• The Korean journal of internal medicine
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• v.33 no.6
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• pp.1241-1251
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• 2018

Background/Aims: To estimate the level of agreement and positivity rates of latent tuberculosis infection (LTBI) tests prior to the use of tumor necrosis factor (TNF) inhibitors in relation to underlying rheumatic diseases and endemic tuberculosis levels. Methods: The Ovid-Medline, Embase, and Cochrane Libraries were searched for articles before October 2013 involving LTBI screening in rheumatic patients, including rheumatoid arthritis (RA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), and psoriatic arthritis. Results: In pooled analyses, 5,224 rheumatic patients had undergone both a tuberculin skin test (TST) and an interferon-gamma release assay (IGRA) before TNF inhibitors use. The positivity of TST, QuantiFERON-TB Gold In Tube (QFT-GIT), and T-SPOT.TB (T-SPOT) tests were estimated to be 29%, 17%, and 18%, respectively. The agreement percentage between the TST and QFT-GIT, and between the TST and T-SPOT were 73% and 75%. Populations from low-to-moderate endemic TB presented with slightly less agreement (71% between TST and QFT-GIT, and 74% between TST and T-SPOT) than patients from high endemic countries (73% between TST and QFT-GIT, and 81% between TST and T-SPOT). By underlying disease stratification, a lower level of agreement between TST and QFT-GIT was found among AS (64%) than among JIA (77%) and RA patients (73%). Conclusions: We reaffirm the current evidence for accuracy of LTBI test done by TST and IGRA among rheumatic patients is inconsistent. Our stratified analysis suggests different screening strategies might be needed in clinical settings considering the endemic status in the patient's country of origin and the precise nature of underlying diseases.

• Journal of Cardiovascular Imaging
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• v.31 no.4
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• pp.191-199
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• 2023

BACKGROUND: Assessment of left ventricular (LV) function plays a pivotal role in the management of patients with valvular heart disease, including those caused by rheumatic heart disease. Noninvasive LV pressure-strain loop analysis is emerging as a new echocardiographic method to evaluate global LV systolic function, integrating longitudinal strain by speckle-tracking analysis and noninvasively measured blood pressure to estimate myocardial work. The aim of this study was to characterize global LV myocardial work efficiency in patients with severe rheumatic mitral stenosis (MS) with preserved ejection fraction (EF). METHODS: We retrospectively included adult patients with severe rheumatic MS with preserved EF (> 50%) and sinus rhythm. Healthy individuals without structural heart disease were included as a control group. Global LV myocardial work efficiency was estimated with a proprietary algorithm from speckle-tracking strain analyses, as well as noninvasive blood pressure measurements. RESULTS: A total of 45 individuals with isolated severe rheumatic MS with sinus rhythm and 45 healthy individuals were included. In healthy individuals without structural heart disease, the mean global LV myocardial work efficiency was 96% (standard deviation [SD], 2), Compared with healthy individuals, median global LV myocardial work efficiency was significantly worse in MS patients (89%; SD, 4; p < 0.001) although the LVEF was similar. CONCLUSIONS: Individuals with isolated severe rheumatic MS and preserved EF, had global LV myocardial work efficiencies lower than normal controls.

• Journal of muscle and joint health
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• v.7 no.1
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• pp.131-147
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• 2000

Almost all patients with rheumatic disease experience fatigue. The fatigue affects the patient's life extensively at home and at work, therefore it is necessary to investigate the nature of the fatigue which the patients perceive. The purpose of this study is to explore the nature and pattern of fatigue of the patients with rheumatic diseases. Rheumatoid arthritis is typical disease for its joint involvement which leads to deformity. Whereas lupus is a characteristic systemic autoimmune disease and the fibromyalgia is characterized by the general bodyache and multiple local tenderness. The prevalence of these diseases and the fatigue was known to be higher in women than men. Therefore the subjects were woman patient diagnosed as rheumatoid arthritis, lupus or fibromyalgia, and they were recruited from the H-Rheumatic Disease Hospital. The two instruments, the Multidimensional Assessment of Fatigue by Belza(1995) and the Piper Fatigue Scale by Piper, et al(1995) were used to explore the nature and pattern of self-reported fatigue. In total, the data from 157 patients were analysed by the SPSS-PC program for statistical analysis. The results were as follows: 1. Most patients with rheumatic disease experienced fatigue and the degree of fatigue was at the middle range by the scores of the two instruments. 2. The degree of fatigue of the patients with fibromyalgia was the highest and the next was that of the patients with lupus and the fatigue of the patients with rheumatoid arthritis. But there were no statistically significant differences among the patients with three rheumatic diseases, except the subcategory, the meaning of fatigue of the Piper Fatigue Scale. 3. Even when the period of the symptom and pain were covariated, there were no statistically significant differences among patients with three rheumatic diseases. The fatigue of the patients with lupus and fibromyalgia is rarely investigated in Korea and this study can be the base for the further understanding of the patients with rheumatic diseases. Therefore repeated studies are required to identify the factors to affect the fatigue and to understanding the nature of the diseases and to develop the nursing interventions to alleviate the fatigue.

