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Background/Purpose: Sphingolipids are major constituents of eukaryotic cell membranes and play key roles in cellular regulatory processes. Our recent results in an experimental stroke animal model demonstrated changes in sphingolipids in response to acute ischemic brain injury. This study aimed to investigate the plasma levels of sphingosine-1-phosphate (S1P) and ceramides in acute ischemic stroke (AIS) patients and their associations with functional outcomes. Methods: Plasma samples were collected from patients with AIS at

Cryptogenic stroke comprises about one-quarter of ischemic strokes with high recurrence rate; however, studies specifically investigating the features and treatment of this stroke subtype are rare. The concept of ‘embolic stroke of undetermined source’ (ESUS) may facilitate the development of a standardized approach to diagnose cryptogenic stroke and improve clinical trials. Since recent large randomized control trials failed to demonstrate a reduction in stroke recurrence with anticoagulants, anti-platelet agents remain the first-line treatment for ESUS patients. Nevertheless, patients with high risk of stroke recurrence (e.g., those with repeated embolic infarcts despite aspirin treatment) require a more extensive survey of stroke etiology, including cardiac imaging and prolonged cardiac rhythm monitoring. Anticoagulant treatments may still benefit some subgroups of high-risk ESUS patients, such as those with multiple infarcts at different arterial territories without aortic atheroma, the elderly, or patients with high CHA2D2-VASc or HOVAC scores, atrial cardiopathy or patent foramen ovale. Several important ESUS clinical trials are ongoing, and the results are anticipated. With rapid progress in our understanding of ESUS pathophysiology, new subcategorizations of ESUS and assignment of optimal treatments for each ESUS subgroup are expected in the near future.

Despite intracerebral haemorrhage causing 5% of deaths worldwide, few evidence-based therapeutic strategies other than stroke unit care exist. Tranexamic acid decreases haemorrhage in conditions such as acute trauma and menorrhoea. We aimed to assess whether tranexamic acid reduces intracerebral haemorrhage growth in patients with acute intracerebral haemorrhage.We did a prospective, double-blind, randomised, placebo-controlled, investigator-led, phase 2 trial at 13 stroke centres in Australia, Finland, and Taiwan. Patients were eligible if they were aged 18 years or older, had an acute intracerebral haemorrhage fulfilling clinical criteria (eg, Glasgow Coma Scale score of7, intracerebral haemorrhage volume70 mL, no identified or suspected secondary cause of intracerebral haemorrhage, no thrombotic events within the previous 12 months, no planned surgery in the next 24 h, and no use of anticoagulation), had contrast extravasation on CT angiography (the so-called spot sign), and were treatable within 4·5 h of symptom onset and within 1 h of CT angiography. Patients were randomly assigned (1:1) to receive either 1 g of intravenous tranexamic acid over 10 min followed by 1 g over 8 h or matching placebo, started within 4·5 h of symptom onset. Randomisation was done using a centralised web-based procedure with randomly permuted blocks of varying size. All patients, investigators, and staff involved in patient management were masked to treatment. The primary outcome was intracerebral haemorrhage growth (33% relative or6 mL absolute) at 24 h. The primary and safety analyses were done in the intention-to-treat population. The trial is registered at ClinicalTrials.gov (NCT01702636).Between March 1, 2013, and Aug 13, 2019, we enrolled and randomly assigned 100 participants to the tranexamic acid group (n=50) or the placebo group (n=50). Median age was 71 years (IQR 57-79) and median intracerebral haemorrhage volume was 14·6 mL (7·9-32·7) at baseline. The primary outcome was not different between the two groups: 26 (52%) patients in the placebo group and 22 (44%) in the tranexamic acid group had intracerebral haemorrhage growth (odds ratio [OR] 0·72 [95% CI 0·32-1·59], p=0·41). There was no evidence of a difference in the proportions of patients who died or had thromboembolic complications between the groups: eight (16%) in the placebo group vs 13 (26%) in the tranexamic acid group died and two (4%) vs one (2%) had thromboembolic complications. None of the deaths was considered related to study medication.Our study does not provide evidence that tranexamic acid prevents intracerebral haemorrhage growth, although the treatment was safe with no increase in thromboembolic complications. Larger trials of tranexamic acid, with simpler recruitment methods and an earlier treatment window, are justified.National Health and Medical Research Council, Royal Melbourne Hospital Foundation.

Indirect revascularization surgery reduce the risk of recurrent vascular events in patients with moyamoya disease (MMD), but the roles of postoperative angiography and ultrasonography in predicting these events remain unclear.This prospective study enrolled patients with MMD who would undergo their first unilateral indirect revascularization surgery. They received preoperative and postoperative ultrasound examination at 1, 3, and 6 months and conventional cerebral angiography. On ultrasonography, postoperative emerging flow (PEF) in an intracranial artery was defined as emerging flow postoperatively with absence of flow preoperatively. Predictors of vascular event frequency reduction were identified from angiographic and ultrasonographic parameters.In total, 52 patients (including 24 pediatric and 24 male patients), who underwent 52 preoperative and 82 postoperative ultrasound examinations, were enrolled. Significant postoperative changes were noted in all the ultrasonographic parameters of ipsilateral superficial temporal artery (STA) and the end-diastolic velocity and flow volume in contralateral STA. During a median follow-up of 5.3 years, indirect revascularization surgery significantly reduced the occurrence of ipsilateral vascular events. Predictors of vascular event frequency reduction included Matsushima grade A or B on the ipsilateral side on angiography (odds ratio [OR] = 22.00, P = 0.002) and lower resistance index (RI) in ipsilateral STA (OR = 0.0001, P = 0.012) but no PEF pattern in ipsilateral middle cerebral artery (OR = 0.14, P = 0.029) on ultrasonography performed within 6 months.Reduction of long-term vascular event frequency probably can be predicted through postoperative angiography and ultrasonography within 6 months after indirect revascularization surgery.

