Taiwan

References



Chang, C.Z., Winardi, D., Loh, J.K., Kung, S.S., Howng, S.L., Jeng, A.Y. and Kwan,

A.L. (2002), Alteration of ischemic reperfusion injury in the rat neocortex by a

potent antioxidant mexiletine. Acta Neurochirurgica, 144 (2), 189-193.

Abstract: The mechanisms by which mexiletine exerts its effects in increasing

myocardial circulation, and smooth muscle perfusion and alleviating diabetic

neuropathic pain have been widely discussed. The purpose of this study was to

examine the protective effect of this compound in ischemia/reperfusion- induced

cerebral injury following middle, cerebral artery occlusion in Spraque-Dawley rats.

Blood flow to the left cerebral hemisphere of the animals was interrupted by

occluding the left cerebral artery and both carotid arteries simultaneously for 3 hrs.

These animals were assigned to one of ten groups and devided into treatment group

and pretreatment group; I) control treatment group (n = 8); 2) vehicle treatment

group (n = 8) 3) lower dose mexiletine (400 pg/kg) treatment group (n = 8); 4)

medium dose mexiletine (800 mug/kg) treatment group (n = 8); 5) high dose

mexiletine (2 mg/kg) treatment group (n = 8): 6) control pretreatment group (n = 8) 7)

vehicle pretreatment group (n = 8): 8) lower dose mexiletine (400 pg/kg)

pretreatment group (n = 8): 9) medium dose mexiletine (800 pg/kg) pretreatment

group (n = 8): and 10) high dose mexiletine (2 mg/kg) pretreatment group (n = 8).

The volume, of cerebral infarction was measured in serial brain sections stained with

triphenyltetrazolium chloride (TTC). Tissue infarction volume and tissue edema

were estimated for each animal. The volume of cerebral infarction was significantly

decreased in rats pretreated with mexiletine, and the ratio of tissue edema was also

decreased as the dose of mexiletine increased. These results demonstrate that

mexiletine, an anti- arrhythmic and use-dependent Na+ channel blocker, has

protective effects in stroke at concentrations sufficient to confer significant

protection, as measured by the volume of infarction and brain edema index in a

model of focal, neocortical ischemia in Spraque-Dawley rats

Keywords: antioxidant/brain/brain edema/BRAIN INJURY/carotid arteries/cerebral

infarction/CEREBRAL-ISCHEMIA/EDEMA/EXCITABILITY/focal/FREE-RADIC

ALS/HYDROXYMEXILETINE/infarction/ischemia/ischemic/mexiletine/MUSCLE-

FIBERS/neocortical ischemia/NITRIC-OXIDE/PAINFUL DIABETIC

NEUROPATHY/protective

effect/rat/rats/reperfusion/stroke/Taiwan/WHITE-MATTER

Liu, C.W., Chu, N.S. and Ryu, S.J. (1991), Ct, Somatosensory and Brain-Stem Auditory

Evoked-Potentials in the Early Prediction of Functional Outcome in Putaminal

Hemorrhage. Acta Neurologica Scandinavica, 84 (1), 28-32.

Abstract: The CT and median somatosensory and brainstem auditory evoked potentials

(SEP and BAEP) were studied in 80 patients with spontaneous putaminal

hemorrhage for their values in the early prediction of functional outcome. The CT

scan was performed within 2 days and EPs within a week after the onset of

symptoms. The activities of daily living was assessed at 6 months. Patients with good

functional recovery had the following findings: 1) the hemorrhage had not involved

the thalamus or the posterior limb of the internal capsule; 2) the SEPs were normal or

had prolonged central conduction time; and 3) the BAEP was normal. When the

cortical SEPs were absent, the majority of patients were moderately or severely

disabled. Attenuation or absence of BAEP wave V always forecase a grave prognosis.

It is concluded that the combined use of CT, SEP and BAEP is an objective and

reliable method for the early prediction of functional outcome in patients with

putaminal hemorrhage

Keywords: activities of daily living/BAEP/brainstem/CT/PROGNOSIS/PUTAMINAL

HEMORRHAGE/SEP/STROKE/STROKE OUTCOME/thalamus

Chen, R.S., Huang, C.C., Lee, C.C., Wai, Y.Y., Hsi, M.S., Pang, C.Y. and Wei, Y.H.

(1993), Overlapping Syndrome of Merrf and Melas - Molecular and

Neuroradiological Studies. Acta Neurologica Scandinavica, 87 (6), 494-498.

Abstract: We describe a 42-year-old woman with overlapping syndrome of MELAS

(mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes)

and MERRF (myoclonus epilepsy and ragged-red fibers). Clinically, she had

episodic headache, stroke-like episode with left hemiparesis and lactic acidosis

commonly found in MELAS syndrome. However, myoclonus seizure, and ataxia

with dyssynergic gait characteristic of MERRF were also noted. Computed

tomographic scans showed a right temporo- parietal hypodense lesion. The lesion

disappeared 20 months later, even magnetic resonance images also failed to reveal

this abnormality. A molecular analysis of mitochondrial DNA was conducted by

using restriction endonucleases ApaI and NaeI. A transition from A to G was found

at the nucleotide position 3243, but not found at the 8344th nucleotide pair. In this

report, we document the fluctuating CT changes and emphasize the importance of

molecular analysis in patients with overlapping syndrome of mitochondrial

encephalomyopathies

Keywords:

COMPUTED-TOMOGRAPHY/CT/DEFECTS/DISEASE/DNA/ENCEPHALOMY

OPATHIES/ENCEPHALOPATHY/EPILEPSY/JUN/LACTIC-ACIDOSIS/MELAS/

MERRF/mitochondrial DNA/mitochondrial

encephalomyopathies/MITOCHONDRIAL

ENCEPHALOMYOPATHY/MITOCHONDRIAL MYOPATHY/MTDNA

ANALYSIS/MUTATION/seizure/STROKE-LIKE EPISODES

Thajeb, P. (1993), Gait Disorders of Multiinfarct Dementia - Ct and Clinical Correlation.

Acta Neurologica Scandinavica, 87 (3), 239-242.

Abstract: Twenty-five patients with various types of gait disorders of multi-infarct

dementia (MID) were reported. The types of gait disorders consisted of lower body

parkinsonism (LBP) plus ataxia (6 patients), LBP plus apraxia (5 patients), and a

combination of LBP plus ataxia and apraxia (14 patients). Hypertension occurred in

23 (92%) of the 25 patients. Nevertheless, individual stroke risk factors and the

locations of infarcts were not significantly different between the subgroups.

Ventriculomegaly and ''leuko-araiosis'' as demonstrated by computed tomography

occurred in more than 80% of patients in each subgroup. Atrophy of the superior

vermis was seen in 16 (80%) of 20 patients with ataxia as compared to 2 (40%) of

the 5 patients without ataxia (p 0.5 for systolic BP, p > 0.1 for

diastolic BP). In patients without history of hypertension, the daytime BP average

(127/89 +/- 7/13 mm Hg) was significantly higher than the nighttime average

(118/80 +/- 2/15 mm Hg) in systole (p 0.05). During

the late stage of stroke, the differences between daytime BP averages (143/95 +/-

24/13 mm Hg) and nighttime BP averages (135/96 +/- 19/12 mm Hg) were not

statistically significant for the hypertensive group (p > 0.05 for both systolic and

diastolic BP). In conclusion, hypertensive patients with cerebrovascular accident did

not exhibit the nocturnal fall of BP both in the acute and late stages of the disease.

The same phenomenon was observed for the diastolic BP in patients without history

of hypertension. The mechanisms of the loss of circadian change of BP and its

clinical implications are the interesting topics for further studies

Keywords: BLOOD PRESSURE/CIRCADIAN

RHYTHM/hypertension/STROKE/TAIWAN

Shieh, S.D., Lin, Y.F., Lu, K.C., Li, B.L., Chu, P.L., Shyh, T.P. and Diang, L.K. (1992),

Role of Creatine-Phosphokinase in Predicting Acute-Renal- Failure in Hypocalcemic

Exertional Heat-Stroke. American Journal of Nephrology, 12 (4), 252-258.

Abstract: Recruits frequently develop hypocalcemia in exertional heat stroke (ExHS)

with rhabdomyolysis and acute renal failure (ARF) from intensive training. It usually

indicated severe skeletal muscle damage. However, the relative risk of ARF in ExHS

patients complicated with hypocalcemia was unknown. The present study was

undertaken to evaluate the value of peak serum creatine phosphokinase (CPK) level

in predicting ARF in ExHS patients with hypocalcemia. Sixty-eight army recruits

with ExHS were hospitalized at the Tri-Service General Hospital, Taiwan: 17 with

ARF and hypocalcemia (group A); 7 with ARF but without hypocalcemia (group B);

20 without ARF but with hypocalcemia (group C); and 24 without ARF or

hypocalcemia (group D). In the 24 patients with ARF (groups A and B) the serum

phosphate and peak CPK levels were significantly higher than in patients without

ARF (groups C and D; p 50%) plus the 5 patients with mild ventricular

dysfunction but no ST segment depression, 13 patients did not have submaximal O-2

pulse/BW significantly lower than untrained men (specificity, 81%)

Keywords: CARDIAC- FAILURE/control chart/CORONARY-ARTERY

DISEASE/ejection fraction/fitness/infarction/MEN/myocardial

ischemia/MYOCARDIAL-INFARCTION/PERFORMANCE/RESPONSES/sensitivi

ty/STROKE VOLUME

Lee, M.Y., Wong, M.K., Tang, F.T., Cheng, P.T. and Lin, P.S. (1997), Comparison of

balance responses and motor patterns during sit- to-stand task with functional

mobility in stroke patients. American Journal of Physical Medicine & Rehabilitation,

76 (5), 401-410.

Abstract: This study was undertaken to explore whether we could provide supportive

laboratory evidence for the clinical observations that a stroke patient has lost

functional mobility/locomotion capability based on dynamic balance responses

(center of force sway patterns) and motor control activities (electromyography

patterns) during the motor task of sit-to-stand. A computerized controlled dynamic

postural control assessment system was developed and used in this study. Various

dynamic balance indexes were introduced and derived from center of force sway

patterns expressed in four domains (space, time, force, and frequency). Motor control

was assessed by multichannel surface electromyography of each side of the lower

limb during the same motor task. The functional mobility capability was evaluated

using the traditional FIM(SM) method. Fourteen stroke patients with right

hemiplegia and nine healthy elderly individuals were recruited as the experimental

and control groups, respectively. Muscle activity was recorded for quadriceps,

hamstrings, anterior tibialis, and triceps surae muscles and was used for analysis.

Center of force sway patterns and ground reaction forces were registered. All signals

were synchronized at ''seat-off.'' Surface electromyographic patterns of activities

recorded during sit-to-stand and dynamic balance indexes computed from center of

force sway patterns were categorized and compared with the functional mobility

scores. Results show that both the motor control patterns and dynamic balance

indexes correlated well to the extent of mobility impairment evaluated using the

traditional FIM(SM) method. An important conclusion for rehabilitation medicine is

that the functional mobility capability of stroke patients may be expressed

numerically using dynamic balance indexes and visualized graphically through

electromyographic motor patterns

Keywords: AGE/balance/CHAIR/elderly/functional mobility/hemiplegia/motor

control/MOVEMENT/rehabilitation/sit-to-stand/stroke

Lin, M.T., Liu, H.H. and Yang, Y.L. (1997), Involvement of interleukin-1 receptor

mechanisms in development of arterial hypotension in rat heatstroke. American

Journal of Physiology-Heart and Circulatory Physiology, 42 (4), H2072-H2077.

Abstract: Rats, under urethan anesthesia, were exposed to a high ambient temperature

(42 degrees C) to induce heatstroke and to assess the hemodynamic changes

associated with heatstroke. Compared with normothermic controls, rats with

heatstroke showed higher values of colonic temperature, heart rate, and plasma levels

of interleukin (IL)-1 but lower values of R wave amplitude, P-R and Q-T intervals,

systolic wave amplitude, diastolic and dicrotic wave duration, mean arterial pressure,

stroke volume, and cardiac output. Animals injected intravenously with an IL-

l-receptor antagonist at-the time of heatstroke induction were protected from some of

the cardiovascular effects of heatstroke, such as depressed ventricular depolarization,

decreased stroke volume, decreased cardiac output, and arterial hypotension. The

hemodynamic changes associated with heatstroke could be mimicked by IL-1 beta

administration. Other cardiovascular parameters such as total peripheral vascular

resistance were unaffected by heatstroke induction or IL-1 beta treatment. The results

indicate that a selective decline in stroke volume or ventricular depolarization

resulting from increased plasma levels of IL-1 may be an important mechanism

signaling arterial hypotension or circulatory failure in rat heatstroke

Keywords: ANTAGONIST/arterial hypotension/cardiac

output/CYTOKINES/ENDOTOXEMIA/EXPRESSION/HEAT-STROKE/heatstroke

/interleukin-1/ONSET/plasma/rat/rats/RELEASE/stroke/stroke

volume/SYSTEM/vascular resistance

Tsai, L.M., Chen, J.H., Lin, L.J. and Teng, J.K. (1997), Natural history of left atrial

spontaneous echo contrast in nonrheumatic atrial fibrillation. American Journal of

Cardiology, 80 (7), 897-900.

Abstract: A prospective study was designed to investigate potential changes of left atrial

(LA) spontaneous echo contrast with time and the effects of antithrombotic therapy

on its presence in 77 patients with chronic nonrheumatic atrial fibrillation (AF),

using serial transesophageal echocardiography (TEE). During a mean follow-up

period of 20 +/- 15 months (range 6 to 77), a total of 197 TEE studies were

performed in these patients. Baseline TEE revealed that LA spontaneous echo

contrast was absent in 43 patients (group 1) and present in 34 (group 2). LA

thrombus was found in 8 of group 2 but in none of the group 1 patients. During the

follow-up period, only 2 of the group 1 patients were receiving antithrombotic agents;

the patients in group 2 without LA thrombus were treated with either warfarin or

aspirin, whereas those with LA thrombus were treated with warfarin. On the latest

TEE study, LA spontaneous echo contrast was observed in 19 of the group 1 patients

(44%) and was persistently found in all of the group 2 patients. During the study

period, no patient was found to develop new LA thrombus formation and only 4

episodes of transient ischemic attack were recorded in 4 patients (embolic event rate

= 3.1% per year). Of these, 2 were observed in group 1 and the remaining 2 were

from group 2 and under aspirin therapy (event rate = 2.2% and 4.7% per year,

respectively). In the subgroup of patients with LA thrombus receiving warfarin

therapy, follow-up TEE revealed complete resolution of the thrombi in 6 and partial

resolution in the remaining 2 in spite of the persistence of LA spontaneous echo

contrast; none of these patients developed clinical thromboembolic events during the

study period. Thus, future occurrence of LA spontaneous echo contrast could be

observed by serial TEE at a substantial rate in patients with nonrheumatic AF who

have no LA spontaneous echo contrast; follow-up TEE should be recommended for

these patients to detect early the potential occurrence of LA spontaneous echo

contrast if preventive antithrombotic therapy is not considered. Although warfarin

therapy is associated with resolution of LA thrombus, neither warfarin nor aspirin is

effective for suppressing the presence of LA spontaneous echo contrast in

nonrheumatic AF. (C) 1997 by Excerpta Medica, Inc

Keywords: atrial fibrillation/MITRAL-VALVE

DISEASE/RESOLUTION/RISK/STROKE/THROMBUS/WARFARIN THERAPY

Lin, K.C., Wu, C.Y. and Trombly, C.A. (1998), Effects of task goal on movement

kinematics and line bisection performance in adults without disabilities. American

Journal of Occupational Therapy, 52 (3), 179-187.

