• Journal of Korean Neurosurgical Society
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• v.50 no.6
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• pp.486-491
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• 2011

Objective : Structural genetic variation, including copy-number variation (CNV), constitutes a substantial fraction of total genetic variability, and the importance of structural variants in modulating susceptibility is increasingly being recognized. CNV can change biological function and contribute to pathophysiological conditions of human disease. Its relationship with common, complex human disease in particular is not fully understood. Here, we searched the human genome to identify copy number variants that predispose to moya-moya type cerebrovascular disease. Methods : We retrospectively analyzed patients who had unilateral or bilateral steno-occlusive lesions at the cerebral artery from March, 2007, to September, 2009. For the 20 subjects, including patients with moyamoya type pathologies and three normal healthy controls, we divided the subjects into 4 groups : typical moyamoya (n=6), unilateral moyamoya (n=9), progression unilateral to typical moyamoya (n=2) and non-moyamoya (n=3). Fragmented DNA was hybridized on Human610Quad v1.0 DNA analysis BeadChips (Illumina). Data analysis was performed with GenomeStudio v2009.1, Genotyping 1.1.9, cnvPartition_v2.3.4 software. Overall call rates were more than 99.8%. Results : In total, 1258 CNVs were identified across the whole genome. The average number of CNV was 45.55 per subject (CNV region was 45.4). The gain/loss of CNV was 52/249, having 4.7 fold higher frequencies in loss calls. The total CNV size was 904,657,868, and average size was 993,038. The largest portion of CNVs (613 calls) were 1M-10M in length. Interestingly, significant association between unilateral moyamoya disease (MMD) and progression of unilateral to typical moyamoya was observed. Conclusion : Significant association between unilateral MMD and progression of unilateral to typical moyamoya was observed. The finding was confirmed again with clustering analysis. These data demonstrate that certain CNV associate with moyamoya-type cerebrovascular disease.

• The Journal of Internal Korean Medicine
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• v.28 no.4
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• pp.863-871
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• 2007

Objects : To gain better insights of East-west integrated treatment of ischemic stroke. We analyzed 89 patients with severe acute ischemic stroke who were admitted to the East-west integrated intensive care unit. Methods : Subjects enrollment was from the East-west integrated intensive care unit of Kyung Hee Medical Center from March 2006 to February 2007. Patients were admitted within 14 days after the onset of ischemic stroke. We assessed the subjects' general characteristics, risk factors, admitting routes and periods, diagnostic imaging, process of western treatment and Korean traditional treatment, complication and consequence. Results : The proportion of males was 50.6%, of females 49.4%, average age was male 66.0$\pm$10.3 and female 71.1$\pm$10.5. Average length of hospital stays was 19.5 days. Monthly admissions were highest in November and December. The admission route was through emergency room (61.8%) or ward (34.8%). Mean Glasgow coma scale score was 10.0$\pm$2.5, average time from symptom of onset to hospital admission was 2.3$\pm$2.2 days. Dominant ischemic vascular territory was middle cerebral artery (66.3%). Initial western treatment was argatroban (22.5%), urokinase (28.1%), and heparinization (38.2%). Distribution of Sasang constitution of So-yang to Tae-eum to So-eum was equal to 5.4 to 2.9 to 1.5. Major complications were observed in 40 (42.7%) patients. In hospital mortality was 12.4% (11 deaths), all of them caused by aggravation of neurological deficit and only 3 of them with major complications. There appears to be a significant positive relationship between length of hospital stay and occurrence of complications (P<0.05). After discharge from the ICU, 64 (71.9%) patients were improved, 11 (12.4%) patients had expired, and 14 (15.8%) patients were transferred. Conclusions : From this study, we suggest that patients with severe acute ischemic stroke should be treated with East-west integrated therapy for more favorable consequences and decreased mortality.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1997.04a
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• pp.103-103
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• 1997

