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Crossed cheiro-oral syndrome (CCOS) is characterized by crossed sensory disturbance confined to the unilateral perioral area and contralateral hand/finger(s). Although a few classical crossed sensory syndromes accurately predict brainstem or spinal involvement, the clinical significance of CCOS remains unclear. In this study, we analyzed the etiology, localization and outcome of CCOS patients. The results showed that ischemic stroke is the exclusive cause of CCOS. The location of responsible stroke is pertinent to the middle or upper level of the lateral medulla oblongata medial to the lateral sulcus. The vascular supply is from the vertebral artery or the posterior inferior cerebellar artery. Half of the CCOS patients progressed to Wallenberg’s syndrome and complicated with disabled daily living. However, no patient died during the follow-up period. A larger size and dorsal extension of the infarction correlated with neurological deterioration. Therefore, CCOS is an independent clinical sign of medullary involvement. It strongly predicts involvement at the lateral medulla oblongata, especially the ischemic stroke, and neurological deterioration. A rapid evaluation of the infarction location and vascular status is suggested in cases of CCOS. [ABSTRACT FROM AUTHOR]

Abstract: We designed and implemented a novel omnidirectional spherical robot. Instead of using wheels or flywheels, a driven ball is installed inside the spherical shell and driven by two orthogonally-mounted rollers; thus, the omnidirectional mobility of the robot with no singularity can be achieved by simple forward kinematic mapping. The dynamic model of the robot is derived, and effect of the model's parameters is evaluated in simulation and discussed. The simulation results also serve as the design guideline for building the empirical system. Several design issues are addressed to ensure the robot's proper development. Finally, the spherical robot is built, and its performance is quantitatively and experimentally evaluated, thus proving its omnidirectional and trajectory-controllable mobility. [Copyright &y& Elsevier]

Abstract: Backgrounds: Nummular headache (NH) is currently considered a form of peripheral neuralgia originating from the terminal branch in epicranial tissue but its etiopathogenesis is still unknown. Since autoimmune disorders often involve the trigeminosensory nerve to provoke craniofacial pain, we hypothesize that autoimmunity aberration may play a role with regard to NH. Methods: We examined the antibodies to antinuclear factor, ds-DNA, extracted nuclear antigens, rheumatoid factor, as well as antiphospholipid antibodies, in 23 primary NH patients. Results: Among them were 16 patients (69.6%) found as having at least one abnormal autoimmune index, namely, antibodies to antinuclear factor in 8 patients, SSA/La in 6 patients, rheumatoid factor in 4 patients, SSB/Ro in 2 patients, and ds-DNA in 1 patient. An abnormal increase of blood anti-beta2-glycoprotein I antibody was noted in 4 patients and lupus anticoagulant in 1 patient, whereas HLA-B27 seropositivity was detected in 1 patient. Except for 2 patients positive for antinuclear factor without other associated features, 15 patients (65%) were finally diagnosed as having Sjogren/sicca syndrome, rheumatoid arthritis or antiphospholipid antibody syndrome. Conclusions: A high prevalence of abnormal autoimmune indices and disorders is present in primary NH patients, suggesting a probable relationship between autoimmunity aberration and epicranial neuralgia in NH. [Copyright &y& Elsevier]

Abstract: Background and purpose: The salt-and-pepper pain is a characteristic sensory disturbance confined to the eyes and regional facial structures. Although a poor prognosis has been mentioned in previously reported patients, the precise pathomechanism and clinical significance are still unknown. Patients and methods: We report four patients with ocular salt-and-pepper pain, and review the clinical course, neuroimaging and prognosis in another eight patients reported in the literature. Results: In our series, they were three men and one woman, and their underlying cause was pontine hemorrhage; hypertensive hemorrhage in three and cavernous hemangioma in one patient, respectively. In these 12 salt-and-pepper patients, the identifiable etiology was exclusively brainstem stroke. Life-threatening or disable neurological deterioration ensued within 24h after pain onset in all patients. Their ocular pain subsided rapidly after neurological deterioration occurred. A dual excitation of nociceptive quinothalamic pain fiber and disinhibition of trigeminosensory system from pontine reticular formation and cerulotrigeminospinal circuit may be responsible for this pain. Conclusion: In clinical practice, ocular salt-and-pepper pain in quiet eyes should be alerted for intracranial pathology and neurological deterioration until underlying cause is identified. [Copyright &y& Elsevier]