Abstract: Objective. This study investigated (a) whether the kinematic profile of a

reaching-for-an-object movement would differ depending on the goal of the reaching

task and (b) the effect of task goal on attentional carryover. Method. Twenty-four

adults without disabilities performed a horizontal line bisection task under three

conditions: (a) a natural condition (pressing the ringing lever of a desk bell), (b) an

impoverished condition (touching the ringing lever of a desk bell), and (c) a control

condition (bisecting a line only). Only the natural and impoverished conditions used

the reaching task (i.e., pressing or couching the ringing lever of the desk bell). The

kinematic profile of reaching for the bell was established with the OPTO-TRAK

system, a quantitative kinematic analysis measure. The line bisection task was

performed immediately after the reaching task, which was located adjacent to the left

of the line to be bisected. Results. The natural condition elicited better quality of

reaching movement than did the impoverished condition. It produced significantly

shorter movement time and higher peak velocity. A less impressive effect was found

for percentage of reach where peak velocity occurs. Bisection performance under the

two experimental conditions was leftward biased relative to the control condition,

and the magnitude of leftward bias in the natural condition was greater than that for

the impoverished condition. Conclusion. Results supported one core assumption of

occupational therapy: goal-directed and functional task can be used to enhance

human performance. If the results hold for clinical populations, manipulations of

functional goals may enhance movement performance of persons with disabilities

and remediate left neglect often seen in clients who have had a stroke

Keywords: ARM MOVEMENTS/attention/HEMISPATIAL

NEGLECT/JUDGMENTS/motivation/motor

control/STROKE/Taiwan/THERAPY/UNILATERAL

NEGLECT/VELOCITY/VISUO-SPATIAL NEGLECT

Wang, R.Y., Tsai, M.W. and Chan, R.C. (1998), Effects of surface spinal cord

stimulation on spasticity and quantitative assessment of muscle tone in hemiplegic

patients. American Journal of Physical Medicine & Rehabilitation, 77 (4), 282-287.

Abstract: Spasticity after a stroke interferes with the normal function of a limb. Electric

stimulation has been used in a variety of ways to decrease spasticity. The purposes of

this study were (1) to quantify the effectiveness of electric stimulation on decreasing

ankle spasticity and (2) to develop a quantitative assessment of muscle tone, which

could be replicated in the clinic. Ten patients with hemiparesis resulting from

ischemic stroke participated in the study according to the selection criteria. Their

mean age was 57 yr, with a mean stroke interval of 12.5 months. Patients received

electric stimulation for 45 min through surface electrodes applied to the skin in the

12th thoracic and Ist lumbar areas. All patients received five electric stimulation

treatment sessions. The electrical pulses were amplitude modulated frequency beat

with a carry frequency of 2500 Hz and a stimulation frequency of 20 Hz. The

stimulation intensity was adjusted to each patient to produce a sensory stimulation.

The pre- and posttreatment evaluation included surface electromyography activity

during passive ankle dorsiflexion, passive ankle dorsiflexion resistance at different

angular velocities, as measured by an isokinetic machine and the modified Ashworth

scale. Our results indicate that the surface spinal cord stimulation with middle

frequency modulated to low frequency for sensory stimulation on the skin of 12th

thoracic and first lumbar area is effective in reducing calf muscle spasticity of

hemiplegic patients. The isokinetic torque measures for spasticity are a sensitive tool

to document the effects of the treatment

Keywords: electric

stimulation/ELECTRICAL-STIMULATION/hemiplegia/INJURY/REFLEX/spasticit

y/stroke/surface spinal cord/Taiwan

Chang, L.H. and Hasselkus, B.R. (1998), Occupational therapists expectations in

rehabilitation following stroke: Sources of satisfaction and dissatisfaction. American

Journal of Occupational Therapy, 52 (8), 629-637.

Abstract: Objective. The purpose of this study was to gain understanding of the

satisfactions and dissatisfactions in the work of occupational therapists with clients

after stroke. Method. Data consisted of narrative descriptions by 32 therapists of

especially satisfying and dissatisfying experiences in practice. Phenomenology and

grounded theory strategies were used for the study design and data analysis. Results.

"Expectation" emerged as the core meaning of occupational therapy in stroke

rehabilitation. Strong satisfaction was expressed when therapist-informants believed

that they had fulfilled their expectations for clients to achieve the following: (a)

maximum neuromuscular and functional recovery in affected upper extremities; (b)

independence in daily activities; and (c) return to living in the community. Major

sources of informants' dissatisfactions were reaching the "plateau" stage of

neurological recovery, disagreement between therapist expectations and client and

family member expectations and working with clients perceived as pearly motivated.

Conclusion. American ideologies about the value of hard work, independence, and

self-sufficiency appear to strongly shape therapists' expectations, satisfaction, and

dissatisfaction in stroke rehabilitation. For occupational therapists, a tension may

exist between the idealism of their therapeutic expectations and the realities of stroke

recovery as it is experienced within the context of clients' ongoing lives

Keywords: cerebrovascular

disorders/LONG-TERM-CARE/OLD-AGE/PLASTICITY/professional-patient

relations/qualitative method/rehabilitation/stroke/Taiwan/THERAPY

Tsai, L.M., Chen, J.H. and Tsao, C.J. (1998), Relation of left atrial spontaneous echo

contrast prethrombotic state in atrial fibrillation associated with systemic

hypertension, idiopathic dilated cardiomyopathy, or no identifiable cause (Lone).

American Journal of Cardiology, 81 (10), 1249-+.

Abstract: To investigate the association of left atrial (LA) spontaneous echo contrast

with the hemostatic state in nonrheumatic atrial fibrillation (AF), we examined the

plasma levels of prothrombin fragment 1+2 and fibrinopeptide A in 73 patients with

chronic nonrheumatic AF undergoing transesophageal echocardiography and 38

age-matched normal subjects. The results support the theory that LA spontaneous

echo contrast in nonrheumatic AF is associated with a hypercoagulable state,

especially in patients with marked LA spontaneous echo contrast

Keywords: ACTIVATION/atrial fibrillation/CLINICAL

IMPLICATIONS/ECHOCARDIOGRAPHY/hypertension/MARKERS/STROKE/Ta

iwan/THROMBOEMBOLIC RISK

Yang, Y.L. and Lin, M.T. (1999), Heat shock protein expression protects against

cerebral ischemia and monoamine overload in rat heatstroke. American Journal of

Physiology-Heart and Circulatory Physiology, 276 (6), H1961-H1967.

Abstract: This study attempted to ascertain whether the ischemic damage to neurons and

monoamine overload in brain that occur during rat heatstroke can be attenuated by

heat shock protein (HSP) 72 induction. Effects of heatstroke on mean arterial

pressure (MAP), cerebral blood flow (CBF), brain dopamine (DA) and serotonin

(5-HT) release, and neural damage score were assayed in rats 0, 16, or 48 h after heat

shock (42 degrees C for 15 min) or chemical stress (5 mg/kg sodium arsenite ip).

Brain HSP 72 in rats after heat shock or chemical stress was detected by Western

blot, and brain monoamine was determined by a microdialysis probe combined with

high-performance-liquid chromatography. Heatstroke was induced by exposing the

animal to a high ambient temperature (43 degrees C); the moment at which MAP and

CBF decreased from their peak values was taken as the time of heatstroke onset.

Prior heat shock or chemical stress conferred significant protection against

heatstroke- induced hyperthermia, arterial hypotension, cerebral ischemia, cerebral

DA and 5-HT overload, and neural damage and correlated with expression of HSP

72 in brain at 16 h. However, at 48 h, when HSP 72 expression returned to basal

values, the above responses that occurred during the onset of heatstroke were

indistinguishable between the two groups (0 h vs. 48 h). These results lead to the

hypothesis that the brain can be preconditioned by thermal or chemical injury, that

this preconditioning will induce HSP 72 and that HSP 72 induction will correlate

quite well with anatomic, histochemical, and hemodynamic protection in rat

heatstroke

Keywords: chemical stress/DEATH/dopamine/heat

shock/HSP70/microdialysis/NEURONAL

DAMAGE/ONSET/RABBITS/RELEASE/REPERFUSION

INJURY/serotonin/SODIUM/stress/STRESS PROTEINS/STROKE

Wong, A.M.K., Su, T.Y., Tang, F.T., Cheng, P.T. and Liaw, M.Y. (1999), Clinical trial

of electrical acupuncture on hemiplegic stroke patients. American Journal of

Physical Medicine & Rehabilitation, 78 (2), 117-122.

Abstract: To assess the efficacy of electrical acupuncture in the rehabilitation of patients

with hemiplegia in stroke, we randomized 128 patients within 2 wk of stroke onset to

receive either comprehensive rehabilitation plus electrical acupuncture (n = 59) or

comprehensive rehabilitation only (n = 59). Electrical acupuncture was administered

by electrical stimulation of acupuncture points through adhesive surface electrodes

five times per week. Neurological status (Brunnstrom's stage) and the Chinese

version of the Functional Independence Measure were assessed before treatment and

at discharge. Patients treated with electrical acupuncture had a shorter duration of

hospital stay for rehabilitation and better neurological and functional outcomes than

the control group had, with a significant difference in scores for self-care and

locomotion (P = 0.02). This result did not postulate the previous study that

acupuncture therapy for stroke patients should depend on needle manual and "de qi"

response. We suggest that electrical acupuncture through adhesive surface electrodes

in conjunction with current optimal rehabilitation programs is a convenient and

effective therapy for stroke patients

Keywords: acupuncture/electrical stimulation/functional electrical

stimulation/REHABILITATION/STIMULATION/stroke

Trombly, C.A. and Wu, C.Y. (1999), Effect of rehabilitation tasks on organization of

movement after stroke. American Journal of Occupational Therapy, 53 (4), 333-344.

Abstract: Objective. The purpose of this study was to examine the effect of presence or

absence of an object (goal-directed action vs. rote exercise) and the effect of

functional specificity of the object on the organization of reaching movements of

persons who have had a stroke. Method. A repeated-measure counterbalanced design

was used in each of two experiments. Eighteen persons who had been hospitalized

after stroke were recruited from the roster of a rehabilitation hospital and through

stroke clubs and volunteered to participate. Fourteen of these became the

data-producing sample. In Experiment 1, the OPTO-TRAK/3020 motion analysis

system was used to record movement when the participants reached for preferred

food (goal-directed action) or to a spatial location (rote exercise). In Experiment 2,

the system recorded movement when participants reached to pick up the receiver of

an active telephone (natural context), a detached receiver (partial context), and a

stick (simulated context). The organization of the reach movement was described

kinematically, as the number of zero crossings of the acceleration profile

(smoothness), movement time (speed), displacement, peak velocity (an indication of

force), and location of peak velocity in the velocity profile (planning strategy).

Results. Goal-directed action produced significantly smoother, faster more forceful,

and more preplanned movement than did the rote exercise condition. Functional

specificity of the context did not significantly affect organization of the reach.

Conclusion. Goal-directed reach enabled persons with stroke to display

characteristics typical of reach to a target by persons who have not had a stroke better

than reaching out in space. These findings support the occupational therapy practice

of using objects in dysfunctional concert to improve coordinated movement.

However, the nature of the objects to be used requires further study

Keywords: ARM MOVEMENTS/CEREBROVASCULAR

ACCIDENT/CONSTRAINTS/COORDINATION/IMAGERY-BASED

OCCUPATION/LEFT HEMIPARESIS/MATERIALS-BASED

OCCUPATION/motor control/motor performance/MOTOR-

PERFORMANCE/NURSING- HOME RESIDENTS/ROTE

EXERCISE/stroke/THERAPY

Beckett, M., Weinstein, M., Goldman, N. and Lin, Y.H. (2000), Do health interview

surveys yield reliable data on chronic illness among older respondents? American

Journal of Epidemiology, 151 (3), 315-323.

Abstract: Previous research evaluating quality of health interview survey data has

generally relied upon comparisons of household interview data with medical records

or other external sources of information. However, "gold standards" are not always

satisfactory or available, This paper illustrates an alternative approach to the

evaluation of data quality- examination of the reliability of reports of chronic

conditions in longitudinal surveys. The data come from national samples of older

Americans (First National Health and Nutrition Examination Survey Epidemiologic

Followup Study, 1971-1975, 1982-1984, 1986) and older Taiwanese (Survey of

Health and Living Status of the Elderly, 1989, 1993, 1996), The results show that,

among respondents who reported a chronic condition at a given interview, the

likelihood that the condition was acknowledged at the subsequent interview was

higher for hypertension and diabetes than for arthritis and stroke. Low levels of

consistency for stroke appear to result partly from the poor wording of questions. In

Taiwan, younger, more educated persons and those experiencing severe conditions

were somewhat more likely to acknowledge the condition at follow-up compared

with their respective counterparts, Women and persons of high cognitive status in the

United States and respondents in both countries who used a proxy to report the

occurrence of a stroke were also more likely to acknowledge conditions at follow-up

Keywords: chronic disease/data collection/DISEASE/HEALTH/health

surveys/hypertension/older/questionnaires/reliability/reproducibility of

results/research design/retrospective studies/stroke/Taiwan/Taiwanese/VALIDITY

How, C.K., Chern, C.H., Wang, L.M. and Lee, C.H. (2000), Heat stroke in a subtropical

country. American Journal of Emergency Medicine, 18 (4), 474-477.

Abstract: In Taiwan, a subtropical country without any history of heat waves, heat

stroke has been considered a rare disease. However, after seeing several cases of the

classic type of heat stroke at the end of the summer of 1998 (an unusual event) we

began to review and collect cases of suspected heat stroke (hyperthermia (>40.6

degrees C) in the presence of altered mental status and anhidrosis) and tried to

explore the possible cause of this unusual phenomenon. Through a emergency

department (ED) chart review, case retraction from International Classification of

Diseases (ICD) code, and ED conferences, six patients were found for the period

from June to August (the hottest months in Taiwan) 1998. We found that the most

common comorbid conditions were hypertension (4/6) and preexisting mental

problems (3/6). All patients lived in the inner part of an urban area, were middle

class, and were not socially isolated. Most of our patients felt unhealthy being

exposed to the cold and avoided staying in air-conditioned rooms. Laboratory

abnormalities and clinical presentations, except for a high fever and conscious

change, seemed to be nonspecific. All cases occurred during two periods of sustained

hotter-than average weather and, to our surprise, we found that three episodes

occurred around the day of the highest weather temperature (38.1 degrees C).

However, the higher temperatures (around 30 degrees to 31 degrees C and 32

degrees to 33 degrees C) did not reach the criteria of a heat wave. Compared with the

other study, our patients seemed to have initial worse outcomes. Because of special

environment and social factors, classic heat stroke may occur occasion ally in

subtropic regions, without previous history of heat waves and where heat stroke

rarely occurs, during periods of the persistently high temperatures. Prevention of heat

stroke in an area with a low incidence includes early health organizations' issue of

advisories or warnings through the media and reminding at teaching emergency

physicians about heat stroke during sustained hot weather, especially when record

temperatures are set

Keywords: CHICAGO/classic heat stroke/CO/emergency department/heat stroke/heat

wave/HEATSTROKE/hypertension/hyperthermia/incidence/stroke/subtropics/Taiwa

n/temperature/WAVE

Meng, N.H., Wang, T.G. and Lien, I.N. (2000), Dysphagia in patients with brainstem

stroke - Incidence and outcome. American Journal of Physical Medicine &

Rehabilitation, 79 (2), 170-175.

