Background and Objectives: Pathophysiological changes of right ventricle (RV) after repair of tetralogy of Fallot (TOF) are coupled with a highly compliant low-pressure pulmonary artery (PA) system. This study aimed to determine whether pulmonary vascular function was associated with RV parameters and exercise capacity, and its impact on RV remodeling after pulmonary valve replacement. Methods: In a total of 48 patients over 18 years of age with repaired TOF, pulmonary arterial elastance (Ea), RV volume data, and RV-PA coupling ratio were calculated and analyzed in relation to exercise capacity. Results: Patients with a low Ea showed a more severe pulmonary regurgitation volume index, greater RV end-diastolic volume index, and greater effective RV stroke volume (p=0.039, p=0.013, and p=0.011, respectively). Patients with a high Ea had lower exercise capacity than those with a low Ea (peak oxygen consumption [peak VO2 ] rate: 25.8±7.7 vs. 34.3±5.5 mL/kg/min, respectively, p=0.003), while peak VO2 was inversely correlated with Ea and mean PA pressure (p=0.004 and p=0.004, respectively). In the univariate analysis, a higher preoperative RV end-diastolic volume index and RV end-systolic volume index, left ventricular end-systolic volume index, and higher RV-PA coupling ratio were risk factors for suboptimal outcomes. Preoperative RV volume and RV-PA coupling ratio reflecting the adaptive PA system response are important factors in optimal postoperative results. Conclusions We found that PA vascular dysfunction, presenting as elevated Ea in TOF, may contribute to exercise intolerance. However, Ea was inversely correlated with pulmonary regurgitation (PR) severity, which may prevent PR, RV dilatation, and left ventricular dilatation in the absence of significant pulmonary stenosis.

INTRODUCTION: Elderly persons who live alone are more likely to be socially isolated and at increased risk of adverse health outcomes, unnecessary hospital re-admissions and premature mortality. We aimed to understand the health-seeking behaviour of elderly persons living alone in public rental housing in Singapore. METHODS: In-depth interviews were conducted using a semi-structured question guide. Participants were selected using a purposive sampling approach. Interviews were conducted until theme saturation was reached. Qualitative data collected was analysed using manual thematic coding methods. RESULTS: Data analysis revealed five major themes: accessibility of healthcare services and financial assistance schemes; perceived high cost of care; self-management; self-reliance; and mismatch between perceived needs and services. CONCLUSION Elderly persons living in one-room rental flats are a resilient and resourceful group that values self-reliance and independence. Most of the elderly who live alone develop self-coping mechanisms to meet their healthcare needs rather than seek formal medical consultation. The insightful findings from this study should be taken into consideration when models of healthcare delivery are being reviewed and designed so as to support the disadvantaged elderly living alone.

OBJECTIVE: The study investigated to compare health care utilization and expenditures between diabetic patients with and without depression in Taiwan. METHODS: Health care utilization and expenditure among diabetic patients with and without depression disorder during 2000 and 2004 were examined using Taiwan's population-based National Health Insurance claims database. Health care utilization included outpatient visits and the use of inpatient services, and health expenditures were outpatient, inpatient, and total medical expenditures. Moreover, general estimation equation models were used for analyzing the factors associated with outpatient visits and expenditures. Multiple logistic regression analysis was applied for identifying the factors associated with hospitalization. RESULTS: The average annual outpatient visits and annual total medical expenditures in the study period were 44.23–52.20; NT$87,496–133,077 and 30.75–32.92; NT$64,411–80,955 for diabetic patients with and without depression. After adjustment for covariates, our results revealed that gender and complication were associated with out-patient visits. Moreover, the time factor was associated with the total medical expenditure, and residential urbanization and complication factors were associated with hospitalization. CONCLUSION: Health care utilization and expenditures for diabetic patients with depression were significantly higher than those without depression. Sex, complications, time, and urbanization are the factors associated with health care utilization and expenditures.
Cohort Studies* ; Delivery of Health Care* ; Depression* ; Health Expenditures* ; Hospitalization ; Humans ; Inpatients ; Logistic Models ; National Health Programs ; Outpatients ; Patient Acceptance of Health Care* ; Taiwan ; Time Factors ; Urbanization

