Search

Simple Summary Even after the implementation of intensity-modulated radiotherapy (IMRT), nasopharyngeal cancer (NPC) survivors may continue to exhibit several physical symptoms that negatively affect long-term quality of life (QoL). An NPC patient cohort study (n = 682) was conducted to examine the potential mediating effect of QoL (evaluated at multiple treatment-related time points) on the cancer stage–mortality association. Patients with advanced NPC exhibited low global health QoL and high QoL-HN35 symptom pre-IMRT, 3 months post-IMRT, and 2 years post-IMRT. Global health QoL and QoL-HN35 symptom scores 2 years after IMRT explained 49.4% and 39.4% of the excessive effect of advanced NPC on mortality risk. Our findings indicate that global health QoL and QoL-HN35 symptom 2 years after IMRT are key mediators of the relationship between advanced NPC and high mortality. These findings emphasize the significance of QoL-HN35 symptom and global health QoL-associated medical support and care for patients with NPC who received IMRT. Abstract Background: Quality of life (QoL) attained before, during, or after treatments is recognized as a vital factor associated with therapeutic benefits in cancer patients. This nasopharyngeal cancer (NPC) patient longitudinal study assessed the relationship among QoL, cancer stage, and long-term mortality in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). Patients and Methods: The European Organization for Research and Treatment of Cancer (EORTC) core QoL questionnaire (QLQ-C30) and the head and neck cancer-specific QoL questionnaire module (QLQ-HN35) were employed to evaluate four-dimensional QoL outcomes at five time points: pre- (n = 682), during (around 40 Gy) (n = 675), 3 months (n = 640), 1 year (n = 578) and 2 years post-IMRT (n = 505), respectively, for 682 newly diagnosed NPC patients treated between 2003 and 2017 at a single institute. The median followed-up time was 7.5 years, ranging from 0.3 to 16.1 years. Generalized estimating equations, multivariable proportional hazards models, and Baron and Kenny’s method were used to assess the investigated effects. Results: Advanced AJCC stage (III–IV) patients revealed a 2.26-fold (95% CI—1.56 to 3.27) higher covariate-adjusted mortality risk than early-stage (I–II) patients. Compared with during IMRT, advanced-stage patients had a significantly low global health QoL and a significantly high QoL-HN35 symptom by a large magnitude at pre-, 3 months, and 2 years post-IMRT. QoL scales at pre-IMRT, 1 year, and 2 years post-IMRT were significantly associated with mortality. The effect changes of mortality risk explained by global health QoL, QoL-C30, and QoL-HN35 symptom were 5.8–9.8% at pre-IMRT but at 2 years post-IMRT were 39.4–49.4% by global health QoL and QoL-HN35 symptoms. Conclusions: We concluded advanced cancer stage correlates with a long-term high mortality in NPC patients treated with IMRT and the association is partially intermediated by QoL at pre-IMRT and 2 years post-IMRT. Therefore, QoL-HN35 symptom and global health QoL-dependent medical support and care should be focused and tailored at 2 years post-IMRT.

To identify standard clinical parameters that may predict the presence and severity of obstructive sleep apnea/hypopnea syndrome (OSA).Case series with chart review.Tertiary academic medical center.A total of 325 adult patients (274 men and 51 women; mean age, 44.2 years) with habitual snoring completed comprehensive polysomnography and anthropometric measurements, including modified Mallampati grade (also known as updated Friedman's tongue position [uFTP]), tonsil size grading, uvular length, neck circumference, waist circumference, hip circumference, and body mass index (BMI).When the aforementioned physical parameters were correlated singly with the apnea/hypopnea index (AHI), we found that sex, uFTP, tonsil size grading, neck circumference, waist circumference, hip circumference, thyroid-mental distance, and BMI grade were reliable predictors of OSA. When all important factors were considered in a multiple stepwise regression analysis, an estimated AHI can be formulated by factoring sex, uFTP, tonsil size grading, and BMI grade as follows: -43.0 + 14.1 × sex + 12.8 × uFTP + 5.0 × tonsil size + 8.9 × BMI grade. Severity of OSA can be predicted with a receiver operating characteristic curve. Predictors of OSA can be further obtained by the "OSA score."This study has distinguished the correlations between sex, uFTP, tonsil size, and BMI grade and the presence and severity of OSA. An OSA score might be beneficial in identifying patients who should have a full sleep evaluation.

