• Journal of Korean Neurosurgical Society
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• 제59권4호
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• pp.346-351
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• 2016

Objective : Early progressive infarction (EPI) is frequently observed and related to poor functional outcome in patients with middle cerebral artery (MCA) infarction caused by MCA occlusion. We evaluated the perfusion parameters of magnetic resonance imaging (MRI) as a predictor of EPI. Methods : We retrospectively analyzed patients with acute MCA territory infarction caused by MCA occlusion. EPI was defined as a National Institutes of Health Stroke Scale increment ${\geq}2$ points during 24 hours despite receiving standard treatment. Regional parameter ratios, such as cerebral blood flow and volume (rCBV) ratio (ipsilateral value/contralateral value) on perfusion MRI were analyzed to investigate the association with EPI. Results : Sixty-four patients were enrolled in total. EPI was present in 18 (28%) subjects and all EPI occurred within 3 days after hospitalization. Diabetes mellitus, rCBV ratio and regional time to peak (rTTP) ratio showed statically significant differences in both groups. Multi-variate analysis indicated that history of diabetes mellitus [odds ratio (OR), 6.13; 95% confidence interval (CI), 1.55-24.24] and a low rCBV ratio (rCBV, <0.85; OR, 6.57; 95% CI, 1.4-30.27) was significantly correlated with EPI. Conclusion : The incidence of EPI is considerable in patients with acute MCA territory infarction caused by MCA occlusion. We suggest that rCBV ratio is a useful neuro-imaging parameter to predict EPI.

• Journal of Chest Surgery
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• 제49권1호
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• pp.15-21
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• 2016

Background: We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). Methods: A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. Results: Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was $61.2{\pm}17.5years$ (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. Conclusion: Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.

• Korean Circulation Journal
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• 제53권7호
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• pp.452-471
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• 2023

The Korean Society of Heart Failure (KSHF) Guidelines provide evidence-based recommendations based on Korean and international data to guide adequate diagnosis and management of heart failure (HF). Since introduction of 2017 edition of the guidelines, management of advanced HF has considerably improved, especially with advances in mechanical circulatory support and devices. The current guidelines addressed these improvements. In addition, we have included recently updated evidence-based recommendations regarding acute HF in these guidelines. In summary, Part IV of the KSHF Guidelines covers the appropriate diagnosis and optimized management of advanced and acute HF.

• Annals of Clinical Neurophysiology
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• 제9권1호
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• pp.1-4
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• 2007

Vertigo is an illusion of rotation, which results from an imbalance within the vestibular system. This review focuses on two common presentations of spontaneous vertigo: acute prolonged spontaneous vertigo and recurrent spontaneous vertigo. Common causes of acute prolonged spontaneous vertigo include vestibular neuritis, labyrinthitis, and brainstem or cerebellar stroke. The history and detailed neurological/neurotological examinations usually provide the key information for distinguishing between peripheral and central causes of vertigo. Brain MRI is indicated in any patient with acute vertigo accompanied by abnormal neurological signs, profound imbalance, severe headache, and central patterns of nystagmus. Recurrent spontaneous vertigo occurs when there is a sudden, temporary, and largely reversible impairment of resting neural activity of one labyrinth or its central connections, with subsequent recovery to normal or near-normal function. Meniere's disease, migrainous vertigo, and vertebrobasilar insufficiency (VBI) are common causes. The duration of the vertigo attack is a key piece of information in recurrent spontaneous vertigo. Vertigo of vascular origin, such as VBI, typically lasts for several minutes, whereas recurrent vertigo due to peripheral inner-ear abnormalities lasts for hours. Screening neurotological evaluations, and blood tests for autoimmune and otosyphilis are useful in assessment of recurrent spontaneous vertigo that are likely to be peripheral in origin.

• Journal of Chest Surgery
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• 제54권3호
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• pp.172-178
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• 2021

Background: Complicated acute type B aortic dissection is a life-threatening condition with high morbidity and mortality. The aim of this study was to report a single-center experience with endovascular stent-graft repair of acute type B dissection of the thoracic aorta and to evaluate the mid-term outcomes. Methods: We reviewed 18 patients treated for complicated acute type B aortic dissection by thoracic endovascular aortic repair (TEVAR) from September 2011 to July 2017. The indications for surgery included rupture, impending rupture, limb ischemia, visceral malperfusion, and paraplegia. The median follow-up was 34.50 months (range, 12-80 months). Results: The median interval from aortic dissection to TEVAR was 5.50 days (range, 0-32 days). There was no in-hospital mortality. All cases of malperfusion improved except for 1 patient. The morbidities included endoleak in 2 patients (11.1%), stroke in 3 patients (16.7%), pneumonia in 2 patients (11.1%), transient ischemia of the left arm in 1 patient (5.6%), and temporary visceral ischemia in 1 patient (5.6%). Postoperative computed tomography angiography at 1 year showed complete thrombosis of the false lumen in 15 patients (83.3%). Conclusion: TEVAR of complicated type B aortic dissection with a stent-graft was effective, with a low morbidity and mortality rate.