Background/purpose: Dabigatran is effective in preventing ischemic stroke and systemic embolism in patients with atrial fibrillation. Although the therapeutic window for dabigatran is wide, its pharmacokinetic properties can differ between specific populations. This study aimed to establish a real-life plasma dabigatran concentration database and investigate potential factors affecting this concentration in Asians. Methods: Patients under dabigatran therapy were recruited. Plasma dabigatran concentration was determined in trough and peak blood samples by using ultra-high performance liquid chromatography with tandem mass spectrometry analysis. Factors affecting the dabigatran concentration were investigated. Results: A total of 46 patients (33 male, 71.7%) were prospectively enrolled. Most of them were receiving a low dose regimen (110 mg twice daily, n = 38, 82.6%). The trough and peak concentrations were significantly correlated (p 3 points, and HAS-BLED score ≥3 points. Multiple linear regression analysis identified body weight and serum creatinine as key factors predicting trough concentration (p = 0.003 and 0.005, respectively). Importantly, drug adherence was the only independent factor associated with low trough concentration, defined as the lowest 20th percentile in our study cohort (n = 10, hazard ratio = 9.07; 95% CI, 1.12 to 73.22; p = 0.004). Conclusion: Dabigatran monitoring may be considered for patients at risk of overexposure, especially those with low body weight and renal insufficiency, and also for detecting those with extremely low drug concentration. Keywords: Adherence, Atrial fibrillation, Dabigatran, Drug concentration, Ischemic stroke, Pharmacokinetics

In this study, we study the influence of ultraviolet (UV) light irradiation [the UV source (254 nm) and the UV-ozone source (6% 185 nm and 94% 254 nm)] and irradiation atmospheres on the characteristics of solution-processed NbZnSn oxide thin film transistors (TFTs). The experimental results indicate the ultraviolet-visible absorption spectrum present a strong absorption at wavelengths less than 300 nm, implying that the UV source and UV-ozone source can be effectively absorbed by the NbZnSn oxide precursor. From the infrared (IR) spectra, the UV-ozone source illumination can accelerate the reaction of solution processed NbZnSn oxide channels. An improvement of device performance is achieved by the NbZnSn oxide channel layers with UV-ozone source. In addition, we also investigate the effects of treatment atmosphere (i.e., N2 or O2) on the electrical performance of TFTs. The influence of UV irradiation and irradiation atmospheres on the material properties of NbZnSn oxide channels and electrical characteristics of the NbZnSn oxide devices is also studied. The correlations between the UV treatment and treatment atmospheres on the TFT performance are investigated.

Background and aims This study investigated risks of short-term (1 and 3 months) and long-term (1-year) recurrent stroke associated with glomerular filtration rate (eGFR) in patients with acute ischemic stroke. Methods From the Taiwan Stroke Registry data, we identified 45,876 acute ischemic stroke patients from April 2006 to April 2014 and classified them into 4 groups based on the eGFR at admission: ≥ 90, 60–89, 30–59, and Results Both the risks of short-term and long-term recurrent stroke increased as the eGFR levels declined. The 1-month recurrent incidence rates increased steadily from 0.54 to 0.59, 0.84 and 0.89 per 1000 person-days, as the eGFR declined from ≥90 to 60–89, 30–59, and Conclusions There is an independent graded association between an increased risk of recurrent stroke and declining eGFR levels in patients with acute ischemic stroke.

Background/purpose: Details of the communication between the caller and dispatcher have not been reported previously in Taiwan. This study aimed to: (1) understand the details of the communication between the caller and dispatcher among the calls for stroke patients, (2) identify factors associated with stroke recognition by dispatchers, and (3) evaluate the association between stroke recognition by dispatchers and stroke management. Methods: We conducted a retrospective observational study involving patients with stroke or transient ischemic stroke transported by the emergency medical service, and arriving at 9 hospitals in Taipei within 3 h of symptom onset from January 1, 2013 to February 28, 2014. Patients were excluded if tape-recording data or prehospital information were not available. Data of the enrolled patients were reviewed. We used stroke dispatch determination as the surrogate for stroke recognition by dispatchers. Multivariable logistic regression was used to identify the factors associated with stroke dispatch determination. Results: A total of 507 patients were included. In approximately 50% of cases, callers were close family members. Ninety-one patients (17.9%) had stroke dispatch determination. After adjustment, stroke reported spontaneously, any symptom included in the Cincinnati Prehospital Stroke Scale reported spontaneously, and dispatcher adherence to the protocol, were associated with stroke dispatch determination significantly. Stroke dispatch determination was associated with receiving pre-arrival notification, shorter door-to-computed tomography time, and thrombolytic therapy. Conclusion: The dispatchers should spend more time identifying stroke patients by following the dispatch protocol. Recognition of stroke by dispatchers was associated with improved stroke care. Keywords: Stroke, Dispatch, Thrombolytic therapy

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.

In this study, we fabricated the nitrogen-doped NbZnSnO channel layers by using the sol-gel method. Monoethanolamine (MEA) was used as a nitrogen additive. From the XPS results, the concentration of oxygen vacancies changes as a function of MEA/Nb ratio. A NbZnSnO film with MEA/Nb of 0.2 shows the lowest amount of oxygen vacancies. TFT electrical performance also shows a device with an MEA/Nb ratio of 0.2 possesses a high carrier mobility (7.4 cm 2 V −1 s −1 ) and good bias stress stability. In addition, we also investigated the effect of the aging time of precursor solution on the electrical characteristics of the TFT. After adding MEA, the annealing temperature of the NbZnSnO channels can be reduced, pertaining to the acceleration of the hydrolysis and condensation reaction.

