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Purpose: To explore a safe and effective therapy in treating diplopia due to traumatic trochlear nerve palsy. Subjects: Two cases of traumatic trochlear nerve palsy both induced by motorcycle traffic accidents were presented in this study. Both cases were right superior oblique muscle palsy after an accidental head injury affected for more than 6 months (case 1) and 4 years (case 2). Methods of treatment: Both cases were subjected to acupuncture therapy at the acupoint BL1 (Jingming) of both eyes using disposable stainless steel acupuncture needles and were clinically evaluated by the ophthalmologist after each session. Each session extended to 20 minutes, 2 or 3 sessions per week till fully recovered. Result: Clinical symptoms of both cases were significantly improved after 3 sessions and continued the treatment for two more months to consolidate the curative effect due to fear of recurrence of symptoms. Conclusion: Acupuncture can be considered an effective therapy in the treatment of diplopia due to traumatic trochlear nerve palsy in addition to conservative therapy.

The study aimed to analyze the psychometric properties of a newly developed Chinese screening tool, the Chinese Version of the Speech Disorders in Parkinson’s Disease Questionnaire (SDPD-C). The SDPD-C contains a 24-item questionnaire with four assessment domains. Overall, 93 patients with idiopathic Parkinson’s disease (PD) (age 70.1 ± 8.9 years) and 76 healthy older adults (age 67.2 ± 8.1 years) participated in the psychometric analysis study. The internal consistency of the SDPD-C was .91 (four dimensions: .69–.85), and test-retest reliability was .91 (four dimensions: .85–.88). The SDPD-C was highly correlated with the Voice Handicap Index-10 and Movement Disorder Society-Unified Parkinson’s Disease Rating Scale II 2.1 (r = .83 and .78, respectively). The SDPD-C scores also differed significantly between stages 1 and 4 of the Hoehn and Yahr Scale ( p < .05). The area under the receiver operating characteristic curve was .955 (95% confidence interval, .927–.983; asymptotic significance p < .001), and the optimal cut-off score of this study was 36, with a sensitivity of .849 and specificity of .947. The results indicate that SDPD-C showed good reliability, validity, accuracy, and discrimination. It can be used as a screening tool for speech disorders in patients with PD.

Aim Chronic kidney disease (CKD) is associated with unfavorable outcomes in patients with ischemic stroke. One major metabolic derangement of CKD is dyslipidemia, which can be managed by statins. This study aimed to investigate whether the association of statins with post-stroke outcomes would be affected by renal function. Methods We evaluated the association of statin therapy at discharge with 3-month outcomes according to the estimated glomerular filtration rate (eGFR) of 50,092 patients with acute ischemic stroke from the Taiwan Stroke Registry from August 2006 to May 2016. The outcomes were mortality, functional outcome as modified Rankin Scale (mRS), and recurrent ischemic stroke at 3 months after index stroke. Results Statin therapy at discharge was associated with lower risks of mortality (adjusted hazard ratio [aHR], 0.41; 95% confidence interval [CI], 0.34 to 0.50) and unfavorable functional outcomes (mRS 3-5; aHR, 0.80; 95% CI, 0.76 to 0.84) in ischemic stroke patients. After stratification by eGFR, the lower risk of mortality associated with statins was limited to patients with an eGFR above 15 mL/min/1.73 m2. Using statins at discharge was correlated with a lower risk of unfavorable functional outcomes in patients with an eGFR of 60-89 mL/min/1.73 m2. Statin therapy in patients with an eGFR of 60-89 mL/min/1.73 m2 may be associated with a higher risk of recurrent ischemic stroke compared with nonusers (aHR, 1.29; 95% CI, 1.07 to 1.57). Conclusions In patients with acute ischemic stroke, the associations of statins with mortality and functional outcomes was dependent on eGFR.

