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

“Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” is the 3rd edition of clinical practice guideline (CPG) for stroke rehabilitation in Korea, which updates the 2nd edition published in 2014. Forty-two specialists in stroke rehabilitation from 21 universities and 4 rehabilitation hospitals and 4 consultants participated in this update. The purpose of this CPG is to provide optimum practical guidelines for stroke rehabilitation teams to make a decision when they manage stroke patients and ultimately, to help stroke patients obtain maximal functional recovery and return to the society. The recent two CPGs from Canada (2015) and USA (2016) and articles that were published following the 2nd edition were used to develop this 3rd edition of CPG for stroke rehabilitation in Korea. The chosen articles' level of evidence and grade of recommendation were decided by the criteria of Scotland (2010) and the formal consensus was derived by the nominal group technique. The levels of evidence range from 1++ to 4 and the grades of recommendation range from A to D. Good Practice Point was recommended as best practice based on the clinical experience of the guideline developmental group. The draft of the developed CPG was reviewed by the experts group in the public hearings and then revised. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” consists of ‘Chapter 1; Introduction of Stroke Rehabilitation’, ‘Chapter 2; Rehabilitation for Stroke Syndrome, ‘Chapter 3; Rehabilitation for Returning to the Society’, and ‘Chapter 4; Advanced Technique for Stroke Rehabilitation’. “Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016” will provide direction and standardization for acute, subacute and chronic stroke rehabilitation in Korea.
Canada ; Consensus ; Consultants ; Humans ; Korea* ; Practice Guidelines as Topic ; Rehabilitation* ; Scotland ; Specialization ; Stroke*

PURPOSE: Nevus sebaceus is a congenital hamartomatous lesion, typically involving head and neck. Various benign and malignant neoplasms can develop in association with nevus sebaceus. We report a case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma in nevus sebaceus. METHODS: A 73-year-old man presented with erythematous to black verrucous nodules on the right subauricular area. The upper part was accompanied with inflammation and ulceration, and no specific findings suspicious for malignant degeneration were found in the lower part preoperatively. The mass was totally excised and the defect was directly closed. Lymph nodes were not involved on concomitant neck dissection. RESULTS: Histopathologic examination confirmed the presence of squamous cell carcinoma in the upper part and basal cell carcinoma in the lower part of a nevus sebaceus. Negative margins were achieved on resection. No clinical problems were found during the 3-month follow-up period. CONCLUSION: We experienced a rare case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma within the same nevus sebaceus. Because patients with nevus sebaceus have risk of malignant changes, surgical excision and work-up for recurrence and metastasis should be considered in suspicious cases. And even in a totally asymptomatic case, the possibility of occult secondary cancer should be informed before surgery in aged patients.
Aged ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Follow-Up Studies ; Head ; Humans ; Inflammation ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Nevus ; Recurrence ; Ulcer

Natural killer (NK) cells play an important role in innate immunity, especially in the response to viral infections, such as hepatitis C virus (HCV). Killer cell immunoglobulin-like receptors (KIRs) are the primary receptors of NK cells that mediate innate immunity. KIRs are also involved in acquired immunity, because some KIRs are expressed on the surface of certain subsets of T cells. In this study, the frequency of KIR genes, HLA-C allotypes, and combinations of KIR genes with their HLA-C ligands were evaluated in two different groups of the Korean population: controls and patients with chronic HCV infection. The study population consisted of 147 Korean patients with chronic HCV infection. The frequency of KIR2DS2 in patients with chronic HCV infection was 9.5% which was significantly lower than 19.5% of the control (P < 0.01). However, there were no significant differences in the frequency of other KIR genes, HLA-C allotypes or different combinations of KIR genes with their HLA-C ligands. This study can contribute to the further prospective study with a larger scale, suggesting the assumption that KIR2DS2 might aid in HCV clearance by enhancing both the innate and acquired immune responses of people in Korea.
Adult ; Aged ; Female ; Genes, MHC Class I ; Genotype ; HLA-C Antigens/genetics ; Hepacivirus/immunology ; Hepatitis C, Chronic/*genetics/immunology ; Humans ; Killer Cells, Natural/immunology/virology ; Male ; Middle Aged ; Receptors, KIR/*genetics/immunology ; Republic of Korea ; T-Lymphocyte Subsets/immunology

