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

Qigong is a gentle exercise that promotes health and well-being. This study evaluated the acute physiological and psychological effects of one session of qigong exercise in older practitioners. A total of 45 participants (mean age, 65.14 years) were recruited. Meridian electrical conductance, State-Trait Anxiety Inventory (STAI), heart rate variability (HRV), and Short Form 36 (SF-36) were evaluated and compared before and after one session of qigong exercise. The results revealed that the electrical conductance of all meridians, except spleen and bladder meridians, increased significantly (p<0.05). Compared with baseline values, upper to lower body ratio and sympathetic/vagal index were significantly improved and closer to 1 (p=0.011 and p=0.007, resp.). STAI-S and STAI-T scores decreased significantly (p<0.001 and p=0.001, resp.). The RR interval of HRV decreased significantly (p=0.035), a significant positive correlation was observed between kidney meridian electrical conductance and SF-36 physical scores (r=0.74, p=0.018), and a positive correlation was observed between pericardium meridian electrical conductance and SF-36 mental scores (r=0.50, p=0.06). In conclusion, one session of qigong exercise increased meridian electrical conductance, reduced anxiety, and improved body and autonomic nervous system balance. These findings provide scientific evidence for acute physiological and psychological effects of qigong exercise in older practitioners.

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.

PURPOSE Tc-99m TRODAT is an agent for dopamine transporters and measuring dopamine innervation of the striatum. An association between Parkinson disease and body burden mercury level has been reported in the scientific published data. The purpose of this study was to investigate the effect of mercury exposure on dopamine transporters in the striatum measured by Tc-99m TRODAT single-photon emission computed tomography (SPECT). METHOD AND MATERIALS Study subjects included 17 workers who worked in a lamp factory at risk for mercury vapor exposure and 15 age-matched healthy controls. All subjects received Tc-99m TRODAT SPECT, brain computed tomography scan, and neurologic examinations. Biologic urine mercury levels at the end of a work week were assessed for workers. RESULTS There were significant differences in specific uptake ratio (SUR) in the striatum, caudate, and putamen between mercury exposure workers and healthy controls on Tc-99m TRODAT SPECT (all P < 0.001). The results showed a significantly negative correlation between urine and cumulative mercury levels and SUR in the striatum on Tc-99m TRODAT SPECT by Pearson analysis (r = -0.501, P = 0.040; r = -0.563, P = 0.019). After adjusting for age, gender, and body mass index, cumulative mercury exposure index (Cum Hg) was demonstrated to be the statistically significant predictor for SUR in the striatum, caudate, and putamen on Tc-99m TRODAT SPECT by multiple linear regression analysis (β = -0.543, P = 0.018; β = -0.521, P = 0.033; β = -0.465, P = 0.048). CONCLUSION Mercury exposure has significantly negative effect on dopamine transporters in the striatum. There is dose-response relationship between cumulative mercury exposure index (Cum Hg) and SUR in the striatum on Tc-99m TRODAT brain SPECT.

Background— Stroke is a leading cause of death around the world. Improving the quality of stroke care is a global priority, despite the diverse healthcare economies across nations. The American Heart Association/American Stroke Association Get With the Guidelines-Stroke program (GWTG-Stroke) has improved the quality of stroke care in 790 US academic and community hospitals, with broad implications for the rest of the country. The generalizability of GWTG-Stroke across national and economic boundaries remains to be tested. The Taiwan Stroke Registry, with 30 599 stroke admissions between 2006 and 2008, was used to assess the applicability of GWTG-Stroke in Taiwan, which spends ≈1/10 of what the United States does in medical costs per new or recurrent stroke. Methods and Results— Taiwan Stroke Registry, sponsored by the Taiwan Department of Health, engages 39 academic and community hospitals and covers the entire country with 4 steps of quality control to ensure the reliability of entered data. Five GWTG-Stroke performance measures and 1 safety indicator are applicable to assess Taiwan Stroke Registry quality of stroke care. Demographic and outcome figures are comparable between GWTG-Stroke and Taiwan Stroke Registry. Two indicators (early and discharge antithrombotics) are close to GWTG-Stroke standards, while 3 other indicators (intravenous tissue plasminogen activator, anticoagulation for atrial fibrillation, lipid-lowering medication) and 1 safety indicator fall behind. Preliminary analysis shows that compliance with selected GWTG-Stroke guidelines is associated with better outcomes. Conclusions— Results suggest that GWTG-Stroke performance measures, with modification for ethnic factors, can become global standards across national and economic boundaries for assessing and improving quality of stroke care and outcomes. GWTG-Stroke can be incorporated into ongoing stroke registries across nations.

