147 results on '"Tsou YA"'
Search Results
2. Common Subtype of Small Renal Mass MR Imaging Characterisation: A Medical Center Experience in Taiwan
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Liu, Ming-Cheng, Liu, Yi-Jui, Lin, Yen-Ting, Hung, Siu-Wan, Chai, Jyh-Wen, Chan, Si-Wa, Chiu, Kun-Yuan, and Tsou, Ya-Ling
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- 2022
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3. Evaluating Mobile Health Apps for Customized Dietary Recording for Young Adults and Seniors: Randomized Controlled Trial
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Liu, Ying-Chieh, Chen, Chien-Hung, Tsou, Ya-Chi, Lin, Yu-Sheng, Chen, Hsin-Yun, Yeh, Jou-Yin, and Chiu, Sherry Yueh-Hsia
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Information technology ,T58.5-58.64 ,Public aspects of medicine ,RA1-1270 - Abstract
BackgroundThe role of individual-tailored dietary recording in mobile phone health apps has become increasingly important in management of self-health care and population-based preventive service. The development of such mobile apps for user-centered designing is still challengeable and requires further scientific evidence. ObjectiveThis study aims to conduct a randomized trial to assess the accuracy and time efficiency of two prototypes for dietary recoding utilization related to the input method of food intake. MethodsWe first present an innovative combinatorial concept for dietary recording to account for dish variation. One prototype was a self-chosen tab app that featured choosing each food ingredient to synthesize an individual dish, whereas the other was an autonomous exhaustive list app that provided one selection from a comprehensive list of dish items. The concept included commercially available choices that allowed users to more accurately account for their individual food selection. The two mobile apps were compared in a head-to-head parallel randomized trial evaluation. Young adults (n=70, aged 18-29) and older adults (n=35, aged 55-73) were recruited and randomized into two groups for accuracy and response time evaluation based on 12 types of food items in use of the developed self-chosen tab and autonomous exhaustive list apps, respectively. ResultsFor the trials based on the self-chosen tab (53 participants) and autonomous exhaustive list groups (52 participants), the two prototypes were found to be highly accurate (>98%). The self-chosen tab app was found to be more efficient, requiring significantly less time for input of 11 of 12 items (P
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- 2019
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4. Demonstration of High Endurance and Retention Spin-Transfer-Torque-Assisted Field-Free Perpendicular Spin-Orbit Torque Cells by an Etch-Stop-on-MgO Process
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Tsou, Ya-Jui, primary, Chen, Wei-Jen, additional, Liu, Chin-Yu, additional, Chen, Yi-Ju, additional, Li, Kai-Shin, additional, Shieh, Jia-Min, additional, Liu, Pang-Chun, additional, Chung, Wei-Yuan, additional, Liu, C. W., additional, Huang, Ssu-Yen, additional, Wei, Jeng-Hua, additional, Tang, Denny D., additional, and Sun, Jack Yuan-Chen, additional
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- 2022
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5. Write Margin Analysis of Spin–Orbit Torque Switching Using Field-Assisted Method
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Tsou Ya-Jui, Huan-Chi Shih, Chee-Wee Liu, and Jih-Chao Chiu
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010302 applied physics ,Physics ,Field (physics) ,Spintronics ,business.industry ,Transistor ,02 engineering and technology ,Atmospheric temperature range ,021001 nanoscience & nanotechnology ,01 natural sciences ,Electronic, Optical and Magnetic Materials ,law.invention ,Magnetic field ,Switching time ,Tunnel magnetoresistance ,Hardware and Architecture ,law ,0103 physical sciences ,Optoelectronics ,Torque ,Electrical and Electronic Engineering ,0210 nano-technology ,business - Abstract
Switching dynamics of perpendicular magnetic tunnel junction (MTJ) driven by spin–orbit torque (SOT) are investigated by the Landau–Lifshitz–Gilbert (LLG)-based physical model considering the temperature dependence. The field-assisted switching method is proposed to develop the reliable sub-ns writing of SOT-magnetoresistive random-access memory (SOT-MRAM) by removing the plateau time. The conventional method of SOT-MTJ requires the large write current, leading to the area increase of access transistors and the penalty of memory density. The write current and the switching time of SOT-MTJ can be efficiently reduced at the same time by our field-assisted method using the enhanced magnetic field. The magnetic field can be provided by the Co magnetic hard mask above the MTJ. Considering an SOT-MRAM array, the surrounded Co metals have the insignificant influence of stray magnetic field on an MTJ at the center. With the write time of 0.2 ns, the 60% reduction of write current is achieved by our field-assisted method compared to the conventional method. The required write current for the SOT switching decreases with the increasing temperature due to the lowering of thermal stability factor. The write Shmoo plots are further analyzed to calculate the write current margin at the various working temperature. The write time of 0.2 ns exhibits the narrow margin of write current ( $2.6~\mu \text{A}$ ) in the temperature range from 25 °C to 85 °C, while the write time of 0.8 ns has the wide write margin of $102~\mu \text{A}$ . The switching behavior and the write margin are also sensitive to the magnetic field.
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- 2019
6. Thermally Robust Perpendicular SOT-MTJ Memory Cells With STT-Assisted Field-Free Switching
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Tsou, Ya-Jui, primary, Chen, Wei-Jen, additional, Shih, Huan-Chi, additional, Liu, Pang-Chun, additional, Liu, C. W., additional, Li, Kai-Shin, additional, Shieh, Jia-Min, additional, Yen, Yu-Shen, additional, Lai, Chih-Huang, additional, Wei, Jeng-Hua, additional, Tang, Denny D., additional, and Sun, Jack Yuan-Chen, additional
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- 2021
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7. Critical Current Reduction of Field-Free Perpendicular SOT-MTJ by STT Assist Using Micromagnetic Simulation
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Chen, Wei-Jen, primary, Tsou, Ya-Jui, additional, Shih, Huan-Chi, additional, Liu, Pang-Chun, additional, and Liu, C. W., additional
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- 2021
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8. Multiparametric Magnetic Resonance Imaging in Diagnosis of Small Renal Mass: A Medical Center Experience In Taiwan
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liu, mingcheng, primary, Tsou, Ya-Ling, additional, Lin, Yen-Ting, additional, Hung, Siu-Wan, additional, Chai, Jyh-Wen, additional, Chiu, Kun-Yuan, additional, Chang, Chih-Hao, additional, and Liu, Yi-Jui, additional
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- 2021
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9. Vertically Stacked Strained 3-GeSn-Nanosheet pGAAFETs on Si Using GeSn/Ge CVD Epitaxial Growth and the Optimum Selective Channel Release Process
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Tsou Ya-Jui, Yu-Shiang Huang, Fang-Liang Lu, Chee-Wee Liu, Wen-Hung Huang, Hung-Yu Ye, and Shih-Ya Lin
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010302 applied physics ,Materials science ,Silicon ,business.industry ,chemistry.chemical_element ,Silicon on insulator ,02 engineering and technology ,Chemical vapor deposition ,021001 nanoscience & nanotechnology ,Epitaxy ,01 natural sciences ,Electronic, Optical and Magnetic Materials ,chemistry ,Etching (microfabrication) ,0103 physical sciences ,Parasitic element ,Optoelectronics ,Wafer ,Electrical and Electronic Engineering ,0210 nano-technology ,business ,Nanosheet - Abstract
Fully compressively strained GeSn quantum-well channels sandwiched by Ge sacrificial layers on 200-mm silicon-on-insulator (SOI) wafers are grown using chemical vapor deposition. The transmission electron microscopy images indicate that dislocations are confined near the relaxed Ge buffer/SOI interface, resulting in low defect densities in the stacked GeSn channels. The top Ge cap is essential to ensure that the top GeSn channel matches the other two channels during the Ge etching. Channel release is obtained by etching of the Ge sacrificial layers with optimum ultrasonic-assisted H2O2. The low thermal budget gate-stack (400 °C) and S/D parasitic resistance reduction are achieved. The first stacked 3-Ge0.93Sn0.07-channel p-gate-all-around FET with ${L} _{\text {CH}}= 60$ nm has a record high ${I}_{ \mathrm{\scriptscriptstyle ON}}=1975~\mu \text{A}/\mu \text{m}$ (per channel width) at ${V}_{\text {OV}}={V}_{\text {DS}}=-1$ V, among all GeSn pFETs. The junctionless device structure is used to simplify the process.
