Seungwon Kwon

Can the Neutrophil-to-Lymphocyte Ratio Appropriately Predict Carotid Artery Stenosis in Patients with Ischemic Stroke?-A Retrospective Study.

BACKGROUND Carotid stenosis is a risk factor in ischemic stroke. Although C-reactive protein, interleukin-6, and tumor necrosis factor-alpha are known to predict carotid atherosclerosis, they are difficult to obtain in clinical practice. By studying the association between neutrophil-to-lymphocyte ratio (NLR) and carotid artery intima-media thickening (IMT) in patients with ischemic stroke, we determined that the NLR can predict carotid stenosis. METHODS We selected 252 patients with acute to subacute ischemic stroke who underwent carotid ultrasonography and complete and differential blood cell count tests. We collected data on sex, age, body mass index (BMI), alcohol consumption, smoking, hypertension, diabetes mellitus, dyslipidemia, and heart disease. Male and female patients were analyzed separately. We divided the subjects into 2 groups according to carotid IMT, and compared baseline characteristics and NLR between the 2 groups. The regression analysis was adjusted for confounding factors such as age, BMI, NLR, smoking, alcohol consumption, and a medical history of hypertension, diabetes mellitus, dyslipidemia, or heart disease. RESULTS Carotid IMT tended to significantly increase with NLR and age in men and with age in women. In men, multiple linear regression analyses adjusted for confounding factors showed that NLR (P < 0.001) and age (P = 0.001) had a significant positive association with carotid IMT (adjusted R(2) = 0.185, root mean squared error [MSE] = 0.152). However, no parameters showed significant positive associations in women. CONCLUSION NLR can be a clinically significant predictor of the degree of carotid stenosis in male patients with ischemic stroke. However, additional studies are required to obtain more concrete results.

Administration of Hwang-Ryun-Haedok-tang, a Herbal Complex, for Patients With Abdominal Obesity: A Case Series

Herbal medicines have received attention as antiabdominal obesity agents. We present a series of 13 cases that demonstrate the positive effect of the herbal complex Hwang-Ryun-Haedok-Tang (HRHT; Tsumura, Tokyo, Japan) on weight and abdominal fat control in patients with abdominal obesity. We treated 13 patients with abdominal obesity treated for 54.46 ± 18.07 days with 5.0 g of HRHT daily. To evaluate the treatment, the morphometric (i.e., waist circumstance, weight, body fat) and biochemical parameters were measured once monthly. After HRHT therapy, the waist circumstance decreased from 91.96 ± 7.99 cm to 87.12 ± 8.09 cm (paired t test, P < .001) and the weight decreased from 78.09 ± 14.35 kg (average ± standard deviation) to 75.72 ± 14.60 kg (paired t test, P < .001). All 13 (100%) patients had low waist circumstances after treatment. Overall, 12 (92.3%) of the 13 patients had a lower weight and body mass index. In the present study, we showed the clinical effects of HRHT on waist circumstance, weight, body mass index, and body fat in patients with abdominal obesity. Further clinical studies investigating the effects of HRHT are needed.

Can Combination Therapy of Conventional and Oriental Medicine Improve Poststroke Aphasia? Comparative, Observational, Pragmatic Study

The aim of the present study was to determine the effectiveness of oriental medicine therapy on poststroke aphasia. The outcome was measured as the delta value of the Aphasic Quotient score. Patients completed test at two timepoints: baseline and discharge time. Patients who received conventional therapy and language therapy were grouped in the Only Language Therapy group. Patients who received conventional therapy, language therapy, and an Oriental medicine regimen were grouped in the Combined oriental Medicine Therapy group. We compared the delta value of the Aphasic Quotient score between two groups. The Combined Oriental Medicine group exhibited a greater improvement than the Only Language Therapy group in the total Aphasic Quotient score and most subsection scores. In particular, there were statistically significant differences in total Aphasic Quotient score and subsections such as spontaneous speech, content delivery, comprehension, auditory verbal comprehension, and command performance. Among severe aphasic patients, the improvement of the Combined oriental Medicine group was better than that of the Only Language Therapy group. Through this study, we suggest combination therapy with the administration of oriental medicine and language therapy can be helpful in the treatment of post-stroke aphasic patients.

