PURPOSE: The study was done to identify factors influencing Yangsaeng in elders. METHODS: Data were collected by questionnaires from 907 elders in D metropolitan city. Measures were Yangsaeng, perceived health status, self-efficacy, and self esteem. Data were analyzed using frequencies, means and standard deviation, t-test, one-way ANOVA, Pearson correlation coefficients, and stepwise multiple regression with SPSS/WIN 13.0 version. RESULTS: The mean score for Yangsaeng the participants was 3.56, out of a possible 5. There were significant differences in Yangsaeng according to age, education level, monthly income, marital status, family structure, and periodic health examination. Yangsaeng correlated positively with perceived health status, self-efficacy and self-esteem. According to the research, factors influencing Yangseng in elders were self-esteem, perceived health status, self-efficacy, family structure, and marital status. CONCLUSION: The positive correlation between Yangsaeng and health promotion behavior and perceived health status, self-efficacy, and self-esteem identified in this study can have an impact on strategies to improve the health of Korean elders. Therefore, the results can be used as a reference for future studies.
Aged ; Aged, 80 and over ; Attitude to Health ; Family Relations ; Female ; *Health Promotion/economics ; Health Status ; Humans ; Male ; Marital Status ; Quality of Life ; Questionnaires ; Self Efficacy

PURPOSE: As endovascular therapy (EVT) has been approved as a treatment guideline for acute ischemic stroke (AIS), it has been increasing in Korea. We conducted a nationwide survey to evaluate the current status of EVT for patients with AIS in Korea. MATERIALS AND METHODS: An electronic survey was sent to a representative clinician at each hospital where EVT was available in Korea. A Google survey was used to distribute the questionnaires and receive responses from October 2017 to December 2017. RESULTS: Among 120 hospitals in our society, 76 participated in this survey. In 26% of the hospitals, more than 50 annual cases of EVT were performed, and 25–50 annual cases in 37%. Fifty-six hospitals (73.7%) achieved successful recanalization (thrombolysis in cerebral infarction ≥2b) in more than 80% of patients. Computed tomography (CT) angiography was the most common imaging modality for AIS treatment, and magnetic resonance (MR) diffusion, MR-perfusion/diffusion, and perfusion CT were frequently used in order. Non-eligibility criteria for EVT included a National Institutes of Health Stroke Scale < 4 (64.5%), the absence of MR perfusion/diffusion mismatch (52.6%), and a low Alberta Stroke Program Early CT Score (42.1%). For anterior circulation stroke, 60% of Korean hospitals adopted a wider time range of “8 hours” from symptom onset, while 70% of hospitals had a time limitation of 12–24 hours for posterior circulation stroke. The most preferred EVT device was a stentriever (89.4%). In the failed cases due to underlying stenosis, 79% of Korean hospitals performed angioplasty or stenting for revascularization. CONCLUSION: This first nationwide survey showed that most Korean hospitals conducted EVT for AIS patients according to the present guideline in the era of mechanical thrombectomy by integrating the clinical experiences of many medical institutions and specialists.
Alberta ; Angiography ; Angioplasty ; Cerebral Infarction ; Constriction, Pathologic ; Diffusion ; Humans ; Ischemia ; Korea* ; National Institutes of Health (U.S.) ; Perfusion ; Specialization ; Stents ; Stroke* ; Thrombectomy

PURPOSE: Although carotid endarterectomy (CEA) is recommended as a treatment for carotid stenosis rather than carotid artery stenting (CAS), CAS has been preferred in Korea. The aim of this study was to analyze long-term outcomes after CAS compared with CEA using Korean nationwide insurance data. MATERIALS AND METHODS: We obtained all data from the nationwide database of the Health Insurance Review & Assessment Service (HIRA) during the study period using several codes regarding the procedure or operation. We included the HIRA data, which included at least one-year follow-up after the procedures. The outcomes associated with both procedures were death, recurrence of ischemic stroke, and admission for cerebral hemorrhage. RESULTS: A total of 16,065 eligible patients who were treated with CAS or CEA between 1 January 2007 and 31 December 2016 were analyzed. The number of patients with CAS and CEA was 12,173 (75.8%) and 3,892 (24.2%), respectively. 8,976 patients (55.9%) were classified as symptomatic patients. CAS was associated with a higher risk of all-cause mortality (adjusted hazard ratio [HR], 1.282; 95% confidence interval [CI], 1.173–1.400). The adjusted rates for recurrent ischemic stroke and cerebral hemorrhage between CAS versus CEA were 24.9% versus 15.9% (HR, 1.474; 95% CI, 1.325–1.639) and 1.5% versus 0.9% (HR, 2.026; 95% CI, 1.322–3.106), respectively. In young symptomatic patients, there was no statistically significant difference in all-cause mortality and cardiovascular death between CAS and CEA. CONCLUSION: Our study using Korean nationwide insurance data demonstrated similar results to previous studies. Until further evidence of CAS is established through prospective studies, CAS should be performed in selected patients according to current guidelines.
Carotid Arteries ; Carotid Stenosis ; Cerebral Hemorrhage ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Humans ; Insurance ; Insurance, Health ; Korea ; Mortality ; Prognosis ; Prospective Studies ; Recurrence ; Stents ; Stroke

