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BACKGROUND: J waves are associated with increased vagal activity in patients with idiopathic ventricular fibrillation in several studies to date. However, the relationship between J waves and autonomic nervous activity in patients without structural heart disease remains under investigation. We investigated whether the presence of a J wave on the surface electrocardiogram (ECG) was related to increased vagal activity in patients without structural heart disease. METHODS: This retrospective study included 684 patients without structural heart disease who had undergone Holter ECG and surface ECG monitoring. Based on the presence of J waves on the surface ECG, patients were divided into two groups: those with J waves (group 1) and those without J waves (group 2). We compared heart rate variability (HRV), reflecting autonomic nervous activity, using 24‐h Holter ECG between the groups. RESULTS: J waves were present in 92 (13.4%) patients. Heart rate (HR) in group 1 was significantly lesser than that in group 2 (P = 0.031). The ratio of low‐frequency (LF) components to high‐frequency (HF) components (LF/HF) in group 1 was significantly lower than that in group 2 (P = 0.001). The square root of the mean squared differences of successive NN intervals in group 1 was also significantly higher than that in group 2 (P = 0.047). In a multivariate regression analysis, male sex, HR, and LF/HF ratio remained independent determinants for the presence of J waves (P = 0.039, P = 0.036, and P < 0.001, respectively). CONCLUSION: In patients without structural heart disease, the presence of a J wave was associated with a slow HR, male sex, and increased vagal activity, independently.

Cation exchange membranes (CEMs) have attracted tremendous attention in electrochemical energy conversion and storage systems owing to their high proton conductivity and chemical stability. However, applications of CEMs suffer from a number of disadvantages such as requirement of costly platinum catalyst, and high crossover of fuels or positively charged redox species due to the electro-osmotic drag. Anion exchange membranes (AEMs) have shown promising characteristics to overcome some of the problems associated with CEMs; the advantages of AEMs being selective transport anionic charge carriers, lower crossover of cationic redox couples, and facile reaction kinetics in energy conversion processes. These unique properties of AEMs result mainly from the density and distribution of positively charged functional groups, along with a macromolecular polymer backbone. As a result, there has been an increasing demand for the development of AEMs with better selectivity, higher chemical stability and conductivity, and a lot of work has been carried out in this area. The aim of this review is to discuss developments in the synthesis and applications of AEMs in the field of electrochemical energy conversion and storage, on which many researchers have been working in recent years.

An anomalous origin of the left coronary artery from the right sinus of Valsalva (RSV) is rare. We herein report the case of an 80-year-old woman who presented to the emergency department with chest pain. Emergent coronary angiography was performed following a diagnosis of non-ST segment elevation myocardial infarction. A right coronary angiogram showed that the common trunk originating from the RSV branched into the left anterior descending and right coronary arteries. Although the initial angiogram failed to show the left circumflex artery (LCx), considered to be the culprit vessel, computed tomographic angiography demonstrated that the LCx was located immediately below the common trunk and exhibited a retroaortic course. We successfully treated the patient and obtained optimal angiography results.

The aim of the present study was to assess the feasibility and usefulness of the arterial stiffness index (ASI) measured non-invasively by computerized oscillometry and by comparing it with the pulse wave velocity (PWV).The study group comprised 60 consutive patients who underwent coronary angiography and whose aorto-femoral PWV were obtained with a Judkins catheter. The ASI was obtained using Cardio Vision MS-2000 (IMDP, Las Vegas, NV, USA): (i) baseline (ASI-B); (ii) hyperemia induced by compression of the arm with cuff pressure for 5 min (ASI-H); and (iii) sublingual nitroglycerin (ASI-N). In total, 34 patients had significant coronary artery disease (CAD). The PWV and all ASI were higher in patients with CAD than in those without CAD (ASI-B, 85.9+/-57.8 vs 48.2+/-24.5, p=0.001; ASI-H, 98.1+/-49.8 vs 48.1+/-21.3, p0.01; ASI-N, 66.7+/-55.7 vs 33.2+/-27.9, p=0.002). However, only ASI-B and ASI-H were positively correlated to the PWV (ASI-B, r=0.27, p=0.03; ASI-H, r=0.49, p=0.001; ASI-N, r=0.19, p=0.16). The ASI was increased after hyperemia in patients with CAD (ASI-H, 85.9+/-57.8 to 98.1+/-49.8, p=0.01), but not in patients without CAD (ASI-H, 48.2+/-24.5 to 48.1+/-21.3, p0.01). After adjusting their age, only ASI-H was correlated to the presence of CAD (r=0.33, p0.01).It is feasible and useful to use the ASI for detection of atherosclerotic coronary disease. The findings of ASI-H suggests that in addition to stiffening of the arterial wall itself, the impairment of flow mediated vasodilation, because of endothelial dysfunction, further increases the arterial stiffness.

