• The Journal of Korean Medicine
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• v.33 no.4
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• pp.1-8
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• 2012

Objectives: The purpose of this study was to specify major tongue diagnostic indicators and evaluate their significance in discriminating pattern identification subtypes in stroke patients. Methods: This study used a community based multi-center observational design. Participants (n=1,502) were stroke patients admitted to 11 oriental medical university hospitals between December 2006 and February 2010. To determine which tongue indicator affected each pattern identification, a decision tree analysis of the chi-square automatic interaction detector (CHAID) algorithm was performed. The chi-squared test was used as the criterion in splitting data with a p-value less than 0.05 for division, which is the main procedure for developing a decision tree. The minimum sample size for each node was specified as n =10, and branching was limited to two levels. Results: From the 9 tongue diagnostic indicators, 6 major tongue indicators (red tongue, pale tongue, yellow fur, white fur, thick fur, and teeth-marked tongue) were identified through the decision tree analysis. Furthermore, each pattern identification was composed of specific combinations of the 6 major tongue indicators. Conclusions: This study suggests that the 6 tongue indicators identified through the decision tree analysis can be used to discriminate pattern identification subtypes in stroke patients. However, it is still necessary to re-evaluate other pattern identification indicators to further the objectivity and reliability of traditional Korean medicine.

• Nutrition Research and Practice
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• v.10 no.5
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• pp.516-523
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• 2016

BACKGROUND/OBJECTIVES: This study was conducted to examine relationships between dietary habits and intakes of antioxidants and B vitamins and the risk of ischemic stroke, and to compare dietary factors according to the presence of cerebral artery atherosclerosis and stroke subtypes. SUBJECTS/METHODS: A total of 147 patients and 144 control subjects were recruited consecutively in the metropolitan area of Seoul, Korea. Sixty participants each in the case and control groups were included in analyses after 1:1 frequency matching. In addition, 117 acute ischemic stroke patients were classified into subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) guidelines. Dietary intake was measured using a semi-quantitative food frequency questionnaire composed of 111 food items and plasma lipid and homocysteine levels were analyzed. RESULTS: When compared with control subjects, stroke patients had unfavorable dietary behaviors and lower intakes of fruits ($73.1{\pm}83.2g$ vs. $230.9{\pm}202.1g$, P < 0.001), vegetables ($221.1{\pm}209.0g$ vs. $561.7{\pm}306.6g$, P < 0.001), and antioxidants, including vitamins C, E, $B_6$, ${\beta}$-carotene, and folate. The intakes of fruits, vegetables, vitamin C, and folate were inversely associated with the risk of ischemic stroke after adjusting for confounding factors. Intakes of vegetables, vitamins C, $B_6$, $B_{12}$, and folate per 1,000 kcal were lower in ischemic stroke with cerebral atherosclerosis than in those without. Overall vitamin $B_{12}$ intake per 1,000 kcal differed according to the TOAST classification (P = 0.004), but no differences among groups existed based on the post-hoc test. CONCLUSIONS: When compared with control subjects, ischemic stroke patients, particularly those with cerebral atherosclerosis, had unfavorable dietary intake, which may have contributed to the development of ischemic stroke. These results indicate that proper dietary recommendations are important for the prevention of ischemic stroke.

• The Journal of Internal Korean Medicine
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• v.30 no.3
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• pp.550-557
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• 2009

Objectives : The purpose of this study was to investigate the possibility of Bi-Su as a pattern identification (PI) index in stroke patients. Methods : The subjects were 424 hospitalized stroke patients within 1 month from onset and diagnosed with the same PI subtypes (dampness & phlegm, qi deficiency, fire & heat, eum deficiency, and blood stasis) by agreement of two clinical experts. Bi-Su type is a kind of body shape (Bi : fat, Su : lean). Bi-Su type and degree (Bi-Su score) were decided by clinical expert. Body mass index (BMI) and waist-hip ratio (WHR) were used as an obesity index. Correlation analysis between Bi-Su score and obesity index (Spearman) and variance analysis for Bi-Su score, BMI, and WHR among PI subtypes (ANOVA) and sex were carried out. Results : While there was partial correlation between Bi-Su type and BMI($r^2$=0.634, p<0.001), the distribution of the BMI group based on the Bi-Su group showed the broadest range. The Bi-Su score in the dampness & phlegm group was higher than in the other groups (p<0.001). BMI in the dampness & phlegm groups was also higher but the BMI differences among PI subtypes was low (p=0.002). The Bi-Su score in the dampness & phlegm group was similar in both sexes, although the hand score in the eum deficiency group was the lowest, especially in males. Conclusions : Although BMI is not an objective enough tool for evaluating Bi-Su type, Bi-Su type is more appropriate than BMI as PI index. Therefore Bi-Su type could be used as one of the PI indices for dampness & phlegm or eum deficiency group in stroke patients.

