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Objective: Adenotonsillectomy is one of the most common surgical procedures performed on children. Caregivers are often concerned about voice change after the procedure, and such concerns remain unsettled. This meta‐analysis analyzed voice change in children after adenotonsillectomy. Data Sources: The PubMed, Medline, EMBASE, and Cochrane databases. Review Methods: The study protocol was registered on PROSPERO. Two authors independently searched for articles using keywords "adenoidectomy," "tonsillectomy, "voice," "nasalance,"and "speech." English articles specifying voice changes after adenotonsillectomy were pooled with standardized mean difference (SMD) using random‐effects model. Evaluation methods were computerized acoustic voice analysis, aerodynamic analysis, nasometer, rhinomanometry, evaluations from a speech‐language pathologist or otolaryngologist, and a caregiver assessment questionnaire. Results: Twenty‐three studies with 2154 children were analyzed (mean age: 8.0 y; 58% boys; mean sample size: 94 children). Due to insufficient data for other outcome variables, this meta‐analysis only summarized changes in the computerized acoustic voice analysis 1 month and 3 months after surgery. The computerized acoustic analysis revealed significant changes in jitter (SMD = −0.36; 95% confidence interval [CI]: −0.60 to −0.11), shimmer (SMD = −0.34; 95% CI: −0.57 to −0.11), and soft phonation index (SMD = −0.36; 95% CI: −0.57 to −0.15) at 1 month after surgery. Parameters including fundamental frequency, jitter, noise‐to‐harmonics ratio, and shimmer were not significantly changed at 3 months after surgery. Conclusions: This meta‐analysis observed small improvements in jitter, shimmer, and soft phonation index 1 month after surgery. No significant effects were observed in voice outcomes 3 months after surgery. Laryngoscope, 134:2538–2550, 2024 [ABSTRACT FROM AUTHOR]

Objectives: This study aims to identify characteristics in image‐based computational fluid dynamics (CFD) in children with obstructive sleep apnea (OSA). Design: Diagnostic study. Setting: Hospital‐based cohort. Participants: Children with symptoms suggestive of OSA were recruited and underwent polysomnography. Main outcome measures: Three‐dimensional models of computational fluid dynamics were derived from cone‐beam computed tomography. Results: A total of 68 children participated in the study (44 boys; mean age: 7.8 years), including 34 participants having moderate‐to‐severe OSA (apnea‐hypopnea index [AHI] greater than 5 events/h), and 34 age, gender, and body mass index percentile matched participants having primary snoring (AHI less than 1). Children with moderate‐to‐severe OSA had a significantly higher total airway pressure (166.3 vs. 39.1 Pa, p =.009), total airway resistance (9851 vs. 2060 Newton‐metre, p =.004) and velocity at a minimal cross‐sectional area (65.7 vs. 8.8 metre per second, p =.017) than those with primary snoring. The optimal cut‐off points for moderate‐to‐severe OSA were 46.2 Pa in the total airway pressure (area under the curve [AUC] = 73.2%), 2373 Newton‐metre in the total airway resistance (AUC = 72.5%) and 12.6 metres per second in the velocity at a minimal cross‐sectional area (AUC = 70.5%). The conditional logistic regression model revealed that total airway pressure, total airway resistance and velocity at minimal cross‐sectional area were significantly associated with an increased risk of moderate‐to‐severe OSA. Conclusions: This study demonstrates that CFD could be a useful tool for evaluating upper airway patency in children with OSA. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to elucidate the revision rate, time to revision, and factors associated with revision of endoscopic sinus surgery (ESS) in Taiwan. Design: Retrospective study. Setting: Population‐based analysis. Participant: We identified all in‐hospital patients, aged >20 years, who underwent ESS between 2000 and 2008 from the Taiwan National Health Insurance Research Database, and followed up with them until 2018. Main outcome measures: Factors associated with revision surgery were analyzed using multivariable Cox proportional hazard model. Results: Overall, 66 592 patients were identified (mean age, 46.3 years; 62% males). The revision rate was 14.5% (9644/66 592) and time to revision surgery was 5.9 years. Multivariable Cox proportional hazard model showed that young age, male gender (hazard ratio [HR] = 1.18; 95% confidence interval [CI], 1.13–1.23), having nasal polyposis (HR = 1.17; 95% CI, 1.12–1.22), having allergic rhinitis (HR = 1.08; 95% CI, 1.04–1.13), having asthma (HR = 1.26; 95% CI, 1.14–1.39), and surgical time of >4 h (HR = 1.11; 95% CI, 1.06–1.16) were associated with increased risk of revision surgery. Concurrent septal surgery (HR = 0.81; 95% CI, 0.76–0.87), turbinate surgery (HR = 0.91; 95% CI, 0.85–0.97), or septal and turbinate surgery (HR = 0.68; 95% CI, 0.64–0.73) were associated with decreased risks of revision surgery. Conclusion: In Taiwan, risk factors for revision ESS are young age, male gender, having nasal polyposis, having allergic rhinitis, having asthma, and long surgical times. Concurrent septal or turbinate surgery decreases the risk of revision. [ABSTRACT FROM AUTHOR]

(1) Background: Due to rapidly increasing average age of Taiwan's population, it is very important to analyze the factors affecting the survival of older adults. (2) Methods: In this study, the 1989 Taiwan Longitudinal Study on Aging, which lasted 22 years and consisted of seven surveys, was used. Furthermore, Cox and Aalen's time-dependent frailty models were used to analyze factors that affect the survival of older adults. (3) Results: Based on past literature, we selected 15 important factors that were closely associated with the survival of older adults and constructed six models based on these factors. The study results showed that, in addition to background characteristics, physical and mental conditions, activities of daily living (ADL), physical performance, and self-rated health had a huge association with the survival of older adults. (4) Conclusions: We selected ten variables (age, gender, population, education level, ADL status, physical performance, self-rated health, smoking, chewing betel nut, and the presence of a spouse), and their combinations were used to generate reduced models, which could be considered as important markers that affect and predict the survival of older adults. [ABSTRACT FROM AUTHOR]

