Physical Activity and Risk of Atrial Fibrillation: A Nationwide Cohort Study in General Population

Although exercise prevents cardiovascular disease and mortality, vigorous exercise and endurance athletics can cause atrial fibrillation (AF). However, no large cohort study has assessed the relationship between physical activity and AF in the general population. We assessed the effect of physical activity at different energy expenditures on the incidence of AF. We studied 501,690 individuals without pre-existing AF (mean age, 47.6 ± 14.3 years; 250,664 women [50.0%]) included in the Korean National Health Insurance Service database. The physical activity level was assessed using a standardized self-reported questionnaire at baseline. During a median follow-up of 4 years, 3,443 participants (1,432 women [41.6%]) developed AF. The overall incidence of AF at follow-up was 1.79 per 1,000 person-years. The subjects who met the recommended physical activity level (500-1,000 metabolic equivalent task [MET] minutes/week) had a 12% decreased AF risk (adjusted hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.80-0.97), but not the insufficiently (1-500 MET-minutes/week; HR: 0.94, 95% CI: 0.86-1.03) and highly active subjects (≥1,000 MET-minutes/week; HR: 0.93, 95% CI: 0.85-1.03). The recommended minimum key target range of physical activity level was associated with the maximum benefit for reduced AF risk in the general population. The dose-response relationship between physical activity level and AF risk showed a U-shaped pattern. Although exceeding the key target range attenuated this benefit, it did not increase the AF risk beyond that during inactivity.ope

IgG4-Related Sclerosing Disease Involving the Superior Vena Cava and the Atrial Septum of the Heart

A 55-year-old woman presented with frequent episodes of syncope due to sinus pauses. During ambulatory Holter monitoring, atrial fibrillation and first-degree atrioventricular nodal block were observed. Magnetic resonance imaging and CT scans showed a tumor-like mass from the superior vena cava to the right atrial septum. Open chest cardiac biopsy was performed. The tumor was composed of proliferating IgG4-positive plasma cells and lymphocytes with surrounding sclerosis. The patient was diagnosed with IgG4-related sclerosing disease. Because of frequent sinus pauses and syncope, a permanent pacemaker was implanted. The cardiac mass was inoperable, but it did not progress during the one-year follow-up.ope

Takayasu arteritis associated with ulcerative colitis and optic neuritis: First case in Korea

Takayasu arteritis (TA) is a chronic vasculitis that affects the aortic arch and its primary branches. Ulcerative colitis (UC) is an inflammatory bowel disease of unknown etiology. Patients diagnosed with both TA and UC have rarely been reported. The pathogenesis of TA and UC is uncertain, but cell-mediated mechanisms play an important role in both diseases, and a genetic factor is thought to have an effect on the coincidence of these two diseases. We herein report a 38-year-old female with TA who had a history of UC with optic neuritis. We believe that this is the first case of the coexistence of TA and UC in Korea.ope

CHA(2)DS(2)-VASc Score in the Prediction of Ischemic Stroke in Patients after Radiofrequency Catheter Ablation of Typical Atrial Flutter

PURPOSE: Despite undergoing successful catheter ablation of typical atrial flutter (AFL), patients remain at increased risk for ischemic stroke. However, data on risk prediction tools for the development of stroke after AFL ablation are lacking. This study investigates whether CHA(2)DS(2)-VASc score is useful for predicting ischemic stroke after successful ablation of typical AFL. MATERIALS AND METHODS: A total of 293 patients (236 men, mean age 56.1+/-13.5 years) who underwent successful radiofrequency catheter ablation for typical AFL were included in this study. The clinical end point was occurrence of ischemic stroke during follow-up after AFL ablation. RESULTS: During the follow-up period (60.8+/-45.9 months), ischemic stroke occurred in 18 (6%) patients at a median of 34 months (interquartile range, 13-65 months). CHA(2)DS(2)-VASc score [hazard ratio 2.104; 95% confidence interval (CI), 1.624-2.726; p<0.001] was an independent predictor for the occurrence of stroke after AFL ablation. The area under the receiver operating characteristic curve for CHA(2)DS(2)-VASc score was 0.798 (95% CI, 0.691-0.904). The CHA(2)DS(2)-VASc score could be used to stratify patients into two groups with different incidences of ischemic stroke (1.6% vs. 14.4%, p<0.001) at a cutoff value of 2. CONCLUSION: CHA(2)DS(2)-VASc score is useful in a prediction model for the risk of stroke after catheter ablation of typical AFL.ope

