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Background and purpose: Opposing-needling technique involves selecting acupoints at unaffected limb. The aim of this study was to evaluate the effect of LI4-LI11 electrical acupuncture at unaffected limb on the cerebral blood flow in ischemic stroke patients using SPECT Methods: We selected 9 ischemic stroke patients. Baseline brain SPECT was done with triple head gamma camera (MultiSPECT3, Siemens, USA) after intravenous administration of 925 MBq of Tc-99m ECD). Fifteen-minute electro-acupuncture at Hapgok (LI 4) and Gokji (LI 11) were applied on unaffected upper limb of subjects. The same dose of Tc-99m ECD was injected during the electro-acupuncture, and the second SPECT images were obtained. Using the computer software (ICON 7.1, Siemens, USA), 3 SPECT slices (upper, middle, lower) surrounding the brain lesion were selected and each slice was divided by 10-16 brain regions. Asymmetry indexes were analyzed in each brain region. We regarded ≥ 10% changes of asymmetry index between before and after electro-acupuncture as significance. Results: Seven Patients (77.8%) had significantly increased perfusion and 2 (22.2%) didn't show increased perfusion in post-acupuncture scans compared to pre-acupuncture scans(baseline). The regions of CBF improvement were mostly frontal lobes and anterior temporal lobes. Conclusions: This study demonstrated that LI4-LI11 electro-acupuncture at unaffected limb increased regional cerebral blood perfusion to the corresponding brain areas in ischemic stroke patients.
Objectives : Transcranial Doppler (TCD) has been reported to be established as useful in detecting spasm after subarachnoid hemorrhage and to be probably useful in diagnosing stenosis or occlusion in intracranial arteries. In the detection of intracranial stenosis using TCD there have been reported some kinds of diagnostic criteria. This study was aimed to evaluate the accordance between TCD and magnetic resonance angiography (MRA) in detection of intracranial stenosis and to find out more accurate criteria for intracranial stenosis using TCD. Methods : Seventy-six stroke patients were evaluated by TCD and MRA. TCD criteria for middle cerebral artery (MCA) stenosis were used by 3 methods; ≥ 80cm/sec of mean velocity(Vm), ≥ 140 cm/sec of systolic velocity(Vs), and both. For stenosis of vertebral(VA) and basilar arteries(BA), the TCD criteria followed by 2 methods; ≥ 70 cm/sec of Vm and ≥ 100 cm/sec of Vs. The stenosis of intracranial artery in MRA followed by the interpretation of specialist in the department of radiology. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and kappa agreement were calculated in each criteria of TCD compared with the result of MRA. Results : The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and kappa agreement using ≥ 80cm/sec of Vm for MCA stenosis were 55.6%, 81%, 34.5%, 91.0%, 77.1%, and 0.293, respectively. Using 140 cm/sec of Vs, those were 44.4%, 92.0%, 50.5%, 90.2%, 84.7%, 0.380, and using both criteria those were 44.4%, 95.0%, 61.5%, 90.5%, 87.3%, 0.445, respectively. Those using ≥ 70 cm/sec of Vm for VA and BA stenosis were 71.4%, 93.7%, 26.3%, 99.0%, 93.0%, 0.186 and using ≥ 100 cm/sec of Vs those were 71.4%, 97.3%, 45.5%, 99.1%, 96.5%, 0.539, respectively. Conclusion : These results suggested that for the diagnosis of MCA stenosis using TCD we should use the criteria of both ≥ 80cm/sec of Vm and 140 cm/sec of Vs, and for the VA and BA stenosis we adapt the criteria of ≥ 70 cm/sec of Vm.
