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The current protocol aims to showcase the technology integration, providing a detailed description of adopting the HealthCloud app, developed by the Healthy Landscape and Healthy People Lab, National Taiwan University (HLHP-NTU), on smartphones and smartwatches to collect data on users' real-time psychological and physiological responses and environmental information. A flexible and integrated research method was proposed because it can be difficult to measure multi-dimensional aspects of personal data in on-site studies in landscape and outdoor recreation research. An on-site study conducted in 2020 at the National Taiwan University campus was used as an application example. A dataset of 385 participants was used after excluding invalid samples. During the experiment, participants were asked to walk around campus for 30 min when their heart rate and psychological-scale items were measured, together with several environmental metrics. This work aimed to provide a possible solution to help on-site studies track real-time human responses that match ambient factors. Due to the app's flexibility, its use on wearable devices shows excellent potential for multidisciplinary research studies.

Graphic design thinking is a key skill for landscape architects, but little is known about the links between the design process and brain activity. Based on Goel’s frontal lobe lateralization hypothesis (FLLH), we used functional magnetic resonance imaging (fMRI) to scan the brain activity of 24 designers engaging in four design processes—viewing, copy drawing, preliminary ideas, and refinement—during graphic design thinking. The captured scans produced evidence of dramatic differences between brain activity when copying an existing graphic and when engaging in graphic design thinking. The results confirm that designs involving more graphic design thinking exhibit significantly more activity in the left prefrontal cortex. These findings illuminate the design process and suggest the possibility of developing specific activities or exercises to promote graphic design thinking in landscape architecture.

A reliable glucose concentration measurement system was proposed that consisted of a circular heterodyne polarimeter and a reusable enzymatic sensor. The circular heterodyne polarimeter was constructed using a highly stable circular heterodyne light source and a compact alignment-free apparatus that provided phase stability of less than 1° within 20 min. The reusable enzymatic glucose sensor can be reused more than 100 times and retain 90% of its initial performance under optimum storage conditions within a month. The proposed method can be used to determine glucose concentrations in aqueous solutions and human serum. The optimum resolution of the proposed method was approximately 0.88 mg/dl for the glucose solution and 0.68 mg/dl for the serum-based sample.

Objective The purpose of this study was to evaluate the association between osteoporosis and salivary gland stone using a population-based claims database. Design A case-control design. Setting Taiwan. Participants We retrieved the sample for this case-control study from the Taiwan "Longitudinal Health Insurance Database 2005." All 557 patients aged 40 years or older with a diagnosis of sialolithiasis were cases, and 1671 matched controls (without sialolithiasis) were selected. Subjects and methods We used the chi-square test to explore differences between cases and controls on socio-demographic characteristics. Furthermore, conditional logistic regressions were used to examine the association of sialolithiasis with previously diagnosed osteoporosis. Results Of 2228 sampled patients, 171 (7.68%) had ever been previously diagnosed with osteoporosis; 58 (10.41%) among cases and 113 (6.76%) among controls (P = 0.005). Conditional logistic regression analysis found that the odds ratio (OR) of prior osteoporosis for cases was 1.79 (95% confidence interval [CI]: 1.24-2.59, P = 0.002) relative to controls after adjusting for urbanisation and the selected medical co-morbidities. Furthermore, we found that among patients aged ≥65 years, the adjusted OR of prior osteoporosis for cases was 1.89 (95% CI = 1.02-3.51). No significant relationship was observed among patients aged Conclusion This study demonstrates an association between sialolithiasis and osteoporosis. Although the finding warrants further investigation, the results call for more awareness of the possible concurrence of osteoporosis among physicians and patients with salivary gland stones.

BACKGROUND This case-control study aimed to find the relationship between prior statin use and head and neck cancer occurrence using a large population-based database. METHODS This study used claims data from the Taiwan Longitudinal Health Insurance Database. We included 5515 patients with head and neck cancer as cases and 5515 propensity score-matched patients without head and neck cancer as controls. Conditional logistic regressions were performed to investigate the relationship between head and neck cancer and prior statin exposure. RESULTS Of the 11 030 total sampled patients, 16.95% had previously received prescriptions for statins. In addition, statin exposure was found in 15.99% of cases and 17.91% of controls. The logistic regression also revealed that the adjusted odds ratio of prior statin exposure for cases was 0.86 (95% confidence interval: 0.77-0.95) compared to propensity score-matched controls. CONCLUSION This study found an inverse association between statin usage and head and neck cancer occurrence.

Texture modification of foods by using thickening agents is a routine practice for assessing and treating dysphagic patients. However, a powder-thickened fluid's viscosity might change over time, and little has been proposed to overcome this inconsistency. This study aimed to evaluate variations in the thickness of a fluid thickened with a common xanthan gum–based powder and to explore the feasibility of a simple advanced preparation method for thickened liquids to improve thickness stability. Thickened fluids with concentrations of 1.0 g/100 mL, 0.7 g/100 mL, and 0.5 g/100 mL were prepared from both freshly opened and previously opened thickening powders. Fluid thickness was measured every 10 min in a series of International Dysphagia Diet Standardization Initiative flow tests. A significant time-dependent decline in thickness was observed for all three concentrations in both groups, namely those prepared with freshly opened and previously opened thickening powders, and the shortest periods to achieve a stable viscosity after liquid preparation for the two groups were 80 and 70 min, respectively. On diluting the thickened liquids from the base liquid, which was prepared at a concentration of 1.0 g/100 mL and stored at room temperature for 90 min, no significant time-dependent thickness changes were observed over the following 60 min. The simple protocol of preparing the thickest "base" liquid in advance and then diluting it to the desired thickness resulted in a consistent liquid thickness, with the prepared liquids ready to be clinically applied and consumed, with high stability within 60 min.