The aim of this study was to improve the performance of a TiO2-nanorod solid–liquid heterojunction (SLHJ) ultraviolet photodetector covered with Al2O3-thin-film passivation layer through liquid phase deposition. First, we prepared a TTIP-HCl solution to grow TiO2 nanorods on a fluorine-doped tin oxide glass substrate through hydrothermal synthesis. During growth, HCl etching caused the TiO2 nanorods to transform from a two-dimensional film to a unidimensional nanorod structure. Because the etching effect strengthened with the HCl concentration, excessively high HCl concentrations resulted in over-etching and thin nanorods, which could easily collapse. By contrast, excessively low concentrations did not result in the formation of nanorod structures. In annealed TiO2 nanorods, the internal impedance of the SLHJ device is reduced, but oxygen vacancies are not reduced. Therefore, we coated the nanorods with a passivated Al2O3 layer though LPD; thus, the abundant oxygen atoms in the solution filled the original oxygen vacancies in TiO2. X-ray photoelectron spectroscopy analysis revealed that the proportions of defective Ti3+ and Ti2+ were substantially decreased, whereas the proportion of stable Ti4+ was increased considerably. Moreover, the responsivity of the photodetector was enhanced by 31% (from 303 to 397 mA/W), yielding a 5-order difference between the photo- and dark currents (from 10–3 to 10–8 A). After passivation, the rise and decay times of the photodetector were 0.5 s and 16.5 s, respectively, and the turn-off time was reduced by 10 s. The analysis results demonstrated that a passivated Al2O3 layer prepared through LPD can reduce oxygen vacancies in oxide semiconductors and improve device performance.

In this study, an indium tin oxide (ITO) glass surface was roughened, and liquid phase deposition (LPD) was used to create TiO2 compact layers to improve the efficiency of dye-sensitized solar cells (DSSCs). ITO glass substrates were first etched with HCl to increase the surface roughness and effectively scatter incident light into the working electrode of a DSSC. This increased the traveling path of the light and light-capturing ability of the cell, thereby enhancing the light absorbance rate. Then, LPD was conducted to create a TiO2 compact layer. The deposition reaction of a chemical liquid was induced to evenly cover the roughed ITO glass surface by using the compact layer. The LPD-TiO2 compact layer effectively inhibited charge recombination on the electrolyte/ITO interface, which enhanced the photovoltaic conversion efficiency of the DSSC. The results verified that the photovoltaic conversion efficiency of the DSSC with the roughened ITO glass improved from 4.67 to 5.05%. After the LPD-TiO2 compact layer was installed, the photovoltaic conversion efficiency was further enhanced to 5.91%, thereby achieving a 26.55% increase in efficiency. An electrochemical impedance spectroscopy revealed that the carrier lifetime increased from 7.17 to 9.34 ms, and the charge collection rate improved from 69.44 to 70.92%. This indicated that the roughened ITO glass and LPD-TiO2 compact layers were highly compatible. Using LPD to cover the uneven ITO glass surface by using an LPD-TiO2 is key to improving the light absorbance rate of DSSC and inhibiting carrier recombination.

Summary Objective This study used the Taiwan Stroke Registry data to evaluate the efficacy and safety of intravenous tissue plasminogen activator (tPA) in treating acute ischemic stroke in patients with renal dysfunction. Design We identified 3525 ischemic stroke patients and classified them into two groups according to the estimated glomerular filtration rate (eGFR) at the emergency department: ≥60, and Results Among patients with eGFR levels of Conclusions tPA for acute ischemic stroke could improve functional outcomes without increasing the risks of upper gastrointestinal bleeding for patients with or without renal dysfunction. The low eGFR was not a significant risk factor for intracerebral hemorrhage among patients receiving tPA treatment.

