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홍근식,유경호,나정호,김한영,구자성,박종무,서대희,박인성,조경희,정근화,박태환,이병철,윤병우 대한신경과학회 2013 대한신경과학회지 Vol.31 No.3
The first edition of Korean Clinical Practice Guidelines for Stroke, which was published in 2009, reflected evidence published prior to June 2007. Since then, many clinical trials and well-designed observational studies provided new evidence that may be pertinent to clinical practice. Accordingly, investigators of the Clinical Research Center for Stroke have timely updated the guidelines. This article summarizes the recent evidence and updated guidelines regarding the use of aspirin for primary stroke prevention, the management of asymptomatic carotid stenosis, the use of antithrombotics in atrial fibrillation for stroke prevention, the diagnosis and management of unruptured aneurysm,intravenous and intra-arterial thrombolysis in acute ischemic stroke, antiplatelet therapy for secondary stroke prevention in patients with non-cardioembolic stroke or transient ischemic attack, and the management of symptomatic carotid stenosis for secondary stroke prevention.
Burden of Ischemic Stroke in Korea: Analysis of Disability-Adjusted Life Years Lost
홍근식,김재용,조용진,서소영,황성일,김상철,김지은,조중양,박희경,배희준,양미화,장명석,한문구,이준영,강동화,박종무,구자성,유경호,오미선,이병철 대한신경과학회 2011 Journal of Clinical Neurology Vol.7 No.2
Background and Purpose:Disability-adjusted life years (DALY), incorporating both disability and mortality, has been widely employed to measure regional and global burdens of stroke. Thus far, the DALY lost to stroke in a population has been estimated using only the crude population-level data; no previous study has incorporated refined data from stroke registries. The aim of this study was to integrate the stroke registry data and the population-level incidence data to project the nationwide DALY lost to ischemic stroke. Methods:From the data of two large ischemic stroke registries, we derived an average DALY lost due to ischemic stroke for each of the following age groups: <45, 45-54, 55-64, 65-74, 75-84,and ≥85 years. The nationwide ischemic stroke incidence for each age group was extracted from a cardiovascular and cerebrovascular surveillance study that analyzed the 2004 Korean Health Insurance database. Results:The average DALY lost due to ischemic stroke for the age groups <45, 45-54, 55-64,65-74, 75-84, and ≥85 years was 5.07, 4.63, 4.35, 3.88, 2.88, and 1.73, respectively. By multiplying the incidence and the average DALY lost, the nationwide DALY lost was determined to be 9,952 for those <45 years, 24,608 for 45-54 years, 50,682 for 55-64 years, 88,875 for 65-74years, 52,089 for 75-84 years, and 8,192 for ≥85 years, respectively. The projected nationwide DALY lost due to 64,688 ischemic strokes in 2004 was 234,399 (121,482 for men and 113,244 for women), and the DALY lost per 100,000 person-years was 483 (500 for men and 469 for women). Conclusions:Incidence data from a population study and DALY values derived from stroke registries can be integrated to provide a more refined projection of the nationwide burden of ischemic stroke. In Korea, more than 230,000 years of healthy life are being lost annually due to ischemic stroke, and hence prompt action is imperative.
Disability-Adjusted Life Years Analysis: Implications for Stroke Research
홍근식 대한신경과학회 2011 Journal of Clinical Neurology Vol.7 No.3
Stroke is a prototype disorder that disables as well as kills people. The disability-adjusted life years (DALY) metric developed by the World Health Organization to measure the global burden of disease integrates healthy life years lost due to both premature mortality and living with disability. Accordingly, it is well suited to stroke research. The DALY has previously been applied only to large but relatively crude population-level data analyses, but now it is possible to calculate the DALY lost in individual stroke patients. Measuring each patient’s stroke outcome with DALY lost has expanded its application to the analysis of treatment effect in acute stroke trials, delineating the poststroke complication impact, the differential weighting of discrete vascular events, and estimating a more refined stroke burden in a specific population. The DALY metric has several advantages over conventional stroke outcome measures: 1) Since the DALY measures the burden of diverse health conditions with a common metric of life years lost, stroke burden and benefits of stroke interventions can be directly compared to other health conditions and their treatments. 2)Quantifying stroke burden or interventional benefits as the life years lost or gained makes the DALY metric more intuitively accessible for public and health system planners. 3) As a continuous, equal-interval scale, the DALY analysis might be statistically more powerful than either binary or ordinal rank outcome analyses in detecting the treatment effects of clinical trials. 4) While currently employed stroke outcome measures take one-time snapshots of disability or mortality and implicitly indicate long-term health impact, the DALY explicitly indicates the burdens of living with disability for an individual’s remaining life.
홍근식,박소영,황선일,서소영,이동하,조중양,김한준,조용진,장우익,김창영 대한신경과학회 2009 Journal of Clinical Neurology Vol.5 No.1
BackgroundaaAcute ischemic stroke secondary to aortic dissection (AoD) is challenging in the era of thrombolysis owing to the diagnostic difficulty within a narrow time window and the high risk of complications. Case ReportaaA 64-year-old woman with middle cerebral artery occlusion syndrome admitted to the emergency room within intravenous recombinant tissue plasminogen activator (rt-PA) time window. Her neurological symptoms improved during thrombolysis, but chest and abdominal pain developed. Repeated history-taking, physical examination, and imaging studies led to the timely diagnosis and surgical treatment of AoD, which produced a successful outcome. ConclusionsaaClinical suspicion is invaluable for the diagnosis of this rare cause of stroke. Considering the stroke mechanism and complications, the risks of thrombolysis might outweigh its benefits.
홍근식,심봉석,정우식,윤하나 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.9
Purpose: We attempted to examine the correlation between metabolic syndrome and lower urinary tract symptoms (LUTS) in the aspect of gender-specific medicine. Materials and Methods: A total of 922 patients participating in a health examination completed the International Prostate Symptom Score (IPSS) questionnaire and the Overactive Bladder Questionnaire Short Form (OABq-SF) symptom bother scale from March 2008 to July 2009. Metabolic syndrome was defined by using the National Cholesterol Education Program Adult Treatment Panel III criteria announced in 2001. We analyzed differences in lower urinary tract symptoms according to the presence of metabolic syndrome and the component elements of metabolic syndrome. Results: The subjects were 538 males and 384 females with a mean age of 48.8±6.8 years. Among all patients, the number of patients with metabolic syndrome was 143 (15.5%); there were 110 males (20.4%) and 33 females (8.6%), showing a significant difference. There were no differences in scores on the IPSS or OABq-SF with respect to the presence or absence of metabolic syndrome in males. In females, however, there were significant differences in the IPSS and OABq-SF depending on the presence or absence of metabolic syndrome. In males and females, the IPSS total score was significantly correlated with age. Also, high-density lipoprotein (HDL) cholesterol in males and triglyceride in females was significantly correlated with the IPSS total score. Conclusions: There are sex differences in the morbidity rate of metabolic syndrome and its effect on lower urinary tract symptoms. Therefore, it is necessary to consider gender-specific medicine in the diagnosis and treatment of LUTS.