Objective To test whether a multistrategy intervention enhanced recovery immediately and longitudinally in patients with severe to moderate upper extremity (UE) paresis. Design Double-blind, randomized controlled trial with placebo control. Setting Outpatient department of a local medical center. Participants People (N=25) with chronic stroke were randomly assigned to 1 of 2 groups: a transcranial direct current stimulation with sensory modulation (tDCS-SM) group (n=14; mean age ± SD, 55.3±11.4y) or a control group (n=11; mean age ± SD, 56.9±13.5y). Interventions Eight-week intervention. The tDCS-SM group received bilateral tDCS, bilateral cutaneous anesthesia, and high repetitions of passive movements on the paretic hand. The control group received the same passive movements but with sham tDCS and sham anesthesia. During the experiment, all participants continued their regular rehabilitation. Main Outcome Measures Voluntary UE movement, spasticity, UE function, and basic activities of daily living. Outcomes were assessed at baseline, at postintervention, and at 3- and 6-month follow-ups. Results No significant differences were found between groups. However, there was a trend that the voluntary UE movement improved more in the tDCS-SM group than in the control group, with a moderate immediate effect (partial η 2 [η p 2 ]=.14, P =.07) and moderate long-term effects (3-mo follow-up: η p 2 =.17, P =.05; 6-mo follow-up: η p 2 =.12, P =.10). Compared with the control group, the tDCS-SM group had a trend of a small immediate effect (η p 2 =.02–.04) on reducing spasticity, but no long-term effect. A trend of small immediate and long-term effects in favor of tDCS-SM was found on UE function and daily function recovery (η p 2 =.02–.09). Conclusions Accompanied with traditional rehabilitation, tDCS-SM had a nonsignificant trend of having immediate and longitudinal effects on voluntary UE movement recovery in patients with severe to moderate UE paresis after stroke, but its effects on spasticity reduction and functional recovery may be limited.

Background: Stroke is one of the leading causes of mortality and neurologic deficits. Management measures to improve neurologic outcomes are in great need. Our previous intervention trial in elderly subjects successfully used salt as a carrier for potassium, demonstrating a 41% reduction in cardiovascular mortality by switching to potassium-enriched salt. Dietary magnesium has been associated with lowered diabetes and/or stroke risk in humans and with neuroprotection in animals.Objective: Because a large proportion of Taiwanese individuals are in marginal deficiency states for potassium and for magnesium and salt is a good carrier for minerals, it is justifiable to study whether further enriching salt with magnesium at an amount near the Dietary Reference Intake (DRI) amount may provide additional benefit for stroke recovery.Design: This was a double-blind, randomized controlled trial comprising 291 discharged stroke patients with modified Rankin scale (mRS) ≤4. There were 3 arms: 1) regular salt (Na salt) (n = 99), 2) potassium-enriched salt (K salt) (n = 97), and 3) potassium- and magnesium-enriched salt (K/Mg salt) (n = 95). The NIH Stroke Scale (NIHSS), Barthel Index (BI), and mRS were evaluated at discharge, at 3 mo, and at 6 mo. A good neurologic performance was defined by NIHSS = 0, BI = 100, and mRS ≤1.Results: After the 6-mo intervention, the proportion of patients with good neurologic performance increased in a greater magnitude in the K/Mg salt group than in the K salt group and the Na salt group, in that order. The K/Mg salt group had a significantly increased OR (2.25; 95% CI: 1.09, 4.67) of achieving good neurologic performance compared with the Na salt group. But the effect of K salt alone (OR: 1.58; 95% CI: 0.77, 3.22) was not significant.Conclusions: This study suggests that providing the DRI amount of magnesium and potassium together long term is beneficial for stroke patient recovery from neurologic deficits. This trial was registered at clinicaltrials.gov as NCT02910427.

Erbium-doped SiO 2 -TiO 2 thin films were prepared by the sol-gel method, using erbium nitrate pentahydrate powder, tetraethyl-orthosilicate (TEOS), and titanium tetraisopropoxide (TTIP) as precursors. The Si/Ti ratios in the SiO 2 -TiO 2 films agree with the TEOS/TTIP molar ratio in the sol-gel precursor. Atomic coordination structure of erbium was defined by extended X-ray absorption fine structure spectrometry (EXAFS) and optical properties of the films were characterized by micro-photoluminescence (Micro-PL). The first-neighbor-shell coordination number of erbium in SiO 2 -TiO 2 thin films would influence the optical properties. The 700 °C-annealed 80%SiO 2 -20%TiO 2 :Er1.0% (mol%) film with the lowest coordination number exhibits the highest photoluminescence intensity. Moreover, Fourier transform infrared spectroscopy (FTIR) analysis reveals that the main bonding structures of SiO 2 -TiO 2 thin films are related to the erbium dopants. The modification of microstructure and chemical bonding configuration in the SiO 2 -TiO 2 films by the Er-doping concentration and its influence on the optical properties are discussed.

Background: Enhancing detection of undiagnosed atrial fibrillation (AF) in hospitalized patients with a recent ischemic stroke is important because of the treatment implications; especially since presence of paroxysmal AF may not be picked up in a single 12-lead electrocardiogram (ECG) test. While several trials have shown improved detection of AF with prolonged ECG monitoring, this strategy is associated with relatively high cost, labor intensity, and patient inconvenience, thereby making it challenging to routinely implement in all hospitals. Fortunately, conventional 24-h Holter monitoring and repeated 12-lead ECGs are readily available to detect paroxysmal AF in all hospitals, but is unclear which is the better strategy for evaluating undiagnosed AF. The objective of his study is to conduct a randomized trial of serial 12-lead ECGs vs. 24-hour Holter monitoring in the detection of AF in ischemic stroke patients without known AF. Methods and analysis: We plan to enroll 1200 participants from six hospitals in Taiwan. Patients will be eligible for enrollment if they are admitted for an acute ischemic stroke within 2 days, are ≥65 years of age, and have no known AF by history or on baseline ECG at admission. We will randomly assign participants in a 1:1 ratio to undergo daily 12-lead ECG once daily for 5 days (intervention group) or 24-h Holter monitoring (control group). Primary outcome is newly detected AF on a 12-lead ECG or AF lasting ≥30 s on Holter monitoring. Trial registration number: ClinicalTrials.gov Identifier: NCT02578979.