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- 2018
10. Hydrophobic Copper Catalysts Derived from Copper Phyllosilicates in the Hydrogenation of Levulinic Acid to γ-Valerolactone
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Tsou, Ya-Ju, primary, To, Thien Dien, additional, Chiang, Yu-Chia, additional, Lee, Jyh-Fu, additional, Kumar, Raju, additional, Chung, Po-Wen, additional, and Lin, Yu-Chuan, additional
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- 2020
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11. Image Recognition Approach for Expediting Chinese Cafeteria Checkout Process
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Wu, Bo-Ting, primary, Tsou, Ya-Wei, additional, Tan, Emerson, additional, and Chang, Feng-Cheng, additional
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- 2020
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12. Phyllosilicate-Derived CuNi/SiO2 Catalysts in the Selective Hydrogenation of Adipic Acid to 1,6-Hexanediol
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Tu, Cheng-Chieh, primary, Tsou, Ya-Ju, additional, To, Thien Dien, additional, Chen, Chao-Huang, additional, Lee, Jyh-Fu, additional, Huber, George W., additional, and Lin, Yu-Chuan, additional
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- 2019
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13. High-Mobility CVD-Grown Ge/Strained Ge0.9Sn0.1/Ge Quantum-Well pMOSFETs on Si by Optimizing Ge Cap Thickness
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Chih-Hao Huang, Schubert S. Chu, Huang-Siang Lan, Tsou Ya-Jui, Yi-Chiau Huang, Hua Chung, Satheesh Kuppurao, Chorng-Ping Chang, Chee-Wee Liu, Chih-Hsiung Huang, and Yu-Shiang Huang
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010302 applied physics ,Materials science ,Silicon ,business.industry ,Scattering ,Oxide ,chemistry.chemical_element ,02 engineering and technology ,Chemical vapor deposition ,021001 nanoscience & nanotechnology ,01 natural sciences ,Electronic, Optical and Magnetic Materials ,chemistry.chemical_compound ,Effective mass (solid-state physics) ,chemistry ,0103 physical sciences ,MOSFET ,Electronic engineering ,Surface roughness ,Optoelectronics ,Electrical and Electronic Engineering ,0210 nano-technology ,business ,Quantum well - Abstract
The high peak mobility of 509 cm2/ $\text {V}\cdot \text {s}$ of the chemical vapor deposition -grown GeSn pMOSFETs is obtained using 1-nm Ge cap. The Ge cap on GeSn can reduce the scattering of oxide/interface charges and surface roughness for the holes in the GeSn quantum wells. However, the thick cap induces holes in the Ge cap itself, leading lower mobility than GeSn channels. The on current is enhanced by external stress due to the effective mass reduction. The normalized noise power density of the GeSn devices decreases with increasing Ge cap thickness, indicating the carrier number fluctuation and correlated mobility fluctuation are suppressed when the holes are away from interface.
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- 2017
14. Novel Vertically-Stacked Tensily-Strained Ge0.85Si0.15 GAA n-Channels on a Si Channel with $\mathrm{SS}=76\mathrm{mV}/\mathrm{dec}, \mathrm{DIBL} =36\mathrm{mV}/\mathrm{V}$, and $\mathrm{I}_{\mathrm{on}}/\mathrm{I}_{\mathrm{off}}=1.2\mathrm{E}7$
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Yi-Chun Liu, Tsou Ya-Jui, Chien-Te Tu, Hung-Yu Ye, Yu-Shiang Huang, C. W. Liu, and Fang-Liang Lu
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010302 applied physics ,Physics ,Condensed matter physics ,Band gap ,0103 physical sciences ,Content (measure theory) ,Short-channel effect ,02 engineering and technology ,021001 nanoscience & nanotechnology ,0210 nano-technology ,01 natural sciences - Abstract
The tensily strained high Ge content (85%) GeSi multi-channels stacked on the Si channel with channel size optimization have good subthreshold behaviors (SS, DIBL, and $\mathrm{I}_{\mathrm{off}}$ ), and meanwhile maintain high $\mathrm{I}_{\mathrm{on}}$ . By narrowing GeSi channel, the bandgap of the GeSi can be increased by quantum confinement and the short channel effect can be suppressed. This also causes the more positive $\mathrm{v}_{\mathrm{t}}$ for GeSi than Si. As a result, $\mathrm{SS}=76\mathrm{mV}/\mathrm{dec}, \mathrm{DIBL}=36\ \mathrm{mV}/\mathrm{V}$ can be achieved due to the benefit of superior subthreshold behaviors of the Si channel underneath. The $\mathrm{I}_{\mathrm{on}}/\mathrm{I}_{\mathrm{off}}$ is improves to be 1.2E7. The high $\mathrm{I}_{\mathrm{on}}=44\mu \mathrm{A}$ perstack at $\mathrm{Vov}= \mathrm{V}_{\mathrm{DS}}=1\mathrm{V}$ , is contributed from both the GeSi and Si channels, and it is further enhanced to $46\ \mu \mathrm{A}$ by the external strain. The relatively low flicker noise indicates that the novel structure can mitigate the reliability issue of GeSi channels by the highly reliable Si channel underneath.
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- 2019
15. Novel Vertically-Stacked Tensily-Strained Ge0.85Si0.15 GAA n-Channels on a Si Channel with $\mathrm{SS}=76\mathrm{mV}/\mathrm{dec}, \mathrm{DIBL} =36\mathrm{mV}/\mathrm{V}$, and $\mathrm{I}_{\mathrm{on}}/\mathrm{I}_{\mathrm{off}}=1.2\mathrm{E}7$
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Huang, Yu-Shiang, primary, Lu, Fang-Liang, additional, Ye, Hung-Yu, additional, Tsou, Ya-Jui, additional, Liu, Yi-Chun, additional, Tu, Chien-Te, additional, and Liu, C. W., additional
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- 2019
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16. First vertically stacked GeSn nanowire pGAAFETs with Ion = 1850μA/μm (Vov = Vds = −1V) on Si by GeSn/Ge CVD epitaxial growth and optimum selective etching
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Chung-En Tsai, Chih-Hao Huang, Yu-Shiang Huang, Fang-Liang Lu, Chee-Wee Liu, Tsou Ya-Jui, and Chung-Yi Lin
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Materials science ,Photoluminescence ,Phonon scattering ,business.industry ,Scattering ,Annealing (metallurgy) ,Nanowire ,Silicon on insulator ,02 engineering and technology ,010502 geochemistry & geophysics ,021001 nanoscience & nanotechnology ,Epitaxy ,01 natural sciences ,Optoelectronics ,Wafer ,0210 nano-technology ,business ,0105 earth and related environmental sciences - Abstract
High material quality of compressively strained GeSn quantum wells sandwiched by Ge barriers on 200mm SOI wafers by CVD are confirmed by reciprocal space mapping (RSM), X-ray diffraction (XRD), and photoluminescence (PL). Due to the growth of relaxed Ge buffer on SOI, the misfit dislocations are confined near the Ge buffer/SOI interface, yielding low defect densities in the stacked GeSn channels. The low selectivity of Cl 2 /HBr between GeSn and Ge, makes it impossible to perform the channel release for stacked devices by etching away the Ge barriers. The channel release by optimum H 2 O 2 etching for stacked two GeSn nanowires with [Sn] = 6%, hole concentration = 1.3E19cm−3, and channel length (L CH ) = 150nm yields I on per channel width = 1400μA/μm for junctionless (JL) devices. Further improvement of Ion to reach record value of I on = 1850 p.A/p.m is achieved by increasing [Sn] to 10%, hole concentration to 6.7E19cm−3 and reducing the L CH to 60nm. Additional 6.3% enhancement of I on is obtained by additional uniaxial compressive strain using wafer bending. The best SS values of 84mV/dec and 88mV/dec are obtained for single-wire and stacked two-wire channels, respectively. JL has lower low frequency (LF) noise than inversion mode (IM) due to its bulk conduction nature. The mobility of JL and IM is dominated by impurity scattering and phonon scattering, respectively, according to the temperature dependence.
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- 2017
17. Field-free Spin-orbit Torque Switching of Perpendicular Magnetic Tunnel Junction Utilizing Voltage-Controlled Magnetic Anisotropy Pulse Width Optimization
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Luo, Zong-You, primary, Tsou, Ya-Jui, additional, Dong, Yi-Cheng, additional, Lu, Ching, additional, and Liu, C. W., additional
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- 2018
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18. Phyllosilicate-Derived CuNi/SiO2 Catalysts in the Selective Hydrogenation of Adipic Acid to 1,6-Hexanediol.
