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Objective: This study proposed a moving average (MA) approach to dynamically process heart rate variability (HRV) and developed aberrant driving behavior (ADB) prediction models by using long short-term memory (LSTM) networks. Background: Fatigue-associated ADBs have traffic safety implications. Numerous models to predict such acts based on physiological responses have been developed but are still in embryonic stages. Method: This study recorded the data of 20 commercial bus drivers during their routine tasks on four consecutive days and subsequently asked them to complete questionnaires, including subjective sleep quality, driver behavior questionnaire and the Karolinska Sleepiness Scale. Driving behaviors and corresponding HRV were determined using a navigational mobile application and a wristwatch. The dynamic-weighted MA (DWMA) and exponential-weighted MA were used to process HRV in 5-min intervals. The data were independently separated for training and testing. Models were trained with 10-fold crossvalidation strategy, their accuracies were evaluated, and Shapley additive explanation (SHAP) values were used to determine feature importance. Results: Significant increases in the standard deviation of NN intervals (SDNN), root mean square of successive heartbeat interval differences (RMSSD), and normalized spectrum of high frequency (nHF) were observed in the pre-event stage. The DWMA-based model exhibited the highest accuracy for both driver types (urban: 84.41%; highway: 80.56%). The SDNN, RMSSD, and nHF demonstrated relatively high SHAP values. Conclusion: HRV metrics can serve as indicators of mental fatigue. DWMA-based LSTM could predict the occurrence of the level of fatigue associated with ADBs. [ABSTRACT FROM AUTHOR]

Objectives. Current approaches via physiological features detecting aberrant driving behaviour (ADB), including speeding, abrupt steering, hard braking and aggressive acceleration, are developing. This study proposes using machine learning approaches incorporating heart rate variability (HRV) parameters to predict ADB occurrence. Methods. Naturalistic driving data of 10 highway bus drivers in Taiwan from their daily routes were collected for 4 consecutive days. Their driving behaviours and physiological data during a driving task were determined using a navigation mobile application and heart rate watch. Participants' self-reported data on sleep, driving-related experience, open-source data on weather and the traffic congestion level were obtained. Five machine learning models - logistic regression, random forest, naive Bayes, support vector machine and gated recurrent unit (GRU) - were employed to predict ADBs. Results. Most drivers with ADB had low sleep efficiency (≤ 80%), with significantly higher scores in driver behaviour questionnaire subcategories of lapses and errors and in the Karolinska sleepiness scale than those without ADBs. Moreover, HRV parameters were significantly different between baseline and pre-ADB event measurements. GRU had the highest accuracy (81.16-84.22%). Conclusions. Sleep deficit may be related to the increased fatigue level and ADB occurrence predicted from HRV-based models among bus drivers. [ABSTRACT FROM AUTHOR]

Objective. Abnormal functional connectivity (FC) and structure in the brain are found in patients with fibromyalgia (FM). This study investigated FC and structural alterations of the visual cortical system, the emerging contributor to pain processing, in patients with FM. Methods. Thirty pain-free participants and 26 patients with FM were enrolled. Clinical characteristics were evaluated using standardized scales. Structural and resting-state functional magnetic resonance imaging were conducted. Seed-based FC analyses, voxel-based morphometry, and surface-based morphometry were performed. The FC and cortical structure of the visual system were compared between the 2 groups. The correlation between functional and structural changes in the visual cortical system with clinical presentation in the FM group was analyzed. Results. The patients with FM showed increased FCs within visual networks, of which the FC between the visual medial network and the right lingual gyrus (LG) was positively correlated with the Fibromyalgia Impact Questionnaire (FIQ) score. However, the FM group showed decreased FCs from the visual occipital network (VON) to several regions, of which the FCs from the VON to the bilateral frontal orbital cortices were negatively correlated with the FIQ and Pittsburgh Sleep Quality Index scores. Cortical thickness of the lateral occipital cortex, LG, and pericalcarine in FM tended to increase. Conclusion. Altered FCs and structure in the visual cortical system might be involved in the pathomechanisms and clinical presentation in FM. These findings could potentially support further studies that seek to find diagnostic methods and mechanism-based therapies in patients with FM. [ABSTRACT FROM AUTHOR]

