6-Hydroxydopamine(6-OHDA) 파킨슨 동물모델에서 NMDA 길항제가 Dl 및 D2에 의한 회전에 미치는 영향

홍근식,김경문,윤병우,전범석 대한신경과학회 1998 대한신경과학회지 Vol.15 No.1

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.

Intravenous Recombinant Tissue Plasminogen Activator Thrombolysis in a Patient with Acute Ischemic Stroke Secondary to Aortic Dissection

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.

간이식수술 후 신경계합병증이 발생한 1예

홍근식,이상건,김상윤,이건욱,서경석 대한신경과학회 2000 대한신경과학회지 Vol.18 No.1

Correlation between Metabolic Syndrome and Lower Urinary Tract Symptoms of Males and Females in the Aspect of Gender-Specific Medicine: A Single Institutional Study

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.

특집 - 당뇨병환자에게 더욱 위험한 뇌혈관질환

홍근식,Hong, Geun-Sik 사단법인 한국당뇨협회 2007 당뇨 Vol.210 No.-

65세 김모씨는 가족들과 외출을 하려다가 갑자기 발음이 어눌해 지면서 우측에 힘이 빠지기 시작하였다. 가족들은 일단 김씨를 다시 집안으로 데리고 들어와 팔 다리를 주므르고 바늘로 손을 따 보았지만 상태는 점점 악화되어 전혀 말도 못하고 일어설 수 도 없었으며 정신도 흐려지는 등 급속히 악화되었다. 김씨의 아들은 뇌졸중이 아닌가 하는 생각이 들었고 최근에 언론매체를 통해 혈관이 막히는 뇌졸중의 경우에 빨리 병원에 가면 막힌 혈관을 다시 뚫어주는 치료가 가능하다는 이야기를 들은 기억을 떠올렸다. 김씨의 아들은 119에 연락해 아버님을 응급실로 모시고 왔다. 김씨가 병원에 도착한 시간은 증상이 발생한 후 약 1시간 만이였다. 뇌촬영을 비롯한 피검사 등이 시행되었고 의료진은 김씨가 혈관이 막힌 뇌졸중, 즉 뇌경색이라고 하였고, 현재 발병한 지 채 2시간이 지나지 않았으므로 혈관을 뚫어주는 혈전용해술을 시행하겠다고 했다. 혈관이 막힌 원인은 오랫동안 가지고 있던 당뇨, 고혈압, 고지혈증 등이 복합적으로 작용하여 혈관에 동맥경화를 유발하고 있다가 혈전이 생기면서 혈관이 막힌 것이라고 하였다. 그리고 혈관을 막고 있는 혈전을 녹이기 위해 혈전용해술을 시행하는 것이라고 하였다. 뇌출혈등의 부작용이 일부에서 동반될 수 있지만 지금 상태에서 가장 최선의 치료는 혈전용해술이라 것이 의료진의 설명이었다. 다음날 김씨는 완벽하지는 않았지만 말하는 기능과 우측 팔다리 마비가 상당히 호전되었다. 1주일 후 김씨의 상태는 더욱 호전 되었고 열심히 재활치료를 받고 있었다. 김씨와 가족들은 의료진으로부터 꾸준히 재활치료를 하면서 3개월 후 정도면 이전과 거의 비슷한 상태로 회복될 수 있을 것이라는 희망적인 이야기를 들을 수 있었다.

Fimasartan-Based Blood Pressure Control after Acute Cerebral Ischemia: The Fimasartan-Based Blood Pressure Control after Acute Cerebral Ischemia Study

홍근식,권순억,박종호,차재관,정진만,김용재,이경복,손성일,이용석,나정호,권지현,하상원,김범준,구자성,최재철,성상민,이수주,박만석,안성환,방오영,황양하,남효석,박종무,배희준,김응규,이경열,오미선 대한신경과학회 2021 Journal of Clinical Neurology Vol.17 No.3

