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Background and aims Renal dysfunction is a potent risk factor for cardiovascular diseases, including stroke. This study aimed to evaluate the impact of admission estimated glomerular filtration rate (eGFR) levels on short-term (1-month) and long-term (1-year) mortality in patients with acute ischemic stroke. Methods From the Taiwan Stroke Registry data, we classified ischemic stroke patients, identified from April 2006 to December 2015, into 5 groups by eGFR at admission: ≥ 90, 60–89, 30–59, 15–29, and Results Among 52,732 ischemic stroke patients, 1480 died within one month. The 1-month mortality rate was over 5-fold greater in patients with eGFR Conclusions After acute ischemic stroke, patients with reduced eGFR are at elevated risks of short-term and long-term deaths in a graded relationship.

We investigated the impact of serum cholesterol levels on 30-day mortality after ischemic stroke in dialysis patients.From the Taiwan Stroke Registry data, we identified 46,770 ischemic stroke cases, including 1101 dialysis patients and 45,669 nondialysis patients from 2006 to 2013.Overall, the 30-day mortality was 1.46-fold greater in the dialysis group than in the nondialysis group (1.75 versus 1.20 per 1000 person-days). The mortality rates were 1.64, .62, 2.82, and 2.23 per 1000 person-days in dialysis patients with serum total cholesterol levels of 120 mg/dL, 120-159 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. Compared to dialysis patients with serum total cholesterol levels of 120-159 mg/dL, the corresponding adjusted hazard ratios of mortality were 4.20 (95% confidence interval [CI] = 1.01-17.4), 8.06 (95% CI = 2.02-32.2), and 6.89 (95% CI = 1.59-29.8) for those with cholesterol levels of 120 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively.Dialysis patients with serum total cholesterol levels of ≥160 mg/dL or 120 mg/dL on admission are at an elevated hazard of 30-day mortality after ischemic stroke.

Molecular‐level airborne sensing is critical for early prevention of disasters, diseases, and terrorism. Currently, most 2D surface‐enhanced Raman spectroscopy (SERS) substrates used for air sensing have only one functional surface and exhibit poor SERS‐active depth. “Aerosolized plasmonic colloidosomes” (APCs) are introduced as airborne plasmonic hotspots for direct in‐air SERS measurements. APCs function as a macroscale 3D and omnidirectional plasmonic cloud that receives laser irradiation and emits signals in all directions. Importantly, it brings about an effective plasmonic hotspot in a length scale of approximately 2.3 cm, which affords 100‐fold higher tolerance to laser misalignment along the z‐axis compared with 2D SERS substrates. APCs exhibit an extraordinary omnidirectional property and demonstrate consistent SERS performance that is independent of the laser and analyte introductory pathway. Furthermore, the first in‐air SERS detection is demonstrated in stand‐off conditions at a distance of 200 cm, highlighting the applicability of 3D omnidirectional plasmonic clouds for remote airborne sensing in threatening or inaccessible areas. MOE (Min. of Education, S’pore) Accepted version

IntroductionFibromyalgia (FM), a common chronic widespread pain syndrome with neurological symptoms affecting ∼10% of the population worldwide. Whereas small fibre neuropathy is a recognized part of FM, surprisingly little is known about large fibre neuropathy. The present study investigates the sensory and motor axonal properties using novel nerve excitability testing (NET) to seek a better understanding of the pathogenesis of this painful disorder.Methods25 FM patients were recruited from the Wan Fang Hospital in Taiwan who fulfilled the American College of Rheumatology diagnostic criteria.1 NCS, pain scores, blood tests and NET were performed in all patients and patients with factors that may confound the results of NET were excluded. Control data were obtained from age and gender-matched healthy controls (HC) who had no neurological deficits or known pain disorders.ResultsThe FM group showed an increase in superexcitability (pConclusionsAlterations in the sensory axonal parameters can be detected while NCS is normal, these findings are compatible with the concept that the sensory system is mainly involved in the pathogenesis of FM. Results implied probable hypofunction of the paranodal fast K+ channel in the sensory axons, known to be associated with the generation of pain.2 Our study highlights the advantage of NET over NCS, in the early detection of axonal dysfunction and may provide further understandings of future therapeutic treatment.ReferencesWolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol 2011;38(6):1113–1122.Kuwabara S, Misawa S. Pharmacologic intervention in axonal excitability: in vivo assessment of nodal persistent sodium currents in human neuropathies. Curr Mol Pharmacol 2008;1(1):61–67.