Abstract: Cheiro-pedal syndrome (CPS) is an incomplete pure sensory disorder confined strictly to simultaneous hand/finger and ipsilateral foot/toe symptoms. However, its clinical significance and pathogenesis are unclear. We present nine patients with typical CPS, and review another seven previously reported patients. Ischemic stroke is the leading cause of CPS in these 16 patients. In 13 patients, the lesions responsible were distributed widely in the brain from the corona radiata to the medulla oblongata whereas in three patients the lesions were found in the cervical spinal cord or peripheral nerves. All patients had a favorable outcome. The close proximity of the cheiral and pedal sensory fibers in the pons, thalamus, internal capsule and the caudal thalamocortical projection increases the vulnerability for CPS. Therefore, the underlying cause of CPS should be investigated rapidly despite it causing only minor symptoms. The pathogenesis of CPS may consist of several interacting factors including preconditioned neuronal damage and proximity of the acral sensory fibers. [Copyright &y& Elsevier]

Abstract: This study presents a supplementary cepstrum-based scheme to achieve blind audio watermarking via the mean-value manipulation. The proposed scheme can work with the conventional statistical mean manipulation to double the watermark capacity under the same framework. As these two cepstral schemes affect the spectrum in low frequencies in a superposition manner, the developed watermarking system employs the conventional scheme to initiate a start and the new one to actually embed watermark bits. During the embedding phase, the rapid variations between frames caused by the watermarking process are avoided by adding a transition space. In addition, the watermarking system maintains data synchronization through the insertion of a sinusoid-like signal which keeps synchronization with the frame rate. Experimental results confirm the robustness of the proposed scheme against various attacks, including time-scaling and time-shifting that many other watermarking techniques failed to survive through. [Copyright &y& Elsevier]

Abstract: Pure motor hemiparesis is a vascular syndromethat is occasionally mimicked by central or spinal pathologies. However, metabolic neuromuscular disorders have not been reported to mimic this condition. We present a 52-year-old male patient with hypokalemic paralysis who presented with the early symptoms of acute-onset pure motor hemiparesis. Neurological examinations revealed right-sided weakness without bulbar, extraocular, or respiratory involvement. Ischemic stroke was initially diagnosed on the basis of the acute-onset unilateral motor deficit and the patient’s history of hypertension, stroke, and previous cerebral infarctions. The right hemiparesis and weakness of the left limbs worsened on the day after admission. The patient’s weakness rapidly reversed after correction of hypokalemia, and a diagnosis of hypokalemic paralysis was finally established. This unusual hemineurological presentation should alert medical personnel to the possibility of reversible metabolic neuromuscular disorders, thereby avoiding delayed diagnosis. [Copyright &y& Elsevier]

Abstract: Objectives: Cheiro-oral syndrome is characterized by sensory impairment confined to perioral area and ipsilateral fingers/hand. It results from an involvement of the ascending sensory tracts above the pons. However, a crossed pattern of perioral and acral paresthesia was rarely reported before. Patients and methods: This study reports the neuroanatomic relationship, course and clinical significance of perioral and contralateral acral paresthesia in four patients. We term it the crossed cheiro-oral syndrome. Results: All patients had lateral or dorsolateral medullary infarctions that were ipsilateral to their perioral paresthesia. The contributory origin is considered a diagonal lesion involving the par oralis fibers within the descending trigeminal sensory tract and acral portion of the lateral spinothalamic tract at the lateral portion of medulla oblongata. Despite of a restricted sensory disturbance at initial, progressive neurological disability terminated to Wallenberg''s syndrome ensued in three patients and disabling deficits persisted in two of them. Conclusion: The crossed cheiro-oral syndrome seems a mild form of Wallenberg''s syndrome. Therefore, it predicts medullary involvement and is also a warning sign for progression. [Copyright &y& Elsevier]

