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허성혁,장대일 대한의사협회 2009 대한의사협회지 Vol.52 No.4
As, until now, many studies have failed to establish the clinical effect of numerous neuroprotectives, antithrombotic therapy must be emphasized as one of critical options among limited treatment strategies in acute ischemic stroke. Based on the accumulating evidences that platelets and coagulating proteins play an important role in the thrombus formation, antiplatelets and anticoagulants are served as antithrombotics. Recently, major advances have been made in understanding the effects of antiplatelets and anticoagulants. Large randomized clinical trials have highlighted the effectiveness and safety of early and continuous antiplatelet therapy in reducing atherothrombotic stroke recurrence. Urgent anticoagulation has been used often to prevent early recurrent stroke and to improve neurological outcomes, however, its formal use in acute stroke has been the subject of debate even in cardioembolic stroke. That’s because anticoagulants also increase the risk of fatal or disabling intracranial hemorrhage and it is difficult to monitor proper anticoagulation. Although early administration of anticoagulants should be considered to prevent the secondary injury and the propagation of thrombosis in patients with atherothrombotic stroke, more evidences are needed especially in patients with infractions secondary to large artery thrombosis or cardioembolism. This review discusses recent advances related to antithrombotic strategies and putative neuroprotectives.
허성혁,조창훈,김혜옥,조용화,윤경식,이주희,박주철,안태범,정경천,윤성상,장대일,박기정 대한신경과학회 2011 Journal of Clinical Neurology Vol.7 No.2
Background and Purpose: Unstable carotid atherosclerotic plaques are characterized by cap rupture, leading to thromboembolism and stroke. Matrix metalloproteinases (MMPs) have been implicated in the progression of atherosclerosis and plaque rupture. The aim of this study was to assess the relationship between the expressions of MMP-2 and MMP-9 and carotid plaque instability. Methods: Eighty atherosclerotic plaques were collected from 74 patients undergoing carotid endarterectomy. Clinical information was obtained from each patient, and plaque morphology was examined at the macroscopic and microscopic levels. The immunohistochemical expressions of MMPs were graded using semiquantitative scales. Results: Macroscopic ulceration (84.6% versus 63.4%, p=0.042) and microscopic cap rupture (79.5% versus 51.2%, p=0.010) were more common in symptomatic than in asymptomatic patients. Immunoreactivities of MMP-2 and MMP-9 were increased in 40 and 36 atheromatous plaques,respectively. Macroscopic ulceration was strongly correlated with the expressions of MMP-2(p<0.001) and MMP-9 (p=0.001). There were significant correlations between increased MMP2 expression and cap rupture (p=0.002), intraplaque hemorrhage (p=0.039), and a thin fibrous cap (p=0.002), and between increased MMP-9 expression and cap rupture (p=0.010) and a large lipid core (p=0.013). Conclusions: Plaque rupture was significantly associated with the development of vascular events in carotid atherosclerotic disease. MMP-2 and MMP-9 are strongly correlated with plaque instability.
허성혁,장대일,서경화,부선희,강명찬,이상범,박기정,안태범,윤성상,정경천 대한신경과학회 2007 대한신경과학회지 Vol.25 No.2
Background: As the elderly population is fast growing, the incidence of stroke is also increasing. We studied the clinical characteristics of nonagenarian stroke compared to a population of patients under the age of ninety. Methods: Subjects included 44 nonagenarian stroke patients and 22,227 control patients aged under ninety. Clinical characteristics including age, sex, risk factors, stroke subtype, and outcome (one-year prognosis, evaluated by a modified Rankin scale) were analyzed. Results: The proportion of nonagenarian stroke accounted for 0.2% of all cases of stroke. Ischemic stroke was more common than hemorrhagic stroke in the nonagenarian group. In addition, the female gender was more frequent (p<0.01). As the patients were older, their admission period was shorter, the discharge against medical advice was increased, and the mortality was higher. Hypertension and atrial fibrillation were significantly higher (p<0.05, p<0.001, respectively) in the nonagenarian ischemic stroke patients. Conclusions: Nonagenarian stroke patients have unique clinical characteristics compared with stroke patients under the age of ninety. Background: As the elderly population is fast growing, the incidence of stroke is also increasing. We studied the clinical characteristics of nonagenarian stroke compared to a population of patients under the age of ninety. Methods: Subjects included 44 nonagenarian stroke patients and 22,227 control patients aged under ninety. Clinical characteristics including age, sex, risk factors, stroke subtype, and outcome (one-year prognosis, evaluated by a modified Rankin scale) were analyzed. Results: The proportion of nonagenarian stroke accounted for 0.2% of all cases of stroke. Ischemic stroke was more common than hemorrhagic stroke in the nonagenarian group. In addition, the female gender was more frequent (p<0.01). As the patients were older, their admission period was shorter, the discharge against medical advice was increased, and the mortality was higher. Hypertension and atrial fibrillation were significantly higher (p<0.05, p<0.001, respectively) in the nonagenarian ischemic stroke patients. Conclusions: Nonagenarian stroke patients have unique clinical characteristics compared with stroke patients under the age of ninety.
