• Journal of Korean Neurosurgical Society
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• 제30권6호
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• pp.717-723
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• 2001

Objective : Subarachnoid hemorrhage(SAH) is still one of the most serious disease with high morbidity and mortality in the neurosurgical field. Clipping of the aneurysmal neck is the gold standard of the surgical treatment of aneurysmal SAH. The purpose of this study was to investigate the role of the postoperative angiography and to assess the risk factors related to the incomplete clipping. Materials and Methods : From July 1995 to June 1998, the pre- and postoperative angiography were performed in 50 patients among total 81 patients who have underwent the aneurysmal surgery. We reviewed the various contributing factors including age, sex, Hunt-Hess grade, Fisher grade and the premature rupture of aneurysm during operation retrospectively. Careful evaluation of pre- and postoperative angiography focusing on the size, shape, and remnant neck of the aneurysms and vasospasm was performed. According to the angiographic findings, the patients were divided into two groups ; a complete clipping group and an incomplete clipping group. The data were analyzed by using unpaired independent sample t test after F-test to compare the significance between two groups. Results : Incomplete clipping of aneurysms was found in 6(12%) patients through the evaluation of postoperative angiography. Among them, three cases were located on the middle cerebral artery territory. Whereas the patient age, sex, Hunt-Hess grade, and Fisher grade were not significant(p>0.05), an intraoperative premature rupture had a statistical significance(p<0.05). A severe vasospasm occurred in 24(48%) cases and one patient with anterior communicating aneurysm was reoperated due to residual sac. Conclusion : According to our experience, the surgeons' judgement is the most reliable factor in deciding the postoperative angiography. During the aneurysmal surgery, the premature rupture always disturbs a complete clipping of aneurysms. Therefore, the temporary clipping of parent arteries is considered essential for a successful clipping. We believe that the postoperative angiography has a role in decreasing the re-bleeding risk due to clip migration and an inaccurate clipping only in the selected cases.

• Investigative Magnetic Resonance Imaging
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• 제6권1호
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• pp.55-63
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• 2002

목적 급성 허혈성 뇌졸중에서 관류 MR영상으로 측정한 상대적 뇌혈용적과 단광자방출전산화단층촬영으로 측정한 상대적 뇌혈류량이 나중에 발생할 뇌경색을 예측할 수 있는지 알아보고자 하였다. 대상 및 방법 급성 일측성 중대뇌동맥 폐색 환자에서 증상 발생 6시간 이내에 관류 MR영상과 99mTc-HMPAO 단광자방출전산화단층촬영을 모두 시행한 13명을 대상으로 하였다. 동맥 폐색에 의한 허혈 부위와 반대측 정상 부위에서 각 관류 변수를 측정하여 그 비(허혈 부위 관류변수 값 / 정상 부위 관류 변수 값)를 구한 후, 나중에 경색으로 이행할 부위와 그렇지 않을 부위를 판별할 수 있는 관류변수 비의 절단값을 계산하였다. 결과 : 경색으로 이행한 부위와 그렇지 않은 부위에서 상대적 뇌혈용적 비의 평균값은 각각 $0.58{\pm}0.27{\;}and{\;}0.99{\pm}0.17$ (p<0.001)이었고, 상대적 뇌혈류량 비의 평균 값은 $0.41{\pm}0.22{\;}and{\;}0.71{\pm}0.14$ (p<0.001)이었다. 경색으로 이행할 부위와 그렇지 않을 부위를 판별하는 절단값은 상대적 뇌혈용적 비가 0.80, 상대적 뇌혈류량 비가 0.56이었다. 각 절단값의 민감도, 특이도, 능률은 뇌혈용적 비가 80.6, 87.5, 82.7%이었고 상대적 뇌혈류량 비가 72.2, 75.0, 73.0%이었다. (두 관류변수 사이에서 p>0.05). 결론 : 급성 허혈성 뇌졸중에서 상대적 뇌혈용적과 상대적 뇌혈류량의 측정은 뇌경색의 발생을 예측하는 데에 유용한 것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제58권3호
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• pp.167-174
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• 2015

