• Journal of Chest Surgery
• /
• 제45권2호
• /
• pp.85-90
• /
• 2012

Background: At present, many surgeons prefer axillary artery cannulation because it facilitates antegrade cerebral perfusion and may diminish the risk of cerebral embolization. However, axillary artery cannulation has not been established as a routine procedure because there is controversy about its clinical advantage. Materials and Methods: We examined 111 patients diagnosed with acute type A aortic dissection between January 2000 and December 2009. The right axillary artery was cannulated in 58 patients (group A) and the femoral artery was cannulated in 53 (group F). The postoperative outcomes were retrospectively reviewed and compared between the two groups. Results: There were 46 male and 65 female patients with a mean age of $58.9{\pm}13.1$ years (range, 26 to 84 years). The extent of aortic replacement in both groups did not differ. There were 8 early deaths (7.2%) and 2 late deaths (1.8%). The mean follow-up duration was $46.0{\pm}32.6$ months (range, 1 month to 10 years). Transient neurologic dysfunction was observed in 11 patients (19.0%) in group A and 14 patients (26.4%) in group F. A total of 11 patients (9.9%) suffered from a permanent neurologic dysfunction. Early and delayed stroke were observed in 6 patients (10.3%) and 2 patients (3.4%), respectively, in group A as well as 2 patients (3.8%) and 1 patient (1.9%), respectively, in group F. There were no statistical differences in the cannulation-related complications between both groups (3 in group A vs. 0 in group F). Conclusion: There were no differences in postoperative neurologic outcomes and cannulation-related complications according to the cannulation sites. The cannulation site in an aortic dissection should be carefully chosen on a case-by-case basis. It is important to also pay attention to the possibility of intraoperative malperfusion syndrome occurring and the subsequent need to change the cannulation site.

• Korean Journal of Acupuncture
• /
• 제24권3호
• /
• pp.205-221
• /
• 2007

Objectives : Aims of this study is to investigate the effects of $LU8{\cdot}KI7$ in rat induced by experimental focal ischemia. Materials and methods : The focal ischemia was induced by intraluminal filament insertion into middle cerebral artery. The groups divided into 6groups, control; no therapy group after ischemia-induced, AT1; acupuncture therapy group at $LU8{\cdot}KI7$ after ischemia-induced, AT2; acupuncture therapy at $LU8{\cdot}KI7$ bilaterally and the needle was twirled and rotated forward with the thumb of the right hand 9times, AT3; acupuncture therapy at $LU8{\cdot}KI7$ bilaterally and the needle was twirled and rotated forward with the forefinger of the right hand 9times, AT4; acupuncture therapy at$LU8{\cdot}KI7$ bilaterally and the needle was inserted to the direction following the flowing route of the meridian(digital direction), AT5; acupuncture therapy at $LU8{\cdot}KI7$ bilaterally, the needle was inserted to the direction following the flowing route of the meridian(digital direction) and the needle was twirled and rotated forward with the thumb of the right hand 9times. Acupuncture therapy was carried out 7times during 2weeks after focal ischemia-induced. The anti-apoptotic and neuroprotective effects of acupuncture are observed by Bax, Bcl-2, mGluR5, cytochrome c, Cresyl violet and ChAT-stain. Results : The intensity of Bax was decreased in AC1, AC4, AC5 group, was increased in AC2, AC3 group. The intensity of Bcl-2 was increased in AC2, AC3, AC4, AC5 group. The intensity of mGluR5 was decreased in AC1 group, was increased in AC4, AC5 group. The intensity of Cytochrome c was increased in ACI, AC2 group, was decreased in AC4, AC5 group. The density of neurons stained by Cresyl violet was increased in all group without control group. The density of ChAT was increased in AC2, ACS group. Conclusions : Our study suggests that AC5 group show anti-apoptotic and neuroprotective effects on cholinergic neuron in focal cerebral ischemia of the stroke in rats.