Predictors of sick sinus syndrome in patients after successful radiofrequency catheter ablation of atrial flutter

PURPOSE: The identification of sick sinus syndrome (SSS) in patients with atrial flutter (AFL) is difficult before the termination of AFL. This study investigated the patient characteristics used in predicting a high risk of SSS after AFL ablation. MATERIALS AND METHODS: Out of 339 consecutive patients who had undergone radiofrequency ablation for AFL from 1991 to 2012, 27 (8%) had SSS (SSS group). We compared the clinical characteristics of patients with and without SSS (n=312, no-SSS group). RESULTS: The SSS group was more likely to have a lower body mass index (SSS: 22.5±3.2; no-SSS: 24.0±3.0 kg/m²; p=0.02), a history of atrial septal defects (ASD; SSS: 19%; no-SSS: 6%; p=0.01), a history of coronary artery bypass graft surgery (CABG; SSS: 11%; no-SSS: 2%; p=0.002), and a longer flutter cycle length (CL; SSS: 262.3±39.2; no-SSS: 243.0±40; p=0.02) than the no-SSS group. In multivariate analysis, a history of ASD [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.2-11.4, p=0.02] and CABG (7.1, 95% CI 1.5-32.8, p=0.01) as well as longer flutter CL (1.1, 95% CI 1.0-1.2, p=0.04) were independent risk factors for SSS. CONCLUSION: A history of ASD and CABG as well as longer flutter CL increased the risk of SSS after AFL ablation. While half of the patients with SSS after AFL ablation experienced transient SSS, heart failure was associated with irreversible SSS.ope

The Case of Isolated Double Atrial Septum with Persistent Interatrial Space

Double atrial septum is very rare atrial septal malformation which has double layered atrial septum with persistent interatrial space between the two atria. Clinically, most cases of this anomaly are asymptomatic unless manifest as thromboembolic complications, such as stroke, or transient ischemic attack, that thrombus may be originated from this interatrial space. We report a case of a 69-year-old man who was diagnosed with isolated double atrial septum by transthoracic echocardiography.ope

Effectiveness Analysis Through Enzyme-Linked Immunosorbent Assay Examination of Antibody After Pandemic H1N1 2009 Influenza Vaccination

Background: A pandemic influenza outbreak started in 2009 by the number of patients discharged each year. But the result of H1N1 influenza vaccination is maintained for research and less state. The purpose of this study was to measure the antibody titers after H1N1 influenza vaccination toestimate demands of different standard vaccination in patients with chronic diseases and elderly patients. Methods: From March 2010 to February 2011, we retrospectively reviewed the medical records of 55 patients admitted to a tertiary hospital. The H1N1 virus antibody titer of each patient was measured through enzyme-linked immunosorbent assay. Titers were measured post vaccination on day 1 and at 1, 3 and 6 months. Results: A total of 55 patients were enrolled in this study. The comorbidities looked at were malignancy, cardiovascular disease, diabetes mellitus, renal disease, cerebrovascular disease, hematologic disease and infectious disease. Five patients (9.1%) had no comorbidities. Patients in their 50’s had the highest positive response rate (58.3%). The antibody titers at 1 month after vaccination were not associated with the number of comorbidities. The ratio of positive response increased gradually at baseline (16.4%) to 1 month (47.8%). After 6 months, there remained no positive response. Conclusion: The H1N1 antibodies were unstable as the values of the titer changed at follow-up (1 month, 3 months, and 6 months). The positive response rates of those in their 50’s and those who had chronic diseases were higher than others. The positive response rates showed that the ability to generate antibodies did not decrease with age or disease conditions.ope

