• Health Policy and Management
• /
• v.33 no.4
• /
• pp.440-449
• /
• 2023

Background: This study aimed to analyze the prehospital process and reperfusion therapy process of acute ischemic stroke in Busan metropolitan area and examine the impact of living arrangement on the early management and functional outcomes of acute ischemic stroke (AIS). Methods: The patients who diagnosed with AIS and received reperfusion therapy at the Busan Regional Cardiovascular Center between September 2020 and May 2023 were selected. We investigated the patients' hospital arrival time (onset to door time) and utilization of 119 emergency ambulance services. Additionally, various time matrices related to reperfusion therapy after hospital were examined, along with the functional outcome at the 90-day after treatment. Results: Among the 753 AIS patients who underwent reperfusion therapy, 166 individuals (22.1%) were living alone. AIS patients living alone experienced significant delays in symptom detection (p<0.05) and hospital arrival compared to AIS patients with cohabitants (370.1 minutes vs. 210.2 minutes, p<0.001). There were no significant differences between the two groups in terms of 119 ambulance utilization and time metrics related with the reperfusion therapy. Independent predictors of prognosis in AIS patients were found to be age above 70, National Institutes of Health Stroke Scale score at admission, tissue plasminogen activator, living alone (odds ratio [OR], 1.785; 95% confidence interval [CI], 1.155-2.760) and interhospital transfer (OR, 1.898; 95% CI, 1.152-3.127). Delay in identification of AIS was shown significant correlation (OR, 2.440; 95% CI, 1.070-5.561) at living alone patients. Conclusion: This study revealed that AIS patients living alone in the Busan metropolitan region, requiring endovascular treatment, face challenges in the pre-hospital phase, which significantly impact their prognosis.

• Journal of Korean Neurosurgical Society
• /
• v.67 no.2
• /
• pp.227-236
• /
• 2024

Objective : Numerous studies have indicated that early decompressive craniectomy (DC) for patients with major infarction can be life-saving and enhance neurological outcomes. However, most of these studies were conducted by neurologists before the advent of intra-arterial thrombectomy (IA-Tx). This study aims to determine whether neurological status significantly impacts the final clinical outcome of patients who underwent DC following IA-Tx in major infarction. Methods : This analysis included 67 patients with major anterior circulation major infarction who underwent DC after IA-Tx, with or without intravenous tissue plasminogen activator. We retrospectively reviewed the medical records, radiological findings, and compared the neurological outcomes based on the "surgical time window" and neurological status at the time of surgery. Results : For patients treated with DC following IA-Tx, a Glasgow coma scale (GCS) score of 7 was the lowest score correlated with a favorable outcome (p=0.013). Favorable outcomes were significantly associated with successful recanalization after IA-Tx (p=0.001) and perfusion/diffusion (P/D)-mismatch evident on magnetic resonance imaging performed immediately prior to IA-Tx (p=0.007). However, the surgical time window (within 36 hours, p=0.389; within 48 hours, p=0.283) did not correlate with neurological outcomes. Conclusion : To date, early DC surgery after major infarction is crucial for patient outcomes. However, this study suggests that the indication for DC following IA-Tx should include neurological status (GCS ≤7), as some patients treated with early DC without considering the neurological status may undergo unnecessary surgery. Recanalization of the occluded vessel and P/D-mismatch are important for long-term neurological outcomes.

• Clinical and Experimental Reproductive Medicine
• /
• v.33 no.4
• /
• pp.229-236
• /
• 2006

Objective: We investigated the expression of uPA and uPAR in eutopic endometrium of advanced stage endometriosis and control patients. Methods: The 33 endometriosis patients and 32 controls were enrolled. Endometrial samples were obtained from 65 premenopausal women aged 29-44 years, undergoing laparoscopic surgery or hysterectomy for non-malignant lesions. Sufficient samples were collected from 33 patients with endometriosis stage Ill and IV and 32 controls without endometriosis confirmed by laparoscopic surgery. The mRNA expression of uPA and uPAR from eutopic endometrium were analyzed by RT-QC PCR. Results: The mRNAs of uPA and uPAR were expressed in eutopic endometrium from endometriosis and normal controls throughout the menstrual cycle. Uterine endometrium from women with endometriosis expresses significantly (p<0.05) higher levels of u-PA mRNA than endometrium from normal women without endometriosis in the proliferative phase. There were no significant differences in expression of uPAR in eutopic endometrium between controls and endometriosis patients. Conclusion: These results suggest that eutopic endometrium from endometriosis patients may be more invasive and prone to peritoneal implantation because of greater u-PA mRNA expression than endometrium from women without endometriosis. Thus, increased proteolytic activity may be one etiology for the invasive properties of the endometrium resulting in the development of endometriosis.

