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This case series reported a group of patients with Guillain–Barré syndrome (GBS) and their plasma cytokine changes before and after immunotherapy. We aimed to understand GBS's pathogenesis and pathophysiology through observing the interval differences of the representative cytokines, which were the thymus and activation regulated chemokine (TARC) for T-cell chemotaxis, CD40 ligand (CD40L) for cosimulation of B and T cells, activated complement component C5/C5a, and brain-derived neurotrophic factor (BDNF) for survival and regenerative responses to nerve injuries. The fluorescence magnetic bead-based multiplexing immunoassay simultaneously quantified the five cytokines in a single sample. From June 2018 to December 2019, we enrolled five GBS patients who had completed before–after blood cytokine measurements. One patient was diagnosed with paraneoplastic GBS and excluded from the following cytokine analysis. The BDNF level decreased consistently in all the patients and made it a potential biomarker for the acute stage of GBS. Interval changes of the other four cytokines were relatively inconsistent and possibly related to interindividual differences in the immune response to GBS triggers, types of GBS variants, and classes of antiganglioside antibodies. In summary, utilizing the multiplexing immunoassay helps in understanding the complex immune mechanisms of GBS and the variation of immune responses in GBS subtypes; this method is feasible for identifying potential biomarkers of GBS.

This study systematically reviewed the relevant studies and summarized the associations of objective measures of residential neighborhood built-environment attributes with sedentary time among adults. Published studies were obtained from PubMed and Scopus, restricting to those published in English language peer-reviewed journals to Oct. 2021. There were nine studies and 48 instances of estimated associations. Most instances showed no statistical-significant associations; by contrast, few instances showed that adults living in a neighborhood characterized by a high density of local destinations and connected intersections were associated with less sedentary time. The findings suggest that a high density of destinations and street intersections around residence may provide opportunities to transfer and access to services, thus reducing the sedentary time. Future research strengthening the research design and measurements are needed to investigate the potential explanations of the associations between residential neighborhood built environments and sedentary time in adults. [ABSTRACT FROM AUTHOR]

Background: Low lipid level is associated with better cardiovascular outcome. However, lipid paradox indicating low lipid level having worse outcomes could be seen under acute injury in some diseases. The present study was designed to clarify the prognostic significance of acute-phase lipid levels within 1 day after admission for stroke on mortality in first-ever statin-naïve acute ischemic stroke (IS) and hemorrhagic stroke (HS).Methods: This observational study was conducted using the data collected from Stroke Registry In Chang-Gung Healthcare System (SRICHS) between 2009 and 2012. Patients with recurrent stroke, onset of symptoms >1 day, and history of the use of lipid-lowering agents prior to index stroke were excluded. Stroke was classified into IS and hypertension-related HS. The primary outcomes were 30-day and 1-year mortality identified by linkage to national death registry for date and cause of death. Receiver operating characteristic (ROC) curve analysis and multivariate Cox proportional hazard models were used to examine the association of lipid profiles on admission with mortality.Results: Among the 18,268 admitted stroke patients, 3,746 IS and 465 HS patients were eligible for analysis. In IS, total cholesterol (TC)

Most reports about oculopharyngeal muscular dystrophy (OPMD) have been contributed by occidental countries, and most of the victims of this disease are racially white. In contrast, this disorder is rarely seen in Asians and has only one African report. Consequently, OPMD has been regarded as a disease of the Western world. The purpose of this paper is to challenge the accuracy of this concept. Methods: In a Chinese immigrant family, 3 patients manifesting signs related to OPMD were examined. Electromyography, nerve conduction studies, muscle biopsy and genetic analysis were performed on the proband. All the 322 papers about OPMD were reviewed and their country of origin was labeled to perceive the approximate prevalence of OPMD. Countries were categorized into groups according to the continents to which they belonged. Results: The proband's muscle histopathology showed small angulated fiber with rimmed vacuoles, ultrastructural pathology exposed filamentous intranuclear inclusions, and genetic analysis of the polyadenylate binding protein nuclear 1(PABPN1) gene revealed 13 GCG trinucleotide repeats in one allele (GCG)13 while being normal in the other. The survey of the country of origin of OPMD reports showed that 80% of these papers were contributed by occidental countries and that the number of publications of OPMD among countries of Americas and Asia were unequal, when compared to those of European countries, which were fairly proportioned. An epidemiologic review of the literature is presented and the prevalence of OPMD is discussed. Conclusion: This is a China-born Chinese patient with both morphologically and genetically proven of OPMD. The very low OPMD report rate in developing countries of East Asia is due to the unfamiliarity of medical workers to OPMD and the unavailability of medical supplies to confirm the diagnosis. In addition, the present and previous reports provide clear evidence that OPMD in these areas is underdiagnosed.