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Tu, Cheng-Chieh, Tsou, Ya-Ju, To, Thien Dien, Chen, Chao-Huang, Lee, Jyh-Fu, Huber, George W., and Lin, Yu-Chuan
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- 2019
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19. Vertically Stacked Strained 3-GeSn-Nanosheet pGAAFETs on Si Using GeSn/Ge CVD Epitaxial Growth and the Optimum Selective Channel Release Process
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Huang, Yu-Shiang, primary, Lu, Fang-Liang, additional, Tsou, Ya-Jui, additional, Ye, Hung-Yu, additional, Lin, Shih-Ya, additional, Huang, Wen-Hung, additional, and Liu, C. W., additional
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- 2018
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20. Evaluating Mobile Health Apps for Customized Dietary Recording for Young Adults and Seniors: Randomized Controlled Trial (Preprint)
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Liu, Ying-Chieh, primary, Chen, Chien-Hung, additional, Tsou, Ya-Chi, additional, Lin, Yu-Sheng, additional, Chen, Hsin-Yun, additional, Yeh, Jou-Yin, additional, and Chiu, Sherry Yueh-Hsia, additional
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- 2018
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21. First vertically stacked GeSn nanowire pGAAFETs with Ion = 1850μA/μm (Vov = Vds = −1V) on Si by GeSn/Ge CVD epitaxial growth and optimum selective etching
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Huang, Yu-Shiang, primary, Lu, Fang-Liang, additional, Tsou, Ya-Jui, additional, Tsai, Chung-En, additional, Lin, Chung-Yi, additional, Huang, Chih-Hao, additional, and Liu, C. W., additional
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- 2017
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22. High-Mobility CVD-Grown Ge/Strained Ge0.9Sn0.1/Ge Quantum-Well pMOSFETs on Si by Optimizing Ge Cap Thickness
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Huang, Yu-Shiang, primary, Tsou, Ya-Jui, additional, Huang, Chih-Hsiung, additional, Huang, Chih-Hao, additional, Lan, Huang-Siang, additional, Liu, Chee Wee, additional, Huang, Yi-Chiau, additional, Chung, Hua, additional, Chang, Chorng-Ping, additional, Chu, Schubert S., additional, and Kuppurao, Satheesh, additional
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- 2017
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23. Efficacy of Adjuvant Sublingual Immunotherapy After Septomeatoplasty.
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Hsieh BH, Kuo YC, Yong SB, Tien HC, Hsu CC, Hsu CL, Tsou YA, Lin CD, Tai CJ, Wang JY, and Shih LC
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- Humans, Male, Female, Adult, Treatment Outcome, Nasal Septum surgery, Middle Aged, Young Adult, Taiwan, Animals, Turbinates surgery, Combined Modality Therapy, Hypertrophy, Sublingual Immunotherapy methods, Rhinitis, Allergic therapy
- Abstract
Background: The efficacy of adjuvant sublingual immunotherapy (SLIT) in correcting structural problems in patients with allergic rhinitis (AR) caused by mite who have undergone septomeatoplasty (SMP) has not been studied., Methods: This non-randomized controlled study recruited patients with AR (caused by mite) and concurrent septal deviation and inferior turbinate hypertrophy, at a tertiary hospital in Taiwan. SMP was performed on all patients as a surgical intervention. The patients were then divided into two groups: the control group, which underwent surgery only, and the experimental group, which received SLIT as an adjuvant treatment. Demographic data and rhinitis control assessment test (RCAT) results were analyzed., Results: A total of 96 patients were enrolled in the study (SMP + SLIT group, n = 52; SMP only group, n = 44). No significant differences were observed in any of the variables between the two groups before and one month after surgery. However, during evaluations at the third and sixth month, the SMP + SLIT group showed significant improvement in the total RCAT scores compared to the SMP only group (28.6 ± 1.56 vs. 24.5 ± 3.66, p < 0.001; 27.1 ± 2.87 vs. 19.9 ± 5.56, p < 0.001). In addition, significantly better control of all RCAT sub-categories was observed in the SMP + SLIT group at the third and sixth month evaluations., Conclusions: SLIT may serve as an ideal adjuvant therapy after SMP in patients with AR., Level of Evidence: 3 Laryngoscope, 134:3073-3079, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)
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- 2024
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24. Clinical Outcomes of Severe Rhinosinusitis Complicated with Cavernous Sinus Syndrome.
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Lin JY, Liu CL, Dai ZY, Li YT, Tsou YA, Lin CD, Tai CJ, and Shih LC
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Background: Various diseases involving the cavernous sinus can cause a condition called cavernous sinus syndrome (CSS), which is characterized by ophthalmoplegia or sensory deficits over the face resulting from the compression effect of internal structure. While tumor compression is the most reported cause of CSS, statistical data on CSS caused by infections are limited. Its risk factors, treatment methods, and clinical outcomes are not well-documented. Methods: In this retrospective study, we reviewed the data of patients admitted to a tertiary medical center from 2015 to 2022 with a diagnosis of acute and chronic sinusitis and at least one diagnostic code for CSS symptoms. We manually reviewed whether patients were involved in two or more of the following cranial nerves (CN): CN III, CN IV, CN V, or CN VI, or at least one of these nerves with a neuroimaging-confirmed lesion in the cavernous sinus. Results: Nine patients were diagnosed with rhinosinusitis-related CSS. The most common comorbidity was type 2 diabetes, and the most common clinical manifestations were diplopia and blurred vision. The sphenoid sinus was the most affected sinus. One patient expired due to a severe brain abscess infection without surgery. The remaining patients underwent functional endoscopic sinus surgery, and 50% of the pathology reports indicated fungal infections. Staphylococcus spp. was the most cultured bacteria, and Amoxycillin/Clavulanate was the most used antibiotic. Only four patients had total recovery during the follow-up one year later. Conclusions: CSS is a rare but serious complication of rhinosinusitis. Patients with diabetes and the elderly may be at a higher risk for this complication. Even after treatment, some patients may still have neurological symptoms.
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- 2024
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25. Impact of occupational noise exposure on the hearing level in hospital staffs: a longitudinal study.
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Wang TC, Yu YC, Hsu A, Lin JY, Tsou YA, Liu CS, Chuang KJ, Pan WC, Yang CA, Hu SL, Ho CY, Chen TL, Lin CD, Pai PY, and Chang TY
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- Humans, Longitudinal Studies, Personnel, Hospital, Hearing, Noise, Occupational adverse effects, Hearing Loss, Noise-Induced epidemiology, Occupational Exposure, Occupational Diseases
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The study aimed to evaluate the impact of occupational noise on hearing loss among healthcare workers using audiometry. A longitudinal study was conducted with a six-month follow-up period in a hospital with 21 participants, divided into high-noise-exposure (HNE) and low-noise-exposure (LNE) groups. Mean noise levels were higher in the HNE group (70.4 ± 4.5 dBA), and hearing loss was measured using pure-tone audiometry at baseline and follow-up. The HNE group had significantly higher mean threshold levels at frequencies of 0.25 kHz, 0.5 kHz, 4.0 kHz, and an average of 0.5, 1, 2, and 4 kHz (all p-values < 0.05) after the follow-up period. After adjusting for confounding factors, the HNE group had significantly higher hearing loss levels at 0.25 kHz, 0.5 kHz, and average frequencies of 0.5, 1, 2, and 4 kHz compared to the LNE group at the second measurement. Occupational noise levels above 65 dBA over six months were found to cause significant threshold changes at frequencies of 0.25 kHz, 0.5 kHz, and an average of 0.5-4.0 kHz. This study highlights the risk of noise-induced hearing loss among healthcare workers and emphasizes the importance of implementing effective hearing conservation programs in the workplace. Regular monitoring and assessment of noise levels and hearing ability, along with proper use of personal protective equipment, are crucial steps in mitigating the impact of occupational noise exposure on the hearing health of healthcare workers., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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26. Bacteriology of Different Phenotypes of Chronic Rhinosinusitis.
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Li YT, Huang SS, Ma JH, Hsieh BH, Tsou YA, Lin CD, Tai CJ, and Shih LC
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- Humans, Retrospective Studies, Case-Control Studies, Quality of Life, Phenotype, Chronic Disease, Nasal Polyps complications, Nasal Polyps surgery, Nasal Polyps diagnosis, Methicillin-Resistant Staphylococcus aureus, Bacteriology, Rhinosinusitis, Rhinitis diagnosis, Sinusitis diagnosis
- Abstract
Objectives: Chronic rhinosinusitis (CRS) reduces the health-related quality of life and subsequently causes a tremendous socio-economic impact. Although many studies have been conducted, few have identified a relationship between bacteriological characteristics and different phenotypes or endotypes. Therefore, this study aimed to elucidate the recent trends in bacterial cultures from different types of CRS in the Asian population., Methods: This retrospective case-control study recruited patients diagnosed with CRS who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. The patients were classified into those with chronic rhinosinusitis with nasal polyps (CRSwNP)/chronic rhinosinusitis without nasal polyps (CRSsNP), eosinophilic chronic rhinosinusitis (eCRS)/non-eosinophilic chronic rhinosinusitis (NECRS), and central compartment atopic disease (CCAD)/lateral-dominant nasal polyp (LDNP) groups. The demographic data and bacteriological characteristics of the groups were analyzed., Results: We included 503 patients, identifying no significant difference between CRSwNP and CRSsNP for several common bacteria in CRS. The number of Staphylococcus epidermidis isolates in culture was significantly higher in the NECRS group (50.46% vs. 32.56%, p = 0.0003) than that in the eCRS group. The number of methicillin-resistant Staphylococcus aureus (MRSA; 8.51% vs. 2.35%, p = 0.0221) positive isolates was significantly higher in the CCAD group than that in the LDNP group., Conclusions: This was the first study in Asia to analyze the relationship between bacteriological characteristics and CCAD. MRSA is significantly higher in the CCAD group than that in the LDNP group. Recognizing the unique microbiology of CRSwNP, eCRS, and CCAD is crucial when selecting antimicrobial therapy to lessen the socio-economic impact., Level of Evidence: 3 Laryngoscope, 134:1071-1076, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)
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- 2024
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27. Chronic Rhinosinusitis and Premorbid Gastrointestinal Tract Diseases: A Population-Based Case-Control Study.