Left atrial (LA) remodeling is associated with adverse cardiovascular events in patients with atrial fibrillation (AF). However, there are limited data on the value of right atrial (RA) remodeling in this population. We investigated the prognostic role of RA enlargement in patients with non-valvular

PURPOSE This study aimed to identify the actor and partner effects of health status, marital satisfaction, and self efficacy on retirement preparation in middle aged couples using the Actor-Partner Interdependence Model. METHODS Participants were 121 middle aged couples living in Seoul, Gyeonggi-do and Daegu City, Korea. All measures were self-administered. The collected data were analyzed using SPSS 20.0 and AMOS 20.0. RESULTS 1) Wife's self efficacy and marital satisfaction showed direct actor and partner effects on retirement preparation in middle aged couples. Wife's health status showed an indirect actor effect through wife's self efficacy and marital satisfaction on wife's retirement preparation, and showed an indirect partner effect through husband's self efficacy on husband's retirement preparation. 2) Husband's self efficacy and marital satisfaction showed only direct actor effect on retirement preparation. Health status among the husbands showed an indirect actor effect on husband's retirement preparation through their self efficacy and marital satisfaction, and an indirect partner effect through wife's marital satisfaction on wife's retirement preparation. 3) The actor effect size of health status on self efficacy and marital satisfaction was larger among husband's than wife's. Additionally, the partner effect size of health status on self efficacy and marital satisfaction was different between the two groups; however, the actor and partner effect size of self efficacy and marital satisfaction on retirement preparation was the same for husband and wife. CONCLUSION The results of this study indicate that nursing intervention strategies for improving self efficacy and marital satisfaction are strongly needed to enhance retirement preparation of middle aged couples in Korean community.

Congenital left ventricular (LV) diverticulum is a rare malformation that can be alone or in association with other congenital abnormalities. Since the several complications have been reported in association with LV diverticulum, as cardiac rupture, heart failure, and endocarditis, patients with LV diverticulum who are managed with conservative treatment would require regular checkups to ascertain the absence of such complications. We report a case of LV diverticulum in a 47-year-old man. He took the serial three-dimensional contrast echocardiography, which was reliable and readily available tool for defining LV diverticulum and monitoring the presence of complications.

Aims: Global measures of left ventricular (LV) function, in particular LV ejection fraction (LVEF) and global myocardial strain measures, are powerful predictors of outcomes in patients with LV dysfunction, heart failure, or both. However, less is known about the relationship between regional myocardial function, especially that assessed by strain echocardiography and clinical prognosis. Methods and results: We studied 248 patients with LV dysfunction, heart failure, or both 5 days after first myocardial infarction (MI) from the VALIANT study. We assessed peak longitudinal strain (LS) via B-mode speckle tracking in 12 segments from the apical 4- and 2-chamber views and visually assessed LV wall motion score (WMS). We related these measures of regional myocardial function to each other and to clinical outcomes over 20-month follow-up. Normal reference values for segmental LS were derived from 50 healthy controls. Regional LS (−7.7%, Q1: −11.2%, Q3: −4.9%) was worse in segments with abnormal WMS, although was significantly impaired even in segments scored as normokinetic compared with normal controls (−10.4 ± 5.2% vs. −20.0 ± 7.6%, P < 0.001). In multivariable Cox proportional hazards models, each additional abnormal LS segment was associated with an increased risk of all-cause mortality (hazard ratio: 1.42, 95% confidence interval: 1.06–1.90, P = 0.02) even after adjustment for clinical covariates, including LVEF, LV end-systolic volume, and number of abnormal segments by WMS. Conclusion: In patients with LV dysfunction, heart failure, or both after MI, regional LS is significantly depressed even in segments with normal WMS, and this measure was related to adverse outcome.

Background: Although prompt reperfusion treatment restores normal epicardial flow, microvascular dysfunction may persist in some patients with acute coronary syndrome (ACS). Impaired myocardial perfusion is caused by intraluminal platelets, fibrin thrombi and neutrophil plugging; antiplatelet agents play a significant role in terms of protecting against thrombus microembolization. A novel antiplatelet agent, ticagrelor, is a non-thienopyridine, direct P2Y12 blocker that has shown greater, more rapid and more consistent platelet inhibition than clopidogrel. However, the effects of ticagrelor on the prevention of microvascular dysfunction are uncertain. The present study is a comparison between clopidogrel and ticagrelor use for preventing microvascular dysfunction in patients with ST elevation or non-ST elevation myocardial infarction (STEMI or NSTEMI, respectively). Methods/design: The TIME trial is a single-center, randomized, open-label, parallel-arm study designed to demonstrate the superiority of ticagrelor over clopidogrel. A total of 152 patients with a spectrum of STEMI or NSTEMI will undergo prospective random assignment to clopidogrel or ticagrelor (1:1 ratio). The primary endpoint is an index of microcirculatory resistance (IMR) measured after percutaneous coronary intervention (PCI); the secondary endpoint is wall motion score index assessed at 3 months by using echocardiography. Discussion: The TIME trial is the first study designed to compare the protective effect of clopidogrel and ticagrelor on coronary microvascular dysfunction in patients with STEMI and NSTEMI. Trial registration: ClinicalTrials.gov: NCT02026219. Registration date: 24 December 2013.