Spontaneous cerebrospinal fluid (sCSF) leak from the skull base has been previously reported, but there are few reports of sCSF leak from the foramen rotundum due to its rare occurrence. This case report describes a 15-year-old male patient that presented with left side watery rhinorrhoea that had been present since he was 4 years of age and a history of repeated bouts of meningitis of unknown cause. A discharge sample from the nose tested positive for beta-2 transferrin. Preoperative computed tomography (CT) revealed a fistula between the cerebellopontine angle and the left sphenoid sinus. There was also a pseudo-Chiari malformation type I with ectopia of the cerebellar tonsil. Endoscopic transnasal surgery identified a leak from the foramen rotundum that was repaired using autologous material and a contralateral pedicle nasoseptal flap. At 6 months after surgery, the patient reported no recurrence of the CSF leakage. Postoperative CT imaging revealed that the cerebellar tonsil was back in the normal position, indicating that the preoperative Chiari malformation was possibly due to decreased CSF volume. This current case shows that a rare case of sCSF leak from the foramen rotundum can be effectively repaired using the endoscopic transnasal approach.

Background/Purpose To evaluate the therapeutic responsiveness of office-based salivary gland ductal irrigation in patients with chronic sialoadenitis. Methods Between August 2017 and April 2019, 55 patients comprising the following three disease groups were enrolled: Sjogren’s syndrome: 39 patients; postradiotherapy sialoadenitis: ten patients; and post-RAI sialoadenitis: six patients. Quantitative salivary scintigraphy was recorded, and a formulated questionnaire including the Summated Xerostomia Inventory was utilized to assess acute/chronic symptoms. All patients received at least three serial salivary gland ductal irrigations with a one-month interval in our outpatient department. Results The general response rates for each disease groups are as follows: Sjogren’s syndrome: 61.5% (24/39); postradiotherapy: 60% (6/10); and post-RAI: 83.3% (5/6). Among the patients with Sjogren’s syndrome, the parotid scintigraphic Tmin showed a significant positive correlation with the responsiveness of salivary irrigation (P = 0.046), whereas the treatment tended to be irresponsive in patients who previously took medicine for their related discomfort (P = 0.009). In the postradiotherapy and post-RAI groups, no significant factors were found to be associated with the responsiveness of irrigation. Conclusion Simple salivary ductal irrigation without complex equipment can be performed as an outpatient procedure to alleviate glandular swelling or xerostomia in patients with Sjogren's syndrome, postradiotherapy sialoadenitis or post-RAI sialoadenitis, and it can be considered an alternative management approach for patients refractory to conventional strategies.

AIM To evaluate feasibility of establishing a clinically applicable reference value through those unaffected salivary gland on sialoscintigraphic data obtained from patients presented with obstructive sialadenitis affected a single gland. MATERIALS AND METHODS Ninety-one patients suffered from single salivary gland swelling, pain/tenderness and received sialoscintigraphic examinations were retrospectively enrolled. The quantitative data parameters, including the uptake ratio, maximal accumulation, maximal excretion, time to maximal (Tmax) and time to minimal (Tmin) activity of the affected and unaffected glands, were calculated for analysis. Data were also obtained and recorded for comparison from 50 patients who fulfill the American-European criteria for the diagnosis of Sjogren's syndrome. RESULTS The maximal excretion appeared to be the best indicator for distinguishing affected and unaffected glands of obstructive diseases, for parotid and submandibular glands (P = 0.0002 and P

People experience a healthy energy gained from the environment and an inner feeling, called the Qi experience. The flow experience has been a popular topic in Western studies, especially within the fields of psychology and health, and in all kinds of activities. Our current study used quantitative and qualitative methods to analyze the relationship between the Qi experience and the flow experience. After collecting data using open-ended questions, we integrated and connected the Qi experience into five orientations: (1) the feeling of Qi; (2) the mind; (3) Qi and consciousness; (4) physical, mental, and spiritual benefits; and (5) the feeling of Tao. The results revealed a high level of consistency between the flow experience and the Qi experience (r= 0.90,p

This study aimed to investigate associations between obstructive sleep apnea (OSA) and urological comorbidities using a large population-based dataset. This cross-sectional study used the Taiwan Longitudinal Health Insurance Database 2005. We included 1236 males with OSA in the study group and 4944 males without OSA in the comparison group. Conditional logistic regressions were performed to examine relationships between OSA and urological comorbidities. We found that patients with OSA had significantly greater prevalences of hypertrophy of the prostate (15.13 vs. 7.28 %), chronic prostatitis (4.37 vs. 2.16 %,), urinary incontinence (3.32 vs. 0.87 %), nocturia (2.02 vs. 0.61 %), erectile dysfunction (2.91 vs. 0.97 %), urinary calculi (12.06 vs. 6.80 %), and prostate cancer (0.97 vs. 0.40 %) than the comparison group. Additionally, the adjusted odds ratios in males with OSA for hypertrophy of prostate, chronic prostatitis, urinary incontinence, nocturia, erectile dysfunction, urinary calculi, and prostate cancer were 2.54 (95 % confidence interval (CI) 2.05~3.15), 1.95 (95 % CI 1.38~2.74), 4.13 (95 % CI 2.63~6.50), 3.54 (95 % CI 2.03~6.18), 2.95 (95 % CI 1.89~4.61), 1.89 (95 % CI 1.53~2.33), and 2.14 (95 % CI 1.03~4.43) than those without OSA, respectively. This study concluded that males with OSA had higher odds ratios of hypertrophy of the prostate, chronic prostatitis, urinary incontinence, nocturia, erectile dysfunction, urinary calculi, and prostate cancer than comparison group.

