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Grading and Interpretation of White Matter Hyperintensities Using Statistical Maps
Ryu, Wi-Sun,Woo, Sung-Ho,Schellingerhout, Dawid,Chung, Moo K.,Kim, Chi Kyung,Jang, Min Uk,Park, Kyoung-Jong,Hong, Keun-Sik,Jeong, Sang-Wuk,Na, Jeong-Yong,Cho, Ki-Hyun,Kim, Joon-Tae,Kim, Beom Joon,Han, American Heart Association, Inc. 2014 Stroke Vol.45 No.12
<P><B>Background and Purpose—</B></P><P>We aimed to generate rigorous graphical and statistical reference data based on volumetric measurements for assessing the relative severity of white matter hyperintensities (WMHs) in patients with stroke.</P><P><B>Methods—</B></P><P>We prospectively mapped WMHs from 2699 patients with first-ever ischemic stroke (mean age=66.8±13.0 years) enrolled consecutively from 11 nationwide stroke centers, from patient (fluid-attenuated-inversion-recovery) MRIs onto a standard brain template set. Using multivariable analyses, we assessed the impact of major (age/hypertension) and minor risk factors on WMH variability.</P><P><B>Results—</B></P><P>We have produced a large reference data library showing the location and quantity of WMHs as topographical frequency-volume maps. This easy-to-use graphical reference data set allows the quantitative estimation of the severity of WMH as a percentile rank score. For all patients (median age=69 years), multivariable analysis showed that age, hypertension, atrial fibrillation, and left ventricular hypertrophy were independently associated with increasing WMH (0–9.4%, median=0.6%, of the measured brain volume). For younger (≤69) hypertensives (n=819), age and left ventricular hypertrophy were positively associated with WMH. For older (≥70) hypertensives (n=944), age and cholesterol had positive relationships with WMH, whereas diabetes mellitus, hyperlipidemia, and atrial fibrillation had negative relationships with WMH. For younger nonhypertensives (n=578), age and diabetes mellitus were positively related to WMH. For older nonhypertensives (n=328), only age was positively associated with WMH.</P><P><B>Conclusions—</B></P><P>We have generated a novel graphical WMH grading (Kim statistical WMH scoring) system, correlated to risk factors and adjusted for age/hypertension. Further studies are required to confirm whether the combined data set allows grading of WMH burden in individual patients and a tailored patient-specific interpretation in ischemic stroke-related clinical practice.</P>
Stroke outcomes are worse with larger leukoaraiosis volumes
Ryu, Wi-Sun,Woo, Sung-Ho,Schellingerhout, Dawid,Jang, Min Uk,Park, Kyoung-Jong,Hong, Keun-Sik,Jeong, Sang-Wuk,Na, Jeong-Yong,Cho, Ki-Hyun,Kim, Joon-Tae,Kim, Beom Joon,Han, Moon-Ku,Lee, Jun,Cha, Jae-Kw Oxford University Press 2017 Brain Vol.140 No.1
<P>Leukoaraiosis or white matter hyperintensities are frequently observed on magnetic resonance imaging of stroke patients. We investigated how white matter hyperintensity volumes affect stroke outcomes, generally and by subtype. In total, 5035 acute ischaemic stroke patients were enrolled. Strokes were classified as large artery atherosclerosis, small vessel occlusion, or cardioembolism. White matter hyperintensity volumes were stratified into quintiles. Mean age (+/- standard deviation) was 66.3 +/- 12.8, 59.6% male. Median (interquartile range) modified Rankin Scale score was 2 (1-3) at discharge and 1 (0-3) at 3 months; 16.5% experienced early neurological deterioration, and 3.3% recurrent stroke. The Cochran-Mantel-Haenszel test with adjustment for age, stroke severity, sex, and thrombolysis status showed that the distributions of 3-month modified Rankin Scale scores differed across white matter hyperintensity quintiles (P < 0.001). Multiple ordinal logistic