Urine myo-inositol as a novel prognostic biomarker for diabetic kidney disease: a targeted metabolomics study using nuclear magnetic resonance

As a leading cause of chronic kidney disease, clinical demand for noninvasive biomarkers of diabetic kidney disease (DKD) beyond proteinuria is increasing. Metabolomics is a popular method to identify mechanisms and biomarkers. We investigated urinary targeted metabolomics in DKD patients. Methods: We conducted a targeted metabolomics study of 26 urinary metabolites in consecutive patients with DKD stage 1 to 5 (n = 208) and healthy controls (n = 26). The relationships between estimated glomerular filtration rate (eGFR) or urine protein-creatinine ratio (UPCR) and metabolites were evaluated. Multivariate Cox analysis was used to estimate relationships between urinary metabolites and the target outcome, end-stage renal disease (ESRD). C statistics and time-dependent receiver operating characteristics (ROC) were used to assess diagnostic validity. Results: During a median 4.5 years of follow-up, 103 patients (44.0%) progressed to ESRD and 65 (27.8%) died. The median fold changes of nine metabolites belonged to monosaccharide and tricarboxylic acid (TCA) cycle metabolites tended to increase with DKD stage. Myo-inositol, choline, and citrates were correlated with eGFR and choline, while mannose and myo-inositol were correlated with UPCR. Elevated urinary monosaccharide and TCA cycle metabolites showed associations with increased morality and ESRD progression. The predictive power of ESRD progression was high, in the order of choline, myo-inositol, and citrate. Although urinary metabolites alone were less predictive than serum creatinine or UPCR, myo-inositol had additive effect with serum creatinine and UPCR. In time-dependent ROC, myo-inositol was more predictive than UPCR of 1-year ESRD progression prediction. Conclusion: Myo-inositol can be used as an additive biomarker of ESRD progression in DKD.

Expansion of Myeloid-Derived Suppressor Cells Correlates with Renal Progression in Type 2 Diabetic Nephropathy

Type 2 diabetic nephropathy (T2DN) progresses with an increasingly inflammatory milieu, wherein various immune cells are relevant. Herein, we investigated the levels of myeloid-derived suppressor cells (MDSCs) and their clinical implication in patients with T2DN. A total of 91 subjects (T2DN, n=80; healthy, n=11) were recruited and their PBMCs were used for flow cytometric analysis of polymorphonuclear (PMN-) and monocytic (M-) MDSCs, in addition to other immune cell subsets. The risk of renal progression was evaluated according to the quartiles of MDSC levels using the Cox model. The proportion of MDSCs in T2DN patients was higher than in healthy individuals (median, 6.7% vs. 2.5%). PMN-MDSCs accounted for 96% of MDSCs, and 78% of PMN-MDSCs expressed Lox-1. The expansion of PMN-MDSCs was not related to the stage of T2DN or other kidney disease parameters such as glomerular filtration rate and proteinuria. The production of ROS in PMN-MDSCs of patients was higher than in neutrophils of patients or in immune cells of healthy individuals, and this production was augmented under hyperglycemic conditions. The 4th quartile group of PMN-MDSCs had a higher risk of renal progression than the 1st quartile group, irrespective of adjusting for multiple clinical and laboratory variables. In conclusion, PMN-MDSCs are expanded in patients with T2DN, and may represent as an immunological biomarker of renal progression.

Erratum: Correction of Abstract. Development and Effects of Simulation Practice Program about Family centered Delivery Care / 여성건강간호학회지

The authors found abstract and key words errors in the published article.

Development and Effects of Simulation Practice Program about Family centered Delivery Care

PURPOSE: This study was conducted to investigate the relationship of knowledge, attitudes and needs of sex education in high school students. METHODS: There were 258 participants who were high school students in S high school in G city. Data were collected from October 1 to October 31, 2011, and analyzed using SPSS/WIN 19.0. RESULTS: The mean score for sexual knowledge was 69.78, sexual attitudes was 63.66, and needs of sex education was 75.37. Sexual knowledge had positive correlation with needs of sex education (r=.17, p=.007). CONCLUSION: The findings of this study indicated a need to develop programs for high school students to increase appropriate sexual knowledge, and to encourage appropriate sexual attitudes, and to reflect needs of sex education.

