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In previous studies, researchers have used singing to treat respiratory function in patients with spinal cord injury. However, few studies have examined the way in which vocal training affects respiratory neural plasticity in patients with spinal cord injury. Vocal respiratory training (VRT) is a type of vocal muscle-related treatment that is often a component of music therapy (MT) and focuses on strengthening respiratory muscles and improving lung function. In this randomized controlled study, we analyzed the therapeutic effects of VRT on respiratory dysfunction at 3 months after cervical spinal cord injury. Of an initial group of 37 patients, 26 completed the music therapy intervention, which comprised five 30-minute sessions per week for 12 weeks. The intervention group (n = 13) received VRT training delivered by professional certified music therapists. The control group (n = 13) received respiratory physical therapy delivered by professional physical therapists. Compared with the control group, we observed a substantial increase in respiratory function in the intervention group after the 12-week intervention. Further, the nerve fiber bundles in the respiratory center in the medulla exhibited a trend towards increased diversification, with an increased number, path length, thickness, and density of nerve fiber bundles. These findings provide strong evidence for the effect of music therapeutic VRT on neural plasticity. This study was approved by the Ethics Committee of China Rehabilitation Research Center (approval No. 2020-013-1) on April 1, 2020, and was registered with the Chinese Clinical Trial Registry (registration No. ChiCTR2000037871) on September 2, 2020.

The study objective was to evaluate the association between cervical spondylosis (CS) and a subsequent diagnosis of obstructive sleep apnea (OSA) in light of the expected constricting impact of CS-associated cervical spine changes on the pharyngeal airway space, a key contributor to OSA.Data were retrieved from the Taiwan National Health Insurance Research Dataset. A total of 98,234 patients who newly received a diagnosis of OSA were identified. We identified four propensity score-matched controls per OSA patient (n = 392,936). Chi-square tests were used to compare cases and controls on sociodemographic characteristics, and multivariable logistic regression modelling to examine the association of OSA with prior CS.Of the 98,234 sampled patients, 18,070 (18.4%) patients had a prior CS diagnosis, significantly different among cases compared to controls, being 18.4% and12.1%, respectively, p 0.001. Logistic regression analysis showed an adjusted odds ratio (OR) of prior CS of 1.778 (95% confident interval (CI): 1.744-1.814) relative to controls. The adjusted odds of prior CS without myelopathy was 1.764 for cases relative to controls (95% CI: 1.727-1.801), and for prior CS with myelopathy (adjusted OR: 1.778, 95% CI: 1.721-1.837). Analysis stratified by age showed that in the 45-64- and64-year age groups, the adjusted ORs of CS were 1.803 (95% CI: 1.758-1.850) and 1.634 (95% CI: 1.568-1.703), respectively, for cases relative to controls.Our results suggest that OSA is associated with prior CS. The results call for professionals to be alert to the possibility of subsequent development of OSA among patients with CS.

Background Tinnitus due to hyperactivity across neuronal ensembles along the auditory pathway is reported. We hypothesized that trigeminal neuralgia patients may subsequently suffer from tinnitus. Using nationwide, population-based data and a retrospective cohort study design, we investigated the risk of tinnitus within 1 year following trigeminal neuralgia. Methods We used the Taiwan National Health Insurance Research Dataset, a claims database, to identify all patients diagnosed with trigeminal neuralgia from January 2001 to December 2014, 12,587 patients. From the remaining patients, we identified 12,587 comparison patients without trigeminal neuralgia by propensity score matching, using sex, age, monthly income, geographic region, residential urbanization level, and tinnitus-relevant comorbidities (hyperlipidemia, diabetes, coronary heart disease, hypertension, cervical spondylosis, temporomandibular joint disorders and injury to head and neck and index year). All study patients (n = 25,174) were tracked for a one-year period to identify those with a subsequent diagnosis of tinnitus over 1-year follow-up. Results Among total 25,174 sample patients, the incidence of tinnitus was 18.21 per 100 person-years (95% CI = 17.66 ~ 18.77), the rate being 23.57 (95% CI = 22.68 ~ 24.49) among patients with trigeminal neuralgia and 13.17 (95% CI = 12.53 ~ 13.84) among comparison patients. Furthermore, the adjusted Cox proportional hazard ratio for tinnitus in the trigeminal neuralgia group was 1.68 (95% CI = 1.58 ~ 1.80) relative to the comparison cohort. Conclusions We found a significantly increased risk of tinnitus within 1 year of trigeminal neuralgia diagnosis compared to those without the diagnosis. Further studies in other countries and ethnicities are needed to explore the relationship between trigeminal neuralgia and subsequent tinnitus.

BACKGROUND This study aimed to evaluate the association between pioglitazone use and the occurrence of head and neck cancer. METHODS Data for this case-control study were retrieved from the Taiwan National Health Insurance Research Database. A total of 21 464 diabetic patients newly diagnosed with head and neck cancers were identified. We used propensity score matching to select 64 392 comparison patients (3:1 ratio). Multiple logistic regression modeling was used to examine the association of head and neck cancer with pioglitazone use in the 5 years preceding the cancer diagnosis. RESULTS Bivariate analysis showed a significant difference in the prevalence of prior using pioglitazone between cases and controls (19.3% vs 18.5%, P

Purpose. To identify potential biomarkers and/or therapeutic targets for bladder cancer we characterized and analysed the composition of the urinary microbiota from bladder cancer and non-cancer patients. Methodology. In this study, we collected urine samples from 29 bladder cancer patients and 26 non-cancer patients. To avoid contamination and the impact of antibiotics, urine specimens were collected in a clean manner prior to antibiotic administration. Using the amplicon-based next-generation sequencing approach, the potential determinant bacteria were estimated in a between-group comparison. The results illustrated the differences in microbiota abundance among cancer and non-cancer patients and the overall number of cases carrying these bacteria. Results. We found that the urine samples contained a conserved microbiota with four phyla ( Firmicutes , Actinobacteria , Proteobacteria and Bacteroidetes ), which accounted for 94.4 % of bacteria in all cases. Comparing the microbiota between the bladder cancer and control group, five genera of bacteria ( Streptococcus , Bifidobacterium , Lactobacillus , Veillonella and Actinomyces ) existed in all samples, but with significant intergroup differences (P