This study demonstrates an association between sialolithiasis and nephrolithiasis. The results call for more awareness of this association among physicians and patients with nephrolithiasis.Very few empirical studies have been conducted to explore the potential association between sialolithiasis and nephrolithiasis. As such, the association between sialolithiasis and nephrolithiasis still remains unclear. This study aimed to explore the possible association between sialolithiasis and nephrolithiasis using a population-based dataset.Using data from the Taiwan Longitudinal Health Insurance Database 2005, this case-control study identified 966 patients with sialolithiasis as cases and 2898 sex- and age-matched subjects without sialolithiasis as controls. Conditional logistic regressions were conducted to examine the association of sialolithiasis with previously diagnosed nephrolithiasis.Out of 3864 sampled patients, 165 (4.27%) had prior nephrolithiasis. Using Chi-square test, it was found that there was a significant difference in the prevalence of prior nephrolithiasis between the cases and controls (10.25% vs 2.28%, p0.001). Moreover, by conditional logistic regression analysis, the odds ratio of prior nephrolithiasis for cases was 4.74 (95% CI = 3.41-6.58, p0.001) when compared to controls after adjusting for monthly income, geographic location, urbanization level of residence, diabetes, hypertension, heart failure, chronic renal disease, and tobacco use.

Little is known regarding the long-term adverse effects of a sialoadenectomy. The purpose of this study was to estimate the risk of coronary heart disease (CHD) among patients receiving a sialoadenectomy procedure by utilizing a cohort study based on a population-based database in Taiwan. This study retrieved data of the study sample from the Longitudinal Health Insurance Database 2005. This retrospective cohort study included 608 patients who underwent a sialoadenectomy and 1824 propensity score-matched comparison patients. We individually tracked each sampled patient for a 3-year period from their index date to discriminate those who subsequently received a diagnosis of CHD during the follow-up period. We found that respective incidence rates of CHD during the 3-year follow-up period were 3.87 (95% confidence interval (CI): 3.01-4.91) and 1.79 (95% CI: 1.45-2.18) per 100 person-years for patients who did and those who did not undergo a sialoadenectomy. The stratified Cox proportional analysis revealed that the hazard ratio of CHD during the 3-year follow-up period was 2.43 (95% CI: 1.77-3.33) than comparison patients. This study demonstrates an association between sialoadenectomy and CHD.

Background/Purpose Acoustic analysis is often used in speech evaluation but seldom for the evaluation of oral prostheses designed for reconstruction of surgical defect. This study aimed to introduce the application of acoustic analysis for patients with velopharyngeal insufficiency (VPI) due to oral surgery and rehabilitated with oral speech-aid prostheses. Methods The pre- and postprosthetic rehabilitation acoustic features of sustained vowel sounds from two patients with VPI were analyzed and compared with the acoustic analysis software Praat. Results There were significant differences in the octave spectrum of sustained vowel speech sound between the pre- and postprosthetic rehabilitation. Acoustic measurements of sustained vowels for patients before and after prosthetic treatment showed no significant differences for all parameters of fundamental frequency, jitter, shimmer, noise-to-harmonics ratio, formant frequency, F1 bandwidth, and band energy difference. The decrease in objective nasality perceptions correlated very well with the decrease in dips of the spectra for the male patient with a higher speech bulb height. Conclusion Acoustic analysis may be a potential technique for evaluating the functions of oral speech-aid prostheses, which eliminates dysfunctions due to the surgical defect and contributes to a high percentage of intelligible speech. Octave spectrum analysis may also be a valuable tool for detecting changes in nasality characteristics of the voice during prosthetic treatment of VPI.

Background Cardiovascular diseases are reported to be associated with both chronic rhinosinusitis (CRS) and dementia. Nevertheless, whether dementia is associated with CRS is still unknown. In the present study, we explored the association between dementia with prior CRS using a population-based data set. Methods This study used the Taiwan Longitudinal Health Insurance Database 2000 as the source of data for a case-control study. We included 8768 subjects with dementia as cases and 8768 age- and sex-matched subjects as controls. We identified cases who had received a diagnosis of CRS before having received a diagnosis of dementia. Conditional logistic regression analyses were performed to examine the association of dementia with previously diagnosed CRS. Results Results showed that of all sampled subjects, 875 (5.0%) had been previously diagnosed with CRS. A chi-squared test showed that there was a significant difference in the prevalences of prior CRS between cases and controls (6.0% versus 4.0%; p < 0.001). The adjusted odds ratio (OR) of prior CRS for subjects with dementia was 1.44 (95% CI, 1.25—1.66) compared with controls. Furthermore, compared with controls, the OR of prior CRS was similar for subjects with dementia for both sexes (the OR for male subjects was 1.48 and OR for female subjects was 1.41). Conclusion We concluded that subjects with dementia had a higher odds of having had prior CRS than controls. This study implies a potential association between CRS and dementia.

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.

Despite evidence linking thyroxin use and breast cancer, little is known regarding the risk of other cancers with thyroxin use. The purpose of this case-control study was to evaluate the association of thyroid cancer with primary hypothyroidism based on a population-based database. The data for this case-control study were retrieved from the Taiwan Longitudinal Health Insurance Database 2005. We included 1285 patients with thyroid cancer as cases and 3855 sex- and age-matched subjects as controls. We used conditional logistic regression to examine the association of thyroid cancer with previously diagnosed hypothyroidism. We found that a prior hypothyroidism diagnosis was found among 37 cases (2.88%) and 33 controls (0.86%). Conditional logistic regression analysis revealed that the cases were more likely to have been previously diagnosed with hypothyroidism than controls (adjusted OR, 3.01; 95%CI, 1.85–4.89). We also found that thyroid cancer was significantly associated with hypothyroidism patients who were regular thyroxin users (adjusted OR, 8.68; 95%CI, 4.34–17.34). However, we failed to observe a significant association between thyroid cancer and hypothyroidism patients who were irregular thyroxin users. This investigation detected a novel association between thyroid cancer and thyroxin use in patients with primary hypothyroidism.