Active maintenance of endothelial cells prevents kidney fibrosis

BACKGROUND: Soluble epoxide hydrolase (sEH) expressed by endothelial cells catalyzes the metabolism of epoxyeicosatrienoic acids (EETs), which are vasoactive agents. METHODS: We used a unilateral ureteral obstruction mouse model of kidney fibrosis to determine whether inhibition of sEH activity reduces fibrosis, the final common pathway for chronic kidney disease. RESULTS: sEH activity was inhibited by continuous release of the inhibitor 12-(3-adamantan-1-ylureido)-dodecanoic acid (AUDA) for 1 or 2 weeks. Treatment with AUDA significantly ameliorated tubulointerstitial fibrosis by reducing fibroblast mobilization and enhancing endothelial cell activity. In an in vitro model of endothelial-to-mesenchymal transition (EndMT) using human vascular endothelial cells (HUVECs), AUDA prevented the morphologic changes associated with EndMT and reduced expression of fibroblast-specific protein 1. Furthermore, HUVECs activated by AUDA prevented the epithelial-to-mesenchymal transition (EMT) of tubular epithelial cells in a co-culture system. CONCLUSION: Our findings suggest that regulation of sEH is a potential target for therapies aimed at delaying the progression of kidney fibrosis by inhibiting EndMT and EMT.

Active maintenance of endothelial cells prevents kidney fibrosis

BACKGROUND: Soluble epoxide hydrolase (sEH) expressed by endothelial cells catalyzes the metabolism of epoxyeicosatrienoic acids (EETs), which are vasoactive agents. METHODS: We used a unilateral ureteral obstruction mouse model of kidney fibrosis to determine whether inhibition of sEH activity reduces fibrosis, the final common pathway for chronic kidney disease. RESULTS: sEH activity was inhibited by continuous release of the inhibitor 12-(3-adamantan-1-ylureido)-dodecanoic acid (AUDA) for 1 or 2 weeks. Treatment with AUDA significantly ameliorated tubulointerstitial fibrosis by reducing fibroblast mobilization and enhancing endothelial cell activity. In an in vitro model of endothelial-to-mesenchymal transition (EndMT) using human vascular endothelial cells (HUVECs), AUDA prevented the morphologic changes associated with EndMT and reduced expression of fibroblast-specific protein 1. Furthermore, HUVECs activated by AUDA prevented the epithelial-to-mesenchymal transition (EMT) of tubular epithelial cells in a co-culture system. CONCLUSION: Our findings suggest that regulation of sEH is a potential target for therapies aimed at delaying the progression of kidney fibrosis by inhibiting EndMT and EMT.

The role of local IL6/JAK2/STAT3 signaling in high glucose–induced podocyte hypertrophy

BACKGROUND: Interleukin-6 (IL6) is an important regulator of cellular hypertrophy through the gp130/Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) pathway. We tested the hypothesis that IL6 and its downstream gp130/JAK2/STAT3 pathway participated in high glucose (HG)–induced podocyte hypertrophy. METHODS: IL6 levels in the media and lysates of podocytes were measured by enzyme-linked immunosorbent assay. Western blots were performed to determine the protein expression levels of gp130/JAK2/STAT3 among podocytes cultured with normal glucose (NG), NG + mannitol, NG + recombinant IL6, HG, and HG + IL6-neutralizing antibodies (IL6NAb). Immunoprecipitation was examined to determine whether gp130 interacted with JAK2 in response to HG or IL6. Podocyte hypertrophy was verified using protein/cell counts and flow cytometry. RESULTS: IL6 levels were significantly increased in the media and lysates of podocytes cultured in HG compared with the NG groups. The nuclear phospho-STAT3/STAT3 ratio was increased by HG and NG + IL6 and was attenuated in the HG + IL6NAb groups, indicating that nuclear STAT3 was activated following JAK2 and cytosolic STAT3 activation in response to IL6 secreted by HG-stimulated podocytes. Immunoprecipitation showed increased phospho-JAK2 recruitment to gp130 in the HG and NG + IL6 groups, and the addition of IL6NAb in the HG group significantly abrogated these increases. Podocyte hypertrophy was significantly increased in the HG and NG + IL6 compared with the NG condition and was diminished by the addition of IL6NAbs to the HG group. CONCLUSION: IL6 might play a prominent role in the local activation of JAK2/STAT3 in podocyte hypertrophy under HG conditions. In vivo studies examining this pathway are warranted.