Objective To investigate the safety of adenoidectomy and risk factors of re-adenoidectomy, and intend to provide evidence-based information to clinicians for further consideration. Methods and materials This study was based on data obtained from Taiwan’s National Health Insurance Research Database from the period 2002–2011. We utilized that data from the hospitalization group and collected information regarding those individuals who accepted adenoidectomy with or without tonsillectomy and post-adenoidectomy bleeding. Thereafter, we performed univariate and multi-variate analysis to explore the possible risk factors of re-adenoidectomy. Results A total of 5435 individuals who accepted a first adenoidectomy with or without tonsillectomy were collected. After further tracing treatment of these individuals, 107 (1.97%) accepted the revision adenoidectomy until 2011. Post-op bleeding was approximately 0.28%. The revision rate associated with patient age showed the following: 0–4 years (0.61%), 4–12 years (2.06%) and 12–18 years (2.56%). The revision rate associated with surgeon age showed: 28–41 years (1.42%), 41–50 years (2.96%), 50–65 years (2.74%); the surgeons’ surgery volume showed low (4.34%), medium (0.71%), and higher (1.02%). There are 4 diseases (otitis media with effusion, sinusitis, chronic pharyngitis, and sleep disorder) that showed a significant relationship with the revision rate when subject to univariate and multivariate analysis. The revision rate incorporating hospital locations, volumes and levels revealed no significant difference with each other. Conclusions Adenoidectomy is a generally safe surgical procedure, with low complication and low revision rate. Our study indicated that the revision rate of adenoidectomy might be lower when performed by young visiting staff with medium to higher surgical volume in the medium to higher volume hospital. If patients had diseases such as otitis media with effusion, sinusitis, chronic pharyngitis, and sleep disorder, they would be subject to higher rate of re-adenoidectomy. Surgeons should be aware and sufficiently explain this information to the parents before surgery.

This study aimed to investigate the annual incidence of parapharyngeal and retropharyngeal abscess (PRPA) based on 10-year population-based data. Patients with PRPA were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of over two million enrollees of the National Health Insurance system that covers over 99% of Taiwan&rsquo, s citizens. During 2007&ndash, 2016, 5779 patients received a diagnosis of PRPA. We calculated the population-wide incidence rates of PRPA by sex and age group (20&ndash, 44, 45&ndash, 64, and &gt, 64) as well as in-hospital mortality. The annual incidence rate of PRPA was 2.64 per 100,000 people. The gender-specific incidence rates per 100,000 people were 3.34 for males and 1.94 for females with a male:female gender ratio of 1.72. A slight increase in incidence rates among both genders over the study period was noted. Age-specific rates were lowest in the 20&ndash, 44 age group with a mean annual incidence of 2.00 per 100,000 people, and the highest rates were noted in the age groups of 45&ndash, 64 and &gt, 64 years with mean annual incidences of 3.21 and 3.20, respectively. We found that PRPA is common in Taiwan, males and older individuals are more susceptible to it, and incidence has increased in recent years.

This population-based study aimed to study the association between tinnitus and cervical spondylosis.A case-control study.We retrieved data from the Taiwan Longitudinal Health Insurance Database. We identified 2465 patients with tinnitus (cases) and 7395 comparison patients by propensity score matching. Multivariable logistic regressions were conducted to estimate the odds (OR) of a diagnosis of cervical spondylosis preceding the tinnitus diagnosis relative to controls.We found that 1596 (16.19%) of 9860 sample patients had received a diagnosis of cervical spondylosis before the index date, significantly different between the tinnitus group and control group (17.20% vs. 15.85%,In conclusion, the study shows a positive association between cervical spondylosis and tinnitus. The findings call for greater awareness among physicians about a possible somatosensory component of cervical spine function which may contribute to tinnitus.

Objective : Gut microbiota has been proposed as a pivotal role in the progression of Spondyloarthritis (SpA), however diverse results remain to be synthesized. We performed a systematic review to collect evidence on the characteristic of the gut microbiota in patients with SpA, as compared to controls. Methods : We systematically searched MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials databases, through June 1, 2021 for studies that compared gut microbiota of cases with SpA versus healthy controls. Results : Of 3756 records identified, 28 studies from 23 articles were included in the analysis. Results of β-diversity showed SpA patients hold a significantly different microbial composition compared with controls. Several taxa-level differences of gut microbiota between SpA (and its subtypes) cases and controls were identified. Fourteen studies including only patients with ankylosing spondylitis (AS) reported increased amounts of Actinobacteria, Dialister, Streptococcus, and Clostridium bolteae, and decreased amounts of Bacteroidales and Parasutterella in AS cases versus controls in ≥ 3 studies. Dialister invisus was increased in axial-SpA cases versus controls in 3 studies. Bacteroides fragilis was increased in enthesitis-related arthritis (ERA) cases versus controls in 2 studies. For all SpA studies, Proteobacteria, Enterobacteriaceae, and Bacteroidaceae were increased, whereas Bacteroidetes, Bacteroidales, and Akkermansia were decreased in cases versus controls in ≥ 3 studies. Over 40% of the studies showed comparable data of both sex and age between cases and controls. Conclusion : The microbial characteristics of SpA summarized in the systematic review laid the groundwork for evidence-based microbial treatment. The microbial variance among subtypes of SpA remains to be explored. Further studies are needed to elucidate how the altered microbiota participate in the pathogenesis of SpA.

Singing, as a method of combining respiratory function exercise and vocal intonation therapy, provides a new direction for respiratory function exercise in patients with spinal cord injury. This randomized controlled trial investigated the effects of oral motor respiratory exercise and vocal intonation therapy on respiratory function and vocal quality in patients with spinal cord injury. Among 31 included patients with spinal cord injury, 18 completed the treatment. These 18 patients were randomly assigned to undergo music therapy (intervention group, 30 min/d, 5 times a week, for a total of 12 weeks; n = 9, 7 males and 2 females; 30.33 ± 11.74 years old) or normal respiratory training (control group, n = 9; 8 males and 1 female; 34.78 ± 11.13 years old). Both patient groups received routine treatment concurrently. Before and at 6 and 12 weeks after intervention, a standard respiratory function test, a voice test, the St. George's Respiratory Questionnaire, and a quality of life questionnaire were administered. The results showed that the inspiratory capacity, forced expiratory volume in 1 second, forced vital capacity, maximal mid-expiratory flow rate, sing-loud pressure level, and sustained note length were significantly increased in the intervention group compared with the control group. The St. George's Respiratory Questionnaire and quality of life results of patients in the intervention group were significantly superior to those in the control group. These findings suggest that oral motor respiratory exercise and vocal intonation therapy, as respiratory training methods in music therapy, are effective and valuable for improving respiratory dysfunction and vocal quality in patients with spinal cord injury. This study was approved by the Ethics Committee of China Rehabilitation Research Center (approval No. 2019-78-1) on May 27, 2019 and was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1900026922) on October 26, 2019.

