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Park S, Lee H, Cho W, Woo HG, Lim H, Kim S, Rhee SY, Yon DK. Efficacy of information and communication technology interventions for the management of diabetes mellitus: An umbrella review and evidence map. Obes Rev 2024; 25:e13714. [PMID: 38350665 DOI: 10.1111/obr.13714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION We validated the quality of evidence and potential benefits of information and communication technology interventions on diabetes-related health outcomes. METHODS We systematically searched PubMed/MEDLINE, Embase, Google Scholar, and CINAHL and manually searched the reference lists of the retrieved review articles from each database's inception to October 2022. Randomized controlled trials were included to determine the benefits of information and communication technology interventions on diabetes outcomes. RESULTS Ten meta-analyses of randomized controlled trials were included, with 37 unique outcomes encompassing 379 studies and >70,000 participants across 47 countries and six continents. Information and communication technology intervention was associated with reduced HbA1c levels in patients with type 1 (moderate certainty), type 2 (moderate certainty), and gestational diabetes (low certainty) and showed potential benefits for type 2 diabetes, demonstrating a reduction in systolic blood pressure (high certainty), low-density lipoprotein cholesterol (low certainty), and body weight (low certainty), whereas those for gestational diabetes demonstrated a reduction in fasting (low certainty) and 2-h postprandial blood glucose levels (low certainty). CONCLUSION This umbrella review and evidence map revealed varying evidence on the potential benefits of information and communication technology interventions for diabetes-related outcomes. Our results demonstrate these interventions to be novel treatment options for policymakers and physicians to establish personalized health strategies.
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Affiliation(s)
- Sangil Park
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Hyeri Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Wonyoung Cho
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyunjung Lim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin, South Korea
| | - Sunyoung Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, South Korea
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Woo HG, Kim HJ, Park J, Lee J, Lee H, Kim MS, Koyanagi A, Smith L, Rahmati M, Yeo SG, Yon DK. Global burden of vaccine-associated multiple sclerosis, 1967-2022: A comprehensive analysis of the international pharmacovigilance database. J Med Virol 2024; 96:e29591. [PMID: 38572940 DOI: 10.1002/jmv.29591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
Vaccine-associated multiple sclerosis (MS) is rare, with insufficient evidence from case reports. Given the scarcity of large-scale data investigating the association between vaccine administration and adverse events, we investigated the global burden of vaccine-associated MS and potential related vaccines from 1967 to 2022. Reports on vaccine-associated MS between 1967 and 2022 were obtained from the World Health Organization International Pharmacovigilance Database (total number of reports = 120 715 116). We evaluated global reports, reporting odds ratio (ROR), and information components (IC) to investigate associations between 19 vaccines and vaccine-associated MS across 156 countries and territories. We identified 8288 reports of vaccine-associated MS among 132 980 cases of all-cause MS. The cumulative number of reports on vaccine-associated MS gradually increased over time, with a substantial increase after 2020, owing to COVID-19 mRNA vaccine-associated MS. Vaccine-associated MS develops more frequently in males and adolescents. Nine vaccines were significantly associated with higher MS reporting, and the highest disproportional associations were observed for hepatitis B vaccines (ROR 19.82; IC025 4.18), followed by encephalitis (ROR 7.42; IC025 2.59), hepatitis A (ROR 4.46; IC025 1.95), and papillomavirus vaccines (ROR 4.45; IC025 2.01). Additionally, MS showed a significantly disproportionate signal for COVID-19 mRNA vaccines (ROR 1.55; IC025 0.52). Fatal clinical outcomes were reported in only 0.3% (21/8288) of all cases of vaccine-associated MS. Although various vaccines are potentially associated with increased risk of MS, we should be cautious about the increased risk of MS following vaccination, particularly hepatitis B and COVID-19 mRNA vaccines, and should consider the risk factors associated with vaccine-associated MS.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Min Seo Kim
- Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Masoud Rahmati
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille (APHM), Aix-Marseille University, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Seung Geun Yeo
- Department of Otolaryngology-Head & Neck Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
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Ryu J, Lee KM, Woo HG, Park JI, Choi SK. Morphologic differences between ruptured and unruptured choroidal anastomosis in adult moyamoya disease: a high-resolution vessel wall imaging study. J Neurosurg 2024; 140:441-449. [PMID: 37877970 DOI: 10.3171/2023.6.jns231017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/16/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Choroidal anastomosis (ChA) has been implicated as the main indicator of an increased hemorrhagic risk in adult moyamoya disease. In this retrospective study, the authors aimed to identify the potential risk factors that can influence the rupture of ChA. METHODS The authors evaluated the clinical and radiological data on brain hemispheres positive for ChA from September 2019 to March 2023. The rupture status of the ChA was determined using previously described methods. Two independent raters quantitatively investigated the lumen diameter (LD) and lumen area (LA) of the ChA using high-resolution vessel wall imaging (VWI). Multivariate logistic regression analysis was conducted to identify the risk factors for ruptured ChA. RESULTS Ruptured and unruptured ChAs were identified in 16 and 60 hemispheres, respectively. Univariate analysis showed that the mean values of the LD (1.251 ± 0.241 vs 0.967 ± 0.214 mm, p < 0.001) and LA (1.607 ± 0.445 vs 0.945 ± 0.372 mm2, p < 0.001) of ChAs were significantly greater in the ruptured group than in the unruptured group. A periventricular anastomosis (PA) score of 1, indicating the angiographic presence of ChA alone, was more prevalent in the ruptured group than in the unruptured group (43.8% vs 11.7%, p = 0.003). Multivariate analysis demonstrated that a larger LA of the ChA (OR 37.01, 95% CI 5.787-236.7, p < 0.001) and PA score 1 (OR 6.661, 95% CI 1.260-35.21, p = 0.026) were independently associated with ruptured ChA hemispheres. Receiver operating characteristic curve analysis revealed that the optimal cutoff point for the LA was 1.285 mm2 (sensitivity 81.3%, specificity 86.7%). CONCLUSIONS A larger LA (> 1.285 mm2) of the ChA and the angiographic presence of ChA alone are independent risk factors for a ruptured ChA. Revascularization surgery for the prevention of future hemorrhage may be indicated for hemispheres with a high-risk unruptured ChA. These characteristics may help to determine treatment strategies for patients with an unruptured ChA.
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Affiliation(s)
| | | | - Ho Geol Woo
- 3Neurology, College of Medicine, Kyung Hee University, Seoul, Korea
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Cho W, Park S, Kim HJ, Lee M, Choi YS, Yeo SG, Lee J, Koyanagi A, Jacob L, Smith L, Rahmati M, Ahmad S, Fond G, Boyer L, Rhee SY, Lee SW, Shin JI, Woo HG, Yon DK. Clinical characteristics and outcomes of patients with mpox during the 2022 mpox outbreak compared with those before the outbreak: A systematic review and meta-analysis. Rev Med Virol 2024; 34:e2508. [PMID: 38282393 DOI: 10.1002/rmv.2508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/12/2023] [Accepted: 12/17/2023] [Indexed: 01/30/2024]
Abstract
On 23 July 2022, the World Health Organization declared the global mpox outbreak as a public health emergency of international significance. The mpox virus (MPXV) that caused the outbreak was classified as clade IIb, which belongs to the West African clade. However, the relationship between MPXV clades and symptoms, as well as the severity of mpox outcomes, is not fully understood. Thus, we aimed to investigate the global mpox prevalence and the differences in clinical manifestations and outcomes among patients with mpox between pre-outbreak (2003-2021) and the current mpox outbreak. In this systematic review and meta-analysis, PubMed/MEDLINE, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar were searched using the keyword "monkeypox" and "mpox" up to 13 October 2022. A random effects model was used to obtain the pooled prevalence and 95% confidence intervals. This study included 27 articles, and 5698 patients with mpox with 19 distinctive features from 19 countries across five continents were assessed. Patients with mpox during the 2022 mpox outbreak showed mild clinical manifestations and outcomes compared with those before the 2022 mpox outbreak: mild rash (relative ratio [RR]: 5.09, 95% confidence interval [CI]: 1.52-17.08), fever (0.68, 0.49-0.94), pruritus (0.25, 0.19-0.32), myalgia (0.50, 0.31-0.81), headache (0.56, 0.35-0.88), skin ulcer (0.32, 0.17-0.59), abdominal symptom (0.29, 0.20-0.42), pharyngitis (0.32, 0.18-0.58), nausea or vomiting (0.15, 0.02-0.93), conjunctivitis (0.11, 0.03-0.38), concomitant infection with HIV (1.70, 0.95-3 0.04), and death (0.02, 0.001-0.31). MPXV clade IIb exhibited higher infectivity but may cause mild disease symptoms and low mortality rate. It is important to consider MPXV infection in patients with mpox-related features and/or a history of sexual transmission to prevent the spread of the disease and recognise the current pandemic threat.
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Affiliation(s)
- Wonyoung Cho
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sangil Park
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Myeongcheol Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Yong Sung Choi
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Seung Geun Yeo
- Department of Otolaryngology - Head & Neck Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Louis Jacob
- Epidemiology of Ageing and Neurodegenerative Diseases, Université Paris-Cité, Paris, France
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Suhana Ahmad
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Guillaume Fond
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Aix-Marseille University, Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Laurent Boyer
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Aix-Marseille University, Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
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Oh J, Lee M, Lee H, Yang H, Park J, Rahmati M, Koyanagi A, Smith L, Fond G, Boyer L, Kim MS, Lee SW, López Sánchez GF, Dragioti E, Woo HG, Yon DK. Hand and Oral Hygiene Practices of South Korean Adolescents Before and During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2349249. [PMID: 38147331 PMCID: PMC10751599 DOI: 10.1001/jamanetworkopen.2023.49249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/10/2023] [Indexed: 12/27/2023] Open
Abstract
Importance Only a few studies have examined the long-term trends of hand and oral hygiene, especially among adolescents. Objective To investigate the 15-year trends in frequency of handwashing and toothbrushing and examine the factors associated with hand and oral hygiene, particularly during the COVID-19 pandemic. Design, Setting, and Participants This cross-sectional study, performed from January 1, 2008, to December 31, 2022, used general population-based data from 963 644 individuals in a national representative survey (Korea Youth Risk Behavior Web-based Survey [KYRBS]). Exposure COVID-19 pandemic. Main Outcomes and Measures Trends in hand and oral hygiene practices were measured by how frequently adolescents washed their hands and whether they fulfilled the recommended guidelines for toothbrushing. An interrupted time series analysis using linear and logistic regression models was performed to assess any associations with the COVID-19 pandemic. Hand and oral hygiene behaviors before and during the pandemic in each sociodemographic subgroup were also compared. Results In the 963 644 adolescents (495 697 [51.4%] male; mean [range] age, 15.01 [12-18] years) who participated in the KYRBS from 2008 to 2022, a 73.3% (95% CI, 59.4%-97.4%; P < .001) immediate increase was seen in overall hand hygiene behavior at the onset of the COVID-19 pandemic compared with the prepandemic period, with a sustained decrease thereafter (β = -0.018; 95% CI, -0.022 to -0.015; P < .001). Meanwhile, no immediate increase was observed in terms of overall oral hygiene behavior (0.1%; 95% CI, -0.9% to 1.1%; P = .82); however, there was a sustained decrease during the pandemic (β = -0.018; 95% CI, -0.020 to -0.016; P < .001). Older age, female sex, nonsmoking status, alcohol use, low household economic level, and poor school performance were significantly associated with poor hand hygiene during the pandemic. Conclusions and Relevance In this cross-sectional study of South Korean adolescents, an increase in the prevalence of hand hygiene was observed during the early pandemic; however, this prevalence decreased over time. Meanwhile, the decrease in the prevalence of oral hygiene was more pronounced during the pandemic. This study recommends stronger guidelines for adolescent health coaches, such as teachers or public health advisers, regarding hygiene behaviors, even after the COVID-19 pandemic ends.
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Affiliation(s)
- Jiyeon Oh
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Myeongcheol Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hojae Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hwi Yang
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Min Seo Kim
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Guillermo F. López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
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Chung SP, Sohn Y, Lee J, Cho Y, Cha KC, Heo JS, Kim ARE, Kim JG, Kim HS, Shin H, Ahn C, Woo HG, Lee BK, Jang YS, Choi YH, Hwang SO. Expert opinion on evidence after the 2020 Korean Cardiopulmonary Resuscitation Guidelines: a secondary publication. Clin Exp Emerg Med 2023; 10:382-392. [PMID: 37620035 PMCID: PMC10790069 DOI: 10.15441/ceem.23.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023] Open
Abstract
Considerable evidence has been published since the 2020 Korean Cardiopulmonary Resuscitation Guidelines were reported. The International Liaison Committee on Resuscitation (ILCOR) also publishes the Consensus on CPR and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) summary annually. This review provides expert opinions by reviewing the recent evidence on CPR and ILCOR treatment recommendations. The authors reviewed the CoSTR summary published by ILCOR in 2021 and 2022. PICO (patient, intervention, comparison, outcome) questions for each topic were reviewed using a systemic or scoping review methodology. Two experts were appointed for each question and reviewed the topic independently. Topics suggested by the reviewers for revision or additional description of the guidelines were discussed at a consensus conference. Forty-three questions were reviewed, including 15 on basic life support, seven on advanced life support, two on pediatric life support, 11 on neonatal life support, six on education and teams, one on first aid, and one related to COVID-19. Finally, the current Korean CPR Guideline was maintained for 28 questions, and expert opinions were suggested for 15 questions.