Aims We aimed to investigate whether thrombus aspiration could preserve the index of microcirculatory resistance (IMR) after primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). Methods and results Sixty-three patients with STEMI were randomised into two groups: primary PCI after thrombus aspiration (aspiration group, n=33) and primary PCI without thrombus aspiration (non-aspiration group, n=30). IMR was measured using a pressure-temperature sensor-tipped coronary wire. Echocardiography was performed at baseline and at six-month follow-up. No significant differences in baseline ejection fraction (EF, 47.3±8.5% vs. 49.5±7.8%, p=0.281) and baseline wall motion score index (WMSI, 1.45±0.31 vs. 1.37±0.27, p=0.299) were observed between the two groups. However, significant differences in IMR (23.5±10.2 U vs. 34.2±21.7 U, p=0.018), %E2%88%86EF (follow-up EF - baseline EF; 3.33±4.6% vs. 0.73±1.9%, p=0.005), and %E2%88%86WMSI (follow-up WMSI - baseline WMSI; -0.121±0.16 vs. -0.004±0.07, p=0.001) were observed between the two groups. Conclusions Thrombus aspiration as an adjunctive method to primary PCI for STEMI may preserve microvascular integrity and have beneficial effects on myocardial microcirculation.

The microbial deoxygenation of a series of aromatic and heteroaromatic N -oxide compounds, including quinoline N -oxides, isoquinoline N -oxides, 2-aryl-2 H -benzotriazole 1-oxides, benzo[ c ]cinnoline N -oxide and azoxybenzenes, has been performed with bakers'yeast-NaOH.

We investigated whether the presence of J wave on the surface electrocardiography (sECG) could be a potential risk factor for ventricular fibrillation (VF) during acute myocardial infarction (AMI). We performed a retrospective study of 317 patients diagnosed with AMI in a single center from 2009 to 2012. Among the enrolled 296 patients, 22 (13.5%) patients were selected as a VF group. The J wave on the sECG was defined as a J point elevation manifested through QRS notching or slurring at least 1 mm above the baseline in at least two leads. We found that the incidence of J wave on the sECG was significantly higher in the VF group. We also confirmed that several conventional risk factors of VF were significantly related to VF during AMI; time delays from the onset of chest pain, blood concentrations of creatine phosphokinase and incidence of ST-segment elevation. Multiple logistic regression analysis demonstrated that the presence of J wave and the presence of a ST-segment elevation were independent predictors of VF during AMI. This study demonstrated that the presence of J wave on the sECG is significantly related to VF during AMI. Graphical Abstract Keywords: J Wave, Ventricular Fibrillation, Acute Myocardial Infarction INTRODUCTION Primary ventricular fibrillation (PVF) during acute myocardial infarction (AMI) refers to VF that occurs early (usually < 48 hr post myocardial infarction), and is not associated with recurrent ischemia or heart failure (1). The incidence of VF was reported to be more than 10% during AMI, and VF usually occurs in a few hours after the onset of chest pain (1). VF is the most frequent cause of death in association with AMI because it usually occurs before medical contact (1). Recent studies have demonstrated that J wave on the sECG has been associated with idiopathic VF in patients who do not have structural heart disease (2). A recent study also reported that the presence of J wave is associated with ventricular arrhythmia in patients who have chronic coronary artery disease (3). So far, few studies reported that the presence of J wave in sECG is associated with VF during AMI (1, 4, 5, 6). Several variables, including J wave, were reported as significant predictors of VF, but failed to get statistical significance. Through this study, we planned to evaluate that the presence of J wave on the sECG could be a potential risk factor for VF during AMI.

