Anti-phospholipase A2 receptor antibody as a prognostic marker in patients with primary membranous nephropathy Volume 37, Issue 3, September 2018, Pages 248–256

In the article, there was an error in Figure 3.

Anti-phospholipase A2 receptor antibody as a prognostic marker in patients with primary membranous nephropathy

BACKGROUND: Phospholipase A2 receptor (PLA2R) has been identified as a major autoantigen in primary membranous nephropathy (MN). We evaluated the association between anti-PLA2R antibodies and clinical outcome in Korean patients with primary MN. METHODS: A total of 66 patients with biopsy-proven MN were included. Serum level of anti-PLA2R antibodies was measured by enzyme-linked immunosorbent assay. Biochemical parameters were estimated initially and at follow-up. RESULTS: Anti-PLA2R antibodies were detected in 52.1% and 27.8% of patients with primary and secondary MN, respectively. Forty-eight patients with primary MN were grouped based on presence or absence of anti-PLA2R antibodies. Proteinuria was more severe in anti-PLA2R-positive patients than in anti-PLA2R-negative patients (urine protein/creatinine ratio 7.922 ± 3.985 g/g vs. 4.318 ± 3.304 g/g, P = 0.001), and anti-PLA2R antibody level was positively correlated with proteinuria. The incidence of chronic kidney disease stage ≥ 3 was higher in anti-PLA2R-positive patients compared with anti-PLA2R-negative patients (P = 0.004). The probabilities of spontaneous remission were higher in anti-PLA2R-negative patients compared with anti-PLA2R-positive patients (P < 0.001). Multivariate analysis demonstrated that anti-PLA2R antibodies are an independent risk factor for developing chronic kidney disease stage ≥ 3 and for not reaching spontaneous remission. CONCLUSION: Detection of anti-PLA2R antibodies at diagnosis in patients with primary MN can predict prognosis and guide treatment decisions.

Acute Myocardial Infarction with Cardiogenic Shock in a Young Adult with Minimal Change Disease / 대한내과학회지

Acute myocardial infarction (AMI) is very rare in young adults. Nephrotic syndrome is an uncommon cause of AMI in young adults and is characterized by excessive proteinuria, hypoalbuminemia, hyperlipidemia, and generalized edema. The hypercoagulable state and accelerated atherosclerosis in patients with nephrotic syndrome may be associated with the development of AMI in young adults. We report herein a case of ST-segment elevation myocardial infarction with sudden cardiac arrest in a young patient with minimal change disease.

Tachycardia-Induced Right Heart Failure and Severe Tricuspid Regurgitation That Improved with Medication / 전남의대학술지

Secondary tricuspid regurgitation (TR) primarily develops due to left heart failure or primary pulmonary diseases. Tricuspid annular dilation, which is commonly caused by right ventricular volume and pressure overload followed by right ventricle dilation, is believed to be the main mechanism underlying secondary TR. It is reported that once the tricuspid annulus is dilated, its size cannot spontaneously return to normal, and it may continue to dilate. These reports also suggest the use of an aggressive surgical approach for secondary TR. In the present report, we describe a case of tachycardia-induced severe TR that was completely resolved without the need for surgery.

