• Journal of Korean Neurosurgical Society
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• v.63 no.4
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• pp.427-432
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• 2020

Three randomized control trials (RCTs), published in 2013, investigated efficacy of mechanical thrombectomy in large vessel occlusions and did not show better results compared to intravenous (IV) recombinant tissue-type plasminogen activator (tPA) alone. However, most clinicians treating stroke consider mechanical thrombectomy as the standard treatment rather than using IV tPA alone. This paradigm shift was based on five RCTs investigating efficacy of mechanical thrombectomy in acute ischemic stroke conducted from 2010 to 2015. They demonstrated that mechanical thrombectomy was effective and safe in acute ischemic stroke with anterior circulation occlusion when performed within 6 hours of stroke onset. There are four reasons underlying the different results observed between the trials conducted in 2013 and 2015. First, the three RCTs of 2013 used low-efficiency thrombectomy devices. Second, the three RCTs used insufficient image selection criteria. Third, following the initial presentation at the hospital, reperfusion treatment required a long time. Fourth, the three RCTs showed a low rate of successful recanalization. Time is the most important factor in the treatment of acute ischemic stroke. However, current trends utilize advanced imaging techniques, such as diffusion-weighted imaging and multi-channel computer tomographic perfusion, to facilitate the detection of core infarction, penumbra, and collateral flows. These efforts demonstrate that patient selection may overcome the barriers of time in specific cases.

• The Korean Journal of Rehabilitation Nursing
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• v.16 no.2
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• pp.90-99
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• 2013

Purpose: This study aimed to examine influence of cognitive function, disease severity and disability on ability to perform activity of daily living (ADL) after ischemic stroke. Methods: A total of 88 patients with ischemic stroke were recruited from January 1, 2008 to December 31, 2012 and assessed with the standardized cognitive test battery and self-reports about disease severity, disability, and ADL. To analyze the data, ANOVA, Pearson correlation coefficients and multiple regression were conducted using SPSS/WIN program. Results: Significant correlations were found between ADL and visuospatial function, visual memory, executive function, and disability (r=.29~.38). Executive function and disability explained 17.3% of total variability in ADL performance after ischemic stroke. Conclusion: Executive function may be a promising target for cognitive rehabilitation after ischemic stroke. Thus, effective therapeutic interventions such as cognitive training for stroke patients should be considered to improve their ability to perform ADL.

• The Journal of Korean Medicine
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• v.28 no.4
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• pp.42-51
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• 2007

Background and Purpose : To prevent ischemic cerebral infarction, it is very important to reduce risk factors which might cause stroke. However, the relationship of coffee consumption with ischemic cerebral infarction still remains unclear. The purpose of this study was to investigate the effects of coffee consumption on the risk of ischemic cerebral infarction in Koreans. Methods : A case-control study was conducted from April 1, 2001 to July 31, 2004. Cases (n=435) of first incident ischemic cerebral infarction were enrolled and were mostly matched by age to stroke-free hospital controls (n=407). All subjects were interviewed, examined and had anthropometric measurements by using an organized questionnaire. The coffee consumption was classified by the average frequency of intake, being none, 1 cup/day, 2-4 cups/day, more than 5 cups/day. Odds ratios (ORs) of ischemic cerebral infarction were proved multivariate analysis after adjustment for demographic factors, diet factors, and vascular risk factors. Results : When adjusted for sex, age, and other factors, coffee consumption and stroke do not have a significant association. (${\leq}$ cup/day OR=1.035, 95% CI=0.880-2.756; 2-4cups/day OR=1.452, 95% CI=0.864-2.440; ${\geq}$ 5 cups/day OR=1.557, 95% CI=0.705-3.435) Conclusions : In this study, we conclude that coffee consumption is not an important risk factor of ischemic cerebral infarction in Koreans. Prospective and cohort study on the relation between coffee consumption and the possibility of inducing ischemic cerebral infarctions in Koreans will be required in the future.

• Korean Journal of Health Education and Promotion
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• v.27 no.4
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• pp.83-90
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• 2010

objectives: This study was conducted to estimate medical expenditure attributable to overweight and obesity in adults with ischemic heart disease and stroke using Korea National Health and Nutrition Examination survey data and Korea National Health Corporation data. methods : The medical expenditure of ischemic heart disease and stroke related to overweight and obesity were composed of inpatient care costs, outpatient care costs and medication costs. The population attributable risk (PAR) of overweight and obesity was calculated from national representative data of Korea such as the National Health Insurance Corporation cohort data and 2005 Korea National Health and Nutrition Examination survey data. results: The medical expenditure attributable to overweight and obesity of ischemic heart disease were 97.4 billion won(74.1-122 billion won). and stroke were 64.6 billion won(33.1-98.1 billion won). Consequently, these costs corresponded to 11.4% of total medical expenditure due to ischemic heart disease and stroke. conclusion: We conclude that overweight and obesity have increased medical expenditure from ischemic heart disease and stroke in Korea. These findings provide important support for implementing overweight and obesity management strategies in Korea.

