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.

Purpose: Outcome analysis of urachal cancer (UraC) is limited due to the scarcity of cases and different staging methods compared to urothelial bladder cancer (UroBC). We attempted to assess survival outcomes of UraC and compare to UroBC after stage-matched analyses. Materials and Methods: Total 203 UraC patients from a multicenter database and 373 UroBC patients in single institution from 2000 to 2018 were enrolled (median follow-up, 32 months). Sheldon stage conversion to corresponding TNM staging for UraC was conducted for head-to-head comparison to UroBC. Perioperative clinical variables and pathological results were recorded. Stage-matched analyses for survival by stage were conducted. Results: UraC patients were younger (mean age, 54 vs. 67 years; p < 0.001), with 163 patients (80.3%) receiving partial cystectomy and 23 patients (11.3%) radical cystectomy. UraC was more likely to harbor ≥ pT3a tumors (78.8% vs. 41.8%). While 5-year recurrence-free survival, cancer-specific survival (CSS) and overall survival were comparable between two groups (63.4%, 67%, and 62.1% in UraC and 61.5%, 75.9%, and 67.8% in UroBC, respectively), generally favorable prognosis for UraC in lower stages (pT1-2) but unfavorable outcomes in higher stages (pT4) compared to UroBC was observed, although only 5-year CSS in ≥ pT4 showed statistical significance (p=0.028). Body mass index (hazard ratio [HR], 0.929), diabetes mellitus (HR, 1.921), pathologic T category (HR, 3.846), and lymphovascular invasion (HR, 1.993) were predictors of CSS for all patients. Conclusion Despite differing histology, UraC has comparable prognosis to UroBC with relatively favorable outcome in low stages but worse prognosis in higher stages. The presented system may be useful for future grading and risk stratification of UraC.

BACKGROUND: We aimed to investigate the effectiveness and safety of adding basal insulin to initiating dipeptidyl peptidase-4 (DPP-4) inhibitor and metformin and/or sulfonylurea (SU) in achieving the target glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM). METHODS: This was a single-arm, multicenter, 24-week, open-label, phase 4 study in patients with inadequately controlled (HbA1c ≥7.5%) T2DM despite the use of DPP-4 inhibitor and metformin. A total of 108 patients received insulin glargine while continuing oral antidiabetic drugs (OADs). The primary efficacy endpoint was the percentage of subjects achieving HbA1c ≤7.0%. Other glycemic profiles were also evaluated, and the safety endpoints were adverse events (AEs) and hypoglycemia. RESULTS: The median HbA1c at baseline (8.9%; range, 7.5% to 11.1%) decreased to 7.6% (5.5% to 11.7%) at 24 weeks. Overall, 31.7% subjects (n=33) achieved the target HbA1c level of ≤7.0%. The mean differences in body weight and fasting plasma glucose were 1.2±3.4 kg and 56.0±49.8 mg/dL, respectively. Hypoglycemia was reported in 36 subjects (33.3%, 112 episodes), all of which were fully recovered. There was no serious AE attributed to insulin glargine. Body weight change was significantly different between SU users and nonusers (1.5±2.5 kg vs. −0.9±6.0 kg, P=0.011). CONCLUSION: The combination add-on therapy of insulin glargine, on metformin and DPP-4 inhibitors with or without SU was safe and efficient in reducing HbA1c levels and thus, is a preferable option in managing T2DM patients exhibiting dysglycemia despite the use of OADs.
Blood Glucose ; Body Weight ; Body Weight Changes ; Diabetes Mellitus, Type 2 ; Fasting ; Hemoglobin A, Glycosylated ; Humans ; Hypoglycemia ; Hypoglycemic Agents ; Insulin Glargine ; Insulin ; Metformin ; Morinda

