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Background: To date, there is no studies have investigated the associations between the Walk Scores of neighborhood environments and the physical activity (PA) and sedentary behavior (SB) of older adults in rural areas. Purpose: The aim of this study was thus to examine the correlations of Walk Scores with sufficient PA and prolonged SB in order to provide appropriate recommendations for older adults living in rural areas. Methods: The sample comprised 1,083 older adults (aged ���65 years). Cross-sectional data on PA, SB, and screen time were obtained by using computer-assisted telephone-based interviews. The Walk Score, which indicates the walkability of a neighborhood, was assessed for each participant's neighborhood, with the resulting scores divided into five classes ranging from class 1 to class 5. Binary logistic regression analyses were adopted. Results: Compared with those living in very car-dependent locations (class 1), older adults who lived in locations classified as a ���walker's paradise��� (class 5) were more likely to meet the moderate-to-vigorous physical activity (MVPA) recommendation (���150 min/week) (odds ratio [OR] = 2.35; 95% confidence interval [CI]: 1.37-4.02). However, older adults who lived in a somewhat walkable area (class 3) (OR= 1.61; 95% CI = 1.05-2.47), very walkable area (class 4) (OR= 1.75; 95% CI= 1.11-2.75), or a walker's paradise (class 5) (OR= 2.58; 95% CI= 1.54-4.33) also had significant likelihoods of excessive SB (���7hr/day). In addition, similar results were found regarding to excessive screen time (���2 hr/day). Conclusions: The results of this study indicate that living in a more walkable neighborhood may support MVPA while also being associated with excessive SB among older adults living in rural areas. These findings provide critical information for improving neighborhood walkability and the health-related behaviors of suburban or rural area residents. Funding: This work was supported by Shao-Hsi Chang received a personal grant from the College of Sports and Recreation, National Taiwan Normal University, and from the Ministry of Science and Technology of Taiwan (Grant Number: MOST 108-2410-H-003-117)., The Health & Fitness Journal of Canada, Vol. 14 No. 3 (2021): Proceedings from the 8th International Society for Physical Activity and Health Congress

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Diabetes mellitus (DM) is a risk factor for atrial fibrillation (AF) and is known to be an important risk factor for death from stroke. The influence of AF on long-term outcomes in patients with ischemic stroke remains controversial. To clarify the exact influence of AF on stroke outcome and exclude the effect from DM, we investigated the influence of AF on the 3-year outcomes of nondiabetic patients with acute first-ever ischemic stroke.Five-hundred seventy-four nondiabetic patients with acute first-ever ischemic stroke were enrolled and had been followed for 3 years. Patients were divided into 2 groups according to whether AF was diagnosed or not. Clinical presentations, risk factors for stroke, laboratory data, comorbidities, and outcomes were recorded.A total of 107 patients (18.6%) had AF. The age was significantly older in patients with AF. Total anterior circulation syndrome occurred more frequently among patients with AF (P .001). The mean length of stay in the acute ward was significantly higher in patients with AF (P .001). Furthermore, dependent functional status following discharge was higher in patients with AF (P .001). Multivariate Cox regression revealed that AF is a significant predictor of 3-year all-cause mortality (hazard ratio = 1.98, 95% confidence interval = 1.07-3.67, P = .022).AF is associated with increased risk of 3-year mortality in nondiabetic patients with acute first-ever ischemic stroke. Careful cardiac evaluation and treatment are essential in patients with AF and stroke.