심방조동 환자에서 고주파 전극도자 절제술 후 동반 되는 동기능부전 증후군의 위험인자에 대한 고찰

The identification of sick sinus syndrome (SSS) in patients with atrial flutter (AFL) is difficult before the termination of AFL. This study investigated the patient characteristics that predicted high risk of SSS after AFL ablation. Out of 339 consecutive patients who had undergone radiofrequency ablation for AFL from 1991 to 2012, 27 (8%) had SSS (SSS group). We compared the clinical characteristics of patients with and without SSS (n = 312, no-SSS group). The SSS group was more likely to have lower body mass index (22.5 ± 3.2 vs. 24.0 ± 3.0 kg/m2, p=0.02), history of atrial septal defect (ASD, 19% vs. 6%, p=0.01), history of coronary artery bypass graft (CABG, 11% vs. 2%, p=0.002), and a longer flutter cycle length (CL) (262.3 ± 39.2 vs. 243.0 ± 40, p=0.02) than the no-SSS group. In multivariate analysis, history of ASD (OR 3.7, 95% CI 1.2-11.4, p=0.02) and CABG (7.1, 95% CI 1.5-32.8, p=0.01) as well as longer flutter CL (1.1, 95% CI 1.0-1.2, p=0.04) were independent risk factors for SSS. Patients with irreversible SSS (n=13) had heart failure more frequently than those with reversible SSS (31% vs. 0%, p=0.03). A history of ASD and CABG as well as longer flutter CL increased the risk of SSS after AFL ablation. While half of the patients with SSS after AFL ablation experienced transient SSS, heart failure was associated with irreversible SSS.open석

Diagnositic significance of adenosine deaminase isozymes in patients with pleural effusion

의학과/석사[한글] Adenosine deaminase(EC 3,5,4,5, ADA)는 adenosine을 inosine과 암모니아로 전환시키는 효소로서 신체의 여러 조직에 분포되어 있으며 어느 조직에서는 ADA 활성도가 높지만 다른 조직에서는 활성도가 낮거나 나타나지 않는 것으로 알려져 있다. 또한 각종 질환과 선천적인 면역 결핍증 환자에서 ADA 활성도가 증가된다고 알려져 있다. ADA의 기능에 관해서는 아직까지 완전히 밝혀져 있지는 않으나 T 임파구의 분화와 증식, 단핵구 세포가 대식세포로의 성숙 및 면역성 기능 변화와 관계가 있음이 보고되어 있다. ADA는 분자량의 크기에 따라 대분자형 (large molecule) ADA isozyme과 소분자형 ADA (small molecule) isozyme이 존재하는데 대분자형 ADA는 조직에 따라 분자량이 230,000에서 440,000으로 보고되었으며, 소분자형 ADA는 36,000에서 38,000으로 보고되었다. 또한 대분자형 ADA와 소분자형 ADA isozyme은 조직에 따라 분포 정도가 다르며 일부 조직에서는 혼재되어 있다. 여러 질환에서 ADA 활성도의 진단적 가치가 보고된 이후 늑막 저류에서의 ADA 활성도 측정은 결핵성 흉막염과 비결핵성 흉막염의 감별진단에 유용한 것으로 알려졌다. 따라서 본 연구에서는 결핵성 흉막염과 비결핵성 흉막염의 ADA 활성도를 측정하여 두 군 사이에 ADA 활성도 차이를 확인하였으며 ADA isozymes의 진단적 가치를 조사하였다. 중요 실험 결과는 아래와 같다. 1. 결핵성 흉막염 환자의 흉막액의 펑균 ADA 활성도는 105.lU/L이었으며, 농흉환자는 169U/L, 그리고 악성과 기타 환자는 18.6U/L로 나타났다. 2. Sephacryl S-300 gel filtration을 시행하였을 때 대분자헝 및 소분자헝 ADA isozyme의 분자량은 각각 240,000과 36,000으로 조사되었다. 3. Gel filtration과 ADA isozyme의 활성 염색을 시행하였을 때 결핵성 흉막염 환자에서는 대분자형 ADA isozyme만 존재하는 것으로 나타났으며, 농흉환자에서는 대분자형 및 소분자형 ADA isozymes이 혼재하는 것으로 나타났다. 이상의 결과로 보아 ADA 활성도가 높은 결핵성 흉막염 환자와 농흉환자의 ADA isozymes의 분포 차이를 조사하면 두 질병의 감별 진단에 유용한 지표로 이용할 수 있을 것으로 사료된다. [영문] Adenosine deaminase (ADA) is an enzyme which catalyzes the irreversible hydrolytic deaminatlon of adenosine to produce inosine and ammonia. It has been reported that some organs oontain very high ADA activity, whereas others contain little or no ADA activity. It is also known that ADA activity is increased in several diseases including combined immunodeficiency. Although the function of ADA is not completely known In various cell types, ADA Is related to the differentiation and proliferation of T lympho cytes , the maturation of monocyte to macrophage, and the change of immune function. ADA can be classified into large ADA and small ADA isozymes according to its molecular weights. The molecular weight of large ADA isozyme was reported to be Mr. 230,000-440,000 in different tissues, and that of small ADA isozyme was reported to be Mr. 36,000-38,000. Two isozymes exist ununiformly in the different organs, although they coexist in some organs. Since the diagnostic value of ADA activity in several diseases was reported, it has been demonstrated that th? determination of ADA activity in pleural flued was useful in the differential diagnosis of pleural effusion. In this study the ADA activity in tuberculous and nontuberculous effusion was determined in an effort to show that differences in two isozyme activity have some diagnostic values. The main results of the experiments are as follows: 1. The mean ADA activities were 105.1 U/L, 169 U/L, 18.6 U/L in tuberculo us effusion, empyema, malignant effusion and transudate, respective1y. 2. Using a Sephacryl S-300 gel filtration column chromatography, molecular weights of large ADA and small ADA isozyme were found to be 240,000 and 36,000, respectively. 3. The gel filtration chromatography and active staining of ADA isozymes showed that large ADA isozyme existed only in tuberculous effusion, and large ADA and small ADA isozymes coexisted in empyema.restrictio

