C.-H. Tsai

Advanced complicated diabetes mellitus is associated with a reduced risk of thoracic and abdominal aortic aneurysm rupture: a population-based cohort study.

Studies have associated diabetes mellitus (DM) with the reduced risk of abdominal aortic aneurysm and thoracic aortic aneurysm and dissection. We used the national insurance data of Taiwan to examine these correlations for an Asian population. The association was also evaluated by DM severity.

Helicobacter pylori infection increases subsequent ischemic stroke risk: a nationwide population-based retrospective cohort study

BACKGROUND AND PURPOSE The association of Helicobacter pylori infection (HP-I) with ischemic stroke (IS) incidence has been studied, but conflicting results have been reported. The purpose of this study was to investigate the association between chronic HP-I and the risk of acute IS by using data from the Taiwan National Health Insurance Research Database. METHODS We identified17 332 patients with HP-I and 69 328 randomly selected age- and gender-matched controls from 1 January 2000 to 31 December 2010. Both cohorts were followed up until the occurrence of IS or until censored. The Cox proportional hazards model was used for assessing the association of HP-I with IS. RESULTS Compared with the control cohort, patients diagnosed with HP-I exhibited a higher incidence rate of IS (14.8 vs. 8.45 per 1000 person years) and a hazard ratio (HR) of 1.52 (95% confidence interval [CI] = 1.40-1.65). The HRs for IS were 1.49 (1.37-1.62) in patients diagnosed with HP-I who had one admission, increasing to 2.26 (1.71-1.98) for those who had two or more admissions when adjusted for age, sex and comorbidities (P for trend < 0.0001). In addition, we observed a significantly positive association between nonembolic IS and increased admissions (P for trend < 0.0001) but negative association with embolic IS. CONCLUSION Chronic HP-I is significantly associated with an increased risk of IS, particularly nonembolic IS. Anti-HP therapy may be beneficial to IS prevention.

Increased risk of brain tumor in patients with Parkinson's disease: a nationwide cohort study in Taiwan

Parkinsons disease (PD) is a neurodegenerative disease. A decreased risk of cancer, except for melanoma, has been observed in patients with PD. The aim of this study was to evaluate the association between brain tumor and PD in a Taiwanese population.

Post-hypoxic cortical myoclonus mimicking spinal myoclonus - electrophysiological and functional MRI manifestations.

Sir, Hypoxia-induced cortical myoclonus usually manifests with multifocal or generalized jerks. We studied an unusual case presenting with only legs jerks by electrophysiological and functional magnetic resonance imaging (fMRI) investigations. A 48-year-old woman suffered an event of thoracic back compression by a falling 500-kg pack of paper complicated with asphyxia, cyanosis and consciousness loss. She was rescued probably 15 min later with endotracheal intubation and was admitted in intensive care unit for 5 days. She developed involuntary leg jerks on the eighth day after the accident. Neurological examination revealed spontaneous and action-triggered myoclonus at lower extremities, more prominent on the right, with no jerks of the upper limbs. Multichannel electromyography (EMG) illustrated short-duration (<30 ms) myoclonic bursts (Fig. 1a). Jerk-locked backaverage recording triggered by right tibialis anterior EMG burst disclosed an electroencephalographic (EEG) event 26 ms prior to the myoclonus (Fig. 1b). fMRI revealed increase in cortical BOLD effect especially on eliciting jerks by dorsiflexing the right foot (Fig. 1c). MRI findings of the brain and thoracic cord were unremarkable. She gave informed consent before receiving studies. Her symptoms were ameliorated by levetiracetam and clonazepam. She could walk with trivial leg myoclonus under the same treatment formula at 1-year follow-up. Based on the level of origin, myoclonus can be classified into cortical, subcortical and spinal myoclonus [1,2]. Patients with cortical myoclonus usually have focal or multifocal jerks. The EMG bursts are usually shorter than 50 ms, and jerklocked EEG event may be recorded [1,2]. Spinal myoclonus contains segmentaland propriospinal myoclonus [3,4]. Amongst them, propriospinal myoclonus is characterized by non-rhythmic jerks of the trunk and low limbs with jerk duration longer than 100 ms [4]. The leg myoclonus and a history of thoracic back compression of current patient led us initially to speculate that her myoclonus was spinal origin. However, the short-duration EMG bursts and the jerk-locked EEG event of backaverage recording indicate that her leg myoclonus is of cortical origin. Because there was a history of transient asphyxia with consciousness loss, post-hypoxic myoclonus (PHM) could be the most possible etiology [5]. PHM may appear after a lag period and may manifest with action myoclonus that mainly involved four limbs [5]. It is quite unusual for chronic PHM to be confined only over the lower limbs. To further investigate the unique manifestation, fMRI was conducted. The BOLD activities of bilateral cortical areas, particular the motor cortex of legs, were more robustly enhanced when patient dorsiflexed her right foot when compared with the left foot (Fig. 1c). The fMRI findings may infer the reason why the patient s jerks were more vigorous on the right leg than those on the left. Although myoclonus was only found at lower limbs, the extensive BOLD effect in the fMRI during right foot dorsiflexion may suggest that the cortical activities could be more widespread than supposed to be.