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.

Cerebral autoregulation (CA) is an important mechanism for maintaining constant cerebral blood flow during changes in blood pressure. Although previous studies have shown that CA may be impaired in patients with intracerebral hemorrhage (ICH), the variability of cerebral blood flow (CBF) in response to changes in CA has not been investigated. In the present study, we recruited twelve patients presenting with acute subcortical ICH and seven non-stroke controls. The status of CA was determined by assessing Pearson’s moving correlation coefficient between arterial blood pressure and cerebral blood flow velocity (CBFV) of the middle cerebral artery (MCA). The variability of CBFV was calculated using nonlinear sample entropy analyses. The results indicated that ICH patients significantly showed poorer CA than controls, particularly localized to the MCA ipsilateral to the ICH (controls 0.17 ± 0.13 versus ICH side 0.41 ± 0.27 and non-ICH side 0.34 ± 0.26, p = 0.044 and 0.120, respectively). Moreover, the variability of CBFV in the hemisphere ipsilateral to the ICH was significantly increased in ICH patients when compared to controls (1.145 ± 0.26 versus 1.66 ± 0.193 and 1.595 ± 0.43, p

Background/purpose We aim to evaluate the accuracy of the new prehospital notification criteria for patients with potential acute stroke in the prehospital setting. Methods We conducted a retrospective observational study from March 2011 to February 2013 of potential acute stroke patients prenotified using the new criteria which were: (1) positive Cincinnati Prehospital Stroke Scale (CPSS); (2) symptom onset within 3 hours; and (3) blood glucose level > 60 mg/dL. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the new criteria were calculated and outcomes of acute stroke patients were reported. Data of all patients with stroke or transient ischemic attack (TIA) transported to the destination hospital were also obtained to evaluate the compliance of emergency medical technicians. Results There were 2888 patients suspected of stroke by emergency medical technicians and 221 patients prenotified due to meeting the criteria. The PPV, NPV, sensitivity, and specificity of the new criteria were 76.9%, 96.6%, 64.9%, and 98.1%, respectively. Onset time > 3 hours (24/51, 47.1%) and seizure (27.5%) were the two most common conditions leading to false prenotification. Of all prenotified patients, 23.1% (51/221) received thrombolytic therapy. Hemorrhagic stroke or ischemic stroke with hemorrhagic transformation (53.8%) and minor symptoms or rapid recovery (26.9%) were the most common reasons excluding correctly prenotified patients from thrombolytic therapy. Conclusion The accuracy of the new prehospital stroke criteria has higher PPV and specificity compared to previous CPSS validation studies.

ZnO–Ru thin films were prepared using a sol–gel spin coating method. We investigated the effects of the Ru-doping concentration, the pH value of precursor and the annealing temperature on the characteristics of the ZnO–Ru thin films. The crystallinity of ZnO–Ru films decreases as the Ru-concentration increases. The surface morphology of the ZnO–Ru films is also related to the pH of the precursors. The optical energy band gap is a function of Ru-doping concentration and the annealing temperature. The correlations among the Zn/Ru ratio, the pH value of the pre-solutions, the annealing temperature and the characteristics of ZnO–Ru films are derived. In addition to the material properties, the application of ZnO–Ru films as a channel layer in thin film transistors is also discussed.

Evidence shows possible benefits from continuous drainage by lumbar drain after aneurysmal subarachnoid hemorrhage (SAH). Under the hypothesis that compartmentalization occurs between the ventricle and subarachnoid space after massive SAH, this study aimed to evaluate the biochemical differences between ventricular and intrathecal cerebrospinal fluid (CSF) and assess the role of CSF lactate in shunt-dependent hydrocephalus (SDHC) after aneurysmal SAH.Patients with modified Fisher grade III/IV aneurysmal SAH who underwent early obliteration were evaluated. Intrathecal and intraventricular CSF were obtained on day 7 post-SAH to measure their biochemical composition in terms of total protein, glucose, ferritin, and lactate. The associations of SDHC with the clinical parameters and CSF data were analyzed.There were 28 patients (mean age, 55.4 y; males, 46.6%), including 18 (64.3%) with SDHC. Intrathecal CSF had significantly higher levels of total protein, ferritin, hemoglobin, and lactate but lower glucose level than intraventricular CSF (all P0.0001). By multivariate analysis of clinical and CSF parameters, elevated intrathecal CSF lactate (P = 0.036) and the presence of intraventricular hemorrhage (P = 0.05) were independent factors associated with SDHC. Moreover, intrathecal lactate5.5 μM effectively predicted the occurrence of SDHC (odds ratio: 32, 95% confidence interval: 3.8-270.8; P = 0.0015).By compartmentalization of the subarachnoid space after SAH, intrathecal lactate level is a useful predictive parameter for long-term SDHC in patients with aneurysmal SAH patients.