일시적인 국소 뇌허혈 rat model에서 중대뇌동맥의 폐쇄시간에 따른 뇌조직의 손상정도를 비교 조사하였다. 웅성 Wistar rats를 isoflurane 홉입마취하에서 우측 내경동맥내로 17 mm의 silicone-coated 4-0 nylon monofilament를 삽입하여, 중대뇌동맥의 기저부를 30분, 60분 또는 90분동안 폐쇄한 후 이 monofilament를 다시 밖으로 뽑아내므로써 23 시간동안 recirculation 시키는 일시적 국소 뇌허혈 rat model을 사용한 결과, 수술 후 거의 모든 rats에서 left hemiparesis 또는 좌측으로의 circling과 같은 신경학적 결손이 나타나므로써 높은 성공률을 가지고서 비교적 용이하게 뇌허혈을 유발시킬 수 있었으며, 2 mm 두께의 fresh brain coronal slices에 대하여 2,3,5-triphenyltetrazolium chloride (TTC) 염색법을 시행하여 slice surface의 사진을 찍고 computerized 영상분석법을 이용하여 필요한 면적을 측정하므로써, coronal slice의 infarction size (%)는 총 면적에 대한 infarction 면적의 %로서, 부종율 (%)은 대조측 대뇌반구 면적의 2배에 대한 동측 대뇌반구와 대조측 대뇌반구 면적 차이의 %로서 산정되어졌다. 30분 허혈군에서는 본 염색법으로는 infarction이 거의 확인되지 않았으나 60분 허혈군 (n=13)에서는 우측 somatosensory frontoparietal cortex와 striatum 양자 모두 또는 일부 rats에서는 striatum에만 국한된 ulfarction이 확인되어졌으며 90분 허혈군 (n=12)에서는 거의 대부분의 rats에서 위 두 지역 모두에서 infarction이 확인되어졌다. Infarction size (%)는 60분과 90분 허혈군 각각에서, frontal pole로부터 5 mm되는 slice에서는 11.9$\pm$1.2 (평균치$\pm$표준오차), 13.7$\pm$1.9이었으며 7 mm되는 slice에서는 19.1$\pm$1.8, 21.9$\pm$2.1이었으며 9 mm되는 slice에서는 14.7$\pm$2.4, 19.7$\pm$2.2이었다. 또한 부종율 (%)은 60분과 90분 허혈군 각각에서, frontal pole로부터 5 mm되는 slice에서는 3.1$\pm$0.6, 3.8$\pm$0.7이었으며 7 mm되는 slice에서는 3.5$\pm$0.3, 5.7$\pm$1.0이었으며 9 $\pm$되는 slice에서는 3.4$\pm$0.5, 5.7$\pm$0.9이었다. 한편 90분 동안의 중대뇌동맥 폐쇄에 따른 뇌조직 손상을 cresyl violet 염색법, NADPH-diaphorase histochemistry, GFAP immunohistochemistry를 사용하여 일부 측정한 결과, 위의 손상지역에서는 뇌신경세포체들의 shrinkage 내지는 소실됨을 확인할 수 있었으며, NADPH-diaphorase-positive neuron들도 대부분 dendrite와 axon같은 cell process들의 fragmentation, shrinkage 내지는 소실되므로써 intensity의 감소현상이 나타났으며, reactive gliosis로 말미암아 GFAP immunoreactive intensity의 증가현상이 나타났다.

• Tuberculosis and Respiratory Diseases
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• v.59 no.1
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• pp.97-103
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• 2005

Hypereosinophilic syndrome (HES) is characterized by a sustained eosinophilia of $1,500/mm^3$ or more in the absence of any known causes or the signs and symptoms of organ involvement. We report a 64-year-old man with HES initially presenting with involvement of the liver and bone marrow. Despite controlling the eosinophilia by corticosteroid, he developed a cerebral infarction and later progressive interstitial pneumonia. Brain angiography revealed a severe stenosis of the proximal right internal carotid artery (ICA) and a complete obstruction of the intracranial ICA. An open lung biopsy revealed fibrosis and lymphoplasma cell infiltration without eosinophils, which were consistent with nonspecific interstitial pneumonia.

• Journal of Korean Neurosurgical Society
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• v.48 no.5
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• pp.391-398
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• 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.