Abstract: Objective: This study was conducted to delineate the incidence and outcome

of dysphagia among hospitalized patients who were referred for rehabilitation

because of brainstem stroke. Design: We retrospectively reviewed the medical

records of 36 patients who were admitted because of brainstem stroke. Information

on the patients' clinical features, feeding status, and the results of clinical and

videofluoroscopic swallowing examinations were obtained through chart review,

Follow-up interviews were conducted via telephone to learn the general medical

condition and feeding status of the patients 7-43 mo after hospital discharge. Results:

A total of 81% of the patients had dysphagia at the time of initial clinical swallowing

evaluation, which was performed 10-75 days after the onset of stroke. A total of 79%

of the dysphagic individuals depended on tube feeding at the initial evaluation; 22%

of all individuals could not resume oral intake at discharge. Statistical analyses

revealed a significant association between poor outcome and disease involving the

medulla, the presence of a wet voice during the initial swallowing test, and a delay or

absence of the swallowing reflex. The incidence of aspiration pneumonia was 11%.

There was a correlation between the detection of aspiration by modified barium meal

videofluoroscopy and the development of aspiration pneumonia. Follow-up

interviews showed that 88% of the 27 patients who were contacted had resumed full

oral intake 4 mo after the onset of stroke. Conclusions: The incidence of dysphagia

was relatively high in our study population. The long-term outcome was favorable

Keywords: ASPIRATION FOLLOWING STROKE/association/brainstem/brainstem

stroke/DISORDERS/dysphagia/incidence/outcome/rehabilitation/STEM

STROKE/stroke/Taiwan

Wang, R.Y., Chan, R.C. and Tsai, M.W. (2000), Functional electrical stimulation on

chronic and acute hemiplegic shoulder subluxation. American Journal of Physical

Medicine & Rehabilitation, 79 (4), 385-390.

Abstract: Objective: The present study investigated and assessed the effectiveness of a

functional electrical stimulation (FES) program in the management of acute and

chronic shoulder subluxation. Design: By their postonset duration, hemiplegic

subjects with subluxation participating in the study were placed into a short-duration

group and a long-duration group. Subjects in each group were further assigned

randomly to either a control subgroup or an experimental subgroup. The

experimental subgroups of both short and long duration received FES therapy in

which supraspinatus and posterior deltoid were induced to contract repetitively up to

6 hr/day for 6 wk. The duration of the FES session and muscle contraction/relaxation

ratio were progressively increased as performance improved. Results: The

experimental subgroup of short duration showed significant improvements in

reducing subluxation as indicated by x-ray compared with the control subgroup of

short duration after the first FES treatment. The same effect was not shown for the

experimental subgroup of long duration. The second FES treatment program only

resulted in an insignificant change of shoulder subluxation for both the short- and

long-duration subgroups. Conclusions: The present study suggests that hemiplegic

subjects with short postonset duration are effectively trained for shoulder subluxation

by the first FES treatment program. The same FES showed not to be effective when

applied to the subjects with subluxation of >1 yr

Keywords: electrical stimulation/functional electrical

stimulation/hemiplegia/PAIN/postonset duration/STROKE/subluxation/Taiwan

Chen-Sea, M.J. (2000), Validating the Draw-A-Man Test as a personal neglect test.

American Journal of Occupational Therapy, 54 (4), 391-397.

Abstract: Objectives. The purpose of this study was to determine the reliability and

validity of a Draw-A-Man Test in measuring personal neglect in patients with right

brain stroke. Method. Draw-A-Man Test was administered to 51 persons with right

cerebrovascular accident (CVA) and 110 age-matched persons without brain insult.

A categorical classification was developed based on the man drawn in the test.

Participants who showed homogeneous bilateral representation of body parts were

considered to not have personal neglect, whereas those who showed unilateral body

parts were considered to have personal neglect. The completed tests were used to

blindly categorize the persons with and without personal neglect according to the

above definition by two raters for calculating interrater reliability The Klein-Bell

ADL (Activities of Daily Living) Scale was also administered to the participants

with right CVA to validate the Draw-A-Man Test. Results. This dichotomy - bilateral

representation versus unilateral representation- showed a high percentage of

agreement between two raters. Rater A classified all 110 " normal" participants as

being without personal neglect and classified 13 of the 51 participants with stroke as

having personal neglect. Participants demonstrating personal neglect showed

significantly poorer ADL performance than did those without personal neglect ADL

performance was also found to be significantly related to somatosensation, motor

status of the impaired limbs, and muscle strength of the sound limbs. However, even

after controlling the effect of these variables by partial correlation, personal neglect

was still highly related to ADL performance. Conclusion. The Draw- A-Man Test is

a reliable and valid tool for discriminating clients with personal neglect from those

without

Keywords: activities of daily living/ADL/brain/cerebrovascular

accident/cerebrovascular

disorders/CVA/INTELLIGENCE/neglect/OCCUPATIONAL

THERAPY/OCCUPATIONAL-THERAPY/personal neglect/reliability/reliability

and validity/SPACE/SPATIAL NEGLECT/strength/stroke/STROKE

PATIENTS/Taiwan/THERAPY/validity/VISUAL NEGLECT

Tsai, D.H., Jiang, Y.D., Wu, K.D., Tai, T.Y. and Chuang, L.M. (2001), Platelet collagen

receptor alpha 2 beta 1 integrin and glycoprotein IIIa pl(A1/A2) polymorphisms are

not associated with nephropathy in Type 2 diabetes. American Journal of Kidney

Diseases, 38 (6), 1185-1190.

Abstract: Platelet glycoprotein receptors play a role in the pathogenesis of chronic

diabetic complications. Genetic polymorphisms of the alpha2 beta1 integrin and

glycoprotein IIIa (GPIIIa) have been associated with myocardial infarction, stroke,

and diabetic retinopathy. To identify risk factors for their development in a cohort of

patients with type 2 diabetes, we evaluated clinical variables and genetic

polymorphisms in the alpha2 beta1 integrin and GPIIIa genes. Two hundred

thirty-four subjects with type 2 diabetes (126 patients with and 108 patients without

diabetic nephropathy), as well as 217 nondiabetic healthy subjects, were recruited for

this study. Clinical factors for investigation included sex, age at diagnosis, duration

of diabetes, body mass index (BMI), and fasting plasma glucose, hemoglobin A(1c)

(HbA(1c)), total cholesterol, and triglyceride levels. Genotypes were determined by

polymerase chain reaction and restriction fragment length polymorphism analyses.

No difference in the BgI II polymorphism of the alpha2 beta1 integrin gene was

found between patients with type 2 diabetes with or without nephropathy (11 [8.7%],

47 [37.3%], and 68 patients [54.0%] versus 10 [9.3%], 32 [29.6%], and 66 patients

[61.1%] for BgI II+/+, BgI II+/-, and BgI II-/- , respectively; P = 0.271). Multiple

logistic regression analyses showed that duration of diabetes, BMI, hypertension, and

poor glycemic control were four independent predictors for the development of

diabetic nephropathy. No contribution of the BgI II+ allele of the alpha2 beta1

integrin was found for the risk for nephropathy (odds ratio, 1.258; 95% confidence

interval, 0.655 to 2.418; P = 0.490). The pI(A2) allele genotype was not found

among our studied subjects. In conclusion, age, duration of diabetes, BMI, and

HbA(1c) level are strong predictors for nephropathy in patients with type 2 diabetes.

However, the BgI II polymorphism of the alpha2 beta1 integrin gene and the Apa I

polymorphism of the platelet GPIIIa gene do not have a major role in the

development of diabetic nephropathy in our population. (C) 2001 by the National

Kidney Foundation, Inc

Keywords: ADHESION/age/alpha 2 beta 1

integrin/cholesterol/CO/COMPLICATIONS/diabetic

nephropathy/genes/genetic/genotype/glucose/glycoprotein IIIa (GPIIIa)

pl(A1/A2)/hypertension/infarction/KIDNEY/MECHANISMS/MELLITUS/MICRO

ALBUMINURIA/MYOCARDIAL-INFARCTION/pathogenesis/PL(A)

POLYMORPHISM/plasma/polymerase chain

reaction/predictors/PROGRESSION/RENAL-FAILURE/restriction fragment length

polymorphism/RISK/risk factors/stroke/Taiwan/triglyceride/type 2 diabetes mellitus

Trombly, C.A. and Ma, H. (2002), A synthesis of the effects of occupational therapy for

persons with stroke, part 1: Restoration of roles, tasks, and activities. American

Journal of Occupational Therapy, 56 (3), 250-259.

Abstract: This article synthesizes research findings regarding the effects of occupational

therapy on the restoration of role, task, and activity performance for persons who

have had a stroke, with the purpose of guiding practice and research. It is the first of

a two-part review of studies. Part II synthesizes research findings regarding the

effects of occupational therapy on remediating impairments, Part I includes 15

studies involving 895 participants (mean age = 70.3 years), Of these studies, 11 (7

randomized controlled trials) found that role participation and instrumental and basic

activities of daily living performance Improved significantly more with training than

with the control conditions. We conclude that occupational therapy effectively

improves participation and activity after stroke and recommend that therapists use

structured instruction in specific, client- identified activities, appropriate adaptations

to enable performance, practice within a familiar context, and feedback to improve

client performance. Empirical research to verify these findings and to characterize

the key therapeutic mechanisms associated with desired outcomes is needed

Keywords: activities of daily living/age/evidence-based

practice/meta-analysis/OCCUPATIONAL

THERAPY/OCCUPATIONAL-THERAPY/PERCEPTUAL

PROBLEMS/RANDOMIZED CONTROLLED

TRIAL/REHABILITATION/stroke/Taiwan/task-specific training/THERAPY

Wang, R.Y., Yang, Y.R., Tsai, M.W., Wang, W.T.J. and Chan, R.C. (2002), Effects of

functional electric stimulation on upper limb motor function and shoulder range of

motion in hemiplegic patients. American Journal of Physical Medicine &

Rehabilitation, 81 (4), 283-290.

Abstract: Objectives: The present study examines functional electric stimulation (FES)

applied on patients with hemiplegia of short and long duration for the purpose of

upper limb motor recovery and increasing shoulder range of motion. Design: Patients

with hemiplegia with subluxation participating in the study were placed into a

short-duration group or a long-duration group. Subjects in each group were then

randomly assigned to either the control or the experimental subgroup. The

experimental groups of both short- and long-duration groups received FES therapy in

which the supraspinatus and posterior deltoid muscles were induced to contract

repetitively up to 6 hr a day for 6 wk. Duration of FES session and muscle

contraction/relaxation ratio were progressively increased as performance improved.

The experimental groups also received a second 6-wk FES therapy 6 wk after

completing the first FES therapy. Results: After the first 6-wk FES therapy, the

experimental group of short-duration hemiplegia showed significant improvements

in motor recovery as indicated by Fugl-Meyer scores compared with the control

group. Such significant improvement did not occur for the experimental group of

long-duration hemiplegia. The changes in the second FES treatment program were

insignificant. Conclusions: This study suggests that patients with hemiplegia of short

duration are effectively trained by FES for motor recovery

Keywords: ARM FUNCTION/electric stimulation/FUGL-MEYER

ASSESSMENT/functional electric stimulation/hemiplegia/motor

function/muscles/NEUROMUSCULAR STIMULATION/PAIN/postonset

duration/RECOVERY/shoulder range of motion/STROKE/SUBLUXATION/Taiwan

Wang, H.C., Hsieh, L.F., Chi, W.C. and Lou, S.M. (2002), Effect of intramuscular

botulinum toxin injection on upper limb spasticity in stroke patients. American

Journal of Physical Medicine & Rehabilitation, 81 (4), 272-278.

Abstract: Objective: To evaluate the therapeutic effect of intramuscular injection of

botulinum toxin on spasticity of the upper limb, with emphasis on its influence over

limb function. Design: An open-label, noncontrolled trial with a duration of 12 wk

was designed to determine the safety and efficacy of intramuscular botulinum toxin

A injection in the treatment of 16 patients with stroke with spastic hemiparesis.

Electromyographically guided intramuscular botulinum toxin A injections were

applied to the spastic limbs. A detailed scale system was used for the evaluation of

muscle tone and functional changes induced by botulinum toxin A treatment. Results:

No major side effect secondary to botulinum toxin A injection was reported.

Statistically significant (P 300 mg/dl, were produced in each group.

Ischemia was induced by unilateral carotid ligation and hemorrhagic hypotension to

30 mmHg for 30 min. Plasma norepinephrine and epinephrine were measured by

radioimmunoassay. Neurologic outcome was evaluated daily for 3 days after

ischemia. Results: Ganglionic blockade decreased blood pressure before the start of

ischemia and plasma epinephrine and norepinephrine during ischemia (P 500 degrees

C). Nevertheless, the CO conversion on Pd/Al2O3 can be significantly promoted by

the addition of CeO2 and K2O. When water participates in the reaction, the CO

conversions on the promoted Pd/Al2O3 catalysts can be further increased. The

promotional extent of CO conversion on the Pd catalysts is in the order:

Pd-K2O-CeO2/Al2O3 > Pd-K2O/Al2O3 > Pd-CeO2/Al2O3 > Pd/Al2O3. Moreover,

Pd-K2O-CeO2/Al2O3 exhibits the highest CO conversion among the Pd catalysts. In

addition, the test results of the monolithic catalysts also reveal that the CO

conversion on PdRh/K2O/Al2O3-CeO2 is quite close to that on PtRh/Al2O3-CeO2

under the simulative gases and the ECE-40 mode driving cycle test. However,

PdRh/K2O/Al2O3-CeO2 exhibits lower HC conversion due to the lower activity for

alkane oxidation. (C) 1998 Elsevier Science B.V. All rights reserved

Keywords: 3-WAY CATALYSTS/additive/ALUMINA/CATALYTIC

COMBUSTION/METAL-CATALYSTS/oxygen-deficient/palladium/Taiwan/two-str

oke motorcycle/WATER/water gas-shift

Lee, H.M., Sheu, C.C. and Chen, J.M. (1998), Handwritten Chinese character

recognition based on primitive and fuzzy features via the SEART neural net model.

Applied Intelligence, 8 (3), 269-285.

Abstract: A handwritten Chinese character recognition method based on primitive and

compound fuzzy features using the SEART neural network model is proposed. The

primitive features are extracted in local and global view. Since handwritten Chinese

characters vary a great deal, the fuzzy concept is used to extract the compound

features in structural view. We combine the two categories of features and use a fast

classifier, called the Supervised Extended ART (SEART) neural network model, to

recognize handwritten Chinese characters. The SEART classifier has excellent

performance, is fast, and has good generalization and exception handling abilities in

complex problems. Using the fuzzy set theory in feature extraction and the neural

network model as a classifier is helpful for reducing distortions, noise and variations.