Purpose: This cross-sectional study was done to compare factors influencing young adolescents’ aggression according to family structure. Methods: Participants were 680 young adolescents aged 11 to 15 years (113 in single father families, 136 in single mother families, 49 in grandparent families, and 382 in both-parent families). All measures were self-administered. Data were analyzed using SPSS 18.0 program and factors affecting young adolescents’ aggression were analyzed by stepwise multiple regression. Results: Levels of young adolescents’ aggression and all variables were significantly different among the four family structure groups. Factors influencing young adolescents’ aggression were also different according to these 4 groups. For single father families, depression-anxiety and family hardiness significantly predicted the level of young adolescents’ aggression (adjusted R square=.37, p

Electrochemical properties of structurally modified quasi-solid-state electrolytes were examined using porous substrates (PSs). The PS was prepared into two categories by a phase inversion method with a brominated poly(phenylene oxide) (BPPO): the sponge and finger types. Effects of the humidification and cosolvent compositions on the morphology of the PS were analyzed by scanning electron microscopy. In all cases of the PSs, a higher VOC was observed of about 0.1 V than that of a liquid electrolyte owing to a suppressed back electron charge transfer. In addition, the PS prepared by the polymer solution of 1 : 4 : 1 (BPPO : N-methyl-2-pyrrolidone : butyl alcohol) with the humidification process showed better photovoltaic properties in terms of the current density and conversion efficiency owing to the appropriate combinations of pore size, tortuosity, and interconnectivity. Effects of the pore structures were intensively examined using electrochemical impedance spectroscopy. The impedance results revealed that large pores at the surface layers are advantageous for a lower RS and RTiO2. Meanwhile, the straight inner structure is beneficial for the facile I−/I3− diffusion, thus lowering RPt. © 2013 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2014, 131, 39739.

PURPOSE This study was done to examine actor and partner effect of dementia knowledge, self-efficacy and depression on dementia preventive behavior in elderly couples. METHODS Participants were 115 couples aged 60 years or over who met eligibility criteria. All measures were self-administered. Data were analyzed using SPSS 18.0 and AMOS 18.0 program. RESULTS Dementia knowledge in elderly couples showed actor and partner effect on dementia preventive behavior. Self-efficacy in the wife did not have direct effects on dementia preventive behavior, but showed indirect effects through dementia knowledge. Self-efficacy in the husband showed direct effects on dementia preventive behavior and indirect effects through dementia knowledge. Wife's depression had direct actor effect on dementia preventive behavior and indirect effect through self-efficacy and dementia knowledge. Husband's depression did not have direct actor effect on dementia preventive behavior, but indirect effect through self-efficacy and dementia knowledge. Effect size of wives' dementia knowledge, self-efficacy and depression on dementia preventive behavior was larger than that of husbands'. Dementia preventive behavior, dementia knowledge and depression had a mutual effect. CONCLUSION Results indicate that to promote dementia preventive activity in elderly couples, programs should be conducted for both of the couple, but focused differently for wife and husband.

Purpose: The purpose of this study was to identify non-psychiatric nurses’ difficulties in caring for patients with mental illness. Methods: Data were collected from eighteen general medical-surgical nurses working at a university hospital in Seoul, Korea. This study involved two focus group discussions and three in-depth individual interviews. All interviews were recorded and transcribed as they were spoken, and data were analyzed using qualitative content analysis. Results: General medical-surgical nurses experienced difficulties in 3 categories, 9 subcategories, 27 codes. The three categories were ‘nurse’ related factors, ‘patient’ related factors, ‘resource’ related factors. The nine categories were ‘unpreparedness’, ‘nursing barriers due to stigma’, ‘undervaluing and avoidance of psychiatric nursing’, ‘eroding into the trap of a vicious cycle’, ‘facing unapproachable patients’, ‘dealing with unhelpful family members’, ‘burdening already overburdened staff’, ‘obstructive environment’, and ‘isolation of staff with heavy responsibilities’. Conclusion: The results of this study indicate the need to develop psychiatric mental health education programs for non-psychiatric nurses. Education about psychiatric mental health and support from institutions for non-psychiatric nurses can reduce their negative attitude toward psychiatric patients and difficulties in caring for psychiatric patients.

Background and objectives We evaluated the utility of two-dimensional (2D) and three-dimensional (3D) left ventricular (LV) global myocardial deformity parameters for assessing LV diastolic function by comparing invasive measures of LV performance. Subjects and methods Echocardiography and LV pressure were assessed in 39 patients. Myocardial LV longitudinal, circumferential, and radial deformations, as well as area strain, were evaluated utilizing 2D and 3D speckle tracking software. The 2D early diastolic strain rate (2D-SRe) was measured from the 3 apical and 3 short axis views. The 3D diastolic index (3D-DI) was calculated by the % change of global strain during the first one-third of the diastolic period. LV end diastolic pressure (LVEDP) and the rate of LV pressure change (dP/dt) were collected using a pressure-conducted catheter and tau was calculated. Results dP/dtmin were related to early mitral annular velocity (e'), 2D-SRelong, 2D-SReradial, as well as 3D-DIlong, and 3D-DIas. Additionally, LVEDP was associated with the ratio of mitral early diastolic velocity (E) to 2D-SRelong, 2D-SRecirc, 2D-SReradial, 3D-DIlong, 3D-DIcirc, and 3D-DIas. E/2D-SRelong, E/2D-SReradial, E/3D-DIlong, and E/3D-DIas were comparable with E/e' in predicting patients with elevated LVEDP. Among those patients with E/e' of 8 to 15, E/3D-DIlong provided incremental value in identifying those with LVEDP ≥15 mm Hg. Conclusion 2D-SRelong, 2D-SReradial, 3D-DIlong, and 3D-DIas were related to LV relaxation, and the ratios of E to those parameters were associated with LVEDP. In addition, among patients with indeterminate E/e', E/3D-DIlong offered incremental value in predicting elevated LVEDP, suggesting it may provide supplementary information in the evaluation of LV diastolic function.

