Jihoon Kang

Seoul National University Bundang Hospital

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Hee‐Joon Bae

Seoul National University Bundang Hospital

Beom Joon Kim

Seoul National University Bundang Hospital

Moon‐Ku Han

Seoul National University Bundang Hospital

Ji Sung Lee

Asan Medical Center

Juneyoung Lee

Boramae Medical Center

Jong‐Moo Park

Eulji University

Jun Yup Kim

Seoul National University Bundang Hospital

Soo Joo Lee

Eulji University Hospital

Kyung Bok Lee

Soonchunhyang University Hospital

Jae‐Kwan Cha

Dong-A University Hospital

Cooperative Institutions

Seoul National University Bundang Hospital

170

Seoul National University

161

University College London

120

Seoul National University Hospital

National University College

Biomedical Research Institute

Yonsei University

Hospital de Sant Pau

Korea University

New Generation University College

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Research Trends of Sustainable Smartcity in South Korea using Keyword Network Analysis

The Korean Career Entrepreneurship & Business Association (2022)

Jooyeon Oh Jihoon Kang

본 연구의 목적은 언어네트워크분석을 통해 지속가능한 스마트시티의 국내연구동향을 분석하는 것이다. 연구결과는 다음과 같다. 첫째, 지속가능한 스마트시티 연구가 처음으로 등장한 시기는 2016년으로 2016년 이후 점차적으로 논문이 증가하는 것으로 나타났다. 둘째, 지속가능한 스마트시티 관련 연구에서 가장 많이 등장하였던 핵심어는 ‘개발(42회)’, ‘기술(40회)’, ‘거버넌스(37회)’, ‘혁신(36회)’, ‘서비스(36회)’ 등의 순으로 나타났다. 셋째, 연결중심성이 높은 핵심어인 ‘기술’, ‘시민’, ‘정책’, ‘혁신’은 매개중심성, 위세중심성, 근접중심성 지표 모두 높게 나타났다. 본 연구결과는 스마트시티 관련 정부 기관들과 민간 기업들에 스마트시티에 대한 정책수립과 전략방향을 수립하는데 유용한 정보가 될 것으로 기대된다.

10.48206/kceba.2022.6.1.69

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Abstract WP1: Recanalization Therapy For Acute Symptomatic Occlusion Of The Intracranial Cerebral Arteries In Korea

Stroke (2013)

Min Uk Jang Jihoon Kang Beom Joon Kim Jeong-Ho Hong Moon‐Ku Han

Background: Despite its clinical importance in the Koreans, the status of recanalization therapy for acute occlusion of the intracranial cerebral arteries has not been reported yet. Methods: Using a nationwide stroke registry, a consecutive series of 642 patients with symptomatic occlusion of intracranial arteries were identified among 3028 who were hospitalized within 12 h of stroke onset at 10 participating centers between 2010 and 2011. Demographics, clinical characteristics, clinical outcomes, and type of recanalization therapy were described. Results: The mean age was 68.6 years (57.2% males, median baseline NIHSS 12). MCA was most commonly affected vessel (65.1%), followed by intracranial ICA (15.3%), PCA (14.2%), basilar artery (11.1%), and ACA (5.1%). Recanalization therapy was applied in 307 patients (47.8%); intravenous thrombolysis only (IVT) in 45.9%, and endovascular treatment (ET) in 54.1%. Intravenous thrombolysis treatment preceded ET in 69.9%. Doses of tPA were 0.6mg/kg in 22.3% and 0.9mg/kg in 77.7%. Recanalization therapy according to occluded vessels and onset-to-arrival time is described in the Table. Recanalization by IAT as seen on angiography was complete (thrombolysis in cerebral infarction [TICI] grade 3) in 29.5% and partial (TICI grade 2A or 2B) in 50.6%. Solitaire were applied to 48.8% of patients with ET and recanalization rate was 86.4%, and Penumbra were applied to 15.1% and recanalization rate (TICI grade 2A~3) was 76.0%. Favorable outcome (modified Rankin Scale, 0-2) was achieved in 39.4% of those with IVT and in 35.4% of those with ET, and symptomatic hemorrhagic transformation occurred in 8.5% and 12.0%, respectively. Conclusion: This study shows that a considerable proportion of patients with symptomatic occlusion of intracranial cerebral arteries are treated by endovascular approach. Efficacy and safety of endovascular approach in this setting should be tested by randomized clinical trials.