In spite of the poor thinning, a 90.24% recognition rate on average for the 605 test

character categories was obtained. The database used is CCL/HCCR3 (provided by

CCL, ITRI, Taiwan). The experiment not only confirms the feasibility of the

proposed system, but also suggests that applying the fuzzy set theory and neural

networks to recognition of handwritten Chinese characters is an efficient and

promising approach

Keywords: ART/character recognition/Chinese/Chinese character recognition/fuzzy

compound features/fuzzy set theory/handwritten Chinese character/handwritten

Chinese character recognition/handwritten Chinese characters

recognition/NETWORK/neural network model/PATTERNS/primitive

features/STROKE EXTRACTION METHOD/Taiwan/thinning

Fang, W., Huang, C.C., Lee, C.C., Cheng, S.Y., Pang, C.Y. and Wei, Y.H. (1993),

Ophthalmologic Manifestations in Melas Syndrome. Archives of Neurology, 50 (9),

977-980.

Abstract: We describe a 1 5-year-old boy with full-blown mitochondrial myopathy,

encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) and chronic

progressive external ophthalmoplegia (CPEO). He presented with visual disturbance,

hearing impairment, continuous partial epilepsy on the right aspect of the face, and

right hemiparesis since the age of 13. Four months later, he experienced another

strokelike episode with continuous partial epilepsy on the left hand. Serial computed

tomographic scans revealed bilateral parieto-occipital hypodense lesions with gyral

enhancement and an additional low- density lesion in the right frontal area 4 months

later, respectively. Results of laboratory examinations disclosed lactic acidosis and

mitochondrial myopathy with many ragged-red fibers. To identify the defective gene

in mitochondrial DNA, a simple molecular test was performed by using restriction

endonuclease Apa 1. A transition from A to G was found at nucleotide position 3243

of the tRNA(Leu) gene. Interestingly, the patient also had marked external

ophthalmoplegia and ptosis commonly found in patients with CPEO. Therefore, we

suggest that ophthalmoplegia also occurs in the MELAS syndrome

Keywords: ARCH/chronic progressive external

ophthalmoplegia/CPEO/DNA/ENCEPHALOMYOPATHY/ENCEPHALOPATHY/

KEARNS-SAYRE SYNDROME/LACTIC-ACIDOSIS/MELAS/mitochondrial

DNA/MITOCHONDRIAL MYOPATHY/MYOCLONUS

EPILEPSY/OPHTHALMOPLEGIA/PERIPHERAL

NEUROPATHY/STROKE-LIKE EPISODES

Merikangas, K.R., Fenton, B.T., Cheng, S.H., Stolar, M.J. and Risch, N. (1997),

Association between migraine and stroke in a large-scale epidemiological study of

the United States. Archives of Neurology, 54 (4), 362-368.

Abstract: Objective: To examine the association between stroke and migraine in an

epidemiological study. Data Sources and Design: The National Health and Nutrition

Examination Survey baseline and first follow-up data were used to investigate cross-

sectional and longitudinal associations between headache/migraine and stroke.

Setting: Study participants from a national probability sample of the civilian

noninstitutionalized population of the United States. Main Outcome Measure:

Self-reported physician diagnosis of stroke. Results: After controlling for established

risk factors for stroke (hypertension, diabetes, heart disease, and gender), both

migraine and severe nonspecific headache were associated with a significantly

increased risk for stroke reported at follow-up. The risk for stroke associated with

migraine decreased as the age at stroke increased. Conclusions: Our results

strengthen previous evidence regarding a nonrandom association of both headache

and migraine with stroke, particularly among young women. To our knowledge, this

is the first systematic examination in a large-scale prospective epidemiological study

of men and women with sufficient statistical power to test the association between

migraine and stroke in women. Severe headache and migraine should be considered

as risk factors for the development of stroke, particularly in the absence of other

well-established stroke risk factors. Further investigation is required to identify the

putative mechanisms underlying comorbidity of migraine and stroke

Keywords: ANTIPHOSPHOLIPID ANTIBODIES/ATTACKS/CEREBRAL

BLOOD-FLOW/CLASSIFICATION/FOLLOW-UP/HEADACHE/hypertension/ISC

HEMIC STROKE/MINNESOTA/MORTALITY/risk

factors/RISK-FACTORS/stroke

Hsu, C.J., Chang, W.N. and Wong, C.Y. (2001), Surgical treatment of tibial plateau

fracture in elderly patients. Archives of Orthopaedic and Trauma Surgery, 121 (1-2),

67-70.

Abstract: This retrospective study involves 22 patients with displaced tibial plateau

fractures who were treated surgically from July 1993 to April 1996. All the patients

were over 60 years old (mean 66.3 years old, range 61-80 years). All of the patients

were treated by open reduction and internal fixation with AO/ASIF buttress plates

(Synthes, Bochum, Switzerland). Additional small fragment plate or inter-fragmental

screws were used in some of them as indicated. Two patients died during follow-up

of causes unrelated to the fractures. The average followup time was 49.8 months

(range 36-68 months). The other 20 patients were interviewed at the outpatient clinic,

and radiographs of bilateral standing knees were taken. By comparison with the

uninjured side on radiographs, condylar joint space depression was noted in 6

patients. However, joint depression greater than 4 mm was not found. Malalignment

with varus or valgus greater than 5 deg was not demonstrated in any case. Their

range of motion was restored in all patients, with more than 120 deg of flexion and

without extension lag except for the one who suffered a superficial wound infection.

No complication required further surgical management. During the period of

follow-up, no accelerated degenerative change in the operated knee joint resulted in

total knee arthroplasty, Two patients needed occasional medical treatment for

residual knee joint pain. Only two patients needed canes for assistance during

walking due to old age and minor stroke. The results justify surgical treatment for

displaced tibial plateau fractures in elderly patients

Keywords: age/ARCH/canes/depression/elderly/infection/retrospective

study/stroke/Taiwan

Sea, M.J.C., Henderson, A. and Cermak, S.A. (1993), Patterns of Visual Spatial

Inattention and Their Functional- Significance in Stroke Patients. Archives of

Physical Medicine and Rehabilitation, 74 (4), 355-360

Keywords: ACTIVITIES OF DAILY LIVING/ARCH/CEREBROVASCULAR

DISORDERS/NEGLECT/NEUROPSYCHOLOGICAL TESTS/OCCUPATIONAL

THERAPY/PERCEPTUAL DISORDERS

Cheng, P.T., Liaw, M.Y., Wong, M.K., Tang, F.T., Lee, M.Y. and Lin, P.S. (1998), The

sit-to-stand movement in stroke patients and its correlation with falling. Archives of

Physical Medicine and Rehabilitation, 79 (9), 1043-1046.

Abstract: Objective: To use kinetic assessment of the sit-to-stand movement as a means

of sorting out those stroke patients at risk for falling. Design: A retrospective study,

using a force platform to assess sit-to-stand performance and to determine its

correlation with falls in stroke patients. Setting: Hospital-based rehabilitation units.

Methods: Thirty-three stroke patients (18 fallers, 15 nonfallers) and 25 age-matched

healthy subjects were included in this study. Subjects sat in an adjustable chair with

their feet on two force plates and performed the standing up/sitting down move ment

at a self- paced, comfortable speed. Results: The rate of rise in force (dF/dT) was

significantly lower in stroke fallers than in stroke nonfallers and healthy subjects

(23.78 +/- 17.38, 55.23 +/- 31.24, and 85.96 +/- 42.4 percent body weight per second,

respectively [p .80), walking ability (r > .39), and some PSRs (r 0.05), respectively. The oral volumes of distribution after

equilibrium were 3.26 +/- 0.74 and 3.13 +/- 0.75 L/kg, and oral clearances were 28.6

+/- 7.0 and 21.9 +/- 4.1 ml/min/kg for (+)- and (-)-pimobendan (p > 0.05),

respectively. In red blood cells, the respective (+)- and (-)-pimobendan

concentrations were 5.8 and 8.4 times higher than those in plasma, indicating a

stereoselective partitioning of drugs between plasma and red blood cells. The

pharmacodynamic effect of pimobendan was evaluated by echocardiography. The

ejection fraction, mean velocity of circumferential fiber shortening, aortic flow peak

velocity, cardiac index, and stroke volume index significantly increased 50% to 60%.

The left ventricular end-systolic dimension, systolic blood pressure, and diastolic

blood pressure significantly decreased 8% to 11%. These effects lasted for more than

8 hours. In a 2-week repeated-dose study, there was no significant dose accumulation

in plasma and red blood cells. The pharmacokinetic parameters were similar to those

in the single-dose study, except for significantly shorter absorption half-lives. The

baseline levels of cardiac index and stroke volume index were significantly higher

than the baseline levels in the single-dose study. This suggests an accumulation of

pharmacodynamic effects despite a relatively short elimination half-life

Keywords: blood pressure/CARDIOVASCULAR PROFILE/DOUBLE-BLIND/DRUG

ENANTIOMERS/ejection fraction/HEMODYNAMICS/INOTROPIC

AGENTS/JUN/MULTICENTER/MYOCARDIAL

ENERGETICS/plasma/STEREOSELECTIVE DISPOSITION/stroke/stroke

volume/TERM/UD-CG 115-BS

Hsueh, I.P., Lee, M.M. and Hsieh, C.L. (2002), The Action Research Arm Test: is it

necessary for patients being tested to sit at a standardized table? Clinical

Rehabilitation, 16 (4), 382-388.

Abstract: Objective: To validate results obtained from using the Action Research Arm

Test (ARAT) at tables of a common height for persons who have experienced a

stroke. Design: Each subject was tested three times with the ARAT while sitting at

three different tables: a table specially designed for the test and two generally

available tables similar in height to the standard table. The patients were randomly

and equally assigned to three different raters and to three different tables in

accordance with a counterbalanced design, All evaluations were completed within a

two-day period. Subjects: Sixty-one patients who had had only one stroke (mean age

63.3 years; median time since stroke onset 81 days; mean ARAT score administered

at the standard table 33.8) participated in this study. Results: The intraclass

correlation coefficient (ICC) for the total scores obtained using the ARAT at the

different tables was 0.99, indicating very high agreement. The ICCs were also very

high in each of the subscales. Conclusion: The results of this study support the use of

the ARAT at ordinary tables roughly similar in height to that specially designed for

use with the ARAT

Keywords: age/INTERRATER RELIABILITY/JUN/SINGLE-BLIND/stroke/STROKE

PATIENTS/Taiwan/TRIAL/UPPER EXTREMITY

Hsueh, I.P. and Hsieh, C.L. (2002), Responsiveness of two upper extremity function

instruments for stroke inpatients receiving rehabilitation. Clinical Rehabilitation, 16

(6), 617-624.

Abstract: Objective: To compare the responsiveness of the Action Research Arm test

(ARAT) and the upper extremity section of the Motor Assessment Scale (UE-MAS)

in assessing the recovery of upper extremity function in stroke inpatients receiving

rehabilitation. Subjects: Forty-eight stroke inpatients. Setting: The physical medicine

and rehabilitation department of a medical centre. Design: The patients were tested at

admission and at discharge from the department. Methods: Various indices,

including effect size d, Wilcoxon test and Spearman's rho, were used to assess

responsiveness. The change in score of the upper extremity subscale of the

Fugl-Meyer scale was used as the external criterion. Results: The responsiveness

indices of both total scores of the ARAT and UE-MAS are generally moderate and

similar (d = 0.52, Wilcoxon Z = 5.03, p 1000 IU/l

and (2) the absence of acute myocardial infarction, stroke and end-stage renal disease.

On admission, those who presented with RM had significantly higher concentration

of blood urine nitrogen (BUN) (83.3 +/- 5.9 vs. 58.8 +/- 2.4 mg/dl, P 90% of the A3243G mutant mtDNA were found to have

significantly lower oxygen consumption rate and electron transfer activities, and

thereby had lower ATP/ADP ratios and declined energy charge. Importantly, the

defective respiratory function elicited by the A3243G mtDNA mutation caused an

increased oxidative stress as indicated by the decreased GSH/GSSG ratio and

enhanced oxidative damage to lipids. Moreover, the cybrids harboring high

proportions of the A3243G mtDNA mutation were found to be much more

vulnerable to an exogenous oxidant, tert- butylhydroperoxide. We thus suggest that

enhanced oxidative damage and elevated oxidative stress contribute to the decline of

mitochondrial function and may be involved in the initiation and progression of the

MELAS syndrome and mitochondrial diabetes. (C) 2001 Elsevier Science Ireland

Ltd. All rights reserved

Keywords: beta cells/CO/COENZYME Q(10)/COMPLICATIONS/diabetes

mellitus/DNA/GENE/glucose/LACTIC-ACIDOSIS/MELAS/MELAS

syndrome/MELLITUS/mitochondrial DNA/mitochondrial DNA

mutation/MTDNA/mutation/oxidative

stress/pathogenesis/PROTEIN-SYNTHESIS/RESPIRATION/stress/STROKE-LIKE

EPISODES/Taiwan

Chuang, L.M., Tsai, S.T., Huang, B.Y. and Tai, T.Y. (2001), The current state of

diabetes management in Taiwan. Diabetes Research and Clinical Practice, 54

S55-S65.

Abstract: The aim of this study was to provide an overview of diabetes management and

complication status in Taiwan. A cohort of 2446 patients (from 25 diabetic centers)

with more than 12 months of diabetes management participated and data were

collected by interviews and reviewing the medical records. Overall, 97% were

diagnosed as type 2 diabetes, with a mean age (+/-S.D.) of 61.6 +/- 11.3 years,

duration of diabetes of 10.3 +/- 7.3 years and age at onset of diabetes of 51.5 +/- 11.8

years. Mean BMI was 25.1 +/- 3.6 kg/m(2) and about 50% had BMI > 25 kg/m(2).

Majority (75%) were treated with oral hypoglycemic agents (OHAs), 14% with

insulin and 10% with combination of insulin and OHA. Mean HbA(1c) was 8.1 +/-

1.6% and 59% had HbA(1c) > 7.4% (1% above the upper limit of normal range,

4.7-6.4%). Mean FBG was 9.0 +/- 3.3 mmol/l and 59% had FBG > 7.8 mmol/l. Of

all the patients who had screening for complications, cataract (38%), neuropathy

(30%), proteinuria. (17%) and stroke (6%) were the most frequently reported eye,

feet, kidney and late complications. We conclude that the majority of patients

involved in this study had unsatisfactory glycaemic control which may lead to

diabetes complications. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved

Keywords: age/CO/COMPLICATIONS/diabetes mellitus/diabetic

complications/DISEASE/glycaemic/metabolic

control/kidney/MELLITUS/MORTALITY/NEUROPATHY/NIDDM/PREVALENC

E/PROGRESSION/RETINOPATHY/RISK-FACTORS/stroke/Taiwan

Hsueh, I.P., Huang, S.L., Chen, M.H., Jush, S.D. and Hsieh, C.L. (2000), Evaluation of

stroke patients with the extended activities of daily living scale in Taiwan. Disability

and Rehabilitation, 22 (11), 495-500.

Abstract: Purpose: This study examined the construct validity of the Nottingham

Extended Activities of Daily Living scale (EADL) in stroke patients in Taiwan.

