This study was conducted to develop a theoretical model for the determinants of activities of daily living in Korean rural elderly people. The theoretical model was derived from Lawton's Ecological Model to explain human behavior. The model includes determinant variables for functional status such as age, sex, physical status, cognitive status, physical environment, social environment, and depression. Data for this study was collected from 189 elderly people in a rural district near Chonju City. The data was analyzed with SPSS PC+ 4.1 and LISREL 8. The analysis of the data showed that the first proposed theoretical model did not fit the collected data well. In order to increase the fit of the model to the data, the model was modified by deleting the exogenous variables of sex, physical environment, and social environment. The fit of the modified model to the data was increased and was move suitable. The results of this study show that the determinants of the activities of Korean rural elderly people were age, perceived physical condition, cognitive status, and depressional status. Age has a significant direct and indirect effect on the activities of daily living of rural elderly people. Perceived physical condition has a significant indirect effect through depression on activities of daily living. Cognitive status also has a significant indirect effect through depression of functional status. Depression has a significant direct effect on the functional status. Physical environment and social environment showed reversal relationships to functional status. In conclusion, the results of this study show that personal characteristic factors are more important than environmental characteristic factors for functional status of elderly people. However, the importance of depression to functional status in korean rural elderly people and the reverse relationship between social environment and functional status, reflect Korean specificity. Korean nursing needs to focus more on this Korean specificity in order to develop nursing knowledge and practice appropriate to Korea people.
Activities of Daily Living ; Aged* ; Depression ; Humans ; Jeollabuk-do ; Korea ; Models, Theoretical ; Nursing ; Sensitivity and Specificity ; Social Environment

The surgeries based on the outpstient department have increased recently. One of the indications of outpatient surgery is chemical peeling of the face that usually re- quires only deep sedation of short duration. The purpose of this study was to evaluate the effeets of ketamine and midszolam for out patient facial chemical peeling. Fifty-nine unpremedicated patients undergoing chemical peeling of the face were anesthetized with bolus intravenous injection of 1mg/kg of ketamine and 0.1 mg/kg of midazolam. Additional dose of ketamine(10-20mg) was given as needed. During operation, we observed systolic and diastolic blood pressure with noninvasive blood pressure monitor and peripheral oxygen saturation(SpO2) with pulse oximeter. All patients were allowed to breathe spontane- ously without ventilatory support during the operation. There was no case of airway ob- struction and SpO2 value was over 97% in most cases. The systolic and diastolic blood pressure and pulse rate were increased after the injection of ketamine and midazolam. And we observed the untoward effect of anesthetics such as the purposeless movement(6.8%), involuntary phonation(3.4%), skin rash(3.4%) and headache(1.7%). In postoperative analysis about the recall, bad dream, mood, and the degree of satisfaction of this type of anesthesia, the rate of patient's positive acceptance was high(86.4%) and the reeovery time was 58min. We conclude that combination of intravenous ketamine and midszolam can produce satisfactory anesthesia with few complications for outpatient chemical peeling surgery of the face.
Ambulatory Surgical Procedures ; Anesthesia* ; Anesthetics ; Blood Pressure ; Blood Pressure Monitors ; Deep Sedation ; Dreams ; Heart Rate ; Humans ; Injections, Intravenous ; Ketamine* ; Midazolam* ; Outpatients* ; Oxygen ; Skin