• Journal of Physiology & Pathology in Korean Medicine
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• v.25 no.2
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• pp.318-321
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• 2011

In this study, when a physician make a diagnosis of the Pattern Identifications(PIs) of stroke patients, the development methods of the PIs classification function is considered by diagnostic questionnaire of the PIs for stroke patients. Clinical data collected from 1,502 stroke patients who was identically diagnosed for the PIs subtypes diagnosed by two clinical experts with more than 3 years experiences in 13 oriental medical hospitals. In order to develop the classification function into PIs using the 44 items-Fire&heat(19), Qi-deficiency(11), Yin-deficiency(7), Dampness phlegm(7)- of them was significant statistically by univariate analysis in 61 questionnaires totally, we make some comparisons of the results of discriminant analysis model and generalized logit model. The overall diagnostic accuracy rate of the PIs subtypes for discriminant model(74.37%) was higher than 3% of generalized logit model(70.09%).

• Korean Journal of Clinical Laboratory Science
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• v.50 no.2
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• pp.126-135
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• 2018

This study examined whether the difference in the middle cerebral artery (MCA) velocities can predict the prognosis of stroke and whether the prognostic impact differs among stroke subtypes. Transient ischemic attack (TIA) or acute ischemic stroke patients, who underwent a routine evaluation and transcranial Doppler (TCD), were included in this study. The MCA asymmetry index was calculated using the relative percentage difference in the mean flow velocity (MFV) between the left and right MCA: (|RMCA MFV-LMCA MFV|/mean MCA MFV)${\times}100$. The stroke subtypes were determined using the TOAST classification. Poor functional outcomes were defined as a mRS score ${\geq}3$ at 3 months after the onset of stroke. A total of 988 patients were included, of whom 157 (15.9%) had a poor functional outcome. Multivariable analysis showed that only the MCA asymmetry index was independently associated with a poor functional outcome. ROC curve analysis showed that adding the MCA asymmetry index to the prediction model improved the discrimination of a poor functional outcome from acute ischemic stroke (from 88.6% [95% CI, 85.2~91.9] to 89.2% [95% CI, 85.9~92.5]). The MCA asymmetry index has an independent prognostic value for predicting a poor short-term functional outcome after an acute cerebral infarction. Therefore, TCD may be useful for predicting a poor functional outcome in patients with acute ischemic stroke.

• Journal of Preventive Medicine and Public Health
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• v.47 no.2
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• pp.104-112
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• 2014

Objectives: To date, studies have not comprehensively demonstrated the relationship between stroke incidence and socioeconomic status. This study investigated stroke incidence by household income level in conjunction with age, sex, and stroke subtype in Korea. Methods: Contributions by the head of household were used as the basis for income levels. Household income levels for 21 766 036 people were classified into 6 groups. The stroke incidences were calculated by household income level, both overall within income categories and further by age group, sex, and stroke subtype. To present the inequalities among the six ranked groups in a single value, the slope index of inequality and relative index of inequality were calculated. Results: In 2005, 57 690 people were first-time stroke patients. The incidences of total stroke for males and females increased as the income level decreased. The incidences of stroke increased as the income level decreased in those 74 years old and under, whereas there was no difference by income levels in those 75 and over. Intracerebral hemorrhage for the males represented the highest inequality among stroke subtypes. Incidences of subarachnoid hemorrhage did not differ by income levels. Conclusions: The incidence of stroke increases as the income level decreases, but it differs according to sex, age, and stroke subtype. The difference in the relative incidence is large for male intracerebral hemorrhage, whereas the difference in the absolute incidence is large for male ischemic stroke.