B cell oligoclonal expansion in the synovium of a patient with early rheumatoid arthritis.

의과학사업단/박사[한글] 류마티스 관절염은 자가면역 반응에 의한 대표적인 만성 관절염이다 류마티스 관절염의 병리기전에서 T 림프구는 초기의 면역 및 염증반응에 중추적 역할을 하며 B 림프구와 활막세포는 관절의 이차적인 파괴 및 손상에 중요한 역할을 하는 것으로 알려져 있다. 초기 류마티스 관절염은 증상 발현 1년 미만의 류마티스 관절염으로 그 기전에 있어 B 림프구의 관련성과 역할이 명확히 알려져 있지 않다. 면역글로불린의 제3상보성 결정부위(complementa.its determining region3; CDR3)는 3개의 CDR 중 변화가 파장 많은 부위로 항원과 직접 결합을 하는 부위이다. CDR3는 V(D)J 유전자 된절의 재배열에 의해 생성되며 다양성을 보여 B 림프구의 clonal marker로 사용되고 있다. 연구자는 초기 류마티스 관절염의 벙태 생리 기전에 B 림프구의 관련성을 화인하기 위하여 초기 류마티스 관절염 환자의 활막 조직에서 CDR3 다양성에 대한 연구를 통하여 B 림프구의 클론성 팽창을 확인하고 클론성 팽창된 면역글로불린 유전자를 클로닝하고자 하였다. 관절염의 증상 발생 후 5개월 되고 류마티스인자가 양성인 초기 류마티스 관절염 환자의 활막 조직 림프구와 말초혈액 림프구 그리고 정상인의 말초혈액 림프구에 대하여 CDR3 fingerprinting analysis를 시행하였으며 폴리아크릴아마이드겔에서 dominant band를 클로닝하여 CDR3 염기서열을 확인하였다. 확인된 염기서열을 이용하여 CDR3 probe를 합성하고 colony hybridization을 시행하여 클론성 팽창을 보인 B림프구리 면역글로불린 가변부위의 염기서열을 확인하였다. 정상인과 초기 류마티스 관절염 환자의 말초혈액에서 면역글로불린 μ 중쇄의 CDR3는 유사한 분포를 널였으며 초기 류마티스 관절염 환자의 활막에서 면역글로불린 중쇄의 CDR3는 다양하고 뚜렷한 clonality를 보였다. 면역글로불린 μ중쇄의 V_(H)I과 V_(H)4 family에서 CDR3 fingerprinting analysis상 보이는 dominant band를 클로닝하여 동일한 CDR3 염기서열을 보임을 확인하였다 Colony hybridization후 V_(H)가변부위 전체를 클로닝하였다. 면역글로불린 μ중쇄 V_(H)1 family에서는 5.1%의 클론성 팽창을 보였으며, 이 클론들은 V1-4.1B, D1-26, J_(H)3B1 유전자 분절의 재배열에 의해 만들어졌고 CDR에서 치환돌연변이와 비치환 돌연변이의 비(replacement mutation/silent mutation ratio;R/S 비)가 1/0으로 치환 돌연변이만 관찰되었다. 면역글로불린 중쇄 V_(H)4 family에서는 5.9%의 클론성 팽창을 보였으며 V4.39, D5-12, J_(H)2 유전자 분절의 재배열에 의해 만들어졌고 CDR에서 R/S비가 10/2(5.0)으로 나타나 항원에 의해 클론성 팽창이 나타났음을 추정할 수 있었다. 초기 류마티스 관절염 환자의 활막에서 면역글로불린 γ 중쇄의 CDR3는 fingerprinting analysis상 dominant band를 보이지 않아 클론성 팽창의 소견이 없음을 알 수 있었다. 결론적으로 초기 류마티스 관절염 환자의 활막 조직에서 B 림프구의 클론성 팽창이 있음을 확인하였고, 이는 항원에 의해서 유도되었을 것으로 생각되어 초기 류마티스 관절염의 병인에 B 림프구가 관여하고 있음을 확인하였다. 