This qualitative case study investigated the impact of sand tray on individuals diagnosed with Alzheimer’s and other forms of dementia. Four participants successfully completed the creation of sand trays while the researcher observed, interviewed, and documented the individual sand trays. The intervention established that sand tray allows the dementia patient to kinesthetically connect to their inner cognitions through the intentional symbolic expression offered by this unique therapeutic medium. Using a series of eight sand trays of varying thematic concepts, the participants were offered a modality to facilitate a synthesization of their continued individuation, presenting a possible neural pathway to connect and express thoughts, feelings, emotions, concerns, challenges, and fears. The findings of this study include the fact that all trays were classified as “empty” and that the majority of the participants placed objects almost exclusively on the right side of the tray, which is commonly associated with the concreteor conscious side. The use of sand tray allowed each individual the opportunity to create autobiographies in the sand and literally navigate through time – past, present, and future, confronting fears, expressing hope and possibilities. The results of the research study offer insight into the psychotherapeutic effects of using sand tray with dementia patients, as well as a better understanding of the cognitive and expressive abilities and limitations of an individual with impaired memory. The results also offer insight into the difficulties with short-term memory in this population and possibly indicate a potential means for monitoring cognitive decline. Keywords: Neurocognitive disorder, Alzheimer’s, dementia, sand tray, play therapy / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2013.

Hung Shieh-Jung Fanny. / Thesis submitted in: August 2002. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 97-109). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / 摘要 --- p.iv / Content --- p.vi / List of Abbreviations --- p.xiii / List of Figure --- p.xv / List of Tables --- p.xix / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Alzheimer's Disease (AD) --- p.1 / Chapter 1.1.1 --- Clinical features --- p.2 / Chapter 1.2 --- Histopathological studies of AD --- p.2 / Chapter 1.2.1 --- Neuritic plaques --- p.2 / Chapter 1.2.2 --- Neurofibrillary tangles (NFT) --- p.4 / Chapter 1.2.3 --- Tau --- p.5 / Chapter 1.3 --- Kinases and Alzheimer's Disease --- p.7 / Chapter 1.4 --- Free radical damage --- p.8 / Chapter 1.5 --- Available treatment for AD --- p.7 / Chapter 1.6 --- A Chinese medicinal material 一 Danshen （（Salviae miltiorrhizcie) --- p.11 / Chapter 1.6.1 --- Chemical constituents --- p.11 / Chapter 1.6.1.1 --- Lipophilic Compounds of Danshen --- p.12 / Chapter 1.6.1.2 --- Water-soluble Compounds of Danshen --- p.17 / Chapter 1.6.2 --- Pharmacological usage --- p.20 / Chapter 1.6.2.1 --- Action on Coronary system --- p.20 / Chapter 1.6.2.2 --- Bacteriostatic action --- p.21 / Chapter 1.6.2.3 --- Actions on the immune system --- p.21 / Chapter 1.6.3 --- Biological activity on brain --- p.22 / Chapter 1.7 --- Objectives and scope of the project --- p.23 / Chapter Chapter 2 --- General Materials and Method --- p.24 / Chapter 2.1 --- Recombinant DNA techniques --- p.24 / Chapter 2.1.1 --- Preparation of E. coli strain DH-5a competent cells --- p.24 / Chapter 2.1.2 --- Transformation of plasmid DNA into competent cells --- p.25 / Chapter 2.1.3 --- Preparation of plasmid DNA using QIAGEN Plasmid Maxipreps kit --- p.25 / Chapter 2.1.4 --- Phenol/ choroform extraction of DNA --- p.26 / Chapter 2.1.5 --- Spectrophotometric quantitation of the amount and purity of DNA --- p.27 / Chapter 2.2 --- Drugs preparation --- p.27 / Chapter 2.2.1 --- Preparation of aqueous extracts of Traditional Chinese Medicine (TCM) --- p.27 / Chapter 2.2.2 --- Preparation of ethanol extracts of Traditional Chinese Medicine (TCM) --- p.27 / Chapter 2.3 --- "3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyl-tetrazolium (MTT) assay " --- p.28 / Chapter 2.4 --- Analysis of proteins from culture cells --- p.28 / Chapter 2.4.1 --- Extraction of total proteins from culture cells --- p.28 / Chapter 2.4.2 --- Quantitation of protein by Bradford method --- p.29 / Chapter 2.4.3 --- Protein separation by sodium dodecylsulphate polyacrylamide gel electrophoresis (SDS-PAGE) --- p.29 / Chapter 2.4.4 --- Western blot analysis --- p.31 / Chapter 2.5 --- Reagents and buffers --- p.32 / Chapter 2.5.1 --- Reagents for competent cell preparation --- p.32 / Chapter 2.5.2 --- Reagents provided by QIAGEN Plasmid Maxipreps kit --- p.33 / Chapter 2.5.3 --- Reagents for SDS-PAGE --- p.34 / Chapter 2.5.4 --- Reagents and buffers for Western Blotting --- p.35 / Chapter 2.5.5 --- Cell lines --- p.36 / Chapter 2.5.6 --- Antibodies --- p.37 / Chapter 2.5.7 --- Plasmids --- p.37 / Chapter 2.5.8 --- Other Chemicals --- p.38 / Chapter Chapter 3 --- The effect of Danshen on GSK-3 induced hyperposphorylation of tau in Cos7 cells / Chapter 3.1 --- Introduction --- p.39 / Chapter 3.1.1 --- Glycogen synthase kinase-3 (GSK-3) --- p.39 / Chapter 3.1.2 --- Structure of GSK-3 --- p.39 / Chapter 3.1.3 --- The importance of GSK-3 in AD --- p.39 / Chapter 3.2 --- Materials and Methods --- p.41 / Chapter 3.2.1 --- Transfection of Gsk-3 and tau into Cos7 monkey kidney cells --- p.43 / Chapter 3.2.2 --- Extraction of total proteins from culture cells --- p.44 / Chapter 3.2.3 --- Quantitation of protein by Bradford method --- p.44 / Chapter 3.2.4 --- Protein separation by sodium dodecylsulphate polyacrylamide gel electrophoresis (SDS-PAGE) --- p.44 / Chapter 3.2.5 --- Western blot analysis --- p.44 / Chapter 3.3 --- Results --- p.45 / Chapter 3.3.1 --- Toxicity test on Cos7 cells --- p.45 / Chapter 3.3.2 --- The effect of ethanol extract of Danshen on GSK-3 β induced tau phosphorylation --- p.45 / Chapter 3.3.3 --- The effect of aqueous extract of Danshen on GSK-3 β induced tau phosphorylation --- p.48 / Chapter 3.3.4 --- The effect of Protocatechualdehyde on GSK-3β induced tau phosphorylation --- p.48 / Chapter 3.3.5 --- The effect of Salvianolic acid B on GSK-3β induced tau phosphorylation --- p.49 / Chapter 3.4 --- Discussion --- p.60 / Chapter Chapter 4 --- Cdk5 induced hyperposphorylation of tau in CHO cells / Chapter 4.1 --- Introduction --- p.63 / Chapter 4.1.1 --- Cyclin dependent kinase 5 (Cdk5) --- p.63 / Chapter 4.1.2 --- Structure of Cdk5 --- p.63 / Chapter 4.1.3 --- Neurological functions of Cdk5 --- p.64 / Chapter 4.2 --- Materials and Methods --- p.66 / Chapter 4.2.1 --- Transfection of p35 and tau into CHO cells --- p.66 / Chapter 4.2.2 --- Extraction of total proteins from culture cells --- p.67 / Chapter 4.2.3 --- Quantitation of protein by Bradford method --- p.67 / Chapter 4.2.4 --- Protein separation by sodium dodecylsulphate polyacrylamide gel electrophoresis (SDS-PAGE) --- p.67 / Chapter 4.2.5 --- Western blot analysis --- p.67 / Chapter 4.3 --- Results --- p.68 / Chapter 4.3.1 --- Toxicity test on CHO cells --- p.68 / Chapter 4.3.2 --- Tau transfection in Cdk5/p35 and TauON3R transiently transfected in CHO cells --- p.68 / Chapter 4.3.3 --- Effect of roscovitine treatment on the transiently tau and p35 transfection in CHO cells --- p.74 / Chapter 4.3.4 --- "Effects of aqueous active components of Danshen, PCAH and SAB on the transiently tau and p35 transfection in CHO cells " --- p.74 / Chapter 4.4 --- Discussion --- p.79 / Chapter Chapter 5 --- Antioxidant effect of Danshen and its active components on lipid peroxidation / Chapter 5.1 --- Introduction --- p.81 / Chapter 5.1.1 --- Red-blood-cell hemolysis model --- p.82 / Chapter 5.2 --- Materials and methods --- p.84 / Chapter 5.2.1 --- Red-blood-cell hemolysis model --- p.84 / Chapter 5.2.2 --- Materials --- p.85 / Chapter 5.2.2.1 --- Animals --- p.85 / Chapter 5.2.2.2 --- Chemicals --- p.85 / Chapter 5.3 --- Results --- p.86 / Chapter 5.3.1 --- Aqueous and ethanol extracts of Danshen --- p.86 / Chapter 