A Case Report of a Middle East Respiratory Syndrome Survivor with Kidney Biopsy Results

A 68-year old man diagnosed with Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) presented with multiple pneumonic infiltrations on his chest X-ray, and the patient was placed on a mechanical ventilator because of progressive respiratory failure. Urinary protein excretion steadily increased for a microalbumin to creatinine ratio of 538.4 mg/g Cr and a protein to creatinine ratio of 3,025.8 mg/g Cr. The isotope dilution mass spectrometry traceable serum creatinine level increased to 3.0 mg/dL. We performed a kidney biopsy 8 weeks after the onset of symptoms. Acute tubular necrosis was the main finding, and proteinaceous cast formation and acute tubulointerstitial nephritis were found. There were no electron dense deposits observed with electron microscopy. We could not verify the virus itself by in situ hybridization and confocal microscopy (MERS-CoV co-stained with dipeptidyl peptidase 4). The viremic status, urinary virus excretion, and timely kidney biopsy results should be investigated with thorough precautions to reveal the direct effects of MERS-CoV with respect to renal complications.

Effects of Clinical Learning Environment on Clinical Practice Stress and Anxiety in Nursing Students / 간호행정학회지

PURPOSE: The purpose of this study was to identify factors in the clinical learning environment that affect clinical practice stress and anxiety in nursing students. METHODS: Participants were 210 senior nursing students from two universities who had completed their clinical experience. Data were collected from self-report questionnaires and analyzed using t-test, ANOVA, and hierarchical multiple regression analysis with the SPSS/WIN 21.0 Program. RESULTS: The mean scores for the clinical learning environment, the clinical practice stress, and anxiety were 3.16+/-0.68, 2.98+/-0.66, and 43.74+/-10.18 points, respectively. The regression analysis showed that the clinical learning environment contributed to 13% of the stress and 20% of the anxiety in the nursing students with the conditions controlled for general characteristics, department satisfaction and social support. CONCLUSION: The results of this study suggest that the clinical learning environment should be carefully assessed to reduce nursing students' stress and anxiety from clinical practice. Therefore, collaboration between nursing universities and teaching hospitals is necessary to optimize clinical learning environment.

Genetic predisposition of donors affects the allograft outcome in kidney transplantation: Single-nucleotide polymorphism of aquaporin-11

BACKGROUND: Aquaporin-11 (AQP11) is a novel member of the aquaporin family. Disruption of the murine Aqp11 gene causes severe proximal tubular injury and renal failure. The rs2276415 (G>A) single-nucleotide polymorphism in the human AQP11 gene results in glycine to serine substitution in a functionally important domain. In this study, the role of the genetic predispositions of AQP11 rs2276415 (G>A) on renal allograft outcomes was evaluated. METHODS: A total of 198 pairs of donors and recipients were enrolled in this study. Long-term graft survival was traced and clinical parameters that could have influenced graft outcome were collected through the electronic medical record system. RESULTS: The genotype distribution and allele frequency of rs2276415 polymorphism were not different between donors and recipients. Despite similar allele frequencies between donors and recipients, the minor allele rs2276415 (GA+AA) of AQP11 from the donors, but not from the recipients, had a harmful effect on the graft survival compared with the wild-type donor (GG; P=0.029). This association was significant after adjusting for several risk factors including age, sex, human leukocyte antigen mismatch, donor type, hypertension, and diabetes mellitus (P=0.032). CONCLUSION: A donor-derived, not recipient-derived, genetic AQP11 polymorphism has different effects on graft outcome. Thus, the genetic influence from donors should be carefully considered for proper management of allografts after kidney transplantation.