PURPOSE: Bladder outlet obstruction (BOO) causes storage and voiding dysfunction in the lower urinary tract. We investigated the expression of transient receptor potential cation channel subfamily M member 8 (TRPM8) to evaluate the relationship between TRPM8 expression and overactive bladder (OAB) in a rat model of BOO. METHODS: Fifty female Sprague-Dawley rats were divided into 4 groups; normal (n=10), normal-menthol (n=10), BOO (n=15), BOO-menthol (n=15). After 3 weeks, cystometry was performed by infusing physiological saline and menthol (3 mM) into the bladder at a slow infusion rate. The histological changes and expression of TRPM8 in the bladder were investigated by Masson's trichrome staining, immunofluorescence and reverse transcription-polymerase chain reaction. RESULTS: Cystometry showed that the intercontraction interval (ICI; 428.2+/-23.4 vs. 880.4+/-51.2, P<0.001), micturition pressure (MP; 25.7+/-1.01 vs. 71.80+/-3.01, P<0.001), and threshold pressure (2.9+/-0.25 vs. 9.2+/-1.58, P<0.01) were significantly increased in BOO rats. The bladder wall was significantly dilated compared with the control. Detrusor muscle hypertrophy and a thick mucosa layer were observed in BOO bladder. After menthol treatment, ICIs were decreased and MPs were increased in the menthol treatment groups. TRPM8-positive cells and mRNA were predominantly increased in the bladder and dorsal root ganglia of all groups compared with the normal group. CONCLUSIONS: Increased bladder wall thickness and proportion of collagen probably affect voiding dysfunction. Furthermore, an increase of TRPM8 expression in BOO may induce entry of Ca2+ from the extracellular space or stores. The increase of Ca2+ probably causes contraction of smooth muscle in BOO. However, OAB symptoms were not observed after menthol treatment although the expression of TRPM8 was abundant in the bladder epithelium after menthol treatment. Although OAB in BOO models may be caused by complex pathways, regulation of TRPM8 presents possibilities for OAB treatment.
Animals ; Cold Temperature ; Collagen ; Contracts ; Epithelium ; Extracellular Space ; Female ; Fluorescent Antibody Technique ; Ganglia, Spinal ; Humans ; Hypertrophy ; Menthol ; Mucous Membrane ; Muscle, Smooth ; Muscles ; Rats ; Rats, Sprague-Dawley ; RNA, Messenger ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Bladder, Overactive ; Urinary Tract ; Urination

BACKGROUND: The flowers of Inula japonica (Inulae Flos) have long been used in traditional medicine for the treatment of inflammatory diseases. In the present study, we investigated the anti-inflammatory properties of Inulae Flos Extract (IFE). METHODS: The anti-inflammatory effects of IFE against nitric oxide (NO), PGE2, TNF-alpha, and IL-6 release, as well as NF-kappa B and MAP kinase activation were evaluated in RAW 264.7 cells. RESULTS: IFE inhibited the production of NO and the expression of inducible nitric oxide synthase (iNOS) in LPS-stimulated RAW264.7 cells. In addition, IFE reduced the release of pro-inflammatory cytokines, such as TNF-alpha and IL-6. Furthermore, IFE inhibited the NF-kappa B activation induced by LPS, which was associated with the abrogation of I kappa B-alpha degradation and subsequent decreases in nuclear p65 and p50 levels. Moreover, the phosphorylation of ERK, JNK, and p38 MAP kinases in LPS-stimulated RAW 264.7 cells was suppressed by IFE in a dose-dependent manner. CONCLUSION: These results suggest that the anti-inflammation activities of IFE might be attributed to the inhibition of NO, iNOS and cytokine expression through the down-regulation of NF-kappa B activation via suppression of I kappa B alpha and MAP kinase phosphorylation in macrophages.
Cytokines ; Dinoprostone ; Down-Regulation ; Flowers ; I-kappa B Proteins ; Interleukin-6 ; Inula ; Macrophages ; Medicine, Traditional ; NF-kappa B ; Nitric Oxide ; Nitric Oxide Synthase Type II ; Phosphorylation ; Phosphotransferases ; Tumor Necrosis Factor-alpha

INTRODUCTIONTo investigate the attitudes of medical and nursing student towards the older Chinese population.

MATERIALS AND METHODSA reliable and valid Chinese language version of Kogan's Attitudes toward Older People (KAOP) with 17 matched item pairs (34 items) was completed by 275 medical and nursing students. Descriptive data analysis was employed.

RESULTSParticipants reported slightly to have a more positive attitudes (Mean, 144.30 +/- 17.89) than those reported from studies in other countries (Jordanian: Mean, 110.6 +/- 21.79). Students who were females (Mean, 148.27 +/- 18.97), younger (Mean, 146.01 +/- 18.59) and studying nursing (Mean, 156.86 +/- 17.56) were more likely to have a more positive attitudes than older (Mean, 140.04 +/- 15.31), males (Mean, 140.47 +/- 15.93), studying medicine (Mean, 138.77 +/- 15.04).

DISCUSSIONResults show that students may have greater ambivalence attitudes on 10 out of 17 matched item pairs which provides useful information for faculty involved in aged care curriculum design. Working as a volunteer in the university hospital may increase students' interactions with the elderly and may positively influence attitudes towards the elderly.