Higher rates of poor cognitive performance are known to prevail among persons with tinnitus in all age groups. However, no study has explored the association between tinnitus and early-onset dementia. We hypothesize that tinnitus may precede or occur concurrently with subclinical or early onset dementia in adults younger than 65 years of age. This case–control study used data from the Taiwan National Health Insurance Research Database, identifying 1308 patients with early-onset dementia (dementia diagnosed before 65 years of age) and 1308 matched controls. We used multivariable logistic regressions to estimate odds ratios (ORs) for prior tinnitus among patients with dementia versus controls. Among total 2616 sample participants, the prevalence of prior tinnitus was 18%, 21.5% among cases and 14.5% among controls (p

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.

Background: The aim of this study was to compare the risk of developing sudden sensorineural hearing loss (SSHL) in patients with hypopharyngeal cancer with that in patients with nasopharyngeal carcinoma (NPC). Methods: A population-based, retrospective cohort study was performed using the Taiwan National Health Research Database databank. Patients selected for this study were diagnosed with hypopharyngeal cancer or NPC and treated with radiotherapy in the period from 2001 to 2004. Routine follow-up was conducted for 8 years (2004–2012), and the incidence of SSHL was calculated at the final follow-up. Results: There was no significant difference in the risk of developing SSHL between the hypopharyngeal cancer group and its control group (p = 1.000). In hypopharyngeal cancer and NPC groups, the rates of SSHL were 0.12% and 1.00%, respectively (p < 0.001). The cumulative hazard of SSHL during the follow-up period was significantly higher in the NPC group than in the control group (p < 0.001). Conclusion: Radiotherapy in patients with hypopharyngeal cancer did not increase the risk of developing SSHL, but postirradiation NPC was significantly associated with an increased incidence of SSHL.

This study aimed to evaluate the prevalence of peripheral vestibular disorders in an Asian population of predominantly Han Chinese ethnicity.Cross-sectional study.Patients with a peripheral vertigo disorder were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of 2 million enrollees of Taiwan's National Health Insurance system covering over 99% of Taiwan's citizens. In 2016, 59,986 patients received a diagnosis of peripheral vestibular disorders in Taiwan. We calculated the population-wide prevalence rates of peripheral vestibular disorders in 2016 by sex and age group (20 to 24, 25 to 29, 30 to 34, 35 to 39, 40 to 44, 45 to 49, 50 to 54, 55 to 59, 60 to 64, 65 to 69, and ≥ 70 years) stratified into five urbanization levels.The prevalence rate of peripheral vestibular disorders was 2,833.4 per 100,000 population during the year. Prevalence of Meniere's disease was 70.4 per 100,000, benign paroxysmal positional vertigo, 446.4, vestibular neuritis 307.2, and other or unspecified peripheral vestibular dizziness, 2,009.5 per 100,000. Prevalence rates steadily increased with age for every type of peripheral vestibular disorder, and were higher among females compared to males. The female-to-male gender ratios were 1.84, 1.89, and 1.93 for Meniere's disease, vestibular neuritis, and other peripheral vestibular dizziness, respectively. Counties with the lowest urbanization level had the highest prevalence rates of all types of peripheral vestibular disorders except vestibular neuritis.Results showed that peripheral vestibular disorders are common in Taiwan, increase with age, are predominantly female, and show higher prevalence in rural areas.2b Laryngoscope, 131:639-643, 2021.

Objective: Despite studies reporting a possible association between malignant otitis externa (MOE) and diabetes, there are no large-scale population-based empirical studies. This nationwide, population-based case-control study explored the association of MOE occurrence with previously diagnosed diabetes. Methods: Data were retrieved from Taiwan’s National Health Insurance Research Database, 753 patients with MOE (cases) and 2 259 propensity score-matched patients without MOE (controls). Multiple logistic regressions were conducted to examine the association of MOE with previously diagnosed diabetes. Results: In total, 728 (24.2%) out of 3 012 sample patients had diabetes prior to the index date. Chi-square test revealed a significant difference in diabetes prevalence among cases and controls (54.8% vs 13.9%, p Conclusions: This study found an association between MOE and diabetes. One clinical practice implication of our study is that when a patient with diabetes complains of otalgia or otorrhea, and physical examination shows swelling of the ear canal or granulation growth, physicians should consider the possibility of MOE.

An amendment to this paper has been published and can be accessed via the original article.

Cervical cancer is the second most common cancer in women worldwide and early detection of cervical cancer is crucial to improve the performance of treatment. Autofluorescence arising from cells and tissues can provide information of cellular energy metabolism. Fluorescence lifetime imaging microscopy (FLIM) can be used to detect the metabolism change indicating the development of precancer. In this study, cervical unstained tissue sections obtained from patients were detected by FLIM, which exhibited the cellular morphology features as clear as the pathology images without using fluorescence probes, and the average lifetime of normal tissue samples was consistently lower than that of precancerous or cancerous samples. The results indicate that FLIM is a rapid and label-free tool with high sensitivity and specificity to detect cervical cancer and precancer.

Objectives/Hypothesis Whereas the impression that poor oral hygiene is linked to the development of sialolithiasis may be widely accepted, very few studies provide evidence to support this. This study therefore aimed to evaluate the association between chronic periodontitis (CP) and the subsequent development of salivary gland stone based on a nationwide coverage database. Study Design A case-control study. Methods A total of 987 subjects with sialolithiasis were included as cases. In a ratio of five controls per case, 4,935 controls matched in terms of sex and age group were selected. Conditional logistic regression analysis was performed to determine the possible association of sialolithiasis with previously diagnosed CP. Results The prevalence of prior CP between cases and controls demonstrated that 1,831 (30.9%) out of the 5,922 sampled subjects had prior CP. By Chi-square test, there was a significant difference in the prevalence of prior CP between the cases and controls (36.8% vs. 29.7%, P