Background: The reported prevalence of sleep disorders in children with chronic kidney disease (CKD) varies greatly. A quantitative meta-analysis to estimate the prevalence of sleep disorders among pediatric CKD patients may provide further information. Objectives: The objective of this study is to estimate the prevalence of sleep disorders in children with CKD. The study protocol was registered on PROSPERO (registration number CRD42021268378). Data sources: Two authors independently searched the PubMed, MEDLINE, EMBASE, and Cochrane review databases up to June 2021. Study eligibility criteria: Eligible studies include data of prevalence of sleep disorders in children with CKD. Study appraisal and synthesis methods: The prevalence of restless legs syndrome, sleep-disordered breathing, pediatric obstructive sleep apnea (i.e., apnea–hypopnea index > 1 event/h in polysomnography), excessive daytime sleepiness, and insomnia/insufficient sleep was estimated using a random-effects model. Subgroup analyses were conducted to compare the prevalence of sleep disorders between children on dialysis and not on dialysis. This meta-analysis included 12 studies with 595 children (mean age: 12.9 years; gender ratio: 55.6% boys; mean sample size: 49.6 patients). Results: The prevalence of restless legs syndrome in children with CKD was 21% (95% confidence interval [CI], 14–30%). The prevalence of sleep-disordered breathing, pediatric obstructive sleep apnea, excessive daytime sleepiness, and insomnia/insufficient sleep was 22% (95% CI, 12–36%), 34% (95% CI, 19–53%), 27% (95% CI, 17–41%), and 14% (95% CI, 7–27%), respectively. Subgroup analysis revealed the pooled prevalence of excessive daytime sleepiness was significantly higher in children on dialysis than in children not on dialysis (43.3% vs. 11.2%; P = 0.018). Children on dialysis also had a high prevalence of other sleeping disorders, although the differences did not reach statistical significance. Children with CKD exhibited a 3.9-fold (95% CI, 1.37 to 10.93) increased risk of restless legs syndrome and a 9.6-fold (95% CI, 3.57 to 25.76) increased risk of excessive daytime sleepiness compared with controls. Limitations: The selected papers are of small sample size, lack of a control group, and exhibit substantial heterogeneity. Conclusions: Sleep disorders are common in children with CKD. Our results indicate that while the prevalence rates of various sleep disorders were higher in children on dialysis than in children not on dialysis, the prevalence of excessive daytime sleepiness was statistically significant in children on dialysis. A higher resolution version of the Graphical abstract is available as Supplementary information. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether sleep surgery is associated with inflammatory cytokine changes. This study hypothesizes cytokines may change after surgery in adult obstructive sleep apnea (OSA). Study Design: Systematic review and meta‐analysis. Methods: The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched PubMed, Embase, and Cochrane review databases from their inception to June 2021. The keywords used were sleep apnea, inflammatory markers, cytokines, and surgery. The effects of sleep surgery on the apnea–hypopnea index (AHI) and inflammatory cytokines were evaluated using a random‐effects model. Both mean difference (MD) and standardized mean difference (SMD) of the changes in cytokines were calculated. Results: Nine studies with 235 adults were included (mean age: 43 years; 82% were men). After sleep surgery, AHI significantly reduced by −11.3 events/h (95% confidence interval [CI], −15.8 to −6.9). In total, 8 and 6 studies were pooled for examining tumor necrosis factor‐alpha (TNF‐α) and interleukin‐6 (IL‐6) levels, respectively. Sleep surgery significantly reduced TNF‐α levels, with an MD of −2.8 pg/ml (95% CI, −5.1 to −0.6) and an SMD of −0.56 (95% CI, −0.85 to −0.27). Furthermore, sleep surgery reduced IL‐6 levels, with an MD of −0.6 pg/ml (95% CI, −1.0 to −0.2) and an SMD of −0.66 (95% CI, −0.89 to −0.43). No covariates were identified to be correlated with cytokine changes in subgroup and meta‐regression analyses. Funnel plots showed possible publication bias in current data. Conclusions: In adults, OSA treatment with sleep surgery improves inflammatory cytokines. Laryngoscope, 132:2275–2284, 2022 [ABSTRACT FROM AUTHOR]

Objective: To evaluate blood pressure (BP) variability in 24-hour ambulatory BP monitoring in children with obstructive sleep apnea (OSA).Study Design: Case series study.Methods: Children aged 4 to 16 years with clinical symptoms were recruited in a tertiary medical center. Overnight polysomnography and 24-hour recordings of ambulatory BP were performed for each child. The severity of OSA was classified as primary snoring (apnea-hypopnea index [AHI] < 1), mild OSA (1 ≤ AHI < 5), moderate OSA (10 > AHI ≥ 5), and severe OSA (AHI ≥ 10). The standard deviation of mean BP was used as an indicator of BP variability.Results: A total of 550 children were included (mean age: 7.6 years; 70% were boys; 20% were obese). Compared with the children with primary snoring, children with severe OSA exhibited significantly higher nighttime systolic BP (108.0 vs. 100.5 mmHg, P < .001), nighttime diastolic BP (58.9 vs 55.6 mmHg, P = .002), nighttime mean arterial pressure (75.3 vs. 70.5 mmHg, P < .001), nighttime systolic BP load (40.5% vs. 25.0%, P < .001), nighttime diastolic BP load (25.3% vs. 12.9%, P < .001), and nighttime systolic BP variability (11.4 vs. 9.6, P = .001). Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP variability (regression coefficient = 0.31, 95% CI = 0.06-0.56, P = .015) after adjustment for age, gender, adiposity, and hypertensive status.Conclusions: OSA in children is associated with increased BP and BP variability.Level Of Evidence: 4 Laryngoscope, 131:2126-2132, 2021. [ABSTRACT FROM AUTHOR]

