En sjukdom af högst elakt släckte : Återfallsfebern på Sveaborg och i Karlskrona 1788-1790

Sommaren 1788 drabbades den svenska flottan av en svårartad febersjukdom. Febern, som senare definierats som febris recurrens el. återfallsfeber, hade sitt ursprung i den ryska flottan. Besättningen ombord skeppet Vladislav, krigsbytet från slaget vid Hogland, bar på ett stort antal smittade klädlöss. Efter flottans ankomst till Sveaborg spred sig sjukdomen snabbt bland manskapet, men även bland fästningens garnison. Förhållandena inom militären, både inom lantarmén och framför allt inom flottan, var gynnsamma för epidemiers spridning. De trånga utrymmena, den ensidiga kosten, det undermåliga dricksvattnet, den bristande hygienen: allt gynnade uppkomsten och spridningen av olika epidemier. Manskapets försämrade allmäntillstånd gjorde, att sjukdomarna blev mera förödande än vad de i andra förhållanden skulle ha varit. Bristen på manskap och material under Gustav III:s ryska krig var enormt, bl.a. var bristen på medicinsk personal och -utrustning skriande. Då flottan och armén drabbades av en epidemi av katastrofala dimensioner stod myndigheterna hjälplösa. Epidemin visaqr tydligt hur illa förberett hela kriget var och hur misskött flottans sjukvård var. På Sveaborg var förhållandena fruktansvärda. Halva garnisonen uppges ha avlidit, och det låg travar av lik överallt. Kaserner m.fl. byggnader adapterades till provisoriska lasarett och det rådde brist på allt. De medicinska myndigheterna representerades av den till fästningen skickade andra fältläkaren, som tillsammans med läkarna på fästningen gjorde sitt bästa i enlighet med tidens vårdmetoder. Då den svenska örlogsflottan i november seglat över tilll Karlskrona spred sig epidemin i staden. Sjukdomen grasserade också bland de civila. Då sjukdomens orsak och utbredningssätt var okända, kunde man varken hindra epidemin från att spridas eller genomföra adekvata vårdmetoder. Tvärtom, med de hemförlovade båtsmännen spred sig sjukdomen även till de övriga delarna av riket. Under 1789 var flottan p.g.a. de många sjukdomsfallen närmast operationsoduglig. Under vårvintern och våren 1790 avtog epidemin. Epidemin var ett svårt medicinskt problem. För att utreda situationen i Karlskrona skickade den tillförordnade regeringen, utredningskommissionen och Collegium medicum sina egna representanter till staden. De olika läkarnas sjukdomssyner grundade sig främst på tron om sjukdomars uppkomst genom miasma och förbättrandet av luftkvaliteten sågs som en väsentlig vårdform. I arbetet jämförs de olika myndigheternas och några av de på platsen varande läkarnas syn på sjukdomens art, dess orsaker och ursprung. De flesta härleder sjukdomen till den ryska flottan, och nämner någon form av smitta. Som främsta sjukdomsorsak nämns dock miasma och de rekommenderade vårdformerna representerade den humoralpatologiska synen. Förste amiralitetsläkaren Arvid Faxe representerar dock en annan åsikt, i det att han enbart tror på sjukdomens överföring via smitta. Epidemin var också ett politiskt problem. Epidemin var en lokal angelägenhet ända till dess att flottans operationer hämmades av manskapsbristen, varefter den blev ett ärende på högsta nivå. Kungen ingrep sommaren 1789 genom att grunda en kommision med rätt vidsträckta befogenheter. I Karlskrona verkar de militära myndigheterna och läkarna ha misstrott och skuldsatt varandra för katastrofen, och förhållandet mellan de till staden sända utredarna och militärerna var likaså inflammerat. Genom källorna återspeglas rivalitet, avund och inbördes konkurrens. Personalbristen var svår, och den skyldiga söktes utanför den egna kretsen. Den danskfödde apotekaren med sina påstott otjänliga mediciner blev en ypperlig syndabock. Örlogsflottan beräknas i sjukdomar ha förlorat omkring 10.000 man i döda, huvudsakligen i Karlskrona (civila inberäknade). Armén och Skärgårdsflottan uppges likadeles ha mist omkring 10.000 man, medan antalet i strid stupade armésoldater endast var ca 1500. Sammanlagt antas alltså ca 20.000 människor ha mist livet; både i återfallsfeber, men även i andra, samtidigt grasserande farsoter. I denna siffra är inte de övriga delarna av riket inberäknade. Epidemin i fråga kan alltså på goda grunder anses vara det svenska 1700-talets största medicinska katastrof.

