• Journal of Physiology & Pathology in Korean Medicine
• /
• v.25 no.1
• /
• pp.138-143
• /
• 2011

In spite of abundant clinical resources of stroke patients, the objective and logical data analyses or diagnostic systems were not established in oriental medicine. As a part of researches for standardization and objectification of differentiation of syndromes for stroke, in this present study, we tried to develop the statistical diagnostic tool discriminating the 4 subtypes of syndrome differentiation using the essential indices considering the sex. Discriminant analysis was carried out using clinical data collected from 1,448 stroke patients who was identically diagnosed for the syndrome differentiation subtypes diagnosed by two clinical experts with more than 3 year experiences. Empirical discriminant model(V) for different sex was constructed using 61 significant symptoms and sign indices selected by stepwise selection. We comparison. We make comparison a between discriminant model(V) and discriminant model(IV) using 33 significant symptoms and sign indices selected by stepwise selection. Development of statistical diagnostic tool discriminating 4 subtypes by sex : The discriminant model with the 24 significant indices in women and the 19 significant indices in men was developed for discriminating the 4 subtypes of syndrome differentiation including phlegm-dampness, qi-deficiency, yin-deficiency and fire-heat. Diagnostic accuracy and prediction rate of syndrome differentiation by sex : The overall diagnostic accuracy and prediction rate of 4 syndrome differentiation subtypes using 24 symptom and sign indices was 74.63%(403/540) and 68.46%(89/130) in women, 19 symptom and sign indices was 72.05%(446/619) and 70.44%(112/159) in men. These results are almost same as those of that the overall diagnostic accuracy(73.68%) and prediction rate(70.59%) are analyzed by the discriminant model(IV) using 33 symptom and sign indices selected by stepwise selection. Considering sex, the statistical discriminant model(V) with significant 24 symptom and sign indices in women and 19 symptom and sign indices in men, instead of 33 indices would be used in the field of oriental medicine contributing to the objectification of syndrome differentiation with parsimony rule.

• Journal of Korean Neurosurgical Society
• /
• v.50 no.1
• /
• pp.1-5
• /
• 2011

Objective : There is no proven regimen to reduce the severity of stroke in patients with acute cerebral infarction presenting beyond the thrombolytic time window. Ozagrel sodium, a selective thromboxane A2 synthetase inhibitor, has been known to suppress the development of infarction. The antiplatelet effect is improved when aspirin is used together with a thromboxane synthetase inhibitor. Methods : Patients with non-cardiogenic acute ischemic stroke who were not eligible for thrombolysis were randomly assigned to two groups; one group received ozagrel sodium plus 100 mg of aspirin (group 1, n=43) and the other 100 mg of aspirin alone (group 2, n=43). Demographic data, cardiovascular risk factors, initial stroke severity [National Institute of Health Stroke Scale (NIHSS) and motor strength scale] and stroke subtypes were analyzed in each group. Clinical outcomes were analyzed by NIHSS and motor strength scale at 14 days after the onset of stroke. Results : There were no significant differences in the mean age, gender proportion, the prevalence of cardiovascular risk factors, stroke subtypes, and baseline neurological severity between the two groups. However, the clinical outcome for group 1 was much better at 14 days after the onset of stroke compared to group 2 (NIHSS score, p=0.007, Motor strength scale score, p<0.001). There was one case of hemorrhagic transformation in group 1, but there was no statistically significant difference in bleeding tendency between two groups. Conclusion : In this preliminary study, thromboxane A2 synthetase inhibitor plus a low dose of aspirin seems to be safe and has a favorable outcome compared to aspirin alone in patients with acute ischemic stroke who presented beyond the thrombolytic time window.

• BMB Reports
• /
• v.42 no.9
• /
• pp.617-622
• /
• 2009

We investigated the genetic associations of ischemic stroke by identifying epistasis of its heterogeneous subtypes such as small vessel occlusion (SVO) and large artery atherosclerosis (LAA). Epistasis was analyzed with 24 genes in 207 controls and 271 patients (SVO = 110, LAA = 95) using multifactor dimensionality reduction and entropy decomposition. The multifactor dimensionality reduction analysis with any of 1- to 4-locus models showed no significant association with LAA (P > 0.05). The analysis of SVO, however, revealed a significant association in the best 3-locus model with P10L of TGF-$\beta{1}$, C1013T of SPP1, and R485K of F5 (testing balanced accuracy = 63.17%, P < 0.05). Subsequent entropy analysis also revealed that such heterogeneity was present and quite a large entropy was estimated among the 3 loci for SVO (5.43%), but only a relatively small entropy was estimated for LAA (1.81%). This suggests that the synergistic epistasis model might contribute specifically to the pathogenetsis of SVO, which implies a different etiopathogenesis of the ischemic stroke subtypes.