Purpose: The purpose of this study was to evaluate trends in medical costs and prognosis in acute ischemic stroke (AIS) patients in Korea from 2008 to 2017 using medical claims data. Materials and Methods: All data for the past decade was collected from a big data hub provided by the Health Insurance Review & Assessment Service. Using several Korean Standard Classification of Disease codes, we estimated the number of patients, the costs of medical insurance, and prognosis according to the treatment with or without endovascular thrombectomy (EVT) among in-patients with AIS. Results: Since 2014, when EVT was covered by insurance, the number of patients who underwent EVT for AIS has increased significantly. Also, in the past decade, the medical costs following inpatient care for AIS with EVT have increased gradually, and the overall medical costs for the first year post-stroke have also increased. The prognosis of AIS patients with EVT was different according to the time of treatment. Annual trends for both mortality and cerebral hemorrhage after treatment of AIS with EVT have gradually decreased. Conclusion In this study, we found that both inpatient medical costs and 1-year cumulative medical costs have gradually increased, and the prognosis has gradually improved in patients receiving EVT treatment among AIS patients.

A rupture of a femoral pseudoaneurysm is an extremely rare complication of endovascular procedures, but its outcome can be life-threatening. In this report, we present a case of a femoral pseudoaneursym rupture in a patient in their early 90s following intra-arterial mechanical thrombectomy for acute ischemic stroke. Despite receiving medical and surgical interventions, the patient subsequently developed multiple organ failure, ultimately resulting in death. This case emphasizes the critical role of appropriate selection of vascular closure technique and careful post-procedural monitoring, particularly in high-risk patients.

We report a case of delayed cerebral infarction due to stent longitudinal folding deformation following carotid artery stenting using a self-expandable stent with an open-cell design. The stented segment of the left common carotid artery was divided into two different lumens by this folding deformation, and the separated lumens became restricted with in-stent thrombosis. Although no established method of managing this rare complication exists, a conservative approach was taken with administration of anticoagulant and dual antiplatelet therapy. No neurological symptoms were observed during several months of clinical follow-up after discharge.
Aged ; Anticoagulants/therapeutic use ; Carotid Arteries/radiography ; Cerebral Infarction/*diagnosis/therapy ; Humans ; Male ; Platelet Aggregation Inhibitors/therapeutic use ; Stents/*adverse effects ; Thrombosis/drug therapy/*etiology ; Ticlopidine/analogs & derivatives/therapeutic use ; Tomography, X-Ray Computed

The symptoms of hypertrophic cardiomyopaty frequently result from impaired left ventricular relaxation, abnormal left ventricular filling, and decreased compliance of left ventricle in spite of normal systolic function. Several studies have suggested that the assessment of transmitral flow velocity waveform with pulsed Doppler echocardiography in patients with hypertrophic cardiomyopathy provide a noninvasive and clinically useful expression of left ventricular diastolic performance. In this study, pulsed Doppler echocardiography was used to measure diastolic indices from transmitral flow velocity waveform and thereby to assess left ventricular diastolic function in 20 patients with hypertrophic cardiomyopathy (14 septal hypertrophy, 3 apical hypertrophy, and 3 concentric hypertrophy). The diastolic indices to measure are isovolumic relaxation time(IVRT), deceleration time(DT), pressure half time(PHT), deceleration of early diastolic flow(DEF), EF slope, peak flow velocity in early diastole(PFVE), peak flow velocity during atrial systole(PFVA), and PFVE/PFVA ratio. The diastolic indices obtained from patients were compared with those in 20 age-matched control subjects without heart disease. The relationship between left ventricular wall thickness index(Th Index) and diastolic indices were evaluated. In addition, the effect of calcium channel-blocking agent on left ventricular diastolic function were evaluated. The results were as follows ; 1) There were no significant differences in RR interval, BP, end-systolic left ventricular dimension, and end-diastolic left ventricular dimension, but significant differences in interventricular septal thickness, posterior wall thickness, and left atrial dimension between hypertrophic group and control group. 2) The systolic index(ejection fraction) showed no significant difference between hypertrophic group and control group. 3) All diastolic indices except PFVA showed significant differences between hypertrophic group and control group. 4) Th Index did not showed a significant correlation with the diastolic indices except PFVE/PFVA. 5) There were no significant changes in RR interval, BP end-systolic left ventricular dimension, end-diastolic left ventricular dimension, left atrial dimension, and ejection fraction between medication and drug withdrawal. IVRT significantly increased after drug withdrawal. But other diastolic indices showed no significant changes after drug withdrawal. According to above results the assessment of left ventricular diastolic function by pulsed Doppler echocardiography was a clinically useful method in detecting diastolic dysfunction in patients with hypertrophic cardiomyopathy. Calcium channel-blocking agent may have beneficial effect in improving left ventricular diastolic function in patients with hypertrophic cardiomyopathy.
Calcium* ; Cardiomyopathy, Hypertrophic* ; Compliance ; Deceleration ; Echocardiography, Doppler, Pulsed* ; Heart Diseases ; Heart Ventricles ; Humans ; Hypertrophy ; Relaxation