• Proceedings of the KOSOMBE Conference
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• v.1998 no.11
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• pp.57-59
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• 1998

For medical students and doctors, knowledge of the three-dimensional (3D) structure of brain is very important in diagnosis and treatment of brain diseases. Two-dimensional (2D) tools (ex: anatomy book) or traditional 3D tools (ex: plastic model) are not sufficient to understand the complex structures of the brain. However, it is not always guaranteed to dissect the brain of cadaver when it is necessary. To overcome this problem, the virtual dissection programs of the brain have been developed. However, most programs include only 2D images that do not permit free dissection and free rotation. Many programs are made of radiographs that are not as realistic as sectioned cadaver because radiographs do not reveal true color and have limited resolution. It is also necessary to make the virtual dissection programs of each race and ethnic group. We attempted to make a virtual dissection program using a 3D image of the brain from a Korean cadaver. The purpose of this study is to present an educational tool for those interested in the anatomy of the brain. The procedures to make this program were as follows. A brain extracted from a 58-years old male Korean cadaver was embedded with gelatin solution, and serially sectioned into 1.4 mm-thickness using a meat slicer. 130 sectioned specimens were inputted to the computer using a scanner ($420\times456$ resolution, true color), and the 2D images were aligned on the alignment program composed using IDL language. Outlines of the brain components (cerebrum, cerebellum, brain stem, lentiform nucleus, caudate nucleus, thalamus, optic nerve, fornix, cerebral artery, and ventricle) were manually drawn from the 2D images on the CorelDRAW program. Multimedia data, including text and voice comments, were inputted to help the user to learn about the brain components. 3D images of the brain were reconstructed through the volume-based rendering of the 2D images. Using the 3D image of the brain as the main feature, virtual dissection program was composed using IDL language. Various dissection functions, such as dissecting 3D image of the brain at free angle to show its plane, presenting multimedia data of brain components, and rotating 3D image of the whole brain or selected brain components at free angle were established. This virtual dissection program is expected to become more advanced, and to be used widely through Internet or CD-title as an educational tool for medical students and doctors.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.316-320
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• 2003

Background: The detection of circulating microemboli by transcranial Doppler ultrasonography (TCD) has the potential to select the patients with high risk for future symptomatic brain embolism. We prospectively evaluated the positive rate and the frequency of microembolic signals (MES) before and after the heart valve surgery (HVS). Material and Method: Fifty in-patients with heart valve disease were enrolled in this study. Patients with history of previous stroke or heart valve surgery were excluded. Two unilateral TCD monitoring sessions were peformed from middle cerebral artery for 1-hour, before and after HVS. Result: Mechanical Heart valves were implanted in 28 patients, tissue valves were implanted in 10 patients, and remaining 12 patients received mitral valve repair. Positive rate of MES was significantly increased after HVS (50%), compared to that of before HVS (8%, p=0.00). There was no relation between MES after HVS and intensity of anticoagulation, cardiac rhythm, patients' age, and history of hypertension. The positive rate of MES after implantation of mechanical heart valve (71.4%) was significantly higher than those after implantation of tissue valve or mitral valve plasty (p=0.002). Conclusion: Positive rate of MES was increased significantly after the implantation of HVS. The changes of MES in those with mechanical prosthesis may be related to the increased risk or embolism after Hvs.

• Korean Journal of Acupuncture
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• v.22 no.2
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• pp.25-41
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• 2005

Objectives : Bambusae Caulis in Liquamen(BCL) has been used to medication for early stroke in the Oriental Medicine. So this study was planned to investigate the effects of BCL on the focal ischemia-induced by intraluminal filament insertion in the rats. Materials and methods: The focal ischemia was induced by Intraluminal Filament insertion into middle cerebral artery. BCL herbal acupuncture at ST36 was carried out during 3 weeks after focal ischemia-induced. Eight-arm radial maze was used for the behavioral task and neuroprotective effect of BCL acupuncture was observed by Cresyl violet, AchE, ChAT-stain Results : The error rate in the eight-arm radial maze task was significantly decreased in BCL1(0.89mg/kg) herbal acupuncture group compared to control group on 3,4,5days, compared to saline acupuncture group on 3,5days. The rate of correct choice was significantly increased in saline acupuncture, BCL1 herbal acupuncture group, BCL2(0.089mg/kg) herbal acupuncture groups compared to control group. The density of neurons in the hippocampal CA1 was the most increased in BCL1 herbal acupuncture group compared to the others. The density of AchE in the hippocampal CA1 was significantly increased in BCL1 herbal acupuncture, BCL2 herbal acupuncture groups compared to control group, and in BCL2 herbal acupuncture groups increased compared to saline acupuncture, control groups. The density of ChAT in the hippocampal CA1 was significantly increased in BCLl herbal acupuncture group compared to saline acupuncture, control groups. Conclusions : These results suggest that BCL herbal acupuncture could be used as a medication for controlling the early stroke.