Purpose: The effects of sleep surgery on the lipid profile of adults diagnosed as having obstructive sleep apnea (OSA) remain unclear. This meta-analysis aimed to clarify whether sleep surgeries improve patients' lipid profile. Methods: The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched the PubMed, MEDLINE, EMBASE, and Cochrane review databases up to September 2020 using keywords such as sleep apnea, OSA, sleep apnea syndromes, lipids, and surgery. The effects of sleep surgery on the apnea–hypopnea index (AHI) and lipid profile parameters were evaluated using a random-effects model. Results: Thirteen studies were included, with a total of 710 patients (mean age: 42.0 years; 85% men; mean sample size: 54.6 patients). The summary estimate of AHI change was − 20.6 events/h (95% CI − 25.9 to − 15.3) and the Epworth Sleepiness Scale score was − 4.2 (95% CI − 5.9 to − 2.5). Sleep surgery lowered total cholesterol (mean − 7.7 mg/dL; 95% CI − 12.2 to − 3.2), low-density lipoprotein (mean − 7.2 mg/dL; 95% CI − 11.0 to − 3.3), and triglyceride (mean − 14.0 mg/dL; 95% CI − 22.2 to − 5.8) levels but did not affect high-density lipoprotein (mean 1.5 mg/dL; 95% CI − 0.6 to 3.7) levels. Subgroup analysis revealed that the lipid profile changes were not associated with the surgical procedure but with the degree of OSA improvement. Meta-regression analyses demonstrated that the improvement in the lipid profile was positively correlated with AHI reduction. Conclusion: Surgeries for OSA may improve the lipid profile, which is positively correlated with the degree of OSA improvement. [ABSTRACT FROM AUTHOR]

Rationale : In human beings and experimental animals, maladaptive impulsivity is manifested by the acute injection of psychostimulants, such as amphetamine. Cannabinoid CB1 receptors have been implicated in the regulation of stimulant-induced impulsive action, but the role of CB1 receptors in timing-related impulsive action by amphetamine remains unknown. Methods: Male rats were used in evaluating the effects of CB1 receptor antagonist and agonist (SR141716A and WIN55,212–2, respectively) systemically administered individually and combined with d-amphetamine on a differential reinforcement of low-rate response (DRL) task, an operant behavioral test of timing and behavioral inhibition characterized as a type of timing impulsive action. Results: A distinct pattern of DRL behavioral changes was produced by acute d-amphetamine (0, 0.5, 1.0, and 1.5 mg/kg) treatment in a dose-dependent fashion, whereas no significant dose effect was detected for acute SR141716A (0, 0.3, 1, and 3 mg/kg) or WIN55,212–2 (0, 0.5, 1, and 2 mg/kg) treatment. Furthermore, DRL behavior altered by 1.5 mg/kg d-amphetamine was reversed by a noneffective dose of SR141716A (3 mg/kg) pretreatment. The minimally influenced DRL behavior by 0.5 mg/kg d-amphetamine was affected by pretreatment with a noneffective dose of WIN55,212–2 (1 mg/kg). Conclusion: These findings reveal that the activation and blockade of CB1 receptors can differentially modulate the timing impulsive action of DRL behavior induced by acute amphetamine treatment. Characterizing how CB1 receptors modulate impulsive behavior will deepen our understanding of the cannabinoid psychopharmacology of impulsivity and may be helpful in developing an optimal pharmacotherapy for reducing maladaptive impulsivity in patients with some psychiatric disorders. [ABSTRACT FROM AUTHOR]

Congenital cytomegalovirus (cCMV) infection is the most prevalent cause of non-genetic sensorineural hearing loss (SNHL) in children. However, the prognostic determinants of SNHL remain unclear. Children with cCMV infection in a tertiary hospital were enrolled. The presence of cCMV-related symptoms at birth, the newborn hearing screening (NHS) results, and the blood viral loads were ascertained. Audiologic outcomes and initial blood viral loads were compared between different groups. Of the 39 children enrolled, 16 developed SNHL. SNHL developed in 60% of children who were initially symptomatic, and in 34.5% of those who were initially asymptomatic with normal hearing or isolated hearing loss, respectively. Failuire in NHS was a reliable tool for early detection of SNHL. The initial viral loads were higher in children who were symptomatic at birth, those who failed NHS, and those who developed SNHL. We observed SNHL deterioration in a patient after CMV DNAemia clearance was achieved, and in another patient with the flare-up of viral load. The presence of cCMV-related symptoms at birth, failure in NHS, and blood viral load might be the prognostic factors for hearing outcomes. Regular audiologic examinations are necessary in all children with cCMV infection even after CMV DNAemia clearance. [ABSTRACT FROM AUTHOR]

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Laryngopharyngeal reflux symptom is a troublesome upper esophageal problem, and reflux symptom index (RSI) is commonly applied for the assessment of clinical severity. We investigated the relationship between the upper esophageal sphincter impedance integral (UESII) and RSI scores in this study. Totally 158 subjects with high-resolution esophageal impedance manometry (HRIM) with RSI questionnaire assessment were recruited. There are 57 (36.08%), 74 (46.84%), 21 (13.29%), and 6 (3.79%) patients were categorized as normal, ineffective esophageal motility disorder, absent contractility, and achalasia by HRIM examination, respectively. Subjects with RSI > 13 were noted to have lower UESII than others with RSI ≦ 13 (7363.14 ± 1085.58 vs. 11,833.75 ± 918.77 Ω s cm; P < 0.005). The ROC analysis yielded a UESII cutoff of < 2900 Ω s cm for the best prediction of subjects with RSI > 13 (P = 0.002). Both female gender and UESII cutoff of < 2900 Ω s cm were significant predictors of RSI > 13 in logistic regression analysis (OR = 3.84 and 2.83; P = 0.001 and 0.01; respectively). Lower UESII on HRIM study, indicating poor bolus transit of UES during saline swallows, is significantly associated with prominent laryngopharyngeal reflux symptoms scored by RSI score. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To evaluate associations between sleep surgery and CRP (C‐reactive protein) levels in adults with obstructive sleep apnea (OSA). Study Design: Meta‐analysis. Methods: Two authors independently searched PubMed, Medline, EMBASE, and Cochrane review databases until July 2019. The keywords used were sleep apnea, OSA, sleep apnea syndromes, surgery, C‐reactive protein (CRP), and inflammatory markers. The effects of sleep surgery on CRP levels were examined using a random‐effects model. Results: Nine studies with 277 patients were analyzed (mean age: 46.5 years; 92% men; mean sample size: 30.8 patients). The mean change in the apnea–hypopnea index (AHI) after surgery was significantly reduced by −21.1 (95% confidence interval [CI], −28.4 to −13.7) events/hr. Overall, sleep surgery resulted in a significant reduction of CRP levels in patients with OSA (standardized mean difference [SMD] = −0.39, 95% CI, −0.67 to −0.11). Patients with postoperative AHI reduction >20 events/hr achieved a greater reduction in CRP than those with AHI reduction <20 events/hr (SMD: −0.72 vs. −0.14, P for heterogeneity =.007). According to subgroup analysis, differences in the CRP levels after surgery were nonsignificant in the different countries (i.e., United States vs. other countries), CRP types (i.e., CRP vs. high‐sensitivity CRP), surgical procedures (i.e., pharyngeal surgery vs. other surgical procedures), and follow‐up period (i.e., <6 vs. >6 months). Conclusions: Sleep surgery for OSA resulted in a significant reduction of CRP levels in adults. The beneficial effect of surgery on CRP levels is greater in patients with large improvement in OSA (i.e., AHI reduction >20 events/hr) after sleep surgery. Laryngoscope, 131:1180–1187, 2021 [ABSTRACT FROM AUTHOR]