Drag på parnassen. Två sextiotalsstudier. : Del I: Medelklass med mänskligt ansikte. Medelklassradikalism i fyra romaner av Christer Kihlman, Jarl Sjöblom, Marianne Alopaeus och Ulla-Lena Lundberg. Del II: Modernistdebatten. Sak, person och fält i en finlandssvensk litteraturdebatt år 1965.

The objective of my dissertation Pull (or Draught, or Moves) at the Parnassus , is to provide a deeper understanding of Nordic Middle Class radicalism of the 1960 s as featured in Finland-Swedish literature. My approach is cultural materialist in a broad sense; social class is regarded a crucial aspect of the contents and contexts of the novels and literary discussions explored. In the first volume, Middle Class With A Human Face , novels by Christer Kihlman, Jarl Sjöblom, Marianne Alopaeus, and Ulla-Lena Lundberg, respectively, are read from the points of view of place, emotion, and power. The term "cryptotope" is used to designate the hidden places found to play an important role in all of these four narratives. Also, the "chronotope of the provincial small town", described by Mikhail Bakhtin in 1938, is exemplified in Kihlman s satirical novel, as is the chronotope of of war (Algeria, Vietnam) in those of Alopaeus and Lundberg s. All the four novels signal changes in the way general "scripts of emotions", e.g. jealousy, are handled and described. The power relations in the novels are also read, with reference to Michel Foucault. As the protagonists in two of them work as journalists, a critical discussion about media and Bourgeois hegemony is found; the term "repressive legitimation" is created to grasp these patterns of manipulation. The Modernist Debate , part II of the study, concerns a literary discussion between mainly Finland-Swedish authors and critics. Essayist Johannes Salminen (40) provided much of the fuel for the debate in 1963, questioning the relevance to contemporary life of the Finland-Swedish modernist tradition of the 1910 s and 1920 s. In 1965, a group of younger authors and critics, including poet Claes Andersson (28), followed up this critique in a debate taking place mainly in the newspaper Vasabladet. Poets Rabbe Enckell (62), Bo Carpelan (39) and others defended a timeless poetry. This debate is contextualized and the changing literary field is analyzed using concepts provided by sociologist Pierre Bourdieu. In the thesis, the historical moment of Middle Class radicalism with a human face is regarded a temporary luxury that new social groups could afford themselves, as long as they were knocking over the statues and symbols of the Old Bourgeoisie. This is not to say that all components of the Sixties strategy have lost their power. Some of them have survived and even grown, others remain latent in the gene bank of utopias, waiting for new moments of change.

Den brændende Fakkel : Om dobbeltgrebet i Knud Lyne Rahbeks liv og revolutionsroman

Professor Knud Lyne Rahbek was a novelist, playwright, poet, magazine editor, journalist, socialite person, host of the Bakkehus , historian, theatre manager, translator, publisher etc., but his versatility either side of 1800 is better known than read and more despised than understood. In terms of methodology, the thesis is based on biographical, historical and philological research, while at the same time making use of formalistic and close reading methods. This study begins and ends with 7th of February 1800, when Kamma and Knud Lyne Rahbek join the exiled P.A. Heiberg at the inn near Frederiksberg Castle. What falls between is an interpretation of Rahbek s works in the service of democracy, human rights and freedom of the press as a pragmatic navigation between activities - both subversive and legitimate. Posterity mistook this range as mere spinelessness, and Rahbek was relegated to the literary and historical margins as an anachronism and as a jack of all trades, who did not know what he really wanted and therefore flitted about in so many fields just to be present. But Rahbek s problem was not one of standpoint, but rather how to find a balance between totalizing attitudes and confrontations between rebellious idealism and deep-rooted absolutism, without foregoing his belief in enlightenment, humanism and tolerance. In this way, and also through his personal conduct, which at that time was seen as jovial bonhommie, he made his contribution to the development of modern democratic Denmark in the full awareness of a popular, peaceful and down-to-earth community. Rahbek s principal work about the event of the French Revolution, which provides the focus for the above, is Camill og Constance. Et Revolutions Skilderie (1799). For today s reader, the novel about the revolution is an obvious example of a historical novel, as it does not only provide fictionalized information about past events placing them in a generally accepted perspective of historical development, but also gives the characters qualities, which, in Rahbek s words, allows the real events to influence the fictional characters. From this point of view, the novel of the revolution has shifted the benchmark for the first real historical novel on the European literary scene back by fifteen years. Lacking the aura so easily foisted on fearless iconoclasts or tragic losers, Rahbek s contribution may seem modest in spite of its enormous volume; but only when it is not evaluated in its full context, which is the development of Denmark towards an international democratic society.

