감염성 심내막염의 신경계 합병증:후향적 분석 100예

김성훈,구자성,윤병우 대한신경과학회 2001 대한신경과학회지 Vol.19 No.3

New Oral Anticoagulants May Be Particularly Useful for Asian Stroke Patients

방오영,홍근식,허지회,Jaseong Koo,권순억,유경호,배희준,이병철,윤병우,김종성 대한뇌졸중학회 2014 Journal of stroke Vol.16 No.2

Atrial fibrillation (AF) is an emerging epidemic in both high-income and low-income countries, mainly because of global population aging. Stroke is a major complication of AF, and AF-related ischemic stroke is more disabling and more fatal than other types of ischemic stroke. However, because of concerns about bleeding complications, particularly intracranial hemorrhage, and the limitations of a narrow therapeutic window, warfarin is underused. Four large phase III randomized controlled trials in patients with non-valvular AF (RE-LY, ROCKET-AF, ARISTOTLE, and ENGAGE-AF-TIMI 48) demonstrated that new oral anticoagulants (NOACs) are superior or non-inferior to warfarin as regards their efficacy in preventing ischemic stroke and systemic embolism, and superior to warfarin in terms of intracranial hemorrhage. Among AF patients receiving warfarin, Asians compared to non-Asians are at higher risk of stroke or systemic embolism and are also more prone to develop major bleeding complications, including intracranial hemorrhage. The extra benefit offered by NOACs over warfarin appears to be greater in Asians than in non-Asians. In addition, Asians are less compliant, partly because of the frequent use of herbal remedies. Therefore, NOACs compared to warfarin may be safer and more useful in Asians than in non-Asians, especially in stroke patients. Although the use of NOACs in AF patients is rapidly increasing, guidelines for the insurance reimbursement of NOACs have not been resolved, partly because of insufficient understanding of the benefit of NOACs and partly because of cost concerns. The cost-effectiveness of NOACs has been well demonstrated in the healthcare settings of developed countries, and its magnitude would vary depending on population characteristics as well as treatment cost. Therefore, academic societies and regulatory authorities should work together to formulate a scientific healthcare policy that will effectively reduce the burden of AF-related stroke in this rapidly aging society.

Apixaban for Secondary Stroke Prevention: Coexistant Cerebral Atherosclerosis May Increase Recurrent Strokes

Jong S. Kim,Jaseong Koo,Dong-Ick Shin,Byung-Su Kim,Jei Kim,Eung-Gyu Kim,Keun-Sik Hong,Hyeju Yi 대한뇌졸중학회 2022 Journal of stroke Vol.24 No.1

Background and Purpose Oral anticoagulants are needed in stroke patients with atrial fibrillation (AF) for the prevention of recurrent stroke. However, the risk of major events or bleeding may be greater in stroke patients than in those without, because the presence of cerebral atherosclerosis or small vessel disease may increase these risks. This study aimed to investigate the outcomes of apixaban-treated stroke patients with AF and assess whether these factors are associated with the outcome. Methods This was a sub-analysis of stroke patients with AF enrolled in a prospective, open-label, multicenter, post-marketing surveillance study in South Korea, who were treated with apixaban and underwent magnetic resonance imaging (MRI) (Clinical trial registration: NCT01885598). Results A total of 651 patients (mean age, 72.5±8.7 years) received apixaban for a mean duration of 82.7±37.4 weeks. Fifty-three bleeding events occurred in 39 patients (6.0%), and 10 (1.5%) experienced major bleeding. Seventeen patients (2.6%) had major events (stroke, n=15, 2.3%; all ischemic), systemic embolism (n=1, 0.2%), and death (n=3, 0.5%). MRI data showed no significant association between white matter ischemic changes and microbleeds, and major events or bleeding. Patients with cerebral atherosclerotic lesions had a higher rate of major events than those without (4.6% [n=10/219] vs. 1.7% [n=7/409], P=0.0357), which partly explains the increased prevalence of major outcomes in this group versus patients without stroke (0.7%, P=0.0002). Conclusions Apixaban is generally safe for patients with ischemic stroke. Increased primary outcomes in stroke patients may in part be attributed to the presence of cerebral atherosclerotic lesions, suggesting that further studies are needed to establish therapeutic strategies in this population.