This study investigated home care aides' (HCAs) oral health care experience, knowledge, and their intention to receive professional training, to explain and predict factors of their intention to receive such training. This cross-sectional study collected data through a structured questionnaire. HCAs affiliated with home care agencies in Taichung, Taiwan were recruited through purposive sampling. A total of 487 questionnaires were distributed from September to December 2015 with 280 valid responses collected (57.4%).This study predicted the factors of HCAs' intention to receive oral health care training through a decision tree analysis. The decision tree model classified the respondents with an accuracy of 77.5%. The optimal predictor variable was oral health care knowledge (χ2 = 66.662, p < 0.0001). Among the low-scoring respondents on oral health care knowledge, 76.4% were classified in the "uninterested" group, whereas 84.8% of the high scorers were classified in the "interested" group. The second best predictor variable was whether oral health care is part of the job responsibility (χ2 = 7.979, p = 0.007). Among those who answered Yes, 92.9% were in the interested group, as were 76.5% of those who answered No. It is recommended to add "disease and oral care-related content" and "safety protection, assessment, and usage of oral care tools during practical oral care process" to the oral healthcare training course content for HCAs in order to improve HCAs' oral healthcare knowledge and oral care skills. These research findings are valuable and may be taken into account in the future development of the in-service educational training of oral healthcare for HCAs. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to gather data that would enable us to suggest more specific guidelines for the management of children with airway disruption. Study Design Retrospective case series with data from five tertiary medical centers. Methods: Children younger than 18 years of age with a disrupted airway were enrolled in this series. Data pertaining to age, sex, etiology and location of the disruption, type of injury, previous surgery, presence of air extravasation, management, and outcome were obtained and summarized. Results: Twenty children with a mean age of 4.4 years (range 1 day–14.75 years) were included in the study. All were evaluated by flexible endoscopy and/or microlaryngoscopy in the operating room. Twelve (60%) children had tracheal involvement; seven had bronchial involvement; and one had involvement of the cricoid cartilage. Nine children had air extravasation, and all these children required surgical repair. Of the 11 who did not have air extravasation, only one underwent surgical repair. Complete healing of the disrupted airway was seen in all cases. Conclusion: This series suggests that if there is no continuous air extravasation demonstrated on imaging studies or clinical examination, nonoperative management may allow for spontaneous healing without sequelae. However, surgical repair may be considered in those patients with continuous air extravasation unless a cuffed tube can be placed distal to the site of injury. For children in whom airway injury occurs in a previously operated area, the risk of extravasation is reduced. This risk is also diminished if positive pressure ventilation can be avoided or minimized. Level of Evidence: 4 Laryngoscope, 131:921–924, 2021 [ABSTRACT FROM AUTHOR]

Congenital cytomegalovirus (cCMV) infection is the leading environmental cause of childhood hearing impairment. However, its significance remains largely undocumented in many regions of the world. The purpose of this study was to investigate the prevalence and clinical features of cCMV infection in East Asia. Neonates born at a municipal hospital in Taipei were prospectively recruited and underwent concurrent hearing and CMV screenings. Those who failed the hearing screening or screened positive for CMV were subjected to a focused audiological and/or virological surveillance. The characteristics of the newborns and their mothers were compared between the CMV-positive and CMV-negative groups. Of the 1,532 newborns who underwent concurrent hearing and CMV screenings, seven (0.46%) were positive for cCMV infection. All seven CMV-positive newborns were asymptomatic at birth, and none of them developed hearing or other symptoms during a follow-up period of 14.4±6.3 months. The mothers of the CMV-positive newborns demonstrated higher gravidity (2.4 ± 1.4 vs. 2.1 ± 1.2) and parity (2.0 ± 1.2 vs. 1.6 ± 0.7) than those in the CMV-negative group; however, the difference did not reach statistical significance. The prevalence of cCMV infection in Taipei newborns was 0.46%, which is slightly lower than that of other populations and that of a previous report in the Taiwanese population. The relatively low prevalence in this study might be attributed to the improved public health system and decreased fertility rate in Taiwan. [ABSTRACT FROM AUTHOR]

Objective: Cone‐beam computed tomography (CBCT) offers three‐dimensional structures in assessing upper airway of patients. This study aims to compare the cone‐beam computerized tomography scan measurements between children with obstructive sleep apnea (OSA) and primary snoring. Study Design: Case–control study. Methods: This prospective study was conducted in a tertiary referral center. Thirty‐six children with moderate‐to‐severe OSA (with apnea‐hypopnea index [AHI] > 5 events/hour) and 36 age‐, gender‐, and obesity‐matched children with primary snoring (AHI <1) were enrolled. The measurements in CBCT parameters were compared between children with moderate‐to‐severe OSA and primary snorers by conditional logistic regression model. Results: A total of 72 children (mean age, 7.9 ± 2.8 years; 64% male) were included. Children with moderate‐to‐severe OSA had a significantly smaller nasopharyngeal (2900 ± 1400 vs. 3800 ± 1800 mm3, P =.017) and oropharyngeal airway volume (5600 ± 2700 vs. 7400 ± 4000 mm3, P =.026) than those with primary snoring. Children with moderate‐to‐severe OSA, as compared to primary snorers, also had a significantly smaller minimal airway area in nasopharynx (77.4 ± 37.7 vs. 107.7 ± 52.0 mm2, P =.006) and oropharynx (66.6 ± 61.9 vs. 101.6 ± 65.8 mm2, P =.023). Moreover, the airway length was not significantly different between children with moderate‐to‐severe OSA and primary snoring. Conclusions: The three‐dimensional CBCT airway analysis could be used as a useful tool to evaluate upper airway in children with OSA. Level of Evidence: 3 Laryngoscope, 131:680–685, 2021 [ABSTRACT FROM AUTHOR]