• Korean Journal of Clinical Laboratory Science
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• v.54 no.1
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• pp.1-8
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• 2022

Erythrocyte sedimentation rate (ESR) evaluation is a useful tool for monitoring disease activity in various inflammatory and non-inflammatory conditions. ESR is known to be influenced by a multitude of confounding factors. The present study aimed to assess the possible determinants of the ESR and its relationship with various risk factors involved in ischemic stroke. ESR and other hematological and biochemical parameters were investigated in 163 ischemic stroke patients (107 males and 56 females) selected based on imaging techniques including magnetic resonance imaging (MRI) or computed tomography (CT) scans. Statistical analysis was performed using the SPSS 16.0 software. Linear regression analysis showed a significant inverse relationship of hemoglobin (Hb) and hematocrit or packed cell volume (PCV) (P<0.001 for females; P<0.01 for males) with the ESR. It was observed that the red blood cell (RBC) count was not strongly correlated with the ESR (P<0.05 for both males and females). It was also observed that sex significantly affected the variables determining the ESR levels, whereas age had no effect. Gender differences were also observed with respect to Hb, RBC, PCV, mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and ESR. The possible determinants of higher ESR levels in ischemic stroke may be sex, Hb, hematocrit, and RBC count, but the role of other clinical and laboratory parameters cannot be underestimated.

• Biomolecules & Therapeutics
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• v.30 no.1
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• pp.55-63
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• 2022

Oleanolic acid (OA), a natural pentacyclic triterpenoid, has been reported to exert protective effects against several neurological diseases through its anti-oxidative and anti-inflammatory activities. The goal of the present study was to evaluate the therapeutic potential of OA against acute and chronic brain injuries after ischemic stroke using a mouse model of transient middle cerebral artery occlusion (tMCAO, MCAO/reperfusion). OA administration immediately after reperfusion significantly attenuated acute brain injuries including brain infarction, functional neurological deficits, and neuronal apoptosis. Moreover, delayed administration of OA (at 3 h after reperfusion) attenuated brain infarction and improved functional neurological deficits during the acute phase. Such neuroprotective effects were associated with attenuation of microglial activation and lipid peroxidation in the injured brain after the tMCAO challenge. OA also attenuated NLRP3 inflammasome activation in activated microglia during the acute phase. In addition, daily administration of OA for 7 days starting from either immediately after reperfusion or 1 day after reperfusion significantly improved functional neurological deficits and attenuated brain tissue loss up to 21 days after the tMCAO challenge; these findings supported therapeutic effects of OA against ischemic stroke-induced chronic brain injury. Together, these findings showed that OA exerted neuroprotective effects against both acute and chronic brain injuries after tMCAO challenge, suggesting that OA is a potential therapeutic agent to treat ischemic stroke.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.437-448
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• 2018

Objective: Acute ischemic stroke (AIS) requires time-dependent reperfusion therapy, and early recognition of AIS is important to patient outcomes. This study was conducted to identify the clinical features and risk factors of AIS patients that are missed during the early stages of diagnosis. Methods: We retrospectively reviewed AIS patients admitted to a hospital through the emergency department. AIS patients were defined as ischemic stroke patients who visited the emergency department within 6 hours of symptom onset. Patients were classified into two groups: an activation group (A group), in which patients were identified as AIS and the stroke team was activated, and a non-activation group (NA group), for whom the stroke team was not activated. Results: The stroke team was activated for 213 of a total of 262 AIS patients (81.3%), while it was not activated for the remaining 49 (18.7%). The NA group was found to be younger, have lower initial National Institutes of Health Stroke Scale scores, lower incidence of previous hypertension, and a greater incidence of cerebellum and cardio-embolic infarcts than the A group. The chief complaints in the A group were traditional stroke symptoms, side weakness (61.0%), and speech disturbance (17.8%), whereas the NA group had non-traditional symptoms, dizziness (32.7%), and decreased levels of consciousness (22.4%). Independent factors associated with missed stroke team activation were nystagmus, nausea/vomiting, dizziness, gait disturbance, and general weakness. Conclusion: A high index of AIS suspicion is required to identify such patients with these findings. Education on focused neurological examinations and the development of clinical decision tools that could differentiate non-stroke and stroke are needed.