BACKGROUND/AIMS: Thrombopoietin (TPO) is an important cytokine for megakaryocyte maturation and platelet production. Because the main site of its production is liver, the failing liver may have a role in thrombocytopenia in chronic liver disease. The aims of this study were to determine the serum TPO levels in cirrhotic patients with thrombocytopenia and clarify the relation between the serum TPO levels and liver function impairment. METHOD: Cirrhotic paitents with thrombocytopenia (LC, n=57, Child class A/B/C; 20/13/24), chronic hepatitis patients (CH, n=24), oncologic patients with thrombocytopenia induced by chemotherapy (HO, n=7), acute viral hepatitis patients (AVH, n=5) and healthy controls (HC, n=5) were enrolled. Serum TPO was measured by an ELISA method. RESULTS: Although the mean platelets counts of LC (69+/-32, x103/ul: mean+/-SD) were lower than those of HC (229+/-29, x103/ul), serum TPO levels in LC (108+/-63 pg/ml: mean+/-SD) were not significantly different from HC (122+/-24 pg/ml). In HO, serum TPO was significantly higher than LC (623+/-746 vs 108+/-63 pg/ml, p<0.05) inspite of comparable platelets counts. In LC, serum TPO level was not significantly different among Child class groups. It was not correlated with serum ALT, serum albumin levels, prothrombin time, serum bile acid, Child class, Child score and partial thromboplastin time, but weakly correlated with serum total bilirubin (p=0.038, r=0.288) and platelet counts (p=0.041, r=0.287). CONCLUSIONS: Although impaired hepatic production of TPO seems to be the main cause of low serum TPO levels in thrombocytopenic cirrhotic patients, there was no correlation between serum TPO level and the severity of liver dysfunction. The role of other factors such as megakaryocyte mass in bone marrow, portal hypertension and hypersplenism may be necessary to explain the putative mechanism between TPO and platelet numbers in liver cirrhosis with thrombocytopenia.
Bile ; Bilirubin ; Blood Platelets ; Bone Marrow ; Child ; Drug Therapy ; Enzyme-Linked Immunosorbent Assay ; Hepatitis ; Hepatitis, Chronic ; Humans ; Hypersplenism ; Hypertension, Portal ; Liver ; Liver Cirrhosis ; Liver Diseases ; Megakaryocytes ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Serum Albumin ; Thrombocytopenia* ; Thrombopoietin*

Objective: While recent studies have found deficits in theory of mind (ToM) skills in individuals at ultra-high risk (UHR) for psychosis, empathic tendencies in these subjects remain unclear. The presence of high schizotypy and compromised executive functions, which are found in UHR individuals, would affect ToM skills and empathic tendencies. We investigated the ToM skills and empathic tendencies of UHR individuals and examined their relationship with schizotypy and executive function. Methods: This study included 28 UHR individuals and 28 age- and sex-matched healthy controls. All participants completed a self-reported empathic scale (Interpersonal Reactivity Index) and the Wisconsin Schizotypy Scales. Additionally, the ToM Picture Stories Task and Wisconsin Card Sorting Test were conducted. Results: UHR individuals showed a trend toward lower self-reported empathic tendencies; however, there were no differences in ToM skills between the two groups. Of the four subscales of the IRI, only empathic concern showed a significant difference between the two groups. Empathic concern was inversely associated with negative schizotypy. Conclusion Our findings suggest that UHR individuals show relatively preserved cognitive empathy but compromised emotional empathy. Furthermore, in UHR individuals, the empathic concern subscale of the IRI was associated with negative schizotypy, while ToM skills were related to positive schizotypy and executive function.

PURPOSE: Foxo3 in female reproduction has been reported to regulate proliferation of granulose cells that form follicles. There are no reports so far that discuss on the role of Foxo3 in males. This study was designed to outline the role of Foxo3 in the testes. MATERIALS AND METHODS: Testes from mice at birth to postpartum week (PPW) 5 were isolated and examined for the expression of Foxo3 using immunostaining. To elucidate role of Foxo3 in Leydig cells, R2C cells were treated with luteinizing hormone (LH) and the phosphorylation of Foxo3. Testosterone and steroidogenic acute regulatory (StAR) protein levels were measured after constitutive active [triple mutant (TM)] human FOXO3 adenovirus was transduced and StAR promoter assay was performed. RESULTS: Foxo3 expression in the testicles started from birth and lasted until PPW 3. After PPW 3, most Foxo3 expression occurred in the nuclei of Leydig cells; however, at PPW 5, Foxo3 was expressed in both the nucleus and cytoplasm. When R2C cells were treated with luteinizing hormone, Foxo3 phosphorylation levels by AKT increased. After blocking the PI3K pathway, LH-induced phosphorylated Foxo3 levels decreased, indicating that LH signaling regulates Foxo3 localization. When active FOXO3-TM adenovirus was introduced into a Leydig tumor cell line, the concentrations of testosterone and StAR protein decreased. When FOXO3 and a StAR promoter vector were co-transfected into HEK293 cells for a reporter assay, FOXO3 inhibited the StAR promoter. CONCLUSION: FOXO3 affects testosterone synthesis by inhibiting the formation of StAR protein. LH hormone, meanwhile, influences Foxo3 localization, mediating its function.
Animals ; Cell Aging/*physiology ; Cell Nucleus/metabolism ; Cytoplasm/metabolism ; Forkhead Transcription Factors/*metabolism ; HEK293 Cells ; Humans ; Leydig Cells/*drug effects/*enzymology/metabolism ; Luteinizing Hormone/blood ; Male ; Mice ; Phosphatidylinositol 3-Kinases ; Phosphoproteins/metabolism ; Phosphorylation ; Signal Transduction/drug effects ; Testosterone/blood/*metabolism