This study attempted to investigate the effects of a tonsillectomy on utilization of medical resources for acute respiratory infections by comparing numbers and costs of clinic visits within 1year before and after a tonsillectomy.Data for this study were retrieved from the Taiwan Longitudinal Health Insurance Database 2005. The study includes 481 patients aged 18-80years who underwent a tonsillectomy and 481 comparison patients. A multivariate regression model employing difference-in-difference was carried out to assess the independent association between a tonsillectomy and the number and costs of clinic visits.We found that for patients who underwent a tonsillectomy, the mean number of clinic visits for acute respiratory care 1year before and after the index date significantly decreased from 7.3 to 4.2 (p0.001). However, for the comparison group, there was no significant difference in the number (p=0.540) or costs (p=0.221) of clinic visits for acute respiratory care 1year before and after the index date. A multivariate regression model revealed that a tonsillectomy was associated with a reduction of 3.38 in the mean number of clinic visits for acute respiratory care (p0.001). In other words, a tonsillectomy reduced by 46.3% (3.38/7.3) the number of clinic visits for acute respiratory care after adjusting for sociodemographic characteristics and medical comorbidities compared to comparison patients.This study demonstrated that a tonsillectomy was of substantial benefit to adult patients in that it provides decreased healthcare utilization for acute respiratory infections.

To assess the association between cataract and chronic rhinosinusitis (CRS) using a population-based database.The study sample for this case-control study was retrieved from Taiwan's Longitudinal Health Insurance Database 2000. The study included 3045 patients who had undergone cataract surgery as cases and 9135 subjects without cataract as controls. Conditional logistic regression was performed to calculate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of having a prior diagnosis of CRS in cases versus controls.In the total study sample, the prevalence of prior CRS was 3.88%; 5.16% among cases and 3.45% among controls (p 0.001). Conditional logistic regression suggested that the unadjusted OR for prior CRS among cases was 1.52 (95% CI 1.25-1.85, p 0.001) compared to controls. After adjusting for monthly income, residential urbanization and geographic region, the OR for prior CRS among cases was 1.58 (95% CI 1.30-1.94, p 0.001) compared to controls. Furthermore, the results consistently suggested that cases had higher adjusted ORs for prior CRS than controls across all age groups (40-59, 60-69, and69 years). It is particularly noteworthy that younger groups demonstrated higher ORs for prior CRS among cases compared to controls. In particular, the adjusted OR for cases aged 40-50 years was 1.71 (95% CI 1.09∼2.66; p 0.05) compared to controls.While the true relationship between CRS and cataract remains to be further investigated, the result of this present study demonstrated CRS may be associated with cataract.

Anxiety disorder (AD) is commonly associated with a number of physical illnesses. No previous study has investigated the association between AD and sudden sensorineural hearing loss (SSNHL). In this study, we investigated the association between prior AD and SSNHL using a population-based dataset in Taiwan. Sampled subjects of this case-control study were retrieved from the Taiwan "Longitudinal Health Insurance Database". We identified 3,522 patients who had a diagnosis of SSNHL as cases and 10,566 age- and gender-matched subjects without SSNHL as controls. A conditional logistic regression was used to calculate the odds ratio (OR) for having previously been diagnosed with AD between cases and controls. We found that of 14,088 patients, 13.4% had a prior AD diagnosis, 17.8 and 11.9% for the SSNHL group and controls, respectively. After adjusting for patient socioeconomic characteristics and comorbid medical disorders, SSNHL patients were more likely to have prior AD than the controls (OR 1.49, 95% confidence interval (CI) 1.34-1.66, p < 0.001). Furthermore, we found that the significant relationship between SSNHL and prior AD decreased with age. The relationship was the most pronounced among those aged ≤44 years, with an adjusted OR of 1.86 (95% CI 1.48-2.33, p < 0.001) for cases compared to controls. We concluded that patients with SSNHL had a higher proportion of prior AD than non-SSNHL-diagnosed controls. Further study is needed to confirm our findings and explore the underlying pathomechanisms.

Human embryonic stem cells (hESCs), due to their self-renewal capacity and pluripotency, have become a potential source of transplantable β-cells for the treatment of diabetes. However, it is imperative that the derived cells fulfill the criteria for clinical treatment. In this study, we replaced common Matrigel with a synthetic peptide-acrylate surface (Synthemax) to expand undifferentiated hESCs and direct their differentiation in a defined and serum-free medium. We confirmed that the cells still expressed pluripotent markers, had the ability to differentiate into three germ layers, and maintained a normal karyotype after 10 passages of subculture. Next, we reported an efficient protocol for deriving nearly 86% definitive endoderm cells from hESCs under serum-free conditions. Moreover, we were able to obtain insulin-producing cells within 21 days following a simple three-step protocol. The results of immunocytochemical and quantitative gene expression analysis showed that the efficiency of induction was not significantly different between the Synthemax surface and the Matrigel-coated surface. Thus, we provided a totally defined condition from hESC culture to insulin-producing cell differentiation, and the derived cells could be a therapeutic resource for diabetic patients in the future.

Objectives/Hypothesis Previous studies showed that chronic rhinosinusitis (CRS) accounts for billions of dollars in healthcare resource utilization. However, all such study estimates of the economic burden of CRS were based on subpopulations in Western societies. This study aimed to investigate differences in the utilization of healthcare services between subjects with CRS and comparison subjects using Taiwan's National Health Insurance database. Study Design A cross-sectional study. Methods In total, 5,849 CRS subjects and 17,547 selected comparison subjects were included in this study. We evaluated healthcare resource utilization in a 1-year period. Variables of healthcare resource utilization included the following: numbers of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatment. We also divided healthcare resource utilization into ear, nose, and throat (ENT) and non-ENT services. Results On the utilization of ENT services, CRS subjects had significantly more outpatient visits (3.9 vs. 1.4, P

Human embryonic stem cells (hESCs), due to their self-renewal capacity and pluripotency, are an important source of cells for regenerative medicine. The immediate obstacles that need to be addressed are the poor cell survival rate of hESCs and their cell quality after cryopreservation. In this study, we used the Cell Alive System (CAS) which combines a programmed freezer with an oscillating magnetic field to reduce cryo-injury during the freezing process. The hESC clumps suspended in freezing medium were divided into three groups: (i) cells frozen by a conventional freezing container, Mr. Frosty and kept in a −80 °C freezer (MF); (ii) cells frozen to −32 °C by CAS, and then transferred to a −80 °C freezer (CAS); (iii) cells frozen to −32 °C by CAS, and then transferred to a pre-cooled Mr. Frosty and kept in a −80 °C freezer (CAS-MF) for overnight. All cryovials were placed in liquid nitrogen for one week, and hESCs were then thawed and cultured on feeder for 7 days. The results of alkaline phosphatase (AP) staining showed that the attachment efficiency of the cells cryopreserved by CAS and CAS-MF was significantly higher (29.0% and 44.0%) than in the MF method (7.0%). Furthermore, we confirmed the cells cryopreserved using CAS-MF could be subcultured while expressing pluripotent markers, differentiate into three germ layers, and maintain a normal karyotype. These results demonstrate that the use of CAS-MF offers an efficient method of hESC banking.