The dietary calcium supplement has been suggested to children and pregnant women for prevention of lead toxicity, because of lead-calcium interaction. Lead workers were supplied free milk in Taiwan; however, part of workers did not drink milk due to lactose intolerance. The goal of this study is to evaluate the effects of milk-intake on the peripheral nervous system in workers with long-term lead exposure. We measured 181 workers' current perception thresholds (CPT) as neurological outcomes. The outcome variables were then correlated to the subject's milk intake, blood lead levels, and index of long-term lead exposure that was calculated by the subject's serial blood lead data in a period of working duration. The potential confounders, including age, gender, body height, smoking and alcohol consumption, were also collected and analyzed in multiple regressions. 23 workers who reported never or rarely drinking milk, which meant that they have suffered from diarrhea or abdomen discomfort after drinking milk since childhood, had higher blood lead parameters but not statistically significant, and higher thresholds in sensory nerve tests, especially, statistically significance on 5 and 250 Hz of hand CPTs, which represent C fiber and A-delta fiber. In multiple regression models with control of potential confounders, significant protective effects of milk intake were found on reducing hand CPTs, but not on foot CPTs. Our study, using measurement of sensory nerve CPTs, revealed that drinking milk (two bottles a day, about 700 g per day) might have an effect to protect lead peripheral neurotoxicity. The detail biochemical mechanisms need further investigations. However, reduction of occupational lead exposure is the essential way to protect lead neuropathy. The authors did not emphasize that offers of milk to workers could be instead of occupational hygiene efforts. Furthermore, lead workers with lactose intolerance might be more susceptible, and need more industrial hygiene interventions.

Background Discharge disposition planning is vital for poststroke patients. We investigated clinical factors associated with discharging patients to nursing homes, using the Taiwan Stroke Registry data collected from 39 major hospitals. Methods We randomly assigned 21,575 stroke inpatients registered from 2006 to 2008 into derivation and validation groups at a 3-to-1 ratio. We used the derivation group to develop a prediction model by measuring cumulative risk scores associated with potential predictors: age, sex, hypertension, diabetes mellitus, heart diseases, stroke history, snoring, main caregivers, stroke types, and National Institutes of Health Stroke Scale (NIHSS). Probability of nursing home care and odds ratio (OR) of nursing home care relative to home care by cumulative risk scores were measured for the prediction. The area under the receiver operating characteristic curve (AUROC) was used to assess the model discrimination against the validation group. Results Except for hypertension, all remaining potential predictors were significant independent predictors associated with stroke patient disposition to nursing home care after discharge from hospitals. The risk sharply increased with age and NIHSS. Patients with a cumulative risk score of 15 or more had an OR of 86.4 for the nursing home disposition. The AUROC plots showed similar areas under curves for the derivation group (.86, 95% confidence interval [CI], .85-.87) and for the validation group (.84, 95% CI, .83-.86). Conclusions The cumulative risk score is an easy-to-estimate tool for preparing stroke patients and their family for disposition on discharge.

To analyse the effect of epilepsy an P300 event-related potentials we studied 27 patients with idiopathic generalized epilepsy (IGE), 13 patients with temporal lobe epilepsy (TLE) and 60 normal controls. The prolongation of P300 latencies was highly cor related with increasing age in controls but not epileptic patients. The age-corrected P300 latency used in this study was actual P300 latency–predicted P300 latency (predicted P300 (msec)=306.20+0.79 age, P =0.001, R 2 =0.32). By using ANOVA analysis, the age-corrected latencies of P300 were significantly longer in TLE patients (19.72±47.82 msec, mean±SD) than in IGE patients (10.97±36.97 msec) and controls (0.23±20.28 msec). Likewise, significantly prolonged P300 latencies were seen in the epileptic patients with a seizure frequency more than 400 times (37.21±47.50 msec). The multivariate-adjusted odds ratio for those who had TLE was 10.97 (95% CI=3.99 − 30.14 ) in the prolonged latencies of P300 compared with that of IGE patients. The odds ratio of longer latencies of P300 was 7.43 (95% CI=2.75 − 20.08) among those who had a high seizure frequency (≧400 times) compared with those who had a low seizure frequency. No interaction between TLE and high frequency of attacks was found. The age at onset of seizure and duration of illness was not associated with P300 latency prolongation. From the above results, we might infer that the seizure type of TLE and a high frequency of seizure are two major independent precipitate factors for abnormal latencies of P300 in the epileptic patients.