• 대한한방내과학회지
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• 제30권4호
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• pp.772-779
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• 2009

Object : In the present study, we investigated the obesity and blood parameters between Qi-deficiency and Fire/Heat pattern identification/syndrome differentiation (PI/SD) in acute stroke patients. Materials and Methods : A total of 391 stroke patients within 7 days after onset were consecutively recruited from 12 hospitals across South Korea from Nov. 1st, 2006 to Jun. 31st, 2009. They were diagnosed as Fire/Heat or Qi-deficiency among five PI/SD subtypes by two independent stroke experts. We investigated the differences of obesity and blood characteristics between Fire/Heat and Qi-deficiency by statistical analyses. Results : In male subjects, obesity was significantly associated with Fire/Heat PI/SD. The averaged mean BMI ($24.13kg/m^2$) and waist circumference(89.34cm) of the Fire/Heat group were higher than those of the Qi-deficiency group ($22.60kg/m^2$ and 83.43 cm, respectively). The number of obese patients was larger in the Fire/Heat group than in the Qi-deficiency group (p = 0.001). Hyperlipidemia was also related with Fire/Heat. However, obesity was not associated with PI/SD in female subjects where the number of hyperlipidemic patients was higher in the Qi-deficiency group. Among blood parameters, the levels of triglycerides and fasting blood sugar were higher in the Fire/Heat group compared with the Qi-deficiency group in male subjects. However, total cholesterol of the Qi-deficiency group was higher than in the Fire/Heat group among female subjects. Conclusion : This study shows that obesity and hyperlipidemia are significantly difference between Qi-deficiency and Fire/Heat. We suggests that PI/SD may be associated with clinical characteristics and large population study between PI/SD and clinical characteristics including blood parameters are needed.

• 재활복지공학회논문지
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• 제12권1호
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• pp.10-19
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• 2018

본 연구는 체감형 가상현실 훈련이 뇌졸중 환자의 인지기능과 일상생활활동에 미치는 효과를 알고자 하였다. 급성기 뇌졸중 환자 41명이 본 연구에 참여하였다. 실험 시작 후, 모든 대상자는 실험군 20명과 대조군 21명으로 무작위로 배정되었다. 두 군은 하루 30분, 주 5회, 4주 동안 보편적인 작업치료를 총 20회기 받았다. 실험군은 체감형 가상현실 훈련을 회기 마다 30분 더 받았으며, 대조군은 보편적인 작업치료를 회기마다 30분 더 받았다. 결과측정은 중재 전과 후에 측정하였다. 인지기능을 확인하기 위하여 Loewenstein 인지평가를 측정하였으며, 집중력과 시각기억을 알아보기 위하여 선추적 검사와 시각기억을 측정하였다. 일상생활활동 능력을 알아보기 위하여 수정바델지수를 사용하였다. 연구 결과, 실험군 18명, 대조군 18명은 특정 문제없이 실험을 완료하였다. 인지기능의 변화량에서 실험군은 대조군보다 집중력과 시각적 작업기억에서 유의하게 더 큰 향상이 있었다(p<.05). 일상생활활동의 변화량을 비교에서 실험군은 대조군보다 자조관리에서 유의하게 더 큰 향상이 있었다(p<.05). 본 연구의 결과는 체감형 가상현실 훈련이 보편적인 치료보다 급성기 뇌졸중 환자의 인지기능과 일상생활능력 향상에 긍정적인 효과를 나타낼 수 있음을 시사한다.

• Korean Journal of Radiology
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• 제23권8호
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• pp.811-820
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• 2022

Objective: To develop a model incorporating radiomic features and clinical factors to accurately predict acute ischemic stroke (AIS) outcomes. Materials and Methods: Data from 522 AIS patients (382 male [73.2%]; mean age ± standard deviation, 58.9 ± 11.5 years) were randomly divided into the training (n = 311) and validation cohorts (n = 211). According to the modified Rankin Scale (mRS) at 6 months after hospital discharge, prognosis was dichotomized into good (mRS ≤ 2) and poor (mRS > 2); 1310 radiomics features were extracted from diffusion-weighted imaging and apparent diffusion coefficient maps. The minimum redundancy maximum relevance algorithm and the least absolute shrinkage and selection operator logistic regression method were implemented to select the features and establish a radiomics model. Univariable and multivariable logistic regression analyses were performed to identify the clinical factors and construct a clinical model. Ultimately, a multivariable logistic regression analysis incorporating independent clinical factors and radiomics score was implemented to establish the final combined prediction model using a backward step-down selection procedure, and a clinical-radiomics nomogram was developed. The models were evaluated using calibration, receiver operating characteristic (ROC), and decision curve analyses. Results: Age, sex, stroke history, diabetes, baseline mRS, baseline National Institutes of Health Stroke Scale score, and radiomics score were independent predictors of AIS outcomes. The area under the ROC curve of the clinical-radiomics model was 0.868 (95% confidence interval, 0.825-0.910) in the training cohort and 0.890 (0.844-0.936) in the validation cohort, which was significantly larger than that of the clinical or radiomics models. The clinical radiomics nomogram was well calibrated (p > 0.05). The decision curve analysis indicated its clinical usefulness. Conclusion: The clinical-radiomics model outperformed individual clinical or radiomics models and achieved satisfactory performance in predicting AIS outcomes.