Metastatic neck nodes are commonly described as "heterogenous" or "inhomogenous" on computed tomographic (CT) images, and this remains a highly subjective issue. The purpose of this study is to justify classical criteria and to develop novel supplemental methods for diagnosing a positive neck node on CT scans.Fifty-four patients with HN SCC were separated into two groups according to their neck nodal status. CT scan digital images were used and the lymph node borders were selected by a radiologist. Lymph node images from the pathologically proven N- (negative for cervical metastases) group were compared to the N+ (positive for cervical metastases) group. Image-analysis software, ImageJ, was used to record and compare various characteristics collected from the images.The image-analysis comparisons shows, the area (size) of the lymph node in the N+ group is much larger than the N- group (474.02 VS.81.55mm(2)) (P0.01). There are no significant differences with regards to distribution of pixel values between the two groups (P=0.79). The lacunarity, a parameter used to describe gappiness or inhomogeneity, of the N+ group was significantly higher than the N- group (P=0.026).While size of the lymph node remains an important factor in the interpretation of a clinically suspicious lymph node metastasis on CT scan images, the distribution of pixel values could not clarify a heterogeneous state. Nevertheless, 'lacunarity' proves to be a more accurate parameter which correlates better to the subjective heterogeneity.

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.

Background:This study aimed to evaluate the association of chronic rhinosinusitis with sudden sensorineural hearing loss using a population-based database.Methods:Sampled subject data were obtained from the Taiwan Longitudinal Health Insurance Database 2000. A total of 3325 patients with sudden sensorineural hearing loss were identified and 9975 controls were randomly selected. A conditional logistic regression was used to calculate the odds ratio for having been previously diagnosed with chronic rhinosinusitis, for cases and controls.Results and conclusion:The adjusted odds ratio of having prior chronic rhinosinusitis among cases compared to controls was 1.36 (95 per cent confidence interval = 1.16–1.60). The significant relationship between sudden sensorineural hearing loss and chronic rhinosinusitis was most pronounced among those patients aged 44 years or less (compared to controls) (odds ratio = 2.18; 95 per cent confidence interval = 1.63–2.92). However, the significant relationship between sudden sensorineural hearing loss and prior chronic rhinosinusitis was not sustained for patients older than 60 years compared to controls.

Little is known regarding associations of periodontitis with diseases of the nose, one of the structures adjacent to the mouth. This study aims to explore the association between periodontitis and previous allergic rhinitis (AR) using a matched patient-control study design from a population-based dataset in Taiwan.Data were sourced from the Longitudinal Health Insurance Database 2000 for 71,182 patients with chronic periodontitis (CP) and 71,182 controls without periodontitis. Generalized linear mixed-model analyses were used to calculate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for previous AR diagnosis in patients and controls.Significant difference was found in prevalence of prior AR for patients and controls (28.4% versus 24.2%; P0.001). Generalized linear mixed model suggested that the OR of previous AR for patients was 1.24 (95% CI: 1.22 to 1.27; P0.001) compared with controls. Adjustments were made for: 1) monthly income; 2) urbanization level; 3) diabetes mellitus; 4) hypertension; 5) coronary heart disease; 6) hyperlipidemia; 7) alcohol abuse; 8) tobacco use disorder; and 9) random effect of geographic region. After adjusting, OR of previous AR diagnosis among patients was 1.21 (95% CI: 1.18 to 1.23; P0.001) compared with controls.An association between periodontitis and prior AR is demonstrated. It is recommended that physicians be more alert for potential risk of subsequent development of CP in patients with AR.

The purpose of this study was to determine the effect of all-trans retinoid acid (ATRA) on two nasopharyngeal cancer (NPC) cell lines and to evaluate the synergistic effect of ATRA used in combination with cisplatin, a standard chemotherapeutic agent for NPC. Two NPC cell lines (NPC-TW01 and NPC-TW04) were used, and the MTT assay was used to analyze cell growth inhibition under various concentrations of ATRA and cisplatin. Under low concentrations of ATRA, the growth of both cell lines was significantly inhibited. When ATRA was used in combination with cisplatin, the resulting synergistic effects were robust and significant. Only a low concentration of ATRA was required to produce a synergistic effect when combined with cisplatin, indicating the potential usefulness of a combination therapy regimen. Therefore, the combination of ATRA and cisplatin is a viable treatment option for NPC and should be further investigated.

The sialendoscopic approach in treating pediatric salivary gland disorders has been reported with great success through the years. Whereas this success has been widely reported in Caucasian populations, relatively little has been reported regarding the use of this procedure in pediatric patients in Asian countries. The purpose of this study is to report our preliminary experience in pediatric sialendoscopy.The data from 20 patients (18years old), who underwent sialendoscopy for obstructive sialoadenitis in the Department of Otorhinolaryngology of Mackay Memorial Hospital between October 2013 and November 2015, were reviewed.Twelve of our 20 patients (60%) were diagnosed with sialolithiasis and 8 of our 20 patients (40%) presented with non-lithiasis obstructive sialoadenitis. Ductal stenosis was found in 13 patients, and 18 patients had debris/mucous plug formation. The overall success rate was 95% (19/20) in our series, and 85% (17/20) of the patients had achieved a complete remission after a single sialendoscopy procedure.Sialendoscopy is an ideal treatment in the management of obstructive sialoadenitis in Asian pediatric patients. If necessary, Holmium:YAG laser lithotripsy and sialostent placement could be applied, and both procedures are well tolerated in pediatric patients.