Objective : This study investigates the role of a burr hole and calvarial bone marrow-derived stem cells (BMSCs) in a transient ischemic brain injury model in the rat and postulates a possible mechanism for the efficacy of multiple cranial burr hole (MCBH) surgery in moyamoya disease (MMD). Methods : Twenty Sprague-Dawley rats (250 g, male) were divided into four groups : normal control group (n=5), burr hole group (n=5), ischemia group (n=5), and ischemia+burr hole group (n=5). Focal ischemia was induced by the transient middle cerebral artery occlusion (MCAO). At one week after the ischemic injury, a 2 mm-sized cranial burr hole with small cortical incision was made on the ipsilateral (left) parietal area. Bromodeoxyuridine (BrdU, 50 mg/kg) was injected intraperitoneally, 2 times a day for 6 days after the burr hole trephination. At one week after the burr hole trephination, brains were harvested. Immunohistochemical stainings for BrdU, CD34, VEGF, and Doublecortin and Nestin were done. Results : In the ischemia+burr hole group, BrdU (+), CD34 (+), and Doublecortin (+) cells were found in the cortical incision site below the burr hole. A number of cells with Nestin (+) or VEGF (+) were found in the cerebral parenchyma around the cortical incision site. In the other groups, BrdU (+), CD34 (+), Doublecortin (+), and Nestin (+) cells were not detected in the corresponding area. These findings suggest that BrdU (+) and CD34 (+) cells are bone marrow-derived stem cells, which may be derived from the calvarial bone marrow through the burr hole. The existence of CD34 (+) and VEGF (+) cells indicates increased angiogenesis, while the existence of Doublecortin (+), Nestin (+) cells indicates increased neurogenesis. Conclusion : Based on these findings, the BMSCs through burr holes seem to play an important role for the therapeutic effect of the MCBH surgery in MMD.

• The Korean Journal of Physiology and Pharmacology
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• 제21권5호
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• pp.475-485
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• 2017

The present study aimed to explore the neuroprotective effect and possible mechanisms of rhGLP-1 (7-36) against transient ischemia/reperfusion injuries induced by middle cerebral artery occlusion (MCAO) in type 2 diabetic rats. First, diabetic rats were established by a combination of a high-fat diet and low-dose streptozotocin (STZ) (30 mg/kg, intraperitoneally). Second, they were subjected to MCAO for 2 h, then treated with rhGLP-1 (7-36) (10, 20, $40{\mu}g/kg$ i.p.) at the same time of reperfusion. In the following 3 days, they were injected with rhGLP-1 (7-36) at the same dose and route for three times each day. After 72 h, hypoglycemic effects were assessed by blood glucose changes, and neuroprotective effects were evaluated by neurological deficits, infarct volume and histomorphology. Mechanisms were investigated by detecting the distribution and expression of the nuclear factor erythroid-derived factor 2 related factor 2 (Nrf2) in ischemic brain tissue, the levels of phospho-PI3 kinase (PI3K)/PI3K ratio and heme-oxygenase-1 (HO-l), as well as the activities of superoxide dismutase (SOD) and the contents of malondialdehyde (MDA). Our results showed that rhGLP-1 (7-36) significantly reduced blood glucose and infarction volume, alleviated neurological deficits, enhanced the density of surviving neurons and vascular proliferation. The nuclear positive cells ratio and expression of Nrf2, the levels of P-PI3K/PI3K ratio and HO-l increased, the activities of SOD increased and the contents of MDA decreased. The current results indicated the protective effect of rhGLP-1 (7-36) in diabetic rats following MCAO/R that may be concerned with reducing blood glucose, up-regulating expression of Nrf2/HO-1 and increasing the activities of SOD.