BackgroundFew studies have compared the optimal duration and intensity of organized multidisciplinary neurological/rehabilitative care delivered in a regional/district hospital with the standard rehabilitative care delivered in the general neurology/rehabilitation ward of a medical center. This study measured functional outcomes and conducted cost-utility analysis of an organized multidisciplinary postacute care (PAC) project in secondary care compared with standard rehabilitative care delivered in tertiary care.MethodsThis prospective cohort study enrolled 1,476 patients who had a stroke between March 2014 and March 2018 and had a modified Rankin scale score of 2–4. After exact matching for age ± 1 year, sex, year of stroke diagnosis, nasogastric tube, and Foley catheter and propensity score matching for the other covariates, we obtained 120 patients receiving PAC (the PAC group) from four regional/district hospitals and 120 patients not receiving PAC (the non-PAC group) from two medical centers.ResultsAt baseline, the non-PAC group showed significantly better functional outcomes than the PAC group, including EuroQol-5 dimensions (EQ-5D), Mini-Mental State Examination (MMSE) and Barthel index (BI). During weeks 7–12 of rehabilitation, improvements in all functional outcomes were significantly larger in the PAC group (P < 0.001) except for Functional Oral Intake Scale (FOIS). Cost-utility analysis revealed that the PAC group had a significantly lower mean (± standard deviation) of direct medical costs (US$3,480 ± $1,758 vs. US$3,785 ± $3,840, P < 0.001) and a significantly higher average gain of quality-adjusted life years (0.1993 vs. 0.1233, P < 0.001). The PAC project was an economically “dominant” strategy.ConclusionsThe PAC project saved costs and significantly improved the functional outcomes of patients with stroke with slight to moderately severe disabilities. Randomized control trials are required to corroborate these results.

This study based on Hartmann-Shack system to provide a non-contact system measuring Wavefront Aberration. Hartmann-Shack system set by optical component can realize that changing optical component to adjust the system. At the end, getting the aberration of normal lens between the simulation by ZEMAX software and comparing with the actual aberration that calculated by Zernike polynomials in software Matlab. To ensure the stability of system.

Ching-Huang Lin,1 Hsien-Chang Lin,2 Chien-Yu Chen,3 Chong-Chung Lih4 1Department of Electronic Engineering, National Yunlin University of Science & Technology, Yunlin, 640, Taiwan; 2Graduate School of Engineering Science and Technology, National Yunlin University of Science & Technology, Yunlin, 640, Taiwan; 3Graduate Institute of Color and Illumination Technology, National Taiwan University of Science and Technology, Taipei, 106, Taiwan; 4Department of Optometry, Central Taiwan University of Science and Technology, Taichung, 406, TaiwanCorrespondence: Chong-Chung LihDepartment of Optometry, Central Taiwan University of Science and Technology, Taichung, 406, TaiwanTel +866 4 22391647 6981Email cclih@phys.nthu.edu.twPurpose: This study used low-level laser irradiation on auricular points for the eyes of junior college teenagers with myopia to observe the changes in refractive errors and eye accommodation. According to the Sterner’s study, we used the relationship between the amplitude and subjective symptoms to assess the degree of improvement in visual fatigue caused by changes in accommodation.Methods: Participants were 49 healthy junior college teenagers, with an average age of 16.04± 0.80 years old, and the refractive errors of both eyes were between − 1.50 D and − 5.00 D. All participants underwent refractive error tests before and after class and after a 30-min break. In a 30-min break, all participants underwent two tests of with (experimental group) and without (control group) low-level laser irradiation on the auricular points. Then, refractive error tests were conducted to evaluate the participants’ eye accommodation.Results: The results revealed that with treatment of the auricular points with and without low-level laser irradiation, the refractive error of the participants’ binocular left and right eyes decreased by − 0.12 D (− 0.18 D) in the experimental grou and by − 0.05 D (− 0.02D) in the control group. For the amplitudes of accommodation (AA) examination, the AA of the participants’ binocular in the experimental group became 7.98 ± 1.35 D (7.65 ± 1.37 D). The AA of participants’ binocular can recover to the level before the class.Conclusion: The results indicated that low-level laser irradiation at auricular points restored the eye accommodation faster than did natural closing of the eyes.Keywords: low-level laser irradiation, myopia, teenager, accommodation, auricular point