BACKGROUND: Anemia is one of the most important risk factors for cardiovascular morbidity and mortality in patients with chronic renal failure. The most effective treatment modality for anemia is erythropoietin injection. Besides erythropoietic effect, erythropoietin has multiple beneficial effects such as anti-oxidant, anti-hypoxic, anti-apoptotic and vasculogenetic effects, and prevents tubular lesions and interstitial fibrosis. Despite lots of advantages of erythropoietin therapy, the number of patients treated with this agent is modest, particularly during the pre-dialysis chronic renal failure. We conducted a clinical trial to evaluate the effects of erythropoietin on renal function in the anemic pre-dialysis patients with chronic renal failure. METHODS: Data of 23 pre-dialysis patients with chronic renal failure were analyzed retrospectively 6 months prior, and prospectively 6 months after the initiation of erythropoietin therapy. Erythropoietin was admitted at a dose of 3000 IU weekly with supplementary iron. RESULTS: The average hematocrit and hemoglobin rose from 22.1+/-2.5%, 7.4+/-0.8 g/dL to 28.4+/-4.2%, 9.6+/-1.5 g/dL, respectively. When linear regression analysis was applied to pre- and post-erythropoietin glomerular filtration rate and 1/Cr, mean rate of decline of glomerular filtration rate were significantly delayed (p=0.039) but that of 1/Cr had a tendency to be delayed but was not statistically meaningful (p=0.099). CONCLUSIONS: Treatment of the anemia with low dose erythropoietin in pre-dialysis patients with chronic renal failure is relatively safe and may slow the rate of renal function deterioration.
Anemia ; Erythropoietin* ; Fibrosis ; Glomerular Filtration Rate ; Hematocrit ; Humans ; Iron ; Kidney Failure, Chronic* ; Linear Models ; Mortality ; Prospective Studies ; Retrospective Studies ; Risk Factors

Four trials of external quality assessment in diagnostic hematology were performed in 2004 with about 440 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, red blood cell count, platelet count, white cell differential count, red blood cell morphology and coagulation test. The response rate was more than 96%. The coefficients of variation in hemoglobin and RBC number was stable but variable in platelet number and WBC number according to measuring cell counts. Blood coagulation study was performed twice. Test results show wide variation according to measuring machine and reagents.
Blood Coagulation ; Cell Count ; Equidae* ; Erythrocyte Count ; Erythrocytes ; Hematology* ; Indicators and Reagents ; Korea* ; Leukocyte Count ; Platelet Count

Four trials of external quality assessment in diagnostic hematology were performed in 2003 with about 430 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, red blood cell count, platelet count, white cell differential count, red blood cell morphology and coagulation test. The response rate was more than 95%. The performance of quality assessment appeared to be gradually improved year by year.
Equidae* ; Erythrocyte Count ; Erythrocytes ; Hematology* ; Korea* ; Leukocyte Count ; Platelet Count