Autoencoder-based Anomaly Detection

Khoa Anh Ngo(노안콰),Junhan Kim(김준한),Jiseob Kim(김지섭),Jaseong Koo(구자성),Seungjae Baeck(백승재),Byonghyo Shim(심병효) 한국통신학회 2021 한국통신학회 학술대회논문집 Vol.2021 No.2

Recently, much research has been devoted to developing deep learning-based anomaly detection techniques. If there is a huge amount of data samples, then deep learning models can be trained to provide an end-to-end solution for anomaly detection. However, in many realistic scenarios, the number of anomalies that can be used for training deep learning models is very limited. In this case, deep learning models trained in the manner of supervised learning performs poor, especially when detecting anomalies in the test phase. In this paper, to overcome this limitation, we put forth an autoencoder-based anomaly detection technique. Through the simulations based on the dataset provided by Samsung display, we show that the proposed technique can detect anomalies well.

딥 러닝 기반의 API와 멀티미디어 요소를 활용한 시니어 라이프 데이터 수집 및 상태 분석

김선대(Seon Dae Kim),박은수(Eun Soo Park),정종범(Jong Beom Jeong),구자성(Jaseong Koo),류은석(Eun-Seok Ryu) 한국방송·미디어공학회 2018 한국방송공학회 학술발표대회 논문집 Vol.2018 No.6

본 논문에서는 시니어를 위한 라이프 데이터 수집 및 행동분석 프레임 워크를 설명하고, 이의 부분적 구현을 자세히 설명한다. 본 연구는 시니어를 위한 라이프 데이터를 바탕으로 보호자가 없는 시니어를 보살핌과 동시에, 보호자가 미처 인지하지 못하는 시니어의 비정상적인 상태를 분석하여 판단하는 시스템을 연구한다. 먼저, 시니어가 시간을 많이 소요하는 TV 앞 상황을 가정하고, 방영되는 TV 콘텐츠와 TV 카메라를 이용한 시니어의 영상/음성 정보로 이상상태와 감정상태, TV 콘텐츠에 대한 반응과 반응속도를 체크한다. 구체적으로는 딥 러닝 기반의 API 와 멀티미디어 데이터 분석에서 사용되는 오픈 패키지를 바탕으로, 영상/음성의 키 프레임을 추출하여 감정 및 분위기를 분석하고 시니어의 얼굴 표정 인식, 행동 인식, 음성 인식을 수행한다.

2D 점자 정보 단말기를 위한 데이지 3 뷰어 설계 및 구현

박은수(Eun Soo Park),김선대(Seon Dae Kim),류영일(Yeongil Ryu),노현준(Hyun-Joon Roh),구자성(JaSeong Koo),류은석(Eun-Seok Ryu) 한국통신학회 2018 한국통신학회 학술대회논문집 Vol.2018 No.1

Low- versus Standard-Dose Intravenous Alteplase in the Context of Bridging Therapy for Acute Ischemic Stroke: A Korean ENCHANTED Study

Jong S. Kim,Yeon-Jung Kim,Kyung Bok Lee,Jae-Kwan Cha,Jong-Moo Park,Yang-Ha Hwang,Eung-Gyu Kim,Joung-Ho Rha,Jaseong Koo,Jei Kim,Yong-Jae Kim,Woo-Keun Seo,김동억,Thompson G. Robinson,Richard I. Lindley,Xia 대한뇌졸중학회 2018 Journal of stroke Vol.20 No.1