regression analysis showed that higher white matter hyperintensity quintiles were independently associated with worse 3-month modified Rankin Scale scores; adjusted odds ratios (95% confidence interval) for the second to fifth quintiles versus the first quintile were 1.29 (1.10-1.52), 1.40 (1.18-1.66), 1.69 (1.42-2.02) and 2.03 (1.69-2.43), respectively. For large artery atherosclerosis (39.0%), outcomes varied by white matter hyperintensity volume (P = 0.01, Cochran-Mantel-Haenszel test), and the upper three white matter hyperintensity quintiles (versus the first quintile) had worse 3-month modified Rankin Scale scores; adjusted odds ratios were 1.45 (1.10-1.90), 1.86 (1.41-2.47), and 1.89 (1.41-2.54), respectively. Patients with large artery atherosclerosis were vulnerable to early neurological deterioration (19.4%), and the top two white matter hyperintensity quintiles were more vulnerable still: 23.5% and 22.3%. Moreover, higher white matter hyperintensities were associated with poor modified Rankin Scale improvement: adjusted odds ratios for the upper two quintiles versus the first quintile were 0.66 (0.47-0.94) and 0.62 (0.43-0.89), respectively. For small vessel occlusion (17.8%), outcomes tended to vary by white matter hyperintensitiy volume (P = 0.10, Cochran-Mantel-Haenszel test), and the highest quintile was associated with worse 3-month modified Rankin Scale scores: adjusted odds ratio for the fifth quintile versus first quintile, 1.98 (1.23-3.18). In this subtype, worse white matter hyperintensities were associated with worse National Institute of Health Stroke Scale scores at presentation. For cardioembolism (20.6%), outcomes did not vary significantly by white matter hyperintensity volume (P = 0.19, Cochran-Mantel-Haenszel test); however, the adjusted odds ratio for the highest versus lowest quintiles was 1.62 (1.09-2.40). Regardless of stroke subtype, white matter hyperintensities were not associated with stroke recurrence within 3 months of follow-up. In conclusion, white matter hyperintensity volume independently correlates with stroke outcomes in acute ischaemic stroke. There are some suggestions that stroke outcomes may be affected by leukoaraiosis differentially depending on stroke subtypes, to be confirmed in future investigations.</P>
지리정보시스템을 활용한 CO₂인벤토리 구축 방안에 관한 연구
오상학 ( Sang Hak Oh ),김대욱 ( Dae Wuk Kim ),류지원 ( Ji Won Ryu ),차재규 ( Jae Gyu Cha ),정응호 ( Eung Ho Jung ) 한국지리정보학회 2011 한국지리정보학회지 Vol.14 No.2
본 연구에서는 탄소배출 인벤토리 구축에 있어서 지리정보시스템을 활용하여 공간 특성에 따라 분포되고 있는 탄소 배출 규모를 살펴 보고자 하였다. 궁극적으로는 공간대응형 탄소배출 인벤토리를 구축함으로서 온실가스 저감형 도시 공간구조 조성을 위한 기본방향을 제시하고, 친환경적인 녹색 도시로의 변화에 기여하고자 하였다. 지리정보시스템에 입력되는 기초 Data 중 속성정보는 대구광역시 에너지 부문(전력, 도시가스)의 2009년 연간 사용량을 가지고 IPCC 가이드라인에서 제시하고 있는 Tier 1에 대입하여 CO₂배출량을 추정하였다. 공간정보는 대구광역시 건축물 대장과 지적도를 연계하여 지번에 따라 건축물 용도별로 토지이용 분류를 실시하여 구축하였다. 에너지 부문의 CO₂배출 인벤토리 구축에 지리정보시스템을 접목함으로서 공간별 CO₂배출 규모를 파악할 수 있었으며, 토지이용에 따라 CO₂배출 현황이 각기 상이한 특성을 가지고 있다는 것을 확인할 수 있었다. In this study, CO₂emission quantities by spatial characteristics using GIS were investigated for building a CO₂emission inventory. Eventually, this study provides the guidelines to build the urban spatial structure for reducing greenhouse gas and contributes to the transition to environmental friendly green city. The attribute data for GIS were energy (electricity and gas) usage in the city of Daegu for 2009 and used for Tier 1 as suggested by the IPCC guideline to estimate amount of CO₂emission. The spatial data were built based on land use types categorized by building purposes with connecting building registers to cadastral maps for Daegu city. Spatial CO₂emission quantities could be calculated by combining CO₂emission inventory for energy and GIS. Also, CO₂emission characteristics were different by land use types.