Aged ; Attitude of Health Personnel ; Female ; Humans ; Male ; Students, Medical ; psychology ; Students, Nursing ; psychology ; Taiwan

In previous case report entitled "Multidetector CT findings of a congenital coronary sinus anomaly: a report of two cases" by Chou et al. (Korean J Radiol 2008;9:S1-S6), there were mistakes. "The Figure 1A and 1B are the MDCT findings of normal coronary sinus of a normal individual." "The Figure 1C to 1E are the MDCT findings of congenital coronary sinus anomaly in 60-year-old woman with Ebstein's anomaly." "The Figure 2J and 2K are illustration of atresia of the right atrial ostium of the coronary sinus with/without PLSVC"

PURPOSE: c-fos expression in spinal neurons that are activated by lower urinary tract stimulation are not organ specific. In this experiment, we demonstrated changes of c-fos expression in bladder-specific preganglionic neurons (PGNs) and interneurons using pseudorabies virus (PRV). MATERIALS AND METHODS: Forty Sprague-Dawley rats were used. We identified the neuronal pathway associated with the bladder by injecting PRV into the detrusor. An immunohistochemical method was used to stain Fos-protein encoded by the c-fos gene. Immunofluorescent staining for PRV was performed to evaluate changes in bladder-specific spinal neurons. RESULTS: Immunofluorescent staining with choline acetyltransferase (ChAT) revealed that the sacral parasympathetic nucleus (SPN) regions contained 9.8 PGNs/ section. In rats with chronic spinal cord injury by intravesical saline instillation, 82.4+/-10.3% of PGNs in SPN exhibited Fos-immunoreactive (IR). Two and a half days after PRV infection, PRV-IR PGNs were observed at 5.4 PGNs/ section, and 2.7+/-1.6% of them exhibited Fos-IR. Unlike ChAT-IR PGNs, PRV-IR PGNs are bladder-specific neurons and PRV-IR and Fos-IR cells found in the back of PRV-IR PGNs are bladder- specific interneurons. Three days after PRV infection, we observed many PRV-IR and Fos-IR cells in the dorsal commissure. These neurons are interneurons distributed in the bladder. CONCLUSION: We confirmed that in chronic spinal cord injury, the patterns of c-fos expression in bladder-specific spinal neurons were similar to those in voiding-reflex related spinal neurons, which had already been demonstrated earlier. We believe that our methodology can be applied to study interactions between voiding and other organs as well, such as the urethra and prostate.
Animals ; Female ; Herpesvirus 1, Suid/*physiology ; Immunohistochemistry ; Interneurons/cytology/metabolism ; Neurons/cytology/*metabolism ; Proto-Oncogene Proteins c-fos/*metabolism ; Rats ; Rats, Sprague-Dawley ; Spinal Cord Injuries/*physiopathology ; Urinary Bladder/cytology/*metabolism/virology

Congenital coronary sinus anomalies are extremely rare, and they have received relatively little attention. This is probably due to the lack of both clinical symptoms and significant cardiac functional disturbance. We present two cases of a coronary sinus anomaly and briefly review the literature. Recognizing and being familiar with the variations of a congenital coronary sinus anomaly in congenital heart disease may avoid a misinterpretation of cardiac catheterization findings and the troublesome disruption of coronary sinus blood return during the surgical management of cardiac lesions.
Coronary Sinus/*abnormalities/*radiography ; Female ; Humans ; Middle Aged ; *Tomography, X-Ray Computed

Vimentin is an intermediate filament that regulates cell attachment and subcellular organization. In this study, vimentin filaments were morphologically altered, and its soluble subunits were rapidly reduced via cadmium chloride treatment. Cadmium chloride stimulated three major mitogen-activated protein kinases (MAPKs): extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and p38, and led apoptotic pathway via caspase-9 and caspase-3 activations. In order to determine whether MAPKs were involved in this cadmium-induced soluble vimentin disappearance, we applied MAPK- specific inhibitors (PD98059, SP600125, SB203580). These inhibitors did not abolish the cadmium-induced soluble vimentin disappearance. Caspase and proteosome degradation pathway were also not involved in soluble vimentin disappearance. When we observed vimentin levels in soluble and insoluble fractions, soluble vimentin subunits shifted to an insoluble fraction. As we discovered that heat- shock protein 27 (HSP27) was colocalized and physically associated with vimentin in unstressed cells, the roles of HSP27 with regard to vimentin were assessed. HSP27-overexpressing cells prevented morphological alterations of the vimentin filaments, as well as reductions of soluble vimentin, in the cadmium-treated cells. Moreover, HSP27 antisense oligonucleotide augmented these cadmium-induced changes in vimentin. These findings indicate that HSP27 prevents disruption of the vimentin intermediate filament networks and soluble vimentin disappearance, by virtue of its physical interaction with vimentin in cadmium-treated SK-N-SH cells.
Cadmium/*pharmacology ; Caspases/metabolism ; Cell Line ; Heat-Shock Proteins/*metabolism ; Humans ; Mitogen-Activated Protein Kinases/metabolism ; Protein Binding/drug effects ; Protein Subunits/chemistry/metabolism ; Solubility/drug effects ; Vimentin/*chemistry/*metabolism