounds have anticancer activity. Sophorolipids Aloxistatin nmr are synthesized by a phylogenetically diverse group of yeasts. The earliest report appears to be that of Gorin et al. (1961), who demonstrated sophorolipid biosynthesis by the anamorphic ascomycetous yeast Candida apicola, which was initially identified as Candida magnoliae. Later, Spencer et al. (1970) showed sophorolipid production by Candida bombicola, and Konoshi et al. (2008) reported Candida batistae to also form sophorolipids. The preceding MRIP three Candida sp. are closely related, but sophorolipid biosynthesis was also demonstrated for the less closely related Wickerhamiella domercqiae (Chen et al., 2006) as well as for the basidiomycetous yeast Rhodotorula bogoriensis (Tulloch et al., 1968). Phylogenetic analysis of sequences for the D1/D2 domains of the nuclear large subunit (LSU) rRNA gene has shown that C. apicola and C. bombicola are members of a clade that is well separated from other ascomycetous

yeasts (Kurtzman & Robnett, 1998). Candida bombicola is the first member of the clade for which ascospore formation was discovered and the species was reassigned to the teleomorphic genus Starmerella (Rosa & Lachance, 1998). With the application of sequence analysis to yeast identification, the group of yeasts related to Starmerella bombicola, now termed the Starmerella clade, has increased markedly in the past decade to over 40 species. Many of these species have not been described as yet but are presently recognized from their gene sequences, which have been deposited in GenBank. Candida apicola, C. batistae and S. bombicola are the only members of the Starmerella clade that have been reported to produce sophorolipids. In the present work, we examined additional species of the Starmerella clade for production of sophorolipids using a matrix-assisted laser desorption/ionisation-time of flight (MALDI-TOF) MS-based screen similar to that used previously to identify bacterial biosurfactants, rhamnolipids, surfactins and iturins (Price et al.

Movement of rcsD mutant cells on swarm media. Video S5. Movement of yeeZ mutant cells in liquid LB media. Please note: Wiley-Blackwell is not responsible for the content or functionality of any supporting materials supplied by the authors. Any

queries (other www.selleckchem.com/products/bay80-6946.html than missing material) should be directed to the corresponding author for the article. “
“The efficacy of allicin compared with fluconazole in alleviating systemic Candida albicans infections was evaluated both in vitro and in vivo through a systemic candidiasis mouse model. Determination of in vitro minimum inhibitory concentrations (MICs) for different C. albicans isolates revealed that both allicin and fluconazole showed different MICs that ranged from 0.05 to 12.5 μg mL−1 and 0.25 to 16 μg mL−1, respectively. A time–kill study showed a significant effect of allicin (P<0.01) against C. albicans, comparable to that of fluconazole. Scanning electron microscopy observation revealed that, similar to fluconazole, allicin produced structural destruction of C. albicans cell surface at low MIC and lysis or puncture at high MIC concentrations. Treatment of BALB/c mice systemically infected with C. albicans showed that although the allicin treatment (at 5 mg kg−1 day−1) was slightly less efficacious than fluconazole treatment in terms of the fungal load reduction and host survival time, it was still effective

selleck compound library against C. albicans in terms of mean survival time, which increased from 8.4 to 15.8 days. These results demonstrate the efficacy of anticandidal effects of allicin both in vitro and in an animal model of candidiasis and affirm the potential of allicin as an adjuvant therapy to fluconazole. Recently, the Sulfite dehydrogenase incidence of systemic candidiasis, which is caused by Candida spp., predominantly Candida albicans, has increased (Chowta et al., 2007). This increase over the last two decades has caused a rise in the use of antifungal drugs (Pereira-Cenci et al., 2008). Azoles such as fluconazole or ketoconazole are usually used for treatment of systemic fungal infections. However, one of the biggest problems faced in clinical practice is

the emergence of resistance to most of these azole drugs due to mutation (Odds et al., 2003; Looi et al., 2005). Clinically adverse effects are also seen with the use of azoles (Al-Mohsen & Hughes, 1998). Therefore the most urgent challenge in pharmaceutical research is the discovery and development of new antifungals from plant and microbial sources. Allicin (diallyl thiosulfinate), one of the sulfur compounds from garlic, has been shown to possess antifungal activity (Yamada & Azuma, 1977). It has been shown that after crushing fresh garlic cloves, allinase rapidly converts the released allin (precursor of allicin) into allicin (Ankri & Mirelman, 1999). Allitridium (diallyl trisulfide), one of the breakdown products from allicin, has also been found to show antifungal activity in vitro (Davis et al., 2003) and in vivo (Davis et al., 1990).