Background/Purpose Mannitol is commonly used in patients with increased intracranial pressure (ICP), but its effect on cerebrovascular pressure reactivity (CVPR) is uncertain. We analyzed the changes of pressure reactivity index (PRx) during the course of mannitol treatment. Methods Twenty-one patients who received mannitol treatment for increased ICP were recruited prospectively. Continuous waveforms of arterial blood pressure (ABP) and ICP were collected simultaneously for 60 minutes (10 minutes at baseline and 50 minutes since mannitol administration) during 37 events of mannitol treatment. The correlation coefficients between the mean ABP and ICP were averaged every 10 minutes and labeled as the PRx. The linear correlation of six time points of PRx in each event was calculated to represent the trend of CVPR changes. The negative slope of correlation was defined as improvement in CVPR under mannitol treatment and vice versa. Results At baseline, the average of ICP was 26.0 ± 9.1 mmHg and the values of PRx were significantly correlated with ICP ( p = 0.0044, r = 0.46). After mannitol administration, the average of ICP decreased significantly to 21.2 ± 11.1 mmHg ( p = 0.036), and CVPR improved in 59.4 % of all events. Further analysis showed that low baseline cerebral perfusion pressure was the only hemodynamic parameter significant association with the improvement of CVPR after mannitol treatment ( p = 0.039). Conclusion Despite lowering ICP, mannitol may have diverse effects on CVPR in patients with intracranial hypertension. Our study suggests that mannitol infusion may have a beneficial effect on CVPR, particularly in those with a low cerebral perfusion pressure at baseline.

Stroke is a leading cause of death and disability in industrialized countries. Approximately 8-14% of stroke survivors suffer from central post-stroke pain (CPSP) when hemorrhagic stroke occurs in lateral thalamic regions, which severely affects their quality of life. Because the mechanisms of CPSP are not well understood, effective treatments have not been developed. In the present study, we tested the hypothesis that persistent CPSP is caused by P(2)X(7)receptor activation after brain tissue damage and subsequent elevations in inflammatory cytokines. A thalamic hemorrhagic rat model was used, characterized by thermal and mechanical allodynia that develops in the subacute to chronic phases upon CPSP onset. We found a significant increase in P(2)X(7) expression in reactive microglia/macrophages in thalamic peri-lesion tissues at 5 weeks post-hemorrhage. Thalamic P(2)X(7) receptors were directly involved in pain transmission and hypersensitivity. The systemic targeting of P(2)X(7) receptors during the acute stage of hemorrhage rescued abnormal pain behaviors and neuronal activity in the thalamocingulate pathway by reducing reactive microglia/macrophage aggregation and associated inflammatory cytokines. After CPSP onset, the targeting of interleukin-1β reversed abnormal pain sensitivity. The aberrant spontaneous thalamocortical oscillations in rats with CPSP were modulated by blocking P(2)X(7) receptors. Taken together, our results suggest that targeting P(2)X(7) may be bi-effective in the treatment of CPSP, as both a pain blocker and immunosuppressant that inhibits inflammatory damage to brain tissue. P(2)X(7)receptors may serve as a potential target to prevent the occurrence of CPSP and may be beneficial for the recovery of patients from stroke.

Background Large anterior choroidal artery (AChA) infarcts are frequently associated with stroke evolution. This study aimed to investigate the major determinants for stroke evolution in patients with large AChA infarcts. Methods We studied 118 consecutive adult patients with acute large AChA infarcts. The diagnosis was confirmed as abnormal hyperintensities in 3 or more rostracaudal magnetic resonance imaging slices (5 mm thickness) using diffusion-weighted imaging within typical AChA vascular regions. Stroke evolution was defined as neurologic deterioration with an increase in National Institutes of Health Stroke Scale (NIHSS) score by at least 4 or an increase of NIHSS score in motor function by at least 2 in 7 days after stroke onset. Results Forty-seven (39.8%) patients developed stroke evolution. Thrombolytic therapy was inversely associated with the occurrence of stroke evolution ( P = .004). Using multivariate analysis, thrombolytic therapy was the only protective determinant for stroke evolution (adjusted odds ratio, .08; 95% confidence interval, .01 to .67). Patients with large AChA infarcts receiving thrombolytic therapy had less unfavorable long-term functional outcome than those not receiving thrombolytic therapy (adjusted odds ratio, .11; 95% confidence interval, .02-.75). Conclusions Thrombolytic therapy is an only determinant factor for stroke evolution in large AChA infarcts, which reduced the risk of stroke evolution and improved functional outcome.

Toll-like receptors (TLRs) are transmembrane pattern-recognition receptors that initiate signals in response to diverse pathogen-associated molecular patterns. Several groups have recently reported a role for TLR2 and TLR4 in ischemic stroke-induced brain injury. However, relatively little is known about the role of TLR8 in ischemic stroke. Here we provide the first evidence that TLR8 activation plays a detrimental role in stroke outcome by promoting neuronal apoptosis and T cell-mediated post-stroke inflammation. TLR8 is expressed in cerebral cortical neurons, where its levels and downstream signaling via JNK are increased in response to oxygen glucose deprivation (OGD). Treatment with a TLR8 agonist activated pro-apoptotic JNK and increased neuronal cell death during OGD. Furthermore, selective knockdown of TLR8 using siRNA protected SH-SY5Y cells following OGD, and TLR8 agonist administration in vivo increased mortality, neurological deficit and T cell infiltration following stroke. Taken together, our findings indicate a detrimental role for neuronal TLR8 signaling in the triggering of post-stroke inflammation and neuronal death.

WO 3 –Sb thin films with and without Sb doping were prepared by the sol–gel spin-coating method. The surface morphology, crystal structure, and binding energy of the WO 3 –Sb films were investigated before and after annealing under O 2 or N 2 atmospheres. After spin-coating, Sb 2 O 3 precipitates on the surface of the as-deposited amorphous WO 3 films with different Sb/W molar ratios. After annealing in O 2 or N 2 ambients, the precipitates start to disappear and then microvoids appear on the surface of the crystalline WO 3 films with 5% and 10% molar ratios of Sb. WO 3 –Sb thin films present the monoclinic phase after annealing at 700 °C in N 2 , whereas films show the tetragonal phase after annealing at the same temperature in O 2 . In addition, Sb segregation occurs on the surface of the WO 3 films with Sb additives after annealing at 700 °C in N 2 ambient. This study discusses the connection among the Sb additive of the WO 3 –Sb films and how they are influenced by the Sb/W molar ratios and the annealing atmospheres of WO 3 –Sb films.

