Background Patients who survive an acute phase of stroke are at risk of falls and fractures afterwards. However, it is largely unknown how frequent fractures occur in the Asian stroke population. Methods Patients with acute (< 7 days) ischemic stroke who were hospitalized between January 2011 and November 2013 were identified from a prospective multicenter stroke registry in Korea, and were linked to the National Health Insurance Service claim database. The incidences of fractures were investigated during the first 4 years after index stroke. The cumulative incidence functions (CIFs) were estimated by the Gray's test for competing risk data. Fine and Gray model for competing risk data was applied for exploring risk factors of post-stroke fractures. Results Among a total of 11,522 patients, 1,616 fracture events were identified: 712 spine fractures, 397 hip fractures and 714 other fractures. The CIFs of any fractures were 2.63% at 6 months, 4.43% at 1 year, 8.09% at 2 years and 13.00% at 4 years. Those of spine/hip fractures were 1.11%/0.61%, 1.88%/1.03%, 3.28%/1.86% and 5.79%/3.15%, respectively. Age by a 10-year increment (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.17–1.30), women (HR, 1.74; 95% CI, 1.54–1.97), previous fracture (HR, 1.72; 95% CI, 1.54–1.92) and osteoporosis (HR, 1.44; 95% CI, 1.27–1.63) were independent risk factors of post-stroke fracture. Conclusion The CIFs of fractures are about 8% at 2 years and 13% at 4 years after acute ischemic stroke in Korea. Older age, women, pre-stroke fracture and osteoporosis raised the risk of post-stroke fractures.

Background The aim of this study was to assess the accuracy of virtual planning of computer-guided surgery based on the actual outcomes of clinical dental implant placement. Methods This retrospective study enrolled patients among whom implant treatment was planned using computer-guided surgery with cone beam computed tomography (CBCT). The patients who received implant according to the guide with the flapless and flapped approach were classified as group 1 and 2, respectively, and the others who could not be placed according to the guide were allocated to the drop-out group. The accuracy of implant placement was evaluated with the superimposition of CBCT. Results We analyzed differences in the deviated distance of the entrance point and deviated angulation of the insertion of implant fixtures. With regard to the surgical approach, group 2 exhibited greater accuracy compared to group 1 in deviation distance (2.22 ± 0.88 and 3.18 ± 0.89 mm, respectively, P < 0.001) and angulation (4.27 ± 2.30 and 6.82 ± 2.71°, respectively, P = 0.001). The limitations of guided surgery were discussed while considering the findings from the drop-out group. Conclusions Computer-guided surgery demonstrates greater accuracy in implant placement with the flapless approach. Further research should be conducted to enhance the availability of guides for cases with unfavorable residual bone conditions.

<b><i>Introduction:</i></b> Antiplatelet agents are usually discontinued to reduce hemorrhagic tendency during the acute phase of intracerebral hemorrhage (ICH). However, their use after ICH remains controversial. <b><i>Methods:</i></b> This study investigated the effect of antiplatelet agents in ICH survivors. We used the National Health Insurance Service-National Sample Cohort 2002–2013 database for retrospective cohort modeling, estimating the effects of antiplatelet therapy on clinical events. Subgroup analyses assessed antiplatelet medication administered before ICH. <b><i>Results:</i></b> The prescription rate of antiplatelets after ICH was also examined. Of 1,007 ICH<i>-</i>surviving patients, 303 subsequent clinical events were recorded, 41 recurrences of nonfatal ICH recurrence, 26 incidents of nonfatal ischemic stroke, 6 nonfatal myocardial infarctions, and 230 incidents of all-cause mortality. The use of antiplatelet therapy significantly decreased the risk of primary outcomes (adjusted hazard ratio [AHR] = 0.743, 95% confidence interval [CI] = 0.578–0.956) and all-cause mortality (AHR = 0.740, 95% CI = 0.552–0.991), especially in patients without a history of antiplatelet treatment. The use of antiplatelet medication after ICH did not significantly increase the recurrence of ICH. The prescription rate of antiplatelet therapy within 1 year was 16.6%. Among 220 patients with a history of using antiplatelet medication, the resumption rate was 0.5% at discharge, 5% after a month, 12.7% after 3 months, and 29.1% after a year. <b><i>Conclusion:</i></b> Using antiplatelet treatment after ICH does not increase chances of recurrence, but lowers the occurrence of subsequent clinical events, especially mortality. However, the prescription and resumption rate of antiplatelet therapy after ICH remains low in South Korea.

The authors analyzed the three-dimensional postoperative condylar position change across the plating systems. This retrospective study was conducted with the patients who underwent bilateral sagittal split ramus osteotomy with setback surgery. The condylar change was analyzed from preoperative cone-beam computed tomography to postoperative 1 month (T1) and postoperative 6 months (T2) using superimposition software, automatically merging based on the anterior cranial base. The condylar changes during T1 and T2 were analyzed across the four types of plates (4-hole sliding, heart-shaped, 3-hole sliding, and 4-hole conventional) Mean intraclass correlation coefficient values were consistently high for each measurement (>0.850). During T1, the conventional plate had a decreased condylar anterior distance when compared with the 3-hole sliding plate ( P = 0.032). During T2, the conventional plate had an increased condylar posterior distance when compared with the 3-hole sliding plate ( P = 0.031). S uperimposition software based on the anterior cranial base could be available for measurement of condylar position with highly reproducible results. After bilateral sagittal split ramus osteotomy, the 3-hole sliding plate could effectively compensate for the anterior displacement of the condyle compared to other plates.