Ischemic tolerance is an endogenous protective mechanism that refers to the ability of a sublethal stimulus to induce tolerance to a subsequent lethal ischemic injury. It was first demonstrated in neuronal cells of the gerbil hippocampus (1), after which it has aroused a considerable interest as a possible therapeutic modality for ischemic brain diseases. However, to expose patients to brief periods of ischemia is both impractical and unsafe. Chemical preconditioning substances that can induce ischemic tolerance, such as endotoxins, cytokines, metabolic inhibitors, potassium, chloride, and neurotoxin 3-nitro-propionic acid (1-5) have also been investigated but were found to have limited clinical application due to toxicity and side effects. A variety of experimental models of cerebral ischemia have found that hyperbaric oxygen preconditioning (HBOP) induces ischemic tolerance and attenuates cerebral injury (6-17). Its protective effect is also visible in other conditions leading to oxidative stress, with final anti-apoptotic result, as well as modulation of neutrophin and immune systems (6-17). The blood-brain barrier (BBB), a highly selective permeability barrier, consists of tight junctions (TJ) between capillary endothelial cells, the basal lamina, pericytes, and astrocyte end-feet (18). It plays an important role in maintaining cerebral homeostasis by restricting molecular movement from the cerebral capillaries to the brain tissue. BBB breakdown can result in a vasogenic edema, hemorrhage, and neuronal cell death, all of which can contribute to the pathophysiology of cerebral ischemic diseases (19). TJs between cerebral endothelial cells are formed by complex interactions of cytoskeletal proteins and tight junction proteins (TJPs), including claudins, occludin, zonula occludens (ZO), and cingulin (20). TJPs increase endothelial electrical resistance and decrease paracellular permeability (21). Changes in their expression can lead to the loss of BBB integrity and BBB breakdown (22). HBOP has been associated with reduced brain edema, decreased infarct volume, and improved neurological function (6-17), but it is not clear whether it directly affects the BBB, particularly TJPs expression. This should be clarified in order to find new therapeutic strategies to attenuate BBB permeability in cerebral ischemic disorders. Therefore, the aim of this study was to examine the HBOP effect on hypoxia-induced BBB breakdown in vitro and the changes of occludin and ZO-1 expression.

Patients with risk factors including younger age, mastoiditis, external ear disease, treatment by older surgeons, and concomitant mastoidectomy should receive detailed management to minimize the probability of re-operation for chronic otitis media (COM).Although COM remains a common ear disease requiring surgical intervention, its re-operation risks are less well-documented. This study aimed to compare patients with COM who underwent re-operation and those patients with no re-operation, and identify the risks of re-operation.This retrospective cohort study analyzed the trend of COM surgery from 1999-2009, and identified the re-operation risks of 18 895 patients with COM who underwent surgery from 2002-2006 using the National Health Insurance Research Database in Taiwan.Among the study population, 129 patients underwent revision surgery during a 5.5 ± 1.5 year follow-up period. A univariate logistic regression analysis showed that the re-operation rate was significantly higher in patients under 18 years of age, those with mastoiditis, disorders of external ear, treatment by surgeons of 50-64 years of age, use of a very high volume surgeon, and combined surgery with mastoidectomy. A multivariate analysis further limited the re-operation risk factors to younger patients, those with mastoiditis, external ear disorders, treatment by older surgeons, and concomitant mastoidectomy.

Rationale: We studied the feasibility of total arathyroidectomy(tPTX)+multi-point transplantation in the forearm for treatment of secondary hyperparathyroidism. Considering the controversial nature of the appropriate timing for and location of this type of surgery, relevant research is relatively rare. Our experience may be a relatively successful one. Patient concerns: Our patient was a 28-year-old woman with end-stage renal disease (ESRD), who was on dialysis for 7 years, and a 2-year history of progressively aggravated bone pain. She also had hypercalcemia and hyperphosphatemia. Diagnoses: Given the patient's history of long-term dialysis, bone pain, high levels of intact parathyroid hormone(i-PTH) and hypercalcemia, we performed ultrasonography which showed solid nodules in the bilateral parathyroid glands. She was accordingly diagnosed with SHPT. Interventions: The patient underwent tPTX+multi-point subcutaneous transplantation in the forearm. Outcomes: Her i-PTH level dropped to < 300 pg/mL, and the symptoms of bone pain markedly reduced after surgery. Lessons: Total parathyroidectomy+multi-point subcutaneous transplantation in the forearm may be a reliable surgical approach for patients with ESRD.

This study aimed to evaluate the relationship between sudden sensorineural hearing loss (SSNHL) and MVP using a population-based dataset. Data for this case-control study were retrieved from the Taiwan Longitudinal Health Insurance Database. In total, 3399 cases of newly diagnosed SSNHL were identified. We used propensity score matching to select 3399 comparison patients (one for every case) from the same dataset. The selected matching variables included age, sex, monthly income, geographical location, urbanization level of the patient's residence, hypertension, diabetes, and hyperlipidemia. Chi-squared tests were used to compare differences in sociodemographic characteristics, while conditional logistic regression analyses were used to examine the association of SSNHL with previously diagnosed MVP. Of the 6798 sampled subjects, 131 (1.93%) patients had received a diagnosis of MVP prior to the index date. A significant difference in the prevalence of prior MVP between cases and controls (2.41% vs. 1.44%, p = 0.004) was observed. The conditional logistic regression analysis conditioned on gender, age, monthly income, urbanization level, geographic region, hyperlipidemia, diabetes, and hypertension suggested that the odds ratio of prior MVP for cases was 1.69 (95% confidence interval (CI): 1.18~2.42) compared to controls. Our study found that patients with MVP had a 1.69-fold higher risk of getting SSNHL compared to patients without MVP.

The relationship between obstructive sleep apnea (OSA) and chronic rhinosinusitis (CRS) still remains unclear. This retrospective cohort study aimed to investigate the relationship between OSA and subsequent CRS using a population-based dataset. The study used data from the Taiwan Longitudinal Health Insurance Database 2005. We selected 971 patients with OSA for the study cohort and 4855 patients without OSA for the comparison cohort. Each patient was tracked for 5 years to determine those who were subsequently diagnosed with CRS. Stratified Cox proportional hazard regression analyses were performed to examine the association of OSA with subsequent CRS. The results revealed that 161 (2.76%) of the total sampled patients were subsequently diagnosed with CRS. Subsequent incidences of CRS were found in 64 (6.59%) patients with OSA and 97 (2.00%) patients without OSA. The adjusted hazard ratio (HR) of subsequent CRS for patients with OSA was 3.18 (95% confidence interval: 2.27~4.45) compared to those without OSA. Furthermore, the HR for CRS was similar for subjects with OSA for both genders (with an adjusted HR of 3.44 for males and 2.63 for females). We concluded that patients with OSA had a higher risk of subsequent CRS compared to patients without OSA regardless of sex.