• The Journal of Korean Medicine
• /
• v.31 no.5
• /
• pp.82-89
• /
• 2010

Objectives: The aim of this study was to determine distribution patterns of TOAST subtypes of ischemic stroke patients admitted to oriental hospitals and to get a better understanding of present conditions in oriental medicine by comparing with the Korea stroke registry (KSR), the largest and representative data. Methods: Clinical data were collected from acute ischemic stoke patients. MRI studies including vascular images were performed in all cases. TOAST criteria were used to determine subtypes of ischemic stroke patients. According to the duration from disease onset to hospital admission time, patients were assigned to 3 groups (Group I0 to 3 d, Group II4 to 7 d, Group III8 to 28 d) and the distribution of TOAST subtypes were compared among these three groups. Results: We collected 514 sets of clinical data from 10 oriental hospitals between May 2007 and September 2009. Small vessel occlusion (SVO) subtype was the most common (57.62%), followed by large artery atherosclerosis (LAA, 29.98%). Compared with TOAST distribution of KSR, the proportion of ischemic stroke patients with SVO subtype was higher than that of KSR. On the other hand the proportion of patients with stroke of undetermined etiology (SUE) was lower. Distributions of SVO, LAA and cardioembolism (CE) in group were I 66.4%, 23.8% and 8.9%, respectively; those in group IIIwere 51.03%, 34.71% and 11.57%, respectively. Conclusions: In oriental hospitals, the proportion of ischemic stroke patients diagnosed as SVO type was higher than that of KSR. At early stage (from onset to 2 d) proportion of SVO was very high, however after 7 days from onset it decreased with concomitant increases in proportions of LAA and CE. These phenomena may be due to the facts that 1) at early stage emergency treatments are limited in oriental hospitals, 2) after early stage many patients prefer oriental treatments, including rehabilitation.

• The Journal of Korean Medicine
• /
• v.28 no.3 s.71
• /
• pp.207-215
• /
• 2007

Objectives : The objective of this study was to assess whether there were sex differences in stroke types, risk factors, warning signs, and stroke complications among patients with first-ever stroke. Methods : Six-hundred seventy six patients with first-ever stroke were recruited at the Department Cardiovascular and Neurologic Diseases (Stroke center) of KyungHee University Oriental Hospital, DongGuk University International Hospital, and Kyungwon University In-cheon Oriental Medical Hospital from September 2005 to June 2007. Patients were hospitalized within 28 days after the onset of stroke. We investigated their stroke types, ischemic stroke subtypes by TOAST classification, risk factors, warning signs, stroke complications, general characteristics such as age, sex, etc. Results : Overall, 347 patients were male and 279 female. Compared with males, female patients were significantly older (mean age 67.3${\pm}$1.1 versus 62.4${\pm}$1.6 years) (P=0.000). We did not find significant sex differences in stroke types or ischemic stroke subtypes by TOAST classification. History of hypertension was significantly more frequent in female than male patients (P=0.000). Among stroke complications, urinary tract infection was significantly more frequent in female than male patients (P=0.003). Among warning signs, blepharospasm was significantly more frequent in female than male patients (P=0.006). Conclusions : Knowledge of sex differences of stroke patients can help us gain better insights on the characteristics of stroke patients. We need further and larger scale research to acquire more concrete conclusions on this theme.

• The Journal of Korean Medicine
• /
• v.45 no.1
• /
• pp.150-164
• /
• 2024

Objectives: This study aimed to investigate the levels of brain iron deposition in Parkinson's disease (PD) patients using Quantitative Susceptibility Mapping (QSM) and to determine whether distinctions compared to the general population exist. Furthermore, we examined potential variations in iron deposition among different PD subtypes. Methods: Structural brain imaging was conducted on 75 participants at Gangdong Kyung Hee University Hospital between August 2017 and May 2020. PD patients were categorized into Tremor Dominant (TD) and Postural Instability and Gait Difficulty (PIGD) subtypes. Voxel-based morphometry and QSM were employed to compare voxel-wise magnetic susceptibility across the entire brain between Normal Controls (NC) and PD groups. Subsequently, QSM values were compared between TD and PIGD groups. Results: QSM values were compared among 46 PD patients and 23 normal controls, as well as between TD (n=22) and PIGD (n=24) groups. Voxel-based QSM analysis revealed no significant differences between groups. Similarly, ROI-based QSM analysis showed no significant distinctions. Conclusions: No significant variations were observed between the PD patient group, NC group, or PD subtypes. This study systematically compared QSM values across a broad range of brain regions potentially linked to PD pathology. Additionally, the subdivision of the PD group into TD and PIGD subtypes for QSM-based iron deposition analysis represents a meaningful and innovative approach.

• The Journal of the Korean life insurance medical association
• /
• v.33 no.2
• /
• pp.12-14
• /
• 2014

Worldwide, stroke is the 2nd or 3rd leading cause of death and a major health problem. Recent advances in medical technology have significantly improved diagnosis and treatment strategies of ischemic stroke. The ischemic stroke subtype is an important determinant of mortality and long-term prognosis of patients. To estimate excess-risks of the ischemic stroke subtype, recently published article, Korean cohort study of stroke, was used as a source article. According to mortality analysis methodology from American academy of insurance medicine, the overall mortality ratio and excess death rate was the highest in patients with SOD, followed by those with CE. Calculated mortality ratio and excess death rate for subtype in this review are SOD, 920%/34‰; CE 267%/34‰; UI 209%/25‰; UM 190%/23‰; UN 188%/15‰; LAA 162%/15‰; LAC 117%/3‰.