• Tuberculosis and Respiratory Diseases
• /
• v.40 no.4
• /
• pp.378-383
• /
• 1993

Background: In recent reports, it has been reported that increased coagulation and decreased fibrinolytic activity has been responsible for abnormal fibrin turnover in exudative pleural effusion. In the cases of empyema, the fibrinopurulent stage is characterized by the fibrin deposition resulting in formation of limiting membranes in the visceral and parietal pleura. Recently attention has been focused on intrapleural fibrinolytic therapy capable of removing intrapleural fibrin deposits by urokinase (UK) in the treatment of empyema. However, these clinical trials have provided the clinical evidences for resolution of pleural loculation after intrapleural urokinase injection (UK-injection), the profiles of fibrinolytic activity following the treatment were still not investigated. Therefore in order to demonstrate the fibrinolytic evidences behind the clinical efficacy of intracavitary UK-injection, we examined intrapleural plasminogen activator activity (PA-activity) and D-dimer (D-Di) concentrations before and after each repeated UK-injection into the pleura in subjects with loculated empyema cavity. Methods: In a group of 14 patients with multiple loculated empyema cavity, PA-activity and D-Di concentrations were measured before and after repeated UK-injection. One hundred thousand IU of UK was injected at each time and all sujects had at least two times of UK injection accoring to clinical decisions. Nine out of 14 sujects had three times of UK-injection. Results: The mean (${\pm}SE$) PA-activity prior to treatemnt was $10.5{\pm}7.0$ and it was increased to $91.9{\pm}27.0,\;432.3{\pm}177.1,\;170.0{\pm}85.3$ IU tPA/ml after first, second and third time of UK-injection respectively (p<0.01). D-Di concentrations were also increased from $4.16{\pm}1.06{\times}10^5$ to $9.62{\pm}1.54{\times}10^5,\;12.31{\pm}1.89{\times}10^5,\;8.54{\pm}1.56{\times}10^5$ ng/ml in the same order as above (p<0.05). Conclusion: The suppressed fibrinolytic activity in the empyema cavity get removed sinificantly after inrracavitary injection of urokinase by generation of additional intrapleural plasmin.

• Journal of Ginseng Research
• /
• v.27 no.3
• /
• pp.110-114
• /
• 2003

Objective; Antistress effect of Korean red ginseng (RG) on postmenopausal women with severe climacteric syndrome (CS) were evaluated from the viewpoint of traditional KAMPO-medicine and Western medicine. Methods; All patients with CS were treated with daily oral administration of 6g RG for 30 days. Nine patients with CS were evaluated with the use of diagnostic scores for KI-deficiency (deficiency of vital energy) and OKETSU (blood stagnation) syndrome from the viewpoint of KAMPO-medicine. In the same patients with CS, peripheral blood levels of ${\beta}$-endorphin and total plasminogen activator inhibitor-1 (t-PAI-1) were measured before and after treatment with RG. In another group, 12 patients with CS, psychological test using CMI, STAI and SDS were performed from the viewpoint of Western medicine. Stress related hormones, such as ACTH, cortisol and DHEA-S in those 12 patients with CS were also measured before and after treatment with RG. Results; KI-deficiency score and OKETSU score in patients with CS were significantly (p<0.001) higher than those in patients without CS. After treatment with RG, both scores were markedly (p<0.001) decreased compared to before treatment with RG. ${\beta}$-endorphin levels in patients with CS were significantly (p<0.05) higher than those in patients without CS. Total PAI-levels in patients with CS were increased before treatment with RG. No significant difference, however, were observed between patients with and without CS. After treatment with RG, both levels of ${\beta}$-endorphin and total PAI-1 in patients with CS were significantly (p<0.001 and p<0.05, respectively) decreased compared to before treatment with RG. CMI and STAI scores in patients with CS were significantly (p<0.05) higher than those in patients without CS. SDS scores in patients with CS were also markedly (p<0.00l) higher than in those without CS. After treatment with RG, all scores decreased within normal range. DHEA-S levels in patients with CS were about a half of those without CS. Consequently, cortisol/DHEA-S (C/D) ratio was significantly(p<0.001) higher in patients with CS than in those without CS. Although the decreased DHEA-S levels were not restored to the levels in patients without CS, the C/D ratio decreased significantly (p<0.05) after treatment with RG. Conclusion; Reinforcement of vital energy and improvement of stagnant blood circulations by oral administration of RG were elucidated from the viewpoint of traditional KAMPO-medicine. From the viewpoint of Western medicine, effect of RG on postmenopsusal women with CS seemed to be brought about in part by not only an improvement of psychoneuroendocrine dysfunctions but also an amelioration of blood coagulation systems.