"Han är en trollkarl. Alla skriver laudatur som går på hans lektioner" : en studie om elevernas uppfattningar om orsakerna till toppresultat i svenska i tre finska gymnasier

Tämä pro gradu -tutkielma on tehty osana Svenska i toppen -projektia, joka alkoi syksyllä 2008 Pohjoismaisten kielten ja pohjoismaisen kirjallisuuden laitoksella. Tutkimuksen tavoitteena on selvittää, mitkä tekijät vaikuttavat lukiolaisten näkökulmasta hyvien tulosten saavuttamiseen ruotsin ylioppilaskirjoituksissa kolmessa suomenkielisessä lukiossa, jotka sijaitsevat Turun, Tampereen ja Joensuun seuduilla. Lisäksi tavoitteena on selvittää, miten maantieteelliset tekijät vaikuttavat opiskelijoiden ruotsin kielen osaamiseen sekä mitä eroja on keskipitkän ja pitkän ruotsin oppimäärän opiskelijoiden asenteissa kieltä kohtaan. Tutkielman aineistona on kolme ryhmähaastattelua, joihin on osallistunut 14 lukiolaista, 11 tyttöä ja 3 poikaa. Haastattelut on tehty joulukuussa 2008 sekä tammi- ja maaliskuussa 2009. Haastatteluissa on käytetty strukturoitua kyselylomaketta, jossa kysytään opiskelijoiden näkemyksiä ruotsin opiskelusta. Tutkimusmenetelmänä on kvalitatiivinen tutkimusote, jossa on piirteitä kolmesta eri menetelmästä: tapaustutkimuksesta, etnografisesta tutkimuksesta sekä temaattisesta analyysistä. Tärkeimpänä teoriataustana on ruotsi toisena kielenä -tutkimus, oppiminen sosiokonstruktivistisena ilmiönä sekä motivaatiotutkimus. Tarkastelen kielenoppijaa luokkahuoneessa sosiaalisena osallistujana omassa oppimisprosessissaan. Oppiminen nähdään kokonaisuutena, johon kuuluu eri osa-alueita, esimerkiksi koulujen käytännöt, yhteisön vaikutus oppimiseen sekä opiskelijan identiteetin muokkautuminen kouluyhteisössä. Motivaatiota tarkastelen kielenoppimisen näkökulmasta, ja se koostuu erilaisista dynaamisista vaiheista, esimerkiksi tavoitteiden asettamisesta oppimisprosessin alussa, valintojen tekemisestä sekä motivaation ylläpitämisestä oppimisprosessin kuluessa. Tutkimuksen tulokset osoittavat, että suurin yksittäinen syy menestykseen opiskelijoiden näkökulmasta on opettaja, joka omalla toiminnallaan voi merkittävästi parantaa opiskelijoiden oppimisedellytyksiä. Työhön panostaminen, opiskelijoiden yksilöllinen kohtaaminen myös luokkahuoneen ulkopuolella ja esimerkiksi omien oppimateriaalien valmistaminen ovat opettajaan liittyviä tekijöitä, jotka voivat nostaa opiskelijoiden motivaatiota huomattavasti. Myös lukion maantieteellisellä sijainnilla on vaikutusta. Paikkakunnilla, joilla ruotsin kieltä käytetään vähän, korostuu opettajan rooli kielellisen oppimisympäristön luomisessa. Keskipitkän ja pitkän ruotsin opiskelijoiden välillä ei tutkimuksessa ilmene eroja asenteissa kieltä kohtaan.