A rare case of hyperoxaluria presenting with acute liver injury and stone-free kidney injury

A 49-year-old woman visited the clinic because of acute hepatitis and acute kidney injury with decreased urine output presenting microscopic hematuria and proteinuria. An abdominal computed tomography revealed a localized, hypoattenuated lesion in a hepatic lateral segment, and kidney biopsy showed oxalate crystal deposition with tubular necrosis. In addition, the patient's 24-hour urinary excretion of oxalate was increased. Her kidney and liver injury improved after sessions of hemodialysis, and urinary oxalate excretion was normalized. Major mutations in primary hyperoxaluria have not been proven. A full sequencing of target genes may be helpful to diagnose a rare form of primary hyperoxaluria.

Influence of Hypertonicity on the Phenotype and Function of Bone Marrow-Derived Dendritic Cells / 대한신장학회지

PURPOSE: Dendritic cells (DCs) are considered the most professional antigen-presenting cells (APCs) because of their unique role in initiating immunity against threatening antigens. Recently, hypertonicity has been suggested to be involved in the activation and development of immune cells such as T cells. And tonicity enhancer binding protein (TonEBP) has been thought to play a pivotal role in this process. Here, we studied the maturation status of DCs and expression of TonEBP in DCs exposed to hypertonic condition. METHODS: Murine bone marrow-derived DCs were generated in the presence of GM-CSF for 6 days, and then exposed to hypertonic media. We evaluated the functional capacities and maturation of DCs using flow cytometry, mixed lymphocyte reaction, and cytokine analysis. Also we investigated the expression of TonEBP in DCs cultured in variable hypertonic media. RESULTS: Mild hypertonicity made CD11c+ DCs to have up-regulation of CD40, 80, and 86. DCs exposed to 320 mOsm/kg media stimulated allogeneic T cell proliferation most effectively compared to DCs exposed to other tonic conditions. However, DCs exposed to 400 mOsm/kg media showed similar stimulatory capacities to isotonic control. Consistent with the phenotype changes, IL-1, 6, and TNF-alpha secretion increased in CD11c+ DCs exposed to mild hypertonic condition. Though we confirmed that TonEBP was expressed in CD11c+ DCs, the amount of upregulation was not dependent on the degree of hypertonicity. CONCLUSION: Our results suggest that hypertonicity enhances the maturation and activation of DCs.

Single Nucleotide Polymorphism in the Promoter Region of H1 Histone Family Member N, Testis-specific (H1FNT) and Its Association Study with Male Infertility

The H1 histone family, member N, testis-specific (H1FNT) is exclusively expressed in the testis, and had its possible role for sperm chromatin formation. The purpose of this study is to investigate any genetic association of H1FNT gene with male infertility, especially at the promoter region. We examined the promoter single nucleotide polymorphisms (SNP) of H1FNT gene which is located within transcription factor binding site for its association with male infertility. The statistical analysis showed that the -1129A>T polymorphism was present at a statistically significance in male infertility (p=0.0059 and 0.0349 for hetero and risk type, respectively). The dual-luciferase promoter assay was performed to examine the polymorphic effect of this promoter SNP by the cloning of promoter region (1700bp fragment) into pGL3-basic vector. In our plasmid based reporter system, there is no big difference between wild and risk type. In conclusion, H1FNT -1129A>T promoter SNP is statistically significant with male infertility, especially with subfertile (non-azoospermia) group. Further analysis of its functional polymorphic effect in vivo may provide the biological significance of testis-specific histone with spermatogenesis.

The Differential Effects of Donor-Strain Immature Dendritic Cell Subtypes and the Blockade of CD40/CD154 Pathway on the Creation of Allograft Tolerance / 대한신장학회잡지

BACKGOUND: Dendritic cells (DC) are pivotal antigen presenting cells and serve a unique role in initiating immunity. To test the hypothesis that pre-immunization of recipient with certain DC subsets of donor origin can influence graft outcome. METHODS: We have studied the effects of immunization with allogeneic CD4+CD11c+(MDC) and CD8+CD11c+(LDC) DCs on the allograft response. RESULTS: Both immature MDC and LDC subsets from DBA/2 were able to prime naive allogeneic C57BL/6 (B6) T cells in MLR. In vitro allogeneic T cell responses were attenuated by the addition of anti-CD154 mAb into the culture. T cells from B6 mice that received DBA/2 MDC intravenously 4 weeks before testing mounted weaker MLR driven cell proliferation than T cells from LDC pretreated B6 mice. Consistent with the MLR results, combined pretreatment with MDC, but not LDC, plus anti-CD154 mAb produced donor-strain specific long-term graft survival and induced tolerance while treatment with LDC plus anti-CD154 mAb created minimal prolongation of allograft survival in a pancreas islet transplant model (DBA/2->B6). The beneficial effects exerted by MDC and anti-CD154 mAb pretreatment were correlated with TH1 to TH2 immune deviation and with the amplified donor-specific suppressive capacity by recipient CD4+CD25+T cells. CONCLUSION: These findings highlight the capacity of MDC to modulate alloimmune responses, and suggest therapeutic approaches for the induction of donor specific tolerance.