Objectives: Obstructive sleep apnea (OSA)may increase the risk of Alzheimer's disease (AD). However, potential associations among sleep-disordered breathing, hypoxia, and OSA-induced arousal responses should be investigated. This study determined differences in sleep parameters and investigated the relationship between such parameters and the risk of AD. Methods: Patients with suspected OSA were recruited and underwent in-lab polysomnography (PSG). Subsequently, blood samples were collected from participants. Patients' plasma levels of total tau (T-Tau) and amyloid beta-peptide 42 (Ab42) were measured using an ultrasensitive immunomagnetic reduction assay. Next, the participants were categorized into low- and high-risk groups on the basis of the computed product (A&#946l42 x T-Tau, the cutoff for AD risk). PSG parameters were analyzed and compared. Results: We included 36 patients in this study, of whom 18 and 18 were assigned to the low- and high-risk groups, respectively. The average apnea--hypopnea index (AHI), apnea, hypopnea index [during rapid eye movement (REM) and non-REM (NREM) sleep], and oxygen desaturation index (≥3%, ODI-3%) values of the high-risk group were significantly higher than those of the low-risk group. Similarly, the mean arousal index and respiratory arousal index (R-ArI) of the high-risk group were significantly higher than those of the low-risk group. Sleep-disordered breathing indices, oxygen desaturation, and arousal responses were significantly associated with an increased risk of AD. Positive associations were observed among the AHI, ODI-3%, R-ArI, and computed product. Conclusions: Recurrent sleep-disordered breathing, intermittent hypoxia, and arousal responses, including those occurring during the NREM stage, were associated with AD risk. However, a longitudinal study should be conducted to investigate the causal relationships among these factors. [ABSTRACT FROM AUTHOR]

Objective. In patients with fibromyalgia (FM), the brain shows altered structure and functional connectivity, but the mechanisms underlying these changes remain unclear. This study investigated the associated changes in brain microstructures and neuroinflammation of patients with FM. Methods. We recruited 14 patients with FM and 14 healthy controls (HCs). Visual analog scale (VAS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II) were used for assessing their pain, anxiety, and depression levels, respectively. Diffusion kurtosis imaging (DKI) was used to visualize microstructural alterations associated with neuroinflammation in specific brain regions. The biomarkers for neuron damage, including serum tau and amyloid ß protein fragment 1-42 (Aß1-42) levels, were assessed. Spearman correlation of DKI parameters with VAS, BAI, and BDI-II scores as well as tau and Aß1-42 levels were assessed. Results. The patients with FM had significantly higher levels of Aß1-42 levels than HCs. Compared with HCs, the patients with FM showed significantly lower DKI parameters in the bilateral dorsolateral prefrontal cortex and orbitofrontal cortex. Patients with FM showed a significant correlation between the axial kurtosis values of the amygdala and VAS scores (left: = -0.60, P = 0.02; right: = -7.04, P = 0.005). Conclusion. To the best of our knowledge, this is the first study to use DKI to examine the brains of patients with FM. We noted significant DKI changes associated with neuroinflammation at specific areas in patients with FM. Our results provide valuable information on brain neuroinflammation and pathophysiological changes in patients with FM. [ABSTRACT FROM AUTHOR]