5.3.2 --- Active components ´ؤ Protocatechualdehyde and Salvianolic acid B --- p.87 / Chapter 5.4 --- Discussion --- p.91 / Chapter Chapter 6 --- General discussion and Outlook / Chapter 6.1 --- General discussion --- p.93 / Chapter 6.2 --- Proposed study in the future --- p.95 / Chapter 6.2.1 --- In vitro kinase assay using gamma32 P ATP and substrate with or without TCM --- p.95 / Chapter 6.2.2 --- Use of neuroblastoma cells (SHSY-5Y) to study the effect of Danshen and its active components on tau phosphorylation --- p.95 / Chapter 6.2.3 --- Thiobarbituric acid-reacting substances (TBARS) assay --- p.96 / Chapter 6.2.4 --- In vitro phosphatase kinase assay --- p.96

by Tsz-Wan Ho. / Thesis submitted in: July 2003. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 107-122). / Abstracts in English and Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / 摘要 --- p.iv / Content --- p.vi / Abbreviations --- p.x / List of Figures --- p.xi / List of tables --- p.xiv / Chapter CHAPTER 1 --- GENERAL INTRODUCTION --- p.1 / Chapter 1.1 --- Alzheimer'sDisease --- p.1 / Chapter 1.2 --- Hallmarks of AD --- p.3 / Chapter 1.2.1 --- The amyloid cascade hypothesis --- p.3 / Chapter 1.2.2 --- The tauopathy hypothesis --- p.4 / Chapter 1.3 --- The Cholinergic Hypothesis --- p.6 / Chapter 1.3.1 --- Cholinergic drug therapy --- p.7 / Chapter 1.3.2 --- Acetylcholinesterase inhibitors --- p.8 / Chapter 1.3.2.1 --- Tacrine --- p.10 / Chapter 1.3.2.2 --- Donepezil --- p.10 / Chapter 1.3.2.3 --- Rivastigimine - ENA-713 --- p.11 / Chapter 1.4 --- AChE inhibitors from plants --- p.12 / Chapter 1.4.1 --- Galanthamine --- p.12 / Chapter 1.4.2 --- Huperzine --- p.14 / Chapter 1.4.3 --- α-onocerin --- p.15 / Chapter 1.4.4 --- (+)-alpha-viniferin --- p.16 / Chapter 1.5 --- My project --- p.17 / Chapter CHAPTER 2 --- MATERIALS AND METHODS --- p.18 / Chapter 2.1 --- Preparation of CMM --- p.18 / Chapter 2.2.1 --- Selecting criteria and sources --- p.18 / Chapter 2.2.2 --- Preparation of aqueous extract --- p.18 / Chapter 2.2.3 --- Preparation of ethanol extract --- p.18 / Chapter 2.3 --- Routine maintenance of cell lines --- p.19 / Chapter 2.4 --- Toxicity test --- p.19 / Chapter 2.5 --- Ellman assay --- p.20 / Chapter 2.6 --- Ellman assay over BuChE --- p.21 / Chapter 2.7 --- Drugs --- p.21 / Chapter CHAPTER 3 --- SCREENING OF ACETYLCHOLINESTERASE INHIBITORS FROM CHINESE MEDICINAL MATERIALS --- p.23 / Chapter 3.1 --- Introduction --- p.23 / Chapter 3.2 --- Materials and Methods --- p.23 / Chapter 3.3 --- Results and discussion --- p.24 / Chapter 3.3.1 --- Preliminary screening of 45 selected TCMs for AChE inhibition --- p.24 / Chapter 3.3.2 --- Rescreening of drugs that show AChE inhibition in both aqueous and organic extracts --- p.25 / Chapter 3.4 --- Discussion --- p.28 / Chapter CHAPTER 4 --- CHARACTERIZATION OF ANTI-ACETYLCHOLINESTERASE ACTIVITY FROM SALVIA MBLTIORRHIZA BGE.(丹參) --- p.33 / Chapter 4.1 --- Introduction --- p.33 / Chapter 4.1.1 --- Clinical application of Danshen --- p.34 / Chapter 4.1.2 --- Pharmacological properties of Danshen and Salvia species --- p.34 / Chapter 4.1.2.1. --- Antiinflammatory and antibacterial responses --- p.35 / Chapter 4.1.2.2 --- Diabetes --- p.35 / Chapter 4.1.2.3 --- Alcoholism --- p.35 / Chapter 4.1.2.4 --- Apoptosis --- p.36 / Chapter 4.1.2.5 --- The effect of Salvia extracts on neuro-receptors --- p.36 / Chapter 4.1.3 --- Anti-cholinesterase activity by the Salvia species --- p.37 / Chapter 4.1.4 --- Active components from Salvia miltiorrhiza Bge --- p.38 / Chapter 4.2 --- Effects of tanshinone derivatives on AChE --- p.39 / Chapter 4.2.1 --- Materials and Methods --- p.39 / Chapter 4.2.2. --- Results --- p.39 / Chapter 4.3 --- Discussion --- p.50 / Chapter CHAPTER 5 --- EXTRACTION OF CRYPTOTANSHINONE FROM SALVIA MILTIORRHIZA --- p.54 / Chapter 5.1 --- Introduction --- p.54 / Chapter 5.1.1 --- Reverse phase high performance liquid chromatography (RP-HPLC) --- p.55 / Chapter 5.2 --- Materials and Methods --- p.56 / Chapter 5.2.1 --- Extracts of