The authors would like to thank Dr Chris Morley, BVSc BSc (Hons) MVPHMgt Ministry of Agriculture, New Zealand, for tracing the source of the Trichostrongylus from the sheep manure that was being used as an organic fertilizer in the salad garden. The authors state that they have no conflicts of interest to declare. “
“A Belgian traveler returning from Laos developed acute schistosomiasis. Feces microscopy and polymerase chain reaction (PCR) followed by sequence analysis revealed Schistosoma mekongi. Schistosome antibody test results and real-time PCR in serum were initially negative or not interpretable. A HRP-2 antigen test for Plasmodium falciparum and an

enzyme-linked immunosorbent assay (ELISA) antibody test for Trichinella yielded false-positive results. Schistosoma mekongi infection is exceptional in travelers. Even when diagnosis is suspected, JNK inhibitor price confirming early stage infection may be complicated by insufficient sensitivity

of schistosome antibody assays and by (false) positive antigen and antibody assays against other pathogens. A 27-year-old male Belgian traveler developed low grade fever, night sweats, and cough soon after returning from a 4 months’ adventurous travel to Laos, Cambodia, and Yunnan province in south China. He had lost some weight but had neither diarrhea nor anorexia. He was a practicing vegetarian. He had, together with his girlfriend, visited the “Four Thousand Islands” (Si Pan Don) region, a conglomerate of islets situated in the Mekong River straddling the Laos–Cambodian border, 5 weeks prior. He reportedly took a daily swim in the Mekong River for ICG-001 in vitro 1 week (D0 = first day of exposure), as well as in a sandy old river bend with stagnant water at the southernmost part of Khong Island, called Don Det, on one occasion. He did not report swimming in rivers or ponds elsewhere during his travel. Symptoms started about 6 weeks after exposure (D45). The patient consulted his family physician 10 days later (D55) and was referred at the outpatient clinic of the Institute of Tropical Medicine,

Antwerp, Belgium (ITMA) 5 days thereafter (D60), when symptoms had already subsided. Clinical signs were unremarkable. OSBPL9 Ultrasound revealed a modest spleen enlargement, and the routine laboratory workup showed a marked hypereosinophilia (Table 1). Chest X-ray was normal. Two serum antischistosome antibody tests were performed at the initial and the subsequent visits: an in-house enzyme-linked immunosorbent assay (ELISA) using a Schistosoma mansoni antigen (mixture of egg and adult worm extract), and an indirect hemagglutination inhibition assay (IHA), using a S mansoni adult worm extract (ELI.H.A Schistosoma, ELITech Group, Puteaux, France), with titration and cut-off at 1/80 (positive at ≥1/160). Up to 15 weeks after exposure (D105), the IHA could not be interpreted because of the presence of antibodies reacting with sheep RBC in the patient’s serum.

pylori infection should have an apparent effect in preventing virulence factor release by stressed or dying bacteria apart from its bacteriostatic or bactericidal activity. Additionally, when allitridi undergoes partial degradation in vivo or there is interference with other factors, it would still be helpful for patients because subinhibitory concentrations of allitridi

effectively suppresses the production of virulence proteins. It has been well documented that VacA plays a role in H. pylori colonization, survival (Salama et al., 2001) and epithelial damage (Telford et al., 1994), whereas CagA is associated with higher grades of gastric RG-7204 mucosal inflammation, atrophic gastritis and gastric carcinoma (Hatakeyama & Higashi, 2005). Therefore, application of allitridi can be expected to decrease the probability of H. pylori infection and to prevent the incidence of H. pylori-related gastric diseases. In this study, our data indicate that the bacteriostatic mechanism of allitridi in H. pylori can

be attributed to its multitarget Selleck Abiraterone inhibitory effects. Figure 4 shows a simple model of the antibacterial mode of action of allitridi according to our results. However, it is still unclear whether this inhibitory effect is direct or indirect. The chemical structure of DATS is allyl-S-S-S-allyl (C6H10S3) (Davis, 2005). It has been suggested that garlic-derived organosulfur compounds can modify SH-containing enzymes via thiol-disulfide exchange (Pinto et al., 2006). The reaction of DATS with protein thiols is allyl-S-S-S-allyl+protein-SHprotein-S-S-allyl+allyl-S-SH. This reaction may either activate or inactivate the SH-containing protein, which is dependent on the intrinsic nature of a protein or an enzyme (Klatt Carnitine palmitoyltransferase II & Lamas, 2000). We postulate that the primary targets of allitridi are likely to