Background and Purpose Following the positive results from recent trials on endovascular therapy (EVT), bridging therapy (intravenous alteplase plus EVT) is increasingly being used for the treatment of acute ischemic stroke. However, the optimal dose of intravenous alteplase remains unknown in centers where bridging therapy is actively performed. The optimal dose for eventual recanalization and positive clinical outcomes in patients receiving bridging therapy also remains unknown. Methods In this prospective Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) sub-study, we explored the outcomes following treatment with two different doses (low- [0.6 mg/kg] or standard-dose [0.9 mg/kg]) of intravenous alteplase across 12 Korean centers where EVT is actively performed. The primary endpoint was a favorable outcome at 90 days (modified Rankin Scale scores 0 to 1). Secondary endpoints included symptomatic intracerebral hemorrhage (ICH) in all patients, and the recanalization rate and favorable outcome in patients who underwent cerebral angiography for EVT (ClinicalTrials.gov, number NCT01422616). Results Of 351 patients, the primary outcome occurred in 46% of patients in both the standard- (80/173) and low-dose (81/178) groups (odds ratio [OR], 1.14; 95% confidence interval [CI], 0.72 to 1.81; P=0.582), although ICHs tended to occur more frequently in the standard-dose group (8% vs.3%, P=0.056). Of the 67 patients who underwent cerebral angiography, there was no significant difference in favorable functional outcome between the standard- and low-dose groups (39% vs.21%; OR, 2.39; 95% CI, 0.73 to 7.78; P=0.149). Conclusions There was no difference in functional outcome between the patients receiving different doses of alteplase in centers actively performing bridging therapy.

Delayed Intravenous Thrombolysis in Patients with Minor Stroke

Yoo, Joonsang,Sohn, Sung-Il,Kim, Jinkwon,Ahn, Seong Hwan,Lee, Kijeong,Baek, Jang-Hyun,Kim, Kyoungsub,Hong, Jeong-Ho,Koo, Jaseong,Kim, Young Dae,Kwak, Jaehyuk,Nam, Hyo Suk,Heo, Ji Hoe S. Karger AG 2018 Cerebrovascular diseases Vol.46 No.1

<P><B><I>Background:</I></B> The actions and responses of the hospital personnel during acute stroke care in the emergency department (ED) may differ according to the severity of a patient’s stroke symptoms. We investigated whether the time from arrival at ED to various care steps differed between patients with minor and non-minor stroke who were treated with intravenous tissue plasminogen activator (IV tPA). <B><I>Methods:</I></B> We included consecutive patients who received IV tPA during a 1.5 year-period in 5 hospitals. Minor stroke was defined as a National Institutes of Health Stroke Scale (NIHSS) score < 5. We compared various intervals from arrival at the ED to treatment between patients with minor stroke and those with non-minor stroke (NIHSS score ≥5). Delayed treatment was defined as a door-to-needle time > 40 min. <B><I>Results:</I></B> During the study period, 356 patients received IV tPA treatment. The median door-to-needle time was significantly longer in the minor stroke group than it was in the non-minor stroke group (43 min [interquartile range [IQR] 35.5–55.5] vs. 37 min [IQR 30–46], <I>p</I> < 0.001). The minor stroke group had a significantly longer door-to-notification time (7 min [IQR 4.5–12] vs. 5 min [IQR 3–8], <I>p</I> < 0.001) and door-to-imaging time (20 min [IQR 15–26.5] vs. 16 min [IQR 11–21], <I>p</I> < 0.001) than did the non-minor stroke group. However, the imaging-to-needle time was not different between the groups. Multivariable analyses revealed that minor stroke was associated with delayed treatment (OR 2.54 [95% CI 1.52–4.30], <I>p</I> = 0.001). <B><I>Conclusions:</I></B> Our findings show that the door-to-needle time was longer in patients with minor stroke than it was in those with non-minor stroke, mainly owing to delayed action in the initial steps of neurology notification and imaging. Our findings suggest that some quality improvement initiatives are necessary for patients with suspected stroke with minor symptoms.</P>