The influence of pneumonia in acute stroke stage on the clinical presentation and long-term outcomes of patients with acute ischemic stroke is still controversial. We investigate the influence of pneumonia in acute stroke stage on the 3-year outcomes of patients with acute first-ever ischemic stroke. Nine-hundred and thirty-four patients with acute first-ever ischemic stroke were enrolled and had been followed for 3years. Patients were divided into two groups according to whether pneumonia occurred during acute stroke stage or not. Clinical presentations, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded. The result showed that a total of 100 patients (10.7%) had pneumonia in acute stroke stage. The prevalence of older age, atrial fibrillation was significantly higher in patients with pneumonia in acute stroke stage. Total anterior circulation syndrome and posterior circulation syndrome occurred more frequently among patients with pneumonia in acute stroke stage (P

In stereoscopic displays, crosstalk is typically observed when the views for both eyes are not clearly separated. Crosstalk affects the quality of 3D images and can cause visual fatigue in observers. According to the results of perception experimentation, different visual depth (disparity) and motion blur can also affect the perception of 3D image quality. Therefore, considering the effects of crosstalk, disparity, and motion blur, we propose an evaluation index to quantify 3D image performance for stereoscopic displays. This index assesses the optical quality of a 3D display as well as the effects of image content. According to human vision experimentation, the 3D image index $(\Delta {\rm X}_{\rm 3D})$ is validated to have a high positive correlation (0.8) with human perception. After combining the human visual mechanism and $\Delta {\rm X}_{{{\rm 3D}}}$ , the proposed index can represent the visual quality of static and dynamic images on stereoscopic displays.

The influence of renal dysfunction on the clinical presentation and outcomes of patients with acute ischemic stroke is still controversial. We investigate the influence of renal dysfunction on the outcomes of patients with acute first-ever ischemic stroke.Nine-hundred thirty-four patients with acute first-ever ischemic stroke were enrolled and followed for 3 years. Renal function was assessed using the equation of the Modification Diet for Renal Disease for estimated glomerular filtration rate (eGFR). Serum creatinine levels were obtained within 3 days of acute stroke onset. Reduced eGFR was defined as eGFR60ml/min/1.73m(2). Clinical presentation, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded.Total 264 patients (28.3%) had a reduced eGFR. The prevalence of older age, hypertension, and atrial fibrillation was significantly higher in patients with a reduced eGFR. Total anterior circulation syndrome occurred more frequently among patients with a reduced eGFR (P=0.010). Multivariate Cox regression revealed that a reduced eGFR is a significant predictor of 3-year mortality (HR=1.67, 95% CI=1.06-2.62, P=0.026).Reduced eGFR during the acute stroke stage is associated with increased risk of 3-year mortality. Furthermore, risk of acute complications and poor functional outcomes following discharge was significantly higher in patients with a reduced eGFR.

Applying steady-state visual evoked potentials (SSVEPs) on a display system, a novel brain-display interaction (BDI) system was presented. This study further proposed an imperceptible flickering visual stimulus to make a SSVEP-based BDI more practical and promising for biomedical applications, such us glaucoma visual field loss diagnosis.

Importance The current assessment of visual field loss in diseases such as glaucoma is affected by the subjectivity of patient responses and the lack of portability of standard perimeters. Objective To describe the development and initial validation of a portable brain-computer interface (BCI) for objectively assessing visual function loss. Design, Setting, and Participants This case-control study involved 62 eyes of 33 patients with glaucoma and 30 eyes of 17 healthy participants. Glaucoma was diagnosed based on a masked grading of optic disc stereophotographs. All participants underwent testing with a BCI device and standard automated perimetry (SAP) within 3 months. The BCI device integrates wearable, wireless, dry electroencephalogram and electrooculogram systems and a cellphone-based head-mounted display to enable the detection of multifocal steady state visual-evoked potentials associated with visual field stimulation. The performances of global and sectoral multifocal steady state visual-evoked potentials metrics to discriminate glaucomatous from healthy eyes were compared with global and sectoral SAP parameters. The repeatability of the BCI device measurements was assessed by collecting results of repeated testing in 20 eyes of 10 participants with glaucoma for 3 sessions of measurements separated by weekly intervals. Main Outcomes and Measures Receiver operating characteristic curves summarizing diagnostic accuracy. Intraclass correlation coefficients and coefficients of variation for assessing repeatability. Results Among the 33 participants with glaucoma, 19 (58%) were white, 12 (36%) were black, and 2 (6%) were Asian, while among the 17 participants with healthy eyes, 9 (53%) were white, 8 (47%) were black, and none were Asian. The receiver operating characteristic curve area for the global BCI multifocal steady state visual-evoked potentials parameter was 0.92 (95% CI, 0.86-0.96), which was larger than for SAP mean deviation (area under the curve, 0.81; 95% CI, 0.72-0.90), SAP mean sensitivity (area under the curve, 0.80; 95% CI, 0.69-0.88; P = .03), and SAP pattern standard deviation (area under the curve, 0.77; 95% CI, 0.66-0.87; P = .01). No statistically significant differences were seen for the sectoral measurements between the BCI and SAP. Intraclass coefficients for global and sectoral parameters ranged from 0.74 to 0.92, and mean coefficients of variation ranged from 3.03% to 7.45%. Conclusions and Relevance The BCI device may be useful for assessing the electrical brain responses associated with visual field stimulation. The device discriminated eyes with glaucomatous neuropathy from healthy eyes in a clinically based setting. Further studies should investigate the feasibility of the BCI device for home-based testing as well as for detecting visual function loss over time.