It is important to have a standardized tympanic membrane (TM) perforation platform to evaluate the various myringoplasty materials that have been studied and developed extensively during recent years. However, currently there are no cellular models specifically designed for this purpose, and animal models remain unsatisfactory. The purpose of this study is to propose an inexpensive, readily available, well-controlled, and easy-to-create cellular model as a substitute for use in the evaluation of TM repairing materials. A trans-well model was created using a cell culture insert with a round hole created at the center of the polycarbonate membrane. HaCaT cells were cultured on the fenestrated culture insert, and the desired myringoplasty graft was placed at the center of the window for one week and observed by fluorescent microscopy under vital staining. Under this cellular model, there was notable migration of HaCaT cells onto the positive control graft (rabbit fascia), while only a few cell clusters were observed on the negative control graft (paper). Model validation showed that the cell migration ratio for the PLLA + 1% hyaluronic acid (HA) graft is significantly higher than using myringoplasty paper, poly L-lactide (PLLA), or PLLA + 0.5% HA (p

Aman in his 60swith a history of hyperlipidemia, gout, and sleep apnea had a consultation for an incidental finding of a left torus tubarius, blackish, mucosal lesion noted during a health examination at a local clinic in July 2014. He had nonasal obstruction, nasal bleeding,or feelingofaural fullness. Fibroscopicevaluation revealedablacknevus–like lesionover the left torus tubarius,without surface necrosis or signs of bleedingwhen touched. Examination of the neck, nasal cavity, and larynx showed no remarkable findings. It was recommended that he receive laser excision of the lesion under endoscopy. During the surgery, the superficial lesion was found to be confined to the left torus tubarius, without invasion of the surrounding structures (Figure, A, arrowhead). Themargins were clearly identified, and laser excisionwasperformed smoothlywith onlyminimal bleeding. The surgical specimenwas a singleblack, soft-tissue fragmentmeasuring0.4 × 0.3 × 0.2 cm.Microscopy revealed smallmixed serous andmucinous glands, normal respiratory epitheliawithmarked oncocytic cell changes, and abundant eosinophilic granular cytoplasm arranged in a tubular andmicrocystic pattern (Figure, B). Scattered brown pigments were noted in the cytoplasm of most oncocytic cells (Figure, C). There was no dyskeratosis. The brown pigment was negative for iron stain (Figure, D) and HMB45 stain, but positive for Fontana Masson stain. Ki-67 staining revealed low proliferative index in the lesion. Some lymphocytic infiltration of the stromawas also noted. A

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.A case-control study.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.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 0.001). By conditional logistic regression analysis, the odds ratio (OR) of prior CP for cases was 1.37 (95% confidence interval [CI], 1.19-1.56) compared to the controls after adjusting for geographic location and tobacco use. Further analyzing the relationship between sialolithiasis and prior CP according to sex, sialolithiasis was associated with prior CP regardless of sex. The adjusted OR of prior CP for the cases was 1.34 (95% CI, 1.10-1.64) and 1.41 (95% CI, 1.15-1.73) for males and females, respectively, when compared to controls.This study demonstrates an association between CP and sialolithiasis.3b.

Although iron-deficiency anemia (IDA) as a rare cause of cerebral sinus thrombosis was supported by several studies, the relationship between IDA and venous thromboembolisms (VTEs) remains unclear. In this study, we evaluated the association between IDA and subsequent VTEs based on a population-based coverage database. We retrieved data for this case-control study from the Taiwan Longitudinal Health Insurance Database 2000. In total, 2522 cases with VTE and 12 610 randomly selected controls were included. A conditional logistic regression was used to examine the association of VTEs with previously diagnosed IDA. The χ test indicated that there was a significant difference in the prevalence of prior IDA between subjects with a VTE and the controls (3.41 vs. 2.06%, respectively, P < 0.001). The conditional logistic regression analysis showed that the odds ratio (OR) of previous IDA for subjects with a VTE was 1.43 [95% confidence interval (CI): 1.10-1.87] compared with the controls after adjusting for monthly income, geographic region, urbanization level, cancer, inflammatory bowel disease, heart failure, hypertension, diabetes, coronary heart disease, hyperlipidemia, renal disease, obesity, and whether or not a subject was hospitalized and whether or not a subject had suffered from a fracture within 1 year prior to the index date. The adjusted OR for prior IDA in subjects with deep-vein thrombosis was 1.43 (95% CI: 1.08-1.90) compared with the controls. However, there was no significant difference in the adjusted OR of prior IDA between subjects with a pulmonary embolism and the controls (OR: 1.10; 95% CI: 0.63-1.92). We concluded that there was an association between IDA and VTEs.

Background Altered immune function after appendicectomy has been associated with autoimmune disease, even though the mechanisms are not clearly elucidated. This study aimed to investigate whether the frequency of new-onset type II diabetes was increased after appendicectomy in a case–control study. Methods This was a retrospective cohort study from the Taiwan Longitudinal Health Insurance Database 2000. The relative risk was compared with that in the general population using population-based data. Each patient was tracked for a 3-year interval to identify those who developed type II diabetes. Cox proportional hazard regression analysis was used to assess the risk of type II diabetes during follow-up. Results A total of 31 512 patients were included in the study, of whom 5252 had an appendicectomy (study cohort) and 26 260 were matched for comparison. Some 714 patients (2·3 per cent) developed type II diabetes during the 3-year follow-up, 161 in the study cohort (3·1 per cent) and 553 in the comparison cohort (2·1 per cent). The adjusted hazard ratio (HR) for type II diabetes in the study cohort was 1·45 (95 per cent c.i. 1·22 to 1·74). This increased risk was most pronounced in men (adjusted HR 1·47, 1·16 to 1·88) and in those with a perforated appendix (adjusted HR 2·28, 1·71 to 3·03), and applied only to patients younger than 65 years of age. Conclusion An increased risk of new-onset type II diabetes within 3 years after appendicectomy was found in patients aged less than 65 years. The risk was highest in men and in those with complicated appendicitis.