BACKGROUND AND PURPOSE: Stroke requires consistent care, but there is concern over the "weekend effect", whereby a weekend admission results in a poor outcome. Our aim was to determine the impact of weekend admission on clinical outcomes in patients with acute ischemic stroke in Korea. METHODS: The outcomes of patients admitted on weekdays and weekends were compared by analyzing data from a prospective outcome registry enrolling 1247 consecutive patients with acute ischemic stroke admitted to four neurology training hospitals in South Korea between September 2004 and August 2005. The primary outcome was a poor functional outcome at 3 months, defined as modified Rankin Scale (mRS) of 3-6. Secondary outcomes were 3-month mortality, use of thrombolysis, complication rate, and length of hospitalization. Shift analysis was also performed to compare overall mRS distributions. RESULTS: On weekends, 334 (26.8%) patients were admitted. Baseline characteristics were comparable between the weekday and weekend groups except for more history of heart disease and shorter admission time in weekend group. Univariate analysis revealed poor functional outcome at 3 months, 3-month mortality, complication rate, and length of hospitalization did not differ between the two groups. In addition, overall mRS distributions were comparable (p=0.865). After adjusting for baseline factors and stroke severity, weekend admission was not associated with poor functional outcome at 3 months (adjusted odds ratio, 1.05; 95% CI, 0.74-1.50). Furthermore, none of secondary endpoints differed between the two groups in multivariate analysis. CONCLUSIONS: Weekend admission was not associated with poor functional outcome than weekday admission in patients with acute ischemic stroke in this study. The putative weekend effect should be explored further by considering a wider range of hospital settings and hemorrhagic stroke.
Heart Diseases ; Hospitalization ; Humans ; Neurology ; Odds Ratio ; Prospective Studies ; Republic of Korea ; Stroke

BACKGROUND AND PURPOSE: Disability-adjusted life years (DALY), incorporating both disability and mortality, has been widely employed to measure regional and global burdens of stroke. Thus far, the DALY lost to stroke in a population has been estimated using only the crude population-level data; no previous study has incorporated refined data from stroke registries. The aim of this study was to integrate the stroke registry data and the population-level incidence data to project the nationwide DALY lost to ischemic stroke. METHODS: From the data of two large ischemic stroke registries, we derived an average DALY lost due to ischemic stroke for each of the following age groups: <45, 45-54, 55-64, 65-74, 75-84, and > or =85 years. The nationwide ischemic stroke incidence for each age group was extracted from a cardiovascular and cerebrovascular surveillance study that analyzed the 2004 Korean Health Insurance database. RESULTS: The average DALY lost due to ischemic stroke for the age groups <45, 45-54, 55-64, 65-74, 75-84, and > or =85 years was 5.07, 4.63, 4.35, 3.88, 2.88, and 1.73, respectively. By multiplying the incidence and the average DALY lost, the nationwide DALY lost was determined to be 9,952 for those <45 years, 24,608 for 45-54 years, 50,682 for 55-64 years, 88,875 for 65-74 years, 52,089 for 75-84 years, and 8,192 for > or =85 years, respectively. The projected nationwide DALY lost due to 64,688 ischemic strokes in 2004 was 234,399 (121,482 for men and 113,244 for women), and the DALY lost per 100,000 person-years was 483 (500 for men and 469 for women). CONCLUSIONS: Incidence data from a population study and DALY values derived from stroke registries can be integrated to provide a more refined projection of the nationwide burden of ischemic stroke. In Korea, more than 230,000 years of healthy life are being lost annually due to ischemic stroke, and hence prompt action is imperative.
Humans ; Incidence ; Insurance, Health ; Korea ; Male ; Registries ; Stroke

BACKGROUND AND OBJECTIVES: We previously reported that, compared with standard cardiopulmonary resuscitation(S-CPR), better hemodynamic effects could be achieved by simultaneous sterno-thoracic cardiopulamonary resuscitation(SST-CPR) in which we compressed the sternum and constricted the thorax circumferentially during the systolic period by using a device. This study was designed to assess whether SST-CPR, compared with S-CPR, improve the survival rate of dogs with cardiac arrest. SUBJECTS AND METHODS: Twenty-five mongrel dogs(19~31kg) were enrolled in this study. After four minutes of ventricular fibrillation induced by an AC current, animals were randomized to resuscitate with either S-CPR(n=13) or SST-CPR(n=12). Epinephrine(1mg) was injected into the right atrium every three minutes after the beginning of CPR. Defibrillation was attempted after 6 minutes of CPR. Standard advanced cardiac life support was started if defibrillation was not successful. RESULTS: SST-CPR resulted in significantly(p<0.001) higher systolic arterial pressure(91+/- 47 vs 47+/-24mmHg), diastolic pressure(43+/- 24 vs 17+/- 10mmHg), coronary perfusion pressure(35+/- 25 vs 13+/- 9mmHg), and end tidal CO2 tension(9+/- 4 vs 3+/- 2mmHg). Two of 13 animals(15%) resuscitated with S-CPR and six of 12 animals(50%) resuscitated with SST-CPR survived until 12 hours after cardiac arrest(p<0.05). CONCLUSION: SST-CPR, compared with S-CPR, improves the short-term survival rate in canine cardiac arrests.
Advanced Cardiac Life Support ; Animals ; Cardiopulmonary Resuscitation* ; Dogs ; Heart Arrest* ; Heart Atria ; Hemodynamics ; Perfusion ; Sternum ; Survival Rate* ; Thorax ; Ventricular Fibrillation