be the SH-containing proteins, and the activity variation of SH-containing protein would result in abundant changes in certain proteins. In summary, to our knowledge, the present study, for the first time, elucidates the antibacterial mode of action of allitridi at a global protein level, which provides a theoretical basis for the potential application of allitridi as a therapeutic agent against H. pylori infection. However, more clinical evaluations of the anti-H. pylori activity of allitridi are still needed. This work was supported by the National Natural Science Foundation of China (accession numbers 30770118, 3000406, 30800037, 30972775 and 30800614), the National Basic Research Program of China (973 Program 2007CB512001) and the Science Foundation of Shandong Province (accession numbers 2005GG3202087 and Y2004C03). S.L. and Y.S. contributed equally to this work. “
“During the establishment of Escherichia coli O157:H7 infection, its capacity to adhere to host intestinal epithelial cells is the critical first step in pathogenesis.

910), the CD4 percentage (P=0.928), or HIV RNA levels (P=0.713); the last available HIV RNA values were also similar (P=0.995), but the patients who did not undergo an OGTT had lower last available CD4 counts learn more [median (IQR) 360 (238–425) vs. The 84 evaluable patients [67 male (80%); median age 45.7 years (range 43.8–49.1 years)] were all Caucasian; 65 (77%) were coinfected with HCV and seven (8%) with HBV; 15 (18%) had a previous AIDS-defining event; 58 (69%) had previously received stavudine and 44 (52%) indinavir. At the time of the study evaluation, 64 patients (76%) had undetectable HIV RNA levels (<50 copies/mL); median (IQR) exposure to any antiretroviral regimen was 12.8 (10.4–16.5) years, with median (IQR) exposure to NRTIs being 11.2 (4.2–18.3) years, that to NNRTIs 1.2 (0.4–2.7) years, and that to PIs 5.9 (2.6–8.0) years. The last available median (IQR) values were: CD4 count, 502 (327–628)cells/μL; CD4 percentage, 24% (19–29%); FPG level, 81 (75–87) mg/dL [4.5 (4.2–4.8) mmol/L]; total cholesterol, 182 (158–203) mg/dL [4.7 (4.1–5.3) mmol/L]; HDL cholesterol, 41 (35–49) mg/dL [1.1 (0.9–1.3) mmol/L]; LDL cholesterol, 103 (81–129) mg/dL [2.7 (2.1–3.3) mmol/L]; and

triglycerides, 130 (92–196) mg/dL [1.5 (1–2.2) mmol/L]. Median (IQR) BMI was 22.9 (21.2–25.5) kg/m2 click here and median (IQR) waist circumference was 82 (77–88) cm; 55 patients (73%) had a BMI of <25, 16 patients (21%) had a BMI of 25–29.9, and four patients (5%) had a BMI of ≥30 kg/m2; and 71 (84%) and 13 selleck chemical (15%) had normal and abnormal waist circumferences, respectively. Eighteen out of 75 patients (24%) had a family history of DM. After the OGTT, nine of 84 patients (11%) were diagnosed as having IGT (six patients) or DM (three patients).

Table 1 shows the demographic and main clinical characteristics of the study patients by OGTT result; patients with IGT or DM had lower CD4 cell counts than those without [median (IQR) 294 (249–388) vs. 515 [342–633] cells/μL, respectively; P=0.047), while no between-group differences were observed for smoking habit, blood pressure, or use of antihypertensive medications. Table 2 shows glucose metabolism parameters in general and by the 2-h post-load results. Median (IQR) HOMA-IR was 2.82 (1.89–4.02), median (IQR) 2-h post-load glucose was 102 (83–119) mg/dL [5.7 (4.6–6.6) mmol/L] and median (IQR) 2-h post-load insulin was 35 (14.0–71.0) mIU/L. Patients with IGT or DM had higher median fasting insulin (P=0.010) and HOMA-IR values (P=0.009) than patients without IGT or DM, and there were also significant differences in 2-h post-load glucose (P<0.0001) and 2-h post-load insulin (P=0.020) levels. Eight (19%) of the 42 patients with a HOMA-IR of >2.82 and one (2%) of the 42 patients with a HOMA-IR of ≤2.82 had IGT or DM (P=0.029).