Pretreatment with dilute sulfuric acid of silvergrass was compared with the pretreatment’s effect on other commonly used lignocellulosic materials, namely rice straw and bagasse, in order to evaluate the potential of this feedstock for ethanol production. The highest yield of xylose from silvergrass was between 70% and 75%, which was similar to bagasse. However, silvergrass gave a higher level of fermentability than bagasse using the hydrolysate because less acetic acid was formed. The release of sugars resulted in an about 2.0-fold increase in specific surface area of the pretreated silvergrass. Increasing the specific surface area did not obviously enhance enzymatic digestibility. The hydrophilicity of the acid pretreated silvergrass was characterized using its Fourier transform infrared (FTIR) spectra. The increase in hydrophilicity may enhance enzymatic adsorption onto lignin and increase the accumulation of cellobiose for enzymatic hydrolysis as pretreatment severity increases. [Copyright &y& Elsevier]

Abstract: Objectives: A restricted neurological deficit is not uncommon in patients with cortical lesions. However, in cheiro-oral syndrome (COS) associated with cortical involvement, the topographic disparity of the cheiral and oral representation area is hardly explained by the restricted sensorium at the homolateral mouth angle/lip and finger/hand, with sparing of the facial structures. Patients and methods: In order to elucidate the factors of clinical significance and pathogenesis in cortical COS, 11 patients with COS associated with contralateral cortical lesions were analyzed, and the cases of similar patients described in the literature were reviewed. Results: In our patients, the etiologies of COS were infarct, subdural hematoma, meningioma, and vascular malformation. The lesions were sizable enough to involve areas beyond the postcentral gyrus of the parietal lobe. A cortical sensory sign was detected in only six patients. Their paroxysmal sensorium without exacerbation on stimulus was in contrast to the clinical features of COS associated with thalamic lesions. Five patients suffered worsening of their neurological deficits without a parallel expansion of their infarct or hemorrhage. Removal of the hematoma or tumor in four patients rapidly abolished their sensorium. Conclusion: Cortical COS is a warning sign of a potentially life-threatening etiology. Since there is a high frequency of exacerbation, COS should be carefully investigated, as a paucity of associated clinical signs was found in our patients. Paroxysmal sensorium signifies possible cortical involvement. Rapid decompression within the “golden period” is encouraged. It seems that the interaction between previously existing vascular compromise, sensory plasticity, and neuronal vulnerability predisposes patients to this peculiar sensory disorder. Epileptogenesis is unlikely. Thus, a reconsideration of COS in clinical practice is warranted. [Copyright &y& Elsevier]

Abstract: We encountered three patients with hypokalemic paralysis following a convulsion in the early stages of alcohol abstinence. The transtubular potassium gradient was less than 2.0, suggesting intracellular potassium shift. Hypokalaemic paralysis may result from retention of intracellular cationic potassium bound by anionic phosphorylated compounds, precipitated by an acceleration of the Na+–K+ pump in alcohol withdrawal and convulsions. These findings warn of the lethal hypokalemia that may occur after convulsions, particularly soon after alcohol abstinence associated with moderate withdrawal symptoms. [Copyright &y& Elsevier]

Abstract: Objective: Vascular occlusion is not an uncommon event in malignancy. However, the frequency of ischemic stroke after chemotherapy has been mentioned only occasionally in clinical studies. A large-scale study is lacking. Methods: A retrospective study was conducted at Chang Gung Memorial Hospital, Kaohsiung, Taiwan, to analyze the incidence of ischemic stroke post-chemotherapy, further, to evaluate a possible causative relationship between the ischemic stroke and the chemotherapy regimen, the interval between the latest chemotherapy session and onset of ischemic stroke and the survival of patients with ischemic stroke post-chemotherapy. The data were retrieved from the Cancer Database from 1993 to 2004. Results: During this period, a total of 10,963 patients, with malignancies were followed-up for 1 month after chemotherapy, underwent 45,294 chemotherapy sessions. Among this group, there were 15 patients experiencing 16 ischemic strokes within the first month after the latest chemotherapy. Among them, 14 patients were followed-up until death and one patient was lost in follow-up after discharge against medical advice. The incidence of post-chemotherapy ischemic stroke was 0.137% and the frequency of chemotherapy cycles complicated by ischemic stroke was 0.035%. Adenocarcinoma was the most common histological type not only in ischemic stroke (40%) but also in overall patients (36.7%). The hemispheric stroke with middle cerebral artery territory involvement was the most common image finding. Platinum compounds, especially cisplatin, were the most commonly used chemotherapeutic agents for ischemic stroke patients. Twelve (75%) of these 16 ischemic strokes occurred within 10 days of the latest chemotherapy session and 10 (62.5%) occurred after the first cycle of chemotherapy. The median survival after ischemic stroke was 4 weeks. Conclusion: Our results provide valuable data on the relationship between malignancy, treated with chemotherapy, and ischemic stroke. The risk of ischemic stroke after chemotherapy is predicted by the use of cisplatin-based chemotherapy not cancer histologic type. Infarction usually involves the territorial subtype, causes obvious neurological disabilities and carries a grave prognosis. [Copyright &y& Elsevier]