Penumbra

Solitaire Cryptographic Algorithm

Stroke

Demographics

10.1161/str.44.suppl_1.awp1

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Clinical effects and safety review of self-expanding stent surgery for extracranial carotid artery stenosis treatment

Genetics and Molecular Research (2014)

Qin-hui Zhu Sungsoon Fang G.F. Wang Zhiming Zhou Shichun Bian

This study aimed to investigate the clinical effects and safety review of self-expanding stent surgery in the treatment of extracranial carotid artery stenosis.Seventy-eight patients with carotid artery stenosis were applied with the self-expanding stent for endovascular interventional therapy.Eighty-one stents were implanted into 80 blood vessels of the 78 patients, in which protective umbrellas were used in 56 cases, and the success rate of stent implantation was 100%.The stenosis degree decreased from the preoperative (86.72 ± 9.5%) to the postoperative (13.43 ± 5.62%) stage, and the blood peak velocity of the stenosed vessels decreased from 189.58 ± 13.5 to 83.73 ± 5.61 cm/s.Transient blood pressure and heart rate decreases occurred in 21 cases, continuously low blood pressure and heart rate decreasing occurred in 29 cases, and acute occlusion of the ipsilateral middle cerebral artery occurred in 1 case, which was resolved through thrombolysis and thrombus breaking in time.Overperfusion symptoms were observed in 13 cases, although without serious complications such as cerebral hemorrhage.The follow-up period continued for 6-32 months, and ultrasonography revealed that ©FUNPEC-RP www.funpecrp.com.

10.4238/2014.july.7.5

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Abstract T MP78: Real Time Prediction of Early Neurologic Deterioration using A Blood Pressure Volatility Model in Acute Ischemic Stroke

Stroke (2014)

Jihoon Kang Maeng Seok Noh Youngjo Lee Min Uk Jang Jeong‐Ho Hong

Objectives: We aimed to develop a blood pressure (BP) embedded real time prediction model for early neurologic deterioration (END) in patients with acute ischemic stroke Methods: We identified consecutive ischemic stroke patients hospitalized within 48 hours of symptom onset from a prospective stroke registry database. BP data during hospitalization were obtained from the electric medical records. Probability of END at each time point of BP measurement was estimated using logistic model with covariates derived from two models for clinical information and BP parameters. A model for clinical information was fitted by using logistic model with patients’ clinical characteristics to predict END. A model for BP was fitted by random-effects models with temporal correlations at each time point of BP measurement with irregular intervals for mean as well as dispersion. Prediction performance was evaluated by calculating receiver operating characteristic (ROC) curve, and the cut-off value of high probability of END was determined at each time point. An alarm criterion for a proportion of high probability of END at each time point was defined as more than 50% of point probabilities being above the cut-off during the prior 24 hours. Predictive values of the prediction model were analyzed. Result: Of 1805 subjects, 18.3% experienced END. The predicted model for END within 24h hours from each time point of BP measurement was fitted by the model for clinical information of age, sex, history of stroke, time to arrival, baseline NIHSS score, diabetes mellitus, initial glucose level, atrial fibrillation, leukocyte count, stroke subtypes, recanalization therapy, and location of symptomatic vessel and by estimated mean of systolic BP and dispersion of diastolic BP from the temporal model for BP. Prediction performance was determined (Area Under Curve of ROC = 0.72) and the cut-off probability of END at each time point was set as > 0.01 (sensitivity = 50% and specificity = 81%). Using these criteria, about 70% of patients with END could be alarmed within 24 hours before the occurrence of END although 20% of those without END were falsely alarmed. Conclusion: This BP-embedded real time prediction model would helpful to predict and give a warning of the following END.

Time point

Stroke

10.1161/str.45.suppl_1.tmp78

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Fasting and Non-Fasting Triglycerides in Patients With Acute Ischemic Stroke

Research Square (Research Square) (2021)

Jun Yup Kim Keon‐Joo Lee Jihoon Kang Beom Joon Kim Moon‐Ku Han

Abstract Introduction: Clinical implications of elevated fasting triglycerides (FTG) and non-fasting triglycerides (NFTG) in acute ischemic stroke (AIS) remain unknown. We aimed to elucidate the correlation and clinical significance of FTG and NFTG levels in AIS patients. Methods Using a multicenter prospective stroke registry, we identified AIS patients hospitalized within 24h of onset with available NFTG results. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all-cause mortality up to one year. Results This study analyzed 2,176 patients. The prevalence of fasting and non-fasting hypertriglyceridemia was 11.5% and 24.6%, respectively. Multivariate analysis revealed that younger age, diabetes, higher body mass index and initial systolic blood pressure were independently associated with both fasting and non-fasting hypertriglyceridemia (all p < 0.05). Patients with higher quartiles of NFTG were more likely to be male, younger, ever-smokers, diabetic, and have family histories of premature coronary heart disease and stroke (all p < 0.05). Similar tendencies were observed for FTG. The composite outcome was not associated with FTG or NFTG quartiles. Conclusion The fasting and non-fasting hypertriglyceridemia were prevalent in AIS patients and showed similar clinical characteristics and outcomes. High FTG and NFTG levels were not associated with occurrence of subsequent clinical events up to one year.