문상관(Sang-Kwan Moon),민인규(In-Kyu Min),박성욱(Sung-Uk Park),정우상(Woo-Sang Jung),박정미(Jung-Mee Park),고창남(Chang-Nam Ko),조기호(Ki-Ho Cho),배형섭(Hyung-Sup Bae),김영석(Young-Suk Kim),김덕윤(Deok-Yoon Kim) 대한한의학회 2010 대한한의학회지 Vol.31 No.1
Objectives : So far it has been reported that acupuncture increases cerebral blood supply and stimulates the functional activity of brain nerve cells. Previous studies have demonstrated that frequently used electro-acupuncture (EA) therapies for stroke increased regional cerebral blood flow (rCBF) in normal volunteers. Though ST 36-ST 41 EA is another prevailing therapy for stroke, there had been no report about its effect on rCBF. This study was to evaluate the effect of ST 36-ST 41 EA on rCBF in normal volunteers using single photon emission computed tomography (SPECT) and statistical parametric mapping (SPM). Methods : In the resting state, <SUP>99m</SUP>Tc-ECD brain SPECT scans were performed on 10 normal volunteers (5 males, 5 female, mean age 23.6±0.5 years). On the other study day, 7 days after the resting examination, 15 minutesEA were applied at ST 36 and ST 41 on the right side of the subjects. Immediately after ST36-ST41 EA, the second SPECT images were obtained in the same manner as the resting state. Significant increases and decreases of rCBF after EA were estimated by comparing their SPECT images with those of the resting state using paired t statistics at every voxel, which were analyzed by SPM with a threshold of p = 0.01, uncorrected (extent threshold : k=100 voxels). Results : EA applied at the right ST36-ST41 significantly increased rCBF in the right inferior parietal lobule (Brodmann area [BA] 40), right retrosubicular area (BA 48), left inferior parietal lobule (BA 40), left middle temporal gyrus (BA 21), left fusiform gyrus (BA 37), left inferior parietal lobule (BA 39), left inferior temporal gyrus (BA 20), and left somatosensory association cortex (BA 7). However, right ST36-ST41 EA significantly decreased rCBF in the right parahippocampal gyrus (BA 35), right cerebellum, left frontopolar area (BA 10), left orbitofrontal area (BA 11), left dorsolateral prefrontal cortex (BA 9), and left dorsal anterior cingulate cortex (BA 32). Conclusions : These results demonstrate that rightST36-ST41 EA increased rCBF prominently in both inferior parietal lobule (BA 40) and right retrosubicular area (BA 48), which suggest that there be correlation between specific EA and corresponding rCBF.
Objectives: This study is aimed to examine the effect of Geopungchunghyul-dan on circumferential strain of carotid artery in outpatients of Kyung Hee University hospital of Korean Medicine. Methods: Retrospective chart review is used from June 2016 to August 2017 for outpatients of Kyung Hee University hospital of Korean Medicine. 14 patients taking Geopungchunghyul-dan over 1 month were speculated. Data of circumferential strain and intima-media thickness was taken from carotid ultrasonography and processed by Wilcoxon signed-rank test. Results: Geopungchunghyul-dan lowered circumferential strain of both carotid arteries after 1 month of administration (p<0.05). Intima-media thickness of both carotid arteries did not changed significantly. Conclusions: Geopungchunghyul-dan may ameliorate arterial stiffness.
Objectives: This study was designed to investigate antihypertensive effect by single adminstration of Chunghyul-dan in stroke patients. Methods: This is a 31-patient case series from retrospective chart review of inpatients who diagnosed with stroke at a Kyung Hee University Korean Medicine Hospital (Seoul) between October 2016 to October 2017. We reviewed patient’s charts with transient and sudden increases in blood pressure who were treated with Chunghyul-dan and analyzed blood pressure over time. In addition we classified patients by using the standardized predictive models for Korean medical diagnostic pattern-identification to find out if there are some differences in responder ratios. Results: Thirty one patients who took Chunghyul-dan were identified. 60 minutes, 120 minutes after 1200mg administration, systolic and diastolic blood pressure decreased significantly compared to baseline. We could not identify the difference between the groups of each pattern-identification because of small number of some groups. Conclusions: Although limited by its retrospective nature, this study suggests that Chunghyul-dan may be effective as short term antihypertensive method for stroke patient.