To use computer-assisted quantitative measurements of upper airway changes during drug-induced sleep endoscopy (DISE) and to correlate these parameters with disease severities and physiologic changes in patients with obstructive sleep apnea/hypopnea syndrome (OSA).A retrospective study.Tertiary academic medical center.A total of 170 patients who failed continuous positive airway pressure therapy and then underwent upper airway surgery were enrolled. All patients received polysomnography and DISE preoperatively. We used ImageJ 1.48v to obtain maximal and minimal measurements, including cross-sectional areas and anterior-posterior and lateral diameters at 4 anatomic levels (retropalatal, oropharyngeal, retroglossal, and retroepiglottic) under DISE, and then computed the percentage changes. We analyzed the clinical values of DISE changes by computer-assisted analysis in patients with OSA and any correlations between these changes and polysomnography parameters.The percentage changes of upper airway showed significant collapses at all 4 anatomic levels (allComputer-assisted quantitative analysis could evaluate upper airway changes of OSA in an objective way and may help identify the sites of obstruction during DISE more accurately. Upper airway showed multilevel collapse with independent significant changes in patients with OSA, with the retropalatal and retroglossal levels playing important roles in particular.

Introduction: The aim of this study was to evaluate the effects of upper airway surgery on daytime sleepiness in nonobese patients with obstructive sleep apnea/hypopnea syndrome (OSA). Methods: This retrospective study included 121 consecutive adult nonobese patients with OSA from a tertiary academic medical center. Patients with OSA who refused continuous positive airway pressure therapy, or in whom it was unsuccessful, and then underwent OSA surgery were enrolled. Evaluations of excessive daytime sleepiness using the Epworth Sleepiness Scale (ESS) and major parameters of objective full-night polysomnography were collected preoperatively and at least 3 months postoperatively. Statistical analysis was performed using the Wilcoxon signed rank test and Wilcoxon rank sum test. Results: When pre- and postoperative ESS and polysomnographic parameters were compared in all patients, ESS scores, apnea/hypopnea index, and snoring index showed statistically significant improvements ( P = .007, P < .001, and P < .001, respectively). When patients were classified into mild, moderate, and severe OSA groups, snoring index had statistically significant improvements in all 3 groups, and apnea/hypopnea index had statistically significant decreases in the moderate and severe OSA groups. Although reductions in ESS scores were found in all 3 groups, the most statistically significant improvement was noted only in the severe OSA group. Conclusions: OSA surgery can improve daytime sleepiness in nonobese patients with OSA, especially for patients with severe OSA. This study elucidates the effects of OSA surgery on daytime sleepiness by excluding the major confounding factor of obesity. This study adds to the literature on the effects of upper airway surgery for nonobese patients with OSA on daytime quality of life.

Objective: To develop an adequate model using reliable clinical and physical factors to predict pediatric obstructive sleep apnea/hypopnea syndrome (OSAS). Methods: Complete anthropometric measurements including BMI z score, tonsil size grading, and updated Friedman tongue position (uFTP) were evaluated. Subjective assessments of clinical symptoms/signs, including snoring visual analog scale (VAS), nasal obstruction, and mouth breathing, were recorded. Results: Eighty-eight children (57 boys and 31 girls, mean age = 9.0 years) were confirmed to have OSAS by comprehensive polysomnography (PSG). When the aforementioned variables were analyzed individually, the results indicated that snoring VAS, nasal obstruction, mouth breathing, and BMI z score were reliable predictors of apnea/hypopnea index (AHI/h) values (correlation coefficient r = 0.386, P < .001; r = 0.416, P < .001; r = 0.255, P = .02; and r = 0.243, P = .02, respectively). When all significant factors were included in the stepwise multiple linear regression analysis, the final predictive model is: Pediatric AHI = 0.108 + 0.103 snoring VAS + 0.894 nasal obstruction + 0.207 BMI z score ( F = 4.06, P = .01). Conclusion: The proposed noninvasive, simple, inexpensive, and easy to perform screening tool could be used to predict pediatric OSAS. An abnormal calculated AHI may prompt clinical physicians to conduct further PSG diagnostics and treatment.

Highlights • The mean NGA during inspiration in patients with dyspnea was less than that in patients without. • The mean age of patients with dyspnea was greater than that of patients without. • Dyspnea that occurred at 0–8 days post operation recovered within 3–17 days after BiPAP., Introduction Dyspnea due to bilateral vocal cord palsy after total thyroidectomy (BVCPATT) is a life-threatening complication; nevertheless, we try to avoid tracheotomy. Methods Using normalized glottal area (NGA), we retrospectively studied 14 patients with BVCPATT. Nine patients without dyspnea were treated conservatively, while five with dyspnea received immediate bilevel positive air-way pressure (BiPAP) treatment. Both right and left recurrent nerves were grossly intact during surgery. Results The mean NGA during inspiration of five patients with dyspnea was less than that of nine patients without (6.21 ± 1.57 (mean ± standard deviation) vs. 20.5 ± 9.5; p = 0.001). The mean age of patients with dyspnea was more than that of patients without (61.6 ± 15.6 vs. 38 ± 10.2; p = 0.007). Five patients with dyspnea that occurred at 0–8 days post operation recovered within 3–17 days after BiPAP. Conclusion Dyspnea occurred in patients with BVCPATT who were relatively older. The mean NGA during inspiration in patients with dyspnea was less than that in patients without. BiPAP might be a new treatment for dyspnea.