• 보건행정학회지
• /
• 제29권3호
• /
• pp.303-311
• /
• 2019

Background: Cerebrovascular disease is included in four major diseases and is a disease that has high rates of prevalence and mortality around the world. Moreover, it is a disease that requires a high cost for long-term hospitalization and treatment. This study aims to figure out the correlation between grip strength, which was presented as a simple, cost-effective, and relevant predictor of cerebrovascular disease, and cerebrovascular disease based on the results of a prior study. And furthermore, our study compared model suitability of the model to measuring grip strength and relative grip strength as a predictor of cerebrovascular disease to improve the quality of cerebrovascular disease's predictor. Methods: This study conducted an analysis based on the generalized linear mixed model using the data from the Korea Longitudinal Study of Ageing from 2006 to 2016. The research subjects consisted of 9,132 middle old age people aged 45 years or older at baseline with no missing information of education level, gender, marital status, residential region, type of national health insurance, self-related health, smoking status, alcohol use, and economic activity. The grip strength was calculated the average which measured 4 times (both hands twice), and the relative grip force was divided by the body mass index as a variable considering the anthropometric figure that affects the cerebrovascular disease and the grip strength. Cerebrovascular diseases, a dependent variable, were investigated based on experiences diagnosed by doctors. Results: An analysis of the association between grip strength and found that about 0.972 (odds ratio [OR], 0.972; 95% confidence interval [CI], 0.963-0.981) was the incidence of cerebral vascular disease as grip strength increased by one unit increase and the association between relative grip strength and cerebrovascular disease found that about 0.418 (OR, 0.418; 95% CI, 0.342-0.511) was the incidence of cerebral vascular disease as relative grip strength increased by unit. In addition, the model suitability of the model for each grip strength and relative grip strength was 11,193 and 11,156, which means relative grip strength is the better application to the predictor of cerebrovascular diseases, irrespective of other variables. Conclusion: The results of this study need to be carefully examined and validated in applying relative grip strength to improve the quality of predictors of cerebrovascular diseases affecting high mortality and prevalence.

• Journal of Korean Neurosurgical Society
• /
• 제63권2호
• /
• pp.188-201
• /
• 2020

Objective : The purpose of this study was to suggest that computed tomography angiography (CTA) is valuable as the only preliminary examination for mechanical thrombectomy (MT). MT after single examination of CTA including noncontrast computed tomography (NCCT) and maximum intensity projection (MIP) improves door-to-puncture time as well as results in favorable outcomes. Methods : A total of 157 patients who underwent MT at Dong Kang Medical Center from April 2015 to March 2019 were divided into two groups based on the examination performed prior to MT : CTA group who underwent CTA with NCCT and MIP, and NCCT+magnetic resonance image (MRi) group who underwent MRI including perfusion images after NCCT. In the two groups, time to CTA imaging or NCCT+MRi imaging after symptom onset, and time to arterial puncture and reperfusion were characterized as time-related outcomes. The evaluation of vascular recanalization after MT was defined as a modified thrombolysis in cerebral infarction (mTICI) scale. National Institutes of Health Stroke Scale (NIHSS) was assessed at the time of the visit to the emergency room and modified Rankin Scale (mRS) was assessed after 90 days. Results : Typically, there were 34 patients in the CTA group and 33 patients in the NCCT+MRi group. A significantly shorter delay for door-to-puncture time was observed (mean, 86±22.1 vs. 176±47.5 minutes; <0.01). Also, a significantly shorter door-to-imege time in the CTA group was observed (mean, 13±6.8 vs. 93±30.8 minutes; p<0.01). Moreover, a significantly shorter onset-to-puncture time was observed (mean, 195±128.0 vs. 314±157.6 minutes; p<0.01). Reperfusion result of mTICI ≥2b was 100% (34/34) in the CTA group and 94% (31/33) in the NCCT+MRi group, and mTICI 3 in 74% (25/34) in the CTA group and 73% (24/33) in the NCCT+MRi group. Favorable functional outcomes (mRS score ≤2 at 90 days) were 68% (23/34) in the CTA group and 60% (20/33) in the NCCT+MRi group. Conclusion : A single-phase CTA including NCCT and MIP images was performed as a single preliminary examination, which led to a reduction in the time of the procedure and resulted in good results of prognosis. Consequently, it is concluded that this method is of sufficient value as the only preliminary examination for decision making.