• The Journal of Internal Korean Medicine
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• v.23 no.1
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• pp.1-4
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• 2002

Objective : Hyperhomocysteinemia has been proven to be an independent risk factor for stroke. The genetic mutation of methylenetetrahydrofolate reductase(MTHFR) elevates serum homocysteine level, but it still remains controversial whether the MTHFR gene mutation could be a predictor of ischemic stroke. Therefore, we studied if this genetic defect could cause ischemic stroke independently. Methods : We gathered ischemic stroke subjects and age, sex-matched controls. Age, gender, past medical history, smoking habit, serum homocysteine level, and the MTHFR genotype were recorded. General characteristics of ischemic stroke subjects were compared to the controls. We classified the stroke according to the related vessels(small and large artery infarction) and single lesion and multiple infraction. Relevant risk of the MTHFR genotype was evaluated in each stroke subtype with multiple logistic regression analysis. Results : When the controls were compared to the whole ischemic stroke, there was no specific difference except some medical histories. However, further analysis based on stroke subtypes showed important results. The small artery infarction group, multiple infraction group had significant odds ratio of the MTHFR TT genotype adjusted for age, gender, medical history and smoking habit. Conclusions : The MTHFR TT genotype is an independent risk factor for certain types of ischemic stroke, small artery infarction and multiple infarction.

• Journal of Preventive Medicine and Public Health
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• v.40 no.4
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• pp.313-320
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• 2007

Objectives : To evaluate the association between body mass index (BMI) and hemorrhagic stroke. Methods : A case-control study was conducted on 2,712 persons (904 cases, 904 hospital controls, and 904 community controls) participating in an Acute Brain Bleeding Analysis study from October 2002 to March 2004. Two controls for each case were matched according to age and gender. The information was obtained by trained interviewers using standardized questionnaire. A conditional logistic regression model was used to estimate the association between BMI and the frequency of having a hemorrhagic stroke. Results : Obese men (25.0 $\leq$ BMI < $30.0\;kg/m^2$) had an odds ratios (OR) of 1.39 (95% CI 1.03 to 1.87) a hemorrhagic stroke, compared to men with a normal BMI (18.5 to $24.9\;kg/m^2$). Conversely, women with lower BMI had a higher risk of having hemorrhagic stroke. With respect to subtypes of hemorrahagic stroke, we observed about a three-fold increase in the risk of intracerebral hemorrhage (ICH) in the highly obese group. However, these trends were not significant in patients with subarachnoid hemorrhages. Conclusions : Obesity was identified as one of the risk factors in hemorrhagic stroke, in particular ICH. Conversely, in women, a lean body weight increases the risk of hemorrhagic stroke. Consequently, managing one's weight is essential to reduce the risks of hemorrhagic stroke.

• The Journal of Internal Korean Medicine
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• v.30 no.4
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• pp.696-707
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• 2009

Objective : We designed this study to investigate differences between stroke reattack and stroke first attack group to establish fundamental data and prevent a secondary stroke. Methods : 826 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 1 April 2007 to 31 August 2009. We compared general characteristics, classification of diagnosis, subtypes of cerebral infarction, risk factors, Sasang constitution, diagnostic classifications between stroke reattck and stroke first attack groups. Results : 1. In general characteristics, age differed significantly between the reattck and first attack groups. 2. Classification of diagnosis differed significantly between reattck and first attack groups. 3. In risk factors, hypertension, diabetes mellitus, alcohol drinking, and stress were significantly different between reattck and first attack groups. 4. Diagnostic classifications were significantly different between reattck and first attack groups. Conclusion : To prevent recurrence of stroke, education on stroke risk factors associated with recurrence is needed. In addition, those who are diagnosed as Dampness-Phlegm need to be well-controlled.

• The Journal of Korean Medicine
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• v.41 no.2
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• pp.23-33
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• 2020

Objectives: To investigate the prevalence of pain, clinical characteristics of pain, association between clinical features and pain of patients with Parkinson's Disease(PD). Methods: We undertook a retrospective review of the medical records of patients diagnosed with PD between 2012 and 2019 at Kyung Hee University Korean Medicine Hospital at Gangdong in South Korea. Results: A total of 172 PD patients met entry criteria and 147 out of 172 patients(85.5%) reported pain. In comparison with general population, PD patients has high prevalence of pain. Female PD patients more frequently reported pain than male (P=0.03). 102 out of 147patients(69.3) complained of musculoskeletal pain, and musculoskeletal pain show significant difference depending on the PD motor subtypes (P=0.039). Pain was mainly locatedin the leg (57.8%) in all PD motor subtypes. Tremor-dominant PD more frequently felt pain in upper limb than postural instability-gait difficulty dominant(PIGD) PD, but it was not statistically significant. Conclusions: These findings showed high prevalence of pain in PD patients, the correlation between female and pain, and the relationship between PD motor subtype and pain type. Our study can contribute to the clinical approach based on a more in-depth understanding of PD patients with pain.