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Affiliation(s)
- Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Youdong Sohn
- Department of Emergency Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jisook Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Youngsuk Cho
- Department of Emergency Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ju Sun Heo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
- Institute of Nano, Regeneration, Reconstruction, Korea University, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, CHA University Ilsan Medical Center, Goyang, Korea
| | - Jae Guk Kim
- Department of Emergency Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyungoo Shin
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chiwon Ahn
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Soo Jang
- Department of Emergency Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Yu Hyeon Choi
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - on behalf of the Guideline Committee of the Korean Association of Cardiopulmonary Resuscitation (KACPR)
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
- Institute of Nano, Regeneration, Reconstruction, Korea University, Seoul, Korea
- Department of Pediatrics, CHA University Ilsan Medical Center, Goyang, Korea
- Department of Emergency Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Pediatrics, Seoul Medical Center, Seoul, Korea
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Park S, Yon H, Ban CY, Shin H, Eum S, Lee SW, Shin YH, Shin JU, Koyanagi A, Jacob L, Smith L, Min C, Yeniova AÖ, Kim SY, Lee J, Hadalin V, Kwon R, Koo MJ, Fond G, Boyer L, Kim S, Hahn JW, Kim N, Lefkir E, Bondeville V, Rhee SY, Shin JI, Yon DK, Woo HG. National trends in alcohol and substance use among adolescents from 2005 to 2021: a Korean serial cross-sectional study of one million adolescents. World J Pediatr 2023; 19:1071-1081. [PMID: 36977821 PMCID: PMC10049906 DOI: 10.1007/s12519-023-00715-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/05/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Although previous studies have provided data on early pandemic periods of alcohol and substance use in adolescents, more adequate studies are needed to predict the trends of alcohol and substance use during recent periods, including the mid-pandemic period. This study investigated the changes in alcohol and substance use, except tobacco use, throughout the pre-, early-, and mid-pandemic periods in adolescents using a nationwide serial cross-sectional survey from South Korea. METHODS Data on 1,109,776 Korean adolescents aged 13-18 years from 2005 to 2021 were obtained in a survey operated by the Korea Disease Control and Prevention Agency. We evaluated adolescents' alcohol and substance consumption prevalence and compared the slope of alcohol and substance prevalence before and during the COVID-19 pandemic to see the trend changes. We define the pre-COVID-19 period as consisting of four groups of consecutive years (2005-2008, 2009-2012, 2013-2015, and 2016-2019). The COVID-19 pandemic period is composed of 2020 (early-pandemic era) and 2021 (mid-pandemic era). RESULTS More than a million adolescents successfully met the inclusion criteria. The weighted prevalence of current alcohol use was 26.8% [95% confidence interval (CI) 26.4-27.1] from 2005 to 2008 and 10.5% (95% CI 10.1-11.0) in 2020 and 2021. The weighted prevalence of substance use was 1.1% (95% CI 1.1-1.2) from 2005 to 2008 and 0.7% (95% CI 0.6-0.7) between 2020 and 2021. From 2005 to 2021, the overall trend of use of both alcohol and drugs was found to decrease, but the decline has slowed since COVID-19 epidemic (current alcohol use: βdiff 0.167; 95% CI 0.150-0.184; substance use: βdiff 0.152; 95% CI 0.110-0.194). The changes in the slope of current alcohol and substance use showed a consistent slowdown with regard to sex, grade, residence area, and smoking status from 2005 to 2021. CONCLUSION The overall prevalence of alcohol consumption and substance use among over one million Korean adolescents from the early and mid-stage (2020-2021) of the COVID-19 pandemic showed a slower decline than expected given the increase during the prepandemic period (2005-2019).
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Affiliation(s)
- Sangil Park
- Department of Neurology, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Hyunju Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Chae Yeon Ban
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyoin Shin
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Seounghyun Eum
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Jung U Shin
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
- Department of Pediatrics, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, CIBERSAM, ISCIII, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Pg. Lluis Companys, Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, CIBERSAM, ISCIII, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Chanyang Min
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Abdullah Özgür Yeniova
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Vlasta Hadalin
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rosie Kwon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Min Ji Koo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Human Biology, University of Toronto, Toronto, ON, Canada
| | - Guillaume Fond
- AP-HM, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Laurent Boyer
- AP-HM, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jong Woo Hahn
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Namwoo Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Eléa Lefkir
- Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Victoire Bondeville
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Pediatrics, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
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Woo HG, Kim DH, Lee H, Kang MK, Song TJ. Association between changes in predicted body composition and occurrence of heart failure: a nationwide population study. Front Endocrinol (Lausanne) 2023; 14:1210371. [PMID: 37937051 PMCID: PMC10627176 DOI: 10.3389/fendo.2023.1210371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023] Open
Abstract
Background Large population-based studies on the association between changes in body composition and the occurrence of heart failure (HF) are rare. We aimed to determine the association between changes in body composition, including the predicted body fat mass index (pBFMI), predicted appendicular skeletal muscle mass index (pASMI), and predicted lean body mass index (pLBMI), and the occurrence of HF. Methods For present study, 2,036,940 people who consecutively underwent national health examinations from 2010~2011 (baseline period) to 2012~2013 (follow-up period) were included. The pBFMI, pASMI, and pLBMI were indirectly investigated using validated anthropometric prediction equations from the Korean National Health and Nutrition Examination Survey cohort. The outcome was defined as at least two or more claims of HF. Results During a median of 7.59 years of follow-up, 22,172 participants (event rate, 1.09%) with HF were observed. Decreased changes in the pASMI and pLBMI were associated with the occurrence of HF among males (hazard ratio [HR] 0.966, 95% confidence interval (CI) [0.944-0.988]; HR 0.939, 95%CI [0.923-0.955], respectively) and females (HR 0.924, 95%CI [0.900-0.947]; HR 0.951, 95%CI [0.939-0.963], respectively). An increased change in the pBFMI was associated with the occurrence of HF in males (HR 1.017, 95%CI [1.001-1.034]). However, paradoxically, a change in the pBFMI was associated with the occurrence of HF in females (HR 0.925, 95%CI [0.909-0.942]). Conclusion Decreased skeletal muscle mass was related to the occurrence of HF. However, the relationship between a change in fat mass and the occurrence of HF was different and even paradoxical depending on sex.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Dong-Hyeok Kim
- Department of Cardiology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hyungwoo Lee
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Min Kyoung Kang
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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Park S, Ha SH, Song B, Woo HG, Heo SH, Chang DI. An interesting case of crossed syndrome: ipsilateral facial paralysis with contralateral glossoplegia. BMC Neurol 2023; 23:370. [PMID: 37848830 PMCID: PMC10580508 DOI: 10.1186/s12883-023-03363-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/17/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Stroke is rarely accompanied with peripheral facial paralysis and supranuclear palsy of the hypoglossal nerve. Both sides of the motor cortex innervate the hypoglossal nucleus; therefore, unilateral lesions of the upper motor neurons rarely result in contralateral lingual paresis. We report a rare case of crossed syndrome with associated hyperacute peripheral hemifacial paralysis and contralateral lingual paresis after a lower pontine tegmentum ischemic stroke. CASE PRESENTATION A 73-year-old man presented with symptoms of hyperacute peripheral hemifacial paralysis. Upon protrusion, the patient's tongue deviated to the contralateral side, without fasciculation or atrophy. Brain imaging showed focal ischemic stroke in the pontine tegmentum. However, lingual hemiparesis and multimodal neuroimaging findings differed. CONCLUSIONS We suggest that cortico-hypoglossal fibers pass through the dorsal pontine. This case of crossed syndrome is a rare report of a lower pontine tegmentum ischemic stroke resembling an upper motor neuron lesion of the contralateral hypoglossal nerve.
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Affiliation(s)
- Sangil Park
- Department of Neurology, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Su Hyeon Ha
- Department of Neurology, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Baeseoup Song
- Department of Neurology, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
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10
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Woo HG, Kang MK, Song TJ. Association of predicted body composition with occurrence of atrial fibrillation. Front Cardiovasc Med 2023; 10:1159087. [PMID: 37881721 PMCID: PMC10595030 DOI: 10.3389/fcvm.2023.1159087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
Background Body mass index (BMI) is insufficient evidence as a risk factor for numerous health disorders. Body composition may be more appropriate for confirming the association with cardiovascular diseases, including atrial fibrillation (AF). This study aimed to examine the association between body composition and the occurrence of AF. Methods A total of 2,673,108 participants (48.6% women) without AF at baseline from the Korean national health insurance data were included. Body composition including appendicular skeletal muscle mass, body fat mass, and lean body mass were indirectly measured through validated anthropometric prediction equations. The diagnosis of AF and comorbidities were defined. Results With a median of 9.5 (interquartile range 9.2-10.1) years' follow-up, 25,841 (0.96%) cases of incident AF were included. In multivariable analysis, higher appendicular skeletal muscle was related to low risk of AF [hazard ratio (HR) 0.829, 95% confidence interval (CI) 0.753-0.912 for men (fifth quintile) and HR 0.888, 95% CI 0.792-0.995 for women (fifth quintile)]. In contrast, a higher body fat mass [HR 1.345, 95% CI 1.221-1.483 for men (fifth quintile) and HR 1.420, 95% CI 1.274-1.591 for women (fifth quintile)] and lean body mass [HR 2.241, 95% CI 2.182-2.303 for men (fifth quintile) and HR 1.516, 95% CI 1.368-1.667 for women (fifth quintile)] were associated with the occurrence of AF. Conclusions In this study, body composition parameters were associated with the occurrence of AF. It should be noted that when appendicular skeletal muscle mass decreases and body fat mass and lean body mass increase, the risk of AF may be increased in general population except underweighted BMI group.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Min Kyoung Kang
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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11
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Park K, Kim SB, Yoon SS, Woo HG. Osmotic demyelination syndrome caused by rapid correction of hyperammonemia and continuous hyperbilirubinemia: a case report and review of the literature. Encephalitis 2023; 3:119-124. [PMID: 37797653 PMCID: PMC10598282 DOI: 10.47936/encephalitis.2023.00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/07/2023] Open
Abstract
Osmotic demyelination syndrome (ODS) is an acute demyelinating disorder characterized by the loss of myelin in the center of the basis pons, defined as central pontine myelinolysis (CPM), and demyelination in locations outside the pons, defined as extrapontine myelinolysis (EPM). ODS including CPM and EPM is mainly caused by rapid correction of hyponatremia. However, there are several reports of ODS in medical conditions such as malnutrition; alcoholism; liver transplantation; malignancy; sepsis; and electrolyte imbalance including hypernatremia, hypokalemia, hypophosphatemia, and chronic illness. ODS caused by rapid correction of hyperammonemia or continuous hyperbilirubinemia without sodium fluctuations has rarely been reported. Because ODS may be irreversible, prevention is crucial. Herein, we report a case of ODS secondary to rapid correction of hyperammonemia and continuous hyperbilirubinemia.