• The Journal of Korean Physical Therapy
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• v.13 no.3
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• pp.799-814
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• 2001

This study was performed to investigate the clinical pictures and rehabilitation service patterns of stroke patients in cities of kimchon(kumi), jinju. pohwang, jeonju and jeju from January 1,2001 to march. Authors developed structured questionnaire, and distributed it to each physical therapist. Total number of distributed questionnaire was 400, and 301 questionnaire were col looted and analysed finally.1. The occurrence rate of hemorrhagic stroke(60.5%) was higher than that of ischemic stroke(39.5%). The highest incidence of the stroke was noted in the group of 50 years and ratio of male to female 1.3 : 1. 2. The several warning sign is motor deficit(42.5%). headache. dizziness, vomitting(31.9%) and difficulty speaking or understanding(10.6%). 3. The most important contributing factor of stroke was hypertension both hemorrhagic(50.0%) and ischemic stroke(40.3%). 4. In the painful stroke patients(53.2%). the major problems were shoulder pain(51.3%) and shoulder-hand syndrom(31.3%). 5. In hemorrhagic stroke. the seasonal preference was autumn and summer. In ischemic stroke. the seasonal preference was autumn and winter. 6. In the surgery, hemorrhgic stroke(44.5%) was higher than that of ischemic stroke(20.2%). 7 The major impairment were motor deficit(95.3%), psychological deficits(24.4%), hearing and speech deficit(23.4%). vision deficit(14.7%) and perception deficit(12.7%). 8. The rehabilitation services for stroke patients were physical therapy(98.0%), occupational therapy(41.5%), oriental therapy(35.1%), speech therapy(17.5%) and psychological therapy(7.4%). 9. The start of rehabilitation service was different according to surgery. 36.5% of patients started physical therapy in 4 week and 32.0% of patients started in 8 week later in surgery and 53.1% of patients started physical therapy in 2 week in not surgery( P<0.05). 10. The highest frequency of rehabilitation service was six times per week.

• Journal of Physiology & Pathology in Korean Medicine
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• v.25 no.4
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• pp.734-742
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• 2011

The purpose of this study was to investigate the distribution and correlation of stroke risk factor according to age with stroke patients. This study was based on clinical data registered in Daejeon Oriental Medical Hospital from November 2006 to December 2010. Study subjects consisted of 779 patients with stroke within 1 month and they were classified according to age and existence of past history such as hypertension, diabetes mellitus, ischemic heart diseaseand stroke family history. Stroke family history was distributed differently according to age unlike past history and in their 50's showed a particularly high rate. There was not statistically significant correlation between stroke family history and past history except for only between stroke family history and diabetes mellitus in the patients in their 80's and more. There was statistically significant correlation between hypertension and diabetes mellitus and especially in the patients in their 60's and 70's. There was statistically significant correlation between hypertension and ischemic heart disease and especially in the patients in their 80's and more. There was statistically significant correlation between diabetes mellitus and ischemic heart disease in the patients in their 60's. There was statistically significant correlation among hypertension, diabetes mellitus and ischemic heart disease, but stroke family history and past history had independence, so management and research for this subject should be required further and further.

• Journal of Korean Neurosurgical Society
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• v.65 no.5
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• pp.665-679
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• 2022

Objective : Patients with mild ischemic stroke experience various sequela and residual symptoms, such as anxious behavior and deficits in movement. Few approaches have been proved to be effective and safe therapeutic approaches for patients with mild ischemic stroke by acute stroke. Sildenafil (SIL), a phosphodiesterase-5 inhibitor (PDE5i), is a known remedy for neurodegenerative disorders and vascular dementia through its angiogenesis and neurogenesis effects. In this study, we investigated the efficacy of PDE5i in the emotional and behavioral abnormalities in rats with mild ischemic stroke. Methods : We divided the rats into four groups as follows (n=20, respectively) : group 1, naïve; group 2, middle cerebral artery occlusion (MCAo30); group 3, MCAo30+SIL-pre; and group 4, MCAo30+SIL-post. In the case of drug administration groups, single dose of PDE5i (sildenafil citrate, 20 mg/kg) was given at 30-minute before and after reperfusion of MCAo in rats. After surgery, we investigated and confirmed the therapeutic effect of sildenafil on histology, immunofluorescence, behavioral assays and neural oscillations. Results : Sildenafil alleviated a neuronal loss and reduced the infarction volume. And results of behavior task and immunofluorescence shown possibility that anti-inflammation process and improve motor deficits sildenafil treatment after mild ischemic stroke. Furthermore, sildenafil treatment attenuated the alteration of theta-frequency rhythm in the CA1 region of the hippocampus, a known neural oscillatory marker for anxiety disorder in rodents, induced by mild ischemic stroke. Conclusion : PDE5i as effective therapeutic agents for anxiety and movement disorders and provide robust preclinical evidence to support the development and use of PDE5i for the treatment of mild ischemic stroke residual disorders.