Objectives. The effects of non-invasive brain stimulation (NBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (TDCS), in treating FM remain inconclusive. The aim of this study was to investigate present evidence of using NBS as an add-on treatment in treating FM. Methods. We conducted a database search of the Medline, Embase, PsycINFO and Cochrane Library electronic databases, from inception to July 2015, to analyse randomized controlled trials of NBS in treating FM. A total of 16 studies were included in the current meta-analysis. Results. The pooled mean effect sizes of the 16 included studies revealed significant favourable effects of NBS. The weighted mean effect size in reducing pain, depression, fatigue, sleep disturbance and tender points and improving general health/function were 0.667 (95% CI 0.446, 0.889), 0.322 (95% CI 0.140, 0.504), 0.511 (95% CI 0.247, 0.774), 0.682 (95% CI 0.350, 1.014), 0.867 (95% CI 0.310, 1.425) and 0.473 (95% CI 0.285, 0.661), respectively. rTMS stimulation yielded a greater effect size compared with that of TDCS (effect size 0.698 and 0.568, respectively; P<0.0001). The primary motor cortex (M1) stimulation yielded a subtle greater effect size in pain reduction compared with that of the dorsolateral prefrontal cortex (effect size 0.709 and 0.693, respectively; P<0.0001). No linear relationships were found between the effect sizes and treatment regimens and dose. Most of reported adverse effects were minor. Conclusions. Both rTMS and TDCS may be feasible and safe modalities for treating FM. The general effects of rTMS and TDCS are compatible in FM patients. M1 stimulation may be better in pain reduction and the dorsolateral prefrontal cortex may be better in depression improvement. [ABSTRACT FROM AUTHOR]

Objective: Asian dust storms (ADS) are long-ranged meteorological phenomena, which are suggested to be associated with several health problems. This study aimed to investigate the risk of stroke hospitalisation following ADS events by conducting a population-based study. Study design and setting: The authors identified 810 947 hospitalisations with an admission diagnosis of stroke during the time period between 2000 and 2009 in Taiwan. The ARIMA method (Auto-Regressive Integrated Moving Average) was used to examine the associations between ADS episodes and the daily number of stroke hospitalisations. Results: There were 46 separate ADS episodes which resulted in a total of 135 ADS days between 2000 and 2009. The Kruskal-Wallis test revealed that there was a significant difference in the mean number of daily stroke admissions among ADS days (239.6), post-ADS days (249.2) and non-ADS days (219.7) (p<0.001). After adjusting for the time-trend effect, ambient temperature, season, SO2 and CO, the authors found post-ADS days 1 and 2 to have a significantly higher number of stroke admission than non-ADS days. Post- ADS days 1 and 2 had significantly higher numbers of ischaemic but not haemorrhagic stroke admissions. Conclusion: The authors conclude that ADS events are associated with an acute increase in stroke admission rates. [ABSTRACT FROM AUTHOR]

Previous reports of comorbid conditions in poliomyelitis survivors mainly focused on some disease categories, such as respiratory diseases, gastrointestinal diseases, psychiatric diseases, neurological diseases and cancer. Data regarding a wide spectrum of medical comorbidities in patients with poliomyelitis is still sparse. This study aimed to investigate and profile the wide range of comorbidities among the survivors of paralytic poliomyelitis in a Chinese population. In total, 2,032 paralytic poliomyelitis patients were selected as the study group and the comparison group consisted of 10,160 randomly selected enrollees. The comorbidities for analysis were based on a modified version of the Elixhauser Comorbidity Index. Conditional logistic regression analyses were computed to investigate the risk of comorbidities for these two groups. As compared to controls, patients with paralytic poliomyelitis had significantly higher prevalence of hypertension, ischemic heart disease, hyperlipidemia, congestive heart failure, cardiac arrhythmias, peripheral vascular disorder, stroke, paralysis, migraines, Parkinson's disease, rheumatoid arthritis, ankylosing spondylitis, pulmonary circulation disorders, chronic pulmonary disease, liver disease, peptic ulcers, hepatitis B or C, deficiency anemias, depression, and lymphoma. Most of the differences are of clinical interest, ORs often being between 2 and 3. No significant difference between poliomyelitis patients and controls was observed in the prevalence of SLE, tuberculosis, alcohol abuse and drug abuse. Our findings demonstrate that survivors of paralytic poliomyelitis in Taiwan are at higher risk of having multiple medical comorbidities although some potential confounding factors including educational level, marital status, obesity and physical activity are not available in our database. The pattern is generally consistent with previous observations from Western populations. Nevertheless, we found several novel associations which have rarely, if ever, been reported previously. [ABSTRACT FROM AUTHOR]