• Korean Journal of Acupuncture
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• 제25권1호
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• pp.229-246
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• 2008

Objectives : Acupoints of LR1(Dadun)${\cdot}$HT9(Shaochong), KI10(Yingu)${\cdot}$HT3(Shaohai) are used as controlling the diseases from heart problems. Especially, when they are used, tonification or sedation techniques method is taken as a controlling the medication for an early stroke in the Korean medicine. So the aim of this study is to investigate the anti-apoptotic and neuroprotective effects of Acupuncture techniques of tonification or sedation at LR1${\cdot}$HT9, KI10${\cdot}$HT3 on the focal ischemia induced by intraluminal filament insertion in rats. Materials and Methods : The focal ischemia was induced by intraluminal filament insertion into middle cerebral artery. The animals were divided into five groups (n=7 in each group) : Control group, no therapy group after ischemia induced; AT-1; acupuncture therapy group at LR1${\cdot}$HT9, KI10${\cdot}$HT3 after ischemia-induced. AT-2; acupuncture therapy at right LR1, HT9(forward direction), KI10${\cdot}$HT3(opposite direction) inserting to the direction of route of the each meridian. AT3; acupuncture therapy at right LR1, HT9(twirling forward with the thumb of right hand 9 times), KI10${\cdot}$HT3(twirling forward with the forefinger of right hand 6 times) AT-4; acupuncture therapy at right LR1, HT9(forward direction, twirling forward with the thumb of right hand 9 times), KI10${\cdot}$HT3(opposite direction, twirling forward with the forefinger of right hand 6 times) inserting to the direction of route of the each meridian. The anti-apoptotic and neuroprotective effects of Acupuncture techniques of tonification or sedation at LR1, HT9, KI10${\cdot}$HT3 were observed by Bax, Bcl-2, mGluR5, Cytochrome c, Cresyl violet and ChAT-stain. Results : The intensity of Bax and Bax/Bcl-2 ratio were increased in ACU-2 and ACU-4 group but decreased in ACU-3 group. The intensity of mGluR5 was increased in ACU-1, ACU-2, ACU-3 and ACU-4 group. The intensity of cytochrome c was decreased in ACU-3 and ACU-4 group. The density of neurons stained by Cresyl violet and ChAT were increased in ACU-1, ACU-3 and ACU-4 group. Conclusions : Our study suggests that acupuncture therapy of tonification at LR1, HT9 by twirling forward with the thumb of right hand 9times, sedation at KI10${\cdot}$HT3 by twirling forward with the forefinger of right hand 6 times after perpendicularly inserting needle shows anti-apoptotic and neuroprotective effects on cholinergic neuron in focal cerebral ischemia of the stroke in rats.

• 한국전문물리치료학회지
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• 제14권1호
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• pp.1-10
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• 2007

This study was designed to examine the effects of electroacupuncture and treadmill exercise on the improvement of muscle atrophy and Brain-Derived Neurotrophic Factor (BDNF) expression in an ischemic stroke model induced by middle cerebral artery occlusion. This study selected 120 Sprangue-Dawley rats, divided them into six groups, and assigned 5 rats to each group. Experiments were conducted for 1, 3 days and 1, 8 weeks, respectively. In each group, changes in weight of muscle and relative muscle of tibialis anterior muscle, histologic observations, and BDNF expression were observed and analyzed. For the changes in muscle weight of unaffected and affected sides of tibialis anterior, muscle atrophy was expressed in an affected side 3 days after ischemic stroke was induced. There was a statistically significant difference in Group VI 1 and 8 weeks after ischemic stroke was induced, compared to Group II (p<.05). For the changes in relative muscle weight of unaffected and affected sides of tibial anterior muscle, there was significant decrease in each group 3 days after ischemic stroke was induced, compared to Group I, while there was a statistically significant increase in Group VI 1 week after ischemic stroke was induced, compared to Group II (p<.05). For neurologic exercise behavior test, Group VI generally had the highest score, compared to other groups. The results of the behavior test suggests that 8 weeks after ischemic stroke was induced, Group VI improved in degeneration and inflammation of muscle fiber and decreased in destruction of nerve cells and cerebral infarction, thus indicating a similar state of muscle fiber and brain tissue in Group I. In immunohistochemical observations, Group 1 week showed increase in BDNF. Based on these results, electroacupuncture and treadmill exercise may improve muscle atrophy and change in BDNF expression of ischemic stroke rats and contribute to the improvement of exercise function.