Congenital left ventricular (LV) diverticulum is a rare malformation that can be alone or in association with other congenital abnormalities. Since the several complications have been reported in association with LV diverticulum, as cardiac rupture, heart failure, and endocarditis, patients with LV diverticulum who are managed with conservative treatment would require regular checkups to ascertain the absence of such complications. We report a case of LV diverticulum in a 47-year-old man. He took the serial three-dimensional contrast echocardiography, which was reliable and readily available tool for defining LV diverticulum and monitoring the presence of complications.

A 67-year-old male patient was admitted with an abrupt sudden cardiac death. He represented with an extreme electrical storm of 30 times of ventricular fibrillation (VF) episodes on one day. External shocks were performed to terminate VF. Transient J-wave in the inferior-lateral leads and Brugada electrocardiography pattern on the right precordial leads appeared during the electrical storm. And J-wave disappeared after the termination of electrical storm. We report a case of the appearance of J-wave during electrical storm in a patient with Brugada syndrome.

Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a case of stent dislodgement in the ascending thoracic aorta. The stent was mechanically distorted in the left circumflex artery (LCX) while being delivered to the proximal LCX lesion. The balloon catheter was withdrawn, but the stent with the guide wire was remained in the ascending thoracic aorta. The stent was unable to be retrieved into the guide catheter, as it was distorted. A goose neck snare was used successfully to catch the stent in the ascending thoracic aorta and retrieved the stent externally via the arterial sheath.

Background: The effect of gestational hypertension on left ventricular (LV) function in previously normotensive young women has not been evaluated. Methods and Results: A total of 106 gestational hypertensive women (GHW, 32.3±4.2 years) and 93 normotensive pregnant women (NPW, 30.2±4.4 years) were enrolled. Transthoracic echocardiography, including 2-dimensional strain echocardiography, was done and myocardial performance (Tei index), LV mass index (LVMI), and relative wall thickness (RWT) were analyzed. GHW had significantly increased wall thickness (interventricular septum, 9.5±0.9mm vs. 8.8±1.0mm, P

Aims Direct renin inhibitors provide an alternative approach to inhibiting the renin–angiotensin–aldosterone system (RAAS) at the most proximal, specific, and rate-limiting step. We tested the hypothesis that direct renin inhibition would attenuate left ventricular remodelling in patients following acute myocardial infarction receiving stable, individually optimized therapy, including another inhibitor of the RAAS. Methods and results We randomly assigned 820 patients between ∼2 and 8 weeks following acute myocardial infarction, with the left ventricular ejection fraction (LVEF) ≤45%, and regional wall motion abnormalities (≥20% akinetic area), to receive aliskiren ( n = 423), titrated to 300 mg, or matched placebo ( n = 397), added to the standard therapy. All patients were required to be on a stable dose of an ACE-inhibitor or ARB, and beta-blocker unless contraindicated or not tolerated. Echocardiograms were obtained at baseline, and following 26–36 weeks of treatment. The primary endpoint was change in left ventricular end-systolic volume from baseline to 36 weeks, and was evaluable in 329 patients in the placebo group and 343 patients in the aliskiren group. We observed no difference in the primary endpoint of end-systolic volume change between patients randomized to aliskiren (−4.4 ± 16.8 mL) or placebo (−3.5 ± 16.3 mL), or in secondary measures of end-diastolic volume, or LVEF. We also observed no differences in a composite endpoint of cardiovascular death, hospitalization for heart failure, or reduction in LVEF >6 points. There were more investigator reported adverse events in the aliskiren group, including hypotension, increases in creatinine and hyperkalaemia. Conclusion Adding the direct renin inhibitor aliskiren to the standard therapy, including an inhibitor of the RAAS, in high-risk post-MI patients did not result in further attenuation of left ventricular remodelling, and was associated with more adverse effects. These findings do not suggest that dual RAAS blockade with aliskiren would provide additional benefit in these high-risk post-MI patients. Clinical Trials Registration: [www.clinicaltrials.gov][1] [NCT00414609][2] [1]: http://www.clinicaltrials.gov [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00414609&atom=%2Fehj%2Fearly%2F2011%2F02%2F10%2Feurheartj.ehq522.atom