OBJECTIVE: The purpose of this study is to investigate the incidence of lymph node metastasis in early endometrial cancer patients and to evaluate preoperative clinicopathological factors predicting lymph node metastasis. METHODS: We identified 142 patients with endometrial cancer between January 2000 and February 2013. All patients demonstrated endometrioid adenocarcinoma with grade 1 or 2 on preoperative endometrial biopsy. Preoperative magnetic resonance imaging showed that tumors were confined to the uterine corpus with superficial myometrial invasion (less than 50%), and there were no lymph nodes enlargements. All patients had complete staging procedures and were surgically staged according to the 2009 FIGO (International Federation of Gynecology and Obstetrics) staging system. Clinical and pathological data were obtained from medical records and statistically analyzed. RESULTS: Of the 142 patients, 127 patients (89.4%) presented with stage 1A, 8 (5.6%) with stage IB, 3 (2.1%) with stage II, and 4 (2.8%) with stage III disease. Three patients (2.1%) had lymph node metastasis-2 IIIC1 and 1 IIIC2 disease. Age, preoperative tumor grade, and myometrial invasion less than 50% on preoperative MRI were not associated with lymph node metastasis. A high preoperative serum CA-125 level (>35 IU/mL) was a statistically significant factor for predicting lymph node metastasis on univariate and multivariate analyses. Lymph node metastasis was only found in patients with preoperative grade 2 tumors or a high serum CA-125 level. CONCLUSION: Preoperative tumor grade and serum CA-125 level can predict lymph node metastasis in apparent early endometrial cancer patients.
Biopsy ; Carcinoma, Endometrioid ; Endometrial Neoplasms* ; Female ; Gynecology ; Humans ; Incidence ; Lymph Nodes* ; Magnetic Resonance Imaging ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis*

Renal cell carcinoma (RCC) is rare relative to other urological cancers, but relatively common overall among males. Even when primary tumors are successfully removed by surgery, metastases are often noted within a few years. On the other hand, masses found at other sites in patients with RCC may represent different primary cancers. We present the case of a 63-year-old man with a right lung mass and a left lung nodule who underwent radical right nephrectomy for RCC. We found no local recurrence of RCC in the abdomen. Despite treatment for RCC, the right lung mass increased in size. We performed a lung needle biopsy and diagnosed primary lung cancer. Postoperatively, the remaining left lung nodule also increased in size. It was diagnosed as an RCC metastasis upon biopsy and removed by wedge resection. The patient was treated with everolimus after the second surgery.
Abdomen ; Biopsy ; Biopsy, Needle ; Carcinoma, Bronchogenic ; Carcinoma, Renal Cell* ; Hand ; Humans ; Lung Neoplasms* ; Lung* ; Male ; Middle Aged ; Neoplasm Metastasis* ; Nephrectomy ; Recurrence ; Urologic Neoplasms ; Everolimus