• Asian Pacific Journal of Cancer Prevention
• /
• v.16 no.16
• /
• pp.6813-6823
• /
• 2015

Glioblastoma, also known as glioblastoma multiforme (GBM), is the most aggressive of human brain tumors and has a stunning progression with a mean survival of one year from the date of diagnosis. High cell proliferation, angiogenesis and/or necrosis are histopathological features of this cancer, which has no efficient curative therapy. This aggressiveness is associated with particular heterogeneity of the tumor featuring multiple genetic and epigenetic alterations, but also with implications of aberrant signaling driven by growth factors. The transforming growth factor ${\beta}$ ($TGF{\beta}$) superfamily is a large group of structurally related proteins including $TGF{\beta}$ subfamily members Nodal, Activin, Lefty, bone morphogenetic proteins (BMPs) and growth and differentiation factor (GDF). It is involved in important biological functions including morphogenesis, embryonic development, adult stem cell differentiation, immune regulation, wound healing and inflammation. This superfamily is also considered to impact on cancer biology including that of GBM, with various effects depending on the member. The $TGF{\beta}$ subfamily, in particular, is overexpressed in some GBM types which exhibit aggressive phenotypes. This subfamily impairs anti-cancer immune responses in several ways, including immune cells inhibition and major histocompatibility (MHC) class I and II abolishment. It promotes GBM angiogenesis by inducing angiogenic factors such as vascular endothelial growth factor (VEGF), plasminogen activator inhibitor (PAI-I) and insulinlike growth factor-binding protein 7 (IGFBP7), contributes to GBM progression by inducing metalloproteinases (MMPs), "pro-neoplastic" integrins (${\alpha}v{\beta}3$, ${\alpha}5{\beta}1$) and GBM initiating cells (GICs) as well as inducing a GBM mesenchymal phenotype. Equally, Nodal promotes GICs, induces cancer metabolic switch and supports GBM cell proliferation, but is negatively regulated by Lefty. Activin promotes GBM cell proliferation while GDF yields immune-escape function. On the other hand, BMPs target GICS and induce differentiation and sensitivity to chemotherapy. This multifaceted involvement of this superfamily in GBM necessitates different strategies in anti-cancer therapy. While suppressing the $TGF{\beta}$ subfamily yields advantageous results, enhancing BMPs production is also beneficial.

• Journal of Korean Neurosurgical Society
• /
• v.50 no.2
• /
• pp.75-80
• /
• 2011