Danshen from different sources for obtaining the chemical profile --- p.55 / Chapter 5.2.2 --- Reverse phase high performance liquid chromatography (RP-HPLC) --- p.57 / Chapter 5.2.2.1 --- Analytical RP-HPLC --- p.57 / Chapter 5.2.2.2 --- Preparative RP-HPLC --- p.58 / Chapter 5.3 --- Results --- p.60 / Chapter 5.3.1 --- Identification of Peaks that contain the proposed active components --- p.60 / Chapter 5.3.2 --- Different samples of Danshen contain different amount of active components that can exert inhibitory effect on hAChE --- p.66 / Chapter 5.4 --- Discussion --- p.75 / Chapter CHAPTER 6 --- EFFECT OF CRYPTOTANSHINONE ON CALCIUM MOVEMENT in SH-SY5Y Cell --- p.80 / Chapter 6.1 --- Introduction --- p.80 / Chapter 6.2 --- Materials and Methods --- p.82 / Chapter 6.2.1 --- Reagents and drugs --- p.82 / Chapter 6.2.2 --- Calcium fluorimetry --- p.82 / Chapter 6.3 --- Results --- p.85 / Chapter 6.4 --- Discussion --- p.96 / Chapter CHAPTER 7 --- GENERAL DISCUSSION --- p.98 / Chapter 7.1 --- Structure-function relationship of crytotanshinone and dihydrotanshinone I --- p.98 / Chapter 7.2 --- Further study on cryptotanshinone and dihydrotanshinone I --- p.100 / Chapter 7.2.1 --- Modulation on nictonic receptor --- p.100 / Chapter 7.2.2 --- Behavioral study on mice --- p.101 / Chapter 7.2.3 --- Large scale production of the desired active components --- p.102 / Chapter 7.3 --- Study on other candidate herbs --- p.102 / References --- p.107

In part ONE of this thesis, including the most up to date information on SARS virology, disease transmission, pathogenesis and laboratory diagnosis will be summarized and presented, including the results of many studies in which I have participated (these references will be underlined as they appear in text). This of course summarizes knowledge that is now known in 2006 but was largely unknown during the initial outbreak. In part TWO, six original clinical studies performed at PWH will be presented: study (1) describes the clinical manifestations and severity of SARS, and its potential to cause major hospital outbreaks; (2) demonstrates the importance of epidemiological linkage in diagnosing SARS; (3) reports the clinical outcomes of a stepwise treatment protocol, which includes the use of corticosteroid therapy as an immunomodulant; (4) demonstrates that corticosteroid therapy can retard viral clearance, and should be used judiciously; (5) demonstrates that a more robust humoral response is associated with severe SARS, thus indicating that passive immunity treatment strategies seem only suitable either during early illness or as prophylaxis; and (6) shows that SARS has few early discriminating laboratory features compared to other causes of community-acquired pneumonia, thus a high index of suspicion is needed to recognize this infection in the absence of worldwide transmission. A thorough review of the relevant published material will be included in the discussion section of each study. / Severe Acute Respiratory Syndrome (SARS) is an emerging infectious disease caused by a novel coronavirus. It caused a global outbreak in 2003, resulting in more than 8000 infections, 700 deaths, and major social and economic disruption. In the initial phase of the SARS outbreak, the medical profession had no knowledge regarding the responsible pathogen, nor the clinical manifestations of SARS and the course of illness. There was no reliable diagnostic tool and no known effective therapy. But for the first time in medical history, we witnessed the rapid accumulation of knowledge on a disease as it evolved, which in turn assisted its management and control. / Since conducting randomized-controlled trials during the 2003 crisis was almost impossible, most of the presented studies are either descriptive or case-controlled in design. However, these studies have laid foundations for recent and future research into the clinical diagnosis and management of SARS. Moreover, the construction of the SARS clinical database has contributed to the work of other investigators, which has resulted in over thirty-six publications. It is my hope that these research endeavors can contribute to the understanding of this emerging, deadly disease. / Lee Lai Shun, Nelson. / "April 2006." / Source: Dissertation Abstracts International, Volume: 69-01, Section: B, page: 0205. / Thesis (M.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 264-292). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