Despite effective vaccine programs, tetanus is occasionally observed in adults. We reviewed clinical presentation data for adult patients with tetanus in the post-vaccine era in Taiwan. Methods: We retrospectively reviewed the medical records of all adult patients (age >18 years) discharged from Chang-Gung Memorial Hospital at Lin-Ko (CGMHLK) after treatment for tetanus between January 1996 and July 2005. Data regarding demographic characteristics, clinical manifestation, treatment, and outcome were collected. To assess the features for different age groups, patients were divided into those aged ≥65 years and those aged

Background: Hyponatremia is the most common electrolyte disorder in hospitalized patients, and is frequently a marker of a significant underlying disease. The prognostic value of hyponatremia in patients with acute first-ever ischemic stroke is not known. We aimed to analyze whether hyponatremia in the acute stroke stage contributed to the risk of mortality or recurrent stroke in these patients. Methods: We studied 925 patients presenting with acute first-ever ischemic stroke between 2002 and 2004. Sodium levels were obtained on arrival at the emergency room within 3 days of acute stroke onset. Hyponatremia was defined as a serum sodium concentration of 134 mmol/l or less. Clinical presentation, stroke risk factors, associated medical disease, and outcome were recorded. All patients were followed for 3 years for survival analysis. A multivariate Cox proportional hazards model was used to identify risk factors for 3-year mortality in these patients. We also constructed Kaplan-Meier survival curves, and compared groups with hyponatremia and normonatremia by means of log rank tests for significant differences. Results: Among the patients with acute first-ever ischemic stroke, 107 (11.6%) were hyponatremic. Among stroke risk factors, the prevalence of diabetes mellitus was significantly higher among hyponatremic patients (p < 0.001). Prevalence of chronic renal insufficiency was also higher in the hyponatremic group (p = 0.002). Clinical presentations, such as the length of acute ward stay, initial impaired consciousness, and clinical course in acute stroke were similar among normo- and hyponatremic patients. Among the complications, pneumonia and urinary tract infection were significantly higher in hyponatremic than in normonatremic patients. After multivariate logistic regression analysis, diabetes mellitus and chronic renal insufficiency were associated with hyponatremia in these patients. Kaplan-Meier analysis indicated that the survival rate was significantly lower in hyponatremic patients than in normonatremic patients (log rank test; p value <0.001). After multivariate Cox proportional hazards model analysis, hyponatremia was a significant predictor of 3-year mortality in these patients after adjustment for related variables (p value = 0.003, hazard ratio = 2.23, 95% confidence interval: 1.30-3.82). Conclusion: Hyponatremia in the acute stroke stage is a predictor of 3-year mortality in patients with acute first-ever ischemic stroke that is independent of other clinical predictors of adverse outcome. [ABSTRACT FROM AUTHOR]

The relationship between the number of myelinated nerve fibers from the hand that are reinnervating the distal glabrous skin of the toe and the number of myelinating nerve fibers originally innervating that toe target was investigated utilizing the toe-to-hand microvascular transplantation model. Digital nerve biopsy specimens suitable for morphometric analysis were obtained from the hand and toe at the time of surgery from 15 patients. Patients received sensory reeducation in the postoperative period to standardize rehabilitation. At a mean of 10.8 months after surgery, the degree of sensory recovery was determined by the hand therapist. Morphometric analysis was done by a neurologist blinded as to final sensory outcome. There was a statistically significant relationship between recovered moving two-point discrimination and ratio of the total number of reinnervating (neurotizing) finger axons compared with the original toe axons (r = 0.703, p < 0.003). A similar relationship was observed for static two-point discrimination (r = 0.802, p < 0.001). These results suggest that degree of sensory recovery in toe-to-hand transfer may be improved by increasing the number of reinnervating myelinated nerve fibers from the hand that neurotizes the free tissue transfer. [ABSTRACT FROM AUTHOR]