Background This study evaluated the significance of mammalian target of rapamycin (mTOR) activation on the prognosis of patients with locally advanced head and neck squamous cell carcinoma (HNSCC) receiving induction chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF). Methods Immunohistochemistry (IHC) for phosphorylated-mTOR and phosphorylated-p70 ribosomal S6 protein kinase (p70S6K) examined in 107 patients with locally advanced HNSCC receiving TPF was correlated with treatment outcome. The effect of mTOR inhibition on HNSCC cell lines was investigated in vitro and in vivo. Results Phosphorylated-mTOR expression was independently significantly associated with response to TPF, progression-free survival (PFS), and overall survival (OS). In cell lines and xenograft models, mTOR inhibitor, everolimus, enhanced the effect of docetaxel. Conclusion In patients with locally advanced HNSCC treated with TPF, phosphorylated-mTOR expression was independently associated with prognosis. In vitro and in vivo, concomitant inhibition of mTOR enhanced the effect of docetaxel. Our findings suggest the potential of mTOR as a therapeutic target for locally advanced HNSCC. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

Objectives/Hypothesis To identify standard clinical parameters that may predict the optimal level of continuous positive airway pressure (CPAP) in adult patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). Study Design This is a retrospective study in a tertiary academic medical center that included 129 adult patients (117 males and 12 females) with OSAHS confirmed by diagnostic polysomnography (PSG). Methods All OSAHS patients underwent successful full-night manual titration to determine the optimal CPAP pressure level for OSAHS treatment. The PSG parameters and completed physical examination, including body mass index, tonsil size grading, modified Mallampati grade (also known as updated Friedman's tongue position [uFTP]), uvular length, neck circumference, waist circumference, hip circumference, thyroid-mental distance, and hyoid-mental distance (HMD) were recorded. Results When the physical examination variables and OSAHS disease were correlated singly with the optimal CPAP pressure, we found that uFTP, HMD, and apnea/hypopnea index (AHI) were reliable predictors of CPAP pressures (P = .013, P = .002, and P < .001, respectively, by multiple regression). When all important factors were considered in a stepwise multiple linear regression analysis, a significant correlation with optimal CPAP pressure was formulated by factoring the uFTP, HMD, and AHI (optimal CPAP pressure = 1.01 uFTP + 0.74 HMD + 0.059 AHI − 1.603). Conclusions This study distinguished the correlation between uFTP, HMD, and AHI with the optimal CPAP pressure. The structure of the upper airway (especially tongue base obstruction) and disease severity may predict the effective level of CPAP pressure. Level of Evidence 4. Laryngoscope, 125:1983–1987, 2015

The objective of this study was to evaluate the relationship between subjective and objective tonsil size measurements in adult patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) and compare the tonsil size measurements with the severity of disease. Fifty-one adult patients (46 males and 5 females) who failed continuous positive airway pressure therapy and underwent OSAHS surgery were recruited. Physical examinations, subjective tonsil size grading preoperatively, and objective tonsil measurements including size (length, width, and height), weight and volume immediately after surgery were recorded. The results showed significant positive correlations between subjective tonsil size grading and all the parameters of the objective tonsil measurements (p < 0.05). When comparing the subjective and objective tonsil measurements with the polysomnographic parameters, the subjective grading was significantly correlated with snoring index (p < 0.05) but showed only borderline correlation with apnea/hypopnea index. However, the objective tonsil measurements were significantly correlated with both snoring index and apnea/hypopnea index (both p < 0.05). Although the subjective tonsil size grading reflected the objective tonsil measurements, the objective tonsil measurements were more meaningful in predicting the severity of OSAHS.

The research presents a novel automatic anemometer based on the technology of automatic multi-dimensional thermoelectric sensor array. The multi-dimensional thermoelectric sensor array was designed to form a double-ring structure using commercial thermocouples to detect real-time airflow temperature distribution, velocity and direction. The sensing arrays and a controllable heater and a human-machine interface that is calibrated by a hot-wire anemometer. The anemometer has advantages of low cost, real-time detection with fast response. Related air flow information has measured accurately and repeatability.

