This report presents the latest statistics on the stroke population in South Korea, sourced from the Clinical Research Collaborations for Stroke in Korea-National Institute for Health (CRCS-K-NIH), a comprehensive, nationwide, multicenter stroke registry. The Korean cohort, unlike western populations, shows a male-to-female ratio of 1.5, attributed to lower risk factors in Korean women. The average ages for men and women are 67 and 73 years, respectively.Hypertension is the most common risk factor (67%), consistent with global trends, but there is a higher prevalence of diabetes (35%) and smoking (21%). The prevalence of atrial fibrillation (19%) is lower than in western populations, suggesting effective prevention strategies in the general population. A high incidence of large artery atherosclerosis (38%) is observed, likely due to prevalent intracranial arterial disease in East Asians and advanced imaging techniques.There has been a decrease in intravenous thrombolysis rates, from 12% in 2017–2019 to 10% in 2021, with no improvements in door-to-needle and door-to-puncture times, worsened by the coronavirus disease 2019 pandemic. While the use of aspirin plus clopidogrel for noncardioembolic stroke and direct oral anticoagulants for atrial fibrillation is well-established, the application of direct oral anticoagulants for non-atrial fibrillation cardioembolic strokes in the acute phase requires further research. The incidence of early neurological deterioration (13%) and the cumulative incidence of recurrent stroke at 3 months (3%) align with global figures. Favorable outcomes at 3 months (63%) are comparable internationally, yet the lack of improvement in dependency at 3 months highlights the need for advancements in acute stroke care.

Background: CycloZ, a combination of cyclo-His-Pro and zinc, has anti-diabetic activity. However, its exact mode of action remains to be elucidated. Methods: KK-Ay mice, a type 2 diabetes mellitus (T2DM) model, were administered CycloZ either as a preventive intervention, or as a therapy. Glycemic control was evaluated using the oral glucose tolerance test (OGTT), and glycosylated hemoglobin (HbA1c) levels. Liver and visceral adipose tissues (VATs) were used for histological evaluation, gene expression analysis, and protein expression analysis. Results: CycloZ administration improved glycemic control in KK-Ay mice in both prophylactic and therapeutic studies. Lysine acetylation of peroxisome proliferator-activated receptor gamma coactivator 1-alpha, liver kinase B1, and nuclear factor-κB p65 was decreased in the liver and VATs in CycloZ-treated mice. In addition, CycloZ treatment improved mitochondrial function, lipid oxidation, and inflammation in the liver and VATs of mice. CycloZ treatment also increased the level of β-nicotinamide adenine dinucleotide (NAD+), which affected the activity of deacetylases, such as sirtuin 1 (Sirt1). Conclusion Our findings suggest that the beneficial effects of CycloZ on diabetes and obesity occur through increased NAD+ synthesis, which modulates Sirt1 deacetylase activity in the liver and VATs. Given that the mode of action of an NAD+ booster or Sirt1 deacetylase activator is different from that of traditional T2DM drugs, CycloZ would be considered a novel therapeutic option for the treatment of T2DM.

Background: Although respiratory tract infection is one of the most important factors triggering acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), limited data are available to suggest an epidemiologic pattern of microbiology in South Korea. Methods: A multicenter observational study was conducted between January 2015 and December 2018 across 28 hospitals in South Korea. Adult patients with moderate-to-severe acute exacerbations of COPD were eligible to participate in the present study. The participants underwent all conventional tests to identify etiology of microbial pathogenesis. The primary outcome was the percentage of different microbiological pathogens causing AE-COPD. A comparative microbiological analysis of the patients with overlapping asthma–COPD (ACO) and pure COPD was performed. Results: We included 1,186 patients with AE-COPD. Patients with pure COPD constituted 87.9% and those with ACO accounted for 12.1%. Nearly half of the patients used an inhaled corticosteroid-containing regimen and one-fifth used systemic corticosteroids. Respiratory pathogens were found in 55.3% of all such patients. Bacteria and viruses were detected in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple bacterial infections were more likely to appear in ACO than in pure COPD (8.3% vs. 3.6%, p=0.016). Conclusion Distinct microbiological patterns were identified in patients with moderate-to-severe AE-COPD in South Korea. These findings may improve evidence-based management of patients with AE-COPD and represent the basis for further studies investigating infectious pathogens in patients with COPD.