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Wu SS, Hung TH, Liao PS, Tsou YA, Hung YT, Lin CD, Tai CJ, Shen TC, and Shih LC
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Objectives: The primary aim was to determine the prevalence of gastrointestinal diseases in patients with chronic rhinosinusitis (CRS), utilizing the National Health Insurance Research Database (NHIRD) in Taiwan. Several studies have supported the existence of distinct immune patterns between the Asian and Western populations in CRS patients. Through the population-based case-control study, we could compare the differences between various regions and provide further treatment strategies for subsequent studies in Asian CRS patients. The secondary aim was to assess whether different types of CRS influence the correlation with specific GI diseases. Understanding how different phenotypes or endotypes of CRS may relate to distinct GI disease patterns could provide valuable insights into the underlying mechanisms and potential shared pathways between these conditions. Methods: We use the NHIRD in Taiwan. Newly diagnosed patients with CRS were selected between January 1, 2001 and December 31, 2017 as the case group, and the controls were defined as individuals without a history of CRS. Patients with CRS were divided into two groups: with nasal polyps and without nasal polyps. We also separated GI tract diseases into four groups based on their different pathophysiologies. Results: This study included 356,245 participants (CRS: 71,249 and control: 284,996). The results showed that CRS was significantly associated with some specific GI tract diseases, including acute/chronic hepatitis B, gastroesophageal reflux disease (GERD) with/without esophagitis, achalasia of cardia, peptic/gastrojejunal ulcer, Crohn's disease, and ulcerative colitis. In addition, when CRS was subcategorized into chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP), GERD with esophagitis and peptic ulcer were significantly associated with CRSsNP. Conclusions: A significant association between CRS and premorbid GI tract diseases has been identified. Remarkably, GERD with esophagitis and peptic ulcer were significantly associated with CRSsNP. The underlying mechanisms require further investigation and may lead to new treatments for CRS. Researchers can further investigate the mechanisms by referring to our classification method to determine the implications for diagnosis and treatment., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2023
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28. Mycobacterial Infection in Recalcitrant Otomastoiditis: A Case Series and Literature Review.
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Tsai T, Lan WC, Mao JS, Lee YC, Tsou YA, Lin CD, Shih LC, and Wang CY
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Otomastoiditis caused by mycobacterial infections is uncommon and recalcitrant. Its clinical presentations, sometimes similar to those of common chronic suppurative otitis media, make diagnosis difficult. This retrospective study analyzed the clinical features, treatment course, and therapeutic outcomes of patients with mycobacterial otomastoiditis. The cases of six patients diagnosed with mycobacterial otomastoiditis or suspected mycobacterial infection between January 2007 and January 2019 in a single tertiary medical center in Taiwan were investigated. Information about predisposing factors, clinical features, culture reports, histopathology, treatment course, and outcomes were collected and analyzed. Relevant literature available in English was also reviewed. One patient was infected with tuberculous mycobacteria, two with suspected tuberculous mycobacteria, and three with nontuberculous mycobacteria. All six patients responded poorly to empiric antibiotic therapy, and diagnosis was not possible at their previous clinics. Five patients underwent tympanomastoidectomies; one was administered antimycobacterial medication without undergoing surgery. Mycobacterial infection was confirmed from a tissue culture or from the histopathology of the specimen, but in two patients, no definitive evidence of tuberculosis was found. Antimycobacterial medication was administered based on clinical suspicion, and improvement was noted. With appropriate therapy, all patients recovered, and no sequelae were observed after treatment. If empiric antibiotic therapy cannot achieve acceptable results, atypical infections, such as mycobacteria, should be considered. Antimycobacterial medication could be administered under clinical suspicion, serving as a diagnosis ex juvantibus. Surgical intervention might help reduce the bacterial load and obtain specimens for accurate diagnosis, but this may be unnecessary if appropriate antimycobacterial medication results in improvement. Early diagnosis and treatment can prevent complications in patients with recalcitrant otomastoiditis.
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- 2023
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29. Clinical feature-based diagnosis criteria of eosinophil and non-eosinophil chronic rhinosinusitis in Taiwan.
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Ma JH, Hsieh BH, Huang SS, Li YT, Tsou YA, Lin CD, Tai CJ, and Shih LC
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Background: The prevalence of eosinophilic chronic rhinosinusitis (ECRS) has increased in Taiwan with a higher recurrence rate of nasal polyps after surgery. Therefore, we aimed to formulate the pre-operative diagnostic criteria for patients with ECRS in Taiwan., Methods: This case-control study included patients diagnosed with CRS with nasal polyps (CRSwNP) who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. The patients were classified into ECRS and non-eosinophilic CRS (NECRS) groups based on their histopathology. Demographic data, symptom severity scores, and computed tomography findings of the two groups were analyzed. We utilized receiver operating characteristic curve (ROC) analysis to evaluate parameters that could predict the diagnosis of ECRS., Results: Total 408 CRSwNP patients were enrolled (ECRS group: 163; NECRS group: 245). ECRS group was strongly associated with asthma (6.1% vs. 2.0%, p = .03), higher blood eosinophil counts (4.3% vs. 2.7%, p < .01), higher serum IgE (285.3 vs. 50.2 IU/mL, p = .02), and higher 22-item Sino-Nasal Outcome Test (SNOT-22) score (40.5 vs. 36.7, p = .03). The ECRS criteria based on ROC curve included the SNOT-22 (>45, 2 points), serum eosinophil count percentage (>4%, 4 points), asthma (4 points), total serum IgE (>140 IU/mL, 4 points), Lund-Mackay score (>9.5, 4 points), and ethmoid-to-maxillary opacification ratio on CT (>1.5, 5 points). The cutoff score was 14 points (sensitivity, 70.2%; specificity, 93.3%)., Conclusions: Clinical-feature-based criteria may predict the diagnosis of ECRS before FESS in Taiwan., Level of Evidence: Level 3., Competing Interests: The authors declare no conflicts of interest relevant to this report., (© 2023 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)
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- 2023
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30. Performance and Operational Feasibility of Epstein-Barr Virus-Based Screening for Detection of Nasopharyngeal Carcinoma: Direct Comparison of Two Alternative Approaches.
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Lou PJ, Jacky Lam WK, Hsu WL, Pfeiffer RM, Yu KJ, Chan CML, Lee VCT, Chen TC, Terng SD, Tsou YA, Leu YS, Liao LJ, Chang YL, Chien YC, Wang CP, Lin CY, Hua CH, Lee JC, Yang TL, Hsiao CH, Wu MS, Tsai MH, Cheng HC, Hildesheim A, Chen CJ, Chan KCA, and Liu Z
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- Humans, Nasopharyngeal Carcinoma diagnosis, Herpesvirus 4, Human genetics, Feasibility Studies, DNA, Viral genetics, Antibodies, Viral, Epstein-Barr Virus Infections, Nasopharyngeal Neoplasms diagnosis
- Abstract
Purpose: Two Epstein-Barr virus (EBV)-based testing approaches have shown promise for early detection of nasopharyngeal carcinoma (NPC). Neither has been independently validated nor their performance compared. We compared their diagnostic performance in an independent population., Methods: We tested blood samples from 819 incident Taiwanese NPC cases (213 early-stage, American Joint Committee on Cancer version 7 stages I and II) diagnosed from 2010 to 2014 and from 1,768 controls from the same region, frequency matched to cases on age and sex. We compared an EBV antibody score using immunoglobulin A antibodies measured by enzyme-linked immunosorbent assay (EBV antibody score) and plasma EBV DNA load measured by real-time PCR followed by next-generation sequencing (NGS) among EBV DNA-positive individuals (EBV DNA algorithm)., Results: EBV antibodies and DNA load were measured for 2,522 (802 cases; 1,720 controls) and 2,542 (797 cases; 1,745 controls) individuals, respectively. Of the 898 individuals positive for plasma EBV DNA and therefore eligible for NGS, we selected 442 (49%) for NGS testing. The EBV antibody score had a sensitivity of 88.4% (95% CI, 86.1 to 90.6) and a specificity of 94.9% (95% CI, 93.8 to 96.0) for NPC. The EBV DNA algorithm yielded significantly higher sensitivity (93.2%; 95% CI, 91.3 to 94.9; P = 1.33 × 10
-4 ) and specificity (98.1%; 95% CI, 97.3 to 98.8; P = 3.53 × 10-7 ). For early-stage NPC, the sensitivities were 87.1% (95% CI, 82.7 to 92.4) for the EBV antibody score and 87.0% (95% CI, 81.9 to 91.5) for the EBV DNA algorithm ( P = .514). For regions with a NPC incidence of 20-100/100,000 person-years (eg, residents in southern China and Hong Kong), these two approaches yielded similar numbers needed to screen (EBV antibody score: 5,656-1,131; EBV DNA algorithm: 5,365-1,073); positive predictive values ranged from 0.4% to 1.7% and 1.0% to 4.7%, respectively., Conclusion: We demonstrated high sensitivity and specificity of EBV antibody and plasma EBV DNA for NPC detection, with slightly inferior performance of the EBV antibody score. Cost-effectiveness studies are needed to guide screening implementation.- Published
- 2023
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31. Long-term rare giant sialolithiasis for 30 years: A case report and review of literature.