Lee, Jin Wuk,Lim, Kwang Soo,Ryu, Dae Won,Koh, Eui Kwan,Yoon, Sung Won,Suh, Byoung Jin,Hong, Chang Seop American Chemical Society 2013 Inorganic chemistry Vol.52 No.15
<P>Five one-dimensional bimetallic W<SUP>V</SUP>Mn<SUP>III</SUP> complexes <B>1</B>–<B>5</B>, consisting of [W(CN)<SUB>6</SUB>(bpy)]<SUP>−</SUP> anions and [Mn(Schiff base)]<SUP>+</SUP> cations, were prepared. The central coordination geometry around each W atom is determined as a distorted dodecahedron (DD) for <B>1</B> and <B>2</B>, and a distorted square antiprism (SAPR) for <B>3</B>–<B>5</B>. Magnetic analyses demonstrate that compounds <B>1</B>, <B>4</B>, and <B>5</B> exhibit antiferromagnetic interactions between magnetic centers, which are different from the ferromagnetic couplings in <B>2</B> and <B>3</B>. For the distorted DD geometry, the Mn–N<SUB>ax</SUB> (ax = axial) bond length increases when moving from <B>1</B> to <B>2</B>, with the Mn–N<SUB>ax</SUB>–C<SUB>ax</SUB> angle remaining constant. The elongation of the bond length is responsible for the reduction in orbital overlap and consequent ferromagnetic coupling in <B>2</B>. In comparison, for <B>3</B>–<B>5</B> with the distorted SAPR geometry, given that the Mn–N<SUB>ax</SUB> bond lengths are similar across all the samples, the increase in the Mn–N<SUB>ax</SUB>–C<SUB>ax</SUB> angles accounts for the enhanced magnetic strength. Notably, a correlation between structure and magnetic exchange coupling is established for the first time in W<SUP>V</SUP>Mn<SUP>III</SUP> bimetallic systems based on the [W(CN)<SUB>6</SUB>(bpy)]<SUP>−</SUP> precursor.</P><P>Five one-dimensional W<SUP>V</SUP>Mn<SUP>III</SUP> compounds were prepared by self-assembling [W(CN)<SUB>6</SUB>(bpy)]<SUP>−</SUP> anions and corresponding Mn Schiff bases. The central geometry around a W atom is taken into consideration to account for the magnetic behavior. In the square antiprismatic systems, a magnetostructural correlation is established in terms of the Mn−N<SUB>ax</SUB>−C<SUB>ax</SUB> angle in the bridging route.</P><P><B>Graphic Abstract</B> <IMG SRC='http://pubs.acs.org/appl/literatum/publisher/achs/journals/content/inocaj/2013/inocaj.2013.52.issue-15/ic400845z/production/images/medium/ic-2013-00845z_0007.gif'></P><P><A href='http://pubs.acs.org/doi/suppl/10.1021/ic400845z'>ACS Electronic Supporting Info</A></P>
Kim, Dong-Eog,Ryu, Wi-Sun,Schellingerhout, Dawid,Jeong, Han‐,Gil,Kim, Paul,Jeong, Sang-Wuk,Park, Man-Seok,Choi, Kang-Ho,Kim, Joon-Tae,Kim, Beom Joon,Han, Moon-Ku,Lee, Jun,Cha, Jae-Kwan,Kim, Dae- Korean Stroke Society 2019 Journal of stroke Vol.21 No.1
<P><B>Background and Purpose</B></P><P>Thrombectomy within 24 hours can improve outcomes in selected patients with a clinical-infarct mismatch. We devised an easy-to-use visual estimation tool that allows infarct volume estimation in centers with limited resources. </P><P><B>Methods</B></P><P>We identified 1,031 patients with cardioembolic or large-artery atherosclerosis infarction on diffusion-weighted images (DWIs) obtained before recanalization therapy and within 24 hours of onset, and occlusion of the internal carotid or middle cerebral artery. Acute DWIs were mapped onto a standard template and used to create visual reference maps with known lesion volumes, which were then used in a validation study (with 130 cases) against software estimates of infarct volume. </P><P><B>Results</B></P><P>The DWI reference map chart comprises 144 maps corresponding to 12 different infarct volumes (0.5, 1, 2, 3, 5, 7, 9, 11, 13, 15, 17, and 19 mL) in each of 12 template slices (Montreal Neurological Institute z-axis –15 to 51 mm). Infarct volume in a patient is estimated by selecting a slice with a similar infarct size at the corresponding z-axis level on the reference maps and then adding up over all slices. The method yielded good correlations to software volumetrics and was easily learned by both experienced and junior physicians, with approximately 1 to 2 minutes spent per case. The sensitivity, specificity, and accuracy for detecting threshold infarct volumes (<21, <31, and <51 mL) were very high (all about >90%). </P><P><B>Conclusions</B></P><P>We developed easy-to-use reference maps that allow prompt and reliable visual estimation of infarct volumes for triaging patients to thrombectomy in acute stroke.</P>