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Affiliation(s)
- Kunwoo Park
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang Beom Kim
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sung Sang Yoon
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
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12
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Park S, Woo HG, Kim S, Kim S, Lim H, Yon DK, Rhee SY. Real-World Evidence of a Hospital-Linked Digital Health App for the Control of Hypertension and Diabetes Mellitus in South Korea: Nationwide Multicenter Study. JMIR Form Res 2023; 7:e48332. [PMID: 37603401 PMCID: PMC10477930 DOI: 10.2196/48332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/15/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Digital health care apps have been widely used for managing chronic conditions such as diabetes mellitus and hypertension, providing promising prospects for enhanced health care delivery, increased patient engagement, and improved self-management. However, the impact of integrating these apps within hospital systems for managing such conditions still lacks conclusive evidence. OBJECTIVE We aimed to investigate the real-world effectiveness of using hospital-linked digital health care apps in lowering blood pressure (BP) and blood glucose levels in patients with hypertension and diabetes mellitus. METHODS Nationwide multicenter data on demographic characteristics and the use of a digital health care app from 233 hospitals were collected for participants aged 20 to 80 years in South Korea between August 2021 and June 2022. We divided the participants into 2 groups: 1 group consisted of individuals who exclusively used the digital health app (control) and the other group used the hospital-linked digital health app. All the patients participated in a 12-week digital health care intervention. We conducted a comparative analysis to assess the real-world effectiveness of the hospital-linked digital health app. The primary outcome was the differences in the systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) level, and postprandial glucose (PPG) level between baseline and 12 weeks. RESULTS A total of 1029 participants were analyzed for the FBG level, 527 participants were analyzed for the PPG level, and 2029 participants for the SBP and DBP were enrolled. After 12 weeks, a hospital-linked digital health app was found to reduce SBP (-5.4 mm Hg, 95% CI -7.0 to -3.9) and DBP (-2.4 mm Hg, 95% CI -3.4 to -1.4) in participants without hypertension and FBG level in all participants (those without diabetes, -4.4 mg/dL, 95% CI -7.9 to -1.0 and those with diabetes, -3.2 mg/dL, 95% CI -5.4 to -1.0); however, there was no statistically significant difference compared to the control group (using only digital health app). Specifically, participants with diabetes using a hospital-linked digital health app demonstrated a significant decrease in PPG after 12 weeks (-10.9 mg/dL, 95% CI -31.1 to -5.3) compared to those using only a digital health app (P=.006). CONCLUSIONS Hospital-linked digital interventions have greatly improved glucose control for diabetes compared with using digital health technology only. These hospital-linked digital health apps have the potential to offer consumers and health care professionals cost-effective support in decreasing glucose levels when used in conjunction with self-monitoring.
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Affiliation(s)
- Sangil Park
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Soeun Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Seoul, Republic of Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
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Yon H, Park S, Shin JU, Koyanagi A, Jacob L, Smith L, Min C, Lee J, Kwon R, Fond G, Boyer L, Kim S, Kim N, Rhee SY, Shin JI, Yon DK, Woo HG. Differences in Pandemic-Related Factors Associated with Alcohol and Substance Use among Korean Adolescents: Nationwide Representative Study. Biomed Environ Sci 2023; 36:542-548. [PMID: 37424248 DOI: 10.3967/bes2023.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/27/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Hyunju Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sangil Park
- Department of Neurology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Jung U Shin
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, CIBERSAM, ISCIII, Barcelona, Spain;Catalan Institution for Research and Advanced Studies (ICREA), Pg. Lluis Companys, Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, CIBERSAM, ISCIII, Barcelona, Spain;Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, University Paris Cité, Paris, France
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Chanyang Min
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, Republic of Korea
| | - Rosie Kwon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Guillaume Fond
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Aix-Marseille University, CEReSS, Health Service Research and Quality of Life Center, Marseille, France;FondaMental Foundation, Creteil, France
| | - Laurent Boyer
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Aix-Marseille University, CEReSS, Health Service Research and Quality of Life Center, Marseille, France;FondaMental Foundation, Creteil, France
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Namwoo Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea;Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea;Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Seoul, Republic of Korea
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Woo HG, Kim HG, Lee KM, Ha SH, Jo H, Heo SH, Chang DI, Kim BJ. Blood viscosity associated with stroke mechanism and early neurological deterioration in middle cerebral artery atherosclerosis. Sci Rep 2023; 13:9384. [PMID: 37296267 PMCID: PMC10256783 DOI: 10.1038/s41598-023-36633-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023] Open
Abstract
Blood viscosity may affect the mechanisms of stroke and early neurological deterioration (END). We aimed to investigate the relationship between blood viscosity, stroke mechanisms, and END in patients with middle cerebral artery (MCA) infarction. Patients with symptomatic MCA atherosclerosis (≥ 50% stenosis) were recruited. Blood viscosity was compared across patients with different mechanisms of symptomatic MCA disease: in situ thrombo-occlusion (sMCA-IST), artery-to-artery embolism (sMCA-AAE), and local branch occlusion (sMCA-LBO). END was defined as four points increase in the National Institutes of Health Stroke Scale score from baseline during the first week. The association between blood viscosity and END was also evaluated. A total of 360 patients (76 with sMCA-IST, 216 with sMCA-AAE, and 68 with sMCA-LBO) were investigated. Blood viscosity was highest in patients with sMCA-IST, followed by sMCA-AAE and sMCA-LBO (P < 0.001). Blood viscosity was associated with END in patients with MCA disease. Low shear viscosity was associated with END in patients with sMCA- LBO (adjusted odds ratio, aOR 1.524; 95% confidence interval, CI 1.035-2.246), sMCA- IST (aOR 1.365; 95% CI 1.013-1.839), and sMCA- AAE (aOR 1.285; 95% CI 1.010-1.634). Blood viscosity was related to END in patients with stroke caused by MCA disease.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Hyug-Gi Kim
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Sang Hee Ha
- Department of Neurology, Gil Medical Center, Gachon University, Incheon, Korea
| | - HangJin Jo
- Department of Mechanical Engineering and Division of Advanced Nuclear Engineering, POSTECH, Pohang, Gyeongbuk, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Song-Pa, PO Box 145, Seoul, 138-600, Korea.
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Park S, Kim HJ, Kim S, Rhee SY, Woo HG, Lim H, Cho W, Yon DK. National Trends in Physical Activity Among Adults in South Korea Before and During the COVID-19 Pandemic, 2009-2021. JAMA Netw Open 2023; 6:e2316930. [PMID: 37273204 DOI: 10.1001/jamanetworkopen.2023.16930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Importance There is a lack of comprehensive data on the association of the COVID-19 pandemic with the prevalence of physical activity in large-scale data sets. Objective To investigate long-term trends in physical activity using information from a nationally representative survey covering 2009 to 2021. Design, Setting, and Participants This general population-based and repeated cross-sectional study was conducted from 2009 to 2021 using the Korea Community Health Survey, a nationally representative survey in South Korea. Data from 2009 to 2021 for 2 748 585 Korean adults were obtained through a nationwide, large-scale, serial study. Data were analyzed from December 2022 through January 2023. Exposure COVID-19 pandemic onset. Main Outcomes and Measures The trend of sufficient aerobic physical activity was measured by prevalence and mean metabolic equivalent of task (MET) score based on World Health Organization physical activity guidelines and defined as 600 MET-min/wk or greater. The cross-sectional survey included age, sex, body mass index (BMI), region of residence, education level, income level, smoking status, alcohol consumption level, stress status, physical activity level, and history of diabetes, hypertension, and depression. Results Among 2 748 585 Korean adults (738 934 aged 50-64 years [29.1%] and 657 560 aged ≥65 years [25.9%]; 1 178 869 males [46.4%]), the prevalence of sufficient physical activity did not change significantly during the prepandemic period (β difference, 1.0; 95% CI, 0.6 to 1.4). During the pandemic, the prevalence of sufficient physical activity decreased significantly, from 36.0% (95% CI, 35.9% to 36.1%) in 2017 to 2019 to 30.0% (95% CI, 29.8% to 30.2%) in 2020 and 29.7% (95% CI, 29.5% to 29.9%) in 2021. Trends showed decreases in the prevalence of sufficient physical activity among older adults (ages ≥65 years; β difference, -16.4; 95% CI, -17.5 to -15.3) and younger adults (ages 19 to 29 years; β difference, -16.6; 95% CI, -18.1 to -15.0) during the pandemic. In particular, the trend of sufficient physical activity declined during the pandemic in females (β difference, -16.8; 95% CI, -17.6 to -16.0), individuals in urban residences (β difference, -21.2; 95% CI, -22.2 to -20.2), healthy participants (eg, those with normal BMI, 18.5 to 22.9: β difference,-12.5; 95% CI, -13.4 to -11.7), and individuals at increased risk of stress (eg, history of a depressive episode; β difference, -13.7; 95% CI, -19.1 to -8.4). Prevalence trends in mean MET score were similar to those in the main results; total mean MET score decreased from the 2017 to 2019 period (1579.1 MET-min/wk; 95% CI, 1567.5 to 1590.7 MET-min/wk) to the 2020 to 2021 period (1191.9 MET-min/wk; 95% CI, 1182.4 to 1201.4 MET-min/wk. Conclusions and Relevance This cross-sectional study found that the national prevalence of physical activity was stable or consistent before the pandemic period, with a marked decrease during the pandemic, particularly among healthy individuals and subgroups at increased risk of negative outcomes, including older adults, females, urban residents, and those with depressive episodes. Future studies may be needed to evaluate the association between the COVID-19 pandemic and changes in physical activity.
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Affiliation(s)
- Sangil Park
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin, South Korea
| | - Wonyoung Cho
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
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Woo HG, Park S, Yon H, Lee SW, Koyanagi A, Jacob L, Smith L, Cho W, Min C, Lee J, Lee H, Kwon R, Fond G, Boyer L, Joo YY, Choi YS, Yeo SG, Rhee SY, Shin JI, Yon DK. National Trends in Sadness, Suicidality, and COVID-19 Pandemic-Related Risk Factors Among South Korean Adolescents From 2005 to 2021. JAMA Netw Open 2023; 6:e2314838. [PMID: 37223902 DOI: 10.1001/jamanetworkopen.2023.14838] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Importance Despite the COVID-19 pandemic's effect on daily life, limited research exists on the prevalence and risk factors of suicidality and sadness among South Korean adolescents. Objectives To examine whether the observed sadness and suicidality in the early to middle periods of the COVID-19 pandemic differed from the expected level and to investigate changes in risk factors for sadness and suicidality. Design, Setting, and Participants This nationwide serial cross-sectional survey study used data on 1 109 776 Korean adolescents aged 13 to 18 years from the Korea Youth Risk Behavior Web-based Survey from 2005 to 2021. Exposure The COVID-19 pandemic. Main Outcomes and Measures The pattern of changes in the percentage or proportion of sadness or suicidality, as well as the risk factors for sadness or suicidality. The transitional effect of the COVID-19 pandemic was assessed using weighted odds ratios (wORs) or weighted beta coefficients with 95% CIs. Results Between 2005 and 2021, 1 109 776 adolescents (mean [SD] age, 15.0 [1.7] years; 51.5% male adolescents; and 51.7% in grades 7-9 and 48.3% in grades 10-12) were included in the Korea Youth Risk Behavior Web-based Survey. The slope of the long-term trends in sadness and suicidality decreased in the prepandemic period (sadness: from 37.8% [95% CI, 37.4%-38.2%] in 2005-2007 to 26.1% [95% CI, 25.9%-26.4%] in 2016-2019; suicidality: from 23.0% [95% CI, 22.7%-23.3%] in 2005-2007 to 12.3% [95% CI, 12.1%-12.5%] in 2016-2019), whereas the slope increased during the COVID-19 pandemic (sadness: from 25.0% [95% CI, 24.5%-25.6%] in 2020 to 26.6% [95% CI, 26.1%-27.1%] in 2021; trend difference in β, 0.249 [95% CI, 0.236-0.262]; suicidality: from 10.7% [95% CI, 10.3%-11.1%] in 2020 to 12.5% [95% CI, 12.1%-12.9%] in 2021; trend difference in β, 0.328 [95% CI, 0.312-0.344]). The trends presented a similar tendency in the subgroups according to sex, school grade, residential area, smoking status, and current alcohol use. Compared with the prepandemic period, the risk factors associated with sadness during the pandemic were younger age (wOR, 0.907; 95% CI, 0.881-0.933), female sex (wOR, 1.031; 95% CI, 1.001-1.062), urban residence (wOR, 1.120; 95% CI, 1.087-1.153), current smoking status (wOR, 1.134; 95% CI, 1.059-1.216), and current alcohol use (wOR, 1.051; 95% CI, 1.002-1.102). Female sex (wOR, 1.064; 95% CI, 1.021-1.109), urban residence (wOR, 1.117; 95% CI, 1.074-1.162), and low economic status (wOR, 1.286; 95% CI, 1.180-1.403) were the risk factors significantly associated with suicidality after the COVID-19 pandemic began. Conclusions and Relevance In this nationwide serial cross-sectional survey study of South Korean adolescents, the slope of the prevalence of sadness and suicidality increased during the COVID-19 pandemic after a decrease prior to the pandemic. The findings suggest that public health measures are needed to recognize vulnerable groups with risk factors and to prevent an increase in sadness and suicidality among adolescents during the COVID-19 pandemic.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sangil Park
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyunju Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Network Centre for Biomedical Research in Mental Health, Health Institute Carlos III, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Pg. Lluis Companys, Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Network Centre for Biomedical Research in Mental Health, Health Institute Carlos III, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Wonyoung Cho
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Chanyang Min
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Hayeon Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Rosie Kwon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Biomedical Engineering, University of Michigan, Ann Arbor
| | - Guillaume Fond
- Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille, France
- Depression and Schizophrenia Expert Center, FondaMental Foundation, Creteil, France
| | - Laurent Boyer
- Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, CEReSS-Health Service Research and Quality of Life Center, Marseille, France
- Depression and Schizophrenia Expert Center, FondaMental Foundation, Creteil, France
| | | | - Yong Sung Choi
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Seung-Geun Yeo
- Department of Otolaryngology-Head & Neck Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
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Eum S, Son JW, Min C, Cho W, Kim S, Woo HG, Kwon R, Lee KN, Han KD, Yon DK, Rhee SY. Ethnic and sex differences in the distributions of body mass index and waist circumference among adults: a binationally representative study in South Korea and the United States. Eur Rev Med Pharmacol Sci 2023; 27:1889-1903. [PMID: 36930486 DOI: 10.26355/eurrev_202303_31555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The ethnic and sex differences in the distributions of body mass index (BMI) and waist circumference (WC) among adults are largely unknown. Therefore, we aimed to investigate the percentiles of BMI and WC in groups divided according to age, sex, and ethnicity. PATIENTS AND METHODS We conducted a population-based binational study of adults aged ≥20 years based on data from two sources: US National Health and Nutrition Examination Survey (2015 to 2020) and Korea National Health and Nutrition Examination Survey (2016 to 2019). RESULTS Weight, height, and WC were measured in 13,144 American adults and 30,191 Korean adults. Overall, BMI increased at younger ages and decreased at older ages, which indicates a reversed U-shaped relationship, and differed in terms of age, sex, and ethnicity. Women in the other Hispanic, non-Hispanic white, non-Hispanic black, and "other ethnic groups" showed a common BMI peak at ages 50-54 years. The patterns of WC distribution were similar to those of BMI distribution. CONCLUSIONS In this binational representative study, we found varied distributions of ethnic and sex differences in BMI and WC. Considering the differences in these distributions may help improve individual and personalized treatment strategies.