We present three neuropathologically-verified and two clinically-probable cases of Creutfeldt Jakob disease. All five had nonspecific prodromal complaints or symptoms prior to overt neurological signs and showed striking progressive neurologic deterioration, especially cognitive decline and cerebellar dysfunction. Myoclonic involuntary movements and complete decapitated states followed in one or two months. The characteristic even pathognomonic in proper clinical settings, features of electroencephalography, magnetic resonance imaging and positron emission tomography and pathologic findings are presented.
Cerebellar Diseases ; Creutzfeldt-Jakob Syndrome* ; Dyskinesias ; Electroencephalography ; Magnetic Resonance Imaging ; Positron-Emission Tomography ; Strikes, Employee

PURPOSE: Clopidogrel is metabolized by the hepatic cytochrome P450 (CYP) system into its active thiol metabolite. CYP3A4 is involved in the metabolism of both clopidogrel and dihydropyridine calcium channel blockers (CCBs). A few reports have suggested an inhibitory interaction between CCBs and clopidogrel. Accordingly, the aim of this study was to determine the effect of CCBs on the antiplatelet activity of clopidogrel by serial P2Y12 reaction unit (PRU) measurements. MATERIALS AND METHODS: We assessed changes in antiplatelet activity in patients receiving both clopidogrel and CCBs for at least 2 months prior to enrollment in the study. The antiplatelet activity of clopidogrel was measured by VerifyNow P2Y12 assay in the same patient while medicated with CCBs and at 8 weeks after discontinuation of CCBs. After discontinuation of the CCBs, angiotensin receptor blockers were newly administered to the patients or dosed up for control of blood pressure. RESULTS: Thirty patients finished this study. PRU significantly decreased after discontinuation of CCBs (238.1+/-74.1 vs. 215.0+/-69.3; p=0.001). Of the 11 patients with high post-treatment platelet reactivity to clopidogrel (PRU> or =275), PRU decreased in nine patients, decreasing below the cut-off value in seven of these nine patients after 8 weeks. Decrease in PRU was not related to CYP2C19 genotype. CONCLUSION: CCBs inhibit the antiplatelet activity of clopidogrel.
Aged ; Aged, 80 and over ; Blood Platelets/*drug effects ; Calcium Channel Blockers/*therapeutic use ; Dihydropyridines/*therapeutic use ; Drug Interactions ; Female ; Humans ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/*therapeutic use ; Ticlopidine/*analogs & derivatives/therapeutic use

OBJECTIVE: There are two established surgical treatment options for carotid artery stenosis. Carotid endarterectomy (CEA) has been accepted as a gold standard for surgical treatment while carotid artery stenting (CAS) has recently become an alternative option. Each treatment option has advantages and disadvantages for the treatment outcomes. We propose a protocol for selection of a proper surgical treatment option for carotid artery stenosis. MATERIALS AND METHODS: A total of 192 published articles on management of carotid artery stenosis were reviewed. Preoperatively considerable factors which had been repeatedly noted in those articles for the risk/benefits of CEA or CAS were selected. According to those factors, a protocol with four categories was established. RESULTS: CEA or CAS is indicated when the patient has a symptomatic stenosis > or = 50%, or when the patient has an asymptomatic stenosis > or = 80%. Each treatment option has absolute indications and favorable indications. Each absolute indication is scored with three points, and each favorable indication, one point. Based on the highest scores, a proper treatment option (CEA or CAS) is selected. CONCLUSION: We have been treating patients according to this protocol and evaluating the outcomes of our protocol-based decision because this protocol might be helpful in assessment of risk/benefit for selection of a proper surgical treatment option in patients with carotid artery stenosis.
Carotid Arteries ; Carotid Stenosis* ; Constriction, Pathologic ; Endarterectomy, Carotid ; Humans ; Stents