Bortezomib is an inhibitor of 26S proteasome, which is an effective treatment for multiple myeloma. The common adverse effects of bortezomib are asthenic conditions, gastrointestinal disturbances, and peripheral neuropathy. Here we describe a patient with dyspnea and general weakness because of complete atrioventricular block while receiving bortezomib. We immediately stopped bortezomib, and after inserting a permanent VDD pacemaker, the patients' symptoms disappeared.

The microbial deoxygenation of a series of aromatic and heteroaromatic N -oxide compounds, including quinoline N -oxides, isoquinoline N -oxides, 2-aryl-2 H -benzotriazole 1-oxides, benzo[ c ]cinnoline N -oxide and azoxybenzenes, has been performed with bakers'yeast-NaOH.

Purpose: This study was designed to develop and test a structural model for children’s adaptation in divorced families. The hypothetical model was constructed based on the Family Resilience Model by McCubbin and McCubbin. Methods: Data were collected using self-report questionnaires from 219 children (3-6th grade) in divorced families. The children attended one of 22 community agencies, 8 after-school programs, 3 elementary schools in three cities in South Korea. The collected data were analyzed using LISREL program to test the hypothetical model. Results: The modified model was constructed by deleting four paths in accordance with the statistical and theoretical criteria. Compared to the hypothetical model, the revised one had a better fit to the data. Self-esteem, and beliefs about parental divorce had direct effects, and family communication and internal control had indirect effects on children’s adaptation in divorced families. These variables explained 56% of the variance in children’s adaptation. Conclusion: The modified model was supported by empirical data. This model could be applied to family nursing interventions with divorced families or any other suffering family transition. When working with children experiencing parental divorce, it is important for nurses to enhance children’s self-esteem, family communication and to decrease children’s negative beliefs about parental divorce to help in their adaptation.

Me3SnC(N2CO2Et was obtained as a yellow, crystalline compound, m.p. 30°C from the reaction of Me3SnNEt2 with HC(N2)CO2Et, and its structure determined by X-ray diffractometry. The Me3SnC(N2CO2Et molecules have a plane of symmetry, the diazoacetic ester group being fixed in the Z-(1)-conformation. The CNN group is almost linear (177.5(7)°) and has bond lengths (CN 131.7(8) and NN 111.9(9) pm) comparable with those in other metalorganic diazoalkanes. As in Me3PbC(N2CO2Et, the oxygen atom of the carbonyl group is weakly coordinated to the tin atom of a neigbouring molecule: SnO 312.5(5) pm, COSn 180.0°.

Background Hemodynamic and functional evaluation with Doppler and tissue Doppler study as a part of comprehensive echocardiography is essential but normal reference values have never been reported from Korean normal population especially according to age and sex. Methods Using Normal echOcaRdiographic Measurements in a KoreAn popuLation study subjects, we obtained normal reference values for Doppler and tissue Doppler echocardiography including tricuspid annular velocities according to current guidelines and compared values according to gender and age groups. Results Mitral early diastolic (E) and late diastolic (A) velocity as well as E/A ratio were significantly higher in women compared to those in men. Conversely, mitral peak systolic and late diastolic annular velocity in both septal and lateral mitral annulus were significantly lower in women compared to those in men. However, there were no significant differences in both septal and lateral mitral early diastolic annular (e') velocity between men and women. In both men and women, mitral E velocity and its deceleration time as well as both E/A and E/e' ratio considerably increased with age. There were no significant differences in tricuspid inflow velocities and tricuspid lateral annular velocities between men and women except e' velocity, which was significantly higher in women compared to that in men. However, changes in both tricuspid inflow and lateral annular velocities according to age were similar to those in mitral velocities. Conclusion Since there were significant differences in Doppler and tissue Doppler echocardiographic variables between men and women and changes according to age were even more considerable in both gender groups, normal Doppler echocardiographic values should be differentially applied based on age and sex.

Purpose: The purpose of this study was to examine the effects of a facial muscle exercise program including facial massage on the facial muscle function, subjective symptoms related to paralysis and depression in patients with facial palsy. Methods: This study was a quasi-experimental research with a non-equivalent control group non-synchronized design. Participants were 70 patients with facial palsy (experimental group 35, control group 35). For the experimental group, the facial muscular exercise program including facial massage was performed 20 minutes a day, 3 times a week for two weeks. Data were analyzed using descriptive statistics, χ²-test, Fisher’s exact test and independent sample t-test with the SPSS 18.0 program. Results: Facial muscular function of the experimental group improved significantly compared to the control group. There was no significant difference in symptoms related to paralysis between the experimental group and control group. The level of depression in the experimental group was significantly lower than the control group. Conclusion: Results suggest that a facial muscle exercise program including facial massage is an effective nursing intervention to improve facial muscle function and decrease depression in patients with facial palsy.