The medico-scientific advances made in the treatment of HIV and AIDS, which emerged in the mid 1990s, were significant. The Highly Active Anti-Retroviral Treatments (HAART) or anti- HIV treatments have been positioned as resources that changed the way HIV is now medically and socially constructed. Although HIV remains incurable, it is now constructed as a chronic disease that is treatable, manageable and people are no longer positioned as living with a ‘death sentence’. The research on which this thesis is based explores the subjective lived experiences of people with HIV living in urban Australia in the context of this change. The effects that the treatments have had on corporeality have also changed the ways people are now living with HIV in the post-treatment era. It is an era in which treatments for HIV are taken-for-granted, but issues, doubts and concerns relating to treatment use are firmly embedded in the everyday life of people with HIV. The findings suggest that whilst AIDS-related mortality has decreased since the availability of effective treatments, the notion of ‘quality of life’, as subjectively constituted and defined, is an ongoing negotiation that is predicated on people locating meaningfulness in their everyday lives. Despite the decreased threat of failing health and death, the findings also suggest that people are continuing to be confronted by, and therefore positioned as, having to make sense of complex issues embedded in living with a disease for which there is no cure. / Doctor of Philosophy (PhD)

published_or_final_version / Public Health / Master / Master of Public Health

abstract / Chinese Medicine / Doctoral / Doctor of Philosophy

Background: Since the beginning of 21st century, several Asian countries started implementing their national free antiretroviral therapy (ART) programs to tackle one of the most striking public health issues in Asia – HIV/AIDS. Despite the efforts being made, the treatment coverage remains as low as 44% in 2010. Previous studies have identified financial constraint is a major barrier in accessing ART and an important reason of poor ART adherence in Asia. The purpose of this literature review is to explore the extent of financial burden experienced by people living with HIV (PLHIV) where free ART policy is implemented, and to provide valuable information for policy-making in reducing financial barriers and improve uptake of ART. Methods: Literature search was performed by entering keywords in PubMed and Medline. Articles were screened and selected for in-depth review according to the inclusion and exclusion criteria. A process on data synthesis was performed on the final eligible papers. Results: Five studies from four Asian countries describing the out-of-pocket health expenditure incurred by PLHIV during the delivery of ART were included in this review. Findings: Out of all direct medical costs, the cost of drug was most important in contributing to the total costs for patients without health insurance, while the cost of transportation was more important for patients covered by health insurance. Direct medical costs increased with advancing stage of disease. Rural patients would have spent up to 1,173% of their monthly income per capita, or more than 100% of their total household expenditure even when ART was provided free-of-charge. Patients have also highlighted free ARV drugs were sometimes not available in the health facility and they had to turn to the private market. Hence, the extent of financial burden in this review might be underestimated. Conclusion: Based on the data available, we concluded that increased accessibility of free ART should be accompanied with sustained ARV drugs supply and increased financial support for PLHIV. / published_or_final_version / Community Medicine / Master / Master of Public Health