We examined the effects of using mobile devices with immersive virtual reality for a short period on the physiological parameters of both eyes. The average age of the 50 participants (23 men and 27 women) was 17.72 ± 1.48 years, and refractive error ranged from 0 D to − 5.00 D. All the participants wore + 3.00 D glasses and underwent a 5-min relaxation adjustment through the atomization method. The participants wore immersive virtual reality (VR) glasses to watch a movie on a roller coaster for 10 min. Their relevant physiological parameters of the eyes were measured both before and after using VR glasses. Compared with before VR use, no significant difference (P > 0.05) was observed in the near-horizontal vergence and refractive error but a significant difference (P 0.2 MPa, and we used Friedenwald’s eye rigidity relationship to obtain the K value (0.065–0.09). Approximately 10% of the participants experienced cybersickness symptoms such as nausea and dizziness. The use of VR to watch three-dimensional movies reduced intraocular pressure, which may help prevent or treat glaucoma. Moreover, the binocular convergence was higher when viewing near-field objects in VR than in the real world. Therefore, individuals with convergence excess may experience symptoms. Binocular parallax is the most likely cause of cybersickness symptoms. Thus, mobile VR devices with higher quality and comfort are necessary.

In this large-scale prospective cohort study, a propensity score matching method was applied in a natural experimental design to investigate how post-acute care (PAC) after stroke affects functional status and to identify predictors of functional status. The main objective of this study was to examine longitudinal changes in various measures of functional status in stroke patients and predictors of scores for these measures before and after PAC. A group of patients who had received PAC for stroke at one of two medical centers (PAC group, n = 273) was compared with a group who had received standard care for stroke at one of four hospitals (three regional hospital and one district hospital, non-PAC group, n = 273) in Taiwan from March, 2014, to October, 2018. The patients completed the functional status measures before rehabilitation, the 12th week and the 1st year after rehabilitation. Generalized estimating equations were used to estimate differences-in-differences models for examining the effects of PAC. The average age was 68.0 (SD = 8.1) years, and males accounted for 57.9%. During the follow-up period, significant risk factors for poor functional outcomes were advanced age, hemorrhagic stroke, and poor function scores before rehabilitation (p &lt, 0.05). Between-group comparisons at subsequent time points revealed significantly higher functional status scores in the PAC group versus the non-PAC group (p &lt, 0.001). Notably, for all functional status measures, between-group differences in total scores significantly increased over time from baseline to 1 year post-rehabilitation (p &lt, 0.001). The contribution of this study is its further elucidation of the clinical implications and health policy implications of rehabilitative care after stroke. Specifically, it improves understanding of the effects of PAC in stroke patients at different follow-up times. Therefore, a policy implication of this study is that standard care for stroke should include intensive rehabilitative PAC to maximize recovery of overall function.

A prism device is utilized in this study for modifying the eye convergence to reduce eye accommodation and enhance the comfort in viewing 3D video. Without changing the contents of 3D films, it aims to apply the myosis, convergence, and accommodation visual triad of eyeballs viewing near distance to not change the eyeball pupillary distance when viewing 3D films. Without convergence, the discomfort caused by intraocular muscle contraction when viewing near distance is reduced. Such an effect of a small prism lens is also proven in this study. When viewing 3D films with 1.0△ lenses, the physiological accommodation reaction of eyes would reduce (the right eye decreases 65% and the left eye decreases 70%), revealing the decreasing tension of intraocular muscle. The subjective psychological evaluation result also shows that viewing 3D images with small prism lenses could enhance the comfort. The evaluation of optical simulation, physiological reaction, and mental fatigue proves that the small prism lens proposed in this study could actually improve the comfort in viewing 3D films., Accommodation, Convergence, Prism, Visual fatigue, Psychological evaluation.

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.