Background and Purpose Blood pressure (BP) control is strongly recommended, but BP control rate has not been well studied in patients with stroke. We evaluated the BP control rate with fimasartan-based antihypertensive therapy initiated in patients with recent cerebral ischemia. Methods This multicenter, prospective, single-arm trial involved 27 centers in South Korea. Key inclusion criteria were recent cerebral ischemia within 90 days and high BP [systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) >90 mm Hg]. BP lowering was initiated with fimasartan. BP management during the follow-up was at the discretion of the responsible investigators. The primary endpoint was the target BP goal achievement rate (<140/90 mm Hg) at 24 weeks. Key secondary endpoints included achieved BP and BP changes at each visit, and clinical events (ClinicalTrials.gov Identifier: NCT03231293). Results Of 1,035 patients enrolled, 1,026 were included in the safety analysis, and 951 in the efficacy analysis. Their mean age was 64.1 years, 33% were female, the median time interval from onset to enrollment was 10 days, and the baseline SBP and DBP were 162.3±16.0 and 92.2±12.4 mm Hg (mean±SD). During the study period, 55.5% of patients were maintained on fimasartan monotherapy, and 44.5% received antihypertensive therapies other than fimasartan monotherapy at at least one visit. The target BP goal achievement rate at 24-week was 67.3% (48.6% at 4-week and 61.4% at 12-week). The mean BP was 139.0/81.8±18.3/11.7, 133.8/79.2±16.4/11.0, and 132.8/78.5±15.6/10.9 mm Hg at 4-, 12-, and 24-week. The treatment- emergent adverse event rate was 5.4%, including one serious adverse event. Conclusions Fimasartan-based BP lowering achieved the target BP in two-thirds of patients at 24 weeks, and was generally well tolerated.

Stroke Statistics in Korea: Part II Stroke Awareness and Acute Stroke Care, A Report from the Korean Stroke Society and Clinical Research Center For Stroke

홍근식,방오영,Jong S. Kim,허지회,유경호,배희준,강동화,이진수,권순우,오창완,이병철,윤병우 대한뇌졸중학회 2013 Journal of stroke Vol.15 No.2

The aim of the current Part II of Stroke Statistics in Korea is to summarize nationally representative data on public awareness, pre-hospital delay, thrombolysis, and quality of acute stroke care in a single document. The public’s knowledge of stroke definition, risk factors,warning signs, and act on stroke generally remains low. According to studies using openended questions, the correct definition of stroke was recognized in less than 50%, hypertension as a stroke risk factor in less than 50%, and other well-defined risk factors in less than 20%. Among stroke warning signs, sudden paresis or numbness was best appreciated,with recognition rates ranging in 36.9-73.7%, but other warning signs including speech disturbance were underappreciated. In addition, less than one third of subjects in a representative population survey were aware of thrombolysis and had knowledge of the appropriate act on stroke, calling emergency medical services (EMS). Despite EMS being an essential element in the stroke chain of survival and outcome improvement, EMS protocols for field stroke diagnosis and prehospital notification for potential stroke patients are not well established. According to the Assessment for Quality of Acute Stroke Care, the median onsetto-door time for patients arriving at the emergency room was 4 hours (mean, 17.3 hours) in 2010, which was not reduced compared to 2005. In contrast, the median door-to-needle time for intravenous tissue plasminogen activator (IV-TPA) treatment was 55.5 minutes (mean, 79.5 minutes) in 2010, shorter than the median time of 60.0 minutes (mean, 102.8minutes) in 2008. Of patients with acute ischemic stroke, 7.9% were treated with IV- TPA in 2010, an increase from the 4.6% in 2005. Particularly, IV-TPA use for eligible patients substantially increased, from 21.7% in 2005 to 74.0% in 2010. The proportion of hospitals equipped with a stroke unit has increased from 1.1% in 2005 to 19.4% in 2010. Performance,as measured by quality indicators, has steadily improved since 2005, and the performance rates for most indicators were greater than 90% in 2010 except for early rehabilitation consideration (89.4%) and IV-TPA use for eligible patients (74.0%). In summary, the current report indicates a substantial improvement in in-hospital acute stroke care, but also emphasizes the need for enhancing public awareness and integrating the prehospital EMS system into acute stroke management. This report would be a valuable resource for understanding the current status and implementing initiatives to further improve public awareness of stroke and acute stroke care in Korea.

편두통과 간질

홍근식 대한두통연구회 2001 두통 Vol.2 No.부록1

Blood Pressure Management for Stroke Prevention and in Acute Stroke

홍근식 대한뇌졸중학회 2017 Journal of stroke Vol.19 No.2

Elevated blood pressure (BP) is the leading modifiable risk factor for stroke and the benefit of BPlowering therapy on the stroke risk reduction is well established. The optimal BP target forpreventing stroke and other vascular events have been controversial, but the evidences fromepidemiological studies and randomized controlled trials (RCTs) support intensive BP lowering forgreater vascular protection, particularly for stroke prevention. For secondary stroke prevention, theevidence of intensive BP lowering benefit is limited since only a single RCT for patients withlacunar infarctions was conducted and most data were driven by exploratory analyses. In acuteintracerebral hemorrhage, immediate BP lowering targeting systolic BP<140 mm Hg isrecommended by guidelines based on the results from RCTs. In contrast, in acute ischemic stroke,early BP lowering is not usually recommended because of no benefit on functional outcome andfuture vascular events and potential harm of stroke progression. This review aims to summarizethe updated evidence for optimal BP management for primary and secondary stroke preventionand in patients with acute stroke.