OBJECTIVES—To evaluate the impact of long term occupational exposure to lead on function of the peripheral nervous system as reflected by vibration perception threshold (VPT), measured with a portable vibrameter. METHODS—217 Workers in a lead battery factory were required to have an annual blood lead measurement during each of the 5 years preceding this study. All were invited to take the VPT test. A total of 206 workers were studied. The associations were analysed between VPTs and current blood lead concentration, mean concentration of blood lead over the past 5 years, maximum blood lead concentration during the past 5 years, index of cumulative blood lead (ICL), time weighted index of cumulative blood lead (TWICL), and percentage of lifespan spent at work in the plant, as well as the other potential confounders. Ordinary multiple regressions, generalised additive models, and hockey stick regression analyses were used to explore the potential existence of a threshold effect of blood lead variables on VPT. RESULTS—VPT at a frequency of 220 Hz ranged from 6 to 100 (10-2 g, or 0.098 m/s2) with a mean (SD) of 19.8 (14.2) for the feet and from 4 to 43 with a mean (SD) of 10.2 (6.1) for the hands. The five variables of exposure to lead were all significantly correlated with VPT of the feet but not the hands. In multiple linear regression analyses, the mean of the blood lead concentrations and the TWICL were significantly associated with VPT of the feet. The relation between VPT of the feet and mean blood lead was shown to be a J shaped curve with a generalised additive model and local smoothing technique. In the hockey stick regression, evidence was found of a threshold effect at a mean blood lead concentration of 31 µg/dl. Above this threshold it was estimated that each increase of 1 µg/dl mean blood lead over 5 years would increase VPT of the feet by 0.29 (10-2 g) or 0.028 m/s2 (at a frequency of 220 Hz) with other potential confounders held constant. CONCLUSION—This study suggests that measurement of vibration sensory threshold is a relatively effective tool for detecting lead neuropathy in field studies, and that lead might cause sensory neuropathy with an effect threshold corresponding to a 5 year mean blood lead concentration of 31 µg/dl. Keywords: blood lead; neuropathy; vibration perception threshold

At six paint factories in northern Taiwan, 325 workers participated in a detailed evaluation that included medical and occupational questionnaires, blood sampling, neurobehavioral tests, vibratory perception threshold tests, and thermal perception threshold tests. Because of cultural differences, a Chinese test battery was modified from the Neurobehavioral Evaluation System 2. Eleven tests were performed: finger tapping, continuous performance, associated learning, symbol-digit, pattern comparison, pattern memory, visual digit span, switch attention, associated delayed recognition, mood scales, and vocabulary. Air concentrations of organic solvents were measured by passive personal samplers and analyzed by gas chromatography. Results showed that major solvents to which the workers were exposed were toluene, xylene, n-hexane, methyl iso-butyl ketone, and n-butyl acetate. The exposure index (EI) was classified by different exposure patterns and different air concentrations in the breathing zone as follows: EI 0, nonexposure; EI 1, low exposure; and EI 2, high exposure (the medians of 8-hr hygienic effects were 0, 0.03, and 0.25, respectively). Because of their diverse socioeconomic status and demographic characteristics, the workers were divided into two groups for additional analysis: one group comprised white-collar workers, including technicians and administrative staff, and the other comprised blue-collar workers. By using multiple linear regression analysis controls for age, sex, education, and alcohol intake, significant associations were found between increased exposure to solvent mixtures and performance on some neuropsychologic tests. In the blue-collar group, significantly prolonged response latencies were observed in the tests of continuous performance, pattern comparison, and pattern memory. Among white-collar workers, significant impairment was observed in the continuous performance test. All three tests involved visual attention and perceptual (speed and memory) functions. It was concluded that these may be the earliest neurotoxic signs of occupational exposure to low-level organic solvents in paint manufacturing workers.

Eighty-six workers in six fiberglass-reinforced plastics manufacturing plants in Taiwan were given a detailed evaluation including medical and occupational questionnaires, symptom questionnaires, blood sampling, and neurobehavioral tests, including cognitive performance, vibratory perception threshold, and thermal perception threshold. A Chinese version of cognitive tests modified from the Neurobehavioral Evaluation System 2 was applied. Fortyone workers directly exposed to styrene at the mean concentration of 22 ppm are compared with 45 workers not subject to styrene exposure. Multiple linear regression analysis controlling for age, sex, education, and alcohol intake revealed significant associations between styrene exposure and responses in some neuropsychologic measurements. No acute or chronic symptom had significant correlation with styrene exposure. Among the neurobehavioral tests, only the continuous performance test and vibration threshold were significantly and adversely affected in workers exposed to styrene. Significant changes in the central and peripheral nervous system were thus detected at a mean styrene exposure of 22 ppm.