Cerebrovascular disease is the second commonest cause of mortality globally and among the commonest causes of disability. However, research executed to probe the heavy metal exposure-stroke incidence relationship is scarce. Accordingly, we executed our study to probe the relationship of heavy metal concentrations (ie, concentrations of lead [Pb], mercury [Hg], cadmium [Cd], and arsenic) in the serum and urine of acute ischemic stroke (AIS) patients with several patient variables.For enrollment, we chose patients who had a first AIS within 7 days after the onset of a stroke. Thus, 33 newly diagnosed patients with AIS were recruited. We determined the aforementioned metals' concentrations by executing inductively coupled plasma mass spectrometry. We also gauged the association between such metal concentrations and patient variables by employing Spearman correlation coefficient. To examine the differences in metal concentrations between the different variables, we implemented an independent Mann-Whitney U test.In our cohort analysis, we noted serum Pb and Cd concentrations to be positively correlated with serum creatinine and hemoglobin. Serum and urine Cd concentrations had a negative correlation with impaired HbA1c in AIS patients. Urine Hg had a positive correlation with C-reactive protein in the participants. Participants who smoked or consumed alcohol had significantly higher Pb and Cd levels in serum than did those who neither smoked nor drank. Patients with AIS who smoked or consumed alcohol had high levels of serum Pb and serum Cd than did those who did not. Patients with AIS who consumed alcohol had significantly higher Pb and Hg urine concentrations than did those who did not.Our study indicated that serum Cd and Pb elevation increased the AIS risk in southern Taiwan patients.

This paper revealed an effective method to judge the quality levels of apples with optical images which could avoid the damages caused by touching measurement. When only using photographs of the apples, the quality levels cannot be effectively identified via auto optical inspection methods. We proposed a structured light projection system for detecting the apple surface topography which is corresponding to the small changes during storage periods. This system uses cosine waves with different phases to project onto the apple surface and then uses three phases to reconstruct the object. In order to get the most suitable spatial frequency for this system, we tested six spatial frequencies: f = 0.001, f = 0.003, f = 0.005, f = 0.008, f = 0.01, and f = 0.08. Test results show that the spatial frequency f = 0.008 is best for our samples and hardware equipment. A convolutional neural network modified from LeNet is used to classify both the pictures: directly captured from apples and the reconstructed pictures from the structured lighting system. Experiments were performed on 30 fresh apples which then storage for a period of 7 days, 14 days and 21 days. The results of the convolutional neural network trained on structured light system samples showed that the accuracy was 87%, but the accuracy of the results of only using photography of apples was just 46%.

The measurements of be am size, divergence angle and beam quality depend on accurate assessment of intensity distribution. In this paper, we utilize image projection method to get intensity distribution of lasers. Lasers with different divergence angles (VCSEL, 24degrees/He-Ne laser, 0.057degrees) are used to be two different cases with respect to large and small divergence angles. The spots are projected on different rotating diffuser films. In the case of VCSEL, we found that the film selection is critical in acquiring correct values when ISO 11146-1:2005 is adopted.

Background No studies have discussed machine learning algorithms to predict the risk of 30-day readmission in patients with stroke. The objective of the present study was to compare the accuracy of the artificial neural network (ANN), K nearest neighbor (KNN), support vector machine (SVM), naive Bayes classifier (NBC), and Cox regression (COX) models and to explore the significant factors in predicting 30-day readmission after stroke. Methods This study prospectively compared the accuracy of the models using clinical data for 1,476 patients with stroke treated in six hospitals between March, 2014 and September, 2019. A training dataset (n=1,033) was used for model development, a testing dataset (n=443) was used for internal validation, and a validating dataset (n=167) was used for external validation. A global sensitivity analysis was performed to compare the significance of the selected input variables. Results Of all forecasting models, the ANN model had the highest accuracy in predicting 30-day readmission after stroke and had the highest overall performance indices. According to the ANN model, 30-day readmission was significantly associated with post-acute care (PAC) program, patient attributes, clinical attributes, and functional status scores before re-habilitation (all P