Head and neck squamous cell carcinoma (HNSCC) include a group of malignant neoplasms that arise from the upper aerodigestive tract and represent the seventh most common cause of cancer-related death. The overall 5-year survival rates have not significantly improved for decades in spite of the advances in the field of oncology and surgery, encouraging further research on factors that might modify disease prognosis. The silent information regulator (SIR) genes (Sirtuins) play key roles in cellular stress and are associated with aging-related diseases including cancer. Currently, seven human sirtuin (SIRT1–7) genes have been identified, but the roles of SIRT genes in HNSCC are still uncertain. Therefore, in this study, we used real-time quantitative reverse transcription-polymerase chain reaction to investigate the expressions of the seven SIRT genes in human HNSCC tissues to assess the changes in cancerous and noncancerous parts and the correlation with different tumor behaviors. Our results demonstrated that the expression levels of SIRT1, SIRT2, SIRT3, SIRT5, SIRT6, and SIRT7 were significantly downregulated in cancerous tissues compared with noncancerous tissues (all p < 0.01). The expression levels of SIRT1, SIRT2, SIRT3, SIRT5, and SIRT7 showed downregulation in advanced stages in respect to early stages (p < 0.05). These results indicate that the downregulation of SIRT genes expression may contribute to the development of cancer and trigger the neoplastic disease to more advanced stages. Our study indicates that SIRT genes expression could help in the diagnosis and represent a prognostic biomarker in HNSCC.

Background Smoking and betel nut chewing are well-known risk factors for head and neck squamous cell carcinoma (HNSCC). Smoking is also a strong prognosticator for patients with locally advanced HNSCC receiving induction chemotherapy. Smoking with or without betel nut chewing is a common practice in Asia. However, little is known regarding whether betel nut chewing can serve as a prognostic factor for smoking patients with locally advanced HNSCC receiving induction chemotherapy. The aim of this study was to evaluate the prognostic impact of betel nut chewing in such patients receiving induction chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF). Methods From January 2010 to December 2012, we retrospectively analyzed 162 smoking patients with locally advanced HNSCC who received induction chemotherapy with TPF at our institution. Background characteristics, including a history of betel nut chewing, were analyzed as potential prognostic factors. Results Among the 162 smoking patients, 131 patients (81 %) were betel nut chewers, while 31 (19 %) were non-betel nut chewers. One hundred fifty-six (96 %) were men, and 6 (4 %) were women. The median age was 53 years. The overall response rates to induction chemotherapy were 57 and 77 % in patients with and without betel nut chewing history, respectively (P = 0.038). The 2-year progression survival rates were 37 and 67 % in patients with and without betel nut chewing history, respectively (P = 0.004). The 2-year overall survival rates were 47 and 71 % in patients with and without betel nut chewing history, respectively (P = 0.017). Betel nut chewing history was independently associated with a poor response to induction chemotherapy, an inferior progression-free survival rate, and a poor overall survival rate. Conclusions Our results indicate that betel nut chewing history is independently associated with poor prognosis in smoking patients with locally advanced HNSCC receiving induction chemotherapy with TPF. Further investigation is warranted to explain this effect of betel nut chewing history on these patients’ prognosis.

Genomic imprinting is associated with many human diseases, including various types of cancers, however, no studies on gene imprinting are related to squamous cell carcinoma of the head and neck (SCCHN) directly.In this study, the expression of a panel of 15 imprinted genes in cancerous and non-cancerous tissues from 73 patients with SCCHN were investigated.Altered expression of carboxypeptidase A4 (CPA4); protein phosphatase 1 regulatory subunit 9A (PPP1R9A); H19, imprinted maternally expressed transcript (non-protein coding) (H19); paternally expressed gene 3 antisense RNA 1 (PEG3-AS1); retrotransposon-like 1 (RTL1), insulin-like growth factor 2 (IGF2); solute carrier family 22 member 3 (SLC22A3); and gamma-aminobutyric acid type A receptor beta3 subunit (GABRB3) was observed. Down-regulation of PPP1R9A (p0.05) and GABRB3 (p0.05) was correlated with more advanced cancer stages. Down-regulation of PEG3-AS1 (p0.05) and GABRB3 (p0.01) was correlated with lymph node metastasis. Poor survival was related to higher expression of CPA4 (p0.01) and lower expression of PEG3-AS1 (p0.05) and IGF2 (p0.05). Chemotherapy was also found to have an impact on the expression of imprinted genes.Loss of imprinting is involved in tumorigenesis of SCCHN.