Objective: To evaluate the reliability of suprahyoid and infrahyoid electromyography (EMG) measurement during swallowing. Methods: In all, 10 healthy volunteers were evaluated for the following surface EMG (sEMG) parameters in the suprahyoid and infrahyoid muscles during swallowing: onset latency, offset latency, duration, peak latency, maximal amplitude during swallowing, and the area under curve (AUC) of the rectified EMG signal. The sEMG was recorded while the participants swallowed five times each of the four fluid volumes (saliva, 2 ml, 5 ml, and 20 ml of water), totaling to 20 swallows. Moreover, the intra-participant variability per parameter was evaluated using the coefficient of variation (CV). Results: Suprahyoid muscles were activated 0.095 s (95% CI, 0.062-0.128) earlier than the infrahyoid muscles.Maximal amplitudes during the 20 ml swallow were 17.484 (−1.543-36.512) and 13.490 (1.254-25.727) μV higher than values obtained during the 2 ml swallow in the suprahyoid and infrahyoid muscles, respectively. Furthermore, the AUC of the rectified EMG signal increased with the volume of swallow in both muscle groups (P=0.003, suprahyoid; P＜0.002, infrahyoid). The intra-individual variabilities of offset latency, duration, and maximal amplitude were relatively low (＜30% CV) in both muscle groups with respect to other parameters. The assessment of each parameter using EMG was highly reliable, with an intraclass correlation coefficient of ＞0.8. Conclusion Among the variable sEMG parameters assessed, the offset latency, duration, and maximal amplitude were the least variable. Although reliability on the rater side showed good results, the swallow-to-swallow variability of the parameters need to be considered in swallowing studies using sEMG.

Objective: To evaluate the reliability of suprahyoid and infrahyoid electromyography (EMG) measurement during swallowing. Methods: In all, 10 healthy volunteers were evaluated for the following surface EMG (sEMG) parameters in the suprahyoid and infrahyoid muscles during swallowing: onset latency, offset latency, duration, peak latency, maximal amplitude during swallowing, and the area under curve (AUC) of the rectified EMG signal. The sEMG was recorded while the participants swallowed five times each of the four fluid volumes (saliva, 2 ml, 5 ml, and 20 ml of water), totaling to 20 swallows. Moreover, the intra-participant variability per parameter was evaluated using the coefficient of variation (CV). Results: Suprahyoid muscles were activated 0.095 s (95% CI, 0.062-0.128) earlier than the infrahyoid muscles.Maximal amplitudes during the 20 ml swallow were 17.484 (−1.543-36.512) and 13.490 (1.254-25.727) μV higher than values obtained during the 2 ml swallow in the suprahyoid and infrahyoid muscles, respectively. Furthermore, the AUC of the rectified EMG signal increased with the volume of swallow in both muscle groups (P=0.003, suprahyoid; P＜0.002, infrahyoid). The intra-individual variabilities of offset latency, duration, and maximal amplitude were relatively low (＜30% CV) in both muscle groups with respect to other parameters. The assessment of each parameter using EMG was highly reliable, with an intraclass correlation coefficient of ＞0.8. Conclusion Among the variable sEMG parameters assessed, the offset latency, duration, and maximal amplitude were the least variable. Although reliability on the rater side showed good results, the swallow-to-swallow variability of the parameters need to be considered in swallowing studies using sEMG.

Objective: The purpose of this study was to understand the mechanism of normal hyoid movement during swallowing by calculating the activity of each muscle involved in the hyoid movement and propose a new kinetic modeling of hyoid movement using videofluoroscopy images. Methods: Eight healthy volunteers with an average age of 56.8 swallowed 2-ml of diluted barium under videofluoroscopy. A video image was digitized to analyze the movement of the hyoid bone. The activity of the muscles acting on the hyoid bone was calculated from the movement of the hyoid bone using kinetic modeling. A surface electromyogram was measured simultaneously with videofluoroscopy, and the muscle force calculated by kinetic modeling was compared with the muscle force measured by surface EMG. Results: The muscles acting on the hyoid bone were divided into three groups according to the direction of force and analyzed. The contraction of the retractor muscle group was observed as a median of 433 ms (95% CI 264-602, P=0.012) earlier than the contraction of protractor muscle group in all subjects. Generally, the peak activity of each muscle group was observed in the order of retractor (0 ms), protractor (592 ms, 95% CI 429-755), and depressor (717 ms, 95% CI 535-899) muscle group. The contraction of the protractor muscle measured by surface electromyography showed an earlier onset latency with a median of 82 2 ms (95% CI 615-102 9, P=0.012 ) compared to the contraction of the protractor muscle calculated by kinetic modeling. Conclusion Kinetic modeling reflects the pattern of contraction in the order of retractor, protractor, depressor muscle groups, as previously known. And it was possible to evaluate the activity of the retractor muscle, which is difficult to evaluate by electromyogram.

