BACKGROUND Delayed neurological sequelae (DNS) caused by carbon monoxide (CO) intoxication poses considerable treatment challenges for clinical practitioners. In this report, we used nuclear medicine imaging and the Mini-Mental State Examination (MMSE) to evaluate the effectiveness of intravascular laser irradiation of blood (ILIB) therapy for the management of DNS. CASE SUMMARY A 51-year-old woman presented to our medical center experiencing progressive bradykinesia, rigidity of limbs, gait disturbance, and cognitive impairment. Based on her neurological deficits, laboratory tests and imaging findings, the patient was diagnosed with delayed neurological sequelae of CO intoxication. She received intensive rehabilitation and ILIB therapy during 30 sessions over 2 mo after diagnosis. Brain single-photon emission computed tomography was performed both prior to and after ILIB therapy. The original hypoperfusion area in bilateral striata, bilateral frontal lobe, right parietal lobe, and bilateral cerebellum showed considerable improvement after completion of therapy. The patient’s MMSE score also increased markedly from 6/30 to 25/30. Symptoms of DNS became barely detectable, and the woman was able to carry out her daily living activities independently. CONCLUSION ILIB therapy could facilitate recovery from delayed neurological sequelae in patients with CO intoxication, as demonstrated by improved cerebral blood flow and functional outcomes in our patient.

Purpose The Lipoprotein lipase (LPL) gene is a significant contributor to dyslipidemia. It has shown associations with several conditions including atherosclerosis, obesity, and metabolic syndrome (MetS). We assessed the interactive association between MetS and rs3779788 of the LPL gene based on aerobic exercise. Materials and Methods Data were available for 7532 Taiwan Biobank (TWB) participants recruited between 2008 and 2016. We used multiple logistic regression to determine the odds ratios (OR) for MetS and their 95% confident intervals (C.I.). Potential variables included LPL rs3779788, aerobic exercise, sex, age, education, marital status, body mass index (BMI), smoking, alcohol consumption, midnight snacking, vegetarian diet, coffee, dietary fat, and tea drinking. Results Aerobic exercise was protective against MetS (OR, 0.858; 95% C.I., 0.743–0.991). Compared to CC/CT genotype, the OR for developing MetS was 0.875, (95% C.I., 0.571–1.341) in TT individuals. The test for interaction was significant for the rs3779788 variant and aerobic exercise (p = 0.0484). In our group analyses, the OR for MetS was 0.841 (95% C.I., 0.727–0.974) in CC/CT and 4.076 (95% C.I., 1.158–14.346) in TT individuals who did aerobic exercise compared to those who did not. Conclusion Our study indicated that aerobic exercise improved metabolic syndrome in Taiwanese adults with rs3779788 CC/CT genotype relative to those with TT genotype.

Background: Rebuilding the strength of the quadriceps as soon as possible after total knee replacement (TKR) is important so as to restore gait stability. To date, there are no standard postoperative strength training programs during the early recovery stage after TKR. Purpose: To compare the therapeutic effects between isokinetic and isotonic strengthening in patients after TKR. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: From April 2018 to August 2020, 37 patients met the inclusion criteria and were randomly assigned to perform either 4-week isokinetic or isotonic strength training programs. Other components of the rehabilitation program were kept the same between the 2 groups. All cases were evaluated by the Timed Up and Go (TUG) test, peak torque of knee extension and flexion (60 and 120 deg/s), 36-item Short Form Health Survey (SF-36), and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Results: After undergoing a 4-week strength training regimen, significant improvements in the TUG test were noted in both groups; however, the time improvement in the isotonic group did not reach the minimal detectable change. All peak torque measurements improved in the isokinetic group but not in the isotonic group for knee flexion at 60 deg/s. The pain subdomain, physical domain, mental domain, total SF-36 score, and WOMAC index all improved significantly in both groups after training. Both training groups improved significantly in peak torque of knee strength, TUG test, and functional scores, but the differences between isokinetic and isotonic training were not statistically significant. Conclusion: The study findings showed that a 4-week strengthening exercise program in the early postoperative stage, involving either isokinetic or isotonic training, resulted in significant improvements in patients undergoing TKR. Registration: NCT02938416 ( ClinicalTrials.gov identifier).

Background Global aphasia without hemiparesis (GAWH) is a rare stroke syndrome characterized by the dissociation of motor and language functions. Here, we present a case of GAWH with the patient later regaining speech fluency. Case presentation A 73-year-old man was admitted to our emergency department immediately after an episode of syncope. On arrival, we noted his global aphasia but without any focal neurologic signs. Computed tomography (CT) perfusion scans showed a large hypodense region over his left perisylvian area. Under the impression of acute ischaemic stroke, he received recombinant tissue plasminogen activator (rtPA) injection and was treated as an inpatient. The patient was later discharged with GAWH status and received regular speech rehabilitation. After 14 months of rehabilitation, the patient gradually recovered his language expression ability. The degree of aphasia was evaluated with the Concise Chinese Aphasia Test (CCAT), and we obtained brain single photon emission computed tomography (SPECT) scans to assess cerebral blood flow. Conclusion A patient with severe impairments of Broca’s and Wernicke’s areas was able to talk fluently despite being unintelligible. SPECT revealed relative high level of radioactivity uptake in the right frontal lobe, suggesting the deficits in speech fluency could have been compensated by the right hemisphere. Although this is a single case demonstration, the results may strengthen the role of the right hemisphere in GAWH patients and suggests additional study that examines the possible benefits of stimulating activity at right homologous regions for recovering language function after global aphasia.

Glenohumeral Subluxation (GHS) is one cause of shoulder pain after stroke. The greater the distance of GHS, the higher is the chance of rotator tendonitis or tearing of the tendon, causing limited motions and excruciating pain. Cross Cerebellar Diaschisis (CCD), a reduction of blood flow in the contralateral cerebellum after the supratentorial stroke, is detectable by a brain perfusion scan, and it has marked impacts on functional outcomes after stroke. We presented here a case on hemiplegic stroke. CCD of the patient persisted for 7 months without improvements. The patient underwent measurement of GHS and Single Photon Emission Computed Tomography to confirm the characteristic relationship. The patient’s GHS persisted for a prolonged period of time during which the acromiohumeral distance was longer than those of the general CCD-free stroke. Together with persisted CCD, the persistence of GHS was correlated with a prolonged CCD, which is presumably one sign of motor deficits associated with CCD.