• 정신신체의학
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• 제10권1호
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• pp.27-36
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• 2002

연구목적: 뇌졸중은 개인의 삶의 질에 부정적인 영향을 미치는 만성 질환이다. 그러나 뇌졸중에 대한 대부분의 연구 및 치료, 그리고 재활은 주로 신체적 측면에 집중되었고, 정선과적 측면과 삶의 질에 대한 고려는 많은 부분이 무시되어 왔다. 따라서 본 연구에서는 신체적 영역, 심리적 영역, 사회적 관계 영역, 그리고 환경 영역을 평가하는 WHO 삶의 질 척도를 사용해 뇌졸중 환자들의 삶의 질을 정상인과 비교하고 뇌졸중 환자의 여러 임상 양상과 삶의 질과의 관련성을 알아보고자 한다. 방법: 98명의 급성기 뇌졸중 환자들과 24명의 정상인을 대상으로 세계보건기구 삶의 질 간편형 척도를 사용하여 각 영역과 총점의 평균을 비교하였다. 그리고 뇌졸중 환자군에서 나이, 성별, 교육수준, 우울 및 불안 증상의 정도, 신체적 장애의 정도 등과 삶의 질과의 상관성을 분석하였다. 또한 이들 요인이 삶의 질에 미치는 영향을 다중회귀분석으로 평가하였다. 결과: 뇌졸중 환자군에서 정상군에 비해 전체 삶의 질 및 각 하위 영역 모두 낮은 삶의 질 수준을 보였다 우울 및 불안 증상, 사회적 지지체계의 정도는 전체 삶의 질 및 대부분의 하위 영역과 유의한 상관성을 보였다. 또한 뇌졸중 환자들 중 남자의 경우 여자에 비해 높은 삶의 칠 수준을 보였다. 그러나 Barthel's index로 평가한 신체적 장애의 정도는 삶의 질 수준과 유의한 상관성이 없었다. 다중회귀분석 결과 우울 및 불안 증상의 정도, 사회적 지지체계의 정도, 그리고 성별이 뇌졸중 환자의 삶의 질에 영향을 미치는 요인으로 추출 되었다. 결론: 뇌졸중 환자의 삶의 질은 정상군에 비해 저하되어 있었다. 또한 우울 및 불안 증상의 정도, 사회적 지지 체계의 정도, 그리고 성별이 뇌졸중 환자의 삶의 질에 영향을 미치는 요인이었다.

• 대한간호학회지
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• 제36권7호
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• pp.1232-1241
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• 2006

Purpose: The purpose of this study was to examine the effects of cerebral ischemia on Type I(soleus) and Type II(plantaris, gastrocnemius) muscles, and to determine the effects of isometric contraction training by electro- stimulation on Type I and II muscles in cerebral ischemia model rats. Method: Twenty-five male Sprague-Dawley rats were randomly divided into four groups: ST(stroke), STES(stroke+electrostimulation), SH(sham) and SHES (sham+electrostimulation). The ST and STES groups received a transient right middle cerebral artery occlusion operation. The SH and SHES groups received a sham operation. The STES and SHES groups had daily isometric contraction training by electrostimulation(100Hz, 45mA, 7.5V) on hindlimb muscles for 7days. Result: Plantaris and gastrocenmius muscle weight, myofibrillar protein contents of soleus and gastrocnemius, and the muscle fiber cross-sectional area of gastrocnemius in the ST group significantly decreased compared with the SH group. Soleus, plantaris, gastrocnemius muscle weight, myofibrillar protein contents of soleus and gastrocnemius, and the Type I muscle fiber cross-sectional area of soleus and the Type II muscle fiber cross-sectional area of gastrocnemius in the STES group significantly increased compared with the 57 group. Conclusion: Hindlimb muscle atrophy occurs after acute stroke and isometric contraction training by electrostimulation during early stages of a stroke attenuates muscle atrophy of Type I and Type II muscles.