Collagen-Induced Arthritis Analysis in Rhbdf2 Knockout Mouse

Rhomboid family member 2 gene (Rhbdf2) is an inactive homologue lacking essential catalytic residues of rhomboid intramembrane serine proteases. The protein is necessary for maturation of tumor necrosis factor-alpha (TNF-α) converting enzyme, which is the molecule responsible for the release of TNF-α. In this study, Rhbdf2 knockout (KO) mice were produced by CRISPR/CAS9. To see the effects of the failure of TNF-α release induced by Rhbdf2 gene KO, collagen-induced arthritis (CIA), which is the representative TNF-α related disease, was induced in the Rhbdf2 mutant mouse using chicken collagen type II. The severity of the CIA was measured by traditional clinical scores and histopathological analysis of hind limb joints. A rota-rod test and grip strength test were employed to evaluate the severity of CIA based on losses of physical functions. The results indicated that Rhbdf2 mutant mice showed clear alleviation of the clinical severity of CIA as demonstrated by the significantly lower severity indexes. Moreover, a grip strength test was shown to be useful for the evaluation of physical functional losses by CIA. Overall, the results showed that the Rhbdf2 gene has a significant effect on the induction of CIA, which is related to TNF-α.

Part 3. Advanced cardiac life support: 2015 Korean Guidelines for Cardiopulmonary Resuscitation

No abstract available.

Catheter Ablation of Atrial Fibrillation Raises the Plasma Level of NGF-beta Which Is Associated with Sympathetic Nerve Activity

PURPOSE: The expression of nerve growth factor-beta (NGF-beta) is related to cardiac nerve sprouting and sympathetic hyper innervation. We investigated the changes of plasma levels of NGF-beta and the relationship to follow-up heart rate variability (HRV) after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). MATERIALS AND METHODS: This study included 147 patients with AF (117 men, 55.8+/-11.5 years, 106 paroxysmal AF) who underwent RFCA. The plasma levels of NGF-beta were quantified using double sandwich enzyme linked immunosorbent assay method before (NGF-beta(pre)) and 1 hour after RFCA (NGF-beta(post-1hr)). HRV at pre-procedure (HRV(pre)), 3 months (HRV(post-3mo)), and 1 year post-procedure (HRV(post-1yr)) were analyzed and compared with plasma levels of NGF-beta. RESULTS: 1) The plasma levels of NGF-beta significantly increased after RFCA (20.05+/-11.09 pg/mL vs. 29.60+/-19.43 pg/mL, p18 pg/mL, low frequency components (LF)/high-frequency components (HF) (p=0.003) and the number of atrial premature contractions (APCs, p=0.045) in HRV(post-3mo) were significantly higher than those with < or =18 pg/mL. 3) The LF/HF at HRV(post-3mo) was linearly associated with the NGF-beta(pre) (B=4.240, 95% CI 1.114-7.336, p=0.008) and the NGF-beta(post-1hr) (B=7.617, 95% CI 2.106-13.127, p=0.007). 4) Both NGF-beta(pre) (OR=1.159, 95% CI 1.045-1.286, p=0.005) and NGF-beta(post-1hr) (OR=1.098, 95% CI 1.030-1.170, p=0.004) were independent predictors for the increase of LF/HF at HRV(post-3mo). CONCLUSION: AF catheter ablation increases plasma level of NGF-beta, and high plasma levels of NGF-beta(pre) was associated with higher sympathetic nerve activity and higher frequency of APCs in HRV(post-3mo).

Early Repolarization and Myocardial Scar Predict Poorest Prognosis in Patients with Coronary Artery Disease

PURPOSE: Recent studies show positive association of early repolarization (ER) with the risk of life-threatening arrhythmias in patients with coronary artery disease (CAD). This study was to investigate the relationships of ER with myocardial scarring and prognosis in patients with CAD. MATERIALS AND METHODS: Of 570 consecutive CAD patients, patients with and without ER were assigned to ER group (n=139) and no ER group (n=431), respectively. Myocardial scar was evaluated using cardiac single-photon emission computed tomography. RESULTS: ER group had previous history of myocardial infarction (33% vs. 15%, p<0.001) and lower left ventricular ejection fraction (57+/-13% vs. 62+/-13%, p<0.001) more frequently than no-ER group. While 74 (53%) patients in ER group had myocardial scar, only 121 (28%) patients had in no-ER group (p<0.001). During follow up, 9 (7%) and 4 (0.9%) patients had cardiac events in ER and no-ER group, respectively (p=0.001). All patients with cardiac events had ER in inferior leads and horizontal/descending ST-segment. Patients with both ER in inferior leads and horizontal/descending ST variant and scar had an increased adjusted hazard ratio of cardiac events (hazard ratio 16.0; 95% confidence interval: 4.1 to 55.8; p<0.001). CONCLUSION: ER in inferior leads with a horizontal/descending ST variant was associated with increased risk of cardiac events. These findings suggest that ER in patients with CAD may be related to myocardial scar rather than pure ion channel problem.