Stroke

Quartile

Clinical Significance

10.21203/rs.3.rs-750314/v1

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Effect of blood pressure on 3-month functional outcome in the subacute stage of ischemic stroke

Neurology (2012)

Jihoon Kang Youngchai Ko Jung Hyun Park Wook‐Joo Kim Myung Suk Jang

ABSTRACT

Objective:

We aimed to study various measures of blood pressure (BP) in the subacute phase of ischemic stroke to determine whether any of them predicted clinical outcome.

Methods:

In this retrospective observational study, a consecutive series of patients hospitalized for ischemic stroke within 48 hours of onset were enrolled. The subacute stage of stroke was defined as the time period from 72 hours of symptom onset to discharge or transfer. During this period, mean, maximum, maximum − minimum, SD, and coefficient of variation of systolic BP (SBP) and diastolic BP (DBP) were determined. A baseline severity-adjusted analysis was performed using each patient’s 3-month modified Rankin Scale score as the primary outcome.

Results:

Among a total of 2,271 patients, the median number of BP measurements was 34 per person and the median interval from onset to discharge was 8.7 days. Measures of variability of BP were associated with poor outcome. One SD increase of maximum − minimum (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.12–1.42), SD (OR, 1.20; 95% CI, 1.07–1.34), or coefficient of variation (OR, 1.21; 95% CI, 1.09–1.35) for SBP, but not mean level of SBP (OR, 0.92; 95% CI, 0.79–1.07), was independently associated with poor outcome. Results were similar for DBP.

Conclusion:

This study shows that variability of BP, but not average BP in the subacute stage of ischemic stroke, is associated with functional outcome at 3 months after stroke onset.

Stroke

10.1212/wnl.0b013e3182749eb8

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Therapeutic induced blood pressure eJevation for the treatment of acute brain ischemia : Case report

Journal of Medicine and Life Science (2010)

Joong‐Goo Kim Jae Young Lee Jee Young Kim Jihoon Kang Sa‐Yoon Kang

Reperfusion of the ischemic brain is the most effective therapy for salvage of penumbral tissue in acute ischemic stroke. However, only a few patients are eligible for thrombolytic therapy due to time limit or other unavoidable contraindications for the treatment in spite of the presence of salvageable tissue. Several small clinical studies have shown that pharmacologically induced blood pressure elevation may improve neurological deficits in acute ischemic stroke, presumably by augmenting blood flow to penumbral brain tissue. We report a patient with acute ischemic stroke who showed successful recovery of neurologic deficit after therapeutic induced hypertension. A 69 years old man presented with acute ischemic stroke due to atherothrombotic occlusion of right internal carotid artery. Initial cranial MRI showed significant perfusion-diffusion mismatch. The patient showed progressive deterioration despite intravenous thrombolysis. Induced hypertension therapy with phenylephrine was started toincrease cerebral blood flow to ischemic brain tissue. Affer elevation of blood pressure, the patient's condition recovered markedly. There was no complication associated with induced hypertension. Drug induced hypertension therapy can be helpful in selected patients with acute ischemic stroke who had perfusion-diffusion mismatch on MRI due to severe stenosis or occlusion of large cerebral arteries.

Stroke

Brain ischemia

10.22730/jmls.2010.7.1.174

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Abstract WMP97: Symptomatic Steno-occlusion Of Major Cerebral Arteries And Stroke Recurrence In Acute Ischemic Stroke Patients With Atrial Fibrillation

Stroke (2023)