Background Guillain-Barre syndrome has been regarded as a spectrum of diseases with many variants. Objective To present a case in which, when the ocular muscles are affected in the beginning, it is very challenging to distinguish Guillain-Barre syndrome from myasthenia gravis. Case Report We describe a patient with Guillain-Barre syndrome who presented initially with isolated ptosis without ophthalmoplegia and subsequently developed descending paralysis. Due to the primary involvement of the lid levators, the patient was initially diagnosed as having a myasthenic crisis. Conclusion Although extremely rare, Guillain-Barre syndrome can present initially as isolated ptosis with subsequent descending paralysis.

Background Lemierre syndrome is characterized by postanginal septicemia and internal jugular vein thrombophlebitis with secondary septic emboli, typically to the lungs. The central nervous system (CNS) is rarely involved. Objective To present a case of Lemierre syndrome featuring cerebral subdural and epidural empyemas. Case Report This case report describes the case of a 17-year-old youth with cerebral subdural and epidural empyemas. The findings of chest computed tomography of the neck and the blood cultures were compatible with Lemierre syndrome. The patient recovered well after antibiotic treatment and surgical debridement. Conclusion Lemierre syndrome can result in infection spreading to the CNS, including cerebral subdural and epidural empyemas. This disease entity should be included in the differential diagnoses of CNS bacterial infections.

Polycystic ovary syndrome (PCOS) is a common and complex female endocrinopathy that is associated with multiple vascular risk factors. Our objective was to investigate the relationship between carotid intima-media thickness (CIMT) and endogenous androgens in young Taiwanese-Chinese women with PCOS. We measured CIMT with B-mode ultrasound in 42 young PCOS patients and 43 controls. Atherosclerosis-associated profiles and endocrinological parameters were also measured. The results showed that although Taiwanese-Chinese PCOS patients tend to possess more risk factors for atherosclerosis than controls, there was no evidence to support that they have a greater CIMT at this age. Furthermore, androstenedione appears to be inversely associated with CIMT.

Non-Hodgkin's lymphoma which occasionally involves the central nervous system, occurs more often in high-grade cases and implicates a poor prognosis. Leptomeningeal metastases may present as multiple cranial nerve involvements. Diagnosis is achieved by recognizing the clinical manifestations, followed by neuroradiologic studies and laboratory examination of the cerebrospinal fluid. But normal studies of either method do not exclude such a diagnosis.We present one female patient with non-Hodgkin's lymphoma, who had multiple cranial nerve palsies as signs of central nervous system involvement, but who had negative results in her neuroimaging studies.Patients with multiple cranial nerve palsies should receive cytological examinations of the cerebrospinal fluid in spite of the negative neuroimaging results.

The "capsular warning syndrome" (CWS) is characterized by recurrent stereotypical episodes of motor and/or sensory dysfunction without cortical signs. CWS is a clinically well recognized entity, and carries a significant risk of capsular infarct. The ischemia is most likely ascribable to hemodynamic changes in diseased small penetrating vessels. Treatment remains controversial and none has been proven effective. We described a 66-year-old man having 15 episodes of stereotypical transient ischemic attack within four days. The findings of the diffusion-weighted image showed abnormalities confined concurrently to the left lateral thalamus, posterior globus pallidus, and posterior corona radiata while the internal capsule was spared. Theses findings suggest involvement of the territory of anterior choroidal artery. We also documented changes in the pattern of attacks after initiation of intravenous urokinase.