• Korean Journal of Acupuncture
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• 제23권3호
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• pp.81-98
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• 2006

Objectives : Acupuncture using a tonification or sedation techniques method is used as a controlling the medication for an early stroke in the Korean medicine. LR3 has indicatons of headache, vertigo, facial paralysis, apoplexy, epiepsy as the source acupoint of a liver meridian. So this study is aims to investigate the anti-apoptotic and neuroprotective effects of acupuncture on the focal ischemia induced by intraluminal filament insertion in rats. Methods : The focal ischemia was induced by intraluminal filament insertion into middle cerebral artery. The animals were divided into seven groups (n=8 in each group) : Normal, intactness group; Conrol group, no therapy group after being ischemia induced; MA-l, acupuncture perpendicularly without Tonification or Sedation techniques at LR3 after being ischemia induced; MA-2, acupuncture obliquely towards the knee at LR3 after being ischemia induced; MA-3, acupuncture obliquely towards the toe at LR3 after being ischemia induced; MA-4, acupuncture obliquely towards the knee and rotate 9 times in a clockwise direction at LR3 after being ischemia induced; MA-5, acupuncture obliquely towards the toe and rotate 6 times in a counterclockwise direction at LR3 after being ischemia induced. The anti-apoptotic and neuroprotective effects of Acupuncture techniques of tonification or sedation at LR3 are observed by mGluR5, Bax, Cresyl violet, ChAT-stain and NGF. Results : The intensity of mGluR5 and the density of ChAT was increased in MA-1 group. The intensity of Bax was decreased in MA-3, MA-4 group. The density of neurons stained by Cresyl violet and ChAT was increased in MA-2, MA-3, MA-4, MA-5 group. The density of neurons stained by NGF was only increased in MA-4 group. Conclusions : Our study suggests that acupuncture perpendicularly without Tonification or Sedation techniques and obliquely towards the knee and rotate 9 times in a clockwise direction(Tonifying technique) at LR3 after being ischemia induced at LR3 shows anti-apoptotic and neuroprotective effects on cholinergic neuron in focal cerebral ischemia of the stroke in rats.

• Korean Journal of Acupuncture
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• 제24권3호
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• pp.205-221
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• 2007

Objectives : Aims of this study is to investigate the effects of $LU8{\cdot}KI7$ in rat induced by experimental focal ischemia. Materials and methods : The focal ischemia was induced by intraluminal filament insertion into middle cerebral artery. The groups divided into 6groups, control; no therapy group after ischemia-induced, AT1; acupuncture therapy group at $LU8{\cdot}KI7$ after ischemia-induced, AT2; acupuncture therapy at $LU8{\cdot}KI7$ bilaterally and the needle was twirled and rotated forward with the thumb of the right hand 9times, AT3; acupuncture therapy at $LU8{\cdot}KI7$ bilaterally and the needle was twirled and rotated forward with the forefinger of the right hand 9times, AT4; acupuncture therapy at$LU8{\cdot}KI7$ bilaterally and the needle was inserted to the direction following the flowing route of the meridian(digital direction), AT5; acupuncture therapy at $LU8{\cdot}KI7$ bilaterally, the needle was inserted to the direction following the flowing route of the meridian(digital direction) and the needle was twirled and rotated forward with the thumb of the right hand 9times. Acupuncture therapy was carried out 7times during 2weeks after focal ischemia-induced. The anti-apoptotic and neuroprotective effects of acupuncture are observed by Bax, Bcl-2, mGluR5, cytochrome c, Cresyl violet and ChAT-stain. Results : The intensity of Bax was decreased in AC1, AC4, AC5 group, was increased in AC2, AC3 group. The intensity of Bcl-2 was increased in AC2, AC3, AC4, AC5 group. The intensity of mGluR5 was decreased in AC1 group, was increased in AC4, AC5 group. The intensity of Cytochrome c was increased in ACI, AC2 group, was decreased in AC4, AC5 group. The density of neurons stained by Cresyl violet was increased in all group without control group. The density of ChAT was increased in AC2, ACS group. Conclusions : Our study suggests that AC5 group show anti-apoptotic and neuroprotective effects on cholinergic neuron in focal cerebral ischemia of the stroke in rats.