Objective : Leukoaraiosis (LA) has been suggested to be related to the poor outcome or the occurrence of symptomatic intracerebral hemorrhage (sICH) after acute ischemic stroke. We retrospectively investigated the influences of LA on long-term outcome and the occurrence of sICH after thrombolysis in acute ischemic stroke (AIS). Methods : In this study, we recruited 164 patients with AIS and magnetic resonance image (MRI)-detected thrombolysis. The presence and extent of LA were assessed using the Fazekas grading system. The National Institutes of Health Stroke Scale score was used to assess the baseline measure of neurologic severity, and the modified Rankin Scale score assessment was used up to 1 year after thrombolysis. Results : Of 164 subjects, 56 (34.2%) showed LA on MRI. Compared to the 108 patients without LA, the patients with LA were of much older age (p<0.01), had a higher prevalence of hypertension (p<0.01), and had a much poorer outcome at 90 days (p=0.05) and 1 yr (p=0.01) after thrombolysis. There were no significant differences in sICH between patients with and without LA on MRI. In univariate analysis for the occurrence of poor outcome at 90 days after thrombolysis, the size of ischemic lesion on diffusion weighted images (DWI), [odds ratio (OR), 1.03; 95% confidence interval (95% CI), 1.01-1.04; p<0.01], recanalization (OR, 0.03; 95% CI, 0.01-0.10; p<0.01), sICH (OR, 12.2; 95% CI, 1.54-95.8), neurologic severity (OR, 1.17; 95% CI, 1.09-1.25; p<0.01), blood glucose level (OR, 1.01; 95% CI, 1.00-1.02; p=0.03), and the presence of LA on MRI (OR, 2.01; 95% CI, 1.04-3.01; p=0.04) were statistically significant. In multivariate analysis, neurologic severity (OR, 1.14; 95% CI, 1.04-1.24; p<0.01), recanalization (OR, 0.03; 95% CI, 0.01-0.11; p<0.01), lesion size on DWI (OR, 1.02; 95% CI, 1.01-1.03; p=0.02), serum glucose level (OR, 1.01; 95% CI; 1.01-1.02; p=0.03), and the presence of LA on MRI (OR, 3.2; 95% CI, 1.22-8.48; p<0.01) showed statistically significant differences. These trends persisted up to 1 yr after thrombolysis. Conclusion : In this study, we demonstrated that the presence of LA on MRI might be related to poor outcome after use of intravenous tissue plasminogen activator in AIS.

• Korean Journal of Community Nutrition
• /
• v.6 no.1
• /
• pp.51-68
• /
• 2001

This investigation studied the relationship between Body Mass Index(BMI) and dietary intake, levels of serum lipid, lipoprotein(a) and plasminogen activator inhibitor-1(PAI-1) of 28.449 Korean adults(16.937 men, 11.542 women) from 1995 to 1999. The dietary assessment was conducted using 24-hour dietary records and food frequency questionnaires. During this five year study, the BMI normal-weight group, as a percentage of the annual test population, decreased from 68.0% to 60.2%, while the BMI overweight and obese groups collectively increased from 25.0% to 29.7%. The levels of serum total cholesterol (TC), LDL-cholesterol(LDL-C), Triacylglycerol(TG) and PAI-1 increased as the values of BMI increased, while the levels of HDL-cholesterol(HDL-C) and lipoprotein(a)(men only) appeared to decrease as values of BMI increased. The levels of daily energy intake also increased as values of BMI increased in both men and women. The obese group had significantly higher levels of carbohydrate, protein, fat(men only), and cholesterol intake than those of the normal-weight, underweight, and overweight groups. In men, BMI positively correlated with the levels of macronutrients and cholesterol intake(p＜0.001), % energy of protein, fat, and alcohol intake(p＜0.001), and the levels of serum TC, LDL-C, TG and PAI-1(p＜0.001), while BMI negatively correlated with % energy of carbohydrate intake, and the levels of Lp(a) and HDL-C(p＜0.001). In women, BMI negatively correlated with level of cholesterol(p＜0.01), fat(p＜0.001), alcohol intake(p＜0.05),% energy of fat (p＜0.001), % energy of alcohol intake and level of and HDL-C(p＜0.001). Subjects who had serum TC, LDL-C, HDL-C, and TG levels greater than the standard reference values(TC＞240mg/㎗, LDL-C＞130mg/㎗, HDL-C＞35, TG＞200mg/㎗) exhibited a higher intake of the three macronutrients, iron, calcium, meat, milk and fatty foods than those subjects who had serum lipid concentrations less-than-or-equal-to the standard reference values. Overall, there was positive correlation between the high risk factors of vascular disease variables, dietary intake, and BMI. Prevalence of hypertension and high blood sugar were increased as BMI increased, but the prevalence of hypertension is decreased as the year goes by. These findings showed that dietary intake, level of serum lipids and other vascular disease risk factors increased as BIM increased. Therefore, middle or upper class Korean adults who have high BMI should improve their eating habits. This involve reducing alcohol, animal fat, high carbohydrate foods, and overall food intake, and balancing intake in order to lower vascular disease risk factors, including obesity.