Previous studies have suggested that hepatic (toxic-metabolic) encephalopathy, the major complication of cirrhosis, is a neuropsychiatric disorder typically seen in patients with liver dysfunction after exclusion of other known brain disease. This study aims to investigate the risk for parkinsonism during a 7-year follow-up period after a diagnosis of cirrhosis. In total, 1361 patients with cirrhosis and 6805 comparison patients without cirrhosis were included in this study. Each patient was then individually tracked for 7 years from the time of their initial diagnosis of cirrhosis to identify those who developed parkinsonism during the follow-up period. Stratified Cox proportional hazard regressions were conducted to calculate the hazard of parkinsonism for the two groups during the follow-up period, after adjusting for patient's age, monthly income, level of urbanization and geographic location. Of the total 8166 sampled patients, 141 (1.7%) developed parkinsonism during the follow-up period, 48 from the study group (3.5% of the patients with cirrhosis) and 93 from the comparison group (1.4% of patients in the comparison group). Stratified Cox proportional hazard regressions show that the hazard for parkinsonism for patients with cirrhosis was 2.65 times as high (95% confidence interval=1.85-3.80, P<0.001) as the patients in the comparison group over the 7-year follow-up period, after adjusting for patient's age, monthly income, level of urbanization and the geographic location of the community in which the patient resided. We concluded that cirrhosis significantly increased the risk of parkinsonism. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Population-based data regarding pregnancy outcomes for patients who experienced stroke during pregnancy is sparse and mainly from Western populations. The authors investigate the association between strokes and pregnancy outcomes in Chinese women through a nationwide case-controlled study. METHODS: A total of 161 women having live singleton births between 2001 and 2003 who had strokes during pregnancy were included in the study group. The authors randomly selected 1288 mothers matched in age and year of delivery for the comparison group. Conditional logistic regressions were performed to examine the odds of low birth weight (LBW), preterm and small-for-gestational-age (SGA) babies between these two groups, after adjusting for the characteristics of mother and infant and comorbid medical disorders. RESULTS: The authors found that the mothers with stroke during pregnancy were more likely to have lower monthly family incomes (p=0.031) and to have gestational hypertension (p=0.004), anaemia (p<0.001) and pre-eclampsia/eclampsia (p=0.039) than the comparison group. Results showed no significant differences in the prevalence of preterm births (5.6% vs 7.1%, p=0.466), LBW (5.6% vs 7.1%, p=0.486) and SGA infants (14.3% vs 16.9%, p=0.396) between women who had strokes during pregnancy and mothers in the comparison group. After adjusting for other potential confounders, conditional logistic regression analyses showed no significant differences in the odds of having preterm, LBW babies and SGA infants between two groups. CONCLUSIONS: The authors found that there is no statistically significant difference in the pregnancy outcomes between Chinese women who had strokes during pregnancy and those who did not. [ABSTRACT FROM AUTHOR]

Background. Guillain-Barré syndrome (GBS) has been sporadically reported to be associated with herpes zoster reactivation. However, the risk for developing GBS after herpes zoster reactivation remains unknown. This study aimed to establish epidemiological profiles regarding the frequency and risk for GBS following herpes zoster. Methods. We extracted 315,595 patients with herpes zoster from a nationwide health registry in Taiwan during the period 2003-2005 and also randomly selected 946,785 matched control subjects. Each participant was individually tracked for 2 months from their index ambulatory care visit to identify those who developed GBS. Stratified Cox proportional hazard regressions were conducted to analyze the difference in the risk of GBS for patients with and without herpes zoster. Results. Of the sample of 1,262,380 patients, 92 (0.01%) presented with GBS during the 2-month follow-up period, 78 from the study group (0.025% of the herpes zoster patients) and 14 from the comparison group (0.001% of patients without herpes zoster). Regression revealed that the adjusted hazard of GBS during the follow-up period was 18.37 times greater (95% confidence interval, 10.22-33.01 times greater; P < .001) for patients with herpes zoster than for those without. Furthermore, we found that patients who developed GBS after herpes zoster were more likely to have prior infection, compared with the likelihood of herpetic patients who did not develop GBS. Conclusions. The risk for GBS is significantly increased among people who have experienced a recent herpes zoster attack, compared with the risk of a matching population. [ABSTRACT FROM AUTHOR]