• Journal of Korean Neurosurgical Society
• /
• 제60권6호
• /
• pp.654-660
• /
• 2017

Objective : Mechanical thrombectomy is increasingly being used for the treatment of acute ischemic stroke. The population over 80 years of age is growing, and many of these patients have acute infarction; however, these patients are often excluded from clinical trials, so the aim of this study was to compare the functional outcomes and complication rates in very elderly patients (age ${\geq}80$ years) and aged patients (60-79 years) treated with mechanical thrombectomy. Methods : Between January 2010 and June 2015, we retrospectively reviewed 113 senior patients (over 60 years old) treated at our institution for acute ischemic stroke with mechanical thrombectomy. They were divided into a very elderly (${\geq}80$ years) and aged (60-79 years) group, with comparisons in recanalization rates, complications, death and disability on discharge be reported. Results : The mean age was 70.3 years in the aged group and 83.4 years in the very elderly group. Elderly patients had higher rates of mechanical thrombectomy failure than the younger group (40% vs. 14%; odds ratio [OR] 4.1; 95% confidence interval [CI] 1.4-11.9; p=0.012). Results from thrombolysis in cerebral ischemia and modified Rankin scale at discharge were worse in the older group (p=0.005 and 0.023 respectively). There were no differences in mortality rate or other complications, but infarction progression rates were significantly higher in the very elderly group. (15% vs. 2.2%; OR 8.0; 95% CI 1.2-51.7; p=0.038). The majority (92.3%) of the patients who failed in aged group were not successful after several trials. However, in half (4 of 8) of the very elderly group, the occlusion site could not be accessed. Conclusion : Patients older than 80 years of age undergoing mechanical thrombectomy for acute infarction were more difficult to recanalize due to inaccessible occlusion sites and had a higher rate of infarction progression, However, mortality and other complications were similar to those in younger patients.

• Journal of Korean Neurosurgical Society
• /
• 제60권6호
• /
• pp.635-643
• /
• 2017

Objective : Acute basilar artery occlusion (BAO) is associated with severe neurological dysfunction and high mortality rates. The benefits of mechanical thrombectomy in BAO have not been explored in recent clinical trials. Therefore, we analyzed outcomes of stent retriever mechanical thrombectomy for BAO, and compared with anterior circulation occlusions (ACO). Methods : In total, 161 consecutive patients (24 BAO, 137 ACO) who underwent mechanical thrombectomy with the stent retriever between January 2013 and August 2016 enrolled in our study. All patients underwent clinical assessment with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS). Radiological results were used to evaluate thrombolysis in cerebral infarction (TICI) scores and successful recanalization was defined by TICI 2b or 3. Results : Mean NIHSS scores at 24 hours and 30 days were significantly higher in the BAO group than the ACO group (p=0.021, p=0.001). mRS at 90 days was significantly higher in the BAO group (4.2) compared with the ACO group (3.0) (p=0.003). The BAO group (2.0) performed fewer stent retriever passages than the ACO group (2.7) (p=0.049). There were no significant differences between the two groups in terms of complications, but the BAO patients experienced a higher mortality (16.6%) rate than ACO patients (5.8%) (p=0.001). In subgroup analysis of BAO, patients with short procedure times achieved successful recanalization (p=0.001) and successfully recanalized patients exhibited more favorable mRS at 90 days (p=0.027). Conclusion : In our study, mechanical thrombectomy of BAO patients showed worse clinical outcome and higher mortality rate than ACO patients. However, mechanical thrombectomy with a stent retriever in BAO is an effective treatment, because successfully recanalized patients showed good clinical outcome in BAO patients.