Author(s): Chien, Yu-Yi; Lin, Fang-Cheng; Zao, John K; Chou, Ching-Chi; Huang, Yi-Pai; Kuo, Heng-Yuan; Wang, Yijun; Jung, Tzyy-Ping; Shieh, Han-Ping D | Abstract: ObjectiveInteractive displays armed with natural user interfaces (NUIs) will likely lead the next breakthrough in consumer electronics, and brain-computer interfaces (BCIs) are often regarded as the ultimate NUI-enabling machines to respond to human emotions and mental states. Steady-state visual evoked potentials (SSVEPs) are a commonly used BCI modality due to the ease of detection and high information transfer rates. However, the presence of flickering stimuli may cause user discomfort and can even induce migraines and seizures. With the aim of designing visual stimuli that can be embedded into video images, this study developed a novel approach to induce detectable SSVEPs using a composition of red/green/blue flickering lights.ApproachBased on the opponent theory of colour vision, this study used 32 Hz/40 Hz rectangular red-green or red-blue LED light pulses with a 50% duty cycle, balanced/equal luminance and 0°/180° phase shifts as the stimulating light sources and tested their efficacy in producing SSVEP responses with high signal-to-noise ratios (SNRs) while reducing the perceived flickering sensation.Main resultsThe empirical results from ten healthy subjects showed that dual-colour lights flickering at 32 Hz/40 Hz with a 50% duty cycle and 180° phase shift achieved a greater than 90% detection accuracy with little or no flickering sensation.SignificanceAs a first step in developing an embedded SSVEP stimulus in commercial displays, this study provides a foundation for developing a combination of three primary colour flickering backlights with adjustable luminance proportions to create a subtle flickering polychromatic light that can elicit SSVEPs at the basic flickering frequency.

Recognizing the cause is essential for the management of meralgia paresthetica (MP), also known as lateral femoral cutaneous neuropathy. The aim of this study was to investigate the etiologies of MP and their influence on each other. This retrospective study enrolled referral patients with electromyographic studies who fulfilled the clinical and electrodiagnostic criteria of MP from January 2003 to December 2013. Data including age, gender, body weight, body height, occupation, and relevant medical history were collected. The etiological analysis was based on age and gender. A total of 50 patients (30 males and 20 females) were enrolled. The average age (±standard deviation) at diagnosis was 49.8±12.8years. Risk factors were identified in 29 cases (58.0%). More patients younger than 50years of age were male (73.1%, p=0.049). Peaks of age occurred between 41-50years in men and 51-60years in women. More males had a body mass index≥24kg/m2 (69.2% vs. 31.6%, p=0.012) and ≥27kg/m2 (34.6% vs. 0.0%, p=0.006). Overweight and obese patients were more vulnerable to occupational factors (50.0% vs. 19.0%, p=0.030). Only one case had diabetes mellitus (2%). Male middle-aged patients with a higher body mass index and certain occupations had an increased risk of MP. In contrast to the peak age distribution of the male patients, the frequency of developing MP was relatively even among the women at all ages. The cause was often obscure.