The Effects of a Stress Management Program on Mental Health and the Coping Behavior for the Children of Alcoholics / 간호학회지

PURPOSE: The purpose of this study was to examine the effects of a stress management program on mental health and coping behavior for children of alcoholics. METHOD: Data was collected from January to February, 2003. The subjects were 20 adolescents from 13 to 18 years old. Data was analyzed using descriptive statistics, chi-square test, and t-test with the SAS program. RESULT: There were statistically significant differences in mental health, active coping, positive cognitive restructuring, and support-seeking for problem solving between the experimental group and the control group. CONCLUSION: The stress management program helped children of alcoholics by enhancing self-esteem, providing information about alcohol, and improving emotional and problem focused coping abilities. This eventually enhanced mental health.

Adenovirus-mediated Gene Therapy of Uteroglobin Protects the Experimental Glomerulonephritis in Mice / 대한신장학회잡지

PURPOSE: Uteroglobin (UG), steroid inducible cytokine-like protein, has potent anti-inflammatory and immunomodulatory action. It is secreted by the mucosal epithelia of virtually all mammals. The aims of this study were to investigate the efficacy of recombinant adenovirus carrying uteroglobin (AdCMV-UG) in prevention and treatment of glomerulonephritis (GN) in mice. METHODS: The AdCMV-UG was created by inserting the uteroglobin cDNA into the pAdTrack- CMV vector and was transfected into the 293 cells through liposome mediated vehicles. AdCMV-UG was injected direct to the both kidneys of 20 mice. In control groups (disease controls), 13 mice received adenoviral vector with GFP and another 11 mice received PBS only. After 5days of viral injection, GN was induced by repetitive intravenous injection of 3.0 mg rabbit anti-GBM Ab to the pretreated mice (C57/B6). Histological and biochemical changes were evaluated 7 and 14 days after injection of anti-GBM Ab. RESULTS: UG was expressed in the renal tissues and mesangial cells infected with the infection of AdCMV-UG. Pretreatment with AdCMV-UG attenuated the cellular crescent formation 7 days after induction of GN when compared to AdCMV-GFP, PBS only. We also observed reduced mesangial matrix expansion in mice treated with adenovirus carrying UG. Proteinuria was significantly reduced in the mice treated with adenovirus carrying UG when compared with disease control mice (AdCMV-UG 102.2+/-20.97, AdCMV-GFP 170.6+/-41.77, and PBS 169.8+/-55.67, respectively p<0.05 mg/mg). However, at 14 days after anti-GBM Ab injection (total 19 days), there was no significant difference in the amounts of prot einuria and morphologic findings between pretreated and disease control groups. CONCLUSION: Adenoviral mediated gene transfer is an effective way of gene delivery. Locally expressed uteroglobin attenuated the severity of glomerulonephritis induced by anti-GBM antibody, although it was transient. Gene therapy using uteroglobin may be constituted for the treatment of human diseases such as chronic GN.

Drinking Pattern, Problem Related Drinking, Perceived Stress, Ways of Coping, and Symptoms of Stress of the Female University Students / 간호학회지

PURPOSE: The purpose of this study was to identify the relationship among problem related drinking, perceived stress, ways of coping, and symptoms of stress of the college women. METHOD: Data was collected by questionnaires from 436 the College Women in S City. It was analyzed using descriptive statistics, Pearson correlation coefficients. RESULT: Three point forty -four of the subject had problem-related drinking, 92.43% were experienced alcohol drinking. The level of perceived stress(M=1.48) showed moderate, and symptoms of stress(M=1.34) showed below. The problem-related drinking showed significant positive correlation with perceived stress(r=.10, p=.03), emotion-oriented coping(r=.13, p=.00), and symptoms of stress(r=.23, p=.03). CONCLUSION: Data from this study suggest that perceived stress, ways of coping, and symptoms of stress are significant influencing factors on problem-related drinking in the Female University Students.