Attentional processes constantly filter sensory inputs, and only

a subset of our environment receives fully elaborated perceptual processing. For example, each time that we make an eye movement, the eyes bring another part of our environment into the center of gaze for detailed processing. In addition to these overt shifts of attention, humans can deploy spatial attention without moving the eyes or the head, known as covert shifts of attention (von Helmholtz, 1867). One longstanding metaphor for covert spatial attention is the ‘attentional spotlight’, the notion that attention can only be allocated to one region of space at a time (e.g. Posner, 1980). These models postulate that the attentional spotlight cannot be divided, but that the size of the spotlight can be adapted to task requirements [i.e. the ‘zoom-lens’ model (Eriksen &

St James, 1986)]. In the attended selleck chemicals region of visual space, reaction times are lower and/or detection accuracy is higher than in unattended regions. This notion of a unitary, indivisible spotlight was supported by earlier visual evoked potential (VEP) studies (e.g. Heinze et al., 1994). However, a growing number of studies have challenged the idea of a single, non-divisible attentional spotlight. Behavioral experiments provide evidence that humans can divide attention among multiple non-contiguous spatial locations (e.g. this website Castiello

& Umilta, 1992; Awh & Pashler, 2000; Gobell et al., 2004), reporting that reaction time and accuracy are modulated in divided attention designs in the same way as in undivided cued attention paradigms. Another line of evidence for a division of spatial attention has been put forward in steady-state VEP (SSVEP) and functional magnetic resonance imaging studies (e.g. Muller et al., 2003a; McMains & Somers, 2004, 2005). These studies reveal brain activation patterns that clearly fit with a divided spotlight account. In recent years, studies providing evidence for a divided spotlight of attention were called into question, Thiamet G on the basis that their results can be explained by a unitary attentional spotlight that simply switches very rapidly between to-be-attended locations (e.g. Jans et al., 2010; VanRullen & Dubois, 2011). Correlates of such a periodic sampling of attention have been observed in electrophysiological experiments in non-human primates (Buschman & Miller, 2009) and in psychophysical experiments in humans (VanRullen et al., 2007). The dynamics of how attentional resources are redirected in the visual field are strongly debated, with estimates of latencies for attentional shifts of between approximately 70 ms (Nakayama & Mackeben, 1989) and 300 ms (Duncan et al., 1994).

Attentional processes constantly filter sensory inputs, and only

a subset of our environment receives fully elaborated perceptual processing. For example, each time that we make an eye movement, the eyes bring another part of our environment into the center of gaze for detailed processing. In addition to these overt shifts of attention, humans can deploy spatial attention without moving the eyes or the head, known as covert shifts of attention (von Helmholtz, 1867). One longstanding metaphor for covert spatial attention is the ‘attentional spotlight’, the notion that attention can only be allocated to one region of space at a time (e.g. Posner, 1980). These models postulate that the attentional spotlight cannot be divided, but that the size of the spotlight can be adapted to task requirements [i.e. the ‘zoom-lens’ model (Eriksen &

St James, 1986)]. In the attended BMS-907351 solubility dmso region of visual space, reaction times are lower and/or detection accuracy is higher than in unattended regions. This notion of a unitary, indivisible spotlight was supported by earlier visual evoked potential (VEP) studies (e.g. Heinze et al., 1994). However, a growing number of studies have challenged the idea of a single, non-divisible attentional spotlight. Behavioral experiments provide evidence that humans can divide attention among multiple non-contiguous spatial locations (e.g. PLX4032 ic50 Castiello

& Umilta, 1992; Awh & Pashler, 2000; Gobell et al., 2004), reporting that reaction time and accuracy are modulated in divided attention designs in the same way as in undivided cued attention paradigms. Another line of evidence for a division of spatial attention has been put forward in steady-state VEP (SSVEP) and functional magnetic resonance imaging studies (e.g. Muller et al., 2003a; McMains & Somers, 2004, 2005). These studies reveal brain activation patterns that clearly fit with a divided spotlight account. In recent years, studies providing evidence for a divided spotlight of attention were called into question, much on the basis that their results can be explained by a unitary attentional spotlight that simply switches very rapidly between to-be-attended locations (e.g. Jans et al., 2010; VanRullen & Dubois, 2011). Correlates of such a periodic sampling of attention have been observed in electrophysiological experiments in non-human primates (Buschman & Miller, 2009) and in psychophysical experiments in humans (VanRullen et al., 2007). The dynamics of how attentional resources are redirected in the visual field are strongly debated, with estimates of latencies for attentional shifts of between approximately 70 ms (Nakayama & Mackeben, 1989) and 300 ms (Duncan et al., 1994).