Keywords: branchial cleft anomalies; fistula; suppuration; thyroid nodule; thyroiditis; ultrasonography EN branchial cleft anomalies fistula suppuration thyroid nodule thyroiditis ultrasonography 110 115 6 01/01/21 20210101 NES 210101 Key points Head and neck ultrasound can be used as a non-invasive image modality for the diagnosis of congenital pyriform sinus fistula (CPSF) in children. If an initial barium esophagogram fails to reveal the sinus tract, repeated study is suggested 4-6 weeks later, following remission of the infectious process.4 CT and MR imaging with contrast medium are helpful diagnostic modalities for cases that present with a solid neck mass or acute swelling of a cervical cyst. Hosokawa et al7 described detailed ultrasonic findings of the caudal site of the sinus tract of the lateral cervical sinus, a hypoechoic sinus tract located between the internal and external carotid arteries; the caudal site of the lateral cervical sinus extends antero-superiorly to the external carotid artery. Gan et al9 reported the ultrasonic findings of three cases of pyriform sinus fistula: two presented with an abscess involving the thyroid gland and adjacent tissue, the other presented with a hyperechoic line of the gas pocket within the fistula. [Extracted from the article]

Objective: Adenotonsillectomy outcomes in obstructive sleep apnea (OSA) treatment among children with Prader-Willi syndrome (PWS) remain unclear. This study aimed to elucidate the effectiveness of adenotonsillectomy in OSA treatment among children with PWS.Data Source: PubMed, MEDLINE, Embase, and Cochrane Review up to February 2019.Review Methods: The registry number of the protocol published on PROSPERO was CRD42015027053. Two authors independently searched the relevant database. Polysomnography outcomes in these children were examined, including net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum and mean oxygen saturation, the overall success rate for a postoperative AHI <1, and the overall success rate for a postoperative AHI <5.Results: Six studies with 41 patients were analyzed (mean age, 5.0 years; 55% boys; mean sample size, 6.8 patients). All children had PWS and received adenotonsillectomy for the treatment of OSA. The AHI was 13.1 events per hour (95% CI, 11.0-15.1) before surgery and 4.6 events per hour (95% CI, 4.1-5.1) after surgery. The mean change in the AHI was a significant reduction of 8.0 events per hour (95% CI, -10.8 to -5.1). The overall success rate was 21% (95% CI, 11%-38%) for a postoperative AHI <1 and 71% (95% CI, 54%-83%) for a postoperative AHI <5. Some patients developed velopharyngeal insufficiency postoperatively.Conclusion: Adenotonsillectomy was associated with OSA improvement among children with PWS. However, residual OSA was frequently observed postoperatively in these patients. [ABSTRACT FROM AUTHOR]

Objective: Treatment for laryngopharyngeal reflux disease (LPRD) is challenging because of delays in recognition and poor responsiveness to proton-pump inhibitor therapy. The aim of this study was to determine the efficacy and safety of liquid alginate suspension for treating LPRD.Methods: A double-blind, placebo-controlled, prospective study comparing 8 weeks of treatment with Alginos Oral Suspension (TTY Biopharm Co. Ltd., Taipei, Taiwan) (sodium alginate 1,000 mg three times daily) with a placebo was conducted on patients who fulfilled the criteria of at least one symptom consistent with LPRD, a total reflux symptom index (RSI) score of > 10, and a total reflux finding score (RFS) of > 5. Those with erosive gastroesophageal reflux disease, as evidenced through screened transnasal upper gastrointestinal endoscopy, were excluded. Efficacy was assessed by RSI, RFS, and ambulatory multichannel intraluminal impedance and pH (MII-pH) monitoring.Results: A total of 80 patients aged 22 to 72 years were enrolled. Compared with baseline, both Alginos (TTY Biopharm Co. Ltd.) and the placebo significantly reduced the total RSI (P < 0.001) and the total number of reflux episodes shown by MII-pH monitoring (P < 0.05) after 8 weeks of treatment. However, liquid alginate suspension was unable to show superiority over the placebo. The incidence of various adverse events from Alginos (TTY Biopharm Co. Ltd.) was relatively low (7.7%) and mild.Conclusion: This study showed that liquid alginate suspension was well tolerated by LPRD patients. It effectively improved symptoms and reflux numbers but was unable to show superiority over placebo. As observed in previous studies, a great placebo effect was present. The importance of lifestyle modification could not be overlooked.Level Of Evidence: 2. Laryngoscope, 128:2252-2260, 2018. [ABSTRACT FROM AUTHOR]

Aim: To determine the characteristics associated with developing a new need for long‐term care among older Taiwanese adults. Methods: We analyzed the 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging. A total of 1986 persons who were aged ≥70 years and had no disability in activities of daily living or need for long‐term care at the baseline served as the study participants. We first identified the potential variables associated with developing a need for long‐term care in demographic, socioeconomic, anthropometric, functional status, mental health, medical and global domains based on the literature and our earlier studies. We then carried out univariable logistic regression analyses to identify the variables most strongly associated with developing a new need for long‐term care within each domain. Variables showing the strongest association were further analyzed in a forward stepwise multivariable logistic regression model to determine the significant predictors. Results: The multivariable model identified age, sex, doing heavy housework, walking 200 m, carrying out calculation, appetite status, frequency of hospitalizations during the past 12 months, living arrangement and weight loss as significant (P < 0.05) predictors. Conclusions: The present study identified nine characteristics that predict the subsequent 4‐year new need for long‐term care of ≥70‐year‐old Taiwanese adults. Age, sex and functional status are the most powerful predictors. The results are useful for identifying older individuals at risk of developing a new need for long‐term care within the next 4 years, enabling implementation of preventive strategies or timely care planning. Geriatr Gerontol Int 2019; 19: 641–646. [ABSTRACT FROM AUTHOR]