This study developed a porous nano anodic aluminum oxide (AAO) based gas microsensor for detecting process carbon monoxide (CO) at room temperature. The small sensing microdevice has stable response with high sensitivity which includes porous AAO structures, gas sensing membrane, interdigitated sensing electrode, heater and temperature sensor. The tungsten oxide (WO3) sensing membrane covers AAO to enlarge total gas sensing surface area to enhance gas sensing response. The Pt interdigitated sensing electrode can also improve the sensitivity. The experimental results showed that the CO gas concentration sensitivity is proportional to temperature. As compared with the sensor without AAO, the concentration range of CO sensed by this microsensor is 100~1000 ppm, the gas sensing resistance change rate can be increased by 87.4 %.

Light intensity enhancement of GaN-based blue light-emitting diodes (LEDs) is performed using different surface roughening technologies. Three roughening technologies are applied that contain surface roughening of p-GaN, textured indium tin oxide (ITO) on roughened p-GaN, and growing ZnO nanorods on textured ITO/p-GaN. A roughened p-GaN surface was grown on the c-plane sapphire substrate at temperature 800 °C. The morphologies of the textured LEDs with roughness in the range from 9.67 nm to 51.13 nm were observed. The light output efficiency of LED with roughened ITO layer is increased up to 73.8 %. Different dimensions of LEDs can be driven by constant injection current 20 mA without increasing threshold voltage, and larger size of ZnO/ITO/p-GaN LED shows higher luminance intensity. The LEDs with ZnO nanorods on roughened ITO/GaN have shown great performance to enhance the power conversion efficiency.

An optical mechatronic magnetic microsensor with temperature compensation based on fiber Bragg grating (FBG) and microelectromechanical system (MEMS) technologies is demonstrated. Parallel nickel-electroplated cantilever beams are fabricated as an attractive bending mechanism for pushing the optical fiber. Related stress induced cantilever bend caused by magnetic force driving reflective wavelength shift that exactly corresponds with photo-elastic coupling effect to characterize microsensors. Two different cycles of gratings in the same fiber have fabricated to perform the function of magnetic sensing and temperature compensation for reducing temperature-induced bias in magnetic measurement automatically. The sensitivity of 2.238 T/nm with null temperature response has obtained which excited by Nd-Fe-B magnets with residual magnetic strength up to 1.26 Tesla.

Objectives: A transoral approach to laser myoneurectomy of the thyroarytenoid muscles was recently reported as an effective technique for treatment of adductor spasmodic dysphonia (ASD). The short-term results were encouraging. In this study, a long-term surgical outcome of this technique is investigated. Study Design: A prospective clinical series. Methods: Fifty-two patients with ASD underwent transoral laryngomicrosurgery with a CO 2 laser to resect the ventricular folds followed by myoneurectomy of the thyroarytenoid muscles. The nerve fibers of recurrent laryngeal nerve terminating at the thyroarytenoid muscle, which were frequently found branching deeply among the posterior belly of this muscle, were vaporized. Care was taken not to damage the vocal ligaments, lateral cricoarytenoid muscles, or arytenoid cartilages. Pre- and postoperative subjective voice assessments, and acoustic and aerodynamic measurements, were performed and statistically analyzed. Results: Twenty-nine of the 52 patients who were followed up for more than 12 months (range, 12-63 months; mean, 31 months) were studied. Moderate and marked vocal improvement was achieved in 90% (26/29) of the patients. Three patients had 30% improvement, which was reported as unsuccessful. Eight of the 26 patients who were satisfied with their postoperative voice still had a mild strain during phonation. Of the eight patients, seven achieved normal or nearly normal voice quality after revision laser surgery. No significant vocal deficit or paralysis was observed in any patient. Conclusions: After long-term follow-up of 31 months on average, approximately 90% of the ASD patients obtained moderate to marked improvement of vocal performance after transoral laser surgery. The long-lasting outcome is encouraging.

Novel pneumatic-controlled logic microdevices based on a microelectromechanical system (MEMS) compatible process and microfluidic control technology have been developed for executing the universal basic logic functions of NOT, NOR, and NAND. The main fabrication processes for the logic microdevices include anisotropic silicon bulk etching, silicone rubber membrane formation, wafer bonding and packaging. The dynamic characteristics and pneumatic-controlled performance of the elastic membranes have been measured using an equipped fluidic instrument, which indicates their potential application to safety monitoring for preventing electric-induced disasters. All logic functions of the microdevices have been demonstrated to correspond exactly to the related truth tables. The newly developed logic microdevices are capable of controlling a liquid or gas system with high sensitivity in a wide dynamic range, and with strong immunity from temperature fluctuations.