6% of all patients with cardiac arrest were discharged from the hospital alive.8 Among those where resuscitation was attempted, 7.9% of treated cardiac arrest patients and one of five patients with ventricular fibrillation survived to hospital discharge. Aboard German vessels an average of five acute severe cardiac cases are reported per year.9 The UK had 35,000 seafarers in 2005; on British ships there were 49 fatalities from cardiovascular diseases in 10 years (1996–2005), of which 36 were found dead.10 That leaves 1.3 witnessed cardiac arrests per year in the UK fleet or maybe one every few years with a shock-able rhythm. Life saving conditions are far

from ideal on most ships without a doctor; hence, there will be years between each time an AED contributes to saving a life on a merchant ship of any flag without a doctor. With such low numbers studies regarding cost-effectiveness GSI-IX will be difficult, if not impossible, to perform. Most seafarers will never have to use an AED. But if there is

one aboard, they will be expected to use it in cases of cardiac arrest. As more than 9 of 10 resuscitation attempts will be unsuccessful, what will be the psychological impact when insensitive investigators ask questions like “Did you use the AED?” and “Did you use it fast enough and correctly? With their new regulations Germany has a golden opportunity—but also an obligation—to show the rest of the world whether AEDs are useful and cost-effective in ships without a physician. Epigenetic Reader Domain inhibitor Oldenburg and colleagues predict that other flag states will follow the German example, but before they do so, they should observe German experience and especially pay attention to the minimum prerequisites for success that the authors are listing. Maybe the most important measure would be to ensure legislation to the effect that use of an AED aboard in case of cardiac arrest should be commended and never criticized regardless of outcome. Every fatality at sea should be properly recorded,

reported, and investigated, but errors done while attempting resuscitation with good intentions should be inadmissible in any court of learn more law. The author has worked part time for a number of cruise companies as an independent maritime medical consultant and as a ship’s doctor. He has not received any financial support or funding of any kind for work connected with this commentary. “
“Mount Kilimanjaro in northern Tanzania attracts 40,000 trekkers each year and is regarded as “Everyman’s Everest.” Although most trekkers’ determination to summit is high, their knowledge of the risks associated with climbing to high altitude is understudied. In 2007, Merritt and colleagues[1] investigated the knowledge levels of trekkers in Cuzco, Peru, and found that 51% of trekkers rated their knowledge of acute mountain sickness (AMS) as low. Climbing Mount Kilimanjaro normally takes between 4 and 7 days.

Until more sensitive and specific methods for assessment of treatment results are available, repeated treatment should be considered in patients with continuous symptoms or other indications of treatment failure even when viable ova are not detectable. Alternatively, given Dabrafenib the low toxicity of praziquantel, repeated treatment of all nonimmune patients after 1 to 3 months might be reasonable. Clinical studies comparing the efficacy of different regiments of praziquantel in treatment of imported schistosomiasis are needed. Both authors

state they have no conflicts of interest to declare. “
“The psychological problems of non-Japanese people are becoming more outstanding, in accordance with the increase of foreign nationals in Japan. Five illustrative cases of English-speaking Wnt cancer patients were analyzed, from the viewpoint of psychosomatic medicine. The most common psychiatric disorders were adjustment disorders, because of the cultural differences and language barriers. The number of non-Japanese people living in Japan is increasing, and consequently the psychological problems of foreign nationals are becoming more outstanding in Japanese medicine.[1]

Psychosomatic medicine (PSM) was established in Japan in 1996 as a specific medical field for “psychosomatic disorders,” which consists of stress-related physical symptoms and psychological distress. To examine expatriate reactions to living in Japan, we examined the cases of five non-Japanese, English-speaking patients who visited

the Department of Psychosomatic Medicine, Sakai Hospital and Nihonbashi Clinic, Kinki University Faculty of Medicine for the first time between June 2004 and July 2011. This study was conducted according to the ethics rules of our hospital. The purpose of this study was explained to the patients and informed consent was obtained for publication of the study. In terms of Japanese proficiency, one patient (case 2) was unable to communicate in Japanese at all, three patients Pregnenolone (cases 1, 3, and 5) were able to exchange greetings, but not express themselves sufficiently, and the remaining patient (case 4) was able to participate in daily conversation, but could not fully explain his symptoms. All of them were considered as having limited Japanese proficiency, therefore history taking, physical examination, and explanation of results were conducted by a doctor in English. The self-rating depression scale (SDS) and the state-trait anxiety inventory (STAI) were used to evaluate emotional distress in terms of depression and anxiety.[2, 3] In SDS, a cut-off score of 50 was adopted in this study to determine that patients were considered to be in a depressive state. In STAI, cut-off scores of 42/45 (STAI-S/T for female) and 41/44 (STAI-S/T for male) were adopted to determine that patients possessed a tendency toward anxiety.