Left Ventricular Strain as Predictor of Chronic Aortic Regurgitation

BACKGROUND: It is not well known about the implication of left ventricular (LV) strain as a predictor for mortality in patients with chronic aortic regurgitation (AR). The purpose of this study was to investigate whether global longitudinal strain measured by two-dimensional speckle-tracking echocardiography could predict long-term outcome in patients with chronic AR. METHODS: This is a single center non-randomized retrospective observational study. The patients with chronic AR from January 2002 to December 2012 were retrospectively enrolled. Following patients were excluded; combined other significant valvular disease, previous heart surgery, aortic disease, congenital heart disease, acute AR and young age under 18 years old. Finally, 60 patients were analyzed and the LV global strain rate was measured on apical four chamber image (GS-4CH). RESULTS: During 64 months follow-up duration, 16 patients (26.7%) were deceased and 38 patients (63.3%) underwent aortic valve replacement (AVR). Deceased group was older (69 years old vs. 51 years old, p < 0.001) and had lower longitudinal strain (-12.05 +/- 3.72% vs. -15.66 +/- 4.35%, p = 0.005). Kaplan-Meier survival curve stratified by GS-4CH showed a trend of different event rate (log rank p = 0.001). On multivariate analysis by cox proportional hazard model adjusting for age, sex, body surface area, history of atrial fibrillation, blood urea nitrogen, LV dilatation, LV ejection fraction and AVR, decreased GS-4CH proved to be an independent predictor of mortality in patients with chronic AR (hazard ratio 1.313, 95% confidence interval 1.010-1.706, p = 0.042). CONCLUSION: GS-4CH may be a useful predictor of mortality in patient with chronic AR.

Tachycardia-Induced Right Heart Failure and Severe Tricuspid Regurgitation That Improved with Medication / 전남의대학술지

Secondary tricuspid regurgitation (TR) primarily develops due to left heart failure or primary pulmonary diseases. Tricuspid annular dilation, which is commonly caused by right ventricular volume and pressure overload followed by right ventricle dilation, is believed to be the main mechanism underlying secondary TR. It is reported that once the tricuspid annulus is dilated, its size cannot spontaneously return to normal, and it may continue to dilate. These reports also suggest the use of an aggressive surgical approach for secondary TR. In the present report, we describe a case of tachycardia-induced severe TR that was completely resolved without the need for surgery.

Case of Recurrent Ventricular Fibrillations with Osborn Wave Developed during Therapeutic Hypothermia

Therapeutic hypothermia (TH) has been used to protect neurological functions in cardiac arrest patient. Although Osborn wave is not pathognomonic of hypothermia, it is a well-known electrocardiogram finding of hypothermic patients. The cellular and ionic mechanisms of the Osborn wave have been suggested, and its relationship to tachyarrhythmias, such as ventricular tachycardia and ventricular fibrillation, is being explored. This case highlights the arrhythmogenic potential of Osborn wave and individual difference in response of TH.

Differential Effects of Antipsychotic Drugs on Dopamine D1 and D2 Receptor mRNAs in the Rat Brain / 대한해부학회지

The principal aim of this study was to determine the effects of antipsychotics (haloperidol, sulpiride, and clozapine) on regulating dopamine (DA) D1 and D2 receptor mRNA levels in the rat caudate putamen (CPu), nucleus accumbens (NAc), and olfactory tubercle (OTu). Twenty male Sprague-Dawley rats (250 g) were treated with haloperidol (1mg/mL), sulpiride (40 mg/mL), clozapine (20 mg/mL), and the control group received only water. Drugs were administered orally for 4 weeks. Antipsychotic drugs had differential effects on DA D1 and D2 receptor gene expression. Haloperidol and sulpiride induced an increase of DA D1 and D2 receptor mRNA levels in the rat CPu, OTu, and NAc; haloperidol caused a greater increase than sulpiride. However, clozapine treatment had less effect on DA receptor mRNAs levels in the same area. Antipsychotic drugs differentially upregulated the expression of DA D1 and D2 receptor mRNAs in the rat brain. These changes may be related, at least in part, to changes of DA concentration following antipsychotics treatment.

The Effects of Increasing Thoracic Mobility on Lumbar Stability

OBJECTIVE: To determine the effects on the lumbar stability caused by various thoracic exercise programs, the extent of spinal posture correction and the increase in thoracic mobility to the extension direction. METHOD: Exercise programs, which can increase the thoracic mobility to the extension direction, were applied to the exercise group. The control subjects were trained for the correct posture according to ergonomic principles by exercise at home and at the clinic. Both groups had three sessions of exercise program per week for 8 weeks. RESULTS: A comparison of the various parameters in the exercise group before and after exercise showed that the VAS, thoracic kyphosis and lumbar mobility decreased significantly (p <0.05), and the thoracic mobility in the extension direction, chest expansion, maximal elevation of the arms and spinal length increased significantly (p <0.05). In addition, the thoracic kyphosis and lumbar mobility increased significantly (p <0.05), and thoracic mobility in the extension direction, chest expansion, maximum elevation of the arms and the spinal length decreased significantly (p <0.05), but the VAS did not show a significant difference. CONCLUSION: A thoracic exercise program, which can correct the posture, improve the functional restrictions of the thoracic spine and reduce the lumbar mobility, is very important.