OBJECTIVE Although plenty of researchers have reported systemic effects originating from chronic periodontitis (CP) on potentially distal inflammatory processes, such as those leading to coronary heart disease, cerebrovascular disease, and cancer, no study has reported the association between CP and sudden sensorineural hearing loss (SSNHL). The present study explored the association between CP and SSNHL using a large, population-based dataset in Taiwan. STUDY DESIGN A case-control study. SETTING Taiwan. PATIENTS We used administrative claims data from the Taiwan National Health Insurance program to identify 2,436 subjects with SSNHL and to randomly select 7,308 controls. MAIN OUTCOME MEASURES A conditional logistic regression analysis was conducted to calculate the odds ratio (OR) for having been previously diagnosed with CP between cases and controls. RESULTS In total, 1,663 (17.1%) of the 9,744 sampled subjects had received a CP diagnosis before the index date; 520 (21.4%) were cases and 1143 (15.6%) were controls. The χ2 test suggested that there was a significant difference in the prevalence of previous SSNHL between cases and controls (p < 0.001). The conditional logistic regression revealed after adjusting for hypertension, diabetes, hyperlipidemia, renal disease, coronary heart disease, obesity, and stroke, the OR of having previously received a CP diagnosis among cases was 1.44 (95% CI = 1.29∼1.63) that of controls. CONCLUSION This study found that SSNHL was significantly associated with a previous diagnosis of CP. Further prospective studies are warranted to confirm our findings and clarify the underlying pathomechanism.

Severe fever with thrombocytopenia syndrome (SFTS), a new disease of zoonotic natural foci has been increasing in recent years. In this review, the disease of human granulocytic anaplasmosis infection due to tickborne and new Bunia virus infection, have similar clinical symptoms. Total of 11 articles were retrieved. The emergence, etiology, nomenclature and pathogenic mechanisms, clinical diagnosis and genotyping of SFTS were summarized, and the current situation of treatment was also evaluated. In conclusion, early detection, identification and treatment are the key points to SFTS, but how to reduce the mortality of critically ill patients is still the focus in the future.

Objectives/Hypothesis Although chronic periodontitis (CP) and chronic rhinosinusitis (CRS) both share immunological disturbances as pathological factors, no prior study has investigated the risk for CP among patients with CRS. This study set out to provide an estimation of risk by utilizing a cohort study design to leverage the statistical power of a population-based dataset in Taiwan. Study Design A retrospective cohort study. Methods In total, 13,782 CRS subjects were included in the study cohort and 41,346 subjects were randomly extracted for the comparison cohort. We individually tracked each subject in this study (N = 55,128) for a 5-year period following their index date to identify those subjects who received a subsequent diagnosis of CP. Cox proportional hazards regression analysis was conducted to calculate the 5-year risk of subsequent CP following a diagnosis of CRS among the sampled subjects. Results The incidence rate of CP during the 5-year follow-up period was 5.12 (95% confidence interval [CI], 4.95-5.30) per 100 person-years and 3.24 (95% CI, 3.17-3.30) per 100 person-years for the study and comparison cohort, respectively. Cox proportional hazards regression revealed that the hazard ratio for CP during the 5-year follow-up period for subjects with CRS was 1.59 times (95% CI, 1.52-1.67) that of comparison subjects after adjusting for monthly income, geographic region, hypertension, diabetes, coronary heart disease, and hyperlipidemia, and censoring for cases who died during the 5-year follow-up period. Conclusions This study detected an increased risk for CP among patients suffering from CRS. CRS patients should be alerted to pay particular attention to their oral hygiene practices to prevent both CP and its downstream sequelae.

Objectives/Hypothesis: It has been recognized that chronic rhinosinusitis (CRS) involves intracranial vessels and may be associated with stroke occurrence. However, the detailed epidemiological profile of stroke risk among patients with CRS is still not well understood. Therefore, this study aimed to explore the frequency and risk for stroke among patients with CRS by conducting a large scale population-based cohort study in Taiwan. Methods: All study cohorts were retrieved from the Taiwan Longitudinal Health Insurance Database. This study included 15,846 CRS subjects in the study cohort and 47,538 randomly selected subjects in the comparison cohort. We individually tracked each subject in this study for a 5 year period following their index dates to identify each subject that received a subsequent diagnosis of stroke. Stratified Cox proportional hazards regressions were analyzed to compare the 5 year risk of subsequent stroke following a diagnosis of CRS. Results: The incidence rate of stroke during the 5-year follow-up period was 10.65 (95% CI: 9.93–11.41) per 100 person years and 7.53 (95% CI: 7.18–7.89) per 100 person years for the study and comparison cohort, respectively. The covariate-adjusted hazard ratio (HR) for stroke revealed that that subjects with CRS were more likely than comparison subjects to have a diagnosis of ischemic stroke during the 5-year follow-up period (HR = 1.34, 95% CI = 1.18–1.53). However, there was no significant difference in the risk of subarachnoid hemorrhage (HR = 1.52, 95% CI = 0.94–2.47) or intracerebral hemorrhage (HR = 0.96, 95% CI = 0.71–1.31). Conclusions: Patients with CRS were at higher risk for stroke occurrence during the 5 year follow-up.

Aim This study set out to explore the association between obstructive sleep apnoea (OSA) and prior chronic periodontitis (CP) by utilizing a population-based data set with a case-control design in Taiwan. Materials and Methods We included 7673 subjects with OSA as cases, and randomly selected 21,963 subjects without a history of OSA as controls. We performed conditional logistic regression analyses to explore the association between OSA and having been previously diagnosed with CP. Results There was a significant difference in the prevalence of prior CP between cases and controls (33.8% versus 22.6%, p

Objectives The study aimed to estimate the risk of developing chronic rhinosinusitis (CRS) among children who had undergone a tonsillectomy by utilizing a cohort study based on a population-based database. Methods Data for this retrospective cohort study were sourced from the Taiwan ”Longitudinal Health Insurance Database 2000”. We included 202 children who had undergone a tonsillectomy as the study group and 2020 sex- and age-matched children as the comparison group. We used stratified Cox proportional hazard regressions to calculate the hazard ratio (HR) and its corresponding 95% confidence interval (CI) for CRS during the 3-year follow-up period. Results Of 2222 sampled children, the incidence rate of CRS during the 3-year follow-up period was 3.2 (95% CI = 2.0–4.8) 1000 person-years; 18.2 (95% CI = 9.1–32.5) per 1000 person-years and 1.7 (95% CI = 0.8–3.0) per 1000 person-years for the study and comparison group, respectively. The stratified Cox proportional analysis showed that the adjusted hazard ratio for CRS during the 3-year follow-up period was 8.28 (95% CI = 3.24–21.16) for children who had undergone a tonsillectomy than comparison patients. Conclusions We demonstrated that the risk of developing CRS is significantly increased among children who have undergone a tonsillectomy.