We report a case in which epidural anesthesia was successfully administered during a cesarean section of a 35 years old parturient patient with severe congestive heart failure and respiratory insufficiency at 33 weeks of gestation. The patient had a past history of mitral regurgitation and mitral valve prolapse treated by mitral valve replacement ten years prior. When limited motion of the prosthetic mitral valve developed, congestive heart failure recurred and was aggravated by the pregnancy. In addition, the patient presented with symptoms of respiratory insufficiency including NYHA III dyspnea, orthopnea, severe pulmonary hypertension (systolic pulmonary arterial pressure: 112 mmHg) due to severe aortic regurgitation, pleural effusion and pulmonary edema on admission. Four-days after admission, with premature labor pain and fetal distress, the patient underwent an emergency cesarean section. Due to the orthopnea, the patient could not breathe in the supine position, and we chose to give epidural anesthesia at a sitting position for preserving self-respiration and to prevent a ventilation-perfusion mismatch that would possibly develop during general anesthesia. Moreover, we could control postoperative pain and maintain a minimal, gradual hemodynamic change throughout the epidural anesthesia. During surgery, the hemodynamic instabilities were controlled by the use of dopamine, dobutamine, ephedrine and milrinone. We safely finished the cesarean section under epidural anesthesia and the patient was sent to the intensive care unit postoperatively to manage congestive heart failure and respiratory insufficiency.
Adult ; Anesthesia, Epidural* ; Anesthesia, General ; Aortic Valve Insufficiency ; Arterial Pressure ; Cesarean Section* ; Dobutamine ; Dopamine ; Dyspnea ; Emergencies ; Ephedrine ; Estrogens, Conjugated (USP)* ; Female ; Fetal Distress ; Heart Failure* ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Intensive Care Units ; Milrinone ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Prolapse ; Obstetric Labor, Premature ; Pain, Postoperative ; Pleural Effusion ; Pregnancy ; Pulmonary Edema ; Respiratory Insufficiency* ; Supine Position

Saccular coronary artery aneurysm, associated with coronary artery fistula, is a very rare condition. A 48-year-old woman was referred to our hospital for the evaluation of an abnormal shadow on the left cardiac border from a chest X-ray film during regular medical health examination. A huge saccular aneurysm with organized thrombi in the proximal left anterior descending artery (LAD) and coronary artery fistulae from LAD and conus branch of the right coronary artery to pulmonary artery was diagnosed by transthoracic echocardiography, multi-detector computer tomography (MDCT), and coronary angiography. The patient received surgical treatment, including thrombectomy of aneurysm, ligation of the inlet and outlet of aneurysmal sac, coronary artery bypass graft (left internal mammary artery-to-distal LAD), and ligation of fistulae. The postoperative course was uneventful, and postoperative echocardiography and MDCT revealed patent bypass graft; however, a small fistula from proximal LAD across aneurysmal sac to pulmonary artery was observed.
Aneurysm ; Arteries ; Coronary Aneurysm ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Vessels ; Echocardiography ; Female ; Fistula ; Humans ; Ligation ; Pulmonary Artery ; Thorax ; Thrombectomy ; Transplants ; X-Ray Film

Saccular coronary artery aneurysm, associated with coronary artery fistula, is a very rare condition. A 48-year-old woman was referred to our hospital for the evaluation of an abnormal shadow on the left cardiac border from a chest X-ray film during regular medical health examination. A huge saccular aneurysm with organized thrombi in the proximal left anterior descending artery (LAD) and coronary artery fistulae from LAD and conus branch of the right coronary artery to pulmonary artery was diagnosed by transthoracic echocardiography, multi-detector computer tomography (MDCT), and coronary angiography. The patient received surgical treatment, including thrombectomy of aneurysm, ligation of the inlet and outlet of aneurysmal sac, coronary artery bypass graft (left internal mammary artery-to-distal LAD), and ligation of fistulae. The postoperative course was uneventful, and postoperative echocardiography and MDCT revealed patent bypass graft; however, a small fistula from proximal LAD across aneurysmal sac to pulmonary artery was observed.
Aneurysm ; Arteries ; Coronary Aneurysm ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Vessels ; Echocardiography ; Female ; Fistula ; Humans ; Ligation ; Pulmonary Artery ; Thorax ; Thrombectomy ; Transplants ; X-Ray Film