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 p =0.002, respectively). Subgroup analysis showed a similar association for hypercholesterolemia in both younger (age Conclusions Acute ischemic stroke in patients with hypercholesterolemia was correlated with reduced severity on admission and less favorable recovery during hospitalization, regardless of age.

An oncoming interactive platform integrated with LCD provides another option not only for handicapped but public to make our daily lives more convenient. Steady-state visual evoked potentials (SSVEPs) are human brain responses to visual stimulation at specific light flashing frequencies. With the improvement of brain-computer interface (BCI) applications in mind, this paper proposed effective and comfortable SSVEP stimuli of high-frequency and polychromatic encoded lights with tunable duty cycles and phases.

Head-mounted virtual reality and augmented reality displays a.k.a. VR/AR goggles created a revolutionary multimedia genre that is seeking ever-broadening applications and novel natural human interfaces. Adding neuromonitoring and neurofeedback to this genre is expected to introduce a new dimension to user interaction with the cyber-world. This study presents the development of a Neuromonitoring VR/AR Goggle armed with electroence-phalo-gram and electrooculogram sensors, programmable milli-Ampere current stimulators and wireless fog/cloud computing support. Beside of its potential use in mitigating cybersickness, this device may have potential applications in augmented cognition ranging from feedback-controlled perceptual training to on-line learning and virtual social interactions. A prototype of the device has been made from a Samsung Gear VR for S6. This study explains its technical design to ensure precision data sampling, synchronous event marking, real-time signal processing and big data cloud computing support. This study also demonstrates the effective-ness in measuring the event-related potentials during a visual oddball experiment.

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 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.

This study investigated the impact of smoking on the initial severity of acute ischemic stroke and examined its subsequent outcome.Patient data was collected from the Stroke Registry in the Chang Gung Healthcare System (SRICHS). A total of 2650 patients admitted for acute ischemic stroke from January to December 2009 were included. Baseline characteristics were compared between smokers and non-smokers. Factors affecting the initial severity and the recovery from neurological deficit were examined by logistic regression analysis. The patients were further divided according to stroke mechanism for subgroup analysis.The total number of smokers and non-smokers was 817 (31.9%) and 1833 (69.1%), respectively. Univariate analysis showed that smokers had lower NIHSS scores on admission than did non-smokers (P0.001). In subgroup analysis, smokers with small-vessel occlusions frequently had higher NIHSS scores on admission than did non-smokers (P=0.001). However, smokers with cardioembolic stroke had lower NIHSS scores on admission as compared to non-smokers (P=0.024). No subgroup had smoking as a significant factor for neurological recovery during hospitalization.Smoking correlated with higher NIHSS scores on admission for small-vessel occlusion. Conversely, it was associated with lower NIHSS scores on admission for cardioembolism.

An evaluation index to quantify the overall 3D image quality for two-view Stereoscopic image is proposed. Considering crosstalk, motion blur, and disparity, the 3D image quality index (ΔX3D) was proven to have a high positive correlation with human perception. Finally, a 3D image can be quantified by ΔX3D with importing the gray-to-gray response time, optical crosstalk, and the disparity of two-eye images.

Objective Primary quadriceps weakness/atrophy is a rare disorder with variable etiologies; therefore, this disorder has been regarded as a clinical syndrome rather than a distinct entity. However, three affected patients of a Taiwanese family demonstrate a uniform pattern of quadriceps weakness and atrophy, their clinical manifestations and pattern of inheritance may suggest a new disease entity. Patients and Methods Three patients in a Taiwanese kindred with selective quadriceps weakness and atrophy, which began after age 40 years, were examined. To disclose the confines of this disorder, muscle CT scans, electromyography, nerve conduction studies and muscle biopsies were performed; and to unravel and better understand the nature of this disorder, histopathological, ultrastructural, immunocytochemical and genetic studies were carried out. Results In two patients with long-standing disease, muscle imaging showed marked atrophy and fat replacement of the anterior thigh muscles and electromyography showed a mixture of myopathic and neuropathic changes. Muscle histopathology on the mildly affected tibialis anterior showed myopathic changes with myofibrillar degeneration and secondary neurogenic alterations. Immunocytochemical staining was not diagnostic but excluded the dystrophinopathies and other well-known muscular dystrophies. Conclusion All previously identified diseases resulting in quadriceps weakness and atrophy have been ruled out and the present disorder appears to be a new disease entity of autosomal dominant late onset quadriceps myopathy.