Abstract: Intracranial embolization usually arises from heart, precerebral artery or aorta but rarely the peripheral artery as retrograde upstream of embolus should be overcome. We encountered a woman who experienced a transient right acronumbness followed by a sudden onset of left hemiplegia and conscious change concurrently. Cranial computerized tomography revealed a hemorrhagic infarct at right lentiform nucleus. Angiography disclosed right axillary artery occlusion at the proximal portion without collateral circulation. Cardioaortic survey and coagulation profile were normal. Thrombectomy was done and radial flow was corrected rapidly. Post-thrombectomic heparinization did not bring complication. Therefore, a distant embolism from peripheral artery at the upper limb should be alerted for cerebral ischemia. A lower density of embolus and no-flow condition in her occluded axillary artery may facilitate the upstreamed embolization. Heparinization, under closed monitor, is not contraindicated for preventing restenosis after thrombectomy in case of hemorrhagic transformation in brain. [Copyright &y& Elsevier]

Although a previous or recent history of varicella-zoster virus (VZV) infection is known to increase the risk of stroke in both children and adults, the influence of zoster sine herpetic remains unclear. We report an immunocompetent man with common cold symptoms and conjunctivitis, followed by an acute onset of bulbar weakness and hemihypesthesia without preceding skin rash. Acute medullary infarction and left vertebral artery stenosis were detected. VZV infection was finally identified. Zoster sine herpetic interferes with accurate diagnosis of infectious stroke, and vertebral artery involvement is unusual in ischemic stroke in this situation. An unexplained course of ischemic stroke event should be suspected in patients with VZV cerebrovasculopathy, especially in those without conventional stroke risk factors and those exhibiting concomitant infectious complications. [Copyright &y& Elsevier]

Electric injury is a common physical injury in daily life. Because of the low resistance of vascular tissue, vascular injury and thrombosis are frequently found in cases of high-voltage electric injury but are rarely reported in low-voltage conditions. We present the case of a diabetic woman who suffered symptomatic brainstem stroke after a short duration of 60 Hz/110V alternate current electric contact with a home washer socket. A stroke risk factor survey did not reveal remarkable cardiac or vascular abnormality, except increased glycohemoglobin levels and decreased protein C activity. In contrast to a direct and adequate energy transfer in high-voltage electric injury, a pre-existing vasculohemostatic deficit, such as coagulopathy, has been proposed to provide a predisposition to thrombosis in low-voltage electric injury. Nevertheless, the findings in this patient remind the possibility of physical triggering factor for stroke occurrence in our environment as new technology and product generates rapidly enough for understanding their safety and biologic effect. [Copyright &y& Elsevier]

Bilaterally progressive tinnitus and hearing impairment occurred in a hypertensive patient shortly after an episode of right ganglionic hemorrhage. Audiometric tests showed a mixed sensorineural and conduction hearing loss. When low-dose gabapentin was administrated for the pre-existing postherpetic thoracic neuralgia, the tinnitus dramatically improved but recurred after discontinuation of the drug. Hearing function did not change. In view of a controversy of gabapentin and tinnitus in previous trials, the findings in this patient support that low-dose gabapentin benefits the subgroup of tinnitus patients with secondary contributing factors, such as stroke. [Copyright &y& Elsevier]

Although the somatosensory afferent of the tip of the tongue runs proximal and parallel along the spinothalamocortical and trigeminothalamocortical pathway up to the sensory cortex, central involvement has been rarely described in cases of nongustatory sensory disturbance at the tip of the tongue. In a hypertensive woman who experienced an acute onset of an isolated numbness at the tip of her tongue, recent small infarctions were found at the postcentral gyrus of the right parietal lobe. Thus, central involvement should not be neglected in the case of sensory disturbance at the tip of tongue. [ABSTRACT FROM AUTHOR]