AIM The purpose of the study was to evaluate the relationship between the number of packs smoked per day and specific uptake ratio (SUR) in the striatum on Tc-99m TRODAT, and frequency of hand tremor. METHODS It was a prospective, cross-sectional study. In all, 23 healthy nonsmokers and 37 current smokers were recruited in the study. All subjects underwent Tc-99m TRODAT SPECT, brain CT scan, thyroid function test, tremor measurement system, and neurologic examinations. RESULTS There were significant differences in the SUR in the striatum on Tc-99m TRODAT and in the frequency of hand tremor in rest state and in arm extended state among nonsmokers (grade I), current smokers with less than 1 pack smoked per day (grade II), and current smokers with equal or more than 1 pack smoked per day (grade III) by ANOVA (all P < 0.001). After adjusting for age and gender, there was a significantly negative correlation between smoke grade and SUR in the striatum on Tc-99m TRODAT by multiple linear regression (β = -0.45, P < 0.001). Smoke grade was the significant predictor for the frequency of hand tremor in rest state and in arm extended state, after adjusting for age and gender by multiple linear regression (β = 14.70, P < 0.001; β = 15.37, P < 0.001). CONCLUSIONS There is a dose-response relationship between the number of packs smoked per day and SUR in the striatum, and the frequency of hand tremor. Decreased dopamine transporter binding in the striatum and increased frequency of hand tremor in smokers may have important implications for evaluating the impact of smoking on the central and peripheral nerve systems.

The purpose of this study is to examine the effects of various levels of alcohol consumption on human response to auditory and visual stimuli in terms of reaction time, movement time, total reaction time, and error rate. Placebo level and three low-level alcohol doses were randomly assigned to 20 male university student volunteers. 30 min. after consuming the alcohol or placebo, participants responded to either auditory or visual stimuli. Total reaction time increased significantly at the mid-low dose of alcohol (0.3 g/kg). For alcohol doses less than .5 g/kg, the change in total reaction time was confined to reaction time, i.e., the processing time between onset of stimulus and onset of movement. Effects of alcohol were significantly more pronounced in the choice-type tests. Notably, the effects of alcohol on total reaction time and error rate were significant for auditory but not visual stimuli.

Lead poisoning remains an occupational hazard in Taiwan. Many studies, based on crossed-section design, have focused on changes in lead-associated neurobehavioral dysfunctions that occur at increased blood lead levels. This study evaluates the changes in neurobehavioral performance of lead workers as blood levels are reduced. We tested 27 lead workers in a lead glaze factory using the computer-based and automated Chinese edition of Neurobehavioral Evaluation System 2 (C-NES II) in 1994, 1996, and 1997. The association of blood lead levels and C-NES II results were analyzed by longitudinal data analysis methods, repeated ANOVA and mixed model analyses after adjustment for potential confounders. Over these 4 years, the mean lead blood levels of workers were reduced from 26.3(SD=12.0) to 8.3(SD=6.9) microg/dL. Based on a mixed model analysis, we found that the negative effects of exposure to lead on neurobehavioral performance can be reversed to some extent with lowering levels of blood lead. During this period, we found significant improvements in 3 subtests: finger tapping, pattern comparison reaction time, and memory. This study tentatively concluded that reversibility of the neurobehavioral performance after reduction of the lead exposure, which encourages industrial hygiene and personal health promotion to reduce their body lead burden. However, though use of NES is more sensitive to detect the changes, the chronic symptoms (using standardized questionnaire) were found to decline slowly when blood lead level is reduced, with no statistically significant difference. The result means that to avoid the lead exposure primarily is essential to prevent chronic symptoms. We conclude that the most important way to prevent and possibly reverse chronic symptoms of lead poisoning remains to be the avoidance of exposure to lead.

This cross-sectional study examined the possible influence on the development of cognitive function among adolescents due to long-term arsenic exposure. Forty-nine junior school students drinking arsenic-containing well water and 60 controls matched with age, sex, education, body height, body weight, body mass index, and socioeconomic status were compared. The former was divided into two groups: high and low exposure, with mean cumulative arsenic levels of 520629.0+/-605824.2 and 13782.2+/-12886.0 ppm, respectively. Four neurobehavioral tests including continuous performance test (CPT), symbol digit (SD), pattern memory (PM) and switching attention (SA) were applied. A strong correlation between age and education caused collinearity in the multiple regression model (r=0.84, P

A total of 368 workers from six paint-manufacturing factories participated in this study. The workers were classified according to type of exposure: direct, intermittent, and no exposure. The workers' liver-function tests were influenced greatly by gender, hepatitis B, alcohol consumption, and body mass index. Both the serum concentration and the odds of abnormality of total serum bile acids were elevated among the directly exposed group. The authors concluded that analysis of covariance should take into account occupational and nonoccupational factors on liver-function tests to avoid any errors. Total serum bile acids also indicated liver dysfunction from solvent exposure.