Methods: The EADL and the Barthel Index were administered via telephone

interview. Minor revisions were made for the EADL to reflect cultural differences

and the recommendations of two previous studies on the use of EADL. One hundred

and fifty three stroke patients from the community participated in the study. Results:

Two items, 'make hot snack' and 'write letters', were deleted from the EADL because

they appeared to be of little discriminative value. The results suggest that a changed

hierarchical order was present among the domestic and leisure subscales. All of the

subscales, then, fulfilled the Guttman scaling criteria (coefficient of reproducibility

>0.9, coefficient of scalability >0.6). The scores of the revised EADL were

significantly related to age and the Barthel Index scores (Spearman correlation

coefficients = 0.41 and 0.69, respectively, p Pt- Na2O/Al2O3 > Pt-CeO2/ Al2O3 > Pt/Al2O3. The promoted

Pt/Al2O3 catalysts are much more active than the unpromoted one for CO and C3H6

oxidation under the stoichiometric point. Under oxygen-deficient conditions and in

the absence of water, C3H6 conversions on all catalysts studied herein increase with

increasing reaction temperature. Nevertheless, this phenomenon contrasts with CO

conversion once oxygen is completely reacted. Pt/Al2O3 exhibits the highest C3H6

conversion and the lowest CO conversion among these catalysts, and the addition of

CeO2, Na2O, and K2O on Pt/Al2O3 can promote the CO conversion. Under

oxygen-deficient conditions and in the presence of water, the water-gas shift and

steam re-forming reactions can take place and result in increases of CO and C3H6

conversions. Pt/Al2O3 is the most active catalyst for the steam re-forming reaction

and the lowest active catalyst for the water-gas shift reaction among these catalysts.

Nevertheless, the addition of basic additives on Pt/Al2O3 catalyst can significantly

enhance the water-gas shift reaction that can reduce CO emission. The promotional

effect is in the order K2O > Na2O > CeO2, that is the same order as the basicity of

the promoted catalysts. Additionally, K2O could be a promising additive to a

catalytic converter of a two-stroke motorcycle since it can significantly enhance CO

conversion

Keywords: 3- WAY CATALYSTS/ACID/additive/ALUMINA/CATALYTIC

COMBUSTION/CERIA/GAS SHIFT

REACTION/HYDROCARBONS/METAL-CATALYSTS/motorcycle/oxygen-defici

ent/STEAM/STORAGE

Lee, C.H. and Chen, Y.W. (1997), Effect of support on a catalytic converter for

removing CO and HC emissions from a two-stroke motorcycle. Industrial &

Engineering Chemistry Research, 36 (12), 5160-5169.

Abstract: The effect of support on the noble metal catalysts for carbon monoxide and

hydrocarbon oxidation was investigated. The reactions were performed under the

stoichiometric and oxygen- deficient conditions. Under the stoichiometric point, the

activities of the powder catalysts for CO and C3H6 oxidation are in the order

Pt/K2O/Al2O3 > Pt/Al2O3 > Pt/Al2O3-SiO2, that is, the same as the order of

basicity of these catalysts. Under an oxygen-deficient condition, Pt supported on an

acidic support, Al2O3-SiO2, exhibits the higher C3H6 conversion and the higher

activity for the steam re-forming reaction. Ln contrast, Pt supported on a basic

support, K2O/Al2O3, exhibits the higher CO conversion and the higher activity for

the water- gas shift reaction, The order of activity of the powder catalysts for the

water-gas shift reaction is the same as the order of basicity of these catalysts. On the

other hand, the testing results of the monolithic PtRh-containing catalysts by the

simulative gases and the ECE-40 mode driving cycle also reveal the same trend as

that of the Pt powder catalysts. Furthermore, the addition of K2O on

PtRh/Al2O3-CeO2 not only increases the basicity of the catalyst but also

significantly reduces the CO emission under the ECE-40 mode driving cycle test.

Therefore, K2O could be a promising additive to a catalytic converter of a two-stroke

motorcycle since it can significantly enhance CO conversion

Keywords: 3-WAY CATALYSTS/additive/CERIA/driving

cycle/EXHAUST/motorcycle/NOBLE-METAL

CATALYSTS/OXIDATION/OXYGEN STORAGE

Lee, C.H. and Chen, Y.W. (1998), Effect of K2O on a Pd-containing catalytic converter

for removing CO and HC emissions from a two-stroke motorcycle. Industrial &

Engineering Chemistry Research, 37 (4), 1260-1266.

Abstract: Noble metals (Pt, Pd, and Ph) supported on Al2O3, K2O/Al2O3,

CeO2/Al2O3, and K2O/CeO2/Al2O3 were prepared and characterized with respect

to surface area, pore volume, and temperature- programmed desorption of CO2. The

effects of K2O on the noble- metal catalysts for carbon monoxide and hydrocarbon

oxidation were investigated. The reactions were carried out under the stoichiometric

and oxygen-deficient conditions. Under the stoichiometric point, the Pd-containing

catalysts exhibit higher activity than the Pt-containing catalysts for both CO and

C3H6 oxidation. Moreover, Pd/K2O/CeO2/Al2O3 is the most active catalyst among

the powder catalysts in this study. Under the oxygen-deficient conditions and in the

presence of water, the CO conversions on Pd/Al2O3 and Pd/CeO2/Al2O3 are

significantly lower than those on Pt/Al2O3 and Pt/CeO2/Al2O3, respectively. In

contrast, the Pd-containing catalysts exhibit higher C3H6 conversion than the

Pt-containing catalysts. However, the CO conversions on the Pd-containing catalysts

can be promoted by the addition of K2O. On the other hand, the test results of the

monolithic catalysts revealed that the CO conversion on PdRh/K2O/Al2O3-CeO2 is

quite close to that on PtRh/Al2O3-CeO2 under the simulative gases and the ECE-40

mode driving cycle test. PtRh/Al2O3-CeO2 is the typical composition of catalytic

converters for two-stroke motorcycles. It infers that PdRh/K2O/Al2O3-CeO2 is a

promising catalytic converter for a two-stroke motorcycle

Keywords: EXHAUST/Taiwan

Chen, S.C., Chen, Y.C., Cheng, N.T. and Huang, M.S. (1998), Simulation of

injection-compression mold-filling process. International Communications in Heat

and Mass Transfer, 25 (7), 907-917.

Abstract: A numerical algorithm is developed to simulate the filling stage of

injection-compression molding (ICM) process. Hele-Shaw fluid flow model

combined with the control-volume/finite- element (CV/FEM) method is

implemented to predict the melt front advancement and the distributions of pressure,

temperature and flow velocity dynamically during the melt- filling process.

processing characteristics were understood by changing processing parameters

including compression speed, switch time from injection to compression,

compression stroke as well as initial cavity thickness using disk parts. The simulated

molding pressures were also compared with those required by conventional injection

molding (CIM) assuming the same entrance flow rate. It was found that the

compression speed and compression stroke are the two factors affecting the molding

pressure most significantly. Switch time also shows apparent effect on the pressure

profiles. Using higher switch time, lower compression speed and higher compression

stroke will result in lower cavity pressures. The melt velocity far from the gate was

found to be higher than that near the gate during the compression stage contrary to

that of CIM resulting in different par? residual stress and melt temperature

distribution. The simulated pressures for both ICM and CIM show good coincidence

with those obtained from cavity pressure measurements. (C) 1998 Elsevier Science

Ltd

Keywords: conventional injection molding/FLOW/molding

pressure/PARTS/process/stress/stroke/Taiwan/THIN

Chang, K.K., Chow, L.P. and Rider, R.V. (1986), Oral-Contraceptives and Stroke - A

Preliminary-Report on An Epidemiologic-Study in Taiwan, China. International

Journal of Gynecology & Obstetrics, 24 (6), 421-430

Keywords: China/Taiwan

Huang, Y.M. and Liu, C.H. (1994), The Effects of Strain-Rate and Anisotropy Upon the

Sheet- Stretching Process. International Journal of Mechanical Sciences, 36 (2),

105-&.

Abstract: A rate-dependent elasto-plastic finite element formulation has been developed

for the large-deformation sheet-stretching process. The formulation used was based

on the power-form constitutive equation applied for the stress-strain-strain rate

relation of the material and Hill's anisotropic yield criterion in the plastic range. A

principle of virtual work rate applied towards a Lagrangian reference system was

adopted. The resulting nonlinear equilibrium equations have been solved through

usage of an incremental method with the R(min) technique. Additionally, the

location of fracture initiation in the material and the total punch stroke were

predicted by the strain energy density criterion. Experimental tests were performed

and have exhibited good agreement with numerical simulations. The method

proposed here has been proven to be capable of evaluating the effects of various

parameters on metal flow and could be modified for solving problems related to

other manufacturing processes

Keywords: process/sheet stretching process/stroke/TAIWAN

Yeh, E.C. and Tsao, Y.J. (1994), A Fuzzy Preview Control Scheme of Active

Suspension for Rough Road. International Journal of Vehicle Design, 15 (1-2),

166-180.

Abstract: A new control algorithm of active suspension is proposed for rough roads. In

this study, a quarter car model is used. The large tyre deflection and the stroke limit

of the actuator are taken into consideration. A virtual damper concept is proposed to

attenuate the tyre deflection by feeding back the relative velocity between road and

unsprung mass to the force actuator. A fuzzy preview control scheme is presented to

generate a reference curve by sensing the road information ahead of the vehicle so

that the actuator can operate within the stroke limit even in the rough road. Computer

simulations are performed to verify the above concepts, and it is shown that

satisfactory performance can be achieved by the proposed control scheme

Keywords: ACTIVE SUSPENSION SYSTEM/FUZZY PREVIEW

CONTROL/stroke/VIRTUAL DAMPER

Chen, L.H. and Lee, Y.K. (1996), A new approach for recognizing multifont Chinese

characters used in a special application. International Journal of Pattern Recognition

and Artificial Intelligence, 10 (3), 203-222.

Abstract: Many approaches for recognizing all of the 5401 commonly used Chinese

characters have been proposed, but they are complex, For some applications such as

cheques, receipts, addresses, in Chinese, etc., only a limited set of printed characters

is needed, but they are usually require a real time response and a high recognition

rate. Based on this reason, here we provide a simpler approach to meet these two

requirements. The approach takes horizontal strokes, vertical ones and crossings

among these strokes as the character features. A fast modified Hough transform is

provided to extract these features, it satisfies an important stroke property that a

dotted line must not be a real stroke. In the learning stage, an error measure is

defined and an optimal stroke matching algorithm is proposed to establish an

accurate random model for each type of characters. In the recognition stage, another

error measure is defined and a nearly-optimal matching algorithm is presented to

speed up the recognition process. It is worth mentioning that the approach does not

use any thinning process. Some experimental results are also provided to show the

effectiveness of the proposed recognizer

Keywords: Chinese/crossing/error measure/horizontal stroke/modified Hough transform

random model/process/RECOGNITION/stroke/thinning/thinning process/vertical

stroke

Leu, D.K. (1996), Finite-element simulation of hole-flanging process of circular sheets

of anisotropic materials. International Journal of Mechanical Sciences, 38 (8-9),

917-&.

Abstract: A hole-flanging operation on a flat circular sheet with a hole in the center is

simulated by an incremental elasto-plastic finite-element method, which incorporates

strain-hardening and anisotropy in the direction normal to the sheet, with care taken

to describe the boundary conditions of penetration, separation and the alternation of

the sliding-sticking state of friction. The simulation clearly demonstrates the

processes of generation of deformation shape until;unloading, The calculated sheet

geometries and the relationship of punch load to punch stroke are in;good agreement

with the experimental data. The stress at the hole periphery in the flange is assumed

to a state of circumferential uniaxial tension, in order to simplify the fracture mode as

a simple tension test. By making use of the instability of uniaxial tension, an

approximate relationship to determine the onset of necking of the hole periphery in

the hole-hanging process is derived and it is found to be influenced by the process

geometry and the plastic properties of the material, such as the stress-concentration

factor K, strain-hardening n and normal anisotropy R, and the estimated value, being

obtained by the derived equation, agrees well with the experimental data. It is noted

that the derived relationship for estimating the instability of the hole-hanging process

can be combined into the developed finite-element model to simulate the critical

condition of the limiting deformation of the hole-hanging process. This combined

method could possibly be applied towards improving both the manufacturing process

and the design of tools for the hole-hanging operation. Copyright (C) 1996 Elsevier

Science Ltd

Keywords:

elasto-plastic/hole-flanging/instability/necking/process/sliding-sticking/stress/stroke

Cheng, R.H., Lee, C.W. and Chen, Z. (1996), Recognition of radicals in handwritten

Chinese characters by means of problem reduction and knowledge guidance.

International Journal of Pattern Recognition and Artificial Intelligence, 10 (6),

657-677.

Abstract: Recognizing handwritten Chinese characters is a complex problem. We break

the problem down into a series of sub- problems and concentrate on the radical

recognition problem. The sub-problems are linked in a hierarchy of three layers:

radical, radical sub-unit, and salient stroke. This problem reduction technique enables

us to solve complex recognition problems effectively. We describe how to analyze

and choose radical sub-units and salient strokes in order to recognize a set of radicals.

We also construct two knowledge bases in the form of decision trees to guide the

hypothesis and test procedures used to solve the recognition sub-problems. The

problem reduction is done in a top-down fashion, while the problem solving process

proceeds in a bottom-up fashion. The advantages of our method are described. The

representation and organization of the two knowledge bases are explicitly described.

The method is tested on two sets of handprinted characters using an TBM PC

(486-33). The recognition rate is over 95.7% and the computer time needed to

recognize a radical averages about 0.07 s. The experimental results indicate that our

method effectively copes with a wide range of ordinary variations encountered in

handwritten Chinese characters

Keywords: ALGORITHM/Chinese/decision tree/handwritten Chinese

character/hypothesis and test/knowledge base/problem

reduction/process/radical/radical sub-unit/salient stroke/stroke

Chen, J.W. and Lee, S.Y. (1997), On-line Chinese character recognition via a

representation of spatial relationships between strokes. International Journal of

Pattern Recognition and Artificial Intelligence, 11 (3), 329-357.

Abstract: Chinese characters are constructed by basic strokes based on structural rules.

In handwritten characters, the shapes of the strokes may vary to some extent, but the

spatial relations and geometric configurations of the strokes are usually maintained.

Therefore these spatial relations and configurations could be regarded as invariant

features and could be used in the recognition of handwritten Chinese characters. In

this paper, we investigate the structural knowledge in Chinese characters and propose

the stroke spatial relationship representation (SSRR) to describe Chinese characters.

An On-Line Chinese Character Recognition (OLCCR) method using the SSRR is

also presented. With SSRR, each character is processed and is represented by an

attribute graph. The process of character recognition is thereby transformed into a

graph matching problem. After careful analysis, the basic spatial relationship

between strokes can be characterized into five classes. A bitwise representation is

adopted in the design of the data structure to reduce storage requirements and to

speed up character matching. The strategy of hierarchical search in the

preclassification improves the recognition speed. Basically, the attribute graph model

is a generalized character representation that provides a useful and convenient

representation for newly added characters in an OLCCR system with automatic

learning capability. The significance of the structural approach of character

recognition using spatial relationships is analyzed and is proved by experiments.

Realistic testing is provided to show the effectiveness of the proposed method

Keywords: attribute graph/character recognition/Chinese/Chinese character/Chinese

character recognition/GRAPH/HANDWRITTEN CHARACTERS/hierarchical

search/maximum clique/ONLINE RECOGNITION/process/spatial relationship

between strokes/stroke/structural approach

Chen, G.Y., Tseng, C.D., Chiang, F.T., Hsu, K.L., Lo, H.M., Tseng, Y.Z. and Lin, F.Y.

