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Population aging and air pollution are global concerns. The purpose of this study is to explore the relationship among particulate matter with a diameter of 2.5 μm or less (PM2.5) knowledge, PM2.5 preventive attitude, and PM2.5 preventive behavioral intention in the elderly. A cross-sectional survey design was applied in this study, including usage intention and snowball sampling. A total of 617 elderly people aged over 65 participated, and the collected data were quantitatively analyzed. The results showed that the mean score of PM2.5 knowledge of the elderly was 10.34 (79.53%) with the standard deviation (SD) of 3.42, the mean score of PM2.5 preventive attitude was 4.58 (91.60%) with SD of 0.49, and the mean score of PM2.5 preventive behavioral intention was 4.72 (94.40%) with SD of 0.40. Elderly people's characteristics regarding PM2.5 knowledge and PM2.5 preventive attitude explained 22% (adjusted R2 = 0.22, F = 30.44, P

SUMMARY One of the major challenges for intensivists is resolving the conflicting interests in end-of-life care. We reviewed patients' characteristics in an intensive care unit to determine the major barriers of practicing good end-of-life care and the medical ethics involved for the care team to resolve these conflicts. (International Journal of Gerontology 2009; 3(1): 26-30)

SUMMARY Background Spontaneous pneumomediastinum is clinically distinct from pneumomediastinum occurring secondary to thoracic hollow organ perforation. The latter may be a catastrophic event requiring invasive intervention, but it is questionable whether such interventions are necessary in spontaneous pneumomediastinum. Limited data are available regarding the characteristics of history and radiologic manifestations in spontaneous pneumomediastinum. The present study aimed to systematically evaluate the initial and subsequent clinical and radiologic manifestations of spontaneous pneumomediastinum as well as the need for additional diagnostic procedures and therapy. Methods A retrospective study of patients with a diagnosis of spontaneous pneumomediastinum in a tertiary medical center from January 1990 to November 2006 was performed. The patients' clinical information and results of radiologic interventions were analyzed. Results A total of 42 patients were included. Spontaneous pneumomediastinum was diagnosed in all cases by chest films. A left pericardial airstrip was the most common initial manifestation. In this series, there was only one patient with a pneumothorax, and none of the patients developed pleural effusion or mediastinal fluid as shown by chest X-rays after the disease onset. Conclusion Spontaneous pneumomediastinum occurs mostly in non-elderly patients. Evaluation of typical clinical information and uncomplicated serial chest X-ray findings of spontaneous pneumomediastinum could avoid unnecessary invasive procedures and intensive care unit stays, which could put pressure on medical resources. A plain film X-ray is adequate for diagnosing spontaneous pneumomediastinum as long as the appropriate findings are sought and there is adequate application of lateral radiography.

SUMMARY We report a 75-year-old man with septic shock induced by ventilator-associated pneumonia caused by multiple drug-resistant Acinetobacter baumannii and catheter-related infection by vancomycin-resistant enterococci. He failed to respond to the initial management, including antibiotics (linezolid, imipenem, sulbactam and colistin) and hemodynamic-guided fluid challenge. However, his condition improved dramatically after the antibiotic regimen was changed to tigecycline and ceftazidime. In addition to the superiority of the antibacterial effect of tigecycline, fluid control can be achieved more easily while using a single antibiotic instead of multiple drugs, which is also important for care of a critically ill elderly man with compromised cardiorespiratory or renal function. Here, we present a patient infected with multiple drug-resistant pathogens, who improved clinically after being treated with tigecycline, to demonstrate the benefits of this antibiotic. (International Journal of Gerontology 2008; 2(3): 124-127)

Kyphoscoliosis is one of the causes of restrictive lung disease. It can lead to chronic hypercapnic respiratory failure and hypoxaemia. The benefits of long term intermittent nocturnal non-invasive positive pressure ventilation (NIPPV) to these patients have been shown in regard to improved vital capacity, total lung capacity, muscle strength and daytime oxygenation. In our case, we found long term intermittent nocturnal NIPPV also had a beneficial effect on exercise capacity and pulmonary hypertension. This is good for patients with kyphoscoliosis not only in terms of their survival but also for their quality of life. We recommend long term intermittent nocturnal NIPPV as a routine intervention for severe kyphoscoliosis with hypoxaemia, and transthoracic echocardiography as a routine evaluation tool for determining the response of pulmonary hypertension to management.

Epithelioid haemangioendothelioma (EHE) is a tumour of vascular endothelial origin. The rarity of EHE has limited the complete understanding of the disease. Here, a unique case of EHE complicated with cardiac tamponade with an unusual initial presentation, scoliosis, is reported. The discordant findings between a Tc99m bone scan and 2-fluoro-2-deoxy-d-glucose positron emission tomography (FDP PET) also serve to impart another lesson about investigating bone metastasis in EHE.