An opto-mechatronic microsensor based on fiber Bragg grating technology for sensing magnetic field strength is developed and tested. The device is fabricated using low temperature silicon-based MEMS compatible technologies. A uniform Fe/Ni layer and embedded Fe/Ni flaps are deposited on the elastic membrane respectively that are actuated by external magnetic field for evaluating sensitivity. The Bragg wavelength shift of 0.37 nm was measured at the distance of 0.32 mm between the microsensor and a magnet with flux density of 1.12 T.

Objectives: To develop a functional and morphologic reconstruction for intraoral buccal/lip mucosal defects after tumor resection. Study Design: A prospective clinical series. Methods: From November 2003 to July 2006, 32 patients underwent free tongue mucosa graft reconstruction after resection of buccal or lip tumors. Graft validity and acceptability, donor site morbidity, and postoperative articulation and swallowing functions were evaluated. Results: Regular postoperative follow-up for at least 6 (mean, 18.5; range, 6–38) months revealed good functional outcomes and satisfactory cosmetic results of grafts at recipient sites in 29 of 32 (90.6%) patients. There were minimal to mild postoperative pain and minor complications at the donor sites. Mouth opening width was preserved, and all patients could tolerate either soft or regular diets. None of the patients had postoperative functional deficiencies involving articulation, swallowing, mastication, or sense of taste. Conclusion: This study demonstrated that free mucosa grafts from the lateral tongue are an excellent alternative for reconstruction of buccal/lip mucosal defects after tumor resection.

This study evaluated the significance of mammalian target of rapamycin (mTOR) activation on the prognosis of patients with locally advanced head and neck squamous cell carcinoma (HNSCC) receiving induction chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF).Immunohistochemistry (IHC) for phosphorylated-mTOR and phosphorylated-p70 ribosomal S6 protein kinase (p70S6K) examined in 107 patients with locally advanced HNSCC receiving TPF was correlated with treatment outcome. The effect of mTOR inhibition on HNSCC cell lines was investigated in vitro and in vivo.Phosphorylated-mTOR expression was independently significantly associated with response to TPF, progression-free survival (PFS), and overall survival (OS). In cell lines and xenograft models, mTOR inhibitor, everolimus, enhanced the effect of docetaxel.In patients with locally advanced HNSCC treated with TPF, phosphorylated-mTOR expression was independently associated with prognosis. In vitro and in vivo, concomitant inhibition of mTOR enhanced the effect of docetaxel. Our findings suggest the potential of mTOR as a therapeutic target for locally advanced HNSCC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E844-E852, 2016.

We have previously demonstrated altered SIRT gene family in head and neck squamous cell carcinoma (HNSCC). In the present study we aimed to investigate whether the SIRT gene family was also altered in peripheral blood (PB) of patients with HNSCC and the possibility to be used as circulating biomarkers.The expression profiles of the 7 SIRT genes of PB leukocytes from 34 patients with HNSCC before and after surgery and 31 healthy individuals were investigated.In the cancer group, the expression level of SIRT1 was down-regulated (p0.05); in contrast, SIRT6 and SIRT7 were significantly up-regulated (p0.001). Patients with advanced-stage HNSCC had lower expression of SIRT1 and SIRT3. Recovery of SIRT6 and SIRT7 was observed in postoperative patients (p0.005).SIRT genes were altered in PB leukocytes of HNSCC patients and SIRT6 and SIRT7 are potential circulating prognostic markers for HNSCC.

To identify standard clinical parameters that may predict the optimal level of continuous positive airway pressure (CPAP) in adult patients with obstructive sleep apnea/hypopnea syndrome (OSAHS).This is a retrospective study in a tertiary academic medical center that included 129 adult patients (117 males and 12 females) with OSAHS confirmed by diagnostic polysomnography (PSG).All OSAHS patients underwent successful full-night manual titration to determine the optimal CPAP pressure level for OSAHS treatment. The PSG parameters and completed physical examination, including body mass index, tonsil size grading, modified Mallampati grade (also known as updated Friedman's tongue position [uFTP]), uvular length, neck circumference, waist circumference, hip circumference, thyroid-mental distance, and hyoid-mental distance (HMD) were recorded.When the physical examination variables and OSAHS disease were correlated singly with the optimal CPAP pressure, we found that uFTP, HMD, and apnea/hypopnea index (AHI) were reliable predictors of CPAP pressures (P = .013, P = .002, and P.001, respectively, by multiple regression). When all important factors were considered in a stepwise multiple linear regression analysis, a significant correlation with optimal CPAP pressure was formulated by factoring the uFTP, HMD, and AHI (optimal CPAP pressure = 1.01 uFTP + 0.74 HMD + 0.059 AHI - 1.603).This study distinguished the correlation between uFTP, HMD, and AHI with the optimal CPAP pressure. The structure of the upper airway (especially tongue base obstruction) and disease severity may predict the effective level of CPAP pressure.4.