p53 and DNA damage checkpoint responses in the human prostate

Prostate cancer is the most common noncutaneous malignancy and the second leading cause of cancer mortality in men. In 2004, 5237 new cases were diagnosed and altogether 25 664 men suffered from prostate cancer in Finland (Suomen Syöpärekisteri). Although extensively investigated, we still have a very rudimentary understanding of the molecular mechanisms leading to the frequent transformation of the prostate epithelium. Prostate cancer is characterized by several unique features including the multifocal origin of tumors and extreme resistance to chemotherapy, and new treatment options are therefore urgently needed. The integrity of genomic DNA is constantly challenged by genotoxic insults. Cellular responses to DNA damage involve elegant checkpoint cascades enforcing cell cycle arrest, thus facilitating damage repair, apoptosis or cellular senescence. Cellular DNA damage triggers the activation of tumor suppressor protein p53 and Wee1 kinase which act as executors of the cellular checkpoint responses. These are essential for genomic integrity, and are activated in early stages of tumorigenesis in order to function as barriers against tumor formation. Our work establishes that the primary human prostatic epithelial cells and prostatic epithelium have unexpectedly indulgent checkpoint surveillance. This is evidenced by the absence of inhibitory Tyr15 phosphorylation on Cdk2, lack of p53 response, radioresistant DNA synthesis, lack of G1/S and G2/M phase arrest, and presence of persistent gammaH2AX damage foci. We ascribe the absence of inhibitory Tyr15 phosphorylation to low levels of Wee1A, a tyrosine kinase and negative regulator of cell cycle progression. Ectopic Wee1A kinase restored Cdk2-Tyr15 phosphorylation and efficiently rescued the ionizing radiation-induced checkpoints in the human prostatic epithelial cells. As variability in the DNA damage responses has been shown to underlie susceptibility to cancer, our results imply that a suboptimal checkpoint arrest may greatly increase the accumulation of genetic lesions in the prostate epithelia. We also show that small molecules can restore p53 function in prostatic epithelial cells and may serve as a paradigm for the development of future therapeutic agents for the treatment of prostate cancer We hypothesize that the prostate has evolved to activate the damage surveillance pathways and molecules involved in these pathways only to certain stresses in extreme circumstances. In doing so, this organ inadvertently made itself vulnerable to genotoxic stress, which may have implications in malignant transformation. Recognition of the limited activity of p53 and Wee1 in the prostate could drive mechanism-based discovery of preventative and therapeutic agents.

Komplexa tal - vad är det?

Komplexa tal har traditionellt undervisats i de finländska gymnasierna som en valbar kurs. Denna situation har förändrats i och med de nya läroplanerna som tagits i bruk senast hösten 2005. Den nya, striktare läroplanen ger inte lika stora valmöjligheter för skolorna att bestämma undervisningsstoffet, inte ens för de valbara kurserna, och därför har många gymnasier varit tvungna att sluta undervisa om komplexa tal. För att fortsättningsvis ge en möjlighet för gymnasieelever att studera komplexa tal finns detta kompendium. Kompendiet fyller två syften. I de gymnasier där komplexa tal fortfarande finns med i läroplanen kan kompendiet användas som läromedel på ifrågavarande kurs. Kompendiet torde vara önskat eftersom det inte existerar något modernt, finlandssvenskt läromedel där de komplexa talen tas upp. Kompendiets andra, huvudsakliga syfte är att finnas till att ge en möjlighet för de elever, som inte går ett gymnasium där komplexa tal undervisas, att på egen hand lära sig grunder om komplexa tal. Kunskap om utvidgandet av talområdet från reella talen till komplexa hör till matematisk allmänbildning, och är till stor nytta om man är intresserad av att fortsätta studera matematik eller naturvetenskaper efter gymnasiet. Kompendiet kommer att läggas ut på nätet för att få det lättillgängligt. I det första kapitlet behandlas matematikens uppkomst. Det andra kapitlet är en introduktion till varför man behöver komplexa tal, där gås tal- och mängdlära igenom samtidigt som de i kompendiet använda beteckningarna introduceras. I det tredje kapitlet behandlas de komplexa talen; grundläggande räkneregler, absolutbelopp och argument, komplexa tal i polär form och lösning till högregradsekvationer är centrala begrepp. de Moivers formel är ett av de viktigare målen, även Eulers formel behandlas kort. Problematik med negativa kvadratrötter tas också upp. Det fjärde kapitlet handlar om de komplexa talens intressanta historia. I kompendiet finns rikligt med exempel och övningsuppgifter. Kapitel fem innehåller extra övningsuppgifter och i kapitel sex finns lösningarna till samtliga uppgifter. Trots att kompendiets omfång avsevärt ökas i och med dessa lösningar är det av värde att de finns med för att kompendiets huvudsakliga syfte skall uppfyllas: att eleverna på egen hand skall kunna lära sig stoffet.