Atrial Fibrillation is Strongly Associated With the Neutrophil to Lymphocyte Ratio in Acute Ischemic Stroke Patients: A Retrospective Study

No study has investigated the relationship between hospital‐admission neutrophil and lymphocyte ratio (NLR) and various stroke risk factors. We sought to determine which stroke risk factor could be the most appropriate predictor of NLR in acute ischemic stroke.

Influence of Herbal Complexes Containing Licorice on Potassium Levels: A Retrospective Study

To observe the influence of these complexes on potassium levels in a clinical setting, we investigated the influence of herbal complexes containing licorice on potassium levels. We retrospectively examined the medical records of patients treated with herbal complexes containing licorice from January 1, 2010, to December 31, 2010. We recorded the changes in the levels of potassium, creatinine, and blood urea nitrogen and examined the differences between before and after herbal complexes intake using a paired t-test. In addition, we investigated the prevalence of hypokalemia among these patients and reviewed such patients. We identified 360 patients who did not show significant changes in the levels of potassium and creatinine (P = 0.815, 0.289). We observed hypokalemia in 6 patients. However, in 5 patients, the hypokalemia did not appear to be related to the licorice. Thus, we could suggest that herbal complexes containing licorice do not significantly influence the potassium levels in routine clinical herbal therapies. However, we propose that follow-up examination for potassium levels is required to prevent any unpredictable side effects of administration of licorice in routine herbal medicine care.

Herbal Medicine, Oreongsan for Recurrent Chronic Subdural Hematoma: A Case Report

Recently, the East-Asian herbal complex Oreongsan (Goreisan in Japanese and Wulingsan in Chinese) has been noted for its usefulness in preventing postoperative recurrence of chronic subdural hematoma (CSDH). Here, we present a case of CSDH, an 84-year-old man which had recurred four times, despite three previous burr-hole surgeries. Following the fourth burr-hole surgery, an herbal medicine called Oreongsan (TJ-17, Tsumura, Japan, 15g/d) was administered to the patient in hopes of preventing another CSDH recurrence. This case was successfully treated with Oreongsan in an attempt to prevent any further recurrences. The potential mechanism of action of Oreongsan is hydrostatic modulation. The inhibitory effect of the Oreongsan on aquaporin-4 found on the CSDH membrane could contribute to its ability to reduce and prevent the aggravation of SDH.

Effectiveness and safety of acupuncture in the treatment of Parkinson’s disease: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE This study aimed to examine the effectiveness and safety of acupuncture in the treatment of Parkinsons disease (PD). METHODS English, Chinese, and Korean electronic databases were searched up to June 2016. Randomized controlled trials (RCTs) were eligible. The methodological quality was assessed using Cochranes risk of bias tool. Meta-analysis was performed using RevMan 5.3. RESULTS In total, 42 studies involving 2625 participants were systematically reviewed. Participants treated using combined acupuncture and conventional medication (CM) showed significant improvements in total Unified PD Rating Scale (UPDRS), UPDRS I, UPDRS II, UPDRS III, and the Webster scale compared to those treated using CM alone. The combination of electroacupuncture and CM was significantly superior to CM alone in total UPDRS, UPDRS I, UPDRS II, and UPDRS IV. Similarly, the combination of scalp electroacupuncture, acupuncture, and CM was significantly more effective than CM alone in total UPDRS. However, our meta-analysis showed that the combination of electroacupuncture and CM was not significantly more effective than CM alone in UPDRS III, the Webster, and the Tension Assessment Scale. The results also failed to show that acupuncture was significantly more effective than placebo acupuncture in total UPDRS. Overall, the methodological quality of the RCTs was low. No serious adverse events were reported. CONCLUSIONS We found that acupuncture might be a safe and useful adjunctive treatment for patients with PD. However, because of methodological flaws in the included studies, conclusive evidence is still lacking. More rigorous and well-designed placebo-controlled trials should be conducted.