Brain-computer interfaces (BCIs) are intuitive systems for users to communicate with outer electronic devices. Steady state visual evoked potential (SSVEP) is one of the common inputs for BCI systems due to its easy detection and high information transfer rates. An advanced interactive platform integrated with liquid crystal displays is leading a trend to provide an alternative option not only for the handicapped but also for the public to make our lives more convenient. Many SSVEP-based BCI systems have been studied in a 2D environment; however there is only little literature about SSVEP-based BCI systems using 3D stimuli. 3D displays have potentials in SSVEP-based BCI systems because they can offer vivid images, good quality in presentation, various stimuli and more entertainment. The purpose of this study was to investigate the effect of two important 3D factors (disparity and crosstalk) on SSVEPs. Twelve participants participated in the experiment with a patterned retarder 3D display. The results show that there is a significant difference (p-value

In this paper, we used the Hilbert-Huang transform (HHT) analysis method to examine the time-frequency characteristics of spike waves for detecting epilepsy symptoms. We obtained a sample of spike waves and nonspike waves for HHT decomposition by using numerous intrinsic mode functions (IMFs) of the Hilbert transform (HT) to determine the instantaneous, marginal, and Hilbert energy spectra. The Pearson correlation coefficients of the IMFs, and energy-IMF distributions for the electroencephalogram (EEG) signal without spike waves, Spike I, Spike II and Spike III sample waves were determined. The analysis results showed that the ratios of the referred wave and Spike III wave to the referred total energy for IMF1, IMF2, and the residual function exceeded 10 %. Furthermore, the energy ratios for IMF1, IMF2, IMF3 and the residual function of Spike I, Spike II to their total energy exceeded 10 %. The Pearson correlation coefficients of the IMF3 of the EEG signal without spike waves and Spike I wave, EEG signal without spike waves and Spike II wave, EEG signal without spike waves and Spike III wave, Spike I and II waves, Spike I and III waves, and Spike II and III waves were 0.002, 0.06, 0.01, 0.17, 0.03, and 0.3, respectively. The energy ratios of IMF3 in the ? band to its referred total energy for the EEG signal without spike waves, and of the Spike I, II, and III waves were 4.72, 6.75, 5.41, and 5.55 %, respectively. The weighted average frequency of the IMF1, IMF2, and IMF3 of the EEG signal without spike waves was lower than that of the IMF1, IMF2, and IMF3 of the spike waves, respectively. The weighted average magnitude of the IMF3, IMF4, and IMF5 of the EEG signal without spike waves was lower than that of the IMF1, IMF2, and IMF3 of spike waves, respectively.

In an attempt to develop safe and robust methods for monitoring migraineurs' brain states, we explores the feasibility of using white, red, green and blue LED lights flickering around their critical flicker fusion (CFF) frequencies as foveal visual stimuli for inducing steady-state visual evoked potentials (SSVEP) and causing discernible habituation trends. After comparing the habituation indices, the multi-scale entropies and the time dependent intrinsic correlations of their SSVEP signals, we reached a tentative conclusion that sharp red and white light pulses flickering barely above their CFF frequencies can replace commonly used 13Hz stimuli to effectively cause SSVEP habituation among normal subjects. Empirical results showed that consecutive short bursts of light can produce more consistent responses than a single prolonged stimulation. Since these high frequency stimuli do not run the risk of triggering migraine or seizure attacks, further tests of these stimuli on migraine patients are warranted in order to verify their effectiveness.