Eru Ilúvatar : Jumala J.R.R. Tolkienin legendariumissa

The purpose of my research is to inquire into the essence and activity of God in the legendarium of the English philologist and writer J.R.R. Tolkien (1892-1973). The legendarium, composed of Tolkien’s writings related to Middle-earth, was begun when he created two Elvish languages, Quenya based on Finnish, Sindarin based on Welsh. Tolkien developed his mythology inspired by Germanic myths and The Kalevala. It is a fictional ancient history set in our world. The legendarium is monotheistic: God is called Eru ‘The One’ and Ilúvatar ‘Father of All’. Eru is the same as the Christian God, for Tolkien wanted to keep his tales consistent with his faith. He said his works were Christian by nature, with the religious element absorbed into the story and the symbolism. In The Silmarillion, set in the primeval ages of Middle-earth, the theological aspects are more conspicuous, while in The Lord of the Rings, which brings the stories to an end, they are mostly limited to symbolic references. The legendarium is unified by its realistic outlook on creaturely abilities and hope expressing itself as humbly defiant resistance. ”The possibility of complexity or of distinctions in the nature of Eru” is a part of the legendarium. Eru Ilúvatar is Trinitarian, as per Tolkien’s faith. Without contextual qualifiers, Eru seems to refer to God the Father, like God in the Bible. Being the creator who dwells outside the world is attributed to Him. The Holy Spirit is the only Person of the Trinity bestown with names: the Flame Imperishable and the Secret Fire. When Eru creates the material world with His word, He sends the Flame Imperishable to burn at the heart of the world. The Secret Fire signifies the Creative Power that belongs to God alone, and is a part of Him. The Son, the Word, is not directly mentioned, but according to one writing Eru must step inside the world in order to save it from corruption, yet remain outside it at the same time. The inner structure of the legendarium refers to the need for a future salvation. The creative word of Eru, “Eä! Let these things Be!”, probably has a connection with the Logos in Christianity. Thus we can find three “distinctions” in Eru: a Creator who dwells outside the world, a Sustainer who dwells inside it and a Redeemer who shall step inside it. Some studies of Tolkien have claimed that Eru is distant and remote. This seems to hold water only partially. Ilúvatar, the Father of All, has a special relation with the Eruhíni, His Children, the immortal Elves and the mortal Men. He communicates with them directly only through the Valar, who resemble archangels. Nevertheless, only the Children of Eru can fight against evil, because their tragic fortunes turn evil into good. Even though religious activities are scarce among them, the fundamental faith and ultimate hope of the “Free Peoples” is directed towards Eru. He is present in the drama of history as the “Author of the Story”, who at times also interferes with its course through catastrophes and eucatastrophes, ‘good catastrophes’. Eru brings about a catastrophe when evil would otherwise bring good to an end, and He brings about a eucatasrophe when creaturely strength is not sufficent for victory. Victory over corruption is especially connected with mortal Men, of whom the most (or least) insignificant people are the Hobbits. However, because of the “primeval disaster” (that is, fall) of Mankind, ultimate salvation can only remain open, a hope for the far future.