Palatoplasty can significantly decrease their middle ear re-intubation rate with a relatively lower hazard ratio compared to children who underwent VTI only.In children with cleft palate, questions remain about the overall effect of ventilation tube insertion (VTI) and palatoplasty for their OME. A large-scale study might offer more evidence for the roles of palatal surgery.This was a retrospective birth cohort study based upon a national database. We analyzed children born between 1999-2004 and diagnosed as cleft palate and/or lips. These children, according to their surgeries, were separated into two groups: (1) VTI only, and (2) VTI and palatoplasty. Kaplan-Meier analysis and log-rank test were used to calculate their cumulative tube re-insertion rates. Their hazard ratios of tube re-insertion were also analyzed.In total, 1205 cleft children were collected, with 151 in the VTI only group and 1054 in the VTI + palatoplasty group. Ventilation tube re-insertion rates were significantly lower in the VTI + palatoplasty group (p = 0.002). The cumulative re-insertion rates also showed a significant difference (p = 0.001). When compared to the VTI only group, the adjusted hazard ratio was 0.528 in the VTI + palatoplasty group (p = 0.001).

The relationship between obstructive sleep apnea (OSA) and chronic rhinosinusitis (CRS) still remains unclear. This retrospective cohort study aimed to investigate the relationship between OSA and subsequent CRS using a population-based dataset. The study used data from the Taiwan Longitudinal Health Insurance Database 2005. We selected 971 patients with OSA for the study cohort and 4855 patients without OSA for the comparison cohort. Each patient was tracked for 5 years to determine those who were subsequently diagnosed with CRS. Stratified Cox proportional hazard regression analyses were performed to examine the association of OSA with subsequent CRS. The results revealed that 161 (2.76%) of the total sampled patients were subsequently diagnosed with CRS. Subsequent incidences of CRS were found in 64 (6.59%) patients with OSA and 97 (2.00%) patients without OSA. The adjusted hazard ratio (HR) of subsequent CRS for patients with OSA was 3.18 (95% confidence interval: 2.27~4.45) compared to those without OSA. Furthermore, the HR for CRS was similar for subjects with OSA for both genders (with an adjusted HR of 3.44 for males and 2.63 for females). We concluded that patients with OSA had a higher risk of subsequent CRS compared to patients without OSA regardless of sex.

Objectives: The primary aim of this study was to obtain the mean hearing thresholds among school-age children residing in the Datong and Jhongshan Districts of Taipei City, Taiwan. Design: Hearing thresholds were obtained from a stratified sample of 1411 students in grades 1, 4, 7, and 10 based on their participation in the annual health examination of school-age children carried out by the Taipei City Government. After otoscopic examination, audiometric testing was undertaken at 0.5 to 4 kHz along with tympanometric screening. The means and SDs obtained from these examinations are reported by grade, gender, ear, and frequency. Results: The mean hearing thresholds ranged between 6.8 and 16.7 dB HL, with the highest (poorest) hearing threshold being obtained at a test frequency of 0.5 kHz. At all the tested frequencies, the hearing thresholds of boys were found to be higher than those of girls. Logistic regressions demonstrating that those students with the highest odds ratios of hearing loss were to be found in the sample of children in grade 1. The odds ratios of hearing loss were also found to be higher among boys than girls and for the left ear rather than the right. Conclusions: These results indicate that the mean thresholds among the study sample were well above (meaning poorer) the pure-tone average of 15 dB HL, as recommended in a previous study. Therefore, the results of this study suggest the need to further determine the etiology of hearing loss among children in grades 1, 4, 7, and 10 in the Datong and Jhongshan Districts of Taipei City and perhaps Taiwan.

Background and Purpose— The occurrence of preeclampsia-eclampsia during pregnancy has been reported to increase the risk of stroke in mainly Western populations. However, few studies have evaluated stroke risk in Asian populations and followed women beyond the early postpartum period. Thus, the present study determined the risk of stroke in women in Taiwan during pregnancy and the first postpartum year. Methods— A population-based cohort study was performed on 1 132 019 parturients during 1999 to 2003 using a dataset linking birth certificates and National Health Insurance hospital discharge data. Stroke-free survival rates were estimated using the Kaplan–Meier method, and the log-rank test was used to examine the effect of preelampsia-eclampsia on the prevalence of stroke. Sociodemographic factors and obstetric complications were used in multivariate logistic regression models to determine the adjusted odds ratios of preeclampsia-eclampsia on the risk of hemorrhagic and ischemic stroke during pregnancy and within the first postpartum year. Results— The incidence of stroke was 21.47 cases per 100 000 deliveries. There were 139 cases of hemorrhagic stroke and 107 cases of ischemic stroke. The respective adjusted relative risk of preeclampsia-eclampsia for hemorrhagic and ischemic stroke were 10.68 (95% CI, 3.40 to 33.59) and 40.86 (95% CI, 12.14 to 137.47) within 3 months antepartum; 6.45 (95% CI, 1.42 to 29.29) and 34.71 (95% CI, 11.08 to 108.68) in the first 3 days postpartum; 5.61 (95% CI, 0.71 to 44.10) and 11.23 (95% CI, 2.45 to 51.59) from 3 days to 6 weeks postpartum; 11.76 (95% CI, 4.05 to 34.11) and 11.60 (95% CI, 3.30 to 40.82) from 6 weeks to 6 months pospartum; and 19.90 (95% CI, 7.75 to 51.11) and 4.35 (95% CI, 0.58 to 32.92) from 6 months to 12 months postpartum. Conclusions— Women with preeclampsia-eclampsia have a significantly higher risk of stroke during pregnancy and in the first postpartum year. These results suggest that women with preeclampsia-eclampsia should be closely monitored even after pregnancy.