Objective: To investigate 24-hour ambulatory blood pressure changes 6 months after surgery among children with obstructive sleep apnea.Study Design: Prospective interventional study.Setting: Tertiary medical hospital.Subjects and Methods: Children aged 4 to 16 years with symptoms of obstructive sleep apnea (apnea-hypopnea index >1) were recruited. All children underwent adenotonsillectomy and postoperative polysomnography overnight. The 24-hour ambulatory blood pressure was measured before and 6 months after surgery.Results: The study cohort enrolled 124 children: mean (SD) age, 7.3 (3.1) years; 73% boys. After surgery, the apnea-hypopnea index significantly decreased from 13.3 (18.1) to 3.3 (7.2) events per hour ( P < .001). Overall systolic blood pressure and diastolic blood pressure were not significantly different following surgery, while daytime systolic blood pressure was slightly increased (114.3 to 117.3 mm Hg, P < .01) postoperatively. The hypertensive group (n = 43) exhibited significantly decreased levels of overall diastolic, nighttime systolic, and nighttime diastolic blood pressure ( P < .05), and 54% of hypertensive children became nonhypertensive after surgery. The nonhypertensive group (n = 81) showed slightly increased levels of nocturnal overall systolic, daytime systolic, and nighttime systolic blood pressure. A generalized linear mixed model revealed that children with hypertension had a greater decrease in systolic and diastolic ambulatory blood pressure during the daytime and nighttime (all P < .05) than those without hypertension.Conclusions: Ambulatory blood pressure changes after adenotonsillectomy among children with obstructive sleep apnea are minimal. The decrease in ambulatory blood pressure after surgery is more prominent for hypertensive children than nonhypertensive children. [ABSTRACT FROM AUTHOR]

Objective: To investigate readmissions among adult inpatients who underwent uvulopalatopharyngoplasty (UPPP) in Taiwan.Design: Population-based survey.Setting: Retrospective study with the National Health Insurance Database.Methods: All cases of inpatient adult UPPP (age >20 years) from 1997 to 2012 were identified through International Classification of Diseases, Ninth Revision, Clinical Modification. Factors associated with readmission within 30 days after surgery were analyzed.Results: A total of 38,839 adults with UPPP were identified (mean age, 39.3 years; men, 73.7%). The incidence of UPPP was 14.6 per 100 000 adults, which increased from 1997 to 2012 (6.7 to 16.7 per 100,000, Ptrend < .001). The rates of readmission for any reason, readmission for bleeding, reoperation for bleeding, and 30-day mortality were 4.2%, 1.7%, 1.0%, and 0.14%, respectively. Young age increased the risk of reoperation for bleeding, and old age increased the risk of readmission for any reason and mortality. Men had an increased risk of readmission and reoperation. Hypertension was associated with an increased risk of readmission for any reason (odds ratio [OR], 1.29; 95% CI, 1.10-1.51), bleeding-related readmission (OR, 1.89; 95% CI, 1.52-2.36), and reoperation (OR, 2.47; 95% CI, 1.84-3.30). Concurrent hypopharyngeal surgery was associated with an increased risk of readmission for any reason (OR, 1.34; 95% CI, 1.07-1.66) and bleeding-related readmission (OR, 1.69; 95% CI, 1.25-2.27). Finally, the use of steroids was associated with an increased risk of bleeding-related readmission and reoperation.Conclusions: The incidence of adult UPPP increased from 1997 to 2012 in Taiwan. Age, sex, comorbidity, concurrent hypopharyngeal surgery, and drug administration were associated with readmission after inpatient UPPP. [ABSTRACT FROM AUTHOR]

Genetic factors are an important cause of idiopathic sensorineural hearing impairment (SNHI). From the epidemiological perspective, mutations of three deafness genes: GJB2, SLC26A4, and MT-RNR1, are much more prevalent than those of other genes worldwide. However, mutation spectra of common deafness genes differ remarkably across different populations. Here, we performed comprehensive genetic examination and haplotype analyses in 188 unrelated Mongolian families with idiopathic SNHI, and compared their mutation spectra and haplotypes to those of other European and Asian cohorts. We confirmed genetic diagnoses in 18 (9.6%) of the 188 families, including 13 with bi-allelic GJB2 mutations, three with bi-allelic SLC26A4 mutations, and two with homoplasmic MT-RNR1 m.1555A>G mutation. Moreover, mono-allelic mutations were identified in 17 families (9.0%), including 14 with mono-allelic GJB2 mutations and three with mono-allelic SLC26A4 mutations. Interestingly, three GJB2 mutations prevalent in other populations, including c.35delG in Caucasians, c.235delC in East Asians, and c.-23+1G>A in Southwest and South Asians, were simultaneously detected in Mongolian patients. Haplotype analyses further confirmed founder effects for each of the three mutations, indicating that each mutation derived from its ancestral origin independently. By demonstrating the unique spectra of deafness-associated mutations, our findings may have important clinical and scientific implications for refining the molecular diagnostics of SNHI in Mongolian patients, and for elucidating the genetic relationships among Eurasian populations. [ABSTRACT FROM AUTHOR]

Summary: The single‐instruction multiple‐data (SIMD) computing capability of modern processors is continually improved to deliver ever better performance and power efficiency. For example, Intel has increased SIMD register lengths from 128 bits in streaming SIMD extension to 512 bits in AVX‐512. The ARM scalable vector extension supports SIMD register length up to 2048 bits and includes predicated instructions. However, SIMD instruction translation in dynamic binary translation has not received similar attention. For example, the widely used QEMU emulates guest SIMD instructions with a sequence of scalar instructions, even when the host machines have relevant SIMD instructions. This leaves significant potential for performance enhancement. We propose a newly designed SIMD translation framework for dynamic binary translation, which takes advantage of the host's SIMD capabilities. The proposed framework has been built in HQEMU, an enhanced QEMU with a separate thread for applying LLVM optimizations. The current prototype supports ARMv7, ARMv8, and IA32 guests on the X86‐64 AVX‐2 host. Compared with the scalar‐translation version HQEMU, our framework runs up to 1.84 times faster on Standard Performance Evaluation Corporation 2006 CFP benchmarks and up to 6.81 times faster on selected real applications. [ABSTRACT FROM AUTHOR]

Although naturally adopting an embarrassingly parallel paradigm, Ray-Tracing is also categorized as an irregular program that is troublesome to run on graphics processing units (GPUs). Conventional designs suffer from a performance penalty due to the irregularity of the control flow and memory access caused by incoherent rays. This work aims to explore the hidden coherency of rays by designing a feedback-guided mechanism that serves the following concept: extraction of the hidden regular portions out of the irregular execution flow. The method records the correlation of ray attributes and the traversed path and groups the newly generated rays to reduce potential irregularities for the ongoing execution. This mechanism captures the information from the entire ray space and can extract the hidden coherency from both primary and derived rays. The result leads to performance gains and an increase in resource utilization. The performance becomes 2 to 2.5 times higher than the original GPU and CPU versions. [ABSTRACT FROM AUTHOR]