Effect on Active Exercise Programs in Employees with Chronic Low Back Pain / 대한산업의학회지

OBJECTIVE: To examine the relative efficacy of three active exercise programs for work-related, chronic low back pain, and to observe to what extent the programs affected the mechanical stability of the lumbar region. METHODS: The subjects were 64 employees who were randomly divided into three groups to match the three active exercise programs which were performed 3 times a week for 6 months. All subjects were assessed with the same measurements at a pre-study examination, and then were reassessed at 2 weeks, 3 months and 6 months after the study. RESULTS: The pain intensity didn't show any significant difference among the three groups. However, the Oswestry Disability Index showed significant differences among the three groups at 6 months and the lumbar and thoracic exercise groups showed significant decreases compared to the general physiotherapy group (p<0.05). Maximal stretching with both hands in the overhead direction showed a significant difference among the three groups at 3 months and 6 months, and the thoracic exercise group at 6 months showed a significant increase in overhead stretching compared to the lumbar exercise and general physiotherapy groups (p<0.05). The lumbar region angle of inclination showed significant differences among the three groups at 2 weeks, 3 months and 6 months, with the thoracic exercise group being decreased significantly more than the lumbar exercise and general physiotherapy groups at 6 months (p<0.05). CONCLUSIONS: Exercise aimed at increasing thoracic mobility has an effect on lumbar stability. Furthermore, it is far more effective for lumbar stabilization than general physiotherapy and deep muscle strengthening lumbar exercise.

Effects of Thoracic Spinal Exercise Program in VDT Workers: Pain Relief and Increased Flexibility / 대한산업의학회지

OBJECTIVES: The purpose of this study of the Thoracic Spinal Exercise Program was to evaluate its effects on VDT workers. These effects were found to include a decrease thoracic kyphosis, increase thoracic spine mobility and decrease in the VAS (visual analog scale). These measures provide a means of assessing the muscle endurance and muscle strength of the subjects. METHODS: This study was conducted during the period from July 1 to August 31, 2003, and involved 58 VDT workers belonging to a company located in Seoul who were working seated in front of a computer for most of the day. After applying the thoracic exercise program, we examined the changes in the of thoracic kyphosis angle, spinal length (C7-S3), TFED (thoracic flexibility in the extension direction), MEBH (maximal elevation with both hands in the overhead direction) and CE (chest expansion). RESULTS: Obtained f om this study are as follows. 1. A significant reduction in the VAS was observed in the exercise group (pre-exercise 5.90 +/- 0.88 points, post-exercise 4.23+/- 0.82 points), as compared with the control group (pre-exercise 6.00+/-0.90 points, post-exercise 5.93+/-0.81 points). 2. A significant reduction in thoracic kyphosis (pre-exercise 36.97+/-7.49, post-exercise 31.83 +/-5.90) and a significant increase in thoracic flexibility in the extension direction (pre-exercise 7 . 4 7+/-2.30, post-exercise 11.77+/-3.65) were observed in the exercise group. The thoracic kyphosis angle showed a significant reduction in the exercise group, as compared to the control group. The thoracic flexibility in the extension direction showed a significant increase in the exercise group, as compared to the control group. 3. There was a significant increase in the spinal length in the exercise group (pre-exercise 494 +/-27.66 mm, post-exercise 518.60+/-27.95 mm). CONCLUSIONS: The Thoracic Spinal Exercise Program results in an increase in thoracic spine mobility and a decrease in pain. In practical terms, the effects of the exercise program are good health and posture.