Hyung Seok Guk Do Yeon Kim Keun‐Sik Hong Jun Yup Kim Jihoon Kang

Introduction: There is lack of knowledge on whether symptomatic steno-occlusion (SYSO), common in acute ischemic stroke (AIS) patients with atrial fibrillation (AF), could increase the long-term risk of stroke recurrence in these patients. Methods: From a prospective cohort of patients with AIS and AF enrolled in 14 centers between Oct 2017 and Dec 2018, we identified patients who underwent MR angiography during hospitalization and completed 3-year follow-up including death during follow-up. SYSO was defined as (1) ≥ 50% stenosis or occlusion of cerebral arteries relevant to acute infarction or (2) any residual stenosis after endovascular treatment. Using cause-specific hazard models with non-stroke death as a competing risk, the risk of any recurrent stroke and recurrent ischemic stroke was estimated according to SYSO, respectively. Results: A total of 889 patients (mean age, 74.4 years; men, 54.6 %; median NIHSS, 6) were analyzed for this study. During the median 1096 days of follow-up, 152 any recurrent strokes, 142 recurrent ischemic strokes, and 208 deaths were observed. Patients with SYSO, compared to those without, were more likely to be older, be female, have hypertension, diabetes and history of stroke/TIA, and be on antiplatelets at discharge and were less likely to be on anticoagulants at discharge ( p <.05). The cumulative incidence of recurrent stroke in patients with and without SYSO was 25.2% and 8.3% at 1 month, 33.1% and 9.9% at 1 year, and 41.8% and 13.1% at 3 years, respectively ( p <.001). With adjusting age, sex, hypertension, diabetes, history of stroke/TIA, discharge antiplatelets, and discharge anticoagulants, SYSO increased the risk of any stroke recurrence (adjusted hazard ratio [95% confidence interval]; 3.02 [2.18-4.20]; p <.001) and ischemic stroke recurrence (3.20 [2.28-4.51]; p <.001). Conclusions: SYSO in AIS patients with AF substantially increased the risk of recurrent stroke by a 3-fold or more. Accordingly, SYSO should be considered in stratifying the risk of recurrence in AIS patients with AF.

Stroke

Cumulative incidence

10.1161/str.54.suppl_1.wmp97

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P118/214 New image transmitting system with stroke fast track for interhospital transfer in Korea

Abstracts (2023)

Jun Yup Kim Do Yeon Kim Beom Joon Kim Moon‐Ku Han Hee‐Joon Bae

Introduction

Patients with acute ischemic stroke (AIS) who require endovascular thrombectomy (EVT) will be transferred from Primary-community-Stroke-Center (PSC) to Thrombectomy-capable-Stroke-Center (TSC). The medical records including images at PSC are copied and delivered through the patient, and TSC doctors make decisions after the patient visits, which delays starting EVT.

Aim of Study

We report the "Stroke Fast Track' system, which could bypass the medical data delivery process.

Methods

"Stroke Fast Track' launched in March 2019. It allows medical records, including images taken at PSC, to be transmitted before the patient arrives at TSC. If the Stroke Fast Track is not used, the patient follows the previous transfer methods. TSC's stroke physicians can check images before a patient arrives, plan a treatment plan, including whether EVT is performed or not.

Results

From March 2019 to August 2022, a total of 138 patients (age, 67.4±15.1; male, 58.7%) were transferred. Among them, 31.9% used the Stroke Fast Track. Transportation time took median 52 minutes by ambulance. EVT was performed on 19 patients (13.8%) at the TSC, which took a median duration of 183 min, composed of 85 min at PSC, 48 min for transportation, and 50 min at TSC. The average door-to-puncture time of the patients who used Stroke Fast Track and those who did not were 53 minutes and 100 minutes, respectively.

Conclusion

The Stroke Fast Track system, which can transmit medical data directly and non-face-to-face before arriving at the TSC, is feasible and can be utilized to shorten the start of EVT.

Disclosure of Interest

Nothing to disclose

Stroke

Fast track

Medical record

10.1136/jnis-2023-esmint.147

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Usefulness of a Weighted-based, Patient-Specific Nomogram for Intravenous Heparin Therapy in Ischemic Stroke Patients

Journal of the Korean Neurological Association (2007)

Yunsook Jhang Jihoon Kang Jungmoo Nam Curie Chung Jong Moo Park

Background: Despite the lack of supporting evidence, intravenous heparin is still given frequently in the treatment of cerebral ischemia. However, there is only one study for the use of heparin nomogram in ischemic stroke or TIA. We evaluated the usefulness of a patient-specific, as well as weight-based, nomogram for the intravenous heparin in patients with ischemic stroke or TIA. Methods: From Sep. 2004 to Sep. 2005, we recruited ischemic stroke patients treated according to the specifically designed heparin nomogram. The therapeutic range (TR) of activated partial thromboplastin time (aPTT) and dose adjustment were specified as a ratio of each patient’s baseline aPTT. The first time to achieve TR (TR-time), to exceed therapeutic threshold (TE-time) and the fraction of time in TR (total time in TR/total time of heparin use, %) were analyzed. Results: A total of 45 patients were included. The mean fraction of time in TR was 72.7±14.4%. Although TR-time and TE-time did not differ according to the use of bolus injection, the fraction of first aPTT at 6 hours after start of infusion in TR was higher with bolus than without bolus (84.8 vs. 58.3, p

Nomogram

Bolus (digestion)

Intravenous bolus

Therapeutic index

Stroke

Source

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