Background: An irregular bedtime schedule is a prevalent problem in young adults, and could be a factor detrimentally affecting sleep quality. The goal of the present study was to explore the association between an irregular bedtime schedule and sleep quality, daytime sleepiness, and fatigue among undergraduate students in Taiwan. Methods: A total of 160 students underwent a semi-structured interview and completed a survey comprising 4 parts: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and a rating of irregular bedtime frequency. Participants were grouped into 3 groups in terms of irregular bedtime frequency: low, intermediate, or high according to their 2-week sleep log. To screen for psychological disorders or distress that may have affected responses on the sleep assessment measures, the Chinese health questionnaire-12 (CHQ-12) was also administered. Results: We found an increase in bedtime schedule irregularity to be significantly associated with a decrease in average sleep time per day (Spearman r = -0.22, p = 0.05). Multivariate regression analysis revealed that irregular bedtime frequency and average sleep time per day were correlated with PSQI scores, but not with ESS or FSS scores. A significant positive correlation between irregular bedtime frequency and PSQI scores was evident in the intermediate (partial r = 0.18, p = 0.02) and high (partial r = 0.15, p = 0.05) frequency groups as compared to low frequency group. Conclusion: The results of our study suggest a high prevalence of both an irregular bedtime schedule and insufficient sleep among university students in Taiwan. Students with an irregular bedtime schedule may experience poor sleep quality. We suggest further research that explores the mechanisms involved in an irregular bedtime schedule and the effectiveness of interventions for improving this condition. [ABSTRACT FROM AUTHOR]

Background: Metatarsalgia is related to repetitive high-pressure loading under the metatarsal head (MH) that causes pain. The high pressure under the MH can be reduced by adequately applying metatarsal pads (MPs). Plantar pressure measurements may provide a method to objectively evaluate pressure loading under the MH. However, it is still unclear if the decrease in plantar pressure under the MH after MP treatment is associated with subjective improvement. This study aims to explore the correlations between subjective pain improvement and outcome rating, and the plantar pressure parameters in metatarsalgia patients treated using MPs. Methods: Thirteen patients (a total of 18 feet) with secondary metatarsalgia were included in this study. Teardrop-shaped MPs made of polyurethane foam were applied just proximal to the second MH by an experienced physiatrist. Insole plantar pressure was measured under the second MH before and after MP application. Visual analog scale (VAS) scores of pain were obtained from all subjects before and after 2 weeks of MP treatment. The subjects rated using four-point subjective outcome scales. The Wilcoxon signed-rank test was used to analyze the difference between the plantar pressure parameters and VAS scores before and after treatment. The Kruskal-Wallis test was applied to compare the plantar pressure parameters in each outcome group. Pearson's correlation was applied to analyze the correlation between the changes in plantar pressure parameters and VAS scores. Statistical significance was set as p < 0.05. Results: MP application decreased the maximal peak pressure (MPP) and pressure-time integral (PTI) under the second MH and also statistically improved subjective pain scores. However, neither the pretreatment values of the MPP and PTI shift in the position of the MPP after treatment, nor the age, gender and body mass index (BMI) of the subjects were statistically correlated with subjective improvement. Declines in the PTI and MPP values after MP application were statistically correlated with the improvement in VAS scores (r = 0.77, R2 = 0.59, p < 0.001; r = 0.60, R2 = 0.36, p = 0.009). Conclusion: We found that the successful decline in the PTI and MPP under the second MH after MP application was correlated to subjective pain improvement. This study provides a strategy for the further design and application of MPs for metatarsalgia treatment. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about a study which compared the risk of treatment outcomes between patients with osteoarthritis (OA) and rheumatoid arthritis (RA).