DeepX: A Software Accelerator for Low-Power Deep Learning Inference on Mobile Devices

© 2016 IEEE. Breakthroughs from the field of deep learning are radically changing how sensor data are interpreted to extract the high-level information needed by mobile apps. It is critical that the gains in inference accuracy that deep models afford become embedded in future generations of mobile apps. In this work, we present the design and implementation of DeepX, a software accelerator for deep learning execution. DeepX signif- icantly lowers the device resources (viz. memory, computation, energy) required by deep learning that currently act as a severe bottleneck to mobile adoption. The foundation of DeepX is a pair of resource control algorithms, designed for the inference stage of deep learning, that: (1) decompose monolithic deep model network architectures into unit- blocks of various types, that are then more efficiently executed by heterogeneous local device processors (e.g., GPUs, CPUs); and (2), perform principled resource scaling that adjusts the architecture of deep models to shape the overhead each unit-blocks introduces. Experiments show, DeepX can allow even large-scale deep learning models to execute efficently on modern mobile processors and significantly outperform existing solutions, such as cloud-based offloading

Prevalence of Fabry disease and GLA variants in young patients with acute stroke: the challenge to widen the screening. The Fabry-Stroke Italian Registry

Background: Fabry disease (FD) is a treatable X-linked lysosomal storage disorder caused by GLA gene variants leading to alpha-galactosidase A deficiency. FD is a rare cause of stroke, and it is still controversial whether in stroke patients FD should be searched from the beginning or at the end of the diagnostic workup (in cryptogenic strokes). Methods: Fabry-Stroke Italian Registry is a prospective, multicentric screening involving 33 stroke units. FD was sought by measuring α-galactosidase A activity (males) and by genetic tests (males with reduced enzyme activity and females) in patients aged 18–60 years hospitalized for TIA, ischemic stroke, or intracerebral hemorrhage. We diagnosed FD in patients with 1) already known pathogenic GLA variants; 2) novel GLA variants if additional clinical, laboratory, or family-derived criteria were present. Results: Out of 1906 patients, we found a GLA variant in 15 (0.79%; 95%CI 0.44–1.29) with a certain FD diagnosis in 3 (0.16%; 95%CI 0.03–0.46) patients, none of whom had hemorrhage. We identified 1 novel pathogenic GLA variant. Ischemic stroke etiologies in carriers of GLA variants were: cardioaortic embolism (33%), small artery occlusion (27%), other causes (20%), and undetermined (20%). Mild severity, recurrence, previous TIA, acroparesthesias, hearing loss, and small artery occlusion were predictors of GLA variant. Conclusion: In this large multicenter cohort the frequency of FD and GLA variants was consistent with previous reports. Limiting the screening for GLA variants to patients with cryptogenic stroke may miss up to 80% of diagnoses. Some easily recognizable clinical features could help select patients for FD screening

Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

BACKGROUND: There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. AIMS: We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. METHODS: From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. RESULTS: The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21-2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13-8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66-12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31-0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97-0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19-0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6-0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02-1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02-1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25-2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26-3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08-2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55-0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up. CONCLUSIONS: Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits

Physical disability and cognitive impairment evolution in benign multiple sclerosis: a five years prospective study

Background. Benign multiple sclerosis (BMS) definition is generally based on a minimum disease duration (DD) during which a maximum expanded disability status scale (EDSS) score is reached. However, EDSS does not account sufficiently for cognitive deficits, which may be as disabling as motor impairment Objectives. To study prospectively the evolution of physical disability and cognitive performance of BMS patients Methods. Among 300 patients seen at Verona MS Center between January and June 2008, 36 patients with relapsing-remitting (RR) course, DD 6510 years, and EDSS score 642.0 were defined BMS cases. Of these, 24 gave consent for inclusion in the study along with 13 sex- and age-matched non-benign MS (n-BMS) patients with RR course, DD 6510 years and EDSS score from 2.5 to 4.5. The two groups were followed for 5 years with neurological examination at least every year and neuropsychological assessment at baseline and at study conclusion. Conventional MRI analysis was done for patients who had a brain scan with the same protocol in 2008 and 2013. Results. At inclusion BMS subjects were 41\ub18 years old (mean\ub1standard deviation) with median DD of 15 years (range 11-29) and median EDSS score 1.5 (range 0-2), while n-BMS patients were 46\ub18 years old, had median DD of 16 years (range 10-27) and median EDSS score 3.0 (range 2.5-4.5). At baseline 16% of patients in both groups failed two or more neuropsychological tests. After 5 years, 23 BMS and 12 n-BMS patients had completed the study. The EDSS score worsened in 8% and 46% of cases, respectively (p=0.008), while the proportion of patients with 652 failed neuropsychological tests at 5 years increased at 25% in both groups. BMS and n-BMS patients who failed 652 tests had a significantly worse work and financial status both at baseline and at 5 years follow-up even after excluding subjects with EDSS score >3.5. Brain MRI T2 lesion location and number increase over time were not significantly associated with neurological and cognitive outcomes. Conclusions. Patients classified as having BMS according to widely used criteria had better physical disability outcome at 5 years compared to n-BMS cases. However, rates of initial cognitive impairment and neuropsychological decline over time did not differ between the two groups, including the possible impact on work and social functioning. Neuropsychological testing is essential even in MS patients with minimal or no physical disability given the distinct trajectories followed by disease progression in cognitive and motor domains