Recent trends in SIMD architecture have tended toward longer vector lengths, and more enhanced SIMD features have been introduced in newer vector instruction sets. However, legacy or proprietary applications compiled with short-SIMD ISA cannot benefit from the long-SIMD architecture that supports improved parallelism and enhanced vector primitives, resulting in only a small fraction of potential peak performance. This article presents a dynamic binary translation technique that enables short-SIMD binaries to exploit benefits of new SIMD architectures by rewriting short-SIMD loop code. We propose a general approach that translates loops consisting of short-SIMD instructions tomachine-independent IR, conducts SIMD loop transformation/ optimization at this IR level, and finally translates to long-SIMD instructions. Two solutions are presented to enforce SIMD load/store alignment, one for the problem caused by the binary translator's internal translation condition and one general approach using dynamic loop peeling optimization. Benchmark results show that average speedups of 1.51× and 2.48× are achieved for an ARM NEON to x86 AVX2 and x86 AVX-512 loop transformation, respectively. [ABSTRACT FROM AUTHOR]

Background: To appraise the ability of a radiomics based analysis to predict local response and overall survival for patients with hepatocellular carcinoma.Methods: A set of 138 consecutive patients (112 males and 26 females, median age 66 years) presented with Barcelona Clinic Liver Cancer (BCLC) stage A to C were retrospectively studied. For a subset of these patients (106) complete information about treatment outcome, namely local control, was available. Radiomic features were computed for the clinical target volume. A total of 35 features were extracted and analyzed. Univariate analysis was used to identify clinical and radiomics significant features. Multivariate models by Cox-regression hazards model were built for local control and survival outcome. Models were evaluated by area under the curve (AUC) of receiver operating characteristic (ROC) curve. For the LC analysis, two models selecting two groups of uncorrelated features were analyzes while one single model was built for the OS analysis.Results: The univariate analysis lead to the identification of 15 significant radiomics features but the analysis of cross correlation showed several cross related covariates. The un-correlated variables were used to build two separate models; both resulted into a single significant radiomic covariate: model-1: energy p < 0.05, AUC of ROC 0.6659, C.I.: 0.5585-0.7732; model-2: GLNU p < 0.05, AUC 0.6396, C.I.:0.5266-0.7526. The univariate analysis for covariates significant with respect to local control resulted in 9 clinical and 13 radiomics features with multiple and complex cross-correlations. After elastic net regularization, the most significant covariates were compacity and BCLC stage, with only compacity significant to Cox model fitting (Cox model likelihood ratio test p < 0.0001, compacity p < 0.00001; AUC of the model is 0.8014 (C.I. = 0.7232-0.8797)).Conclusion: A robust radiomic signature, made by one single feature was finally identified. A validation phases, based on independent set of patients is scheduled to be performed to confirm the results. [ABSTRACT FROM AUTHOR]

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Objectives/hypothesis: To investigate the effects of diseases severity on postoperative complications following adenotonsillectomy (T&A) in children with sleep-disordered breathing (SDB).Study Design: Retrospective study.Methods: Children aged <18 years were enrolled and underwent T&A for treating SDB. Polysomnography was used to classify the disease severity: primary snoring (apnea-hypopnea index [AHI] <1), mild (AHI = 1-5), moderate (AHI = 5-10), and severe obstructive sleep apnea [OSA] (AHI ≥10). Postoperative bleeding was graded using a severity scale (level I, self-reported bleeding; level II, requiring inpatient admission; level III, requiring reoperation). Primary bleeding is defined as hemorrhage occurring within the initial 24 postoperative hours. Perioperative respiratory complications are defined as oxygen saturation of less than 90%, 92%, or 95% in the recovery room. Major respiratory complications include laryngospasm, pulmonary edema, pneumonia, and intubation at recovery stage.Results: A total of 610 children were included, of whom 42 (6.9%), eight (1.3%), and six (1.0%) children showed levels I, II, and III postoperative bleeding, respectively. Only one child had primary bleeding. The incidence and timing of postoperative bleeding did not differ significantly for children with different OSA severities. The rate of perioperative respiratory complications ranged from 1.6% to 14.3% on the basis of their definitions. The Cochran-Armitage test supported the trend that perioperative respiratory complications increase with the AHI. Six children developed major respiratory complications, which were not significantly associated with OSA severity.Conclusions: Children with severe OSA have increased risks of perioperative respiratory complications. However, OSA severity does not influence major respiratory complications or postoperative bleeding in children.Level Of Evidence: 4. Laryngoscope, 127:2646-2652, 2017. [ABSTRACT FROM AUTHOR]

Ray-tracing has received great attention over the years due to the high demand for global illumination appliances. Due to its embarrassingly parallel characteristics, the ray-tracing algorithm has been ported to the graphics processing unit (GPU) on heterogeneous systems that run thousands of threads in a single-instruction-multiple-thread fashion. However, the irregularity of ray-tracing causes a performance penalty on the GPU. The control flow divergence and early-termination problems severely degrade the hardware utilization, which makes the GPU computation inefficient while traversing through each iteration of the algorithm. Furthermore, additional overheads caused by data marshalling and load unbalancing negate the benefits of using heterogeneous systems. To tackle these issues, we designed a pipeline-based runtime methodology that leverages the features of heterogeneous system architecture (HSA)-compliant heterogeneous frameworks, such as shared virtual memory and fast kernel dispatching. This method merges the workloads from different iteration stages and dispatches them simultaneously. The merged workload is further assigned to a heterogeneous queue to enhance load balancing and scalability. With the proposed technologies, the performance of ray-tracing is enhanced significantly while effectively increasing the utilization of HSA-compliant heterogeneous systems. Based on the experiment results, the throughput becomes 4.37 times greater than the original setup on average in a single GPU mode and would always yield a greater throughput with a heterogeneous queue on multiple cores. [ABSTRACT FROM PUBLISHER]