Lanthanum-modified lead zirconate titanate (Pb 0.93 La 0.07 (Zr 0.3 Ti 0.7 ) 0.93 O 3 , PLZT7/30/70) thin films with and without a seeding layer of PbTiO 3 (PT) were successfully deposited on indium-doped tin oxide (ITO) coated glass substrate via spin coating in conjunction with a sol–gel process, and a top transparent conducting thin film of SnO 2 was also prepared in the same way. The thicknesses of PLZT and PT layers are 0.5 μm and 24 nm, respectively. The retardance of PLZT film was measured by a new heterodyne interferometer and enhanced by application of a seeding layer of PT. The Pockels linear electro-optical coefficient of PLZT film with a PT layer was determined to be 3.17 × 10 −9 m/V when the refractive index is considered as 2.505, which is one order larger than 1.4 × 10 −10 m/V for PLZT12/40/60 doped with Dy reported in the literature. The root-mean-square (rms) roughness of PLZT thin film with a PT layer ( R rms = 6.867 nm) was larger than that of PLZT film ( R rms = 0.799 nm). From the comparisons, the average transmittance of PLZT film with a PT seeding layer was 77.01%, which was a little smaller than that of PLZT film (around 80.75%). Experimental results imply that the PT seeding layer plays a key role in the increase of retardance value, leading to a higher Pockels coefficient.

Dysphagia increases the risk of pneumonia in stroke patients. This study aimed to evaluate bedside swallowing screening for prevention of stroke-associated pneumonia (SAP) in acute stroke patients admitted to the intensive care unit (ICU). Consecutive acute stroke patients admitted to the stroke ICU from May 2006 to March 2007 were included. Patients were excluded if they were intubated on the first day of admission or had a transient ischemic attack. A 3-Step Swallowing Screen was introduced since October 2006 and therefore patients were divided into pre-screen and post-screen groups. A binary logistic regression model was used to determine independent risk factors for SAP and in-hospital death. There were 74 and 102 patients included in the pre- and post-screen groups, respectively. Pneumonia was associated with higher National Institutes of Health Stroke Scale (NIHSS) score, older age, nasogastric and endotracheal tube placement. After adjusting for age, gender, NIHSS score and nasogastric and endotracheal tube insertion, dysphagia screening was associated with a borderline decrease in SAP in all stroke patients (odds ratio, 0.42; 95% CI, 0.18-1.00; p=0.05). However, dysphagia screening was not associated with reduction of in-hospital deaths. Systematic bedside swallowing screening is helpful for prevention of SAP in acute stroke patients admitted to the ICU.

Background/Purpose Intracranial dural arteriovenous fistulas (DAVFs) can be complicated by ischemic stroke. This study investigated the frequency and determinants of ischemic stroke in patients with intracranial DAVF. Methods We conducted a retrospective study of consecutive patients with intracranial DAVF. Patients with pure hemorrhagic stroke or without available brain imaging for clarifying stroke type were excluded. DAVF was diagnosed by cerebral catheter angiography. Cognard classification and location of DAVFs were ascertained. The clinical characteristics, outcome, and radiographic findings were recorded. Factors associated with occurrence of ischemic stroke in the patients with DAVFs were determined. Results A total of 134 patients were enrolled. Six patients (4.5%) had ischemic stroke (mean age: 53.8 ± 13.4 years) and 128 patients were free from stroke (mean age: 55.4 ± 15.2 years). Men accounted for 83% in the ischemic stroke group and 34% in the non-stroke group. Chemosis, exophthalmos and tinnitus were more frequent in the non-stroke group, whereas seizure and mental decline were more frequent in the ischemic stroke group. DAVF was associated with highest risk of ischemic stroke at locations other than the cavernous sinus or large sinuses. Ischemic stroke also correlated with types of DAVF involving cortical venous drainage, including type IIb (18%), III (15%), and IV (100%). No patient with DAVF type I and IIa had ischemic stroke. The rate of ischemic stroke in patients with concomitant DAVF and cerebral sinus thrombosis was higher than in DAVF patients without cerebral sinus thrombosis. Venous infarct was the major subtype of ischemic stroke in five DAVF patients. Endovascular therapy was the most common choice in both groups, and fewer patients in the ischemic stroke group did not receive any treatment for DAVFs. Conclusion Location and type of DAVF were two important factors related to the occurrence of ischemic stroke in DAVF patients.

This paper develops a linear heterodyne interferometer based on phase-locked extraction for measuring low optical rotation angle. The validity of the proposed design is demonstrated by measuring a half-wave plate. The average relative error in the measured rotation angle of the half-wave plate is determined as just 0.74%. When applied to the measurement of glucose solutions with concentrations ranging from 0 to 1.2 g/dl, the average relative error in the measured rotation angle of glucose solutions is determined to be 1.46%. The correlation coefficient between the measured rotation angle and the glucose concentration is determined to be 0.999991, while the standard deviation is just 0.00051°. The current system is capable of measuring glucose concentration as low as 0.01 g/dl with an error of 6.67% in the rotation angle measurement. Overall, the experimental results demonstrate the ability of the proposed system to obtain highly accurate measurement of the optical rotation angle.

RuO 2 –SiO 2 thin films with different Si/Ru molar ratios were prepared by the sol–gel method, using the hydrate ruthenium (III) chloride (RuCl 3 ·3.5H 2 O) and tetraethylorthosilicate as precursors. The crystal structure, resistivity, chemical bonding configuration, transmittance, carrier concentration, and mobility of the RuO 2 –SiO 2 films were investigated before and after annealing in N 2 ambient at 400–700 °C. The resistivity of the RuO 2 –SiO 2 films with different Si/Ru molar ratios decreased abruptly after annealing at 400–700 °C. On the other hand, RuO 2 phase precipitated in the RuO 2 –SiO 2 films with different Si/Ru molar ratios after annealing. Fourier transform infrared spectroscopy spectra indicated that the water absorption occurs for as-deposited RuO 2 –SiO 2 films with different Si/Ru molar ratios. The transmittance of all RuO 2 –SiO 2 films presented transmittance maximums after annealing at 700 °C. The carrier concentration and mobility of RuO 2 –SiO 2 films are related to the Si/Ru molar ratios and the annealing temperature. This study discusses the connection among the material properties of the RuO 2 –SiO 2 films and how they are influenced by the Si/Ru molar ratios and the annealing temperatures of RuO 2 –SiO 2 films.