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Mao JS, Lee YC, Chi JC, Yi WL, Tsou YA, Lin CD, Tai CJ, and Shih LC
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Background: Sialolithiasis is one of the most common salivary gland disorders, most commonly affecting the submandibular gland. Submandibular sialolithiasis can be treated using non-invasive conservative measures and invasive treatments. Treatment selection was based on the ductal system anatomy and the size and location of the stones. This study aimed to review the updates on sialolithiasis treatment and compare the different management strategies of the variables., Case Summary: This report presents a case of a long-term, rare, and giant sialolithiasis within the submandibular gland parenchyma for 30 years in an older adult. Our patient presented with painless right submandibular swelling. Computed tomography revealed a calcified mass measuring 35 mm × 20 mm within the right submandibular gland. In this case, the infection and fibrosis of the affected gland and size of the stone did not provide us with other alternatives except for the excision of the involved gland. Thus, right submandibular sialoadenectomy was performed via the transcervical approach. After the surgery, the patient recovered without any complaints, side effects, or complications., Conclusion: Tailored management is important for preserving gland function, maintaining low risk, and reducing patient discomfort., Competing Interests: Conflict-of-interest statement: The authors declare no conflict of interest., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)
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- 2023
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32. Longitudinal changes in swallowing function after surgery and proactive swallowing therapy for oral cancer.
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Meng NH, Li CI, Hua CH, Lin TC, Chiu CJ, Lin CL, Tsai MH, Chiu PJ, Chang WD, and Tsou YA
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- Humans, Deglutition, Retrospective Studies, Pharynx, Deglutition Disorders etiology, Mouth Neoplasms surgery
- Abstract
Background: This study aimed to describe and explore the longitudinal changes in swallowing function among patients with oral cancer who underwent surgery and proactive swallowing therapy from baseline to 1-year postoperation., Methods: We retrospectively studied 118 patients over a 4.5-year duration. Swallowing functional assessment including 10-item Eating Assessment Tool (EAT-10), Functional Oral Intake Scale (FOIS), M. D. Anderson Dysphagia Inventory, and Modified Barium Swallow Impairment Profile (MBSImP™) was performed at baseline, 1-month, 6-month, and 1-year postoperatively., Results: All swallowing parameters worsened 1-month postoperation. EAT-10, FOIS, and MBSImP™ oral and pharyngeal impairment scores improved significantly compared with 1-month postoperation at 6 months. Other swallowing parameters, except for weight, did not differ significantly from baseline at 6 months. The rate of tube-feeding dependency was 11.5% and 5.6% at 1 and 6 months postoperation, respectively., Conclusions: Periodic swallowing functional assessments help delineate the longitudinal changes in swallowing functional outcomes., (© 2023 Wiley Periodicals LLC.)
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- 2023
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33. Primary versus salvage intratympanic steroid treatment for idiopathic sudden sensorineural hearing loss.
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Lan WC, Lin CD, Tsou YA, Shih LC, Aoh Y, Lu CC, Hsu HS, Lai CY, and Wang CY
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Objective: The objective of this research is to compare primary and salvage intratympanic (IT) steroid treatments in terms of hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL)., Methods: The patients were randomized into two (primary and salvage) groups. Both groups received systemic steroid treatment for 2 weeks. The primary group also received IT dexamethasone injection three times during the treatment period, whereas the salvage group received IT dexamethasone injection only if no or slight recovery was noted at the 2-week follow-up. If needed, salvage steroid injection was administered three times during the following 2 weeks. Hearing recovery was analyzed according to the modified American Academy of Otolaryngology-Head and Neck Surgery criteria., Results: The degrees of hearing improvement at the 3-month follow-up were similar in the two groups. Compared with baseline, the pure-tone average values and speech discrimination scores improved by 38.45 ± 21.95 dB HL and 34.32% ± 30.55%, respectively, in the primary group and 36.80 ± 22.33 dB HL and 31.87% ± 27.88%, respectively, in the salvage group ( p = .762 and .659, respectively). In addition, the complete or partial hearing recovery rates were also similar in the primary and salvage groups (67.7% vs. 73.3%, respectively; p = .780). In the salvage group, 18 patients required no IT steroid injection because they recovered after systemic steroid treatment., Conclusion: Primary and salvage IT steroid treatments for ISSNHL led to similar outcomes. In summary, salvage IT steroid injection is recommended for patients with ISSNHL patients to prevent unnecessary IT injection., Level of Evidence: 2., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)
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- 2023
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34. Distal Mean Nocturnal Baseline Impedance Predicts Pathological Reflux of Isolated Laryngopharyngeal Reflux Symptoms.
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Luo HN, Wang CC, Lin YC, Chuang CY, Tsou YA, Fu JC, Yang SS, Chang CS, and Lien HC
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Background/aims: Diagnosis of isolated laryngopharyngeal reflux symptoms (ILPRS), ie, without concomitant typical reflux symptoms (CTRS), remains difficult. Mean nocturnal baseline impedance (MNBI) reflects impaired mucosal integrity. We determined whether esophageal MNBI could predict pathological esophagopharyngeal reflux (pH+) in patients with ILPRS., Methods: In this cross-sectional study conducted in Taiwan, non-erosive or low-grade esophagitis patients with predominant laryngopharyngeal reflux symptoms underwent combined hypopharyngeal multichannel intraluminal impedance-pH monitoring when off acid suppressants. Participants were divided into the ILPRS (n = 94) and CTRS (n = 63) groups. Asymptomatic subjects without esophagitis (n = 25) served as healthy controls. The MNBI values at 3 cm and 5 cm above the lower esophageal sphincter (LES) and the proximal esophagus were measured., Results: Distal but not proximal esophageal median MNBI values were significantly lower in patients with pH+ than in those with pH- (ILPRS in pH+ vs pH-: 1607 Ω vs 2709 Ω and 1885 Ω vs 2563 Ω at 3 cm and 5 cm above LES, respectively; CTRS in pH+ vs pH-: 1476 vs 2307 Ω and 1500 vs 2301 Ω at 3 cm and 5 cm above LES, respectively, P < 0.05 for all). No significant differences of any MNBI exist between any pH- subgroups and healthy controls. The areas under the receiver operating characteristic curve in the ILPRS group were 0.75 and 0.80, compared to the pH- subgroup and healthy controls ( P < 0.001 for both), respectively. Interobserver reproducibility was good (Spearman correlation 0.93, P < 0.0001)., Conclusion: Distal esophageal MNBI predicts pathological reflux in patients with ILPRS.
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- 2023
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35. Validation of Pharyngeal Acid Reflux Episodes Using Hypopharyngeal Multichannel Intraluminal Impedance-pH.
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Chen YY, Wang CC, Lin YC, Kao JY, Chuang CY, Tsou YA, Fu JC, Yang SS, Chang CS, and Lien HC
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Background/aims: Hypopharyngeal multichannel intraluminal impedance-pH (HMII-pH) technology incorporating 2 trans-upper esophageal sphincter impedance channels has been developed to detect pharyngeal reflux. We used the HMII-pH technique to validate the candidate pharyngeal acid reflux (PAR) episodes based on the dual-pH tracings and determined the interobserver reproducibility., Methods: We conducted a cross-sectional study in tertiary centers in Taiwan. Ninety patients with suspected laryngopharyngeal reflux and 28 healthy volunteers underwent HMII-pH test when off acid suppressants. Candidate PAR episodes were characterized by pharyngeal pH drops of at least 2 units and reaching a nadir pH of 5 within 30 seconds during esophageal acidification. Two experts manually independently identified candidate PAR episodes based on the dual-pH tracings. By reviewing the HMII-pH tracings, HMII-pH-proven PAR episodes were subsequently confirmed. The consensus reviews of HMII-pH-proven PAR episodes were considered to be the reference standard diagnosis. The interobserver reproducibility was assessed., Results: A total of 105 candidate PAR episodes were identified. Among them 84 (80.0%; 95% CI, 71.0-87.0%) were HMII-pH-proven PAR episodes (82 in 16 patients and 2 in 1 healthy subject). Patients tended to have more HMII-pH-proven PAR episodes than healthy controls (median and percentile values [25th, 75th, and 95th percentiles]: 0 [0, 0, 3] vs 0 [0, 0, 0], P = 0.067). The concordance rate in diagnosing HMII-pH-proven PAR episodes between 2 independent observers was 92.2%., Conclusion: Our preliminary data showed that 80.0% (71.0-87.0%) of the proposed candidate PAR episodes were HMII-pH-proven PAR episodes, among which the interobserver reproducibility was good.