Despite the great socioeconomic burden of stroke, there have been few reports of stroke statistics in Korea. In this scenario, the Epidemiologic Research Council of the Korean Stroke Society launched the “Stroke Statistics in Korea” project, aimed at writing a contemporary, comprehensive, and representative report on stroke epidemiology in Korea. This report contains general statistics of stroke, prevalence of behavioral and vascular risk factors, stroke characteristics, pre-hospital system of care, hospital management, quality of stroke care, and outcomes. In this report, we analyzed the most up-to-date and nationally representative databases, rather than performing a systematic review of existing evidence. In summary, one in 40 adults are patients with stroke and 232 subjects per 100,000 experience a stroke event every year. Among the 100 patients with stroke in 2014, 76 had ischemic stroke, 15 had intracerebral hemorrhage, and nine had subarachnoid hemorrhage. Stroke mortality is gradually declining, but it remains as high as 30 deaths per 100,000 individuals, with regional disparities. As for stroke risk factors, the prevalence of smoking is decreasing in men but not in women, and the prevalence of alcohol drinking is increasing in women but not in men. Population-attributable risk factors vary with age. Smoking plays a role in young-aged individuals, hypertension and diabetes in middle-aged individuals, and atrial fibrillation in the elderly. About four out of 10 hospitalized patients with stroke are visiting an emergency room within 3 hours of symptom onset, and only half use an ambulance. Regarding acute management, the proportion of patients with ischemic stroke receiving intravenous thrombolysis and endovascular treatment was 10.7% and 3.6%, respectively. Decompressive surgery was performed in 1.4% of patients with ischemic stroke and in 28.1% of those with intracerebral hemorrhage. The cumulative incidence of bleeding and fracture at 1 year after stroke was 8.9% and 4.7%, respectively. The direct costs of stroke were about ₩1.68 trillion (KRW), of which ₩1.11 trillion were for ischemic stroke and ₩540 billion for hemorrhagic stroke. The great burden of stroke in Korea can be reduced through more concentrated efforts to control major attributable risk factors for age and sex, reorganize emergency medical service systems to give patients with stroke more opportunities for reperfusion therapy, disseminate stroke unit care, and reduce regional disparities. We hope that this report can contribute to achieving these tasks.
Adult ; Aged ; Alcohol Drinking ; Ambulances ; Atrial Fibrillation ; Cerebral Hemorrhage ; Emergency Medical Services ; Emergency Service, Hospital ; Epidemiology ; Female ; Hemorrhage ; Hope ; Humans ; Hypertension ; Incidence ; Korea ; Male ; Mortality ; Prevalence ; Reperfusion ; Risk Factors ; Smoke ; Smoking ; Stroke ; Subarachnoid Hemorrhage ; Writing

OBJECTIVE: To investigate the proportion of aspiration pneumonia cases among patients with community-acquired pneumonia in Korea. METHODS: This retrospective study included patients with community-acquired pneumonia who had been admitted to the emergency department of a university-affiliated tertiary hospital in Gyeonggi Province, Korea between January 1, 2016 and December 31, 2016. Among these patients, those with aspiration pneumonia were identified using ICD-10 codes (J69.*). Patients with recurrent pneumonia were excluded, as were those who were immunocompromised. The proportion of cases of aspiration pneumonia was calculated, and the characteristics and clinical outcomes of patients with aspiration pneumonia and non-aspiration pneumonia were compared. RESULTS: The proportion of aspiration pneumonia cases among patients with community-acquired pneumonia was 14.2%. Patients with aspiration pneumonia were significantly more likely to be older (p<0.001) and male (p<0.001), and to have a higher confusion, uremia, respiratory rate, blood pressure, and age ≥65 years (CURB-65) score (p<0.001) as compared to patients with non-aspiration pneumonia. They were also more likely to require admission to the intensive care unit (p<0.001) and a longer hospital stay (p<0.001). CONCLUSION: Aspiration pneumonia accounts for 14.2% of all cases of community-acquired pneumonia in Korea. These data may contribute to the establishment of healthcare strategies for managing aspiration pneumonia among Korean adults.
Adult ; Blood Pressure ; Community-Acquired Infections ; Delivery of Health Care ; Emergency Service, Hospital ; Gyeonggi-do ; Humans ; Intensive Care Units ; International Classification of Diseases ; Korea ; Length of Stay ; Male ; Pneumonia ; Pneumonia, Aspiration ; Respiratory Rate ; Retrospective Studies ; Tertiary Care Centers ; Uremia