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Affiliation(s)
- S Eum
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
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Ban CY, Shin H, Eum S, Yon H, Lee SW, Choi YS, Shin YH, Shin JU, Koyanagi A, Jacob L, Smith L, Min C, Yeniova AÖ, Kim SY, Lee J, Yeo SG, Kwon R, Koo MJ, Fond G, Boyer L, Acharya KP, Kim S, Woo HG, Park S, Shin JI, Rhee SY, Yon DK. 17-year trends of body mass index, overweight, and obesity among adolescents from 2005 to 2021, including the COVID-19 pandemic: a Korean national representative study. Eur Rev Med Pharmacol Sci 2023; 27:1565-1575. [PMID: 36876712 DOI: 10.26355/eurrev_202302_31399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE There is a lack of pediatric studies that have analyzed trends in mean body mass index (BMI) and the prevalence of obesity and overweight over a period that includes the mid-stage of the COVID-19 pandemic. Thus, we aimed to investigate trends in BMI, overweight, and obesity among Korean adolescents from 2005 to 2021, including the COVID-19 pandemic. SUBJECTS AND METHODS We used data from the Korea Youth Risk Behavior Web-based Survey (KYRBS), which is nationally representative of South Korea. The study included middle- and high-school students between the ages of 12 and 18. We examined trends in mean BMI and prevalence of obesity and/or overweight during the COVID-19 pandemic and compared these to those of pre-pandemic trends in each subgroup by gender, grade, and residential region. RESULTS Data from 1,111,300 adolescents (mean age: 15.04 years) were analyzed. The estimated weighted mean BMI was 20.48 kg/m2 (95% CI, 20.46-20.51) between 2005 and 2007, and this was 21.61 kg/m2 (95% CI, 21.54-21.68) in 2021. The prevalence of overweight and obesity was 13.1% (95% CI, 12.9-13.3%) between 2005 and 2007 and 23.4% (95% CI, 22.8-24.0%) in 2021. The mean BMI and prevalence of obesity and overweight have gradually increased over the past 17 years; however, the extent of change in mean BMI and in the prevalence of obesity and overweight during the pandemic was distinctly less than before. The 17-year trends in the mean BMI, obesity, and overweight exhibited a considerable rise from 2005 to 2021; however, the slope during the COVID-19 pandemic (2020-2021) was significantly less prominent than in the pre-pandemic (2005-2019). CONCLUSIONS These findings enable us to comprehend long-term trends in the mean BMI of Korean adolescents and further emphasize the need for practical prevention measures against youth obesity and overweight.
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Affiliation(s)
- C Y Ban
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.
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Jung S, Lee HA, Kang IS, Shin SH, Chang Y, Shin DW, Park M, Kim YD, Nam HS, Heo JH, Kim TH, Yu HT, Lee JM, Heo SH, Woo HG, Park JK, Ro SY, Kim CK, Lee YS, Do JK, Kim DH, Song TJ, Park J. Corrigendum: Clinical implications of atrial fibrillatioN detection using wearabLE devices in patients with cryptogenic stroke (CANDLE-AF) trial: Design and rationale. Front Cardiovasc Med 2023; 10:1199185. [PMID: 37153467 PMCID: PMC10155058 DOI: 10.3389/fcvm.2023.1199185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fcvm.2022.837958.].
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Affiliation(s)
- Sodam Jung
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Hye Ah Lee
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - In Sook Kang
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Sang Hoon Shin
- Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yoonkyung Chang
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Dong Woo Shin
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Mooseok Park
- Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Young Dae Kim
- College of Medicine, Yonsei University, Seoul, South Korea
| | - Hyo Suk Nam
- College of Medicine, Yonsei University, Seoul, South Korea
| | - Ji Hoe Heo
- College of Medicine, Yonsei University, Seoul, South Korea
| | - Tae-Hoon Kim
- Severance Cardiovascular Hospital, Seoul, South Korea
| | - Hee Tae Yu
- Severance Cardiovascular Hospital, Seoul, South Korea
| | | | - Sung Hyuk Heo
- Kyung Hee University Medical Center, Seoul, South Korea
| | - Ho Geol Woo
- Kyung Hee University Medical Center, Seoul, South Korea
| | - Jin-Kyu Park
- Hanyang University Seoul Hospital, Seoul, South Korea
| | - Seung-Y. Ro
- Korea University Guro Hospital, Seoul, South Korea
| | | | - Young-Soo Lee
- Daegu Catholic University Medical Center, Daegu, North Gyeongsang, South Korea
| | - Jin Kuk Do
- Daegu Catholic University Medical Center, Daegu, North Gyeongsang, South Korea
| | - Dong-Hyeok Kim
- Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Tae-Jin Song
- Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Junbeom Park
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
- Correspondence: Junbeom Park
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Woo HG, Kim HG, Lee KM, Ha SH, Jo H, Heo SH, Chang DI, Liebeskind DS, Kim BJ. Wall Shear Stress Associated with Stroke Occurrence and Mechanisms in Middle Cerebral Artery Atherosclerosis. J Stroke 2023; 25:132-140. [PMID: 36746383 PMCID: PMC9911838 DOI: 10.5853/jos.2022.02754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/08/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Various mechanisms are involved in the etiology of stroke caused by atherosclerosis of the middle cerebral artery (MCA). Here, we compared differences in plaque nature and hemodynamic parameters according to stroke mechanism in patients with MCA atherosclerosis. METHODS Consecutive patients with asymptomatic and symptomatic MCA atherosclerosis (≥50% stenosis) were enrolled. MCA plaque characteristics (location and plaque enhancement) and wall shear stress (WSS) were measured using high-resolution vessel wall and four-dimensional flow magnetic resonance imaging, respectively, at five points (initial, upstream, minimal lumen, downstream, and terminal). These parameters were compared between patients with asymptomatic and symptomatic MCA atherosclerosis with infarctions of different mechanisms (artery-to-artery embolism vs. local branch occlusion). RESULTS In total, 110 patients (46 asymptomatic, 32 artery-to-artery embolisms, and 32 local branch occlusions) were investigated. Plaques were evenly distributed in the MCA of patients with asymptomatic MCA atherosclerosis, more commonly observed in the distal MCA of patients with artery-to-artery embolism, and in the middle MCA of patients with local branch occlusion. Maximum WSS and plaque enhancement were more prominent in the minimum lumen area of patients with asymptomatic MCA atherosclerosis or those with local branch occlusion, and were more prominent in the upstream area in those with artery-to-artery embolism. The elevated variability in the maximum WSS was related to stroke caused by artery-to-artery embolism. CONCLUSION Stroke caused by artery-to-artery embolism was related to plaque enhancement and the highest maximum WSS at the upstream point of the plaque, and was associated with elevated variability of maximum WSS.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyug-Gi Kim
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sang Hee Ha
- Department of Neurology, Asan Medical Center, Seoul, Korea
| | - HangJin Jo
- Department of Mechanical Engineering & Division of Advanced Nuclear Engineering, POSTECH, Pohang, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dae-il Chang
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - David S. Liebeskind
- Department of Neurology, University of California in Los Angeles, Los Angeles, CA, USA
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, Korea,Correspondence: Bum Joon Kim Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-958-8499 E-mail:
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Ryu J, Mi Lee K, Geol Woo H, Chung Y, Keun Choi S. Clinical Significance of “Periventricular Collateral Enhancement Sign” in Symptomatic Moyamoya Disease: A Vessel Wall Imaging Study. Eur J Radiol 2022; 157:110599. [DOI: 10.1016/j.ejrad.2022.110599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/02/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
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22
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Noh KC, Choi HY, Woo HG, Chang JY, Heo SH, Chang DI, Kim BJ. High-on-Aspirin Platelet Reactivity Differs Between Recurrent Ischemic Stroke Associated With Extracranial and Intracranial Atherosclerosis. J Clin Neurol 2022; 18:421-427. [PMID: 35796267 PMCID: PMC9262451 DOI: 10.3988/jcn.2022.18.4.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose Ischemic stroke recurs despite the use of antiplatelet agents. Various mechanisms are involved in recurrence due to intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS). High-on-aspirin platelet reactivity (HAPR) may differ between recurrent stroke due to ICAS and ECAS. Methods Patients with recurrent ischemic stroke as a result of large-artery atherosclerosis despite taking aspirin were enrolled consecutively. Ischemic stroke was classified as stroke due to ICAS or ECAS according to the location of the culprit stenosis. An aspirin reaction units (ARU) value of >550 IU was defined as HAPR. HAPR and its associated factors were compared between the two groups and also considering the mechanism of stroke. Results Among the 190 patients with recurrent stroke (111 with ICAS and 79 with ECAS), 36 (18.3%) showed HAPR. The ARU value was higher in the ECAS than the ICAS group (492±83 vs. 465±78, mean±standard deviation; p=0.028), as was the proportion of patients with HAPR (27.8% vs. 12.6%, p=0.008). Being male and having stroke due to ECAS (reference=stroke due to ICAS: odds ratio=5.760; 95% confidence interval=2.154–15.403; p<0.001) was independently associated with HAPR. The ARU value differed according to the stroke mechanism, and was highest in those with artery-to-artery embolism. Artery-to-artery embolism was independently associated with HAPR in both the ICAS and ECAS groups. Conclusions Recurrent stroke due to ECAS was more strongly associated with HAPR and insufficient antiplatelet inhibition than was that due to ICAS. Artery-to-artery embolism was associated with HAPR in recurrent ischemic stroke as a result of ICAS or ECAS.
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Affiliation(s)
- Kyung Chul Noh
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea.,Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Hye-Yeon Choi
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Jun Young Chang
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
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Jung S, Lee HA, Kang IS, Shin SH, Chang Y, Woo Shin D, Park MS, Kim YD, Nam HS, Heo JH, Kim TH, Yu HT, Lee JM, Heo SH, Woo HG, Park JK, Roh SY, Kim CK, Lee YS, Do JK, Kim DH, Song TJ, Park J. Clinical Implications of Atrial Fibrillation Detection Using Wearable Devices in Patients With Cryptogenic Stroke (CANDLE-AF) Trial: Design and Rationale. Front Cardiovasc Med 2022; 9:837958. [PMID: 35445088 PMCID: PMC9013795 DOI: 10.3389/fcvm.2022.837958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/28/2022] [Indexed: 11/14/2022] Open
Abstract
Background Although many electrocardiography wearable devices have been released recently for the detection of atrial fibrillation (AF), there are few studies reporting prospective data for wearable devices compared to the strategy of the existing guidelines in the detection of atrial fibrillation (AF) after cryptogenic stroke. A tiny single-patch monitor is more convenient than a conventional Holter monitor recording device and, therefore, longer duration of monitoring may be acceptable. Methods and Design The CANDLE-AF study is a multicenter, prospective, randomized controlled trial. Patients with transient ischemic attack or ischemic stroke without any history of AF will be enrolled. The superiority of the 72-h single-patch monitor to standard strategy and non-inferiority of the 72-h single-patch monitor to an event-recorder-type device will be investigated. Single-patch monitor arm will repeat monitoring at 1, 3, 6, and 12 months, event-recorder-type arm will repeat monitoring twice daily for 12 months. The enrollment goal is a total of 600 patients, and the primary outcome is the detection of AF which continues at least 30 s during study period. The secondary outcome is the rate of changes from antiplatelet to anticoagulant and major adverse cardiac and cerebrovascular events within 1 year. Conclusions The results of CANDLE-AF will clarify the role of a single-lead patch ECG for the early detection of AF in patients with acute ischemic stroke. In addition, the secondary outcome will be analyzed to determine whether more sensitive AF detection can affect the prognosis and if further device development is meaningful. (cris.nih.go.kr KCT0005592).
