• The Journal of Internal Korean Medicine
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• v.27 no.4
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• pp.905-914
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• 2006

Background and Purpose : The purpose of this study was to classify according to the TOAST classification (Trial of Org 10172 in Acute Stroke Treatment) acute stroke patients (first-ever stroke) treated at the Department of Internal Medicine of Kyungwon University In-cheon Oriental Medical Hospital. Methods : In the time period Oct. 2005 to Oct. 2006. 101 patients with a first-ever stroke admitted to the Department of Internal Medicine of Kyungwon University In-cheon Oriental Medical Hospital were included. Patients were hospitalized within 14 days after the onset of stroke. They had neurological deficits for a time more than 24 hours. We classified patients according to the original TOAST classification (Trial of Org 10172 in Acute Stroke Treatment) Results : The incidence in males was 54.4%, in females was 45.6%. Ischemic stroke (86.l%) was more common than hemorrhagic stroke (13.9%). The results of TOAST classification in this study were as follows: small-vessel occlusion, 72.4% large-artery atherosclerosis. 14.9 % cardioembolism, 4.6% stroke of other determined etiology, 4.6%: stroke of undetermined etiology, 3.5%. Patients in the small-vessel occlusion subgroup in this study were the most frequent. The result of this study is that Korean stroke registry is not in accordance with western medicine. Conclusions : The TOAST classification system is the most widely accepted tool to categorize stroke subtypes in western medicine, but in oriental medicine, it is not yet widely accepted. The authors suggest the general use of the TOAST classification to determine adequate management for stroke patients, to predict the prognosis and recurrence of stroke and to develop a Korean standard of stroke in oriental medicine.

• The Journal of Korean Medicine
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• v.28 no.1 s.69
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• pp.35-41
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• 2007

Objectives : To gain better insights on the characteristics of stroke patients admitted to oriental medical hospitals, we analyzed the data of 363 consecutive patients with acute ischemic stroke from Hanbang Stroke Registry supported by the Ministry of Science and Technology of Korea. Methods : Subjects' enrollment was in the oriental medical hospitals of 3 universities located in the metropolitan region from October 2005 to October 2006. We assessed the subjects' general characteristics, risk factors, and etiology of stroke. Each patient's TOAST classification type was confirmed by two independent specialists. Those were small vessel occlusion (SVO), large artery atherosclerosis (LAA), cardioembolism (CE), stroke with other determined etiology (SOE), and stroke with undetermined etiology (SUE).Results 'The distribution of the subjects' general characteristics and risk factors for stroke were similar with result storm previous reports. However, in the TOAST classification, SVO was the major type occupying 78.5% in the total subjects, which is the highest share compared with other research with similar methods. These results imply that patients with more severe symptoms rarely visit oriental medical hospitals. Conclusion : Assuming that this research will continue adding patient's data continuously, this work will help us to understand the features of stroke patients at oriental medical hospitals, and contribute to expansion of the Korean Hanbang Stroke Data Bank.

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

• The Journal of Internal Korean Medicine
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• v.28 no.1
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• pp.92-96
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• 2007

Objectives : This study investigated the clinical effect of a drinking habit in acute stroke patients. Methods : 409 acute stroke patients were included from October 2005 to October 2006. Patients were hospitalized within 14 days after the onset of stroke at DongGuk University International Hospital, Kyungwon University In-cheon Oriental Medical Hospital, or Department of Cardiovascular and Neurologic Diseases (Stroke Center), Kyung Hee University Oriental Hospital. We investigated general characteristics, drinking habit, and stroke subtype by TOAST classification. Results : Among drinking subjects, hemorrhagic stroke was more frequent than ischemic stroke (odds ratio 3.04), and less in small vessel occlusion than others (odds ratio 1.84). Ischemic stroke was associated with a longer (30 yrs) drinking habit than hemorrhagic stroke. Conclusions : To acquire more concrete conclusions on this theme, we need further and larger scale research.

• The Journal of Internal Korean Medicine
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• v.29 no.3
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• pp.675-683
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• 2008

Objectives : This study was designed to examine the effects of hyperbaric oxygen therapy on cerebral infarction. Methods : Fifty-five patients with acute or subacute cerebral infarction were classified into two groups, the study group and control group. The study group was treated by hyperbaric oxygen therapy(HBOT) for 2 weeks(5 times/week) and the control group wasn't treated by HBOT. We compared the score of National Institutes of Health Scale(NIHSS scale) between two groups. We subdivided the study group by TOAST classification and onset stage, and compared the results. All of this data was analyzed by statistical method. Results : The study group patients who were treated by hyperbaric oxygen therapy saw more improvement than the control group patients in NIHSS score, and there was significant consideration. Among the study group patients, we saw more improvement during the first week period than in the course of the second week, and there was significant consideration. Conclusion : These results suggest that hyperbaric oxygen therapy(HBOT) could be a useful medical treatment to treat cerebral infarction. Further studies are needed on more cases to make sure that hyperbaric oxygen therapy (HBOT) is surely effective for cerebral infarction.

• The Journal of Korean Medicine
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• v.28 no.3 s.71
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• pp.207-215
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• 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 Internal Korean Medicine
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• v.28 no.1
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• pp.25-33
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• 2007

Background and Purpose : This study was to survey complication according to the TOAST classification and Sasangconstitution in first-ever AICD (acute ischemic cerebrovascular disease) patients. Methods : From 1 Oct. 2005 to 31 Oct. 2006. 97 patients with a first-ever stroke were included in the study. patients were hospitalized within 14 days after the onset of stroke at Kyungwon University Incheon Oriental Hospital. We recorded patient's complications according to the standard operation procedure of 'A stroke study for standardization and science on Korean Medicine' Results : Complications were recorded in 23 cases (24%). The most common complication was upper respiration infection in 11 cases (11%). No statistical significance was shown between complications of AICD and Sasangconstitutions, but complications rate of LAA was higher than SVO in AICD patients (odds ratio 4.17 95% CI 1.127${\sim}$7.307). Conclusions : To acquire more concrete data on this theme. we need further and larger scale research.

• 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.

• The Journal of the Society of Stroke on Korean Medicine
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• v.7 no.1
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• pp.40-45
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• 2006

Objectives : This study was aimed to assess the distribution of Sasang constitution(SC) in acute stroke patients. Methods : We assessed the type of SC of acute stroke patients in the oriental medical hospitals of 3 universities located in metropolitan region from October 2005 to October 2006 by Questionnaire for the Sasang Constitution Clssification II(QSCCII). We investigated general characteristics, stroke type, blood test results, alcohol drinking, smoking and dietary preferences according to SC. Results : 236 subjects were included into the final analysis. 1. This study showed that the proportion of So-yang was highest of all constitutions(45.3%). And the body weight, body mass index, the waist circumference(WC), the hip circumference(HC), and the WC/HC ratio recorded the significantly high result in Tae-eum. 2. In the TOAST classification, SVO was the major type occupying 81.7% in the total subjects. 3. In Tae-eum, total cholesterol, triglyceride and 2 hours postprandial plasma glucose level were the highest and fasting glucose was significantly highest of all constitutions. Conclusion : From this study, we could roughly seize the distribution of Sasang constitution in acute stroke patients. For the further research, it seems to be necessary to construct fundamental databases for stroke by increasing the number of patients and by analyzing delicate characteristics of each constitution type.

• 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.