Objective:This study uses 5-year population data to determine the incidence rate of sudden sensorineural hearing loss (SSNHL) in Taiwan, taking into consideration the age and gender of patients, as well as seasonal variations. Study Design:A retrospective cross-sectional study. Method: The data used is from the Taiwan National Health Insurance Research Database covering the period from 1998 to 2002. A total of 9,267 sample patients were identified from the database by a principal diagnosis of unspecified sudden hearing loss (ICD-9-CM code 3882). The autoregressive integrated moving average (ARIMA) method was also carried out in order to identify any variations in the monthly incidence rates of SSNHL. Results:We find that for the period under examination, gender-specific incidence rates per 100,000 of the population were 8.85 for males, and 7.79 for females, and that there was an increase in age-specific SSNHL incidence with age. The ARIMA test for seasonality was found to be significant for the whole sample. Of all the seasons in Taiwan, the highest SSNHL incidence rates were found in autumn. Conclusions: Our finding of significant variations in the monthly incidence of SSNHL provides valuable information for otolaryngologists and public health officials, creating an awareness of periods of a potential increased risk of SSNHL.

Primary non-Hodgkin’s lymphoma (NHL) of the sinonasal tract is uncommon. Morphologically and radiographically, sinonasal lymphomas are difficult to distinguish fromother malignant neoplasms or non-neoplastic processes. However, there is no general consensus about the need of routine histopathological examination for nasal polyps among otolaryngologists. We present a case of primary sinonasal NHL mimicking chronic hinosinusitis and debate the issue of routine histopathological examination. We suggest that all tissues removed from the sinonasal tract during surgery must be submitted for histopathological examination. Failure to do so may miss diagnosis and delay appropriate treatment.

Neovascularization, including angiogenesis, arteriogenesis and vasculogenesis, occurs in physiological and pathological state. Efficient and controlled reconstruction of functional vascular network is necessary. Nerves and blood vessels establish intricate branching network in every organ which share anatomical and functional characteristics. Nerves direct vessel branching patterns and arterial differentiation in the developmental embryonic limb skin. Various neurotransmitters exert antiapoptotic, chemotactic and proliferative effect on EC and SMC, and modulate all the phases of neovascularization. Hence, we proposed that the perivascular nerves may play critical roles in neovascularization.

Objectives/Hypothesis Although it is known that inflammatory processes can elevate the risk of cancer, to date the association between allergic rhinitis (AR) and nasopharyngeal carcinoma (NPC) remains unknown. This study aimed to evaluate the association between NPC and AR based on a population-based database in Taiwan. Study Design A case-control study. Methods In total, 1,799 NPC cases and 5,397 randomly selected controls without NPC were included. We evaluated the prevalence and risk of prior AR between cases and controls. We also performed a conditional logistic regression analysis to calculate the odds ratio (OR) for having been previously diagnosed with AR between cases and controls. Results In total, 2,453 of the 7,196 study subjects (34.1%) had previously received an AR diagnosis; 875 (48.6%) were cases and 1,578 (29.2%) were controls (P

OBJECTIVE T regulatory (Treg) cells are a heterogeneous population that consists of CD4(+)CD25(low)CD45RA(+) [naive Treg (nTreg) cells] and CD4(+)CD25(high)CD45RA(-) [activated Treg (aTreg) cells] subsets. We investigated the effects of HIV infection and HAART on distinct Treg subsets. METHODS HIV-infected adult patients naive to HAART (n=57), patients with acute HIV infection (n=13), and healthy controls (n=92) were recruited for a cross-sectional study. Patients receiving HAART were followed up in a longitudinal study. RESULTS Compared with healthy controls, we observed a reduced proportion of nTreg cells and an elevated frequency of aTreg cells in peripheral blood from HAART-naive patients. Moreover, nTreg cells showed a decreased CD31(+) frequency, whereas aTreg cells showed an increased CD31(+) frequency, indicating impaired thymic output and excessive conversion from nTreg to aTreg cells. nTreg and aTreg cells both displayed higher levels of Ki67(+), reflecting hyperproliferation. The longitudinal study showed that HAART successfully recovered nTreg but not aTreg cell frequency. Higher baseline naive CD4 T-cell percentages were associated with faster reconstitution of nTreg cell frequency as well as CD4(+) T-cell count. CONCLUSION Our data suggest that the disturbed homeostasis of Treg cells in HIV-infected patients is probably caused by excessive conversion from nTreg to aTreg cells, and impaired thymic output of nTreg cells. nTreg cells can be recovered by HAART, which was associated with baseline naive CD4(+) T-cell percentages, indicating that reconstitution of nTreg cells may benefit from earlier antiretroviral treatment.

There is no increased risk for sudden sensorineural hearing loss (SSNHL) among people who have experienced a recent herpes zoster attack, compared with a matching population.The pathogenesis of SSNHL remains unknown, but viral infection is considered to be one of the main causes. The objective of this case-cohort study was to investigate the frequency and risk for SSNHL following a recent herpes zoster attack in the general population.We extracted 313 612 patients with herpes zoster from a nationwide health registry in Taiwan, and also randomly selected 313 612 matched control subjects. Each participant was individually tracked for 2 months from their index ambulatory care visit to identify those who developed SSNHL. Stratified Cox proportional hazard regressions were conducted to analyze the risk of SSNHL for the sampled patients.Of the sample of 627 224 patients, 121 (0.02%) had SSNHL during the 2-month follow-up period, 59 from the study group (0.02% of the herpes zoster patients) and 62 from the comparison group (0.02% of patients without herpes zoster). Regression analysis revealed no increased adjusted hazard of SSNHL during the 2-month follow-up period for patients with herpes zoster as compared to those without (hazard ratio = 0.89, 95% confidence interval (CI) = 0.63-1.28, p = 0.540).

The treatment of sudden sensorineural hearing loss (SSNHL) has remained one of the most controversial issues in otolaryngology, and there are wide disparities between clinicians' treatment methods for SSNHL. Using five-year population-based data, we explored the relationship between physician and hospital characteristics and the length of stay (LOS) for SSNHL patients in Taiwan. The dataset was derived from the National Health Insurance Research Database. The patients in the study sample were identified by a principal diagnosis of sudden hearing loss. A total of 8712 hospitalization cases between 1998 and 2002 inclusive were included. Multiple regression analyses were performed in order to explore the relationship between physician and hospital characteristics and LOS, adjusting for patients' age and gender, as well as complications or comorbidities. The mean LOS for the duration of the study period was 5.62 days, while the regression analysis showed that, as compared to district hospitals, the LOS in medical centers and regional hospitals was 0.42 and 0.37 days longer, respectively (all p < 0.001). The analysis also revealed that the LOS was 0.71 days shorter for patients who were attended by physicians specializing in otolaryngology than for those attended by physicians specializing in other areas (p < 0.001). This study concludes that there is indeed a relationship between physician and hospital characteristics and the LOS for SSNHL patients. The results of this study serve to highlight the importance of developing treatment protocols for SSNHL so as to reduce the variation in physician or hospital behavior.