• Korean Journal of Acupuncture
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• v.22 no.3
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• pp.137-156
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• 2005

Objectives : Cnidium officinale(CO) has been used for medication for stroke in the Oriental Medicine. So this study was planned to investigate the effects of CO on the focal ischemia-induced by Middle Cerebral Artery Occlusion(MCAO) in rats Materials and methods : The focal ischemia was induced by MCAO. CO extracts through oral administration and herbal acupuncture at GB2l was carried out during 3 weeks after focal ischemia-induced. Eight-arm radial maze was used for the behavioral task. For the neuroprotective effect of CO, we investigated AchE, ChAT, and NGF-expression by immnohistochemical method. Results : The error rate in the eight-arm radial maze task was significantly decreased in normal group compared to control group on 1-6days, OA-CO1(CO oral administration, 0.8g/kg) group on 1-6days, OA-CO2(CO oral administration, 1.6g/kg) group on 1-3,5,6days, HA-CO1(CO herbal acupuncture, 0.016g/kg) group on 2,3,6days, HA-CO2(CO herbal acupuncture, 0.008g/kg) group on 1-3,5,6days. The rate of correct choice was significantly increased in OA-CO1, HA-CO2. The density of neurons in the hippocampal CA1 was the most increased in OA-CO1, HA-CO1, HA-CO2. The density of ChAT in the hippocampal CA1 was increased in OA-CO1, HA-CO2. The density of ChAT in the hippocampal CA1 was significantly increased in OA-CO1, HA-CO2. The density of NGE in the hippocampal CAI was significantly increased in OA-CO1, OA-CO2, HA-CO2. Conclusions : These results suggest that CO oral administration with 0.8g/kg and CO herbal acupuncture with 0.008g/kg might be used as a regulator of cell death of cholinergic system induced by stroke.

• Korean Journal of Acupuncture
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• v.22 no.4
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• pp.43-56
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• 2005

Objectives : The acupuncture has been used as treatment of disease in the oriental medicine. In this study, it was investigated at had an effects of Heart JEONGGYEOK(心正格) of SAAM five evolutive phase acupuncture techniques(舍岩五行鑛法) for appling deficiency in the heart induced by experimental focal ischemia. Materials and methods : The focal ischemia was induced by middle cerebral artery occlusion for 2hours. The groups divided into 6 groups, normal(intactness group), control(no therapy group after ischemia-induced), AT1(reinforcing acupoint of Heart JEONGGYEOK : acupuncture therapy group at LR1, HT9 after ischemia-induced), AT2(reinforcing acupoint of Kidney JEONGGYEOK : acupuncture therapy group at LU8, KI7 after ischemia-induced) AT3(combination of reinforcing acupoint of Heart JEONGGYEOK and Kidney JEONGGYEOK : acupuncture therapy group at LR1, HT9, LU8, KI7 after ischemia-induced) AT4(reinforcing and reducing acupoint of Heart JEONGGYEOK : acupuncture therapy group at LR1, HT9, HT3, KI10 after ischemia-induced), AT4(reinforcing and reducing acupoint of Heart JEONGGYEOK : acupuncture therapy group at LRI, HT9, HT3, KI10 after ischemia-induced). Acupuncture therapy was carried out during 3 weeks after focal ischemia-induced. Eight-arm radial maze was used for the behavioral task and neuropretective effect of acupuncture therapy was observed by Cresyl violet, AchE, ChAT-stain. Results : The error rate in the eight-arm radial maze task was significantly decreased in AT3 group on 3days, in AT1 and AT4 groups on 4days, in AT3 and AT4 groups on 5days compared to the control group. The rate of correct choice was significantly increased AT4 group compared to the control group. The density of neurons in the hippocampal CA1 were significantly increased in all experiment groups, AT1, AT2, AT3 and AT4 groups compared to the control group. The density of AchE in the hippocampal CA1 was significantly increased in AT4 group compared to the control group. The density of ChAT in the hippocampal CA1 were significantly increased in AT1 and AT3 group compared to the control group. Conclusions : These results suggest that reinforcing and reducing acupoint of Heart JEONGGYEOK could be used as a medication for controlling the stroke by deficiency in the heart.