BACKGROUND: It has been suggested that the activation of proinflammatory cytokines and growth factors play an important role in many renal injury processes including ischemia-reperfusion. The activation of renin-angiotensin system in ischemia-reperfusion renal injury may be also involved in injury process. METHODS: In order to evaluate the renal gene expressions of renin, TGF-beta, TNF-alpha, MCP-1, endothelin-1, iNOS, Fas and the role of renin-angiotrensin system (RAS) in experimental unilateral renal ischemia-reperfusion (I-R) injury, 28 male Sprague-Dawley rats weighing 250-270 g underwent sham operation (n=6), I-R injury (clamping left renal artery for 60 minutes) without any treatment (n=11), I-R injury with angiotensin converting enzyme inhibitor (enalapril 100 mg/L in drinking water for one week, n=11) under thiopental sodium anesthesia (50 mg/kg, body weight, I.P.). Systolic blood pressure was measured with tail cuff method before surgery and 24 hours after surgery. Plasma renin activity (PRA) of all study group was measured at the time of sacrifice, 24 hours after surgery. Competitive RT- PCR was performed for the estimation of renin, TGF-beta, TNF-alpha, MCP-1, endothelin-1, iNOS, and Fas gene expression levels of the kidneys. The magnitude of each gene expression was expressed the ratio to beta-actin gene. RESULTS: The systolic blood pressure of untreated I-R injured group (135+/-6 mmHg, mean+/-SE) was significantly higher than those of sham operated (105+/-3 mmHg) rats and enalapril treated I-R injured rats at 24 hour after surgery (98+/-2 mmHg) (p<0.05, p<0.05). PRA of untreated I-R injury group was 6.6+/-1.1 ng/mL/hr and also significantly higher than that of sham operated rats (2.6+/-0.3 ng/mL/hr) (p<0.05). Renal gene expressions of renin, TGF-beta, MCP-1, TNF-alpha, endothelin-1, iNOS and Fas of untreated I-R injured rats were significantly higher than those of sham operated rats at 24 hours after surgery. The level of TGF-beta, TNF-alpha, MCP-1, endothelin-1, iNOS and Fas gene expressions of ACEI treated I-R injured rats was significantly lower than those of untreated I-R injured rats (all, p<0.05). CONCLUSION: With the above result, we speculate that the early up-regulation of renin, TGF-beta, MCP- 1, TNF-alpha, endothelin-1, iNOS, and Fas genes in the kidney may be related to the renal injury mechanism in this model and at least in part, the early activation of renin-angiotensin system of the kidney may be involved in this mechanism.
Actins ; Anesthesia ; Animals ; Blood Pressure ; Body Weight ; Cytokines ; Drinking Water ; Enalapril ; Endothelin-1 ; Gene Expression ; Humans ; Intercellular Signaling Peptides and Proteins ; Kidney ; Male ; Peptidyl-Dipeptidase A ; Plasma ; Polymerase Chain Reaction ; Rats ; Rats, Sprague-Dawley ; Renal Artery ; Renin ; Renin-Angiotensin System* ; Tail ; Thiopental ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha ; Up-Regulation

BACKGROUND: The progression of hydronephrosis due to urinary obstruction is one of major causes of end stage renal failure. The activation of renin-angiotensin system (RAS) and renal cell apoptosis may be involved in this mechanisms. METHODS: In order to investigate the role of RAS in renal injury mechanism and renal expression of TGF-beta, bcl-2 and Fas in experimental unilateral ureteral obstruction (UUO) mouse model, 15 CBA strain mice were underwent sham operation (n=5), UUO without treatment (n=5) and UUO with angiotensin converting enzyme inhibitor (ACEI, enalapril, n=5) under ethyl ether anesthesia. Each group was sacrificed at 72 hours after surgery. Competitive RT-PCR was performed for the estimation of renin, angiotensin II AT1 receptor (AT1 R), TGF-beta, bcl-2, Fas and glyceraldehyde-3-phosphate-dehydrogenase (GAPDH) gene expression levels in the kidneys. RESULTS: Systolic blood pressure (SBP) and renal gene expressions of renin and AT1 R in untreated control UUO group were significantly increased compared to sham operated group at 72 hours after surgery. The level of TGF-beta and bcl-2 gene expressions of ACEI treated UUO group was significantly lower than that of untreated UUO group. On the other hand, Fas gene expression of ACEI treated UUO group was not significantly different from that of ACEI untreated UUO group. CONCLUSION: We speculate that the upregulation of bcl-2 and Fas gene expressions and the early activation of renin-angiotensin system of kidney are important factors of renal injury mechanism in this model. (Korean J Nephrol 2003;22(2): 174-184)
Anesthesia ; Angiotensin II ; Animals ; Apoptosis ; Blood Pressure ; Enalapril ; Ether ; Gene Expression ; Genes, bcl-2 ; Hand ; Hydronephrosis ; Kidney ; Mice ; Peptidyl-Dipeptidase A ; Renal Insufficiency ; Renin ; Renin-Angiotensin System* ; Transforming Growth Factor beta ; Up-Regulation ; Ureter* ; Ureteral Obstruction*

Four trials of external quality assessment in diagnostic hematology were performed in 2002 with about 400 participating laboratories in Korea. We performed quality assessment for white blood cell count, hemoglobin, red blood cell count, platelet count, reticulocyte count, white cell differential count, and red blood cell morphology test. The response rate was more than 90%. The performance of quality assessment appeared to be gradually improved year by year.
Equidae* ; Erythrocyte Count ; Erythrocytes ; Hematology* ; Korea* ; Leukocyte Count ; Platelet Count ; Reticulocyte Count