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- 2023
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36. Macrophage secretory IL-1β promotes docetaxel resistance in head and neck squamous carcinoma via SOD2/CAT-ICAM1 signaling.
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Hsieh CY, Lin CC, Huang YW, Chen JH, Tsou YA, Chang LC, Fan CC, Lin CY, and Chang WC
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- Animals, Mice, Macrophages, Tumor Microenvironment, Humans, Signal Transduction, Docetaxel pharmacology, Docetaxel therapeutic use, Head and Neck Neoplasms drug therapy, Intercellular Adhesion Molecule-1 genetics, Squamous Cell Carcinoma of Head and Neck drug therapy, Interleukin-1beta metabolism
- Abstract
Docetaxel (DTX) combined with cisplatin and 5-fluorouracil has been used as induction chemotherapy for head and neck squamous cell carcinoma (HNSCC). However, the development of acquired resistance remains a major obstacle to treatment response. Tumor-associated macrophages are associated with chemotherapeutic resistance. In the present study, increased infiltration of macrophages into the tumor microenvironment (TME) was significantly associated with shorter overall survival and increased resistance to chemotherapeutic drugs, particularly DTX, in patients with HNSCC. Macrophage coculture induced expression of intercellular adhesion molecule 1 (ICAM1), which promotes stemness and the formation of polyploid giant cancer cells, thereby reducing the efficacy of DTX. Both genetic silencing and pharmacological inhibition of ICAM1 sensitized HNSCC to DTX. Macrophage secretion of IL-1β was found to induce tumor expression of ICAM1. IL-1β neutralization and IL-1 receptor blockade reversed DTX resistance induced by macrophage coculture. IL-1β activated superoxide dismutase 2 and inhibited catalase, thereby modulating intracellular levels of ROS and inducing ICAM1 expression. Arsenic trioxide (ATO) reduced macrophage infiltration into the TME and impaired IL-1β secretion by macrophages. The combinatorial use of ATO enhanced the in vivo efficacy of DTX in a mouse model, which may provide a revolutionary approach to overcoming acquired therapeutic resistance in HNSCC.
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- 2022
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37. A comparison of central compartment atopic disease and lateral dominant nasal polyps.
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Shih LC, Hsieh BH, Ma JH, Huang SS, Tsou YA, Lin CD, Huang KH, and Tai CJ
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- Humans, Case-Control Studies, Endoscopy methods, Chronic Disease, Nasal Polyps surgery, Nasal Polyps diagnosis, Sinusitis surgery, Sinusitis diagnosis, Rhinitis surgery, Rhinitis diagnosis, Asthma surgery, Rhinitis, Allergic surgery, Eosinophilia
- Abstract
Background: The characteristics and surgical outcomes of central compartment atopic disease (CCAD) vary by region and race. Therefore, we aimed to identify the risk factors, symptom severity, and prognosis of CCAD in the Asian population., Methods: This case-control study recruited patients diagnosed with chronic rhinosinusitis with nasal polyps who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. Patients were classified into CCAD and lateral-dominant nasal polyp (LDNP) groups based on endoscopic and computed tomography imaging findings. The demographic data, symptom severity scores, and surgical outcomes of the 2 groups were analyzed., Results: Our study included 442 patients (CCAD group: n = 51; LDNP group: n = 391). We found that CCAD was strongly related to both asthma (9.8% vs 3.5%, p = 0.04) and allergic rhinitis symptoms (43.3% vs 26.6%, p = 0.01). Higher eosinophil counts were detected in blood serum (5.8% vs 2.8%, p < 0.01) and histopathologic profiles (57.0 vs 17.3, p < 0.01) among patients with CCAD. Improvements in 22-item Sino-Nasal Outcome Test (SNOT-22) score and mucociliary clearance time (MCT) after surgical intervention revealed that the CCAD group had a better response to FESS (SNOT-22 score: -31.82 vs -22.66, p < 0.01; MCT: -233.06 vs -191.93 seconds, p = 0.03). The revision FESS rate was not different between the 2 groups., Conclusion: Polyps originating from the central compartment were found to be related to asthma and allergic rhinitis in Taiwanese patients. A higher eosinophil count was suggested in both serum and local nasal tissue from patients with CCAD. FESS serves as an effective treatment for symptom relief in patients with CCAD., (© 2022 ARS-AAOA, LLC.)
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- 2022
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38. Dysphagia in a Patient with Esophageal and Hypopharyngeal Cancers After Esophageal Reconstruction: A Pharyngeal Clearance Facilitating Maneuver.
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Meng NH, Tsou YA, Yang PY, Chen HC, and Chang CW
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- Deglutition, Humans, Pharynx, Deglutition Disorders etiology, Hypopharyngeal Neoplasms complications, Hypopharyngeal Neoplasms surgery
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- 2022
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39. The Changes in the Severity of Deep Neck Infection Post-UPPP and Tonsillectomy in Patients with OSAS.
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Hu PC, Shih LC, Chang WD, Lai JN, Liao PS, Tai CJ, Lin CD, Yip HT, Shen TC, and Tsou YA
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The main aim of this study is to compare the incidence rate and severity of deep neck infection (DNI) in patients post-UPPP+ T (uvulopalatopharyngoplasty plus tonsillectomy) and without UPPP+ T. We utilized the data derived from the Longitudinal Health Insurance Database (LHID) of the National Health Insurance Research Database (NHIRD) in Taiwan from 1 January 2000 to 31 December 2012. Patients who had undergone combined UPPP and tonsillectomy were selected using National Health Insurance (NHI) surgical order. Patients with DNI were selected using International Classification of Diseases (ICD-9-CM) code. A logistic regression model was applied for risk analysis. There were 1574 patients in the UPPP+ T cohort, and 6,296 patients who did not undergo combined UPPP and tonsillectomy for the control group. Our analysis showed that patients with an obstructive sleep apnea syndrome (OSAS) history constitute 76.1% ( n = 1198) of the UPPP+ T cohort. Compared to the control group, there was no significantly increased incidence rate of DNI after UPPP+ T within 1-60 months. Patients undergoing combined UPPP and tonsillectomy had a lower intubation rate for DNI, with an adjusted odds ratio of 0.47 (95% CI = 0.32-0.69). The combined UPPP and tonsillectomy does not increase the risk of DNI within 1-60 months. Furthermore, combined UPPP and tonsillectomy can reduce the severity for DNI by decreasing the intubation rate and length of hospitalization.
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- 2022
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40. Probiotic Strains Isolated from an Olympic Woman's Weightlifting Gold Medalist Increase Weight Loss and Exercise Performance in a Mouse Model.
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Lin WY, Kuo YW, Lin JH, Lin CH, Chen JF, Tsai SY, Lee MC, Hsu YJ, Huang CC, Tsou YA, and Ho HH
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- Animals, Gold, Humans, Mice, Weight Lifting, Weight Loss, Lactobacillus plantarum physiology, Probiotics
- Abstract
Obesity is a worldwide health problem. Calorie-restricted diets constitute a common intervention for treating obesity. However, an improper calorie-restricted diet can lead to malnutrition, fatigue, poor concretion, muscle loss, and reduced exercise performance. Probiotics have been introduced as an alternative treatment for obesity. In the present study, we tested the weight loss and exercise performance enhancement effectiveness of probiotic strains of different origins, including four isolated from an Olympic weightlifting gold medalist ( Bifidobacterium longum subsp. longum OLP-01, Lactobacillus plantarum PL-02, Lactobacillus salivarius subsp. salicinius SA-03, and Lactococcus lactis subsp. lactis LY-66). A high-fat diet (HFD) was used to induce obesity in 16 groups of mice ( n = 8/group). The mice were administered probiotic supplements at a dosage of 4.1 × 10
9 CFU/kg/day for 10 weeks. All probiotic supplementation groups showed a significant reduction in body weight and fat mass compared with the HFD group. TYCA06, CS-773, BLI-02, PL-02, bv-77, and OLP-01 were the most effective in facilitating weight loss and fat reduction, which may be due to fatty-acid absorbing activity. PL-02, LY-66, TYCA06, CS-773, and OLP-01 elevated the animals' grip strength and exhaustive running duration. PL-02, LY-66, and OLP-01 increased tissue glycogen (liver and muscle) levels and muscle capillary density and reduced blood lactate production levels after exercise. In conclusion, OLP-01, PL-02, LY-66, TYCA06, and CS-773 were highly effective in enhancing weight loss and exercise performance. This study should be repeated on humans in the future to further confirm the findings.- Published
- 2022
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41. Hypothyroidism and related comorbidities on the risks of developing tinnitus.