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Affiliation(s)
- Sodam Jung
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - In Sook Kang
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Sang Hoon Shin
- Division of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yoonkyung Chang
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Dong Woo Shin
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Moo-Seok Park
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea
| | - Jung Myung Lee
- Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Jin-Kyu Park
- Division of Cardiology, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Seung-Young Roh
- Devision of Cardiology, Korea University Guro Hospital, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Young-Soo Lee
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Jin Kuk Do
- Department of Neurology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Dong-Hyeok Kim
- Division of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
- *Correspondence: Dong-Hyeok Kim
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, South Korea
- Tae-Jin Song
| | - Junbeom Park
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
- Junbeom Park
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Woo HG, Park S, Yoon SS. Simultaneous bilateral central retinal artery occlusion in a patient with dilated cardiomyopathy. Quant Imaging Med Surg 2022; 12:5296-5299. [PMID: 36330186 PMCID: PMC9622442 DOI: 10.21037/qims-22-456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022]
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Chang Y, Lee JS, Woo HG, Ryu DR, Kim JW, Song TJ. Improved oral hygiene care and chronic kidney disease occurrence: A nationwide population-based retrospective cohort study. Medicine (Baltimore) 2021; 100:e27845. [PMID: 34964752 PMCID: PMC8615368 DOI: 10.1097/md.0000000000027845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/11/2021] [Indexed: 01/05/2023] Open
Abstract
Oral diseases or poor oral hygiene have close connections with systemic inflammatory reaction, which is one of major mechanism in the development of chronic kidney disease (CKD). We conducted a research assuming that better oral hygiene care would be negatively related with the risk of developing new-onset CKD.From 2003 to 2004, a total of 158,495 participants from the Korean national health insurance data sharing service which provides health screening data including variables as age, sex, vascular risk factors, medication information, indicators regarding oral hygiene, and laboratory results. The diagnosis of CKD and vascular risk factors were defined according to the International Statistical Classification of Diseases and Related Health Problems codes-10th revision. The follow-up period for the study subject was until the occurrence of CKD, until death, or Dec 31, 2015.Approximately 13.3% of the participants suffered from periodontal disease, and 40.7% brushed their teeth at least three times a day. With a median of 11.6 (interquartile range 11.3-12.2) years' follow-up, the cohort included 3223 cases of incident CKD. The 10-year incidence rate for CKD was 1.80%. In multivariable analysis with adjustment for age, sex, demographics, vascular risk factors, blood pressure, and blood laboratory results, frequent tooth brushing (≥3 times a day) was negatively related to occurrence of CKD (hazard ratio: 0.90, 95% confidence interval [0.83-0.99], P = .043, P value for trend = .043).Participants with improved oral hygiene (≥3 times a day) have showed less risk of CKD. Additional interventional studies are in need to establish causative relationship between oral hygiene and risk of CKD.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital and College of Medicine, Seoul, Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin-Woo Kim
- Department of Oral and Maxillofacial Surgery, Ewha Womans University, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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Lee JS, Woo HG, Hwang KJ. Tongue Tremor After Levetiracetam Administration. J Clin Neurol 2021; 17:588-589. [PMID: 34595872 PMCID: PMC8490891 DOI: 10.3988/jcn.2021.17.4.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jin San Lee
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kyoung Jin Hwang
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea.
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Woo HG, Chang Y, Lee JS, Song TJ. Tooth loss is associated with an increased risk of hypertension: A nationwide population-based cohort study. PLoS One 2021; 16:e0253257. [PMID: 34129621 PMCID: PMC8205122 DOI: 10.1371/journal.pone.0253257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/01/2021] [Indexed: 02/07/2023] Open
Abstract
Tooth loss is closely associated with suboptimal oral care. Suboptimal oral care can facilitate local infections. These can lead to systemic inflammation and endothelial dysfunction, which are important pathological mechanisms of hypertension. The aim of this study was to investigate the link between tooth loss and the risk of hypertension. From the national health insurance system-health screening cohort in Korea, 19,680 participants who underwent three or more health examinations, including blood pressure measurements, between January 2003 and December 2008, without any history or diagnosis of hypertension were included in this study. Hypertension was defined as the diagnosis of hypertension (International Classification of Diseases-10 code “I10–11”) accompanied by the prescription of an antihypertensive agent or at least one health examination result of blood pressure of ≥140/90 mmHg. Kaplan-Meier survival curves with the log-rank test were used to evaluate the relationship between oral hygiene indicators and the incidence of hypertension. Cox proportional hazard models were applied to determine the association between oral hygiene indicators and the development of hypertension. During a median follow-up of 7.4 years, 1,853 patients developed hypertension. The estimated incidence of hypertension within seven years was 8.8%. Multivariable analysis confirmed a significant relationship between the number of lost teeth and hypertension (hazard ratio: 2.26; 95% confidence interval [1.24–4.10], p = 0.007, p for trend = 0.005). There was a positive association between the number of lost teeth and the risk of hypertension in a longitudinal research. In conclusion, the number of lost teeth may be associated with the risk of development of hypertension.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
- * E-mail:
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Chang Y, Woo HG, Jeong JH, Kim GH, Park KD, Song TJ. Microbiota dysbiosis and functional outcome in acute ischemic stroke patients. Sci Rep 2021; 11:10977. [PMID: 34040060 PMCID: PMC8155119 DOI: 10.1038/s41598-021-90463-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/11/2021] [Indexed: 11/09/2022] Open
Abstract
Currently, few studies are reported on the composition of microbiota in stroke patients and the association with stroke prognosis. This study investigated the differing microbiota composition in stroke patients and confirmed the association of microbiota composition with poor functional outcome. Between January of 2018 and December of 2019, 198 patients with acute cerebral infarction were included in this study. For the case–control study, age and sex-matched normal healthy subjects (n = 200) were included when receiving their health screening examinations. We isolated bacterial extracellular membrane vesicles and extracted DNA from blood samples. Taxonomic assignments were performed by using the sequence reads of 16S rRNA genes following blood microbiota analysis. Statistical analysis was conducted appropriately by using Statistical Analysis System software. The mean age of the stroke patients were 63.7 ± 12.5 years, and the male sex was 58.5%. Of the total enrolled patients, poor functional outcome (modified Rankin Score ≥ 3) was noted in 19.7%. The principal component analysis of microbiota composition revealed significant differences between healthy control subjects and stroke patients. At the genus level, Aerococcaceae(f), ZB2(c), TM7-1(c), and Flavobacterium were significantly increased in stroke patients compared to the healthy controls, whereas Mucispirillum, rc4-4, Akkermansia, Clostridiales(o), Lactobacillus, and Stenotrophomonas were decreased considerably. For the functional outcome after ischemic stroke, Anaerococcus, Blautia, Dialister, Aerococcaceae(f), Propionibacterium, Microbacteriaceae(f), and Rothia were enriched in the group with good outcomes, whereas Ruminococcaceae(f) and Prevotella were enriched in the group with poor outcome. There was apparent dysbiosis of blood microbiota in patients with acute ischemic stroke compared to healthy people. Ruminococcaceae(f) and Prevotella were elevated in stroke patients with poor functional outcome.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology , Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jee Hyang Jeong
- Department of Neurology , Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Geon Ha Kim
- Department of Neurology , Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kee Duk Park
- Department of Neurology , Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology , Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine , 260, Gonghang-daero, Gangseo-gu, 07804, Seoul, Republic of Korea.
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Woo HG, Ryu J, Kim EJ, Lee KM. Styloidogenic jugular venous compression syndrome as a source of cerebral venous sinus thrombosis. Quant Imaging Med Surg 2021; 12:4316-4319. [PMID: 35919052 PMCID: PMC9338375 DOI: 10.21037/qims-22-106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/15/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jiwook Ryu
- Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Eui Jong Kim
- Department of Radiology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University College of Medicine, Seoul, Korea
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Woo HG, Chung H, Lee JS, Heo SH. Double-Chamber Left Ventricle as a Potential Cardioembolic Source in Acute Ischemic Stroke. J Clin Neurol 2021; 17:470-472. [PMID: 34184456 PMCID: PMC8242305 DOI: 10.3988/jcn.2021.17.3.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyemoon Chung
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jin San Lee
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea.
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Woo HG, Lee HA, Ryu DR, Song TJ. Association of Mortality with Antiplatelet Treatment in Patients with Stent Placement or Angioplasty: A Population-Based Nested Case-Control Study. Yonsei Med J 2021; 62:75-85. [PMID: 33381937 PMCID: PMC7820450 DOI: 10.3349/ymj.2021.62.1.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/22/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Antiplatelet drugs are essential in patients with cardiovascular disease who undergo stent placement. We hypothesized that risks of mortality would differ according to adherence to antiplatelet agents, number of antiplatelet agents, and antiplatelet regimens in patients undergoing stent placement or angioplasty. MATERIALS AND METHODS Between 2002 and 2013, we initially enrolled 8671 subjects who underwent stent placement or angioplasty in the National Health Insurance Service-National Sample Cohort in Korea. Using the International Classification of Diseases, 10th revision, the incidence of all-cause death, including cardiovascular disease, cerebrovascular disease, and cancer, was defined. Using a nested case-control study design, controls were matched to cases at a ratio of 4:1, and a total of 5415 subjects were eligible for this study. RESULTS During a median follow-up period of 3.51 years, the incidence rate of all-cause death was 40 per 1000 person-years. We found that adherence to antiplatelet monotherapy significantly decreased risk of death by cerebro-cardiovascular disease, compared with discontinuation of antiplatelets [adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) (0.41-0.96)]. Compared with dual antiplatelet therapy (DAPT), aspirin and clopidogrel monotherapy significantly reduced death by cerebro-cardiovascular disease [adjusted OR 0.65, 95% CI (0.44-0.95) and adjusted OR 0.58, 95% CI (0.35-0.96), respectively]. There was no significant difference of mortality between aspirin monotherapy and clopidogrel monotherapy. CONCLUSION Our study demonstrated that adherence to antiplatelet therapy and antiplatelet monotherapy, compared with DAPT, in patients with stent placement or angioplasty may have a beneficial effect on mortality in cerebro-cardiovascular disease.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hye Ah Lee
- Clinical Trial Center, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Dong Ryeol Ryu
- Department of Nephrology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Tae Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
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Woo HG, Ryu J, Oh CH, Lee JH, Lee JS. Postpartum reversible cerebral vasoconstriction syndrome confined to the bilateral cervical vertebral arteries. Neurol Sci 2020; 42:1603-1605. [PMID: 33099698 DOI: 10.1007/s10072-020-04845-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/17/2020] [Indexed: 05/30/2023]
Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, 02447, South Korea
| | - Jiwook Ryu
- Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, 02447, South Korea
| | - Chi Hyuk Oh
- Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, 02447, South Korea
| | - Jae Hong Lee
- Department of Neurology, Seosan Jungang General Hospital, Seosan, 32010, South Korea
| | - Jin San Lee
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, 02447, South Korea.
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Woo HG, Heo SH, Kim EJ, Chang DI, Song TJ, Kim BJ. Atherosclerotic plaque locations may be related to different ischemic lesion patterns. BMC Neurol 2020; 20:288. [PMID: 32731859 PMCID: PMC7391573 DOI: 10.1186/s12883-020-01868-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022] Open
Abstract
Background Atherosclerosis of the internal carotid artery (ICA) is an important cause of ischemic stroke. Artery-to-artery embolism is the major stroke mechanism in patients with atherosclerotic carotid disease. This study hypothesized that the atherosclerotic ICA geometry and plaque location would be associated with lesion pattern in patients with acute ischemic stroke. Methods Ischemic stroke patients with symptomatic proximal ICA disease (> 50% diameter stenosis) were enrolled. The carotid plaque location was divided into high-apical and low-body types. The geometric parameters of the ICA (angles between arteries) were measured, and ischemic lesion patterns were classified according to the number, location, and size of the lesions. Factors associated with plaque location and lesion pattern, dichotomized by size, were investigated. Results Of the 93 acute ischemic stroke patients enrolled, 31 had high-apical and 62 had low-body plaques. Hyperlipidemia was more prevalent and the common carotid artery (CCA)-ICA angle was wider (167.7 ± 10.4° vs 162.3 ± 9.8°, p = 0.019) in patients with low-body than high-apical plaques. Low-body plaques were more frequently associated with small scattered or cortical lesions (54.8% vs. 32.3%, p = 0.040), whereas high-apical plaques were more frequently associated with large lesions having additional lesions (38.7% vs. 11.3%, p = 0.002). The presence of low-body plaques (odds ratio: 3.106, 95% confidence interval: 1.105–8.728, p = 0.032) was independently associated with the small lesion-only pattern. Conclusions Low-body plaques are more frequently associated with small scattered lesions, whereas high-apical plaques are more frequently associated with large lesions having additional lesions. A wide CCA-ICA angle is associated with low-body plaque of the carotid artery.