Objective:This study utilizes 5-year population data to examine the association between weather conditions and the incidence of sudden sensorineural hearing loss (SSNHL) in Taiwan with a specific focus on ambient temperature, relative humidity, atmospheric pressure, rainfall and total hours of sunshine. Method: The data, covering the period from 1998 to 2002, is sourced from the Taiwan National Health Insurance Research Database (NHIRD), with a total of 8712 first-time admissions being identified from the database by a principal diagnosis of unspecified sudden hearing loss (ICD-9-CM code 3882). After controlling for time trend effects, this study adopted the autoregressive integrated moving average regression method as a means of evaluating the effects of climatic and monthly factors on SSNHL incidence rates. Results:Although significant associations were found between ambient temperature, relative humidity and the SSNHL incidence rates for the total population, after adjusting for seasonality, months and trends, the significant relationship between SSNHL incidence rates and the climatic parameters disappeared. Conclusions: This study has demonstrated that after adjusting for seasonality, months and trends, there is no significant relationship between monthly SSNHL incidence rates and weather conditions. Therefore, the theory that weather is a triggering factor in SSNHL pathogenesis is not supported by this study.

This study sets out to explore the relationship between hospital characteristics, asthma length of stay (LOS), and costs per discharge. The study adopts hospitalization data from the Taiwan National Health Insurance Research Database covering the period from 1997 to 2001. Study subjects were identified from the database by principal diagnosis of asthma or asthmatic bronchitis, with a total of 139,630 cases being included in the study. Multiple-regression analyses were performed to explore the relationship between LOS, costs per discharge and hospital characteristics, adjusting for age, gender, and discharge status of patients, as well as complications or comorbidities. The regression analyses showed that, compared with district hospitals, medical centers and regional hospitals have longer and more statistically significant LOS, as well as higher costs. Hospitals operating on a for-profit basis have shorter LOS and lower costs than public and not-for-profit hospitals. This study shows the existence of wide variations in LOS and costs per discharge for asthma hospitalizations, between the various types of hospitals in Taiwan.

Background This study sets out to determine whether adjustments for specific patient caesarean delivery risk factors have an affect on the assessment of performance rates among the municipal hospitals of Taipei City. Methods Analysis of National Health Insurance (NHI) claims data, linked with birth certificate data, was undertaken on a cohort of 27,693 live births in the six general hospitals of the Taipei Medical Hospital System (TMHS) between 1999 and 2001. Using multivariable logistic regression modeling of the risk factors independently associated with caesarean deliveries, an expected caesarean delivery rate was constructed for each of the hospitals. By contrasting observed rates with expected rates to quantify the magnitude of the deviation from average practice, a measurement similar to relative risk (RR) was also constructed for each hospital. Results The observed rates for two of the six hospitals examined fell within the expected 95% confidence interval (CI), two were above the expected upper limit, and two were below the expected lower limit. The RR ranking of Hospitals A (RR = 1.08, CI = 1.01–1.15) and C (RR = 1.01, CI = 1.00–1.03) improved from first to second, and third to fourth, whilst the RR of Hospitals B (RR = 1.09, CI = 1.05–1.14) and D (RR = 1.02, CI = 0.99–1.06) worsened from second to first, and fourth to third, respectively. The RR rankings of Hospitals E (RR = 0.92, CI = 0.88–0.96) and F (RR = 0.80, CI = 0.77–0.84) were the same as the observed rates. Conclusions Caesarean delivery rate profiles, or hospital comparisons without risk adjustment, may be methodologically biased and may lead to unfair judgments by healthcare purchasers.

Objective To examine the putative association between obstructive sleep apnea (OSA) and sudden sensorineural hearing loss (SSNHL) using a nationwide population-based data set. Obstructive sleep apnea has been associated with generalized inflammation and nervous-endocrine, cardiovascular, and other systemic biophysiologic phenomena. However, to our knowledge, no investigations have been conducted using large data sets to examine the association between OSA and auditory disorders. Design Case-control study. Participants We identified 3192 patients diagnosed with SSNHL from the Taiwan Longitudinal Health Insurance Database as the study group and randomly extracted the data of 15 960 subjects matched by sex, age and year of first SSNHL diagnosis as controls. Main Outcome Measures Cases of OSA were identified by having been diagnosed as OSA prior to the index date of SSNHL diagnosis. Conditional logistic regression matched on age group and sex was used to assess the possible association between SSNHL and OSA among the sampled patients. Results Of 19 152 patients, 1.2% had OSA diagnoses prior to the index date; OSA was diagnosed in 1.7% of the SSNHL group and 1.2% of the controls. After adjusting for sociodemographic characteristics and co-morbid medical disorders, we found that male patients with SSNHL were more likely to have prior OSA than controls (odds ratio, 1.48; 95% CI, 1.02-2.16) (P = .04). No such association was found among female patients. Conclusions Male patients with SSNHL had a higher proportion of prior OSA than non-SSNHL-diagnosed controls; no such association was found among female patients. Further study will be needed to confirm our findings, explore the underlying pathomechanisms, and investigate the difference between sexes.

Background and Aims: It is known that the renin-angiotensin system (RAS) regulates fibrosis. Polymorphisms in the genes of the RAS may contribute to the outcome of liver cirrhosis. Angiotensinogen (AGT), mainly produced in the liver, is the substrate of renin. The aim of this study was to determine whether polymorphisms in the promoter region of the AGT gene are associated with liver cirrhosis in patients with chronic hepatitis B. Methods: Restriction fragment length polymorphism PCR was used to study polymorphisms in the promoter region of the AGT gene in patients with liver cirrhosis and in a control population. Four polymorphisms were assayed: G-217A, G-152A, A-20C and A-6G. Results: A statistically significant relationship was seen between polymorphisms of the AGT core promoter region and liver cirrhosis in patients with chronic hepatitis B (A-20C, P = 0.007; A-6G, P = 0.042). However, the distributions of the AGT-217 and AGT-152 genotypes were not significantly different from the control population (P = 0.615 and P = 0.170, respectively). Conclusions: Polymorphisms of the core promoter region of the AGT gene (AGT-20 and AGT-6) were associated with liver cirrhosis in patients with chronic hepatitis B.