A retrospective cohort study on the outcomes of ischemic stroke patients with adjuvant Korean Medicine treatment

This study aims to examine the long-term effect of adjuvant treatment in Korean Medicine (KM) clinics in ischemic stroke patients, using a national sample cohort from the National Health Insurance Service in Korea between 2010 and 2013. The National Health Insurance Service – National Sample Cohort database from 2002 to 2013 was used in this study. Ischemic stroke patients were defined and covariates were included to account for socioeconomic variables, comorbidities and disease severity. Propensity score matching was applied. Cox proportional hazards modeling and Kaplan-Meier analysis were applied to determine the differences between KM and non-KM treated groups. The results shows that KM-treated group had a higher probability of survival than non-KM group patients. No significant difference was observed between the risk of readmission between the treated and non-treated patients. Kaplan-Meier analysis showed a weak effect of KM treatments in the patients with 8 to 28 days of hospital stay for a lower risk of recurrence than in non-treated patients. In conclusion, KM treatment of mild to moderate ischemic stroke patients has a mild effect on the survival probability of stroke. Its effect for improving long-term recurrence need to be explored in the future studies.

Complementary and Alternative Medicine for Idiopathic Parkinson’s Disease: An Evidence-Based Clinical Practice Guideline

Patients with idiopathic Parkinson’s disease (IPD) require long-term care and are reported to use complementary and alternative medicine (CAM) interventions frequently. This CAM-specific clinical practice guideline (CPG) makes recommendations for the use of CAM, including herbal medicines, acupuncture, moxibustion, pharmaco-acupuncture, and qigong (with Tai chi) in patients with IPD. This guideline was developed using an evidence-based approach with randomized controlled trials currently available. Even though this CPG had some limitations, mainly originating from the bias inherent in the research on which it is based, it would be helpful when assessing the value of the CAM interventions frequently used in patients with IPD.

Pharmacoacupuncture for Idiopathic Parkinson’s Disease: A Systematic Review of Randomized Controlled Trials

Introduction Pharmacoacupuncture is a new acupuncture treatment that stimulates acupuncture points by injecting herbal medicine into them. Recently, pharmacoacupuncture has been widely used in the treatment of idiopathic Parkinsons disease in traditional East Asian medicine. The purpose of this systematic review is to evaluate the efficacy and safety of pharmacoacupuncture in the treatment of idiopathic Parkinsons disease. Methods The following electronic databases were searched for studies published in or before December 2016: Medline, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, OASIS, and CNKI, without language restriction. The main outcome assessed was the total Unified Parkinsons Disease Rating Scale (UPDRS) score. The details of the pharmacoacupuncture intervention, such as the herbal medicine and acupuncture points used, were also investigated. Results From 138 studies, 3 randomized controlled trials were included; the number of patients analyzed was 134. Most of the studies showed considerable methodological flaws. There was heterogeneity of the intervention type and treatment duration in the included studies. Therefore, we could not conduct a meta-analysis. In one study, adjunctive bee venom pharmacoacupuncture therapy significantly improved total UPDRS scores compared with conventional therapy alone. Another study, which used adjunctive Kakkonein pharmacoacupuncture, did not reveal significant improvement compared with conventional therapy alone. A third study reported that Mailuoning pharmacoacupuncture was able to significantly improve the modified Webster Symptom Score when compared with no treatment. Adverse events related to the pharmacoacupuncture were reported in only one case, itching caused by the bee venom. Conclusions Our findings regarding the efficacy of pharmacoacupuncture as a therapy for idiopathic Parkinsons disease are currently inconclusive. Further large and rigorous clinical trials are needed.