PURPOSE: To investigate the efficiency or potency of functional MRI (fMRI) for the determination of language dominance by comparing the results of fMRI with those of the Wada test. MATERIALS AND METHODS: Among 34 patients with intractable seizure who underwent both fMRI and the Wada test, we analyzed the results of 30 (men:women=19:11; mean age=29.7 years). Using echoplanar imaging and the blood oxygen level dependent technique, fMRI was performed using a 1.5 T MR imager with a standard head coil. The language task consisted of two parts: reading words and generating words. For fMRI, a multi-event multi-task paradigm consisting of two sets of activation, rest, and alternative periods was used. Image processing involved the use of the Z test (Z threshold = 1.0 -1.2). To determine the lateralization index, we calculated the activation pixels within the whole frontal cortex., and to ascertain the discrepancy between the two tasks, the clustering grade of activation pixels was measured. After the injection of thiopental, language dominance was determined by means of a modified Wada test. The results of this and the findings of fMRI were compared with the results of Fisher 's exact test (p < 0.05). RESULTS: The correlation indices between the findings of fMRI and the results of the Wada test were 77% for word generation and 50% for reading. The diference was only marginally significant (p = 0.06). For the two tasks, the opposite results were 33% for reading and 3.3% for word generation, and these were significantly different (p < 0.05). The clustering grade for more than one unit was 40% for word generation, and 23% for readings, a difference which was not statistically significant(p> 0.05). CONCLUSION: For the determinaton of language dominance, fMRI showed good correlation with the Wada test. The word generation task was more efficient than the reading task. fMRI which is non-invasive and repeatable, is therefore more efficient and useful than the invasive Wada test.
Brain ; Echo-Planar Imaging ; Head ; Humans ; Magnetic Resonance Imaging* ; Oxygen ; Reading ; Seizures* ; Thiopental

The facial nerve is mainly composed of motor fibers and is distributed to the muscles of facial expressions. In ophthalmology clinics, orbicularis oculi muscle innervated by the facial nerve is involved in spontaneous and voluntary blinking, winking, and more forceful eyelid closure. To understand pathophysiogy of facial nerve palsy due to brain stem lesion involving nucleus, 50% Horseradish Peroxidase (HRP) was injected into nerve stump innervating orbicularis oculi muscle of cat and serial sections of midbrain were studied with light and dark field of light microscope to examine morphology and distribution of the facial nuclei. The HRP-labelled motor neurons were located exclusively within the intermediate division of the ipsilateral facial nuclei and no labelled neurons were found in the contralateral facial nuclei, in the nuclei of the trigeminal nerve, or any other brain stem nuclei. The mean diameter of HRP-labelled motor neurons was 45 micrometer. Most of them were multipolar in shape containing many dendrites. These result suggest that the intermediate division of ipsilateral facial nuclei play an important role in innervating orbicularis oculi muscle.
Animals ; Armoracia* ; Blinking ; Brain Stem ; Cats* ; Dendrites ; Eyelids ; Facial Expression ; Facial Nerve ; Horseradish Peroxidase* ; Mesencephalon ; Motor Neurons* ; Muscles ; Neurons ; Ophthalmology ; Paralysis ; Trigeminal Nerve