정맥내 Alteplase를 사용한 급성허혈뇌졸중환자에서 HAT점수를 이용한 출혈변환과 기능예후의 예측
허성혁,이상훈,이도경,정유진,황경진,박기정,안태범,윤성상,정경천,장대일 대한신경과학회 2012 대한신경과학회지 Vol.30 No.2
Background: Intravenous thrombolysis with alteplase is the most effective therapy for acute ischemic stroke, hemorrhagic transformation (HT) is a potentially dangerous complication of such thrombolysis. Few studies have investigated the predictors of HT after thrombolysis in Korean stroke patients. Methods: From 2003 to 2009, acute ischemic stroke patients who received intravenous alteplase were included from prospective stroke registry of Kyung Hee University Hospital. Patients submitted to CT or MRI scans with gradient echo sequences within 12-36 hours of thrombolysis. The Hemorrhage After Thrombolysis (HAT) score [ranging from (minimum risk) to 5 (maximum risk)] was calculated retrospectively for each patient. The predictive ability of the HAT score for HT and symptomatic intracranial hemorrhage (sICH) was calculated using C statistics. Results: Among 151 consecutive patients, HT was confirmed in 35 on follow-up brain imaging. Atrial fibrillation (OR=2.709, 95%CI=1.118-6.567) and low one-third CT scan (OR=3.419, 95%CI=1.281-9.121) increased the risk of HT after intravenous thrombolysis in multivariate logistic regression analysis. HT, sICH (based on the National Institute Neurological Disorders and Stroke and the Safe Implementation of Treatment in Stroke - Monitoring Study definitions),unfavorable [modified Rankin Scale (mRS) score of 2-6] and poor (mRS score of 3-6) outcomes at 3 months, and mortality at 3 months were increased with higher HAT scores (C statistic=0.632, 0.637, 0.843, 0.670, 0.689, and 0.659, respectively;p=0.018, 0.036, 0.042, 0.002, 0.015, and <0.001). Conclusions: The HAT score can be used to predict the risk of sICH following intravenous thrombolysis and long-term clinical outcome.
허성혁(Seong-Hyeok Heo),김수진(Su-Jin Kim) 한국기계가공학회 2017 한국기계가공학회지 Vol.16 No.5
In this research, a practical stiffness calculation method is developed and applied for modifying the height of the headstock, turret, and tailstock of a CNC lathe to enlarge the turntable diameter. The casting structure is assumed to be a rigid body and the linear motion element to be an elastic spring to simplify the turret stiffness calculation model. The stiffness of the sliding guide and ball screw of the original lathe is measured with a push tester and LVDT sensor, and the turret stiffness of the modified lathe is predicted and compared with experimental results to verify the model. The measured stiffness of the original turret is 0.17 kN/μm and that of the modified turret is 0.11 kN/μm, i.e., an 18% difference from the predicted result. The verified stiffness calculation model can be used to develop another modified lathe.
Transient Global Amnesia with Transient Ischemic Attack in the Habenular Nucleus
Heo, Sung Hyuk,Park, Key Chung,Yoon, Sung Sang,Ahn, Tea Beom,Chang, Dae Il,Chung, Kyung Cheon 경희대학교 2006 慶熙醫學 Vol.22 No.1
일과성 전기억상실증은 최근 확산강조 자기공명영상에서 관찰되는 해마의 허혈성 변화로 가장 많이 보고되어 있으나 그 기전은 아직까지 명확히 밝혀져 있지 않다. 우리는 기억과 학습의 중요한 기능을 하는 것으로 알려진 고삐핵의 일과성허혈발작에 의한 일과성 전기억상실증을 경험하여 보고하는 바이다. 환자는 증상발현 7시간과 96시간 이후에 연속적으로 확산강조 자기공명영상을 시행하였고, 처음 영상에서 나타난 고삐핵의 매우 작은 고신호강도 병변이 이후 영상에서는 관찰되지 않았다. The TGA can be produced by the small and discrete thalamic structure like habenular nucleus that is thought to be related with the cholinergic network for learning and memory in the central nervous system.