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Background: Guidelines do not recommend reperfusion therapy in acute ischemic stroke patients with mild symptoms considering low gain compared to the risk. However, some patients with mild first symptoms experience neurological deterioration (ND) after hospitalization. We aimed to analyze clinical features and outcomes of patient who received reperfusion therapy after ND occurred. Methods: We enrolled patients who were admitted within 7 days after acute ischemic stroke or TIA between January 2012 and July 2018 from a multicenter stroke registry database in Korea (CRCS-K). Patients who 1) admitted via emergency room, and 2) received reperfusion therapy including intravenous tissue plasminogen activator and/or endovascular treatment were included. Clinical features and outcomes such as modified Rankin Scale (mRS) score distribution at 3 months after stroke were compared between patients received reperfusion therapy after ND and those without ND before the treatment. Results: Among 51325 patients, 6577 (12.8%) received reperfusion therapy were identified. Reperfusion therapy was performed after ND in 136 patients (2.1%). Mean time of onset to needle is 342.1 and 167.2, and onset to perfusion is 1351.6 and 422.0 in patients treated after ND, and those without, respectively. TIA history was more frequent and atrial fibrillation history was less frequent in patients treated after ND. Initial median (IQR) National Institute of Health Stroke Scale (NIHSS) score was 8 (5 - 12), 10 (6 - 16) in patients treated after ND, and those without, respectively. Large artery atherosclerosis was more frequent in patients treated after ND (42.9 % vs. 26.7%). There was higher rate of good outcome at 90 days in patients treated after ND (84 [61.8%]) compared with those without ND before treatment (3359 [52.2%]; OR, 1.38 [95% CI, 1.02-1.87]). In multivariable analysis, good outcome at 90 days in patients treated after ND lacked statistical significance (OR, 1.06 [95% CI, 0.71-1.62]). There is no significant statistical difference of death at 90 days (13.2% vs. 10.4%, p = 0.364). Conclusion: Reperfusion therapy could apply patients with mild first symptoms experience ND after hospitalization and expect similar prognosis compared to those without ND before the treatment.

This paper proposes how to develop storytelling contents for foster local culture industry based on the lifestyle and literature works of Man-Jung Kim, a great scholar in the late Joseon dynasty. He wrote various literary works such as classic novels, poetries, proses, and criticisms during his exile life. Storytelling content based on his work will play an important role in globalizing Korean contents. The development method of storytelling contents uses the basic elements: 'text + narration + champ' based on the champ theory. We will look at similar storytelling content development cases based on the exile literature in Korea and benchmark them to develop Kim's storytelling content development plans. Twelve experts participate to brainstorm for developing various new ideas of storytelling contents. It is important to approach Kim's work from a comprehensive and integrated perspective in order to develop valuable storytelling contents. Concludingly, to build local cultural assets, it is important to focus not only on the core values of Kim's works, but also in building a collaborative system among local governments, storytellers, cultural artists, tourists, and citizens.

Objective: Neurologic Deterioration (ND) is known to be related to disability and poor outcomes. However, no large epidemiologic study on ND has been reported. Methods: Patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) admitted within 7 days of symptom onset were identified. Under a component of a quality assurance program of stroke care, we have captured ND during hospitalization prospectively with regular monitoring and systemic audits. ND was defined as any new neurological symptoms/signs or neurological worsening within 3 weeks of onset, satisfying one or more of the followings: increase of total NIHSS score ≥ 2, subscore 1a, 1b, or 1c (level of consciousness) ≥ 1, or subscore 5a, 5b, 6a, or 6b (motor)≥1, or any new neurological deficit (even unmeasurable by NIHSS scores). We investigated the incidence, timing, causes and outcomes of ND. Results: From December 2010 to September 2015, 29446 patients with AIS or TIA were admitted to 15 participating centers. Seventy-one percent of the patients were hospitalized within 24hours of onset. Deterioration occurred in 18.2% during median 10.1 days of hospitalization, its cumulative incidence was 5.6% at 1 day, 9.1% at 2 days, 10.9% at 3 days, 14.2% at one week. As causes of ND, progression was most common (73%), followed by recurrence (8.5%). Compared to those without ND, patients with ND were more likely to be older, be females, be hospitalized earlier, have stroke subtypes of large arterial disease or cardioembolism, have relevant steno-occlusion of major cerebral arteries, and have severer neurologic deficits. ND was independently associated with poorer functional outcome (modified Rankin scale 3 or more) at 3 months (adjusted odds ratio, 5.58; 95% confidence intervals (CI), 5.10-6.11) and one year (4.85; 4.43-5.32), and incidence of major vascular events (stroke, myocardial infarction, all-cause death) up to one year (adjusted hazards ratio, 1.64; 95% CI, 1.50-1.79). Conclusions: Our study reveals that about one fifths of AIS or TIA patients deteriorate neurologically during hospitalization and this deterioration is associated with poor functional outcome and subsequent major vascular events. Further researches for its prediction, detection and treatment are warranted.