Gradient-type Hopfield networks have been widely used in optimization problems solving. This paper presents a novel application by developing a matrix oriented gradient approach to solve a class of linear matrix inequalities (LMIs), which are commonly encountered in the robust control system analysis and design. The solution process is parallel and distributed in neural computation. The proposed networks are proven to be stable in the large. Representative LMIs such as generalized Lyapunov matrix inequalities, simultaneous Lyapunov matrix inequalities, and algebraic Riccati matrix inequalities are considered. Several examples are provided to demonstrate the proposed results. To verify the proposed control scheme in real-time applications, a high-speed digital signal processor is used to emulate the neural-net-based control scheme.

Pillar implants provide a reasonable outcome with minimal post-operative morbidity and complications in treating patients with sleep-disordered breathing (SDB) who had obvious palatal obstruction. The palatal structure is responsible for a normal functioning Eustachian tube; however, little is known if there is any potential otologic implication of minimally invasive palatal stiffening surgery for SDB. The aim of this study is to evaluate the effects of Pillar implantation on middle ear function. We performed a prospective study in a tertiary referral center. Thirty SDB patients (25 men, 5 women; mean age, 44.3 years) who underwent Pillar implants for treating palatal obstruction were enrolled. The subjects had normal otologic exam and no previous history of chronic ear disease. Pure-tone audiometry and tympanometry were performed pre-operatively, and post-operative days 1 and 7, and months 1 and 3. Baseline and post-operative middle ear pressures (MEPs) in decipascals were compared. Statistical analysis was performed by repeated measures of ANOVA. Eight patients (8/30, 26.7%) reported otologic complaints such as ear pressure and/or otalgia within 1 week post-operatively. No permanent otologic discomfort occurred. A trend toward reduced MEP was noted in this study. The decrease in MEP became apparent on post-operative day 1 after surgery. However, mean pressure changes were no longer significantly different from pre-operative values by 1 week after surgery. Pillar implantation for SDB induces changes in middle ear function. However, the changes were temporary and not significant 1 week after surgery.

Circadian clock regulates daily rhythms in various physiologic processes and deregulated circadian clock are linked to cancers. We have previously demonstrated the association between altered circadian clock genes (CCGs) and head and neck squamous cell carcinoma (HNSCC). The purpose of this study was to investigate whether the CCGs were also altered in peripheral blood (PB) of patients with HNSCC.The 9 CCGs expression profiles of PB leukocytes from 94 patients with HNSCC and 56 healthy individuals were investigated using real-time quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) and immunocytochemistry.All the 9 CCGs were significantly downregulated in the PB of preoperative patients (p.0001). Recovery of PER1 and CLOCK expression was observed in postoperative patients with good prognosis but not in patients that died within 1 year after surgery.CCGs were also altered in PB leukocytes of patients with HNSCC and PER1 and CLOCK are potential circulating prognostic markers for HNSCC.

A novel solar microsensor with microelectromechanical system (MEMS)-based packaging for improving solar tracking efficiency was proposed and a functional solar power sensing array was also developed. Solar energy as a renewable energy source in the world is the most important issue. The microsensor with different shapes of masks as light inlet was fabricated on silicon wafers to provide variable attenuation effect of the sunlight. To detect light incident elevation and azimuth accurately, a circuit module for a maximum power tracking system is developed conducting the automatic tracking function by feedback control technique. The best angle related sensitivity for the microsensors covered with inside-shrunk and inside-extended windows are 128.6 Ω/degree and 150.2 Ω/degree, respectively. The collimated process of the incident solar power by developed solar microsensor keeps maximum solar energy collection with the best long-term efficiency in photovoltaic energy conversion. The microsensor to sense collimated solar intensity is designed to promote solar energy collection efficiency and an intelligent bi-axes dynamic solar tracking device will develop in the future.