Cutaneous porphyrias : Clinical and histopathological study

The prevalence of variegate porphyria (VP) (2.1:100 000, in 2006 n=108) was higher in Finland than elsewhere in European countries due to a founder effect (R152C). The incidence of VP was estimated at 0.2:1 000 000 based on the number of new symptomatic patients yearly. The prevalence of porphyria cutanea tarda (PCT) was 1.2:100 000 (in 2006 n=63), which is only one fourth of the numbers reported from other European countries. The estimated incidence of PCT was 0.5:1 000 000. Based on measurements of the uroporphyrinogen decarboxylase activity in erythrocytes, the proportion of familial PCT was 49% of the cases. The prevalence of erythropoietic protoporphyria (EPP) was at 0.8:100 000 (in 2006 n=39) including asymptomatic carriers of a mutation in the ferrochelatase (FECH) gene. The incidence of EPP was estimated at 0.1:1 000 000. After 1980 the penetrance was 37% among patients with VP. Of the mutation carriers (n=57) 30% manifested with skin symptoms. Frequency of skin symptom as only clinical sign was stable before or after 1980 (22% vs. 21%), but acute attacks became infrequent (29% vs. 7%). Of the symptomatic patients 30% had both acute attacks and skin symptoms and 80% had skin symptoms. Fragility (95%) and blistering (46%) of the skin in the backs of the hands were the most common skin symptoms. Transient correction of porphyrin metabolism using eight haem arginate infusions within five weeks had no effect on the skin symptoms in three of four patients with VP. In one case skin symptoms disappeared transiently. One patient with homozygous VP had severe photosensitivity since birth. Sensory polyneuropathy, glaucoma and renal failure developed during the 25-year follow-up without the presence of acute attacks. The I12T mutation was detected in both of his alleles in the protoporphyrinogen oxidase gene. Lack of skin symptoms and infrequency of acute attacks (1/9) in the patients with I12T mutation at the heterozygous stage indicate a mild phenotype (the penetrance 11%). Four mutations (751delGAGAA, 1122delT, C286T, C343T) in the FECH gene were characterised in four of 15 families with EPP. Burning pain (96%) and swelling (92%) of the sun-exposed skin were the major skin symptoms. Hepatopathy appeared in one of 25 symptomatic patients (4%). Clinical manifestations and associated factors of PCT were similar in the sporadic and familial types of PCT. The majority of the patients with PCT had one to three precipitating factors: alcohol intake (78%), mutations in hemochromatosis associated gene (50%), use of oestrogen (25% of women) and hepatitis B or C infections (25 %). Fatty liver disease (67%) and siderosis (67%) were commonly found in their liver biopsies. The major histopathological change of the sun-exposed skin in the patients with VP (n=20), EPP (n=8) and PCT (n=5) was thickening of the vessel walls of the upper dermis suggesting that the vessel wall is the primary site of the phototoxic reaction in each type of porphyria. The fine structure of the vessel walls was similar in VP, EPP and PCT consisting of the multilayered basement membrane and excess of finely granular substance between the layers which were surrounded by the band of homogenous material. EPP was characterised by amorphous perivascular deposits extending also to the extravascular space. In direct immunofluorescence study homogenous IgG deposits in the vessel walls of the upper dermis of the sun-exposed skin were demonstrated in each type of porphyria. In EPP the excess material around vessel walls consisted of other proteins such as serum amyloid protein, and kappa and lambda light chains in addition to the basement membrane constituents such as collagen IV and laminin. These results suggest that the alterations of the vessel walls are a consequence of the repeated damage and the repairing process in the vessel wall. The microscopic alterations could be demonstrated even in the normal looking but sun-exposed skin of the patients with EPP during the symptom-free phase suggesting that vascular change can be chronic. The stability of vascular changes in the patients with PCT after treatment indicates that circulating porphyrins are not important for the maintenance of the changes.

Atrial remodeling in atrial fibrillation : Epidemiological, clinical and magnetocardiographic aspects

Atrial fibrillation is the most common arrhythmia requiring treatment. This Thesis investigated atrial fibrillation (AF) with a specific emphasis on atrial remodeling which was analysed from epidemiological, clinical and magnetocardiographic (MCG) perspectives. In the first study we evaluated in real-life clinical practice a population-based cohort of AF patients referred for their first elective cardioversion (CV). 183 consecutive patients were included of whom in 153 (84%) sinus rhythm (SR) was restored. Only 39 (25%) of those maintained SR for one year. Shorter duration of AF and the use of sotalol were the only characteristics associated with better restoration and maintenance of SR. During the one-year follow-up 40% of the patients ended up in permanent AF. Female gender and older age were associated with the acceptance of permanent AF. The LIFE-trial was a prospective, randomised, double-blinded study that evaluated losartan and atenolol in patients with hypertension and left ventricular hypertrophy (LVH). Of the 8,851 patients with SR at baseline and without a history of AF 371 patients developed new-onset AF during the study. Patients with new-onset AF had an increased risk of cardiac events, stroke, and increased rate of hospitalisation for heart failure. Younger age, female gender, lower systolic blood pressure, lesser LVH in ECG and randomisation to losartan therapy were independently associated with lower frequency of new-onset AF. The impact of AF on morbidity and mortality was evaluated in a post-hoc analysis of the OPTIMAAL trial that compared losartan with captopril in patients with acute myocardial infarction (AMI) and evidence of LV dysfunction. Of the 5,477 randomised patients 655 had AF at baseline, and 345 patients developed new AF during the follow-up period, median 3.0 years. Older patients and patients with signs of more serious heart disease had and developed AF more often. Patients with AF at baseline had an increased risk of mortality (hazard ratio (HR) of 1.32) and stroke (HR 1.77). New-onset AF was associated with increased mortality (HR 1.82) and stroke (HR of 2.29). In the fourth study we assessed the reproducibility of our MCG method. This method was used in the fifth study where 26 patients with persistent AF had immediately after the CV longer P-wave duration and higher energy of the last portion of atrial signal (RMS40) in MCG, increased P-wave dispersion in SAECG and decreased pump function of the atria as well as enlarged atrial diameter in echocardiography compared to age- and disease-matched controls. After one month in SR, P-wave duration in MCG still remained longer and left atrial (LA) diameter greater compared to the controls, while the other measurements had returned to the same level as in the control group. In conclusion is not a rare condition in either general population or patients with hypertension or AMI, and it is associated with increased risk of morbidity and mortality. Therefore, atrial remodeling that increases the likelihood of AF and also seems to be relatively stable has to be identified and prevented. MCG was found to be an encouraging new method to study electrical atrial remodeling and reverse remodeling. RAAS-suppressing medications appear to be the most promising method to prevent atrial remodeling and AF.