Although venous thrombosis is a frequently encountered problem in nephrotic syndrome, the occurrence of arterial thrombosis is much less common, and is usually associated with a poor prognosis. To the best of our knowledge, there has been only one reported case of concurrent cerebral and femoral artery thrombosis, that of a 23-year-old male who finally died. Herein, we report a case of a 35-year-old woman with nephrotic syndrome. She developed cerebral and femoral arterial thrombosis simultaneously when the nephrotic syndrome relapsed. Immediate thrombectomy of the femoral artery, followed by anticoagulation and immunosuppressive therapy, were employed. The patient recovered completely and is now doing well. Our experience indicates that multiple artery thrombosis in nephrotic patients may not necessarily carry a poor outcome if early and aggressive treatment can be undertaken.

A forty-six-year-old premenopausal woman developed headache, nausea and vomiting, left hemiparesis, and seizure two days after parenteral use of progesterone and 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.

With brain-computer interface (BCI) applications in mind, we analyzed the amplitudes and the signal-to-noise ratios (SNR) of steady-state visual evoked potentials (SSVEP) induced in the foveal and extra-foveal regions of human retina. Eight subjects (age 20-55) have been exposed to 2° circular and 16°-18° annular visual stimulation produced by white LED lights flickering between 5Hz and 65Hz in 5Hz increments. Their EEG signals were recorded using a 64-channel NeuroScan system and analyzed using non-parametric spectral and canonical convolution techniques. Subjects' perception of flickering and their levels of comfort towards the visual stimulation were also noted. Almost all subjects showed distinctively higher SNR in their foveal SSVEP responses between 25Hz and 45Hz. They also noticed less flickering and felt more comfortable with the visual stimulation between 30Hz and 45Hz. These empirical evidences suggest that lights flashing above the critical flicker fusion rates (CFF) of human vision may be used as effective and comfortable stimuli in SSVEP BCI applications.

The short-term effects after experimental partial and total denervation on histochemical fiber type profiles were studied in rat soleus muscles by the myofibrillar ATPase stain. In 58 control soleus muscles, a total of 155788 fibers were counted, comprising type 1 (75.1%), type 2A (13.3%), type 2B (1.4%) and type 2C (10.3%), respectively. In 34 animals with total denervation, including 17 with soleus nerve resection at 1cm before entering the soleus muscle and 17 with total sciatic neurectomy, the proportion of type 1 fiber was decreased in denervated muscles to 39.1% 5 weeks after the procedures. In parallel with a decrease in type 1 fiber proportion, undifferentiated type 2C fibers increased, thereby suggesting muscle fiber type dedifferentiation taking place in totally denervated muscle. In contrast, 24 muscles with partial denervation showed a decreased proportion of type 1 fibers at the initial stage followed by an increase in type 1 fiber to 89.0% 5 weeks after denervation, resulting from an active reinnervating process.

The effects of partial and total denervation on muscle fibers were studied in rat soleus muscles by quantitative computer imaging analysis. Within 5 weeks after denervation, there was a progressive reduction of the soleus muscle weight in total denervation groups but a gradual recovery beginning in the third week and reaching 75% of the control in the fifth week in the partial denervation group. The reduction of muscle mass was mainly due to the replacement of large and medium-sized fibers by small atrophic fibers.In totally denervated muscles, cross-sectional fiber area showed a rapid decline after denervation, but the shape of fiber size distribution was nearly normal. On the other hand, partially denervated muscles showed an asymmetrical fiber size distribution with a shift toward large fibers. In control and totally denervated muscles, mean fiber area strongly correlated with the standard deviation from the mean, but in partially denervated muscles, this strong correlation no longer existed and was replaced by larger standard deviations. It is concluded that only partially denervated muscles show significant variations in fiber size.

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.