(1997), Congenital mitral stenosis: Challenge of percutaneous transvenous mitral

commissurotomy. International Journal of Cardiology, 60 (1), 99-102.

Abstract: A 26-year-old woman with congenital mitral stenosis and embolic stroke was

referred to our hospital. The echocardiogram showed a hypoplastic posterior mitral

valve leaflet with short, unbalanced chordal attachments to the posteromedial

papillary muscle. The mitral valve area was 0.9 cm(2) by the pressure half-time

method. There was no left atrial thrombus and spontaneous echo contrast.

Percutaneous transvenous mitral commissurotomy was performed since the

suggestion of surgical management was refused by her family members. A rupture at

the chordae tendinae of the hypoplastic posterior papillary muscle developed during

the procedure and needed mitral replacement. We advise that percutaneous

transvenous mitral commissurotomy be avoided in adult patients with congenital

mitral stenosis having an asymmetric and hypoplastic mitral valve. (C) 1997 Elsevier

Science Ireland Ltd

Keywords: BALLOON ANGIOPLASTY/chordae tendinae rupture/congenital mitral

stenosis/hypoplastic mitral valve/percutaneous transvenous mitral

commissurotomy/stroke/VALVOTOMY

Tsai, L.M., Lin, L.J., Teng, J.K. and Chen, J.H. (1997), Prevalence and clinical

significance of left atrial thrombus in nonrheumatic atrial fibrillation. International

Journal of Cardiology, 58 (2), 163-169.

Abstract: The prevalence and clinical significance of left atrial thrombus were

prospectively investigated in a consecutive series of 219 patients with chronic

nonrheumatic atrial fibrillation using transesophageal echocardiography. Fifteen left

atrial thrombi were detected in 15 of the 219 patients (6.8%); 12 of these thrombi

(80%) were confined to the left atrial appendage. Left atrial spontaneous echo

contrast was visualized in 85 patients (39%). All the thrombi were found in the left

atria with spontaneous echo contrast. Patients with left atrial thrombus had

significantly lower left ventricular ejection fraction than those without (49+/-14% vs.

59+/-14%; PG(8344) MUTATION/brain/CHINESE

FAMILY/DNA/encephalopathy/FEATURES/heteroplasmy/LACTIC-ACIDOSIS/M

ELAS/MELAS SYNDROME/MERRF/mitochondrial DNA/mitochondrial

encephalomyopathies/molecular analysis/mtDNA/mutation/MYOCLONIC

EPILEPSY/phenotype/POINT MUTATION/prognosis/RED FIBERS

MERRF/STROKE-LIKE EPISODES/Taiwan/TRANSFER RNALEU(UUR) GENE

Wang, T.D., Chen, W.J., Su, S.S.Y., Su, T.C., Chen, M.F., Liau, C.S. and Lee, Y.T.

(2001), Increased levels of tissue plasminogen activator antigen and factor VIII

activity in nonvalvular atrial fibrillation: Relation to predictors of thromboembolism.

Journal of Cardiovascular Electrophysiology, 12 (8), 877-884.

Abstract: Introduction: Given that nonvalvular atrial fibrillation (AF)- associated stroke

can be either cardioembolic or atherothrombotic, we investigated the relationships

between nonvalvular AF and hemostatic factors reflecting intrinsic thrombogenic and

atherogenic potentials (tissue plasminogen activator [t-PA] antigen, plasminogen

activator inhibitor-1, and factor VIII activity). We also evaluated the clinical

applicability of these hemostatic factors by examining whether AF subjects with

established clinical or echocardiographic predictors of thromboembolism had higher

levels of these factors. Methods and Results: Of the 3,212 participants of a Chinese

population-based study, 53 subjects (1.7 %) with AF were identified. Among the

hemostatic factors measured, t-PA antigen (median 12.8 vs 8.1 ng/mL; P 75 years, hypertension, diabetes, and left ventricular

systolic dysfunction), whereas in AF subjects with no thromboembolic predictors,

plasma levels of hemostatic factors examined were similar to those without AF.

Conclusion: We demonstrated that nonvalvular AF was independently associated

with increased peripheral levels of t- PA antigen and factor VIII activity. Levels of

both hemostatic factors were primarily elevated in AF subjects with predictors of

thromboembolism. Whether these hemostatic factors are independently predictive of

future thromboembolic events in AF patients requires further investigation

Keywords: ACUTE-PHASE REACTION/age/ANGINA-PECTORIS/ASPIRIN/atrial

fibrillation/blood pressure/Chinese/cholesterol/CO/coagulation/COAGULATION

ACTIVITY/FOLLOW- UP/hypertension/MARKERS/MITRAL-

STENOSIS/MYOCARDIAL-INFARCTION/nonvalvular atrial

fibrillation/plasma/plasminogen activators/predictors/RISK FACTOR/risk

factors/STROKE/Taiwan/thromboembolism

Yu, W.C., Hsu, T.L., Tai, C.T., Tsai, C.F., Hsieh, M.H., Lin, W.S., Lin, Y.K., Tsao,

H.M., Ding, Y.A., Chang, M.S. and Chen, S.A. (2001), Acquired pulmonary vein

stenosis after radiofrequency catheter ablation of paroxysmal atrial fibrillation.

Journal of Cardiovascular Electrophysiology, 12 (8), 887-892.

Abstract: Introduction: Elimination of the initiating focus within the pulmonary vein

(PV) using radiofrequency (PF) catheter ablation is a new treatment modality for

treatment of drug-refractory atrial fibrillation. However, information on the

long-term safety of PF ablation within the PV is limited. Methods and Results: In

102 patients with drug-refractory atrial fibrillation and at least one initiating focus

from the PV, series transesophageal echocardiography was performed to monitor the

effect of RF ablation on the PV. There were 66 foci in the right upper PV and 65 foci

in the left upper PV. Within 3 days of ablation, 26 of the ablated right upper PVs (39

%) had increased peak Doppler flow velocity (mean 130 +/- 28 cm/sec, range 106 to

220), and 15 of the ablated left upper PVs (23%) had increased peak Doppler flow

velocity (mean 140 +/- 39 cm/sec, range 105 to 219). Seven patients had increased

peak Doppler flow velocity in both upper PVs. No factor (including age, sex, site of

ablation, number of RF pulses, pulse duration, and temperature) could predict PV

stenosis after RF ablation. Three patients with stenosis of both upper PVs

experienced mild dyspnea on exertion, but only one had mild increase of pulmonary

pressure. There was no significant change of peak and mean flow velocity and of PV

diameter in sequential follow-up studies up to 16 (209 +/- 94 days) months.

Conclusion: Focal PV stenosis is observed frequently after PF catheter ablation

applied within the vein, but usually is without clinical significance. However,

ablation within multiple PVs might cause pulmonary hypertension and should be

considered a limiting factor in this procedure

Keywords: age/ARRHYTHMIAS/atrial fibrillation/CO/CORONARY

SINUS/DISEASE/DOGS/ENERGY/hypertension/INITIATION/pulmonary vein

stenosis/radiofrequency catheter

ablation/stenosis/STROKE/Taiwan/temperature/TRANSESOPHAGEAL

ECHOCARDIOGRAPHY/velocity/VENTRICULAR-TACHYCARDIA

Tseng, W.Y.I., Liao, T.Y. and Wang, J.L. (2002), Normal systolic and diastolic

functions of the left ventricle and left atrium by cine magnetic resonance imaging.

Journal of Cardiovascular Magnetic Resonance, 4 (4), 443-457.

Abstract: Volume and phase characteristics of the left ventricle (LV) and left atrium

(LA) were assessed in 31 healthy Asian adults (19 males and 12 females) using cine

magnetic resonance imaging (MRI) and an automated boundary detection algorithm.

Volume indexes of the LV and LA were smaller than published results obtained

mostly from Westerners. Other than LV mass index and percent emptying of the LA,

there was no gender difference in all LV/LA indexes. In associating LV/LA

functions with the body size and heart rate (HR), we found that LV mass and the

minimum LA volume correlated strongly with the body surface area, the maximum

LA volume and the reservoir volume correlated strongly with the body weight, and

the time to LV peak-filling rate (LVPFRt) and the time to LA peak-emptying rate

(LAPERt) correlated strongly with the HR. In associating LV with LA functions, we

found that LA conduit volume contributed more than 50% of the LV stroke volume,

and correlated with both systolic and diastolic functions of the LV. Moreover,

LVPFRt and LAPERt were virtually identical, indicating a mechanical coupling

between LV and LA during diastole. In conclusion, using time-resolved,

three-dimensional volume data obtained from cine MRI, we have established

normative values of LV and LA functions and their functional relationships in

healthy Asian adults. The imaging acquisition protocol, data analysis algorithms, and

the established normative values provide the basis for the study of left heart function

in patients

Keywords: ANGIOGRAPHY/cardiac function/cine

MRI/ECHOCARDIOGRAPHY/EJECTION FRACTION/HEART/heart

rate/HUMANS/left atrium/left ventricle/magnetic resonance

imaging/MASS/MRI/MYOCARDIAL-INFARCTION/stroke/stroke

volume/Taiwan/TRANSPORT FUNCTION/VALIDATION/VOLUME

Lin, S.Z., Chiou, T.L., Song, W.S. and Chiang, Y.H. (1996), Isovolemic hemodilution

normalizes the prolonged passage of red cells and plasma through cerebral

microvessels in the partially ischemic forebrain of rats. Journal of Cerebral Blood

Flow and Metabolism, 16 (2), 280-289.

Abstract: The objective of this study was to determine whether hemodilution could

normalize the mean transit times of red blood cells (Tr) and plasma (Tp) through

cerebral microvessels in a partially ischemic brain. Wistar-Kyoto (WKY) rats, aged

30-40 weeks, were divided randomly into three groups. The first group was the

nonocclusion, nonhemodilution (NN) normal control group. The second group was

the occlusion, nonhemodilution (ON) group, in which animals were treated with

bilateral carotid artery ligation. The third group was the occlusion-hemodilution (OH)

group, in which animals were treated with bilateral common carotid artery ligation

and, then, isovolemic hemodilution by replacing blood with the same volume of 3%

modified fluid gelatin. Local cerebral blood flow (1CBF) and microvascular volumes

of red blood cells (Vr) and plasma (Vp) in 14 brain structures were measured using

C-14-iodoantipyrine, iron-55- labeled red blood cells, and C-14-inulin, respectively.

The amount of oxygen delivered to local brain structures (OD), cerebral

microvascular blood volume (Vb), mean transit time of blood (Tb), Tr, and Tp

through cerebral microvessels were calculated from the data. Two hours after carotid

artery ligation, 1CBF decreased by similar to 38% in forebrain structures, 22% in

rostral hindbrain areas, and 8% in the caudal hindbrain (29% for all 14 structures).

The decreases in ODs were parallel with those of 1CBFs, at 33, 17, and 2% in the

three regions, respectively (24% for all structures). In contrast, Vb increased by 68,

37, and 16% in the three regions, respectively (48% for all structures). Tr and Tp

were markedly prolonged (180% for Tr and 154% for Tp) in the forebrain regions,

moderately (91% for Tr and 73% for Tp) in the rostral hindbrain, and mildly (60%

for Tr and 13% for Tp) in the caudal hindbrain, with a mean increase of 136% for Tr

and 111% for Tp in all structures. When data in the OH and NN groups were

compared, 1CBF values tended to be slightly higher and Vb values were significantly

higher (p 0.05). In contrast, a correlation was observed between

serum glutamic pyruvic transaminase and rT(3) (r = 0.45; P 15 = severe. Duplex findings were

categorized according to velocity criteria into 50% stenosis if ICA PSV > 140 or ratio of ICA

and common carotid artery in PSV >2. No detectable flow at ICA was considered

occlusion. Stroke subtype was classified according to TOAST criteria. Results. Two

hundred nineteen consecutive patients were enrolled, including 127 with mild, 65

with moderate, and 27 with severe stroke. The prevalence of ICA stenosis > 50% in

each group was 3.6%, 1.4%, 0.9%, respectively. Two patients in the severe group

had total ICA occlusion. The overall prevalence of significant ICA lesions was 6.8%.

Conclusions. There is no positive correlation of stroke severity with the severity of

duplex findings, which may be due to low prevalence of significant ICA lesions or

other stroke mechanisms. Most of the patients had mild stroke, and the majority had

ICA stenosis 50%) of the

carotid or vertebrobasilar artery in 11 of 51 stroke patients. Serum levels of ICAM-1

[mean (SE)] were higher (P E-es = 0.86 x DeltaE(es(sb)) + 0.67 (r = 0.88, p 0.59, 15 PYRENE

METABOLISM/CULTURE/cytochrome

P450/CYTOCHROME-P450-DEPENDENT

MONOOXYGENASES/ENZYMES/HAMSTER

TISSUES/HEALTH/HUMAN-LIVER/motorcycle/OXIDATIVE

STRESS/RAT/RNA/Taiwan

Chiu, C.P. and Horng, R.F. (1994), Effects of Intake Air-Temperature and Residual-Gas

Concentration on Cycle-To-Cycle Combustion Variation in A 2- Stroke Cycle Si

Engine Equipped with An Air-Assisted Fuel- Injection System. Jsme International

Journal Series B-Fluids and Thermal Engineering, 37 (4), 957-965.

Abstract: Irregular combustion is the major disadvantage of two-stroke cycle S. I.

engines under low load conditions. This study was intended to find the cause of the

irregular combustion and to suggest ways to deal with this problem. The effects of

intake air temperature, skip firing and fuel-injection timing on the cycle-to-cycle

combustion variations in a two-stroke low- pressure air-assisted fuel injection S. I.

engine were investigated. The cylinder pressures of successive engine cycles were

recorded for statistical analysis. The intake air temperature was changed from 35 to

70 degrees C. The residual gas concentration was changed by skip firing strategy,

with skip 0, skip 4, skip 5 and skip 6. The air-injection timing which determines the

fuel-air mixture injection timing into the cylinder was controlled by an electronic

control unit. The items of injection timing were changed from 180 to 230 deg-

ATDC. Results showed that the effects of intake air temperature, residual gas

concentration variation and air- injection timing on combustion variations were

significant. Raising the intake air temperature, reducing the residual gas content and

adjusting the air-injection timing have greatly decreased cycle-to-cycle combustion

variations and unburnt HC emission. The optimal values of coefficient of variation of

indicated mean effective pressures (COVlmep) exist under the effects of the above

parameters

Keywords: 2-STROKE CYCLE SI ENGINE/CYCLE-TO-CYCLE COMBUSTION

VARIATION/LOW-PRESSURE AIR-ASSISTED FUEL INJECTION/RESIDUAL

GAS/SKIP FIRING

Lee, H.J. (1994), High-Performance Internal-Combustion Engine with Gas-Cushioned

Piston. Jsme International Journal Series B-Fluids and Thermal Engineering, 37 (2),

434-442.