With damage to a duct or papilla after sialendoscopy, a stent may be necessary to prevent re-stenosis and for maintaining the salivary duct open after complete sialendoscopy. However factors affecting outcomes and complications after stent placement remain unclear. This study aimed to report preliminary experiences in salivary duct stent placement after sialendoscopy. Data from 35 procedures in 33 patients who received sialendoscopy with salivary duct stent placements at Mackay Memorial Hospital between October 2013 and June 2014 were recorded and compared for clinical data, as well as procedural techniques, findings, and outcomes. In the 35 stent placement procedures, the hypospadias silastic stent tubes were used in 27 and the Fr. 5 pediatric feeding tubes were used in the remaining eight. When the hypospadias silastic stent tubes were used for stenting, the stent obstruction and irritation rates were higher compared to those who used the Fr. 5 pediatric feeding tube (100 vs. 0 % and 67 vs. 33 %, respectively). None of the stents secured by a 5-0 nylon suture were complicated by dislocation but when the stents were secured by 6-0 nylon sutures, the dislocation rate went as high as 47.4 %. The duration needed for salivary duct stent placement might be potentially shortened to only 2 weeks. If a salivary duct stent is intended to be placed for a certain period before its scheduled removal, a suture strength equivalent or stronger than the 5-0 nylon suture should be considered for stent fixation.

No study has reported the relationship between statin use and sudden sensorineural hearing loss (SSNHL). In this study, we examined the association between statin use and SSNHL using a population-based dataset.A case-control study.Taiwan.The study sample was selected from the Taiwan Longitudinal Health Insurance Database. We identified 1263 subjects aged ≥40 years with SSNHL and 6315 sex-, age-, hypertension-, and coronary heart disease-matched controls. We used conditional logistic regression to compute the odds ratio (OR) for having been a previous statin user between cases and controls. Furthermore, we performed conditional logistic regression to explore the relationship of regular and irregular statin users with SSNHL.There was a significant difference in the prevalence of statin use between cases and controls (27.2% vs 21.3%, respectively; P.001). The OR of statin use before the index date for cases was 1.36 (95% confidence interval [CI], 1.18-1.57) compared to controls after taking gender, age group, hypertension, coronary heart disease, diabetes, renal disease, and hyperlipidemia into consideration. Furthermore, compared to controls, the adjusted ORs of regular and irregular statin use for cases were 1.30 (95% CI, 1.11-1.52) and 1.49 (95% CI, 1.11-1.93), respectively, compared to controls.This study found that SSNHL was significantly associated with previous statin use.

The purpose of this study was to evaluate the association between cholelithiasis and developing sialolithiasis using a population-based coverage database.The data for this study were sourced from the Taiwan Longitudinal Health Insurance Database. We included 745 subjects with sialolithiasis as cases and 3725 sex-matched and age-matched subjects without sialolithiasis as controls.Chi-square test revealed a significant difference in the prevalence of prior cholelithiasis between the cases and controls (8.6% vs 4.1%; p .001). Furthermore, conditional logistic regression analysis indicated that the odds ratio (OR) of prior cholelithiasis for the cases was 2.19 (95% confidence interval [CI] = 1.62-2.98) when compared with the controls after adjusting for monthly income, geographic location, urbanization level, and tobacco use disorder. The adjusted OR of prior cholelithiasis for cases was 2.20 (95% CI = 1.46-3.33) and 2.15 (95% CI = 1.38-3.42) than controls for men and women, respectively.This study demonstrates an association between sialolithiasis and cholelithiasis.

Background Despite many reports linking allergic rhinitis (AR) to problems of the eye, the relationship between AR and open-angle glaucoma (OAG) has not been studied. The purpose of this epidemiology study was to provide an estimation of the association of OAG with AR by using a population-based data set in Taiwan. Methods We retrieved our study sample for this case–control study from the Longitudinal Health Insurance Database 2000. We extracted 7063 subjects with OAG as cases and 21,189 matched controls (three controls per case). We used conditional logistic regression analyses to calculate the odds ratio (OR) and corresponding 95% confidence interval (CI) to describe the association between OAG and having previously been diagnosed with AR. Results A chi-squared test showed that there was a significant difference in the prevalence of prior AR between cases and controls (28.8% versus 22.3%; p < 0.001). A conditional logistic regression analysis suggested that the OR of having previously been diagnosed with AR for cases was 1.40 (95% CI, 1.31∼1.48; p < 0.001) compared with controls after adjusting for monthly income, geographic region, urbanization level, hypertension, diabetes, asthma, coronary heart disease, hyperlipidemia, and hypothyroidism. It also revealed that OAG was consistently and significantly associated with prior AR across all age groups. In particular, subjects aged 50∼59 years had the highest OR for prior AR among cases compared with controls (OR, 1.77; 95% CI, 1.53∼2.06; p < 0.001). Conclusion This outcome research found that there was an association between AR and OAG.