Arterial stiffness has been known as a major contributory factor to cardiovascular (CV) morbidity and mortality in patients with hypertension. Pulse wave velocity (PWV), a surrogate measurement of large artery damage, has not been ascertained as an independent risk factor of coronary artery disease (CAD). The aim of this study was to assess whether PWV is associated with CV risk.We prospectively enrolled 326 consecutive patients undergoing coronary angiography for the assessment of suspected CAD. Arterial stiffness was assessed through aorto-femoral PWV using fluid-filled system. PWV was higher in patients with CAD than those without CAD (12.5 +/- 5.1 vs 10.2 +/- 3.1 m/s, p0.001). In multivariate logistic regression analysis, after entering for age, diabetes and other CV risk factors, PWV remained the significant independent variable for CAD (p = 0.050). When the severity of CAD was expressed as one-, two- or three-vessel disease, PWV was a significantly associated with the severity of CAD (p0.001).Our findings suggest that PWV is an independent risk marker for CAD, as well as strongly associated with the severity of CAD.

Despite recovered normal epicardial coronary flow after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), microvascular damage and dysfunction limit the effect of primary PCI. The purpose of this study was to evaluate whether manual thrombectomy

BACKGROUND: Measurement of the cardiac chamber is essential, and current guidelines recommend measuring and reporting values for both sides of the cardiac chamber during echocardiographic evaluation. Normal echocardiographic reference values have been suggested previously, but detailed information about right-sided chambers and values according to gender was not included. METHODS: This is a prospective multicenter (23 centers) study evaluating normal Korean adult subjects using comprehensive echocardiography. We included normal adult subjects (age; 20-79 years old) who had no significant cardiac disorders or illnesses, such as hypertension or diabetes, which could affect cardiac structure and function. We measured the cardiac chamber including both right and left ventricles as well as atria according to current echocardiography guidelines and compared values according to gender and age groups. RESULTS: A total of 1003 subjects were evaluated and the mean age was 48 ± 16 years. Left ventricular (LV) dimensions increased, but LV volume decreased in older subjects. Right ventricular (RV) area decreased in women and older subjects, and the RV long-axis dimension showed a similar trend. Left atrial (LA) volume increased in men but there were no differences in LA volume index between men and women. The dimension of great arteries increased in men and older subjects. CONCLUSION: Since there were considerable differences between men and women and in the different age groups, and the trends differed significantly between different echo variables, normal echocardiographic cutoff values should be differentially applied based on age and gender.

Purpose We aimed to discover clinical and angiographic predictors of microvascular dysfunction using the index of microcirculatory resistance (IMR) in patients with ST-segment elevation myocardial infarction (STEMI). Materials and Methods We enrolled 113 patients with STEMI (age, 56±11 years; 95 men) who underwent primary percutaneous coronary intervention (PCI). The IMR was measured with a pressure sensor/thermistor-tipped guidewire after primary PCI. The patients were divided into three groups based on IMR values: Low IMR [31 U (48.1±17.1 U), n=37]. Results The age of the Low IMR group was significantly lower than that of the Mid and High IMR groups. The door-to-balloon time was

Purpose: This cross-sectional study was done to compare factors influencing smartphone addiction in middle school boys and girls. Methods: Participants were 390 middle school students (boys 198, girls 192) who were living in Seoul. Data were analyzed using SPSS 20.0 program. Results: Factors influencing smartphone addiction for boys were stress, the motivation to use smartphone as a tool of ostentation and fashion, depression, self-control, and teacher control over the use of smartphone. Factors influencing smartphone addiction for girls were stress, the motivation to use smartphone as a tool of ostentation and fashion. Conclusion: The results suggest that it is necessary to consider gender characteristics in order to develop effective management programs for smartphone addiction in middle school students.