• The Journal of the Society of Stroke on Korean Medicine
• /
• v.9 no.1
• /
• pp.1-7
• /
• 2008

Objectives : We questioned whether the tongue diagnosis is effective for judging seriousness of cerebrovascular accidents. This study is about the relationship between tongue diagnosis and National Institute of Health Stroke Scale(NIHSS) in acute stroke patients. Methods : 738 subjects were recruited from the patients admitted to the department of internal medicine at Kyung-Hee University oriental medical center, Kyung-Hee University East-West Neo Medical Center, Kyungwon university Incheon oriental medical center, Kyungwon university Songpa oriental medical center and DongGuk university Ilsan oriental medical center from April 2007 to August 2008. We looked at the tongue as in three dimensions of tongue color, tongue fur color and tongue body. And, we calculated NIHSS means according to the subtypes of three dimensions. Results : 1. In the Tongue color, from the most commom to least common colors were pale red, red, pale, bluish purple, and ect. The NIHSS mean score of red is significantly higher than pale and pale red. 2. In the Tongue fur color, white fur was the most common, and then yellow fur, etc. There is no significant difference among three subtypes in the NIHSS mean score. 3. In the Tongue body, etc. is the most common, followed by teeth-marked tongue, enlarged tongue, blood patchy tongue, and mirror tongue. The NIHSS mean score of teeth-marked tongue is significantly lower than blood patchy tongue and mirror tongue. Conclusions : The tongue color and the tongue body are useful indexes for judging seriousness of cerebrovascular accidents presented by NIHSS. But in our study, the tongue fur color was not useful. Further study is necessary on the tongue fur.

• Journal of Society of Preventive Korean Medicine
• /
• v.14 no.1
• /
• pp.111-123
• /
• 2010

Backgrounds : Stroke is characterized by loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain, and classified into hemorrhage and ischemia. Stroke is known to be affected by genetic factors and other diseases such as hypertension and cardiovascular diseases. However, the distinctive association between stroke and genetic variations has not discovered yet. Objectives : This study investigated the effects of fibrinogen level and genetic variations in FGA (Fibrinogen alpha chain) gene on stroke in Korean stroke patients and controls. Methods : DNA samples from 674 stroke patients diagnosed by Oriental medical hospitals and 267 controls were used in this study. Two common single nucleotide polymorphism(SNP) with high minor allele frequency(MAF), rs2070011G/A of promoter region and nonsynonymous rs6050A/G of exon 5 in FGA gene, were targeted for Taqman genotyping. Because the TOAST classification is important to the factors and symptoms of stroke, ischemic patients were further classified into five subtypes using diagnosis and clinical data. One-way ANOVA and chi-square test were used for clinical data and genetic association, respectively. Haploview v4.1 program was used for linkage disequilibrium(LD), haplotype and haplotype block analysis. Results : The levels of red blood cells and fibrinogen from clinical data were shown to be significant factors for the sub-groups of TOAST classification. No significant associations of stroke, hemorrhage, ischemic and subtypes of TOAST with rs2070011 and rs6050 of FGA gene were found(P > 0.05). However, rs2070011 in promoter region and nonsynonymous rs6050 in exon 5 which produce the amino acid change from threonine to alanine showed a haplotype block and three haplotypes of A-G, G-A, A-A, suggesting that rs2070011 and rs6050 might be co-segregated in generic recombination. Although A-A haplotype of stroke patients showed 64-69% low frequency compared to controls, there was no significant association between stroke and haplotype(P > 0.05). Conclusion : This study showed that there was no significant association between stroke and two SNP of rs2070011G/A and nonsynonymous rs6050A/G in FGA gene. However, these two SNP compose a haplotype block and three haplotypes of A-G, G-A, A-A. This finding suggests that rs2070011 and rs6050 are so close as to be positioned as linkage disequilibrium. Nevertheless, no significant association between haplotypes and stroke was found.

• Journal of Physiology & Pathology in Korean Medicine
• /
• v.23 no.5
• /
• pp.964-968
• /
• 2009

The purpose of this study is to select the major pulse indicators and evaluate their significance in discriminating the subtypes of Pattern Identifications (PI) from stroke patients. Decision tree analysis was carried out using clinical data collected from 835 stroke patients with the same subtypes diagnosed identically by two experts with more than 3 year clinical experiences. Among the 10 pulse indicators, 6 major pulse indicators (slow, rapid, strong, weak, slippery, and fine pulse) were selected by decision tree analysis. The accumulated distributions of six pulse indicators in each PI showed that strong was major pulse indicator in Fire-Heat pattern, slippery in Dampness Phlegm pattern, weak in Qi Deficiency pattern. But there were two major combinations in Yin deficiency pattern, weak or fine with rapid pulse and weak or fine without rapid pulse. Therefore, it is suggested that 6 pulse indicators can be used for discrimination of PI in stroke patients, though the combination studies between these pulse indicators and the other PI indicators are left for further study.