BACKGROUND: Patients who survive an acute phase of stroke are at risk of falls and fractures afterwards. However, it is largely unknown how frequent fractures occur in the Asian stroke population. METHODS: Patients with acute (< 7 days) ischemic stroke who were hospitalized between January 2011 and November 2013 were identified from a prospective multicenter stroke registry in Korea, and were linked to the National Health Insurance Service claim database. The incidences of fractures were investigated during the first 4 years after index stroke. The cumulative incidence functions (CIFs) were estimated by the Gray's test for competing risk data. Fine and Gray model for competing risk data was applied for exploring risk factors of post-stroke fractures. RESULTS: Among a total of 11,522 patients, 1,616 fracture events were identified: 712 spine fractures, 397 hip fractures and 714 other fractures. The CIFs of any fractures were 2.63% at 6 months, 4.43% at 1 year, 8.09% at 2 years and 13.00% at 4 years. Those of spine/hip fractures were 1.11%/0.61%, 1.88%/1.03%, 3.28%/1.86% and 5.79%/3.15%, respectively. Age by a 10-year increment (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.17–1.30), women (HR, 1.74; 95% CI, 1.54–1.97), previous fracture (HR, 1.72; 95% CI, 1.54–1.92) and osteoporosis (HR, 1.44; 95% CI, 1.27–1.63) were independent risk factors of post-stroke fracture. CONCLUSION: The CIFs of fractures are about 8% at 2 years and 13% at 4 years after acute ischemic stroke in Korea. Older age, women, pre-stroke fracture and osteoporosis raised the risk of post-stroke fractures.
Accidental Falls ; Asian Continental Ancestry Group ; Epidemiology ; Female ; Hip Fractures ; Humans ; Incidence ; Korea ; National Health Programs ; Osteoporosis ; Prospective Studies ; Risk Factors ; Spine ; Stroke

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is a rare but near-fatal complication of peritoneal dialysis (PD). Despite the high mortality rate of EPS, the surgical treatment strategy of severe EPS is yet to be established.METHODS: We retrospectively analyzed outcomes of patients with EPS who underwent enterolysis for intractable EPS at Seoul National University Hospital between 2001 and 2018. EPS was diagnosed based on the clinical symptoms and radiological findings of abdominal computed tomography (CT). CT scans were scored according to an EPS scoring system that assessed peritoneal thickening and calcification as well as bowel thickening, tethering, loculation, and dilatation.RESULTS: Thirteen patients (nine males and four females; age, 48 [29–63] years) underwent enterolysis for severe EPS. PD duration (11 [6–21] years) was not associated with survival. Two patients were newly diagnosed with EPS following kidney transplantation. Five patients died of infectious complications immediately after the surgery. Eight patients survived after the first surgery; however, five of them underwent reoperation but died of persistent infection, fistula formation, or adhesive bowel obstruction. Four young (< 60 years) male patients with relatively low CT scan scores (< 13) survived for > 2 years after the first surgery. Median survival duration from EPS diagnosis was 22 (1.3–184) months and that from the first surgery was 9 (0.3–153) months.CONCLUSION: The high mortality rate of EPS suggests the importance of appropriate surgical intervention in young symptomatic male EPS patients with relatively low CT scan scores.
Adhesives ; Diagnosis ; Dilatation ; Female ; Fistula ; Humans ; Kidney Transplantation ; Korea ; Male ; Mortality ; Peritoneal Dialysis ; Peritoneal Fibrosis ; Reoperation ; Retrospective Studies ; Seoul ; Tomography, X-Ray Computed