There is a lack of population-level analysis of revision adenoidectomy in children. This study reveals the revision rates and factors associated with paediatric revision adenoidectomy in Taiwan. From the Taiwan National Health Insurance Research Database, we identified all in-hospital children (age <18 years) who underwent adenoidectomy between 2000 and 2007. All children had received at least 5 years of follow-up from the index date, and the clinical records until 2012 were examined. Factors affecting the paediatric revision adenoidectomy were analysed using the multivariable Cox proportional hazards model. A total of 10,396 children were enrolled (mean age 7.3 years; 66% boys; mean follow-up period 8.7 years). Two hundred and seventy-five children underwent revision adenoidectomy, and the mean interval between primary adenoidectomy and revision surgery was 2.97 years. Only 58.5% of children underwent revision surgery at the initial hospital. The incidence of revision surgery was highest in the second year (0.69%), followed by the third year (0.53%) after primary adenoidectomy. The multivariable Cox proportional hazards model revealed that young age [hazard ratio (HR) = 0.8], male gender (HR = 1.57), surgery at an eastern hospital (HR = 2.08), surgical indication of adenoid hypertrophy (HR = 1.51), and concurrent ventilation tube insertion (HR = 2.61) or nasal surgeries (HR = 4.84) were associated with revision adenoidectomy. The incidence of revision adenoidectomy in Taiwan was 2.6%. Male gender, young age, concurrent nasal or ventilation tube insertion, and surgery at an eastern hospital increased the risk of revision. [ABSTRACT FROM AUTHOR]

Aim To evaluate the predictive abilities of single items and their combinations in the instrumental activities of daily living and Nagi scales to predict emerging care-need of older adults. Methods We analyzed the 1999 (baseline) and 2003 (end-point) datasets of the Taiwan Longitudinal Study on Aging. After excluding the proxy respondents, incomplete data or those who had care-need at baseline, 2521 of the 2890 participants (aged ≥65 years at baseline) were included in data analysis. Care-need was defined as a person receiving formal or informal care, or having any activities of daily living dependency. The predictive abilities of the items in instrumental activities of daily living or Nagi scale, singly or in combination to predict emerging care-need during the subsequent 4 years were evaluated by the improvement in values of Nagelkerke R2, Akaike information criterion and Bayesian information criterion in logistic regression models. Results The single item 'doing heavy housework' showed the best predictive abilities among all others. When combined this item with 'walking 200 m,' the two-item indicator significantly improved the predictive abilities. However, no three-item combined indicator improved the predictive abilities. Conclusions The two-item indicator that combines 'doing heavy housework' and 'walking 200 m' from the instrumental activities of daily living and Nagi scales showed superior ability to predict emerging care-need of older Taiwanese. The indicator could serve as the foundation for developing a scale to predict emerging care-need of older adults. Geriatr Gerontol Int 2017; 17: 375-381. [ABSTRACT FROM AUTHOR]

Objective: The prevalence of metabolic syndrome (MS) has increased rapidly in Taiwan and worldwide. We aim to determine the association between sleep-disordered breathing (SDB) and MS in a Chinese general population. Methods: This case-control study recruited subjects who have undergone a prospective electrocardiogram-based cardiopulmonary coupling (CPC) sleep spectrogram as part of the periodic health check-ups at the National Taiwan University Hospital. Comprehensive anthropometrics, blood biochemistry, prevalence of MS and its individual components were compared with Bonferroni correction between 40 subjects with SDB, defined as the CPC-derived apnea–hypopnea index (CPC-AHI) >5 event/hour and 80 age- and sex-matched controls, defined as CPC-AHI <1 event/hour. MS was diagnosed based on the Adult Treatment Panel III, with a modification of waist circumference for Asians. Results: Subjects with SDB were more obese with larger waist circumferences (95.1±12.9 vs. 87.3±6.9, P < .001) and borderline higher BMI (27.0±4.9 vs. 24.3±2.5, P = .002). Waist circumference was independently associated with the presence of SDB after adjustment for BMI, systolic blood pressure and fasting blood glucose in multiple regression analyses. Subjects with SDB had a higher prevalence of central obesity (72.5% vs. 42.5%, P = .002), hyperglycemia (45.0% vs. 26.3%, P = .04), MS (45.0% vs. 22.5%, P = .01) and number of MS components (2.4 ± 1.6 vs. 1.7 ± 1.4, P = .01) than the control group. Waist circumference was significantly correlated with both CPC-AHI (r = .492, P = .0013) and PSG-AHI (r = .699, P < .0001) in the SDB group. Conclusions: SDB was associated with a higher prevalence of MS and its individual components, notably central obesity, in a Chinese general population. Large-scale screening of high risk population with MS to identify subjects with SDB for appropriate management is warranted. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To develop a clinical risk prediction model that identifies children with obstructive sleep apnea (OSA) in a clinical setting by examining the symptoms, physical status, and OSA-18 questionnaire results.Design: Single institutional, cross-sectional study.Methods: Children aged 2 to 18 years with symptoms of OSA were enrolled. Pediatric OSA was diagnosed through full-night polysomnography. Clinical data, namely demographics, symptoms, OSA-18 survey results, tonsil and adenoid sizes, and the weight of each child, were examined for constructing a simple point-based clinical model for OSA prediction. Variables for the risk model were selected using multivariable logistic regression analyses.Results: Of the 310 participants (mean age, 7.6 ± 3.7 years; boys, 67%), 170 (55%) experienced OSA. Modeling variables were determined using several univariate logistic regression analyses, followed by multivariable logistic regression analyses. A point-based clinical model incorporating the age, tonsil size (5 points maximum), adenoid size (5 and 20 points for age > 6 years and < 6 years, respectively), obesity (5 points for age > 6 years), and breathing pauses (5 points) was developed (area under the curve = 0.832). Moreover, the optimal cutoff points for predicting the apnea-hypopnea index of > 1 and > 5 were 10 (sensitivity, 72.9%; specificity, 65.0%) and 12 (sensitivity, 77.5%; specificity, 56.9%), respectively. Internal validation using the bootstrap method revealed no apparent overfitting problem.Conclusion: A novel clinical prediction model was developed for determining the risk of pediatric OSA; the model can be useful in identifying high-risk patients among those with sleep disturbances.Level Of Evidence: 4. Laryngoscope, 126:2403-2409, 2016. [ABSTRACT FROM AUTHOR]