Background and Purpose— The observation that smokers with stroke could have better outcome than nonsmokers led to the term “smoking paradox.” The controversy of such a complex claim has not been fully settled, even though different case mix was noted. Analyses were conducted on 2 independent data sets to evaluate and determine whether such a paradox truly exists. Methods— Taiwan Stroke Registry with 88 925 stroke cases, and MJ cohort with 541 047 adults participating in a medical screening program with 1630 stroke deaths developed during 15 years of follow-up (1994–2008). Primary outcome for stroke registry was functional independence at 3 months by modified Rankin Scale score ≤2, for individuals classified by National Institutes of Health Stroke Scale score at admission. For MJ cohort, mortality risk by smoking status or by stroke history was assessed by hazard ratio. Results— A >11-year age difference in stroke incidence was found between smokers and nonsmokers, with a median age of 60.2 years for current smokers and 71.6 years for nonsmokers. For smokers, favorable outcome in mortality and in functional assessment in 3 months with modified Rankin Scale score ≤2 stratified by the National Institutes of Health Stroke Scale score was present but disappeared when age and sex were matched. Smokers without stroke history had a ≈2-fold increase in stroke deaths (2.05 for ischemic stroke and 1.53 for hemorrhagic stroke) but smokers with stroke history, 7.83-fold increase, overshadowing smoking risk. Quitting smoking at earlier age reversed or improved outcome. Conclusions— “The more you smoke, the earlier you stroke, and the longer sufferings you have to cope.” Smokers had 2-fold mortality from stroke but endured stroke disability 11 years longer. Quitting early reduced or reversed the harms.

Aim To evaluate the relationship between dipeptidyl peptidase-4 inhibitor (DPP4i) treatment and chronic rhinosinusitis (CRS) in diabetic patients. Methods We used the Longitudinal Health Insurance Database for this population-based and population-matched cohort design study. Chi-square and Wilcoxon rank-sum tests were used to evaluate the association between categorical and continuous variables, respectively. The Kaplan–Meier method with the log-rank test was used to estimate the risk of CRS and DPP4i users. Results A total of 6198 diabetic patients were included in this cohort study. DPP4i users had a lower risk of developing CRS. The risk of CRS was significantly lower in women, patients with a Diabetes Complications Severity Index score higher than 4, patients with comorbidities, and patients with higher cumulative defined daily dose in the DPP4i group. Conclusion The results of our study demonstrate that the use of DPP4i treatment could decrease CRS risk in diabetic patients in Taiwan.

Background Few studies have examined the relationship between the amounts of heavy metal and stroke incidence. The aim of this study was to explore the relationship between levels of heavy metals, including Pb, Hg, As, and Cd, in patients with acute ischemic stroke (AIS). Methods We selected patients with first-ever AIS onset within 1 week as our study group. Healthy controls were participants without a history of stroke or chronic disease, except hypertension. The serum levels of Pb, Hg, As, and Cd in participants in the experimental and control groups were determined. All participants received a 1-g infusion of edetate calcium disodium (EDTA). Urine specimens were collected for 24 h after EDTA infusion and measured for heavy metal levels. Results In total, 33 patients with AIS and 39 healthy controls were enrolled in this study. The major findings were as follows: (1) The stroke group had a significantly lower level of serum Hg (6.4 ± 4.3 μg/L vs. 9.8 ± 7.0 μg/L, P = 0.032, OR = 0.90, 95% CI = 0.81–0.99) and a lower level of urine Hg (0.7 ± 0.7 μg/L vs. 1.2 ± 0.6 μg/L, P = 0.006, OR = 0.27, 95% CI = 0.11–0.68) than the control group. (2) No significant difference in serum Pb (S-Pb), As (S-As), and Cd (S-Cd) levels and urine Pb (U-Pb), As (U-As) and Cd (U-Cd) levels was observed in either group. Conclusions Our study found low levels of serum and urine Hg in first-ever patients with AIS, providing new evidence of dysregulated heavy metals in patients with AIS. Electronic supplementary material The online version of this article (10.1186/s12929-018-0446-0) contains supplementary material, which is available to authorized users.

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.