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Hsu A, Tsou YA, Wang TC, Chang WD, Lin CL, and Tyler RS
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- Comorbidity, Humans, Incidence, Longitudinal Studies, Retrospective Studies, Risk Factors, Taiwan epidemiology, Vertigo complications, Hearing Loss complications, Hearing Loss epidemiology, Hypothyroidism complications, Hypothyroidism epidemiology, Sleep Initiation and Maintenance Disorders complications, Sleep Initiation and Maintenance Disorders epidemiology, Tinnitus epidemiology, Tinnitus etiology
- Abstract
This is a retrospective longitudinal study that uses data from the National Health Insurance Research Database (NHIRD) of Taiwan of which hypothyroid patients who received a diagnosis between 2000 and 2010 were selected and followed up until 2011. The primary outcome of this study was the occurrence of tinnitus (ICD-9-CM code 388.3). The relevant comorbidities were selected as potential confounders according to the literature, which included vertigo (ICD-9-CM code 386), insomnia (ICD-9-CM code 780), anxiety (ICD-9-CM code 300.00), and hearing loss (ICD-9-CM code 388-389). The overall incidence of tinnitus was significantly higher in the hypothyroidism cohort than in the non-hypothyroidism cohort (9.49 vs. 6.03 per 1000 person-years), with an adjusted HR of 1.35 (95% CI 1.18-1.54) after adjusting potential confounders. The incidences of tinnitus, as stratified by gender, age, comorbidity, and follow-up time, were all significantly higher in the hypothyroidism cohort than those in the non-hypothyroidism cohort. The incidence of tinnitus significantly increased with age (aHR = 1.01, 95% CI 1.01-1.02). In conclusion, we report the relationship between hypothyroidism and the increased risk for tinnitus. We also found that hypothyroidism patients are at increased risk of developing tinnitus when associated with comorbidities including vertigo, hearing loss, and insomnia., (© 2022. The Author(s).)
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- 2022
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42. Suture medialization of middle turbinate during endoscopic sinus surgery does not impair olfaction.
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Shih LC, Hsu CC, Bing-Han H, Lee IT, Tsou YA, Tsai MH, and Tai CJ
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- Chronic Disease, Endoscopy, Humans, Smell, Sutures, Turbinates surgery, Olfaction Disorders, Paranasal Sinuses surgery, Rhinitis surgery
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- 2022
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43. Cranial Electrotherapy Stimulation to Improve the Physiology and Psychology Response, Response-Ability, and Sleep Efficiency in Athletes with Poor Sleep Quality.
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Chang WD, Tsou YA, Chen YY, and Hung BL
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- Adult, Athletes, Humans, Skull, Sleep physiology, Young Adult, Electric Stimulation Therapy methods, Sleep Quality
- Abstract
Athletes often have poor sleep quality before a competition. Sleep quality can stabilize mood and improve sports performance. The randomized controlled study explored the effects of cranial electrotherapy stimulation (CES) on the physiology, psychology, response-ability, and sleep quality of athletes who had poor sleep quality before a competition. Athletes who had poor sleep quality (Pittsburgh Sleep Quality Scale score > 5) and had a competition in less than 2 months were recruited. The athletes were grouped into the CES group, which received a 2-week CES treatment ( n = 20, age = 21.55 ± 2.26 years), and a placebo group ( n = 20, age = 21.05 ± 1.46 years), which received a 2-week sham CES treatment. We performed biochemical analysis, a simple reaction time test, choice reaction time tests, the Profile of Mood States, heart rate variability (HRV), and an Actigraphy activity recorder to measure outcomes before and after the interventions. Our results revealed no significant differences in blood urea nitrogen, creatine phosphate, testosterone, cortisol, and saliva pH between and within groups ( p > 0.05). Significant decreases in negative mood states (i.e., anger, tension, and depression) and choice reaction time in the CES group were noted ( p < 0.05), moreover, the anger, tension, and depression mood decreased from 0.36 ± 0.45 (95% CI = 0.16-0.55), 1.62 ± 0.97 (95% CI = 1.19-2.04), and 1.67 ± 1.06 (95% CI = 1.20-2.13) to 0.11 ± 0.20 (95% CI = 0.02-0.19, p = 0.03), 1.12 ± 0.74 (95% CI = 0.79-1.44, p = 0.04), and 0.81 ± 0.75 (95% CI = 0.48-1.13, p = 0.001), respectively. Additionally, choice reaction time was decreased from 420.85 ± 41.22 ms (95% CI = 402.78-438.91) to 399.90 ± 36.71 ms (95% CI = 383.81-415.98, p = 0.04) and was also noted in the CES group. For HRV, and Actigraphy activity for sleep measure, the low-frequency (LF)/high-frequency (HF) ratios changed from 1.80 ± 1.39 (95% CI = 1.19-2.40) to 1.21 ± 0.73 (95% CI = 0.89-1.53, p = 0.10), and sleep efficiency decreased from 87.94 ± 6.76% (95% CI = 84.97-90.90) to 81.75 ± 9.62% (95% CI = 77.53-85.96, p = 0.02) in the CES group. The change in LF/HF after the trial were found between CES and placebo groups (p < 0.05). Yet, the decrease in sleep efficiency in the placebo group were noted ( p < 0.05). However, we found that the regression line for sleep efficiency was decreased less during the study while using CES. The CES intervention could reduce negative emotions, improve choice reaction times, enhance the parasympathetic and sympathetic nerve activity imbalances, and slow sleep efficiency deterioration. Regardless, small effect sizes of the application of CES on psychology response, response-ability, and sleep efficiency were concluded in athletes with poor sleep quality before a competition.
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- 2022
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44. Autologous Fat Plus Platelet-Rich Plasma versus Autologous Fat Alone on Sulcus Vocalis.
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Tsou YA, Tien VH, Chen SH, Shih LC, Lin TC, Chiu CJ, and Chang WD
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Sulcus vocalis is a frequent cause of glottic insufficiency that leads to incomplete vocal fold closure during phonation. Type II sulcus vocalis is defined as a partial defect of the lamina propria (LP). Treatment with fillers, such as fat or hyaluronic acid (HA), in the vocal folds is widely used, but the duration of effect is variable. Platelet-rich plasma (PRP) can enhance the survival of autologous fat in fat grafting, and also is used to treat sulcus vocalis. This study aimed to compare the effectiveness of autologous fat graft versus fat graft plus PRP to treat type II sulcus vocalis. Thirty-four patients with a voice handicap index (VHI) ≥ 11 were randomized to two groups, which received LP injections of fat graft ( n = 17) or fat graft plus PRP ( n = 17). At 1 month and 6 months after injection, the VHI decreased significantly in both groups. The fat plus PRP group had better Jitter, Shimmer, and noise to harmonic ratio (NHR) in 1 month and 6 months after surgery. The fat plus PRP group resulted in lower VHI scores one month after surgery, and stroboscopy revealed sustained smaller gaps after six months. These results indicate that a combination of fat graft plus PRP is safe and effective for treating sulcus vocalis type II and associated vocal atrophy.
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- 2022
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45. Esophageal Pressure and Clinical Assessments in the Gastroesophageal Reflux Disease Patients with Laryngopharyngeal Reflux Disease.
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Tsou YA, Chen SH, Wu WC, Tsai MH, Bassa D, Shih LC, and Chang WD
- Abstract
Laryngopharyngeal reflux disease (LPRD) might be associated with reflux symptoms, and its severity is correlated with the Reflux Symptoms Index. Diagnosis is often challenging because of a lack of accurate diagnostic tools. Although an association between LPRD and gastroesophageal reflux disease (GERD) exists, the extent to which esophageal pressure changes in patients with LPRD with GERD has been unknown. Therefore, this study surveys the clinical assessments and extent of esophageal pressure changes in LRPD patients with various GERD severities, and compares esophageal sphincter pressures between ages, genders, and body mass index (BMI). This observational study assessed patients with LPRD and GERD. High-resolution esophageal manometry was used to gather data pertaining to the area pressure on the upper esophageal sphincter (UES) and lower esophageal sphincter (LES), and the correlation between such pressure and symptom severity was determined. We compared the esophageal pressure of different UES and LES levels in the following categories: gender, age, BMI, and GERD severity. We analyzed correlations between esophageal pressure and clinical assessments among 90 patients with throat globus with laryngitis with LPRD. LPRD was measured using laryngoscopy, and GERD was measured using esophagoscopy and 24 h PH monitoring. There were no significant differences in the clinical assessments among the four grades of GERD. The LPRD patients with serious GERD had a lower UES and LES pressure. The lowest pressure and longer duration of LES and UES were also observed among patients with LPRD of grade D GERD. No significant differences in UES and LES pressures among ages, genders, or BMIs were noted.
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- 2021
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46. Autologous Fat Injection Laryngoplasty for Unilateral Vocal Fold Paralysis.
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Chang WD, Chen SH, Tsai MH, and Tsou YA
- Abstract
Background: Unilateral vocal palsy (UVFP) affects the voice and swallowing function and could be treated by various materials to achieve improved mucosal wave and better closure during phonation. Injection laryngoplasty is considered an exemplary method for these patients and could be injected as early as possible. We conducted a systematic review and meta-analysis for the subjective and objective outcomes of autologous fat injection laryngoplasty (AFIL) and assessed the effects for patients with UVFP., Methods: We searched studies from PubMed and EBSCO databases with PRISMA appraisal to search for articles about the effects of AFIL on UVFP. The published articles were reviewed according to our inclusion and exclusion criteria. The short- and long-term outcomes of perceptual, acoustic analysis, and quality of life were also analyzed by meta-analysis., Results: Eleven articles were reviewed, and seven studies were selected for meta-analysis. AFIL improves the perceptual outcome and some voice parameters in short-term and long-term results, i.e., jitter, shimmer, and maximal phonation time (MPT). It also significantly improved the voice handicap index (VHI) in the long term, suggesting an increase in quality of life., Conclusions: AFIL is considered a reliable treatment method for UVFP and could even last for over 12 months.