Background Arterial dissection involving cervicocranial arteries usually results in ischemia or SAH. This study correlated the clinical manifestations, image characteristics, and outcome of arterial dissection and compared the differences between arterial dissection of anterior and posterior circulation at our institute. Methods Clinical symptoms and neuroradiologic findings were retrospectively analyzed in 73 patients (6-75 years old) who had a spontaneous arterial dissection of cervicocranial vessels verified by angiography or MRI. Twenty-four cases of ACAD and 49 cases of PCAD were included in this study. Results The leading presentation of arterial dissection of ACAD group was ischemic stroke (79.2%), and that of posterior circulation was SAH (44.9%), followed by ischemic stroke (42.8%). In the ACAD group, the extracranial ICA was more commonly involved (62.5%), with long segmental narrowing the most common angiographic finding. In the PCAD group, the intracranial VA was more commonly involved (81.6%), with alternating narrowing and dilatation the leading angiographic picture. All the cases presenting with ischemic stroke or headache were conservatively treated with anticoagulants or antiplatelets, except for one treated with intra-arterial thrombolysis for thromboembolism in basilar artery at an early stage. One of them died of progressed brainstem infarct in spite of anticoagulation therapy. All the others reached improved or stable clinical condition. Eighteen cases were treated by surgical or endovascular intervention. None of them had rebleeding. Of the 5 patients with SAH due to dissecting lumens without treatment, 2 died of rebleeding. Conclusions Ischemia is the predominant presentation of ACAD; and PCAD has similar occurrence of SAH and ischemia. Intracranial arterial dissection is not uncommon; and it should be kept in the list of differential diagnosis of young stroke. Aggressive treatment of arterial dissection presenting with SAH should be considered; otherwise, rebleeding may occur.

In this study, NH4H2PO4, Li2CO3, and Ca(OH)2 raw materials were mixed with and without adding water or pressing pressure. The three types of mixture (i.e., raw mixtures, waterish mixtures, and dense mixtures) were then subjected to microwave irradiation. The samples were characterized by various methods of analysis method. With adding water, the particles changed from irregularity into aggregation. Simultaneously, the existence of H3PO4 and increase in hydroxyl group of waterish mixtures is due to the decomposition of NH4H2PO4, which could promote microwave absorption. In addition, dense mixtures could change into glass after microwave irradiation with increasing pressing pressure. The connection between mixtures with and without adding water or pressing pressure and degree of microwave absorption, and how they are influenced on glass formation is discussed.

Multivariate models have not been widely used to predict the outcome of acute stroke patients admitted to the intensive care unit (ICU). The purpose of this study was to determine potential measures observed in the first 12 h post-stroke that predict early mortality and functional outcomes in ICU-admitted stroke patients. Eight hundred and fifty acute stroke patients (ischemic stroke, 508; intracerebral hemorrhage, 342) were included in this analysis between November 2002 and December 2006. Measures of interest were obtained in the first 12 h after onset of stroke were analyzed for three types of outcome: 3-month mortality, 3-month mortality or institutional care, and poor functional outcomes at discharge. Poor functional outcomes were defined as a Barthel index80 or a Rankin scale2. Multivariate regression models were used to determine the predictive value of the observed measures. After 3 months, 17% of patients had died; 21% were alive but being cared for in institutional settings; and 62% were alive and living at home. Functional status at discharge indicated 16% of patients had died, poor function in 50%, and good function in 34% of patients. Initial stroke severity, measured by National Institute of Health Stroke Scale, and dependence on a ventilator predicts 3-month mortality and poor outcome in all stroke patients. In addition, old age, previous stroke, and total anterior circulatory infarct were associated with poor outcome in ischemic stroke patients; old age, low body mass index and the presence of intraventricular hemorrhage were associated with poor outcomes in intracerebral hemorrhage patients. In conclusion, early stroke mortality and outcome at discharge can be predicted in the first few hours following an acute stroke for moderate to severe ICU-admitted stroke patients.

This study investigates the thermal stability of thermally grown silicon dioxide (thermal SiO 2 ), fluorinated silicate glass (FSG), hydrogen silsesquioxane (HSQ), and organosilicate glass (OSG). Samples with and without sputtered copper films, as-prepared and after annealing at 200 ∼ 800 °C in vacuum, have been investigated by various methods of analysis. For the as-prepared dielectrics, it is found that the densities of HSQ and OSG are less than those of SiO 2 and FSG due to the greater roughness and more porous structure of HSQ and OSG. After annealing at 800 °C, the HSQ structure converts to a SiO 2 -like structure, which is mainly due to decomposition of HSQ. Furthermore, the methyl groups and oxygen atoms are also liberated from OSG after high temperature annealing. A plateau in the Cu profile near the Cu/dielectric interface is observed in the results of secondary ion mass spectrometry after annealing at 450 °C. On the other hand, penetration of Cu atoms across the interface between Cu and HSQ, and across the interface between Cu and OSQ, are observed for Cu/HSQ and Cu/OSG systems after annealing at 450 °C. The thermal stability of these four dielectrics are discussed and compared.