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Affiliation(s)
- Ho Geol Woo
- Departments of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sung Hyuk Heo
- Departments of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Eui Jong Kim
- Departments of Radiology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dae-Il Chang
- Departments of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Tae Jin Song
- Department of Neurology, Seoul Hospital Ewha Womans University College of Medicine, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Song-Pa, PO Box 145, Seoul, 138-600, South Korea.
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Woo HG, Song TJ, Jung JS, Oh SW, Lee SC, Seok JM, Yang KI. Association between the high risk for obstructive sleep apnea and intracranial carotid artery calcification in patients with acute ischemic stroke. Sleep Breath 2020; 25:299-307. [PMID: 32562170 DOI: 10.1007/s11325-020-02117-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is an independent risk factor for stroke. Furthermore, intracranial carotid artery calcification (ICAC) is a marker for subclinical atherosclerosis and future cardiovascular events. We investigated the association between the high risk for OSA and ICAC in patients with acute ischemic stroke. METHODS We retrospectively investigated 73 patients who were admitted to the hospital with acute ischemic stroke in the internal carotid artery (ICA) territory due to large-artery atherosclerosis. The risk for OSA was assessed using the Berlin Questionnaire, and patients were classified into low-risk (LR-OSA) and high-risk groups (HR-OSA). We compared the burden of ICAC between the two groups. Univariable and multivariable analyses were conducted to investigate the association of high risk for OSA with the presence of calcium in intracranial ICA. RESULTS The HR-OSA group of 35 patients (48%) was significantly older and had a higher rate of hypertension and diabetes mellitus than the LR-OSA group. The HR-OSA group had more frequent ICAC (92% vs. 63%, p < 0.001), higher Agatston score (162.0 vs. 8.5, p < 0.001), and greater total volume of ICAC (261.2 mm3 vs. 20.1 mm3, p < 0.001) in the intracranial ICA. Presence of calcium in symptomatic intracranial ICA was positively correlated with age (odds ratio, OR, 1.432; 95% confidence interval, CI, 1.098-1.868) and HR-OSA (OR, 18.272; 95% CI, 0.500-668.401) in multivariable logistic regression analysis. CONCLUSIONS This study showed that the presence of calcium in symptomatic intracranial ICA was related to high risk for OSA in patients with acute ischemic stroke.
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Affiliation(s)
- Ho Geol Woo
- Departments of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jo Sung Jung
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea
| | - Se Won Oh
- Department of Radiology, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Seung Cheol Lee
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, South Korea
| | - Jin Myoung Seok
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, South Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, South Korea.
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Chang Y, Woo HG, Lee JS, Song TJ. Better oral hygiene is associated with lower risk of stroke. J Periodontol 2020; 92:87-94. [PMID: 32432793 DOI: 10.1002/jper.20-0053] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/22/2020] [Accepted: 03/26/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Periodontal disease or poor oral hygiene may lead to local infection, inflammation, and systemic inflammatory reactions, which are important mediators of development of stroke. We aimed to investigate the association of oral hygiene with risk of stroke in a nationwide population-based cohort. METHODS From Korean National Health Insurance System-Health Screening Cohort, 206,602 participants without missing data regarding demographic information, medical history, or blood/urine examination results were included. The presence of periodontal disease and indicators of oral hygiene, such as number of tooth brushings, dental visit history, dental scaling, and number of teeth loss and dental caries were evaluated. Occurrence of stroke including cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage was defined as newly registration of International Classification of Diseases-10 codes from I60 to I64 accompanying brain CT and/or MR examination at that time of diagnosis. RESULTS The 7337 (3.6%) cases of stroke including 5795 (79.0%) cases of cerebral infarction, 1568 (21.4%) cases of cerebral hemorrhage, and 621 (8.5%) cases of subarachnoid hemorrhage occurred during a median 10.4 years follow-up. In multivariable analysis, frequent tooth brushing (≥3 times per day) was negatively associated with risk of stroke occurrence (hazard ratio [HR]: 0.78, 95% confidence interval [CI]: 0.73-0.84). Number of dental caries (≥4) was positively related to stroke occurrence (HR: 1.28, 95% CI: 1.13-1.44). CONCLUSIONS Regular oral hygiene behavior was negatively, and infrequent oral hygiene care was positively associated with risk of occurrence for stroke, respectively. Brushing one's teeth three or more times daily may be associated with lower risk of stroke.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ho Geol Woo
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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Lee K, Lee JS, Kim J, Lee H, Chang Y, Woo HG, Kim J, Song T. Oral health and gastrointestinal cancer: A nationwide cohort study. J Clin Periodontol 2020; 47:796-808. [DOI: 10.1111/jcpe.13304] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/14/2020] [Accepted: 05/04/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Kijeong Lee
- Department of Neurology Department of Radiology Severance Hospital Yonsei University College of Medicine Seoul Korea
| | - Ji Sung Lee
- Clinical Research Center Asan Institute for Life Sciences Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Jinkwon Kim
- Department of Neurology Yongin Severance Hospital Yonsei University College of Medicine Seoul Korea
| | - Huisong Lee
- Department of Surgery Mokdong Hospital Ewha Womans University College of Medicine Seoul Korea
| | - Yoonkyung Chang
- Department of Neurology Mokdong Hospital Ewha Womans University College of Medicine Seoul Korea
| | - Ho Geol Woo
- Department of Neurology Seoul Hospital Ewha Womans University College of Medicine Seoul Korea
| | - Jin‐Woo Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine Ewha Womans University Seoul Korea
| | - Tae‐Jin Song
- Department of Neurology Seoul Hospital Ewha Womans University College of Medicine Seoul Korea
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Chang Y, Lee JS, Lee KJ, Woo HG, Song TJ. Improved oral hygiene is associated with decreased risk of new-onset diabetes: a nationwide population-based cohort study. Diabetologia 2020; 63:924-933. [PMID: 32128623 DOI: 10.1007/s00125-020-05112-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/23/2020] [Indexed: 12/14/2022]
Abstract
AIMS/HYPOTHESIS Inflammation plays an important role in the development of diabetes, a major global health problem. Periodontal disease is also common in the general population. Because periodontal disease and poor oral hygiene can provoke transient bacteraemia and systemic inflammation, we hypothesised that periodontal disease and oral hygiene indicators would be associated with the occurrence of new-onset diabetes. METHODS In this study we analysed data collected between 2003 and 2006 on 188,013 subjects from the National Health Insurance System-Health Screening Cohort (NHIS-HEALS) in Korea who had no missing data for demographics, past medical history, oral hygiene indicators or laboratory findings. The presence of periodontal disease was defined on the basis of a modified version of ICD-10 codes (Korean Classification of Disease, sixth edition), if claims for treatment for acute periodontitis (K052), chronic periodontitis (K053) and periodontosis (K054) were made more than two times by a dentist, or if, according to medical records, subjects received treatment by a dentist for periodontal disease with ICD-10 codes K052, K053 or K054. Oral hygiene behaviours (number of tooth brushings, a dental visit for any reason and professional dental cleaning) were collected as self-reported data of dental health check-ups. Number of missing teeth was ascertained by dentists during oral health examination. The incidence of new-onset diabetes was defined according to ICD-10 codes E10-E14. The criterial included at least one claim per year for both visiting an outpatient clinic and admission accompanying prescription records for any glucose-lowering agent, or was based on a fasting plasma glucose ≥7 mmol/l from NHIS-HEALS. RESULTS Of the included subjects, 17.5% had periodontal disease. After a median follow-up of 10.0 years, diabetes developed in 31,545 (event rate: 16.1%, 95% CI 15.9%, 16.3%) subjects. In multivariable models, after adjusting for demographics, regular exercise, alcohol consumption, smoking status, vascular risk factors, history of malignancy and laboratory findings, the presence of periodontal disease (HR 1.09, 95% CI 1.07, 1.12, p < 0.001) and number of missing teeth (≥15 teeth) remained positively associated with occurrence of new-onset diabetes (HR 1.21, 95% CI 1.09, 1.33, p < 0.001, p for trend <0.001). Frequent tooth brushing (≥3 times/day) was negatively associated with occurrence of new-onset diabetes (HR 0.92, 95% CI 0.89, 0.95, p < 0.001, p for trend <0.001). CONCLUSIONS/INTERPRETATION Frequent tooth brushing may be an attenuating factor and the presence of periodontal disease and an increased number of missing teeth may be augmenting factors for the occurrence of new-onset diabetes. Improving oral hygiene may be associated with a decreased risk of occurrence of new-onset diabetes.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, South Korea
| | - Ki-Jung Lee
- Department of Neurology, Eunpyeong St Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, 260, Gonghang-daero, Gangseo-gu, 07804, Seoul, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, 260, Gonghang-daero, Gangseo-gu, 07804, Seoul, Republic of Korea.
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Chang Y, Kim J, Woo HG, Ryu DR, Oh HJ, Song TJ. Plasma Fibroblast Growth Factor 23 Concentration Is Associated with Intracranial Cerebral Atherosclerosis in Acute Ischemic Stroke Patients. J Clin Neurol 2020; 16:29-36. [PMID: 31942755 PMCID: PMC6974828 DOI: 10.3988/jcn.2020.16.1.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Fibroblast growth factor 23 (FGF23) is associated with atherosclerosis via nitric-oxide-associated endothelial dysfunction and calcium-phosphate-related bone mineralization. This study aimed to determine the association of the plasma FGF23 concentration with intracranial cerebral atherosclerosis (ICAS) and extracranial cerebral atherosclerosis (ECAS). METHODS We prospectively enrolled 262 first-ever ischemic stroke patients in whom brain magnetic resonance was performed and a blood sample acquired within 24 h after admission. Plasma FGF23 concentrations were measured using an enzyme-linked immunosorbent assay. The presence of ICAS or ECAS was defined as a ≥50% decrease in arterial diameter in magnetic resonance angiography. The burden of cerebral atherosclerosis was calculated by adding the total number of vessels defined as ICAS or ECAS. RESULTS Our study population included 152 (58.0%) males. The mean age was 64.7 years, and the plasma FGF23 concentration was 347.5±549.6 pg/mL (mean±SD). ICAS only, ECAS only, and both ICAS and ECAS were present in 31.2% (n=82), 4.9% (n=13), and 6.8% (n=18) of the subjects, respectively. In multivariate binary and ordinal logistic analyses, after adjusting for sex, age, and variables for which p<0.1 in the univariate analysis, the plasma FGF23 concentration (per 100 pg/mL) was positively correlated with the presence of ICAS [odds ratio (OR)=1.07, 95% CI=1.00-1.15, p=0.039], burden of ICAS (OR=1.09, 95% CI=1.04-1.15, p=0.001), and burden of ECAS (OR=1.06, 95% CI=1.00-1.12, p=0.038), but it was not significantly related to the presence of ECAS (OR=1.05, 95% CI=0.99-1.12, p=0.073). CONCLUSIONS The plasma FGF23 may be a potential biomarker for cerebral atherosclerosis, particularly the presence and burden of ICAS in stroke patients.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jinkwon Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Geol Woo
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Dong Ryeol Ryu
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hyung Jung Oh
- Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Tae Jin Song
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
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Chang Y, Woo HG, Park J, Lee JS, Song TJ. Improved oral hygiene care is associated with decreased risk of occurrence for atrial fibrillation and heart failure: A nationwide population-based cohort study. Eur J Prev Cardiol 2019; 27:1835-1845. [PMID: 31786965 DOI: 10.1177/2047487319886018] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS Poor oral hygiene can provoke transient bacteremia and systemic inflammation, a mediator of atrial fibrillation and heart failure. This study aims to investigate association of oral hygiene indicators with atrial fibrillation and heart failure risk in Korea. METHODS We included 161,286 subjects from the National Health Insurance System-Health Screening Cohort who had no missing data for demographics, past history, or laboratory findings. They had no history of atrial fibrillation, heart failure, or cardiac valvular diseases. For oral hygiene indicators, presence of periodontal disease, number of tooth brushings, any reasons of dental visit, professional dental cleaning, and number of missing teeth were investigated. RESULTS During median follow-up of 10.5 years, 4911 (3.0%) cases of atrial fibrillation and 7971 (4.9%) cases of heart failure occurred. In multivariate analysis after adjusting age, sex, socioeconomic status, regular exercise, alcohol consumption, body mass index, hypertension, diabetes, dyslipidemia, current smoking, renal disease, history of cancer, systolic blood pressure, blood and urine laboratory findings, frequent tooth brushing (≥3 times/day) was significantly associated with attenuated risk of atrial fibrillation (hazard ratio: 0.90, 95% confidence interval (0.83-0.98)) and heart failure (0.88, (0.82-0.94)). Professional dental cleaning was negatively (0.93, (0.88-0.99)), while number of missing teeth ≥22 was positively (1.32, (1.11-1.56)) associated with risk of heart failure. CONCLUSION Improved oral hygiene care was associated with decreased risk of atrial fibrillation and heart failure. Healthier oral hygiene by frequent tooth brushing and professional dental cleaning may reduce risk of atrial fibrillation and heart failure.