The population of adolescent and adults with congenital heart disease (CHD) has grown rapidly. Right ventricular (RV) dysfunction remains an important issue of concern in the long-term follow up of these patients. While circulating biomarkers have shown promise in the assessment and monitoring of adult patients with left heart diseases, little is known of the role of biomarkers in reflecting RV performance in CHD patients. Emerging circulating biomarkers that reflect underlying pathophysiologic processes have gained increasing attention. These include inflammatory cytokines namely tumour necrosis factor (TNF)-α, a biomarker of apoptosis annexin A5 (AnxA5), carboxy-terminal propeptide of type I procollagen (PICP) and amino-terminal propeptide of type III procollagen (PIIINP) that reflects collagen synthesis and turnover, low circulating levels of cardiac troponin T as detected by highly sensitive assay (hs-cTnT) that may reflect subclinical myocardial injury, and microRNAs found to be involved in cardiac remodeling. The studies in this thesis aimed to test the hypothesis that circulating biomarkers may be altered in patients with volume-overloaded right ventricles after repair of tetralogy (TOF) and pressure-overloaded right ventricles after atrial switch operation for complete transposition of the great arteries (TGA), and are related to indices of RV function. In patients after TOF repair, increased circulating PICP and PIIINP levels were associated with worse subpulmonary RV and left ventricular (LV) function. In particular, these propeptides correlated positively with LV mechanical dyssynchrony, implicating a possible role of increased collagen synthesis in its pathogenesis. Increased plasma levels of hs-cTnT were further found in 30% of female, but not male patients. Female patients with elevated hs-cTnT levels compared to those without had greater RV volumes and LV mechanical dyssynchrony. Independent correlates of hs-cTnT in patients as determined from multivariate analysis were sex and RV ejection fraction. MicroRNA profiling following validation confirmed alteration of circulating levels of miR-99b and miR-766 in repaired TOF patients, a pattern distinct from that reported for left heart diseases. The miRNA expression was, however, not related to the cardiac functional indices. Patients after atrial repair for TGA had significantly higher circulating AnxA5 and TNF-αlevels, but similar PICP, PIIINP levels, compared with controls. Elevated AnxA5 level was associated with impaired systemic RV myocardial deformation, increased subpulmonary ventricular eccentricity, and increased TNF-αlevel. Elevation of hs-cTnT is found in 39% of the patients. The positive correlation between hs-cTnT level and systemic RV volume may suggest a role of hs-cTnT in reflecting RV remodeling. Circulating microRNA expression profiling and further validation identified 11 upregulated microRNAs (miR-16, miR-106a, miR-144*, miR-18a, miR-25, miR-451, miR-486-3p, miR-486-5p, miR-505*, let-7e and miR-93). Among them, miR-18a and miR-486-5p correlated negatively with systemic ventricular myocardial acceleration during isovolumic contraction, a relatively-load independent measure of systemic RV contractility. To conclude, these biomarkers reflect in varying extent the structural, functional, biological alteration of the subpulmonary and systemic right ventricles of the CHD patients late after surgical repair. These data may provide new perspectives in the understanding of progressive RV dysfunction in the adult CHD population and hopefully shed more lights on novel therapeutic interventions. / published_or_final_version / Paediatrics and Adolescent Medicine / Doctoral / Doctor of Philosophy

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