Background Chronic infection has been proposed to increase the risk of atherosclerosis in several experimental and epidemiological studies. However, the relationship of chronic hepatitis B virus (HBV) infection and atherosclerosis remains controversial. We conducted this cross-sectional study to evaluate the association of carotid atherosclerosis with hepatitis B seropositivity. Methods and results In this cross-sectional study, we collected data from subjects undergoing health examination, including B-mode carotid ultrasonography, hepatitis B surface antigen (HBsAg) status and assessment of traditional cardiovascular risk factors, at our institutes in Taiwan between 2002 and 2003. Cases with chronic hepatitis C had been excluded. Of the 508 eligible subjects, 87 (17.1%) were positive for HBsAg and only six of them were positive for HBeAg. Compared with HBsAg negative subjects, the ORs (and 95% CIs) for the subjects with chronic hepatitis B to have carotid atherosclerosis were 1.24 (0.73–2.10) indexed by the presence of carotid atherosclerotic plaque (Intima-media thickness, IMT ≥ 1.3 mm), 0.74 (0.38–1.42) by maximal common carotid artery IMT ≥ 75th percentile, and 1.09 (0.62–1.90) by extracranial carotid artery atherosclerotic score ≥ 2, with the use of multivariate logistic regression analyses. Conclusion Hepatitis B virus seropositivity was not associated with an increased severity of carotid atherosclerosis in Taiwanese.

Early detection and management of preclinical atherosclerotic disease is the mainstream strategy in the prevention and treatment of atherosclerotic vascular disease. Increased intima-media thickness (IMT) and presence of atherosclerotic plaque of extracranial carotid artery (ECCA) have been identified as important markers for prediction of cardiovascular morbidity and mortality. The use of carotid ultrasound in noninvasive cardiology also gains much attention because of the advantage of high reproducibility in the measurements of IMT and ECCA atherosclerotic plaque scores. The superior role of carotid IMT as a good index of preclinical atherosclerosis in association with cardiovascular risk factors leads to worldwide application, not only in epidemiologic observations but also in pharmacologic intervention studies. Regarding the measurements of IMT, common carotid artery has been demonstrated to be highly reliable and easily accessible as compared with those measured at other segments in carotid arteries. Considering the nature of noninvasive, repeatability and reliability, we have demonstrated the feasibility of the measurements of carotid atherosclerosis in community-based, occupational and clinical studies in Taiwan. Thus, this review focuses on the rational and practical use of carotid ultrasound as a window for cardiovascular disease.

Accurate distinction of internal carotid artery (ICA) severe stenosis from occlusion in patients with acute stroke is crucial because carotid revascularization may reduce the risk of recurrent stroke. We report a 68-year-old man who had acute onset of right hemiparesis and hemiparesthesia. Head magnetic resonance imaging (MRI) on the first day and computed tomography (CT) angiography the next day showed total occlusion or pseudo-occlusion of the left ICA. However, carotid ultrasonography at around the same time clearly demonstrated focal severe stenosis of the left ICA orifice and catheter carotid angiography later confirmed the findings. The patient received angioplasty and stenting of the left ICA 3 weeks after stroke, and his follow-up course was uneventful. The case report highlights the value of carotid ultrasonography in distinguishing critical stenosis from occlusion of the carotid artery in patients with acute ischemic stroke.

Pain or paresthesia is one of the major symptoms after stroke. Nonpharmacological treatments including motor cortex electric stimulation or repetitive transcranial magnetic stimulation have been applied to treat such symptoms. However, the underlying pathomechnism of post-stroke pain/paresthesia, especially the excitability of motor cortex, has not been fully elucidated. Here we enrolled thirteen patients (11 men, age 58.8 ± 9.0 years-old) with persistent post-stroke paresthesia or pain but without motor weakness in the contralateral limbs (duration = 4.0 ± 4.9 years). The locations of stroke were pontine, lateral medulla or thalamus. We investigated the short-interval intracortical inhibition and the intracortical facilitation of the motor cortex in the stroke and healthy side of each patient. Paired stimuli of short (3, 5 and 7 ms) and medium (10, 15 and 20 ms) interstimulus intervals (ISI) were pseudo-randomly mixed with a single stimulus. The motor evoked potentials were recorded from the first dorsal interosseous muscle. There was no difference in the rest motor threshold ( p = 0.72). The intracortical inhibition at ISI of 3 ms were absent ( p = 0.045), and there was significant facilitation at ISI of 5, 7, 10, 15, 20 ms in stroke side ( p p p = 0.087) and a trend of facilitation at ISI of 10 and 15 ms ( p = 0.057 and 0.077 respectively) in the healthy side. These findings suggested impairment of intracortical inhibition in the motor cortex of stroke side in patients with post-stroke paresthesia or pain.

Substantial evidence clearly indicates the immuno-inflammatory nature of atherosclerosis and the important roles of monocytes and other leukocytes in atherogenesis. The relationship between atherosclerosis and the peripheral monocyte count, however, has been equivocal and uncertain so far. One possible reason may be an opposing effect of different major risk factors of atherosclerosis on the monocyte count, e.g. smoking increases the monocyte count while hypercholesterolemia is accompanied by a lower monocyte count. Since smoking is well shown to increase leukocyte counts prominently in weeks, our study included only non-smokers who participated in a health check program at our hospital from 1996 to 1998 and had received a carotid duplex study with extra payment. Our results revealed the followings: In male non-smokers (n=571), the presence of carotid atherosclerosis was associated with significant increases in the counts of all leukocyte, neutrophil, and monocyte (P0.005,0.001 and0.05, respectively), and, after adjustments for age and body mass index, there were significant positive links between these three leukocyte counts and the severity of carotid atherosclerosis, judged by either the sum score of all carotid plaques or the score of the most severe carotid plaque. On the contrary, in female non-smokers (n=614), there was no significant link between differential leukocyte counts and either the presence or severity of carotid atherosclerosis. These results are compatible with recently recognized sex differences in the mechanism and pathophysiology of atherosclerosis, and together with relevant results in the literature, suggest that monocytes and neutrophils are the main types of leukocytes involved in atherosclerosis.