향후 클론성 팽창을 보인 클론을 이용하여 재조합 항체를 합성한다면 초기 류마티스 관절염의 원인항원을 찾고 병태생리를 밝히는 데 많은 도움을 줄 것으로 생각된다. -------------------- 핵심되는말 : 초기 류마티스 관절염, 활막 조직, B림프구, 클론성 팽창, CDR3 [영문] Several studies have tried to find evidence for B cell oligoclonal expansion in longstanding rheumatoid arthritis(RA) synovium. The optimal time to investigate antigen-driven B cell response in the synovium is during the early phase of RA. The objective of this study is to find evidence of a clonally-expanded immunoglobulin heavy chain in the synovium of an early RA patient. Peripheral blood lymphocyte (PBL) and synovial tissue were obtained from an early RA patient of 5 months duration, and PBL from an age- and sex-matched healthy adult as control. Complementarily determining region 3 (CDR3) fingerprinting analysis was performed. Briefly, RNA was isolated and CDNA was synthesized with M-MLV reverse transcriptase. Two-stage PCR was performed to amplify the CDR3 region using family-specific primers for heavy chain variable region. CDR3 regions were separated according to their lengths by running polyacrylamide gel electrophoresis. Restricted bands were cut and cloning and sequencing were performed. With a synthetic oligonucleotide probe from the CDR3 region, cfllony hybridization was done for first PCR product. Immunoglobulin variable region sequence containing an identical CDR3 region with the probe was searched. In control PBL and early RA PBL, similar pattern of CDR3 lengths was observed in V_(H)I-6 families of γ heavy chain but multiple restricted bands in V_(H)I-6 families of μ heavy chain. In early RA synovium, however, multiple restricted CDR3 bands were seen in V_(H)I, 3, 4, 5 families of μ heavy chain, but no restricted CDR3 band was shown in γ heavy chain families. The clonally expanded μ heavy chain sequences containing V_(H)I (5.1%) alld V_(H)4 family (5.9%) were found. The variable region sequence of V_(H)1 clone(RAm1-1) was produced from germline Vl-4.1B, D1-26, and J_(H)3B1, and the variable region sequence of V_(H)4 clone(RAm4-1) from V4.39, D5-12, and J_(H)2 gene segment. Clonal expansion was observed only in μ heavy chain but not γ heavy chain. These data show that there are oligoclonal B cell expansion in early RA synovium and that dntigen-driven B cell immune responses might be involved in early RA synovium.ope