Abstract: For a typical reciprocating internal combustion engine with a piston, cylinder,

connecting rod and crankshaft, there will be unnecessarily high side thrust acting on

the piston in high- speed motion during the Power stroke. This inherent side thrust

will induce extra rubbing friction force and wear on the cylinder wall, thus reducing

the engine power output. As a solution to this, the piston rings/crown can be

innovatively redesigned to produce a transverse gas pressure to counteract the piston

side thrust due to the tilting connecting rod. Thus the piston will move in the cylinder

in a gas-cushioned manner to reduce adverse mechanical effects. Naturally, due to

various engine limitations, this technology of gas-cushioned piston can be designed

to be most effective only under certain operating conditions, such as a specific

economical cruise speed of a ship or aircraft. In conjunction, the associated dynamics

analysis and design of engine reciprocating mechanism is greatly enhanced by

employing an ingenious varied-mass lumping method combined with the percussion

concept developed by the author

Keywords: ENGINE FRICTION/GAS-CUSHIONED PISTON/stroke/VARIED-MASS

LUMPING METHOD

Tzen, C.Y., Tsai, J.D., Wu, T.Y., Chen, B.F., Chen, M.L., Lin, S.P. and Chen, S.C.

(2001), Tubulointerstitial nephritis associated with a novel mitochondrial point

mutation. Kidney International, 59 (3), 846-854.

Abstract: Background. Nephropathy caused by mitochondrial disorders is a relatively

newly recognized disease. Only a few cases have been reported in the literature, and

most of them are proximal tubulopathy-presenting Fanconi syndrome. Here we

report on a novel mutation in two familial cases of tubulointerstitial nephropathy

associated with concentrating defect. Methods. Renal biopsy specimens were

examined by light microscopy and electron microscopy. Mitochondrial genomic

DNA isolated from renal biopsy specimens was amplified by polymerase chain

reaction (PCR) and sequenced in its entirety. The DNA sequences were analyzed by

(1) comparing with the Anderson et al's mitochondrial sequences; (2) comparing

with DNA sequences obtained from 97 human controls, including both healthy

individuals and patients with renal diseases; and (3) comparing with the counterparts

in 90 different species. Results. Dismorphic mitochondria with occasional

intramitochondrial inclusions were found in the renal tubular epithelial cells. A novel

mitochondrial point mutation was identified at the position 608, that is, the distal end

of the anticodon stem of the tRNA(Phe) molecule. The A to G substitution at this

position was not observed in 97 human controls and was found to be highly

conserved in evolution. Conclusions. We have identified an A608G mutation of

mitochondrial genome in two cases whose presentation include tubulointerstitial

nephritis and stroke

Keywords: A608G mutation/adenosine 5'-triphosphate/CLINICAL

PHENOTYPE/D-LOOP/defect/DNA/DNA CONTROL REGION/DNA

sequencing/ENCEPHALOPATHY/EPISODES

MELAS/GENE/genetics/HEREDITARY OPTIC

NEUROPATHY/KIDNEY/LACTIC- ACIDOSIS/MTDNA

MUTATION/mutation/OVERLAP SYNDROME/polymerase chain reaction/renal

tubular epithelial cells/stroke/Taiwan/tRNA(Phe) mutation

Lin, Y.P., Chen, C.H., Yu, W.C., Hsu, T.L., Ding, P.Y.A. and Yang, W.C. (2002), Left

ventricular mass and hemodynamic overload in normotensive hemodialysis patients.

Kidney International, 62 (5), 1828-1838.

Abstract: Background. It remains uncertain whether the hemodynamic parameters are

important determinants of left ventricular mass (LVM) in normotensive chronic

hemodialysis (NTHD) patients, as has been found in their hypertensive counterparts.

Methods. Forty NTHD patients (mean age, 53.7 +/- 14.4 years; male/female, 18/22)

without the requirement of antihypertensive drugs for at least six months were

studied. Controls were 41 hypertensive hemodialysis patients (HTHD) and 46

normotensive subjects with normal renal function (NTNR). The influence of

anthropometrics, cardiovascular structure and function, and volume status on LVM

(by two-dimensional echocardiography) was analyzed by steps of multiple linear

regression. Results. As compared with the NTNR and NTHD group, the HTHD

group had obvious pressure and volume/flow overload, and greater LV wall

thickness, chamber size and mass. In contrast, NTHD subjects had similar blood

pressure, large artery function, LV chamber size and stroke volume as the NTNR

subjects. However, the NTHD patients still had greater wall thickness and LVM,

along with greater cardiac output, lower total peripheral resistance and lower

end-systolic meridional stress to volume ratio (ESSV) than the NTNR group. LVM

in the NTHD group was significantly positively related to averaged systolic blood

pressure (SBPavg), body surface area, extracellular fluid (ECF), carotid

intima-media thickness (IMT), aortic pulse wave velocity (PWV), and negatively

related to ESSV and Kt/V. The independent significant noncardiac structural

determinants of LVM in NTHD subjects were ESSV, SBPavg, PWV and SV (model

r (2) = 0.617, P 0.7). The Rivermead Mobility Index

scores were highly correlated with the Barthel Index scores (Spearman rs > 0.6) and

the Berg Balance Scale scores (Spearman rs > = 0.8, all ps 1.53) was associated with an odds ratio of 3.35 for carotid

atherosclerosis when compared with the lowest tertile (300 mu g/L. Conclusions Long-term exposure to inorganic

arsenic from well water was associated with an increased prevalence of

cerebrovascular disease, especially cerebral infarction

Keywords: ALCOHOL-CONSUMPTION/arsenic/BLACKFOOT

DISEASE/BLOOD-PRESSURE/CEREBRAL INFARCTION/cerebrovascular

disorders/COPPER

SMELTER/DRINKING-WATER/HEART/HEART-DISEASE/hypertension/infarcti

on/prevalence/risk factors/RISK- FACTORS/STROKE/Taiwan/water

pollution/WELL WATER

Yip, P.K., Jeng, J.S., Lee, T.K., Chang, Y.C., Huang, Z.S., Ng, S.K. and Chen, R.C.

(1997), Subtypes of ischemic stroke - A hospital-based stroke registry in Taiwan

(SCAN-IV). Stroke, 28 (12), 2507-2512.

Abstract: Background and Purpose To better understand the clinical pattern and further

elucidate the risk factors and outcome in different subtypes of cerebral infarction (CI)

of the Chinese in Taiwan, we analyzed the National Taiwan University Hospital

Stroke Registry in 1995 and performed an ethnic comparison with similar data banks.

Methods From the National Taiwan University Hospital Stroke Registry in 1995, 676

patients (383 men and 293 women; mean age, 64.9 years; SD, 13.8 years; range, 1 to

98 years) with CI were recruited for this analysis. CI was classified into five subtypes

based on clinical manifestations, ultrasonographic studies, and neuroimaging

findings: large- artery atherosclerosis, lacunae, cardioembolism, other less common

determined causes, and undetermined cause. Vascular risk factors, extracranial

carotid artery atherosclerosis, and 30- day case-fatality rates were investigated in

each subtype of CI. Results Of all CI patients, 17%, 29%, 20%, 6%, and 29% were

classified as large-artery atherosclerosis, lacunae, cardioembolism, other determined

causes, and undetermined cause subtypes, respectively. The present results were

compared with those from eight similar Western stroke registries. The relative

incidence of lacunar CI in Chinese patients was more common, but large-artery

atherosclerotic CI was less common than in whites. Hypertension was frequently

seen in CI patients, especially in those with lacunae (85%) and large- artery

atherosclerosis (69%). Patients with cardioembolism had a higher percentage of atrial

fibrillation (69%), left ventricular hypertrophy, and ischemic heart disease than the

other patients. Patients with large-artery atherosclerosis had more vascular risk

factors, such as hypertension, diabetes mellitus, smoking, and carotid stenosis.

Cardioembolic patients had higher case-fatality rates than other CI patients. Of the

cardioembolic patients, 17.3% and 21.8% died within 30 days and during

hospitalization, respectively. Conclusions The proportion of CI subtypes varied in

different stroke registries. This may be partly due to applied classification criteria

and racial-ethnic differences. Awareness of the risk factors and outcome in each

subtype of stroke may afford further insights into the surveillance and treatment of

cerebrovascular disease

Keywords: atrial fibrillation/ATRIAL-FIBRILLATION/CEREBRAL

INFARCTION/CHINESE/CLASSIFICATION/COMMUNITY/DATA-BANK/HEA

RT/HONG-KONG/hypertension/hypertrophy/infarction/ischemic

stroke/NORTHERN MANHATTAN STROKE/OCCLUSIVE

CEREBROVASCULAR-DISEASE/POPULATION/racial

differences/registries/stroke/stroke classification/stroke registry/Taiwan

Fuh, J.L., Liu, H.C., Wang, S.J., Liu, C.Y. and Wang, P.N. (1997), Poststroke

depression among the Chinese elderly in a rural community. Stroke, 28 (6),

1126-1129.

Abstract: Background and Purpose A door-to-door survey was conducted in two

townships in the Kinmen islets to investigate the prevalence and other characteristics

related to depressive disorders of stroke survivors in an elderly Chinese population.

Methods Our target population comprised the registered residents greater than or

equal to 65 years old (n=2056) of a total population of 26105 on August 1, 1993. All

participants answered a questionnaire, filled in a Geriatric Depression Scale-short

form (GDS-S), and received a neurological examination. Depression was defined as

a GDS-S score greater than or equal to 5. Results Twenty-eight of 45 stroke

survivors (62.2%) and 491 of 1471 nonstroke subjects (33.4%) were classified as

depressed. The frequency of stroke survivors' depressive disorders was significantly

higher that of nonstroke subjects (P 6

increased significantly in conjunction with hypertension, age greater than or equal to

65 years, left ventricular hypertrophy on ECG, and smoking. However, hypertension

and smoking were the 2 evident determinants of carotid stenosis greater than or equal

to 50% after adjustment for other covariates. Compared with the normotensive

subjects, the ORs (and 95% CIs) for the hypertensive patients to develop carotid

atherosclerosis were 5.0 (3.0 to 8.4) indexed by maximal common carotid artery IMT

greater than or equal to 75th percentile, 3.7 (1.8 to 7.9) by ECCA score >6, and 4.8

(1.4 to 16.5) by carotid stenosis greater than or equal to 50%.

Conclusions-Hypertension strongly influence carotid atherosclerosis. Our findings

reinforce the hypothesis that hypertension has a major role in the pathogenesis of

atherosclerosis

Keywords: age/ALCOHOL-CONSUMPTION/atherosclerosis/B-MODE

ULTRASOUND/blood

pressure/BLOOD-PRESSURE/CARDIOVASCULAR-DISEASE/carotid

arteries/carotid artery/carotid stenosis/CORONARY-ARTERY

DISEASE/HEART-DISEASE/hypertension/hypertrophy/INTIMA-MEDIA

THICKNESS/ISOLATED SYSTOLIC

HYPERTENSION/pathogenesis/RISK-FACTORS/stenosis/STROKE/Taiwan/WAL

L THICKNESS

Chang, K.C., Tseng, M.C., Weng, H.H., Lin, Y.H., Liou, C.W. and Tan, T.Y. (2002),

Prediction of length of stay of first-ever ischemic stroke. Stroke, 33 (11), 2670-2674.

Abstract: Background and Purpose-Accurate information about hospital resource

utilization is necessary for management of healthcare service. The purpose of this

study was to determine the demographic and clinical predictors of length of hospital

stay (LOS) of acute care hospitalization for first-ever ischemic stroke patients.

Methods-A group of 330 patients who suffered from first-ever ischemic stroke and

were consecutively admitted to a medical center in southern Taiwan were followed

prospectively. Because our intention was to identify the major predictors of LOS

from the information available at admission, we evaluated only those factors that

could be assessed at the time of admission. Univariate analysis and multiple

regression analysis were used to identify the main predictors of LOS. Results-The

median LOS was 7 days (mean, 11 days; range, 1 to 122 days). Among the

prespecified demographic and clinical characteristics, National Institutes of Health

Stroke Scale (NIHSS) score at admission, the quadratic term of the initial NIHSS

score, modified Barthel Index score at admission, small- vessel occlusion stroke, sex,

and smoking were the main explanatory factors for LOS. In particular, for each

1-point increase in the total score of NIHSS, LOS increased approximately 1 day for

patients with mild or moderate (score 0 to 15 points) neurological impairments, while

LOS decreased approximately 1 day for patients with severe (score >15 points)

neurological impairments. Conclusions-The severity of stroke, as rated by the total

score on NIHSS, is an important factor that influences LOS after acute stroke

hospitalization

Keywords: Barthel Index/CARE/CEREBROVASCULAR

EVENTS/CLINICAL-TRIALS/costs and cost analysis/DIAGNOSIS/INPATIENT

COSTS/ischemic/ischemic stroke/length of hospital

stay/MODEL/ORG-10172/outcome/predictors/SCALE

SCORE/stroke/Taiwan/TREATMENT TOAST

Mao, H.F., Hsueh, I.P., Tang, P.F., Sheu, C.F. and Hsieh, C.L. (2002), Analysis and

comparison of the psychometric properties of three balance measures for stroke

patients. Stroke, 33 (4), 1022-1027.

Abstract: Background and Purpose-This study compared the psychometric properties of

3 clinical balance measures, the Berg Balance Scale (BBS), the Balance subscale of

the Fugl-Meyer test (FM- B), and the Postural Assessment Scale for Stroke Patients

(PASS), in stroke patients with a broad range of neurological and functional

impairment from the acute stage up to 180 days after onset. Methods-One hundred

twenty-three stroke patients were followed up prospectively with the 3 balance

measures 14, 30, 90, and 180 days after stroke onset (DAS). Reliability (interrater

reliability and internal consistency) and validity (concurrent validity, convergent

validity, and predictive validity) of each measure were examined. A comparison of

the responsiveness of each of the 3 measures was made on the basis of the entire

group of patients and 3 separate groups classified by degree of neurological severity.

Results-The FM-B and BBS showed a significant floor or ceiling effect at some DAS

points, whereas the PASS did not show these effects. The BBS, FM-B, and PASS all

had good reliability and validity for patients at different recovery stages after stroke.

The results of effect size demonstrated fair to good responsiveness of all 3 measures

within the first 90 DAS but, as expected, only a low level of responsiveness at 90 to

180 DAS. The PASS was more responsive to changes in severe stroke patients at the

earliest period after stroke onset, 14 to 30 DAS. Conclusions-All 3 measures tested

showed very acceptable levels of reliability, validity, and responsiveness for both

clinicians and researchers. The PASS showed slightly better psychometric

characteristics than the other 2 measures

Keywords: balance/BARTHEL ADL INDEX/cerebrovascular

disorders/FUGL-MEYER ASSESSMENT/FUNCTIONAL INDEPENDENCE

MEASURE/HEMIPLEGIC PATIENT/INPATIENT

REHABILITATION/INTERRATER RELIABILITY/MOTOR-ASSESSMENT

SCALE/PERFORMANCE/POSTURAL CONTROL/recovery/reliability and

validity/reproducibility of results/STANDING BALANCE/stroke/Taiwan

Lin, T.N., Sun, S.W., Cheung, W.M., Li, F.H. and Chang, C. (2002), Dynamic changes

in cerebral blood flow and angiogenesis after transient focal cerebral ischemia in rats

- Evaluation with serial magnetic resonance imaging. Stroke, 33 (12), 2985-2991.

Abstract: Background and Purpose-Angiogenesis occurs after cerebral ischemia, but the

relationship between angiogenesis and cerebral hemodynamic change is unknown.

The aim of the present study was to investigate the relationship between ischemia-

induced angiogenesis and hemodynamics in a well-defined 3- vessel occlusion model

of the rat by using diffusion- (DWI), perfusion-, and T2-weighted MRI (T2WI).