• Korean Journal of Radiology
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• 제19권6호
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• pp.1161-1171
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• 2018

Objective: The aim of this study was to investigate diffusion tensor (DT) imaging-derived properties of benign oligemia, true "at risk" penumbra (TP), and the infarct core (IC) during the first 3 hours of stroke onset. Materials and Methods: The study was approved by the local animal care and use committee. DT imaging data were obtained from 14 rats after permanent middle cerebral artery occlusion (pMCAO) using a 7T magnetic resonance scanner (Bruker) in room air. Relative cerebral blood flow and apparent diffusion coefficient (ADC) maps were generated to define oligemia, TP, IC, and normal tissue (NT) every 30 minutes up to 3 hours. Relative fractional anisotropy (rFA), pure anisotropy (rq), diffusion magnitude (rL), ADC (rADC), axial diffusivity (rAD), and radial diffusivity (rRD) values were derived by comparison with the contralateral normal brain. Results: The mean volume of oligemia was $24.7{\pm}14.1mm^3$, that of TP was $81.3{\pm}62.6mm^3$, and that of IC was $123.0{\pm}85.2mm^3$ at 30 minutes after pMCAO. rFA showed an initial paradoxical 10% increase in IC and TP, and declined afterward. The rq, rL, rADC, rAD, and rRD showed an initial discrepant decrease in IC (from -24% to -36%) as compared with TP (from -7% to -13%). Significant differences (p < 0.05) in metrics, except rFA, were found between tissue subtypes in the first 2.5 hours. The rq demonstrated the best overall performance in discriminating TP from IC (accuracy = 92.6%, area under curve = 0.93) and the optimal cutoff value was -33.90%. The metric values for oligemia and NT remained similar at all time points. Conclusion: Benign oligemia is small and remains microstructurally normal under pMCAO. TP and IC show a distinct evolution of DT-derived properties within the first 3 hours of stroke onset, and are thus potentially useful in predicting the fate of ischemic brain.

• 대한디지털의료영상학회논문지
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• 제13권2호
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• pp.83-90
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• 2011

To prospectively determine the diagnostic performance a combination of standard bolus-chase magnetic resonance (MR) angiography and MR angiography with time-resolved imaging of contrast kinetics (TRICKS) for depicting severity of the head and neck vascular diseases. Over a period of two months, A total of 100 patients(average ages : $50{\pm}8$, male : 60, female : 40) with head and neck vascular diseases were performed on the GE excite 3.0 T units with 8-channel head coil and 4-channel NV coil. Imaging parameters for a typical study were as follow: SBC(TR/ TE/ FA/ SliceThicken./ Slab/ Freq./ FOV/ BW/Scan Time) = 5.4/ min/ 30/ 2/ zip2/ 70/ $224{\times}448$/ 30/ 62.50/ 28, TRICKS(TR/ TE/ FA/ Slice Thicken/Slab/ Freq./ FOV/ BW/ Temp Res./ Scan Time = 3.6/ min/ 25/ 4/ 30/ $160{\pm}384$, zip512/ 30/ 100/ 1 to 1.5/ 23). The analysis of all MR images, which have respect-ively classified two techniques into some diseases. The results of the former were divided into two groups(SBC, TRICKS)with 4 grading of two reader, respectively. Wilcoxon signed rank test was used to determine if a significant difference between imaging techniques existed(p < 0.05). In 33 of 100 patients, arterio-venous malformation was 11% at TRICKS, subclavian vein stenosis : 8%, fistular sinus : 4%, jugular vein stenosis:6%, Middle Cerebral Artery bypass surgery : 4%, p < 0.05). The rest of 67 patients were considered as the results of SBC(14% in the basilar artery stenosis, carotid stenosis : 16%, vertebral stenosis : 17%, central neuro-cytoma : 5%, meningioma : 5%, Not appliable : 10%, p < 0.05). Sensitivity and specificity of TRICKS MR angiography in SVS, FS, JVS, MCABS were improved compared with those at standard MR angiography. In SBS MR angiography which were improved in BAS, CS, VS, CN, Meningioma. In conclusion, TRICKS MR angiography of the SVS, FS, JVS, MCABS is superior to standard MR angiography regarding the number of diagnostic grading. The SBS MR angiography were improved in BAS, CS, VS, CN, Meningioma. and assessment of the degree of luminal narrowing on both TRICKS and SBS.