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- 2021
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47. Combined Transoral Robotic Tongue Base Surgery and Palate Surgery in Obstructive Sleep Apnea Syndrome: Modified Uvulopalatopharyngoplasty versus Barbed Reposition Pharyngoplasty.
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Tsou YA, Hsu CC, Shih LC, Lin TC, Chiu CJ, Tien VH, Tsai MH, and Chang WD
- Abstract
Background: Successful surgery outcomes are limited to moderate to severe obstructive sleep apnea (OSA) syndrome. Multilevel collapse at retropalatal and retroglossal areas is often found during the drug-induced sleep endoscopy (DISE). Therefore, multilevel surgery is considered for these patients. The aim of our study was to survey surgical outcomes by modified uvulopalatoplasty (UPPP) plus transoral robotic surgery tongue base reduction (TORSTBR) versus barbed repositioning pharyngoplasty (BRP) plus TORSTBR., Methods: The retrospective cohort study was performed at a tertiary referral center. We collected moderate to severe OSA patients who were not tolerant to positive pressure assistant PAP from September 2016 to September 2019; pre-operative-operative Muller tests all showed retropalatal and retroglossal collapse; pre-operative Friedman Tongue Position (FTP) > III, with the tonsils grade at grade II minimum, with simultaneous velum (V > 1) and tongue base (T > 1), collapsed by drug-induced sleep endoscopy (DISE) under the VOTE grading system. The UPPP plus TORSTBR ( n = 31) and BRP plus TORSTBR ( n = 31) techniques were offered. We compare the outcomes using an Epworth sleepiness scale (ESS) questionnaire, and measure the patients' apnea-hypopnea index (AHI), lowest O
2 saturation, cumulative time spent below 90% (CT90), and arousal index (AI) by polysomnography six months after surgery; we also measure their length of hospital stay and complications between these two groups., Results: Comparing BRP plus TORSTBR with UPPP plus TORSTBR, the surgical success rate is 67.74% and 38.71%, respectively. The significantly higher surgical success rate in the BRP plus TORSTBR group was noted. The surgical time is shorter in the BRP plus TORSTBR group. The complication rate is not significant in pain, bleeding, dysgeusia, dysphagia, globus sensation, and prolonged suture stay, even though the BRP plus TORSTBR rendered a higher percentage of globus sensation during swallowing and a more prevalent requirement of suture removal one month after surgery. The length of hospital stay is not significantly different between the two groups., Conclusion: In conclusion, BRP plus TORSTBR is a considerable therapy for moderate to severe OSA patients with DISE showing a multi-level collapse in velum and tongue base area. The BRP technique might offer a better anterior-posterior suspension vector for palate level obstruction.- Published
- 2021
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48. Additive Antiproliferative and Antiangiogenic Effects of Metformin and Pemetrexed in a Non-Small-Cell Lung Cancer Xenograft Model.
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Wang JL, Lan YW, Tsai YT, Chen YC, Staniczek T, Tsou YA, Yen CC, and Chen CM
- Abstract
Lung cancer is heterogeneous and challenging to cope with once it has progressed. Chemotherapy is the first step once no active driver mutation has been discovered. Non-antitumor drugs have been found to be beneficial when used as adjuvants to chemotherapy. In this study, the additive effect and mechanism of metformin combined with pemetrexed in non-small-cell lung cancer (NSCLC) cells were elucidated. Three NSCLC cell lines, A549, H1975, and HCC827, were used to analyze tumor cell proliferation, colony formation and the cell cycle in vitro when exposed to metformin alone, pemetrexed alone or their combination. We found that combination treatment in three cell lines exerted antiproliferative effects through cell cycle arrest in the S phase. An ex vivo chicken chorioallantoic membrane (CAM) assay was used to examine the antiangiogenic effect of metformin combined with pemetrexed on vascular structure formation. We further created an A549 orthotopic xenograft model with an in vivo imaging system (IVIS) and explored the associated indicators involved in the tumorigenic process. The in vitro results showed that the combination of metformin and pemetrexed exhibited an antiproliferative effect in reducing cell viability and colony formation, the downregulation of cyclin D1 and A2 and the upregulation of CDKN1B, which are involved in the G1/S phase. For antiangiogenic effects, the combination therapy inhibited the vascular structure, as proven by the CAM assay. We elucidated that combination therapy could target VEGFA and Endoglin by RT-qPCR, ELISA and histopathological findings in an A549 orthotopic NSCLC xenograft model. Our research demonstrated the additive antiproliferative and antiangiogenic effects of the combination of metformin with pemetrexed in NSCLC and could be applied to clinical lung cancer therapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Wang, Lan, Tsai, Chen, Staniczek, Tsou, Yen and Chen.)
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- 2021
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49. Effects of Whole-Body Vibration and Balance Training on Female Athletes with Chronic Ankle Instability.
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Chang WD, Chen S, and Tsou YA
- Abstract
We explored the effects of 6-week whole-body vibration (WBV) and balance training programs on female athletes with chronic ankle instability (CAI). This randomized controlled study involved female athletes with dominant-leg CAI. The participants were randomly divided into three groups: WBV training (Group A), balance training (Group B), and nontraining (control group; Group C). Groups A and B performed three exercise movements (double-leg stance, one-legged stance, and tandem stance) in 6-week training programs by using a vibration platform and balance ball, respectively. The Star Excursion Balance Test (SEBT), a joint position sense test, and an isokinetic strength test were conducted. In total, 63 female athletes with dominant-leg CAI were divided into three study groups (all n = 21). All of them completed the study. We observed time-by-group interactions in the SEBT ( p = 0.001) and isokinetic strength test at 30°/s of concentric contraction (CON) of ankle inversion ( p = 0.04). Compared with the control group, participants of the two exercise training programs improved in dynamic balance, active repositioning, and 30°/s of CON and eccentric contraction of the ankle invertor in the SEBT, joint position sense test, and isokinetic strength test, respectively. Furthermore, the effect sizes for the assessed outcomes in Groups A and B ranged from very small to small. Female athletes who participated in 6-week training programs incorporating a vibration platform or balance ball exhibited very small or small effect sizes for CAI in the SEBT, joint position sense test, and isokinetic strength test. No differences were observed in the variables between the two exercise training programs.
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- 2021
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50. Operative and Conservative Management of Laryngeal Contact Granuloma: A Network Analysis and Systematic Review.
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Tsai SW, Ma YF, Shih LC, Tsou YA, and Sung CK
- Subjects
- Conservative Treatment, Granuloma, Humans, Recurrence, Granuloma, Laryngeal diagnosis, Granuloma, Laryngeal surgery, Voice
- Abstract
Objective: Laryngeal contact granuloma is a disease of benign hypertrophic granulation tissue at the medial side of vocal process. Numerous studies of conservative and surgical management have reported effectiveness, yet optimal treatment has not been standardized. We compared primary and secondary outcomes of conservative and surgical treatment using endoscopic grading, Voice Handicap Index-10 (VHI-10), maximum phonation time (MPT), and recurrence rate., Methods: We performed literature searches of MEDLINE, PubMed, and EMBASE from November 1985 to October 2017, with randomized controlled trials and case control studies of at least three months follow-up as the inclusion criteria. Outcomes included laryngoscopic findings, MPT, and VHI-10. Data regarding study design, outcome analysis, follow-up time, and disease remission were systematically collected., Results: A total of 1069 patients were abstracted from 19 papers. With conservative treatment, 98% of patients' laryngeal granuloma resolved within three months, and 84% for the surgical group. There was a decrease in VHI-10 of 2.69 (95% credible interval (CI) -9.52 to 3.82) and 6.48 (95% CI -15.00 to 1.94) for conservative and surgical management, respectively. MPT improvement was 1.27 s (95% CI: 2.03-5.84) for conservative treatment and 5.02 s (95% CI: 0.78-8.07) for surgical. For all 19 studies, absolute recurrence risk for control, conservative, and surgical measures were respectively 4%, 16%, and 29%., Conclusions: Most patients treated conservatively or surgically alone responded to treatment, but conservative management was favored. VHI-10 and MPT improvement in surgical patients were noted, but only the latter was statistically significant. In regard to recurrence, conservative management had better outcome than surgical. Taken together, the results suggest that minimally symptomatic granulomas have higher response rate and lower recurrence risk when treated conservatively, while larger, symptomatic granulomas may favor surgical excision followed by medical management to reduce risk of recurrence., (Published by Elsevier Inc.)
- Published
- 2021
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