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Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Korea
| | - Ho Geol Woo
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Korea
| | - Jin Park
- Department of Critical Care Medicine, Ewha Womans University Seoul Hospital, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Tae-Jin Song
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Korea
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Song TJ, Baek IY, Woo HG, Kim YJ, Chang Y, Kim BJ, Heo SH, Jung JM, Oh K, Kim CK, Yu S, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Chung JW, Bang OY, Kim GM, Seo WK. Characteristics and Factors for Short-Term Functional Outcome in Stroke Patients With Atrial Fibrillation, Nationwide Retrospective Cohort Study. Front Neurol 2019; 10:1101. [PMID: 31681159 PMCID: PMC6813464 DOI: 10.3389/fneur.2019.01101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/01/2019] [Indexed: 01/07/2023] Open
Abstract
Background and aims: Atrial fibrillation (AF) is a major cause of ischemic stroke; however, detailed clinical data and prognostic factors for stroke patients with AF are lacking in Korea. We aimed to investigate clinical information and factors associated with functional outcomes of stroke patients with AF from the Korean nationwide ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION) database. Methods: From January 2013 to December 2015, consecutive clinical information from acute stroke patients with AF or history of AF was collected from 11 centers in Korea. Collected data included demographics, risk factors, pre-stroke medication, stroke severity, stroke subtypes, concomitant cerebral atherosclerosis, brain image findings, recanalization therapy, discharge medication, and functional outcome at 3 months after index stroke. Results: A total of 3,213 stroke patients (mean age, 73.6 ± 9.8 years; female, 48.6%) were included. The mean CHA2DS2-VASc score was 4.9. Among the 1,849 (57.5%) patients who had brain image and functional outcome data, poor outcome (modified Rankin scale > 2) was noted in 53.1% (981/1,849) of patients. After adjusting for age, sex, and variables that had a p < 0.05 in univariate analysis or well-known factors for functional outcome, presence of asymptomatic extracranial cerebral atherosclerosis [odd ratio (OR): 1.96, 95% confidence interval (CI): 1.36–2.82, p = 0.001] and less frequent prior stroke statin intake (OR: 0.69, 95% CI: 0.49–0.98, p = 0.038) were associated with poor functional outcome. Conclusion: Our results suggest that presence of non-relevant extracranial cerebral atherosclerosis may affect poor functional outcome and prior stroke statin therapy may be feasible in Korean stroke patients with AF.
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Affiliation(s)
- Tae-Jin Song
- Department of Neurology, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - In-Young Baek
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St.Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Younkyung Chang
- Department of Neurology, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Jong-Ho Park
- Department of Neurology, MyongjiHospital, Hanyang University, College of Medicine, Goyang-si, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju-si, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Yang-Ha Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
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Shin YY, Ha SH, Woo HG, Heo SH, Chang DI, Kim BJ. Subclinical Peripheral Arterial Disease in Patients with Acute Ischemic Stroke: A Study with Ultrasonography. J Stroke Cerebrovasc Dis 2019; 28:104370. [PMID: 31522885 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/14/2019] [Accepted: 08/25/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) is an advanced form of atherosclerosis defined by an abnormal ankle-brachial index (ABI). However, the ABI provides no information about the location of atherosclerosis. We investigated the clinical implication of PAD confirmed using lower-extremity ultrasonography (LEUS), with consideration of the atherosclerosis location. METHODS Patients with acute ischemic stroke who underwent LEUS were enrolled. Patients with PAD were further divided into those with PAD at the proximal (above-popliteal artery, PADP) and distal (below-tibialis artery, PADD) segments. The clinical outcome was compared between patients with and without PAD, and between PADP and PADD. The atherosclerosis location in the cerebral artery was also compared between groups. RESULTS Among 289 patients, PAD was observed in 108 (37.4%) patients (43 had PADP and 65 had PADD). Patients with PAD were slightly older (P < .001) and had more significant carotid artery stenosis (30.6% versus 12.7%, P < .001) than those without. Patients with PAD had poor 3-month functional outcome than those without (modified-Rankin Scale score: 3 [interquartile range, 1-4] versus 2 [1-3], respectively, P = .003). Diabetes, high-stroke severity, and the presence of PADP (odds ratio, 3.893; 95% confidence interval, 1.454-10.425; P = .007) were independently associated with poor functional outcome at 3 months. Patients with PADP showed higher prevalence of extracranial stenosis than those with PADD (41.9% versus 23.1%; P = .038). CONCLUSIONS Our study suggests that subclinical PAD, especially PADP, is associated with poor functional outcome at 3 months after stroke onset. Interestingly, the location of cerebral atherosclerosis differed according to the location of PAD.
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Affiliation(s)
- Yu Yong Shin
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; Department of Neurology, Naeun Hospital, Incheon, Republic of Korea
| | - Sang Hee Ha
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Ho Geol Woo
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea.
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Woo HG, Chang Y, Ryu DR, Song TJ. Plasma Klotho concentration is associated with the presence, burden and progression of cerebral small vessel disease in patients with acute ischaemic stroke. PLoS One 2019; 14:e0220796. [PMID: 31398214 PMCID: PMC6688787 DOI: 10.1371/journal.pone.0220796] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 07/23/2019] [Indexed: 12/26/2022] Open
Abstract
Klotho is a soluble or membrane-bound anti-aging protein, whose protective actions are important for a prudential function of many organs. Because Klotho and cerebral small vessel disease (SVD) are associated with ageing process and endothelial dysfunction, it is possible that Klotho has an association with cerebral SVD. We aimed to investigate the association of plasma Klotho concentration with the presence, burden and progression of cerebral SVD. We prospectively enrolled 262 patients with first-ever acute cerebral infarction, performed brain MRI and collected their blood samples within 24 hours of admission. An enzyme-linked immunosorbent assay was used for evaluating plasma Klotho concentration. We estimated the total SVD score of each patient after determining the presence and burden of high-grade white matter hyperintensities (HWMHs), cerebral microbleeds (CMBs), high-grade perivascular spaces (HPVSs) and asymptomatic lacunar infarctions (ALIs). Univariate and multivariate analyses were conducted to investigate association of Klotho with cerebral SVD and the total SVD score. Of the 262 patients, 152 (58.0%) were men. The mean age of these patients was 64.7 years. The mean ± standard deviation of plasma Klotho concentration was 329.8 ± 194.1 pg/mL. In multivariate analysis, plasma Klotho concentration was negatively associated with the presence of HWMHs [Odds ratio (OR): 0.13, p = 0.047], HPVSs (OR: 0.22, p = 0.024) and ALIs (OR: 0.53, p = 0.021) but not associated with the presence of CMBs (OR: 0.39, p = 0.404). Plasma Klotho concentration was also negatively related to the total SVD score (unstandardized coefficients beta: −0.895, standard error = 0.317, p = 0.005, R2 = 0.239). Furthermore, plasma Klotho concentration was negatively related to the presence (OR: 0.75, 95% CI: 0.59–0.96, p = 0.025) and severity of cerebral SVD progression (OR: 0.72, 95% CI: 0.56–0.92, p = 0.009). In conclusion, plasma Klotho concentration was negatively associated with the presence, burden and progression of cerebral SVD.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yoonkyung Chang
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Dong-Ryeol Ryu
- Department of Nephrology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
- * E-mail:
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Woo HG, Jung C, Sunwoo L, Bae YJ, Choi BS, Kim JH, Kim BJ, Han MK, Bae HJ, Jung S, Cha SH. Dichotomizing Level of Pial Collaterals on Multiphase CT Angiography for Endovascular Treatment in Acute Ischemic Stroke: Should It Be Refined for 6-Hour Time Window? Neurointervention 2019; 14:99-106. [PMID: 31302985 PMCID: PMC6736504 DOI: 10.5469/neuroint.2019.00080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/09/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Although endovascular treatment is currently thought to only be suitable for patients who have pial arterial filling scores >3 as determined by multiphase computed tomography angiography (mpCTA), a cut-off score of 3 was determined by a study, including patients within 12 hours after symptom onset. We aimed to investigate whether a cut-off score of 3 for endovascular treatment within 6 hours of symptom onset is an appropriate predictor of good functional outcome at 3 months. Materials and Methods From April 2015 to January 2016, acute ischemic stroke patients treated with mechanical thrombectomy within 6 hours of symptom onset were enrolled into this study. Pial arterial filling scores were semi-quantitatively assessed using mpCTA, and clinical and radiological parameters were compared between patients with favorable and unfavorable outcomes. Multivariate logistic regression analysis was then performed to investigate the independent association between clinical outcome and pial collateral score, with the predictive power of the latter assessed using C-statistics. Results Of the 38 patients enrolled, 20 (52.6%) had a favorable outcome and 18 had an unfavorable outcome, with the latter group showing a lower mean pial arterial filling score (3.6±0.8 vs. 2.4±1.2, P=0.002). After adjusting for variables with a P-value of <0.1 in univariate analysis (i.e., age and National Institutes of Health Stroke Scale score at admission), pial arterial filling scores higher than a cut-off of 2 were found to be independently associated with favorable clinical outcomes (P=0.012). C-statistic analysis confirmed that our model had the highest prediction power when pial arterial filling scores were dichotomized at >2 vs. ≤2. Conclusion A pial arterial filling cut-off score of 2 as determined by mpCTA appears to be more suitable for predicting clinical outcomes following endovascular treatment within 6 hours of symptom onset than the cut-off of 3 that had been previously suggested.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Cheolkyu Jung
- Department of Radiology, Seoul National University Bundang Hospital, Korea
| | - Leonard Sunwoo
- Department of Radiology, Seoul National University Bundang Hospital, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Korea
| | - Byung Se Choi
- Department of Radiology, Seoul National University Bundang Hospital, Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Korea
| | - Seunguk Jung
- Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sang-Hoon Cha
- Department of Radiology, Chungbuk National University College of Medicine, Cheongju, Korea
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Abstract
Background: The Klotho protects the cardiovascular system by protecting against cell apoptosis, inhibiting the production of reactive oxygen species, and modulating inflammation. We aimed to investigate relationship of plasma Klotho concentrations with functional outcome at 3 months after acute cerebral infarction. Methods: We prospectively enrolled 262 first-ever acute cerebral infarction patients from whom a blood sample was acquired within 24 h of admission. An enzyme-linked immunosorbent assay was used for evaluating plasma Klotho concentration. Functional outcome on admission and three months was evaluated. Results: Of the 262 patients, 152 (58.0%) were men. The mean age of these patients was 64.7 years. The mean ± standard deviation of plasma Klotho concentrations was 312.7 ± 153.3 pg/mL. As opposed to patients with good outcome, plasma Klotho levels were lower in the poor outcome group (207.8 ± 96.2 vs. 342.5 ± 153.5 pg/mL, p = .001). In multivariate analysis, increased plasma Klotho concentrations were independently associated with good functional outcome (Odds ratio: 2.42, 95% confidence interval: 1.45-4.04, p < .001). Conclusions: Increased plasma Klotho concentrations were associated with good functional outcome in patients with acute ischemic stroke. We attribute these associations to the pleiotropic effects of Klotho in stroke and vascular diseases. Key message Increased plasma Klotho concentrations were associated with good functional outcome in patients with acute ischemic stroke.