Leukocyte count predicted the risk of first-time myocardial infarction and ischemic stroke. The aim of this study was to determine the role of elevated leukocyte count in non-diabetic patients admitted for acute first-ever ischemic stroke on clinical presentation and 3-year mortality. We studied 462 patients with acute first-ever ischemic stroke without diabetes mellitus or active infection at admission. Patients were classified into 2 groups according to their leukocyte count. A white blood cell (WBC) count ≥ 10,000/μL was defined as an elevated leukocyte count, otherwise as normal. Clinical presentation, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded. 64 patients (13.9%) had elevated leukocytes. Multivariate logistic regression showed that an elevated platelet count was positively associated with the elevated leukocyte count, while a low serum sodium level was negatively associated with an elevated leukocyte count (P = 0.008, P = 0.003, respectively). An elevated leukocyte count was associated with a higher risk of a stroke in evolution (P = 0.021). Multivariate Cox regression analysis revealed that an elevated leukocyte count is a significant predictor of 3-year mortality [P = 0.010, HR = 3.26 (1.33–7.98)]. In conclusion, higher leukocyte counts during the acute stroke stage are associated with increased risk of 3-year mortality in patients with acute, first-ever ischemic stroke.

Signal analysis is a field of study that attempts to extract information features from various physical phenomena. Fourier transform (FT), wavelet transform (WT), and Hilbert-Huang transformation (HHT) are the 3 major approaches used in signal analysis (Huang et al., 1998) (Yan & Gao, 2007). FT is a global energy-frequency distribution approach that is suitable for analyzing linear, strictly periodic, and stationary signals. In contrast, HHT is a good method for analyzing non-linear and non-stationary signals, such as those associated with wind, earthquakes, electrocardiographs (ECGs), and electroencephalograms (EEGs). This method can also used to describe the local features of dynamic signals, and illustrate the energy-frequency-time distribution of these signals. The 2 principal steps employed in HHT are empirical mode decomposition (EMD) and Hilbert spectral analysis, EMD is used to decompose local signals to finite data sets, which are referred to as intrinsic mode functions (IMFs), and Hilbert transforms (HTs) are used in conjunction with the obtained IMFs to determine the instantaneous frequencies (IFs), time-frequency-energy distributions of the local time signals. A number of studies have been performed to elucidate various aspects of signal analysis. Cohen reviewed the fundamental ideas, methods, and characteristics of the time-frequency analysis approaches employed until 1989 (Cohen, 1989). Blanco et al., used the Gabor transform (GT) time-frequency analysis approach to facilitate identification of the source of epileptic seizures (Blanco et al., 1997). The GT approach is similar to the fast FT approach, but GT offers the advantage of allowing the analysis of the frequencies and their time evolution. Blanco et al., adopted GT to achieve maximal concentration of the time and frequency characteristics for epilepsy and obtain accurate information on the time evolution of the frequency epileptic activity. Tzallas et al., used short-time Fourier transform and 12 different time-frequency distributions for studying epilepsy classification problems and discussed the obtained sensitivity, accuracy, and selectivity results, and the characteristic data features for the detection of epilepsy (Tzallas et al., 2009). However, they did not use the HHT-based time-frequency analysis approach to define epileptic sharps. Sharabaty et al., used the HHT signal-analysis approach to determine the alpha and theta localizations for estimation of the vigilance level, and

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 (³70 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.

Pituitary apoplexy is a rare but life-threatening disorder. Clinical presentation of this condition includes severe headache, impaired consciousness, fever, visual disturbance, and variable ocular paresis. Signs of meningeal irritation are very rare. However, if present and associated with headache, fever, and pleocytosis, meningeal irritation may lead to misinterpretation as infectious meningoencephalitis. To the best of our knowledge, pituitary apoplexy with an initial presentation mimicking infectious meningoencephalitis had rarely been reported in the literature. Here, we report a 57-year-old man who had acute severe headache, high fever, neck stiffness, disturbance in consciousness, and left ocular paresis. Laboratory data showed leukocytosis, an elevated C-reactive protein level, and neutrophilic pleocytosis in the cerebrospinal fluid. Because bacterial meningoencephalitis was suspected, empiric antibiotic therapy was administered but in vain. Further examinations indicated a diagnosis of pituitary adenoma with apoplexy. After the immediate administration of intravenous corticosteroid supplement and surgical decompression, the patient recovered.