• Reproductive and Developmental Biology
• /
• v.33 no.2
• /
• pp.107-111
• /
• 2009

The transfection efficiency of a transgene into pig and goat fetal fibroblast cells (PFF and GFF, respectively) was tested using co-transfection of a human tissue-type plasminogen activator (tPA) transgene and neomycin-resistant ($Neo^r$) gene, followed by G418 selection. To initially test G418 resistance, GFF and PFF were incubated in culture medium containing different concentration of G418 for 2 weeks, and cell survival was monitored over time. Based on the obtained results, the concentrations chosen for G418 selection were 800 ug/ml and 200 ug/ml for GFF and PFF, respectively. For co-transfection experiments, the pBC1/tPA and $Neo^r$ vectors were co-transfected into GFF and PFF ($1{\times}10^6$ cells in each case) using the FuGENE6 transfection reagent, and resistant colonies were obtained following 14 days of G418 selection. We obtained 96 and 93 drug-resistant colonies of GFF and PFF, respectively, only 54 and 39 of which, respectively, continued proliferating after drug selection. PCR-based screening revealed that 23 out of 54 analyzed GFF colonies and 5 out of 39 analyzed PFF colonies contained insertion of the tPA gene. Thus, the experimentally determined transfection efficiencies for tPA gene co-transfection with the $Neo^r$ gene were 42.6% for GFF and 12.8% for PFF. These findings suggest that co-transfection of a transgene with the $Neo^r$ gene can aid in the successful integration of the transgene into fetal fibroblast cells.

• Nutritional Sciences
• /
• v.1 no.1
• /
• pp.70-76
• /
• 1998

This study was designed to investigate the relationship between body mass index (BMI) and dietary intake, and the relationship between BMI and plasma lipid levels in Korean adults. This study was conducted from January 1 to December 31 of 1997. It consisted of 3781 subjects (men 2402, women : 1379) with the majority between the ages of 40 and 59. The dietary assessment was based upon a twenty-four-hour food record. Subjects were classified into one of four reference BMI groups : underweight ($\leq 20 kg/m^2$), normal (20.1-25.0 kg/$m^2$), overweight (25.1-30.0 kg/$m^2$), and obese (>30 kg/$m^2$). The biochemical assessment included measurements of plasma total cholesterol (TC), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), triglyceride (TG), lipoprotein (a), and plasminogen activator inhibitor-1 (PAI-1). The BMI study showed that 60.5% of the men measured were normal and 32.6% of the men were overweight and/or obese subjects. Sixty-four percent of the women were normal and 20.3% of the women measured were overweight and/o. obese subjects. With respect to the daily energy intake of the men and women subjects, the levels of daily energy intake appeared to increase as values of BMI increased. Men of the overweight group had significantly higher protein, fat and cholesterol intake than those of the normal or the underweight groups. The alcohol intake of the men in the overweight group was also significantly higher than that of the men in the underweight group. With respect to percent energy intake of macronutrients, there was no significant difference between the four BMI groups and percent energy intake for all the subjects in the study. The ratio of percent energy intake of carbohydrates : protein : fat : alcohol of the normal women group was 62 : 17 : 20 : 1, respectively. Women apparently had a higher intake of carbohydrates than men (52 : 17 : 19 : 10). With respect to the levels of plasma TC, LDL-C, TG, and HDL-C, the levels of plasma TC, LDL-C and TC appeared to increase as the values of BMI increased, while the level of HDL-C appeared to decrease as values of BMI increased. Levels of lipoprotein (a) appeared to be inversely related to the values of BMI, and levels of PAI-1 appeared to increase as values of BMI increased. The results of this study demonstrate that there is a relationship between dietary intake and BMI, and that there is a relationship between BMI and blood lipids levels.