Liver Laceration with Hemoperitoneum after Cardiopulmonary Resuscitation / 대한구급학회지

It is well known that external chest compression during cardiopulmonary resuscitation is frequently associated with various complications. These complications predominantly involve trauma to the heart, lungs, and chest wall, whereas cases involving intra-abdominal injury are much less frequent. The present report describes a rare case of a female patient with severe hemoperitoneum associated with liver injury after cardiopulmonary resuscitation. Although emergent angiography and embolization of the hepatic artery were performed and transfusion of various kinds of blood products was done continuously, the patient expired the next day.

Retrograde Stanford type A aortic dissection after endovascular stent graft placement for type B dissection / 대한내과학회지

Endovascular stent graft placement in Stanford type B aortic dissection has increased as a result of the demonstration of its safety and efficacy. Despite the advantage of reduced mortality and morbidity, the mid-to long-term prognosis and possible complications associated with the procedure are a source of concern. Among the many possible complications, retrograde type A dissection after stent grafting for type B dissection is considered rare; however, this life-threatening event appears to be underrecognized. Here, we report a case that converted to open surgery due to a retrograde type A dissection after endovascular stent graft placement for a Stanford type B dissection. This is the first report of a retrograde type A dissection after endovascular stent graft placement in Korea.

Serological Predictors for the Recurrence of Atrial Fibrillation After Electrical Cardioversion

BACKGROUND AND OBJECTIVES: Although electrical cardioversion (CV) is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF), AF frequently recurs in spite of antiarrhythmic medications. We investigated the predictors of failed CV and AF recurrence after successful CV. SUBJECTS AND METHODS: In 81 patients (M:F=63:18, 59.1+/-10.5 years old) with AF who underwent CV, clinical findings and pre-CV serologic markers were evaluated. RESULTS: During 13.1+/-10.6 months of follow-up, 8.6% (7/81) showed failed CV, 27.16% (22/81) showed early recurrence atrial fibrillation (ERAF; 2 weeks), and 32.1% (26/81) remained in SR and had no recurrence (NR). Plasma levels of transforming growth factor beta (TGF)-beta were significantly higher in patients with failed CV than in those with successful CV (p=0.0260). Patients in whom AF recurred were older (60.4+/-9.0 years old vs. 55.3+/-12.5 years old, p=0.0220), and had lower plasma levels of stromal cell derived factor (SDF)-1alpha (p=0.0105). However, there were no significant differences in these parameters between ERAF patients and LRAF patients. CONCLUSION: Post-CV recurrence commonly occurs in patients aged >60 years and who have low plasma levels of SDF-1alpha. High plasma levels of TGF-beta predict failure of electrical CV.

Acute Myocardial Infarction due to Polyarteritis Nodosa in a Young Female Patient

Coronary artery aneurysms are uncommon, are usually associated with atherosclerosis, and rarely involve all three major coronary arteries. The present report describes a rare case of a young female patient presenting with acute myocardial infarction (AMI). Coronary angiography revealed multiple severe aneurysmal and stenotic changes. Based on clinical feature and angiographic findings, it was strongly suspected that the patient had polyarteritis nodosa (PAN) complicated by AMI. The patient was treated with standard cardiac medications and immunosuppressive agents and has remained stable without further complications during a follow-up period of 6 months.

Endovascular Treatment of Isolated Common Iliac Artery Aneurysms With Short Necks Using Bifurcated Stent-Grafts

Elective surgical repair has traditionally been considered to be the treatment of choice for the exclusion of isolated iliac artery aneurysms (IAAs). Recently, endovascular repair has evolved as an alternative to surgical repair, especially in patients at high surgical risk. However, in the absence of sufficient proximal necks, iliac artery aneurysms are not suitable for direct deployment of a tubular-shaped endograft. Here we report two cases of IAAs with short proximal necks that were excluded using an endovascular bifurcated stent-graft. The bifurcated stent-graft was successfully deployed with complete exclusion of the aneurysm. In neither case was there evidence of procedural failures. There were no signs of significant complications. We conclude that endovascular repair of IAAs with short proximal necks is feasible and efficient using an endovascular bifurcated stent-graft.

Permanent Pacemaker for Syncope after Heart Transplantation with Bicaval Technique

Sinus node dysfunction occurs occasionally after heart transplantation and may be caused by surgical trauma, ischemia to the sinus node, rejection, drug therapy, and increasing donor age. However, the timing and indication of permanent pacemaker insertion due to sinus node dysfunction following heart transplantation is contentious. Here, we report a case of a permanent pacemaker insertion for syncope due to sinus arrest after heart transplantation, even with a bicaval technique, which has been known to associate with few incidences of sinus node dysfunction.