Interleukin-32 plays an essential role in human calcified aortic valve cells

Interleukin-32 (IL-32) is an inflammatory cytokine produced mainly by T, natural killer, and epithelial cells. Previous studies on IL-32 have primarily investigated its proinflammatory properties. The IL-32 also has been described as an activator of the p38 mitogen-activated protein kinase (MAPK) and NF-κB, and induces several cytokines. In this study, we hypothesized that the inflammatory regulators NF-κB, MAP kinase, STAT1, and STAT3 are associated with the expression of the IL-32 protein in human calcified aortic valve cells. This study comprised aortic valve sclerotic patients and control group patients without calcified aortic valve. Increased IL-32 expression in calcified aortic valvular tissue was shown by immunohistochemical staining and western blotting. There was an increase in NF-κB p65 level, p-ERK, p-JNK, and p-p38 MAPK activation underlying IL-32 expression in the study. The level of p-STAT3 but not p-STAT1 was found to be increased in calcified aortic valve tissue. In cultured primary human aortic valve interstitial cells, inhibition of NF-κB or MAPK kinase pathways results in a decrease of IL-32 expression. Treatment of recombinant IL-32 induced the levels of TNF-α, IL-6, IL-1β, and IL-8. Our findings demonstrate that IL-32 may be an important pro-inflammatory molecule involved in calcific aortic valve disease.

Risk of developing pressure sore in amyotrophic lateral sclerosis patients – a nationwide cohort study

Prior investigations with few cases have disclosed lack of pressure sore (PrS) formation was characteristic in amyotrophic lateral sclerosis (ALS) patients. However, studies with larger samples are lacking to ascertain this concept.

P22-14 Cortical and non-cortical myoclonus of Creutzfeldt-Jakob disease (CJD): Precious lesson learned from a patient

neurological disease that mimicks a motor neuron disease, in which EMG exam and clinical evolution suggests an axonal motor neuropathy. Methods: We describe a 36 years-old male patient with human immunodeficiency virus (HIV) infection, with a rapid onset dysphagia and limb weakness. Neurological involvement worsened after two weeks and he was unable to walk and to swallow. Enteral nutrition were needed. We performed several electrophysiological studies with needle EMG, nerve conduction studies and transcranial magnetic stimulation. Results: Motor and sensory nerve conduction studies were normal. Needle EMG showed acute signs of diffuse denervation in upper and lower limbs and bulbar muscles. Transcranial magnetic stimulation were normal, without signs of upper motor neuron involvement. After antirretroviral treatment the patient progressively improved his symptoms. Several EMG tests demonstrated signs of reinnervation. Conclusion: There are few descriptions in the literature about patients with HIV infection and motor neuron disease. Reversibility of some of these reported cases is surprising. We describe a patient with clinical and electrophysiological presentation that mimicks a motor neuron disease, although reinnervation evidence after 2.5 months suggests a selective involvement of distal motor nerve axons.

Focal Hand Myoclonus Caused by a Small Hematoma underneath the Cerebral Motor Cortex

Short Reports 3 Keime-Guibert F, Graus F, Fleury A, Rene R, Honnorat J, Broet P, Delattre JY: Treatment of paraneoplastic neurological syndromes with antineuronal antibodies (anti-Hu, anti-Yo) with a combination of immunoglobulins, cyclophosphamide, and methylprednisolone. J Neurol Neurosurg Psychiatry 2000;68:479–482. 4 Blaes F, Strittmatter M, Merkelbach S, Jost V, Klotz M, Schimrigk K, Hamann GF: Intravenous immunoglobulins in the therapy of paraneoplastic neurological disorders. J Neurol 1999;246;299–303. 5 Graus F, Elkon KB, Lloberes P, Ribalta T, Torres A, Ussetti P, Valls J, Obach J, Agusti-Vidal A: Neuronal antinuclear antibody (anti-Hu) in paraneoplastic encephalomyelitis simulating acute polyneuritis. Acta Neurol Scand 1987;75:249–252. 6 Byrne T, Mason WP, Posner JB, Dalmau J: Spontaneous neurological improvement in anti-Hu-associated encephalomyelitis. J Neurol Neurosurg Psychiatry 1997;62:276–278. 7 Darnell RB, DeAngelis LM: Regression of small-cell lung carcinoma in patients with paraneoplastic neuronal antibodies. Lancet 1993;341:21–22. 8 Forman D, Rae-Grant AD, Matchett SC, Cowen JS: A reversible cause of hypercapnic respiratory failure: Lower motor neuronopathy associated with renal cell carcinoma. Chest 1999;115:899–901. 9 Ball JA, Warner T, Reid P, Howard RS, Gregson NA, Rossor MN: Central alveolar hypoventilation associated with paraneoplastic brain-stem encephalitis and anti-Hu antibodies. J Neurol 1994;241:561–566. 10 Graus F, Keime-Guibert F, Rene R, Benyahia B, Ribalta T, Ascaso C, Escaramis G, Delattre JY: Anti-Hu-associated paraneoplastic encephalomyelitis: Analysis of 200 patients. Brain 2001;124:1138–1148.