Long-term clinical, cognitive and MRI characteristics of patients with untreated benign multiple sclerosis: a natural history study

Objective Benign multiple sclerosis (MS) is a debated clinical entity, due to the absence of objective biomarkers of such disease subtype. The aim of the present study is to identify clinical, cognitive and MRI features of MS patients with long disease duration and low physical disability level, who were never treated with disease-modifying drugs (DMDs). Materials and Methods MS patients (McDonald\u2019s criteria 2010) with at least 10 years of disease duration, EDSS score 643.5 and never exposed to DMDs were identified among 520 MS cases currently followed at Verona University Hospital MS Center. Patients accepting to participate in the study underwent neurological examination, cognitive assessment (Rao\u2019s battery and Stroop test) and brain MRI including 3D T1, FLAIR and DIR sequences. Other clinical variables were retrospectively collected at the time of the first visit at our Center and prospectively updated thereafter. Results Thirty-five patients fulfilling inclusion criteria were identified. Twenty-one (60%) were females, current mean age was 51 (\ub1 10) years, with mean age at onset 30 (\ub1 9) years, median disease duration 18 (10-64) years, median EDSS score at last follow-up (2013 or 2014) 1.0 (0-3), and relapsing-remitting clinical course in all cases. Fifty-per-cent of cases had sensory symptoms at onset, 72% recovered completely after the first clinical episode, 79% were free from relapses during the first and second year from onset, and 11% had no clinical relapses during the disease course. Up to now fourteen patients have completed neuropsychological evaluation: 8 resulted normal, 4 cognitively impaired ( 653 failed tests), and 2 had borderline results (1-2 failed tests). Of the 9 subjects who performed the MRI protocol, all had multiple disseminated T2 lesions in brain white matter, while 7 (78%) had at least one intracortical lesion. Six patients underwent both neuropsychological and MRI assessment: cortical lesions were detected in 3 cases with cognitive impairment and in 2 cases without; one subject had neither cognitive impairment nor cortical lesions. Discussion and Conclusions Sensory symptoms at onset, full recovery after the first clinical event, and absence of relapses during the first and second year from onset may be considered clinical predictors of a benign disease course. MS patients with low physical disability after 18 years from onset seem to maintain preserved cognitive functions, despite the presence of cortical involvement. High efficiency of CNS compensatory mechanisms, neuronal plasticity, and limited extension of cortical lesions may be hypothesized as possible explanations of our finding

Epileptic falling seizures associated with seizure-induced cardiac asystole in drug-resistant temporal lobe epilepsy

Clinical history: A 52-year-old gentleman with positive family history for epilepsy. At 1 year of age he suffered from prolonged febrile seizures. At 29 years, he started to present brief episodes of loss of contact, staring and psychomotor arrest, paleness, oro-alimentary and right-hand gestural automatisms; the episodes occurred usually once or twice per month. At 49 years, the episodes increased in frequency and about 50% of them started to be complicated by abrupt and sudden falls to the ground. Despite several antiepileptic treatments, his seizures were never completely controlled. The patient was admitted to undergo long-term video–EEG monitoring for presurgical evaluation. General history: Arterial hypertension; duodenal ulcer; chronic HVB hepatitis; deep venous thrombosis with pulmonary embolism; thrombophilia (heterozygous factor V Leiden mutation). Examination: Unremarkable. Right-handed (Oldfield score: +1). Brain MRI: Right mesial temporal sclerosis (Fig. 1). Interictal EEG: Sporadic theta activities occasionally associated with spikes during sleep in the right temporal leads. Long-term video-EEG monitoring: Three stereotyped seizures were recorded during a 10-day computerized video-EEG monitoring. All of them occurred while the patient was sitting, and displayed stereotyped electroclinical features: the clinical onset was characterized by psychomotor arrest, oscillations of the trunk, and then backward fall in two seizures, frontward in the third episode; then oro-alimentary and right-hand automatisms were observed. A very brief postictal state followed. Ictal EEG showed a brief flattening in the right fronto-temporal leads, followed by a rhythmic theta-delta discharge with phase reversal in F8-T4; then delta activity mainly confined to the right temporal leads appeared. The EKG lead showed periods of asystole whose durations ranged from 5 to 8 seconds, associated with the right temporal rhythmic theta activity (Fig. 2), then the heart rate progressively resumed to baseline. The fall of the patient occurred few seconds after the end of the asystole, when the heart rate was starting to recover