• Journal of muscle and joint health
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• v.9 no.2
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• pp.144-153
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• 2002

This study was designed to explore use of unconventional treatments and identify related variables of patients with rheumatic disease. One hundred fifty rheumatic patients were recruited from two university based rheumatic centers according to selection criteria. Collected data were analyzed using SAS program through with a structured questionnaire. T-test, ANOVA, and Scheffe's test were adopted. The results were as follows: 1. 77.7% of the subjects were over forties and mean age was 48.5 years. 74.0% were women and 73.2% were living with their spouse. 82.0% of them was good or moderate or good economic status, 38.3% was university graduates. 2. 58.0% of the subjects had rheumatoid arthritis, and mean duration of suffering rheumatic disease was 6.5 years. 89.3% of them had joint pain and their mean pain score was 4.07. Most painful joints were hip(58.0%), finger(42.0%), wrist(42.0%), and the number of painful joint was 5.4. 70% of the subjects using unconventional treatments, the most common treatments using them was herb medicine(42.7%) and acupuncture(36.7%). 3. Level of pain was different according to subject's age, educational background, diagnosis, number of painful joints, and using unconventional treatments or not. It is recommended that use of a larger sample to understand more about unconventional treatments and pain of patients with rheumatic disease. More research is needed to consider developing individual nursing interventions for their well-being and quality of life.

• Journal of Chest Surgery
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• v.52 no.1
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• pp.9-15
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• 2019

Background: Although aortic valve repair can reduce prosthesis-related complications, rheumatic aortic regurgitation (AR) caused by leaflet restriction is a significant risk factor for recurrent AR. In this study, we evaluated the long-term results of the leaflet extension technique for rheumatic AR. Methods: Between 1995 and 2016, 33 patients underwent aortic valve repair using the leaflet extension technique with autologous pericardium for rheumatic pure AR. Twenty patients had severe AR and 9 had combined moderate or greater mitral regurgitation. Their mean age was $32.2{\pm}13.9$ years. The mean follow-up duration was $18.3{\pm}5.8$ years. Results: There were no cases of operative mortality, but postoperative complications occurred in 5 patients. Overall survival at 10 and 20 years was 93.5% and 87.1%, respectively. There were no thromboembolic cerebrovascular events, but 4 late deaths occurred, as well as a bleeding event in 1 patient who was taking warfarin. Twelve patients underwent aortic valve reoperation. The mean interval to reoperation was $13.1{\pm}6.1$ years. Freedom from reoperation at 10 and 20 years was 96.7% and 66.6%, respectively. Conclusion: The long-term results of the leaflet extension technique showed acceptable durability and a low incidence of thromboembolic events and bleeding. The leaflet extension technique may be a good option for young patients with rheumatic AR.

• Journal of Korean Public Health Nursing
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• v.16 no.2
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• pp.337-345
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• 2002

This study was designed to explore health promoting lifestyle patterns (HPLP) and self-care activities and identify related variables of patients with rheumatic disease. One hundred fifty rheumatic patients were recruited from two university based rheumatic centers according to selection criteria. Collected data were analyzed using SAS program through which with a structured questionnaire. T-test. ANOVA, and Pearson correlation coefficients were tested. The results were as follows: 1. The mean HPLP score of the subjects was 2.71, showed significant differences with economic condition and educational level. The better economic condition and more educated, showed the higher HPLP score. 2. They showed the highest practices in nutrition(mean score=3.11), and the lowest practices in exercise(mean score = 1.99). 3. The mean self-care activity score of the subjects was 3.36, showed significant differences with economic condition and educational level. The better economic condition and more educated, showed the higher self-care activity score. 4. The HPLP score of the subjects showed positive correlations with self-care activity score(r= .66). Developing health promotion programs focused on exercise and stress management is recommended not only for better health practices of patients with rheumatic disease but also for enhancing their level of well-being and life satisfaction.