Atrial Electric Signal During Sinus Rhythm in Lone Paroxysmal Atrial Fibrillation

Atrial fibrillation (AF) is the most common tachyarrhythmia and is associated with substantial morbidity, increased mortality and cost. The treatment modalities of AF have increased, but results are still far from optimal. More individualized therapy may be beneficial. Aiming for this calls improved diagnostics. Aim of this study was to find non-invasive parameters obtained during sinus rhythm reflecting electrophysiological patterns related to propensity to AF and particularly to AF occurring without any associated heart disease, lone AF. Overall 240 subjects were enrolled, 136 patients with paroxysmal lone AF and 104 controls (mean age 45 years, 75% males). Signal measurements were performed by non-invasive magnetocardiography (MCG) and by invasive electroanatomic mapping (EAM). High-pass filtering techniques and a new method based on a surface gradient technique were adapted to analyze atrial MCG signal. The EAM was used to elucidate atrial activation in patients and as a reference for MCG. The results showed that MCG mapping is an accurate method to detect atrial electrophysiologic properties. In lone paroxysmal AF, duration of the atrial depolarization complex was marginally prolonged. The difference was more obvious in women and was also related to interatrial conduction patterns. In the focal type of AF (75%), the root mean square (RMS) amplitudes of the atrial signal were normal, but in AF without demonstrable triggers the late atrial RMS amplitudes were reduced. In addition, the atrial characteristics tended to remain similar even when examined several years after the first AF episodes. The intra-atrial recordings confirmed the occurrence of three distinct sites of electrical connection from right to left atrium (LA): the Bachmann bundle (BB), the margin of the fossa ovalis (FO), and the coronary sinus ostial area (CS). The propagation of atrial signal could also be evaluated non-invasively. Three MCG atrial wave types were identified, each of which represented a distinct interatrial activation pattern. In conclusion, in paroxysmal lone AF, active focal triggers are common, atrial depolarization is slightly prolonged, but with a normal amplitude, and the arrhythmia does not necessarily lead to electrical or mechanical dysfunction of the atria. In women the prolongation of atrial depolarization is more obvious. This may be related to gender differences in presentation of AF. A significant minority of patients with lone AF lack frequent focal triggers, and in them, the late atrial signal amplitude is reduced, possibly signifying a wider degenerative process in the LA. In lone AF, natural impulse propagation to LA during sinus rhythm goes through one or more of the principal pathways described. The BB is the most common route, but in one-third, the earliest LA activation occurs outside the BB. Susceptibility to paroxysmal lone AF is associated with propagation of the atrial signal via the margin of the FO or via multiple pathways. When conduction occurs via the BB, it is related with prolonged atrial activation. Thus, altered and alternative conduction pathways may contribute to pathogenesis of lone AF. There is growing evidence of variability in genesis of AF also within lone paroxysmal AF. Present study suggests that this variation may be reflected in cardiac signal pattern. Recognizing the distinct signal profiles may assist in understanding the pathogenesis of AF and identifying subgroups for patient-tailored therapy.