Several reports mention that statin (HMG-CoA reductase inhibitor) use seems to be associated with several neurologic disorders and that the lipid-lowering effect of statins may contribute to some neural toxicity. This study aimed to evaluate the association between statin use and Bell’s palsy using a population-based health insurance database. This case-control study identified 1,977 subjects with Bell’s palsy as cases and 5,931 sex- and age-matched subjects without Bell’s palsy as controls from the Taiwan Longitudinal Health Insurance Database 2000. Conditional logistic regressions was used to estimate the odds ratio (OR) and 95 % confidence interval (CI) for previous use of statins between the cases and controls. The associations of regular and irregular statin users with Bell’s palsy were further analyzed. By Chi-square test, there was a significant difference in the prevalence of statin use between cases and controls (23.2 vs. 16.4 %, p

Background: The Venturi-principle atomizer is a commonly used device in otolaryngology practices. The purpose of this study is to evaluate the possible route of bacterial contamination from the nasal vestibule to the atomizer tip through the jet airflow created during the use of the Venturi atomizer. Methods: Thirty nostrils from 15 enrolled volunteers were tested. The aerosols generated by spraying sterilized saline into the nostrils were collected using a specially made aerosol-collecting nozzle cap. The collected samples were sent for bacterial culture, and nasal vestibular swab cultures were performed for comparison. Results: In the aerosol-exposed group, 18 out of 30 samples (60%) were positive for bacterial growth, confirming the bacterial contamination from the nasal vestibule to the atomizer tip through the reverse jet airflow. The bacteria species in 8 of the 18 positive samples were identical to those from the nasal swab culture results from the same nostril. Conclusion: In ordinary otolaryngology practices, there are significant risks for bacterial contamination from the nasal vestibule to the tip of the Venturi atomizer even without direct contact. Clinicians must be more aware of this pattern of contamination, which has not been reported in the existing literature.

SummaryObjective Several observational studies raised the possibility that the use of statins may decrease the overall risk of cancer and of specific cancers. This study aimed to evaluate the association of statin use with thyroid cancer based on a population-based data set. Design The data for this case–control study were sourced from the Taiwan Longitudinal Health Insurance Database 2000. We included 500 subjects with thyroid cancer as cases and 2500 gender- and age-matched subjects without thyroid cancer as controls. We used a conditional logistic regression to calculate the odds ratio (OR) and its corresponding 95% confidence interval (CI) for having previously used statins between cases and controls. Results The OR of prior statin use for cases was 1·39 (95% CI = 1·08–1·78) compared to controls, and thyroid cancer was significantly associated with previous regular statin use (OR = 1·40, 95% CI = 1·05–1·86). However, thyroid cancer was not significantly associated with previous irregular statin use (OR = 1·35; 95% CI = 0·88–2·07). Furthermore, the significant association between thyroid cancer and previous statin use only existed for females (OR: 1·43; 95% CI: 1·07–1·90) but not for males (OR: 1·28; 95% CI: 0·75–2·17). Conclusions We concluded that statin use was associated with thyroid cancer in female patients.

IMPORTANCE Vascular events play a big part in the development of sudden sensorineural hearing loss (SSNHL), but only those associated with sickle-cell anemia have been previously associated with SSNHL. This study demonstrates an association between SSNHL and prior iron-deficiency anemia (IDA).OBJECTIVE To evaluate the association between IDA and SSNHL using a nationwide population-based database.DESIGN, SETTING, AND PARTICIPANTS In this case-control study in Taiwan, participants with SSNHL (n = 4004) were identified, and controls (n = 12 012) were randomly selected.MAIN OUTCOMES AND MEASURES Conditional logistic regression was used to calculate the ORs (95%CIs) for IDA in participants with SSNHL vs controls.RESULTS Of the 16 016 sampled participants, 533 (3.3%) had previously been diagnosed with IDA, including 172 (4.3%) participants with SSNHL and 361 (3.0%) controls. The χ2 test revealed a significant difference (P < .001) in the prevalence of prior IDA between participants with SSNHL and controls. By conditional logistic regression, we found that the OR for previous IDA among the participants with SSNHL was 1.34 (95%CI, 1.11-1.61) (P < .01)after adjusting for monthly income, geographic region, urbanization level, and comorbidities(ie, hypertension, diabetes, hyperlipidemia, renal disease, and coronary heart disease). The significant relationship between SSNHL and prior IDA was most pronounced among those 44 years or younger (adjusted OR, 1.91; 95%CI, 1.35-2.72) (P < .001) for the participants with SSNHL compared with controls, and the strength of this relationship decreased with age.CONCLUSIONS AND RELEVANCE There is an association between SSNHL and prior IDA.Patients with IDA, especially those younger than 60 years, should be more aggressively surveyed and managed to reduce hearing-related morbidities.

Cryptococcosis of the larynx is rare. In this manuscript we present a case of laryngeal cryptococcosis with a clear history of pigeon exposure. Cryptococcal laryngitis may present as hoarseness without other typical symptoms, even in immunocompetent individuals.

Background Very little is known about the relationship between non-sickle cell anemia and stroke. The purpose of this study is to evaluate the association of iron-deficiency anemia (IDA) with stroke based on a nationwide coverage database in Taiwan. Methods The case-control study subjects were obtained from the Taiwanese Longitudinal Health Insurance Database 2000. We included 51,093 subjects with stroke as cases and randomly selected 153,279 controls (3 controls per case) in this study.Separate conditional logistic regression analyses were used to calculate the odds ratio (OR) for having been previously diagnosed with IDA between cases and controls.We further analyzed the association between stroke and IDA by stroke subtype. Results Results showed that 3,685 study subjects (1.81%) had been diagnosed with IDA prior to the index date; of those subjects, 1,268 (2.48%) were cases and 2,417 (1.58%) were controls (p

This study aimed to explore the prevalence of a broad spectrum of comorbid medical conditions among patients with chronic rhinosinusitis (CRS), using a population-based dataset.A cross-sectional study.In total, 5,734 CRS subjects and 17,202 comparison subjects were included in this study. Separate conditional logistic regression analyses were performed to calculate the odds ratio (OR) for each of 39 medical comorbidities between subjects with and without CRS.For 27 of the 39 study comorbidities, results showed that subjects with CRS had a statistically significantly higher OR than subjects without CRS after adjusting for sociodemographic characteristics. Ranks of the top five comorbid relationships from the strongest ORs to the lowest were as follows: asthma (OR=3.09), chronic pulmonary disease (OR=3.04), weight loss (OR=2.58), obesity (OR=2.50), and migraines (OR=2.30).Our results indicate that subjects with CRS have an increased prevalence of various comorbidities.3b.