• Journal of Korean Neurosurgical Society
• /
• 제48권5호
• /
• pp.391-398
• /
• 2010

Objective : This study was designed to validate the cell trafficking efficiency of the in vivo bioluminescence image (BLI) study in the setting of transplantation of the luciferase expressing bone marrow-derived mesenchymal stem cells (BMSC), which were delivered at each different time after transient middle cerebral artery occlusion (MCAO) in a mouse model. Methods : Transplanting donor BMSC were prepared by primary cell culture from transgenic mouse expressing luciferase (LUC). Transient focal infarcts were induced in 4-6-week-old male nude mice. The experiment mice were divided into five groups by the time of MSC transplantation : 1) sham-operation group, 2) 2-h group, 3) 1-day group, 4) 3-day group, and 5) 1-week group. BLI for detection of spatial distribution of transplanted MSC was performed by detecting emitted photons. Migration of the transplanted cells to the infarcted area was confirmed by histological examinations. Differences between groups were evaluated by paired t-test. Results : A focal spot of bioluminescence was observed at the injection site on the next day after transplantation by Signal intensity of bioluminescence. After 4 weeks, the mean signal intensities of 2-h, 1-day, 3-day, and 1-week group were $2.6{\times}10^7{\pm}7.4{\times}10^6$. $6.1{\times}10^6{\pm}1.2{\times}10^6$, $1.7{\times}10^6{\pm}4.4{\times}10^5$, and $8.9{\times}10^6{\pm}9.5{\times}10^5$, respectively. The 2-h group showed significantly higher signal intensity (p<0.01). The engrafted BMSC showed around the infarct border zones on immunohistochemical examination. The counts of LUC-positive cells revealed the highest number in the 2-h group, in agreement with the results of BLI experiments (p<0.01). Conclusion : In this study, the results suggested that the transplanted BMSC migrated to the infarct border zone in BLI study and the higher signal intensity of LUC-positive cells seen in 2 hrs after MSC transplantation in MCAO mouse model. In addition, noninvasive imaging in real time is an ideal method for tracking stem cell transplantation. This method can be widely applied to various research fields of cell transplantation therapy.

• Korean Journal of Acupuncture
• /
• 제22권4호
• /
• pp.67-81
• /
• 2005

Objectives : Cervus Elaphus(CE) has been used to medication for ischemic stroke in the Oriental Medicine. So this study was planned to investigate the effects of CE herbal acupuncture therapy(CE-HAT) on the focal ischemia-induced by intraluminal filament insertion in the rats. Materials and methods : The focal ischemia was induced by middle cerebral artery occlusion for 2hours. The groups divided into 6 groups, normal(intachess group), control(no theray group after ischemia-induced), CE-HAT1(Cervus Elaphus-herbal acupuncture therapy group at LR1, HT9 after ischemia-induced), CE-HAT2(Cervus Elaphus-herbal acupuncture therapy group at LU8, KI7 after ischemia-induced), CE-HAT3(Cervus Elaphus-herbal acupuncture therapy group at LR1, HT9, LU8, KI7 after ischemia-induced), CE-HAT4(Cervus Elaphus-herbal acupuncture therapy group at LR1, HT9, HT3, KI10 after ischemia-induced). CE-HAT was carried out during 3 weeks after focal ischemia-induced. Eight-arm radial maze was used for the behavioral task and neuropretective effect of CE-HAT was observed by Cresyl violet, AchE, ChAT-stain. Results : The error rate in the eight-arm radial maze task was significantly decreased in CE-HAT1, CE-HAT2, CE-HAT4 on 3days, CE-HAT4 on 4days, CE-HAT2, CE-HAT4 on 5days, CE-HAT3, CE-HAT4 on 6days. The rate of correct choice was significantly increased in CE-HAT4. The density of neurons in the hippocampal CA1 was significantly increased in CE-HAT1, CE-HAT2, CE-HAT3, CE-HAT4, compared to control group. The density of ChAT in the hippocampal CA1 was significantly increase in CE-HAT4. The density of ChAT in the hippocampal CA1 was significantly increased CE-HAT1. Conrlusions : These results suggest that the Cervus Elaphus-herbal acupuncture therapy could be used as a medication for controlling the stroke induced by deficiency.