Background: Clinical outcome of internal carotid artery (ICA) occlusion is highly variable and the reason is uncertain. Aim: To study the predictive factors of clinical outcome and stroke recurrence in patients with ischemic stroke associated with unilateral atherosclerosis-related ICA occlusion. Settings and Design: Prospective study in neurology department of a single hospital. Materials and Methods: We prospectively studied 66 patients who suffered from first-ever ischemic stroke associated with unilateral atherosclerosis-related ICA occlusion over a period of two years. The end point was death or stroke recurrence. Statistical Analysis: Chi-square or Fisher's exact test was used to analyze predictors of early functional outcome. Multivariate analysis was used to analyze predictors of death or stroke recurrence within two years. Result: Higher age (=70 years) predicted a worse functional outcome (P = 0.049). Total anterior circulation syndrome (TACS) was associated with a poor functional outcome (P < 0.001), but lacunar syndrome had a better outcome (P = 0.001). Stroke in evolution predicted a poor outcome (P = 0.001), while those with symptom improvement had a better outcome (P = 0.016). Pneumonia predicted a poor outcome (P = 0.021). Five patients expired and 22 patients suffered from recurrent stroke in the following 24 months. Previous transient ischemic attack (TIA) and anemia were associated with a higher risk of death or recurrent stroke within two years (P = 0.036, P = 0.012). Conclusion: High age, TACS, stroke in evolution and pneumonia were predictors for poor functional outcome. Previous TIA and anemia were predictors for death and recurrent stroke within two years. [ABSTRACT FROM AUTHOR]

A forty-six-year-old premenopausal woman developed headache, nausea and vomiting. left hemiparesis, anti seizure two days after parenteral use of progesterone anti estradiol. Diabetes mellitus (DM) was found during admission. Computed tomography showed a hemorrhagic infarct in the right frontal lobe and increased density in the superior sagittal sinus (SSS). Left carotid angiography found occlusion of the left internal carotid artery (ICA). Right carotid angiograms failed to show the SSS and inferior sagittal sinus, suggestive of venous sinus thrombosis. Coexistence of the cerebral artery and the venous sinus occlusion has been described infrequently. In this case, the authors postulate that the use of estradiol and progesterone and the underlying DM increased vascular thrombogenicity, which provided a common denominator for thrombosis of both the ICA and the venous sinus. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to investigate the effect of hypercholesterolemia on recovery after acute ischemic stroke. Methods: Data of 3048 patients admitted for acute ischemic stroke from January to December 2009 were collected from the Stroke Registry in the Chang Gung Healthcare System. Baseline characteristics of patients with and without hypercholesterolemia were compared. The association of hypercholesterolemia with neurological severity and recovery was analyzed using multivariate logistic regression. The patients were then divided on the basis of age for subgroup analysis. Results: The number of patients with and without a history of hypercholesterolemia was 474 (15.6%) and 2574 (84.4%), respectively. Univariate analysis showed that patients with hypercholesterolemia had a lower National Institutes of Health Stroke Scale (NIHSS) score on admission (p = 0.004). However, during hospitalization, these patients displayed less improvement in their NIHSS score (p = 0.002). These results remained significant in multivariate logistic regression analysis (p < 0.001 and p = 0.002, respectively). Subgroup analysis showed a similar association for hypercholesterolemia in both younger (age < 70) and older (age≥70) age groups. Conclusions: Acute ischemic stroke in patients with hypercholesterolemia was correlated with reduced severity on admission and less favorable recovery during hospitalization, regardless of age. [ABSTRACT FROM AUTHOR]

Background: We examined the relationships between objectively assessed neighborhood environment and the patterns of sedentary behavior among older adults. Methods: A total of 126 community-dwelling older adults (aged 65 years or above) were recruited. Data on neighborhood environmental attributes (resident density, street intersection density, sidewalk availability, accessible destinations, and accessible public transportation), accelerometer-assessed total time and patterns of sedentary behavior (number and duration of bouts), and sociodemographic characteristics were collected. Multiple linear regression models were developed. Results: After adjustment for potential confounders, greater sidewalk availability was negatively related to the number of sedentary bouts (β = -0.185; 95% CI: -0.362, 0.015; p = 0.034) and sedentary bout duration (β = -0.180; 95% CI: -0.354, -0.011; p = 0.037). Conclusions: This study revealed that a favorable neighborhood environment characterized by sidewalk availability is negatively associated with sedentary behavior patterns in Taiwanese older adults. These findings are critical to inform environmental policy initiatives to prevent sedentary lifestyle in older adults., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Chang, Rutherford, Hsueh, Yu, Park, Wang and Liao.)