Summary: Dengue is a common mosquito-transmitted viral disease prevalent at many undeveloped and developing countries. Although, neurological complication and hemostatic disturbance are common in dengue virus infection, cerebral ischaemia is barely mentioned. A 61-year-old woman experienced an acute onset of right hemiparesis in her early course of dengue virus type II infection. Extensive laboratory investigation revealed an increase of lupus anticoagulant activity and a prolonged activated partial thromboplastin time that were normalized in the convalescent stage. Her human leucocyte antigens were A2, A11, B8, Cw7, DR4 and DR9. This patient highlights the co-operation between transient activation of humoral immunity and preferential immunogenetic for coagulopathic thrombosis in specific viral disease. [Copyright &y& Elsevier]

Abstract: The enzymatic saccharification of three different feedstocks, rice straw, bagasse and silvergrass, which had been pretreated with different dilute acid concentrations, was studied to verify how enzymatic saccharification was affected by the lignin composition of the raw materials. There was a quantitatively inverse correlation between lignin content and enzymatic digestibility after pretreatment with 1%, 2% and 4% sulfuric acid. The lignin accounted for about 18.8–21.8% of pretreated rice straw, which was less than the 23.1–26.5% of pretreated bagasse and the 21.5–24.1% of pretreated silvergrass. The maximum glucose yield achieved, under an enzyme loading 6.5FPUg−1 DM for 72h, was close to 0.8g glucose/g glucan from the enzymatic hydrolysis of the pretreated rice straw; this was twice that from bagasse and silvergrass. A decrease in initial rate of glucose production was observed in all cases when the raw materials underwent enzymatic saccharification with 4% sulfuric acid pretreatment. It is suggested that the higher acid concentration led to an inhibition of β-glucosidase activity. Fourier transform infrared (FTIR) spectroscopy further indicated the chemical properties of the rice straw and silvergrass become more hydrophilic after pretreatment using 2% of sulfuric acid, but the pretreated bagasse tended to become more hydrophobic. The hydrophilic nature of the pretreated solid residues may increase the inhibitive effects of lignin on the cellulase and this could become very important for raw materials such as silvergrass that contain more lignin. [Copyright &y& Elsevier]

Abstract: Lignocellulose has drawn great attention in the bioethanol industry as an alternative feedstock for ethanol production due to its renewability, abundance and non-food crop characteristics. Acid hydrolyzation of lignocellulose releases sugars (mainly d-xylose) and several derivatives. The sugars in the hydrolyzate are then converted into ethanol by fermentation. Since acetic acid is believed to be one of the inhibitors which limit the yield of ethanol, it is beneficial to remove acetic acid from the hydrolyzates before fermentation. In this study, a Desal-5 DK nanofiltration (NF) membrane was used to separate acetic acid from xylose, using a synthetic acetic acid–xylose solution as the model. The Desal-5 DK membrane had an isoelectric point of 3.7 and a pore size of 0.83nm based on streaming potential measurement and model calculation. It was found that both the solution pH and the applied pressure affected the separation performance. The observed retention of xylose and acetic acid varied from 28% to 81% and −6.8% to 90%, respectively, depending on the solution pH and the applied pressure. The maximum separation factor was 5.4 when the system was operated at pH 2.9 and 24.5bar. In addition, negative retention of acetic acid was observed only in the presence of xylose. The results suggested that intermolecular interactions play an important role in the separation of xylose and acetic acid. [Copyright &y& Elsevier]

Abstract: Squamous cell carcinoma antigen (SCCA) is traditionally engaged for detecting and following up malignancy from a squamous cell origin. We encountered an unusual increase of blood SCCA but no other cancer markers in a patient associated with an infective lumbar spondylitis due to Pseudomonas aeruginosa. An overshooting of Th1 expression, such as tumor necrosis factor alpha, bumped up by his uremia as a result of P. aeruginosa infection may hasten SCCA. Therefore, SCCA might additionally serve as a serological marker for infection besides squamous cell cancer, and its false-positive increase also highlights the appropriateness of tumor marker screening. [Copyright &y& Elsevier]