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Affiliation(s)
- Jun-Beom Lee
- a Department of Neurology , Hongik Hospital , Seoul , Korea
| | - Ho Geol Woo
- b Department of Neurology , College of Medicine, Ewha Womans University , Seoul , Korea
| | - Yoonkyung Chang
- b Department of Neurology , College of Medicine, Ewha Womans University , Seoul , Korea
| | - Yoon Mi Jin
- c Department of Molecular Medicine, College of Medicine , Ewha Womans University , Seoul , Korea
| | - Inho Jo
- c Department of Molecular Medicine, College of Medicine , Ewha Womans University , Seoul , Korea
| | - Jinkwon Kim
- d Department of Neurology , Gangnam Severance Hospital, Yonsei University College of Medicine , Seoul , Korea
| | - Tae-Jin Song
- b Department of Neurology , College of Medicine, Ewha Womans University , Seoul , Korea
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46
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Woo HG, Chung I, Gwak DS, Kim BK, Kim BJ, Bae HJ, Han MK. Recurrent ischemic stroke in atrial fibrillation with non-vitamin K antagonist oral anticoagulation. J Clin Neurosci 2019; 64:127-133. [PMID: 30929960 DOI: 10.1016/j.jocn.2019.03.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/25/2019] [Accepted: 03/21/2019] [Indexed: 11/29/2022]
Abstract
The etiology or rate of recurrent ischemic stroke according to dosing methods including drug adherence in patients taking non-vitamin K antagonist oral anticoagulants (NOACs) remain uncertain. We investigated the association between dosing methods including drug adherence achieved with NOACs and the presence of major vessel occlusion (MVO) in patients with ischemic stroke with non-valvular atrial fibrillation (NVAF). From July 2013 through December 2016, 120 patients with recurrent ischemic stroke with NVAF on NOACs were retrospectively analyzed. Patients taking non-standard doses of NOACs were divided into the missed dose group that discontinued NOACs for ≥48 h prior to arrival, and the under-dose group that used lower doses of NOACs. A logistic regression analysis was performed to determine the association between MVO and dosing methods including drug adherence. There were 60 (50.0%), 39 (32.5%), and 21 (17.5%) patients, respectively, in the standard dose, under-dose, and missed dose groups. Twelve patients (20.0%) in the standard dose group, 15 (38.5%) in the under-dose group, and 13 (61.9%) in the missed dose group had MVO. MVO was significantly higher in the missed dose group than in the standard dose and under-dose groups (P = 0.002). In patients with ischemic stroke with NVAF, who are on NOACs, anticoagulation caused by missed or lowered doses of NOACs was significantly associated with MVO in patients with recurrent cardioembolic stroke.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
| | - Inyoung Chung
- Department of Neurology, Seoul National University Bundang Hospital, Republic of Korea
| | - Dong Seok Gwak
- Department of Neurology, Seoul National University Bundang Hospital, Republic of Korea
| | - Baik Kyun Kim
- Department of Critical Care Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
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47
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Woo HG, Chung I, Gwak DS, Kim BK, Kang JH, Kim BJ, Bae HJ, Han MK. Intracerebral hemorrhage associated with warfarin versus non-vitamin K antagonist oral anticoagulants in Asian patients. J Clin Neurosci 2018; 61:160-165. [PMID: 30587420 DOI: 10.1016/j.jocn.2018.10.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/24/2018] [Indexed: 01/14/2023]
Abstract
Non-valvular atrial fibrillation patients receiving non-vitamin K antagonist oral anticoagulants (NOACs) have half the incidence of intracerebral hemorrhage (ICH) compared to those receiving warfarin. However, the differences in outcomes of NOAC-associated ICH (NICH) and warfarin-associated ICH (WICH) remain controversial. In this study, we investigated the clinical outcome and radiologic findings of ICH in Asian patients receiving NOACs or warfarin. We retrospectively reviewed the medical records of 544 ICH patients admitted to our hospital from January 2013 through December 2017, and compared the baseline demographics, clinical characteristics, ICH-related radiologic findings, and clinical outcome between the WICH and NICH groups. WICH and NICH were diagnosed in 46 and 13 patients, respectively. Lesions were located more frequently in the supratentorial deep area (45.7% and 46.2%) than the lobar area (30.4% and 30.8%) or brainstem and cerebellum (23.9% and 23.1%) in the WICH and NICH groups, respectively. The hematoma expansion and concomitant intraventricular hemorrhage (IVH) rate was significantly higher in the WICH group than in the NICH group (58.7% versus 7.7%, P = 0.001 and 50.0% versus 15.4%, P = 0.030, respectively). Hematoma expansion (odds ratio [OR]: 50.546; 95% confidence interval [CI]: 2.763-924.748; P = 0.008) and concomitant IVH (OR: 9.240; 95% CI: 1.450-58.892; P = 0.019) were independently associated with mortality at three months, after adjustment for confounding variables. Our results indicate that the radiological findings and clinical outcome at three months in patients with ICH are more favorable in those receiving NOAC therapy than in those receiving warfarin treatment.
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Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Inyoung Chung
- Department of Neurology, Seoul National University Bundang Hospital, Republic of Korea
| | - Dong Seok Gwak
- Department of Neurology, Seoul National University Bundang Hospital, Republic of Korea
| | - Baik Kyun Kim
- Department of Critical Care Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Ji Hoon Kang
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
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48
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Jung S, Jung C, Hyoung Kim J, Se Choi B, Jung Bae Y, Sunwoo L, Geol Woo H, Young Chang J, Joon Kim B, Han MK, Bae HJ. Procedural and clinical outcomes of endovascular recanalization therapy in patients with cancer-related stroke. Interv Neuroradiol 2018; 24:520-528. [PMID: 29792090 DOI: 10.1177/1591019918776207] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective Embolism due to coagulopathy might be the main pathomechanism underlying cancer-related stroke (CRS). CRS patients with a large artery occlusion could be candidates for endovascular recanalization therapy (ERT), although its procedural and clinical outcomes are not well known. This study aimed to investigate the procedural and clinical outcomes of ERT in CRS patients and the characteristics associated with outcomes compared with those of conventional stroke patients. Methods A registry of consecutive acute ischemic stroke patients who underwent ERT between January 2011 and October 2015 was retrospectively reviewed. CRS patients are described as those who had (a) cryptogenic stroke with advanced or metastatic cancer; (b) no other possible causes of stroke such as cardioembolism (CE) and large artery atherosclerosis (LAA); and (c) elevated D-dimer levels or diffusion-restricted lesions in multiple vascular territories. We compared procedural and clinical outcomes at discharge among CRS, CE, and LAA patients. Results A total of 329 patients were finally enrolled in this study; of these, 19 were CRS patients. The rate of successful recanalization, defined as modified treatment in cerebral infarction grade 2b or 3, was lower in the CRS group than in the LAA and CE groups (63% versus 84% versus 84%, p = .06). CRS subtype was an independent predictor for successful recanalization after ERT in the multivariate analysis (odds ratio, 0.317; 95% confidence interval, 0.116-0.867; p < .001). No significant difference in the rate of good clinical outcomes at discharge was observed among groups. Conclusions Although clinical outcomes at discharge were similar for CE and LAA patients, complete recanalization seemed more difficult to achieve in CRS patients than in conventional stroke patients.
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Affiliation(s)
- Seunguk Jung
- 1 Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Cheolkyu Jung
- 2 Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyoung Kim
- 2 Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Se Choi
- 2 Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Jung Bae
- 2 Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Leonard Sunwoo
- 2 Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho Geol Woo
- 2 Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jun Young Chang
- 1 Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Beom Joon Kim
- 3 Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon-Ku Han
- 3 Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee-Joon Bae
- 3 Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
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49
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Woo HG, Jung C, Kim BJ, Han MK, Bae HJ, Bae YJ, Choi BS, Kim JH, Sunwoo L. Abstract WMP12: Feasibility of Permanent Stenting With Solitaire Fr as a Rescue Treatment for the Reperfusion of Acute Intracranial Artery Occlusion. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wmp12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Solitaire FR can be used not only as a tool for mechanical thrombectomy but also as a detachable permanent stent. Our aim was to assess the feasibility and safety of permanent stenting with Solitaire FR (erv3, Irvine, CA, USA) compared with other self-expanding stents for intracranial artery recanalization for acute ischemic stroke.
Materials and Methods:
From January 2011 through January 2016, 2,979 patients with acute ischemic stroke were retrospectively selected. Among them, 27 patients who underwent permanent stenting (13 patients with Solitaire FR (Solitaire group) and 14 patients with other self-expanding stents (other stent group)) were enrolled. The post-procedural mTICI grade and angiographic and clinical outcomes at discharge and 3 months were assessed. The safety and efficacy of permanent stenting of Solitaire FR stent placement for acute large arterial occlusion were evaluated.
Results:
Stent placement was successful in all cases. mTICI 2b-3 reperfusion was noted in 84.6% of Solitaire group and in 78.6% of other stent group. Procedure time was significantly shorter in Solitaire group than other stent group (
P
= 0.022). No significant differences were found in mTICI grade, NIHSS score at discharge, mRS at 3 months, and rate of hemorrhagic transformation between the two groups. Acute in-stent thrombosis rate at discharge was significantly lower when glycoprotein IIb/IIIa inhibitor was injected during the procedure (
P
= 0.013).
Conclusions:
Permanent stenting of Solitaire FR compared with other self-expanding stents appears to be feasible and safe as a rescue tool for refractory intra-arterial therapy.
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Affiliation(s)
- Ho Geol Woo
- Seoul National Univ Bundang Hosp, Seongnam, Korea, Republic of
| | - Cheolkyu Jung
- Seoul National Univ Bundang Hosp, Seongnam, Korea, Republic of
| | - Beom Joon Kim
- Seoul National Univ Bundang Hosp, Seongnam, Korea, Republic of
| | - Moon-Ku Han
- Seoul National Univ Bundang Hosp, Seongnam, Korea, Republic of
| | - Hee-Joon Bae
- Seoul National Univ Bundang Hosp, Seongnam, Korea, Republic of
| | - Yun Jung Bae
- Seoul National Univ Bundang Hosp, Seongnam, Korea, Republic of
| | - Byung Se Choi
- Seoul National Univ Bundang Hosp, Seongnam, Korea, Republic of
| | - Jae Hyoung Kim
- Seoul National Univ Bundang Hosp, Seongnam, Korea, Republic of
| | - Leonard Sunwoo
- Seoul National Univ Bundang Hosp, Seongnam, Korea, Republic of
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50
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Woo HG, Sunwoo L, Jung C, Kim BJ, Han MK, Bae HJ, Bae YJ, Choi BS, Kim JH. Feasibility of Permanent Stenting with Solitaire FR as a Rescue Treatment for the Reperfusion of Acute Intracranial Artery Occlusion. AJNR Am J Neuroradiol 2017; 39:331-336. [PMID: 29242362 DOI: 10.3174/ajnr.a5477] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 10/04/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Solitaire FR can be used not only as a tool for mechanical thrombectomy but also as a detachable permanent stent. Our aim was to assess the feasibility and safety of permanent stent placement with the Solitaire FR compared with other self-expanding stents for intracranial artery recanalization for acute ischemic stroke. MATERIALS AND METHODS From January 2011 through January 2016, we retrospectively selected 2979 patients with acute ischemic stroke. Among them, 27 patients who underwent permanent stent placement (13 patients with the Solitaire FR [Solitaire group] and 14 patients with other self-expanding stents [other stent group]) were enrolled. The postprocedural modified TICI grade and angiographic and clinical outcomes were assessed. The safety and efficacy of permanent stent placement of the Solitaire FR for acute large-artery occlusion were evaluated. RESULTS Stent placement was successful in all cases. Modified TICI 2b-3 reperfusion was noted in 84.6% of the Solitaire group and in 78.6% of the other stent group. Procedural time was significantly shorter in the Solitaire group than in the other stent group (P = .022). Shorter procedural time was correlated with favorable outcome (ρ = 0.46, P = .035). No significant differences were found in the modified TICI grade, NIHSS score, mRS, and hemorrhagic transformation rate between the 2 groups. The acute in-stent thrombosis rate at discharge was significantly lower when a glycoprotein IIb/IIIa inhibitor was injected during the procedure (P = .013). CONCLUSIONS Permanent stent placement with the Solitaire FR compared with other self-expanding stents appears to be feasible and safe as a rescue tool for refractory intra-arterial therapy.
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Affiliation(s)
- H G Woo
- From the Departments of Radiology (H.G.W., L.S., C.J., Y.J.B., B.S.C., J.H.K.)
| | - L Sunwoo
- From the Departments of Radiology (H.G.W., L.S., C.J., Y.J.B., B.S.C., J.H.K.)
| | - C Jung
- From the Departments of Radiology (H.G.W., L.S., C.J., Y.J.B., B.S.C., J.H.K.)
| | - B J Kim
- Neurology (B.J.K., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Bundang, Seongnam, Korea
| | - M-K Han
- Neurology (B.J.K., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Bundang, Seongnam, Korea
| | - H-J Bae
- Neurology (B.J.K., M.-K.H., H.-J.B.), Seoul National University Bundang Hospital, Bundang, Seongnam, Korea
| | - Y J Bae
- From the Departments of Radiology (H.G.W., L.S., C.J., Y.J.B., B.S.C., J.H.K.)
| | - B S Choi
- From the Departments of Radiology (H.G.W., L.S., C.J., Y.J.B., B.S.C., J.H.K.)
| | - J H Kim
- From the Departments of Radiology (H.G.W., L.S., C.J., Y.J.B., B.S.C., J.H.K.)
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