• 생명과학회지
• /
• 제17권7호통권87호
• /
• pp.1019-1022
• /
• 2007

뇌졸중 환자에 사용되는 tPA치료법은 혈전을 용해시키고 혈액의 흐름을 용이하게 해 주기 때문에 매우 중요하게 사용되고 있다. 동물 실험모델을 이용한 이전의 실험결과에 따르면 tPA뿐 아니라 tPA의 일종인 pamite-plase 역시 30분 이내 탁월한 혈전 용해의 효과를 보여주었다. 그러나 fPA치료법은 단시간 처리와 출혈, 부종과 같은 여러 가지 부작용이 수반될 수 있으며 이들은 MMP-9의 활성 조절과 깊은 관련이 있는 것으로 보고되고 있다. 본 연구에서는 임상에 사용되는 tPA의 한 종류인 alteplase와 이러한 부정적인 효과를 극복하기 위해 개발된 pamiteplase의 MMP-9활성에 미치는 효과를 비교 분석하였다. 랫트의 뇌로부터 추출한 신경세포에서 alteplase의 처리는 농도의존적으로 MMP-9의 발현을 촉진시켰고 활성화된 형태의 MMP-2역시 증가되는 양상을 보였다. 반면, pamiteplase의 경우 MMP-2와 MMP-9의 발현양상에 영항을 미치지 않았다. 유사한 효과는 뇌신경계를 구성하는 다른 세포인 성상세포에서도 관찰되었다. 즉 대뇌의 성상세포를 분리, 배양하여 이들의 효과를 확인한 결과 신경세포에서와 마찬가지로 alteplase의 경우 농도의존적으로 증가하였고 pamiteplasse의 경우 변화를 나타내지 않았다. Pamiteplase는 뇌신경구성세포에서 출혈과 부종을 유도하는 데 관련이 있는 것으로 보고된 MMP-9의 활성에 영향을 미치지 않는 것으로 보아 alteplase에 비해 보다 효과적인 치료제로서의 가능성을 보여주고 있다.

• 한국전문물리치료학회지
• /
• 제9권2호
• /
• pp.61-81
• /
• 2002

The purposes of this research were to investigate home care rehabilitation services in rural areas and to collect basic data about disabled persons necessary when for carrying out rehabilitation services. Respondents were selected from six of a total of eight townships (Myon) and one town (Eup) in the Wonju city area. Wonju is in Kangwon Province (Do). Of a total of 338 names provided by the Myon offices, 298 persons were located and included registered and non-registered persons. Conditions included stroke, spinal cord injury, and cerebral palsy in addition to disabilities classified as first, second or third degree, in the case of registered cases. Respondent demographic characteristics, medical characteristics, rehabilitation service needs, willingness to receive rehabilitation service and individual opinions regarding rehabilitation services were analysed by frequency and percentage. The results were as follows: 1) Rehabilitation services received by disabled persons living at home in the rural areas surrounding Wonju city were medical rehabilitation (41.7%), diagnosis (36.5%), rehabilitation assistive devices (7.6%), social assistance (7.1%), rehabilitation counseling (3.0%), vocational rehabilitation (1.8%), educational rehabilitation (1.6%) and housekeeping services (0.5%). The majority of rehabilitation services were medical rehabilitation provided at hospitals and oriental medicine hospitals. 2) Sixty point eight percent of respondents expressed their willingness to receive home care rehabilitation services. Needs expressed were highest for medical rehabilitation (27.0%), followed by social assistance (19.4%), medical examination (12.4%), physician-generated diagnosis in the home setting (11.6%), sociopsychological rehabilitation (9.3%), vocational rehabilitation (7.6%), rehabilitation engineering (6.0%), educational rehabilitation (3.3%), and housekeeping services (3.3%). 3) Rehabilitation service needs were analyzed by severity classification: 65.8% of first degree, 62.7% of second degree and 55.6% of third degree disability classification, and 62.7% of non-registered disabled individuals responded that rehabilitation service was necessary. 4) Rehabilitation service needs were also analyzed by diagnosis: 62.6% of stroke, 85.5% of amputation, 60.0% of spinal cord injury and 52.4% of traumatic brain injury respondents answered positively that they were willing to receive rehabilitation service if it were to be provided. Rehabilitation service utilization data of disabled individuals living at home in rural areas were investigated and their rehabilitation needs analyzed. This critical information can be used when community-based rehabilitation programs for disabled persons living at home are planned for provision out of a public health center or when community-based rehabilitation welfare policy is formulated.