Prevention and Treatment of Experimental Glomerulonephritis Using Recombinant Uteroglobin / 대한신장학회잡지

Glomerulonephritis(GN) is characterized by cognate immune responses against self or non-self antigen. It is suggested that the crescentic GN is a manifestation of cell-mediated immune response akin to delayed type hypersensitivity. Uteroglobin(UG) is a steroid-dependent, immunomodulatory, and cytokine-like protein. It was reported that UG prevented fibronectin(Fn) deposition in the glomeruli of normal mice to form Fn-UG heterodimers that competed with Fn self-aggregation. We hypothesized that UG would prevent the development of experimental GN induced by anti-glomerular basement membrane globulin(anti-GBM Ab) in mice through immunomodulatory properties. GN was induced by intravenous injection of 4.5 mg rabbit anti-GBM Ab to mice(C57BL/6). Renal injury was evaluated at 7, 14, and 21 days thereafter. UG-treated mice(n=10) were received for 3 days(0.5 mg/mouse/day) beginning 1 hour after anti-GBM Ab injection. Also, disease-control mice(n=10) were received PBS for 3 days after anti-GBM Ab. Proteinuria was significantly reduced in the mice treated with UG when compared with the disease-control mice after 7 and 14 days of anti-GBM Ab injection. The amount of proteinuria was similar between UG treated and normal control mice. The mesangial matrix expansion and cellular crescent were markedly attenuated by the injection of UG. The proliferative responses of mesangial cells(C57BL/6) to LPS were blunted with the addition of UG in dose-dependent manner. In this study, we revealed the preventive effects of UG in the experimental model of glomerulonephritis. This result in turn could provide the basis for the treatment of human disease such as chronic glomerulonephritis.

The Effects of Polymorphism in the MCP-1 Gene Regulatory Region on MCP-1 Expression and the Manifestation of Lupus Nephritis / 대한신장학회잡지

BACKGROUND: Monocyte chemoattractant protein- 1(MCP-1) plays an important role in progression of lupus nephritis.(LN) The genetic polymorphism in the regulatory region would influence clinical manifestations by controlling serum levels of MCP-1. METHODS: We determined the genotypes of the MCP-1 gene, the secretion of MCP-1 by pheripheral blood monocytes(PBMCs) and transcription activity according to polymorphism on ELISA and luciferase assay. We also correlated serum MCP-1 level with proteinuria according to the genotypes to evaluate the clinical implication of genetic polymorphism in LN. RESULTS: 10 patients with SLE(20%) were AA homozygous, 21(42%) GA heterozygous, and 18(38%) GG homozygous, which was similar with normal controls[AA 9(20%), GA 27(58%), GG 46(22%)](n= 46). By in-vitro stimulation of PBMCs using Phytohemagglutinin, differential expression of MCP-1 appeared according to the genotypes at -2518 position; PBMCs from AA homozygotes 22.37+/-.07 ng/mL, GA 6.98+/-.72 ng/mL, GG 5.48+/-.22 ng/mL. In the luciferase assay, the gene construct with G at -2518 site showed decreased activity to 39% of that showed by A gene construct. In addition, After cells were treated with TNF-alpha 10 ng/mL), the transcription activity of A gene construct was approximately 3 fold greater than that of G gene construct. Levels of serum MCP-1 were significantly higher in patients with SLE(n=89) than normal controls(n=21)(418.17+/-35.30 pg/mL vs. 127.78+/-14.53 pg/mL, respectively; p0.05). But, in patients with LN, levels of serum MCP-1 were significant higher in patients with AA genotype than those of GA genotyes and GG genotypes(p<0.01). CONCLUSION: MCP-1 gene polymorphism at regulatory region may be a considerable marker for LN and may modulate the level of protein expression. Our study could make it possible to screen high risk individuals, thus help us to develop a practical application of the molecular findings in clinical practice.