A transoral approach to laser myoneurectomy of the thyroarytenoid muscles was recently reported as an effective technique for treatment of adductor spasmodic dysphonia (ASD). The short-term results were encouraging. In this study, a long-term surgical outcome of this technique is investigated.A prospective clinical series.Fifty-two patients with ASD underwent transoral laryngomicrosurgery with a CO(2) laser to resect the ventricular folds followed by myoneurectomy of the thyroarytenoid muscles. The nerve fibers of recurrent laryngeal nerve terminating at the thyroarytenoid muscle, which were frequently found branching deeply among the posterior belly of this muscle, were vaporized. Care was taken not to damage the vocal ligaments, lateral cricoarytenoid muscles, or arytenoid cartilages. Pre- and postoperative subjective voice assessments, and acoustic and aerodynamic measurements, were performed and statistically analyzed.Twenty-nine of the 52 patients who were followed up for more than 12 months (range, 12-63 months; mean, 31 months) were studied. Moderate and marked vocal improvement was achieved in 90% (26/29) of the patients. Three patients had 30% improvement, which was reported as unsuccessful. Eight of the 26 patients who were satisfied with their postoperative voice still had a mild strain during phonation. Of the eight patients, seven achieved normal or nearly normal voice quality after revision laser surgery. No significant vocal deficit or paralysis was observed in any patient.After long-term follow-up of 31 months on average, approximately 90% of the ASD patients obtained moderate to marked improvement of vocal performance after transoral laser surgery. The long-lasting outcome is encouraging.

A novel electro-optical magnetic microsensor with reducing interference packaging mechanism for sensing magnetic field strength is demonstrated. Both capacitive and optical fiber sensing microstructures surrounded magnetic shields are fabricated in a chip using low temperature silicon-based MEMS compatible technology. Varied NiFe permalloy flaps embedded on polyimide membranes were used as flexible sensing mechanisms to actuate side-polished fiber and capacitor plate. The fiber Bragg gratings are used as optical sensors with high sensitivity. Results of simulations and experiments show that the structures can reduce interference and then increasing sensitivity and performance effectively. A sensitivity of 0.35nm/T is achieved by evaluating the peak shift of Bragg wavelength excited by Nd-Fe-B magnets with residual magnetic strength up to 1.12 T.

The ultrasonic transducer's micropackaging with particle pollution restraint mechanisms using micromachining process is proposed. The developed packaging with active dustproof mechanisms is very promising, because it permits the advantages of shielding, protection, reliability and signal connection. Technical approaches to the capacitive micro-ultrasonic transducer packaging are divided into three parts: micromachining cap structures, die attachments, and dustproof mechanisms. Simulations for handling the packaging issues are relatively developed. Features of the technology for restraint electrodes on microcap are described. The measurements for various physical and electrical parameters and the packaging needed to make optimal measurements is given. Future directions and potentials of the packaging technology are discussed

The concept of constructing a fuzzy filter algorithm based on the largeness of the residuals of the processed data is proposed, which results in smoothing the processed data through an equivalent smoothing window. Based on this approach, three fuzzy filter algorithms are constructed: the fuzzy least square smoother, the fuzzy recursive least square filter, and the fuzzy kalman filter. This approach can also include some extra information such as the richness of the processed data and the possibility of parameter variation in decision making. By doing so, this approach can also be used for abnormal data rejection, forgetting factor adjustment, and parameter tracking. Simulations of applying this method for observation and comparison are conducted, and some comments are given.

A fully integrated wireless inductance-capacitance (LC) coupling microsensor was designed and fabricated by MEMS technology. The sensing loop was formed by connecting a deformable parallel-plated capacitor and a planar spiral inductor with a Ni(80)Fe(20) core. Polyimide and PMMA were used to isolate and package the devices. Typical dimension of the sensors was 5 × 5 mm2 × 0.77 mm. Different electroplated inductive coils (30, 40, and 60 turns) were fabricated to connect with a 4 × 4 mm2 plate capacitor in series. The LC sensing module for measuring liquid-level induced frequency responses was setup. Experimental results show that frequency response decreased as liquid level increased and sensitivity is about 7.01 kHz/cm with deviation less than 2%. Developed planar spiral inductor with high permeability magnetic core can provide a wide range of frequency variation in LC sensing applications.

Based on the operational concept of quasi-static state and optoelectronic measurement technology, this research develops a real-time dynamic imaging system for centrifugal microfluidic platforms. Unlike the conventional centrifugal inspection system, which can only be used for examination of the final steady stage in microflow analysis, the developed system with a multi-speed controller and object tracking design is fabricated with low cost to recognize dynamic microflow patterns for different kinds of compact disc-type centrifugal microstructures. The characteristics of rotational control efficiency and image acquisition quality are obtained from fluidic microvalve experiments that are achieved in measuring microflow dynamic responses and in visualizing transient microflow patterns. A man–machine interface was connected with a computer to perform the control and alignment adjustments to catch exact image data for following analysis. The rotation stability of the system has been evaluated, and the rotation speed up to 4500 rpm with vertical vibration less than ±0.2 mm is achieved measured at radial distance of 5 cm. The image acquisition is transferred via USB 2.0 at a speed of up to 30 images per second to the display and memory module.