• Journal of Ginseng Research
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• v.42 no.2
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• pp.144-148
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• 2018

Background: Panax ginseng is a well-known immune modulator, and there is concern that its immune-enhancing effects may negatively affect patients with rheumatoid arthritis (RA) by worsening symptoms or increasing the risk of adverse effects from other drugs. In this randomized, crossover clinical trial, we evaluated the impact of Korean Red Ginseng (KRG) on disease activity and safety in RA patients. Methods: A total of 80 female RA patients were randomly assigned to either the KRG (2 g/d, n = 40) treatment or placebo (n = 40) groups for 8 wk, followed by crossover to the other treatment group for an additional 8 wk. The primary outcome was the disease flare rate, defined as worsening disease activity according to the disease activity score 28 joints-erythrocyte sedimentation rate (DAS28-ESR). The secondary outcomes were development of adverse events (AEs) and patient reported outcomes. Outcomes were evaluated at baseline and 8 wk and 16 wk. The outcomes were compared using the Chi-square test. Results: Of the 80 patients, 70 completed the full study. Their mean age was 51.9 yr, and most exhibited low disease activity (mean DAS28-ESR $3.5{\pm}1.0$) at enrollment. After intervention, the flare rate was 3.7% in each group. During KRG treatment, 10 AEs were reported, while five AEs were developed with placebo; however, this difference was not statistically significant (p = 0.16). Gastrointestinal- and nervous system-related symptoms were frequent in the KRG group. Conclusion: KRG is not significantly associated with either disease flare rate or the rate of AE development in RA patients.

• IMMUNE NETWORK
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• v.7 no.3
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• pp.124-132
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• 2007

Background: Regulatory T cells (Tregs) have been investigated intensively for some decades. These cells regulate the immune system, prevent overactivated immune responses and can be used therapeutically. For rheumatoid arthritis (RA), understanding the functions and status of Tregs is an important step for understanding immune regulation in this autoimmune disease. Methods: We investigated the percentages, phenotypes and suppressive functions of $CD4^+CD25^+$ Tregs in peripheral blood (PB) of patients with RA. Results: The percentages were higher in the patients (n=12) than in healthy controls (n=10), and the cells expressed the $CD45RB^{low}$, CTLA-4 and CCR7 phenotypes. We also investigated the expression of Foxp3 and secretion of interleukin (IL)-10 induced $CD4^+CD25^+$ Tcells by anti-CD3 antibody treatment. A suppressive function of the patients' cells was shown through coculture with $CD4^+CD25^-$ T cells in vitro. Conclusion: We suggest that, despite their increased numbers and suppressive function, they manage the ongoing inflammation ineffectively. It might be possible to apply IL-10 to induce the proliferation of IL-10-producing Tregs as therapy for RA.

• Journal of muscle and joint health
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• v.5 no.2
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• pp.222-237
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• 1998

In an attempt to investigate the effect of long-term aquatic exercise program on lower limbs' muscle strength, knee Joint flexion, pain reduction and weight changes with aquatic exercise program. Forty three women with arthritis were pre and post tested for changes of muscle strength, range of motion, weight and pain. This data was collected from April 1, 1997 to February 24, 1998. The mean age was 52.5. Statistically significant in lower limbs' muscle strength with an aquatic exercise program by age, BMI, education, rheumatic drug use, illness duration until 12 weeks after experiment. Statistically significant in knee joint flexion with aquatic exercise program by age, BMI, education, rheumatic drug use, illness duration until 12 weeks after experiment. Statistically significant in pain reduction with aquatic exercise program by age, BMI, education, rheumatic drug use, illness duration until 12 weeks after experiment. Statistically significant in weight changes with aquatic exercise program by age, BMI, education, rheumatic drug use, illness duration until 6 weeks after experiment. As a conclusion, aquatic exercise programs for the patients with arthritis require at least 12 weeks and a variety of aquatic exercise programs for the effective control should be developed.

• Journal of Chest Surgery
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• v.17 no.3
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• pp.346-355
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• 1984

77 cases of Aortic Valve Replacement, which were composed of 64 rheumatic valvular heart disease and 13 combined congenital heart disease, were operated at Seoul National University Hospital for Aortic valvular disease during the period from June 1968 to December 1983. Among these 64 rheumatic aortic valvular heart disease cases, 8 patients were expired during and immediate after operation and overall mortality rate was 12.5%. For more precise remarks, these patients were divided into two periodic groups, 1st period [from 1968 to 1976] and 2nd [from 1977 to 1983] when annual open heart surgery were over 100 cases, and in 1st period three of four patients were died and in 2nd period five of sixty patients were died and its mortality rate was 8.3%. There were 12 cases of postoperative complication, which were 3 cases of remaining other valvular heart disease required MVR, 2 paravalvular leaks [one of them got Redo AVR], 4 thromboembolism or problem of anticoagulant therapy, 2 late death due to SBE with replaced valve failure and one functional AS with small sized valve. Operative death was affected by pump-time and aortic cross-clamping time, heart size, Ejection Fraction, LVEDP and symptom duration, and other many factors may influence the survival rate. Improved operative technique and myocardial protection and meticulous evaluation of the preoperative patient status will make the AVR safer.