Objectives: Acupuncture has been specially applied on the rehabilitation after stroke in Asia for thousands of years. It was reported that acupuncture increased cerebral blood supply and stimulated the functional activity of brain nerve cells by using brain image techniques. This study was to evaluate the effect of GB 34-GB 39 electro-acupuncture (EA) on regional cerebral blood flow (rCBF) in stroke patients and normal volunteers using Single Photon Emission Computed Tomography (SPECT). Methods: The study procedure was divided into two part; patients and volunteers study. For patients study, ten ischemic stroke patients(3 males, 7 females, mean age 68.5±8.9 years old) were selected. Baseline brain SPECT was done with triple head gamma camera (MultiSPECT3, Siemens, USA) after intravenous administration of 1,110 MBq of 99mTc-ECD. Fifteen-minute EA at GB 34 and GB 39 were applied on affected limb. The same dose of 99mTc-ECD was injected during the EA, and the second SPECT images were obtained. Using the computer software (ICON 7.1, Siemens, USA), 3 SPECT slices (upper, middle, lower) surrounding the brain lesion were selected and each slice was divided by 10-16 brain regions. Asymmetry indexes (AI) were analyzed in each brain region. We regarded over 10% changes of AI between before and after EA as significance. For volunteers study, 10 healthy human volunteers (5 males, 5 females, mean age 28.1±6 years old) were selected. In the resting state, 99mTc-ECD brain SPECT scans were performed. On the 7th day after the resting examination, 15 minute EA was applied at GB 34 and GB 39 on the right side of the subjects. Immediately after EA, the second SPECT images were obtained with the same manner as the resting state. Significant increases and decreases of rCBF after EA were estimated by comparing their SPECT images with those of the resting state using paired t statistics at every voxel, which were analyzed by statistical parametric mapping with a threshold of p = 0.01, uncorrected (extent threshold: k=100 voxels). Results: In stroke patients, six(75%) of eight had significantly increased perfusion in post-acupunture scans compared to baseline state. In normal volunteers, GB 34-GB 39 EA increased rCBF in both hemisphere including right ventral posterior cingulate(Brodmann area (BA) 23), left superior temporal, anterior transverse temporal(BA 22, 41), left parastriate, peristriate(BA 18, 19), right occipitotemporal, angular(BA 37, 39), left rostral postcentral, caudal postcentral and preparietal(BA 2, 3, 5). However GB 34-GB 39 EA decreased rCBF in right hemisphere including triangular and middle frontal lobes. Conclusions: The results demonstrated that GB 34-GB 39 EA increased cerebral perfusion in ischemic stroke patients also increased rCBF grossly in temporal lobes in normal volunteer. It is also suggested that there may be a correlation between GB meridian and the territory of middle cerebral artery.
Background Most patient with stroke have hypertnesion and the stroke accidental rate is very closely connected with hypertension. So, the proper diagnosis and treatment of the hypertension play very important roles the treatment and the prognosis of stroke as well as on the prevention of recurrent stroke. The goal of this study is to improve the treatment of hypertension in stroke-inpatients by investigating the 24-hours blood pressure using the ambulatory blood pressure monitoring. Methods 52 inpatient with stroke were randomly selected in the 2nd internal medicine department, Kyunghee oriental hospital and devided into normotensive and hypertensive groups by the standard-whether he/she takes the blood pressure drugs. We set the machine (ambulatory blood pressure monitoring) to check the blood pressure (including systolic and diastolic blood pressure) and pulse rate every 30 minutes from 06:00 to 22:00 and every 1 hour from 22:00 to 06:00. And the frequency percentage of systolic blood pressure over 140mmHg and the diastolic blood pressure over 90mmHg makes the blood pressure load. Results The mean systolic blood pressure during 24 hours were 129±10.3㎜Hg at normotensive group and 140 14.9㎜Hg at hypertensive group and the mean diasolic blood pressure were 79 7.0㎜Hg at normotensive group and 83 8.2㎜Hg at hypertensive group. The blood pressure loads were 30.0 22.0% (systolic) and 21.1 18.2(diastolic) at normotensive group. That were 51.2 30.3%(systolic) and 36.0 24.1%(diastolic) at hypertensive group. The pattern of circardian blood pressure was lowest at the time from 00:00 to 06:00 and made the rapid increase temporalily to reach the turning point at 07:00. After that time it decreased a little bit and continued with no significant change and made the highest point at 19:00 and it decreased rapidly after 22:00. The patter of circardian pulse rate was similar to blood pressure pattern. In systolic and diastolic blood pressure, there was no significant difference between ambulatory and casual blood pressure. Conclusions These results show that the diagnosis of hypertension with casual blood pressure is available as well as ambulatory blood pressure and that more intensive control of blood pressure is required in stroke-inpatients with hypertension. And the change of pulse rate can be another useful standard to diagnosis hypertension and to rule out the inappropiate things among the datas from ambulatory blood pressure monitoring. Key words: Ambulatory blood pressure, Stroke