Methods-Rats were subjected to 60 minutes of transient middle cerebral artery

occlusion or sham operation. DWI and T2WI were used to characterize the extent of

the ischemic lesion from 4.5 hours to 14 days after reperfusion. A flow-sensitive

alternating inversion recovery method and dynamic susceptibility contrast MRI were

used to evaluate the temporal changes in relative cerebral blood flow (CBF) and

cerebral blood volume (CBV), respectively. Rats were randomly selected and killed

at each time point for investigation of vascular density and for hematoxylin-eosin

staining. Results-Ischemic lesions developed in the ipsilateral cortex, as

demonstrated by DWI and T2WI. CBF was significantly increased in the ipsilateral

cortex, especially in the cortical outer layer from day I to day 14, and peaked on day

7 (P25% of baseline identified the shivering threshold. Sedation

was evaluated by using the Observer's Assessment of Sedation/Alertness scale.

Two-way repeated-measures ANOVA was used to identify interactions between

drugs. Data are presented as mean +/- SD; P < 0.05 was statistically significant.

Results - The shivering thresholds on the study days were as follows: control, 36.7

+/- 0.3 &DEG;C; dexmedetomidine, 36.0 +/- 0.5 &DEG;C ( P < 0.001 from control);

meperidine, 35.5 +/- 0.6 degreesC ( P < 0.001); and meperidine plus

dexmedetomidine, 34.7 +/- 0.6 &DEG;C ( P < 0.001). Although meperidine and

dexmedetomidine each reduced the shivering threshold, their interaction was not

synergistic but additive ( P = 0.19). There was trivial sedation with either drug alone

or in combination. Respiratory rate and end- tidal PCO2 were well preserved on all

days. Conclusions - Dexmedetomidine and meperidine additively reduce the

shivering threshold; in the small doses tested, the combination produced only mild

sedation and no respiratory toxicity

Keywords: ACUTE STROKE/additive/BLOOD-FLOW/body temperature

regulation/BODY-TEMPERATURE/BRAIN

INJURY/CARDIAC-ARREST/COPENHAGEN

STROKE/depression/dexmedetomidine/hypothermia/meperidine/MODERATE

HYPOTHERMIA/plasma/SLIGHTLY INCREASES/stroke/SWEATING

THRESHOLD/temperature/VASOCONSTRICTION

Chang, C.N. and Defai, H. (1985), Stroke-In-Evolution - An Indication for An

Emergency Extracranial Intracranial Bypass. Surgical Neurology, 23 (4), 443-446

Lin, M.T. (1997), Heatstroke-induced cerebral ischemia and neuronal damage -

Involvement of cytokines and monoamines. Thermoregulation, 813 572-580

Keywords: BLOOD-FLOW/BRAIN/CELL-DEATH/DOPAMINE

RELEASE/HEAT-STROKE/HYPERTENSION/INJURY/INTERLEUKIN-1/RATS/

SEROTONIN

Lee, T.K., Chen, Y.C. and Kuo, T.L. (1987), Comparison of the Effect of

Acetylsalicylic-Acid on Platelet- Function in Male and Female-Patients with

Ischemic Stroke. Thrombosis Research, 47 (3), 295-304

Keywords: TAIWAN

Ho, C.H., Hu, H.H. and Wong, W.J. (1989), The Serial Hemostasis-Related Changes in

Patients with Cerebral Infarction - Comparison Between Progressing and

Non-Progressing Stroke. Thrombosis Research, 56 (5), 635-647

Lee, T.K., Chan, K.W.A., Huang, Z.S., Ng, S.K., Lin, R.T., Po, H.L., Yuan, R.Y., Lai,

M.L., Chang, T.W., Yan, S.H., Deng, J.C., Liu, L.H., Lee, K.Y., Lie, S.K., Sung,

S.M. and Hu, H.H. (1997), Effectiveness of low-dose ASA in prevention of

secondary ischemic stroke, the ASA Study Group in Taiwan. Thrombosis Research,

87 (2), 215-224.

Abstract: This randomized double-blind controlled study was carried out to investigate

the effect of 100 mg acetylsalicylic acid(ASA) per day on the secondary prevention

of ischemic stroke. Patients who suffered a first ischemic stroke from 13

participating hospitals were enrolled. They were independent or only partially

dependent in activities of daily living and all had received brain CT for diagnosis.

Eligible patients were randomly allocated to the 100 mg ASA or the nicametate

citrate(a vasodilator) groups, and trial medications were started within three to six

weeks after the onset of stroke. The primary end point was cerebral reinfarction, and

intracranial hemorrhage was classified as an adverse event. Four hundred and

sixty-six patients participated in this study; and 222 cases (136 males and 86 females)

were allocated to the ASA group while 244 cases (150 males and 94 females) were

assigned to the nicametate group. No significant difference in baseline characteristics

between the two groups was observed. Cerebral reinfarction developed 6.3% (14/222)

in the ASA group and 11.9% (29/244) in the nicametate group. According to the

Cox's proportional hazards model, the estimated risk ratio (ASA group vs.

nicametate group) was 0.538, with a 95% confidence interval of 0.284-1.019. The

result was of borderline statistical significance. The risk for cerebral reinfarction was

reduced by almost 50% among those who took 100 mg ASA versus those who took

nicametate. (C) 1997 Elsevier Science Ltd

Keywords: ACETYLSALICYLIC-ACID/ACTIVATION/activities of daily

living/AGGREGATION/ASPIRIN/aspirin/brain/CEREBRAL

ISCHEMIA/Chinese/clinical trials/ischemic/ischemic

stroke/PLATELET-FUNCTION/stroke/stroke prevention/Taiwan/TRIAL

Lin, J.S., Shen, M.C., Tsai, W. and Lin, B. (2000), The prevalence of C677T mutation

in the methylenetetrahydrofolate reductase gene and its association with venous

thrombophilia in Taiwanese Chinese. Thrombosis Research, 97 (3), 89-94.

Abstract: C677T mutation of the methylenetetrahydrofolate reductase gene remains a

controversial risk factor for venous thrombosis in Whites. The prevalence of

methylenetetrahydrofolate reductase C677T genotype and its association with

vascular thrombosis are not well established in Chinese population. We conducted a

case-control study to investigate the prevalence of methylenetetrahydrofolate

reductase C677T gene mutation and its association with venous thrombophilia in

Taiwanese Chinese. The subjects consisted of 112 venous thrombophilic patients and

125 healthy controls, with similar age (p = 0.08) and sex (p = 0.58). The prevalent

rates of C/T heterozygote were 32.8 and 44.6%; whereas those of T/T homozygote

were 6.4 and 8.0% in the controls and patients, respectively. Neither C/T

heterozygote (odds ratio, 1.7; 95% confidence interval, 1.0-3.0, p = 0.05) nor T/T

homozygote (odds ratio, 1.4; 95% confidence interval, 0.5-4.0, p = 0.5) was

significantly associated with venous thrombosis. Even when only subjects (52

patients and 107 controls) with normal inhibitor protein levels were analyzed, the

association of T/T homozygote with venous thrombosis remained insignificant (p =

0.06) with an odds ratio (95% confidence interval) of 3.4 (0.99-11.7). We concluded

that, in Taiwanese Chinese, methylenetetrahydrofolate reductase C677T mutation is

a common genetic mutation, but T/T homozygote is not a significant risk factor for

venous thrombophilia. (C) 2000 Elsevier Science Ltd. All rights reserved

Keywords: 5/10-METHYLENETETRAHYDROFOLATE

REDUCTASE/age/association/Chinese/COMMON

MUTATION/CORONARY-ARTERY DISEASE/deep vein

thrombosis/FACTOR-V-LEIDEN/FOLIC-ACID/genetic/genotype/homocysteine/IS

CHEMIC STROKE/methylenetetrahydrofolate

reductase/mutation/MYOCARDIAL-INFARCTION/PLASMA

HOMOCYSTEINE/prevalence/RISK FACTOR/risk

factor/Taiwan/Taiwanese/thrombosis/VASCULAR-DISEASE/venous

thrombophilia/venous thrombosis

Wu, T.H., Chen, T.H.H. and Lee, T.K. (2000), Factors affecting the first recurrence of

noncardioembolic ischemic stroke. Thrombosis Research, 97 (3), 95-103.

Abstract: Studies of the factors affecting the first recurrence of ischemic stroke have

reported inconsistent findings. Types of initial stroke and the racial differences in

study samples are among the explanations that may account for this inconsistency.

The aims of this study were to estimate the cumulative recurrence rates of

noncardioembolic ischemic stroke and identify the factors that influence the first

recurrence of noncardioembolic ischemic: stroke in the Taiwanese Chinese

population. Four hundred and sixty-six patients with noncardioembolic ischemic

stroke from thirteen hospitals in Taiwan were, followed up in this study to ascertain

first recurrence of noncardioembolic ischemic stroke between October 1992 and

April 1995. The Kaplan-Meier method was used to estimate the cumulative

recurrence rate. The Cox regression model was used to ascertain the significant

factors affecting the first recurrence of noncardioembolic ischemic stroke. The

overall cumulative recurrence rate was 10.5% (49/466) from the fellow-up period of

30 months. After adjustment for age, sex, treatment modes, and variables pertinent to

blood pressure, the site of brain lesion remained a significant factor. The relative risk

of first recurrence for the basal ganglion vs. the region of middle cerebral artery was

3.06 (95% CI: 1.29- 7.26). The brain lesion site was demonstrated to be an

independent predictor of risk for the first recurrence of noncardioembolic ischemic

stroke among the Taiwanese Chinese population. Whether this finding was also seen

in other populations should be corroborated in future research. (C) 2000 Elsevier

Science Ltd. All rights reserved

Keywords: age/blood pressure/brain/CEREBRAL

INFARCTION/Chinese/COMMUNITY/DISEASE/ischemic/ischemic stroke/middle

cerebral artery/MORTALITY/noncardioembolic

stroke/PREDICTORS/PREVENTION/PROGNOSIS/PROJECT/racial

differences/risk factors/RISK-FACTORS/stroke/SURVIVAL/Taiwan/Taiwanese

Tzeng, G.H. and Chen, J.J. (1998), Developing a Taipei motorcycle driving cycle for

emissions and fuel economy. Transportation Research Part D-Transport and

Environment, 3 (1), 19-27.

Abstract: The purposes of this study are to develop a representative driving cycle for

motorcycles in metropolitan Taipei and to ascertain the emissions and fuel economy

of the cycle. We collected extensive driving cycle data and proposed a methodology

to develop a Taipei motorcycle driving cycle (TMDC). The characteristics of TMDC

are high average acceleration and deceleration, high acceleration-deceleration

changes and low average travel speed. Forty-five motorcycles were tested in a

laboratory by using the ECE-40 and TMDC test procedure. The emissions of

motorcycles tested by TMDC are higher than ECE, whether they are two-stroke or

four-stroke engines. Furthermore, the CO and HC emissions of two-stroke engine

motorcycles are higher than four-stroke engine motorcycles, and the NOx emission

of two-stroke engine motorcycles are lower than four-stroke engine motorcycles,

whether they are tested by TMDC or ECE. The fuel economy of two-stroke engine

motorcycles tested by TMDC is lower than ECE, but the fuel economy of four-stroke

engine motorcycles tested by TMDC is higher than ECE. A linear regression of

TMDC in terms of ECE emissions shows them to be highly correlated, as is fuel

economy. (C) 1998 Elsevier Science Ltd. All rights reserved

Keywords: driving cycle/motorcycle/motorcycles

Hu, W.C., Wu, M.T., Liu, C.P., Shyu, L.Y. and Hsu, T.L. (2002), Left ventricular 4D

echocardiogram motion and shape analysis. Ultrasonics, 40 (1-8), 949-954.

Abstract: The article describes the methodology and the processes of modeling the

function and the motion of left ventricle using transesophageal echocardiograph. The

parameters can be used in studying the functionality of left ventricle, the status of

abnormality of myocardial, and the geometric and morphological of left ventricle in

shape analysis. The parameters describes the motion of left ventricle are the left

ventricular (LV) floating long axis, the morphological parameters. The LV

morphological parameters describe the wall motion, the LV chamber cavity variation,

the effective R-ratio of endomyocardial chamber of LV, the area surface curvature,

and the global surface curvature circularity. The parameters such as stroke volume,

ejection fraction used in evaluation of LV functions are also extracted. (C) 2002

Published by Elsevier Science B.V

Keywords: ejection fraction/IMAGES/left ventricle/LV long axis/LV shape and

functional analysis/MODEL/stroke/stroke volume/Taiwan/trans-esophageal

echocardiogram/wall motion

Lai, S.T., Wan, J.S., Yu, T.J., Huang, C.H. and Shih, C.T. (1995), The Experience of

Simultaneous Carotid Endarterectomy and Myocardial Revascularization. Vascular

Surgery, 29 (5), 351-357.

Abstract: Between January 1988 and April 1994, simultaneous carotid endarterectomy

and myocardial revascularization were performed in 20 patients (16 men and 4

women) with a mean age of 67.38 +/- 11 years (range: fifty-six to seventy-eight

years). The neurologic presentations included asymptomatic carotid bruit in 4

patients (20%), history of transient ischemic attack (TIA) in 11 (55%), and previous

stroke with recent history of TIA in 5 (25%). Preoperatively, 14 patients (70%) were

in New York Heart Association functional class III, with the remainder in either class

I (5%) or class II (25%). Coronary arteriography demonstrated severe coronary

atherosclerosis involving a double-vessel disease in 4 patients (20%), and

triple-vessel disease in 16 (80%). Two patients (10%) had left main coronary artery

stenosis, and 4 had previous recent myocardial infarction. All patients received

unilateral carotid endarterectomy and a mean number of 3.5 distal anastomoses of

coronary arteries. No patient died within thirty days after simultaneous operation,

and operative mortality rate was zero. The late mortality rate was 20%, with only 1

death related to myocardial infarction and 1 attributable to contralateral stroke.

According to a proposed guideline, the long-term outcome is determined by the

extent and severity of the cardiovascular disease. Simultaneous operation is

appropriate for a subgroup of patients with coexisting carotid and coronary artery

disease

Keywords: atherosclerosis/cardiovascular disease/coronary artery

disease/infarction/ischemic/stenosis/stroke

Li, J.L. and Yeh, S.L. (2003), Do "Chinese and American see opposite apparent motions

in a Chinese character"? Tse and Cavanagh (2000) replicated and revised. Visual

Cognition, 10 (5), 537-547.

Abstract: In a paper entitled "Chinese and Americans see opposite apparent motions in a

Chinese character", Tse and Cavanagh (2000) showed that when a Chinese character

was presented stroke by stroke and the participants were asked to judge the motion

direction of the last stroke (a horizontal line), the American participants perceived

the direction predicted by transformational apparent motion, while the Chinese

participants saw the opposite, writing direction. We demonstrate that Chinese readers

do not always perceive the direction of writing; only when there are writing clues

(such as a handwritten script presented in a writing sequence for a long enough

duration) is the writing direction perceived. The top-down factors that make Chinese

readers see the writing direction are the script and the stroke sequence, which are

derived from writing experiences

Keywords: Chinese/Chinese

character/MOVEMENT/ORDER/PERCEPTION/SENSATION/stroke/Taiwan