In addition to CAPD, various modalities of peritoneal dialysis such as CCPD and NIPD have been introduced recently. The adequacy in these peritoneal dialysis has been evaluated by clearance of small molecular weight solutes such as creatinine(molecular weight 113 Dalton) and urea(molecular weight 60 Dalton). The middle molecular weight solutes(molecular weight 3,000 to 12,000 Dalton) have been regarded as one of the uremic toxins. Relatively larger clearance of middle molecular weight solutes is one of the advantages of CAPD compared with HD. Although peritoneal transport of middle molecular solutes can be different from that of small molecular weight solutes because of its size, there are a few reports about peritoneal transport characteristics and clearance of middle molecular weight solutes in various modalities of PD. We wanted to analyze peritoneal transport characteristics and clearances of middle molecular weight solute in various modalities of peritoneal dialysis in comparison with small molecular weight solutes. To evaluate the potential differences in peritoneal transport characteristics and clearances of middle and small molecules in CAPD, CCPD and NIPD, we compared transport characteristics and clearance of beta2-MG and creatinine. 35 CAPD patients, 9 CCPD patients, 7 NIPD patients were included in the study, who were clinically stable for at least one month without peritonitis. he beta2-MG concentrations in serum and dialysate as measured by radioimmunoassay. Standard peritoneal equilibration test and a weekly peritoneal clearance for creatinine and beta2-microglobulin were used. The results were as follows: 1)Dialysate to plasma ratio of beta2-MG were 0.11+/-0.03, 0.13+/-0.05, 0.10+/-0.02, 0.08+/-0.03, respectively in high(N=6), high average(N=13), low average(N= 14), low(N=7) group according to PET. There were significant differences between high average and low average, high average and low group(p<0.05). Correlation between D/Pbeta2-MG ratio and D/Pcr ratio was significant(spearman's p=0.453, p<0.05). 2)In 35 CAPD patients, peritoneal creatinine and beta2-MG clearance were 48.9, 8.2L/wk, respectively and there was a weak correlation between them (Spearman's p=0.294, p<0.05). 3)The peritoneal creatinine clearance were 48.9, 41.0, 35.9L/wk and beta2-MG clearance were 8.2, 5.5, 4.1L/wk, respectively in CAPD, CCPD and NIPD. The ratio of peritoneal beta2-MG clearance to creatinine clearance were 0.16, 0.14, 0.11, respectively in CAPD, CCPD and NIPD. Peritoneal beta2-MG clearance in APD such as CCPD and NIPD is lesser than that in CAPD. In conclusion, peritoneal transport characteristics for beta2-MG differ from that for creatinine, although peritoneal clearnce for beta2-MG corrleated with that for creatinine. Perioneal clearance for beta2-MG was better in CAPD than in APD.
Creatinine ; Humans ; Molecular Weight ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Plasma ; Radioimmunoassay

BACKGROUND: Early esophageal cancer has a good prognosis compared with advanced esophageal cancer, so early detection of the cancer is emphasized. Early esophageal cancer is considered as esophageal cancer located within the submucosal layer and without metastasis in the operative specimen. Despite this criterion, evidence has accumulated suggesting that submucosal tumors have a very different prognosis from intra-epithelial and intramucosal lesions. The purpose of this study is to define the characteristics of and the appropriate operative method for esophageal cancer. METHODS: Medical records of 19 patients who had received an esophagectomy and who had been diagnosed as having early esophageal cancer between 1981 and 1996 at this hospital were reviewed. RESULTS: There was 17 cases of submucosal lesions and 2 cases of mucosal lesions. 74% of the patients had alcohol or smoking history. When endoscopic findings were classified according to the endoscopic classification of JSED, there were 5 cases of type 0-I, 4 cases of type 0-III, 4 cases of type 1, and others. Type 0-I and 0-III were common. The accuracy of the endoscopic ultrasonographic finding was 39% compared with the postoperative pathologic finding. The mean duration of follow-up was 21 months, and there were 2 recurrences during follow-up. One recurred 13 months after the operation and the other 23 months after the operation. Both of them were submucosal lesions and received a transhiatal esophagectomy. CONCLUSIONS: Annual endoscopic examination with lugol staining may be needed for early detection of esophageal cancer. Submucosal lesions of early esophageal cancer should be managed with an esophagectomy and lymph node dissection. Also, expertness of the endoscopist is very important in deciding on an of operative method.
Classification ; Esophageal Neoplasms* ; Esophagectomy ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Smoke ; Smoking