Moonkyoo Kong,1 Sung Hee Shin,2 Eunmi Lee,3 Eun Kyoung Yun2 1Department of Radiation Oncology, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, 2College of Nursing Science, Kyung Hee University, 3Department of Quality Improvement, Kyung Hee University Medical Center, Seoul, Republic of Korea Background: There have not yet been any published studies on the effects of laughter therapy on radiation-induced dermatitis in breast cancer patients treated with radiotherapy (RT). We assessed the effectiveness of laughter therapy in preventing radiation dermatitis in patients with breast cancer. Methods: Thirty-seven patients were prospectively enrolled in this study. Eighteen patients were assigned to the experimental group and the other 19 patients were assigned to the control group. The patients who were assigned to the experimental group received laughter therapy during RT. Laughter therapy was started at the onset of RT and was provided twice a week until completion of RT. The patients who were assigned to the control group only received RT without laughter therapy. The grade of radiation dermatitis was scored by a radiation oncologist who was blinded to subject assignment. The patients' evaluation of pain within the RT field was also assessed. Results: In the experimental group, radiation dermatitis of grade 3, 2, and 1 developed in five (33.3%), five (33.3%), and five patients (33.3%), respectively. In comparison, in the control group, radiation dermatitis of grade 3, 2, 1, and 0 developed in seven (36.8%), nine (47.4%), two (10.5%), and one patient (5.3%), respectively. The experimental group exhibited a lower incidence of grade 2 or worse radiation dermatitis than the control group (33.3% versus 47.4%). The mean maximal pain scores in the experimental and control group were 2.53 and 3.95, respectively. The experimental group complained of less severe pain than the control group during RT. However, these differences were not statistically significant. Conclusion: The results of this study show that laughter therapy can have a beneficial role in preventing radiation dermatitis in patients with breast cancer. To confirm the results of our study, well-designed randomized studies with large sample sizes are required. Keywords: breast cancer, radiotherapy, radiation dermatitis, laughter therapy

OAs(NMe2)3 (HMAsT) is obtained in low yields by reacting OAsCl3 with excess HNMe2 or by ozonolysis of As(NMe2)3; however, it is formed in yields >65% by using (Me3Si)2O2 and As(NMe2)3 in hydrocarbon solution. The structure of HMAsT was established by IR/Raman, NMR and mass spectroscopy, and single crystal X-ray structure analysis. The structure determination revealed (sp3C)-H…O–hydrogen bonding in the solid state. Acid-base reaction by methanolysis affords ionic [Me2NH2] [O2As(OMe)2] while iodide is oxidized to iodine.

A 65-year-old man was presented to our emergency room complaining of severe chest pain. Electrocardiogram and cardiac enzyme suggested acute anterior wall myocardial infarction, and the total occlusion of the left anterior descending coronary artery was recannalized via primary coronary intervention. Another critical stenosis was detected in the distal right coronary artery. We deployed a stent in the right coronary artery 5 days after the first procedure, and finished the procedure using a collagen plug device (Angioseal, DAIG). Both percutaneous coronary interventions were performed via right femoral arterial approach. The patient was discharged without complications with the exception of a 4 4 cm hematoma in the right groin. However, the patient complained of continuous right groin pain and purulent discharge from the puncture site one week after the second procedure. Therefore, we recommended him for admission again, began antibiotic treatment, and

Introduction: Although dobutamine stress echocardiography (DSE) is frequently associated with dynamic left ventricular outflow tract obstruction (LVOTO), its clinical significance in women with chest pain is little known. Objectives: We assessed provked clinical significance of dynamic left ventricular outflow tract obstruction (LVOTO) by dobutamine stress echocardiography (DSE) in women with chest pain. Methods: Of 880 women patients from chest pain in Korean women’s registry (which was a multicenter registry of Korean women who visited in clinic for chest pain, 102 patients (57 10 years) without DSE-provoked ischemia were included. LVOTO was defined by the presence of a systolic flow with dagger-shaped late peaking and peak LVOT pressure gradient equal to or greater than 30mmHg in the LVOT or the midventricular area, not present at baseline and that disappeared after the recovery phase. The presence of CAD was defined as any epicardial coronary artery stenosis 50%. Treadmill test was also performed in all patients and Duke treadmill score (DTS) was calculated. Results: Fifty of 102 patients had no provoked LVOTO (group 1) and 52 (51%) had provoked LVOTO (group 2). Group 2 were older than group 1 (p1⁄40.001). Group 2 had smaller LV diameter but had larger LV mass index and relative wall thickness (all p

Purpose: This study was done to examine actor and partner effect of self-esteem and family stress on depression of middle-aged married couples. Methods: Participants were 133 couples aged 40-60 years, who lived in Seoul, Incheon, or Gyeonggi provinces. All measures were self-administered. Data were analyzed using SPSS 18.0 and AMOS 18.0 program. Results: Husband and wife's self-esteem had an actor effect (wife β=-.45, p

We report a case of hypersensitivity skin reaction to prasugrel. The patient exhibited a generalized skin rash after treatment with prasugrel, which was resolved after discontinuation of prasugrel and substitution to clopidogrel. Clopidogrel was successfully administered as an alternative to prasugrel without any signs of further hypersensitivity.