A Sociomedical Research on Oriental Hospital Out and Inpatients of Cerebrovascular Accident / 한국역학회지

This study is comprehend the reality and characteristics of C.V.A. patients and to be helpful to its prevention and cure by resarching C.V.A. outpatient or inpatients who visited some of the oriental hospitals during three months from April 1 to June 30 1996 which are located in Taegu and Kungbuk Province, and concluded as follow: 1. The general characteristics of the subjects were: (1) 52.3% of the subjects were male. (2) In terms of age, 34.7% of them were in the sixties. (3) In terms of job, 28.5% of them were housewives(the highest percentage). (4) 77.6% of them had their spouses. (5) 67.2% of them were middle class. (6) In terms of educational background, 24.6% of them were literate of korean alphabets, and 23.4% were elemantary school gradurates. (7) 51.6% of them were outpatients. 2. 73.3% of the subjects experienced C.V.A. for the first time, and 23.1% were at recurrence, and 3.6% were chronic. 3. In terms of C.V.A. types, 49.8% of the subjects had cerebral hemorrhage, and 41.9% had cerebral infarction, and 8.3% had the others. In cerebral hemorrage, the percentage in "male, forties, job of sales service, unmarried, middle class, high educational background" were higher than the others respectively. And in cerebral infarction, the percentages in female, over seventies, official job, married, upper class were higher than the others respectively. 4. In terms of reasons of C.V.A. 49.5% of them were high blood pressure, and 24.2% were high stress, and 18.8% were overwork, and 4.0% were fatness, and 2.5% were heredity. In high blood pressure, the percentages in "high age, teacher, unmarried, lower class, low educa-tional background" were higher than the others respectively. 5. In terms of family members' C.V.A. , 56.7% of the subjects answered negatively, and 43.3% positively. In terms of the diseases which they had now except for C.V.A., 33.6% of them had hypertention, and 16.2% had diabetes, and 9.4% had neuralgia, and 4.0% had heart disease, and 16.6% had the otehrs, and 20.2% had no other disease. In heart disease, the percentages in "male, teachers, middlelower class, middle school graduates, inpatients" were higher than the others respectively. In neuralgia, the percentages in "fifties and sixties, housewives, spouse alive, upper class, literate of Korean alphabet" were higher than the others respectively. In terms of the diseases which they had now except for C.V.A., 33.6% of them had hypertension, and 16.2% had diabetes, and 9.4% had neuralgia, and 4.0% had heart diseases, the percentages in "fifties and sixties, housewives, spouse alive, upper class, literate of Korean alphabets" were higher than the others respectively. 6. In terms of the diseases which they had before C.V.A., 22.4% of them had hypertension, and 18.8% had diabetes, and 8.1% had heart diseases, and 11.2% had neuralgia and arthritis, and 7.8% had cancer, and 21.7% had the others. 7. In terms of exercise behaviors before C.V.A., 41.2% of them did nothing, and 58.8% did sometimes. 8. In terms of fatness level by self judgement, 36.1% of them thought "proper", and 41.1% thought themselves "fat(the highst percentage), and housewives(45.5%) thought themselves "fat". 9. In terms of favorite food, 50.2% of them liked meat, and 33.2% liked vegetables, and 13.0% liked fish. 10. In terms of fancy things of C.V.A. patients, 57.0% of them were non-smokers, and 53.1% were non-drinkers, and 55.2% disliked coffee. In smoking level, 16.6% of them smoked less than five pieces a day. In drinking, 18.0% of them drank half a glass of soju. In coffee, 25.3% of them drank a cup of coffee a day. 11. The level of satisfaction with C.V.A. patient-healing methods ; In medical therapy, 43.3% of C.V.A. patients thought it "usual", and 44.1% thought it "satisfactory" and 7.9% thought it "unsatis-factory". In acupunture and moxibustion 39.7% of the C.V.A. patients thought it "usual", and 53.0% thought it satisfactory" and 3.3% thought it "unsatisfactory". The level of satisfaction With Physiotherapy was average 61.7% and 4.0% was "unsatisfactory". From above statement, by considering those characteristics we should develop programs and materials to be health to the prevention and cure of C.V.A. and we should help hospitals and medical personnel families concerned to make use of them.