[Show abstract][Hide abstract] ABSTRACT: To identify the ranges of hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) levels which are associated with the lowest all-cause mortality.
PLoS ONE 10/2014; 9(10):e109501. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Myostatin is a negative regulator of skeletal muscle mass and may also modulate energy metabolism secondarily. We aim to investigate the relationship between serum myostatin and the metabolic variables in diabetic (DM) and non-diabetic subjects.
PLoS ONE 09/2014; 9(9):e108230. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Adiponectin might play a protective role in cardiometabolic and peripheral auditory disorders, but its role on central auditory function was still unclear. The aim of this study was to examine whether there is an association between plasma adiponectin levels and central auditory function in adults. We recruited 297 adults, with normal or symmetrical sensorineural hearing loss and normal cognitive functions. Multivariate linear regression was performed to assess the association between plasma adiponectin concentrations and pitch pattern sequence (PPS) score, which was one of central auditory tests. The results showed that there were 224 (75.4 %) women and 73 (24.6 %) men in this study. The mean age was 58.1 ± 8.4 years, the mean waist circumference (WC) was 81.1 ± 8.3 cm, and the mean body mass index (BMI) was 24.0 ± 3.0 kg/m(2). The mean PPS score was 71.5 ± 14.1 %, and plasma adiponectin concentration was 12.7 ± 5.5 g/mL. After adjusting for age, gender, WC, coronary artery disease, hypertension, diabetes mellitus, chronic kidney disease, smoking and drinking, plasma adiponectin concentrations (coefficient ± standard error, β ± SE = -0.09 ± 0.16, p = 0.563) were found to have no significant associations with PPS score. When WC was excluded from these variables in the multivariate linear regression model, plasma adiponectin concentrations (β ± SE = -0.03 ± 0.15, p = 0.855) were still not significantly associated with PPS score. In conclusion, plasma adiponectin levels were not significantly associated with PPS score, which was one of central auditory function tests. More studies should be conducted for the underlying mechanisms of obesity-related central auditory dysfunction.
[Show abstract][Hide abstract] ABSTRACT: Non-attendance in outpatient clinics might disrupt medical care, interfere with outpatient clinic processing, and waste health service resources. This study was performed to identify predictive factors for non-attendance in endocrinology and metabolism (Endo/Meta) patients.
Non-attendance was examined for a period of 6 months in Endo/Meta outpatient clinics in a medical center in Taiwan. Effects of physician, clinic, and patient characteristics, and appointment patterns in non-attendance were assessed by ξ(2) test and multivariate logistic regression.
During the study period, a total of 13,584 patients booked appointments for 609 Endo/Meta clinics managed by 11 specialists. The mean number of appointments per patient was 2.3 ± 1.1. The total number of registered visits was 31,143. The total number of non-attendances was 2272. The overall proportion of non-attendance in Endo/Meta patients was 7.3%. The proportion of non-attendance varied with different physician teaching status and on different weekdays. In multivariate logistic regression, physician age (p = 0.0009), physician teaching status (p = 0.0013), number of physician shifts per week (p< 0.0001), patient age (p< 0.0001), first-time appointment (p< 0.0001) and registration order in the clinic (p < 0.0001) had significant effects on non-attendance, whereas physician and patient sex, weekdays and daytimes of clinics had no significant effect on non-attendance.
Determinants of non-attendance in Endo/Meta patients include older physician age, lower physician teaching status, number of physician shifts per week, younger patient age, first-time appointment, and later registration order in the clinic. Research on non-attendance should be applied to improve quality of medical care. Optimal ways to ensure attendance deserve further investigation.
Journal of the Formosan Medical Association 12/2010; 109(12):895-900. · 1.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To analyze auditory brainstem response (ABR) data in patients with vestibular schwannomas (VS) in an effort to identify correlations between abnormal ABR parameters and tumor size.
Cross-sectional study with chart review.
Tertiary referral hospital.
Retrospective chart review and analysis of bilateral ABR records in patients with VS. Interaural latency differences of interpeak I-V (ILD-I-V) and ILD-V longer than 0.2 ms were used as abnormal criteria.
Thirty patients with a mean age of 50 +/- 14 years were included in this study. The most frequent changes in ABR parameters included those of ILD-I-V (100%), wave V latency (96.7%), ILD-V (93.3%), and interpeak I-V latency (90%). Average VS tumor size was 2.48 +/- 1.31 cm. For patients with VS greater than or equal to 2 cm, the prevalences of abnormal ipsilateral interpeak III-V latency, contralateral wave V latency, and interpeak III-V latency showed statically significant differences (P = 0.0035, P = 0.0267, and P = 0.0273, respectively) compared to those in patients with VS less than 2 cm. Tumor size was positively correlated with pure-tone average (P = 0.0106) and with the total number of bilateral abnormal ABR parameters (P = 0.004).
We identified a correlation between ABR parameters and VS tumor size. An ipsilateral ILD-I-V greater than 0.2 ms was sensitive for detecting VS. Abnormal contralateral wave V and interpeak III-V latency indicated a tumor size potentially larger than 2 cm. Further studies are needed to confirm these findings.
Otolaryngology Head and Neck Surgery 12/2009; 141(6):695-700. · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The study attempted to highlight the differences of mechanical properties in microchambers and macrochambers between patients with type 2 diabetes mellitus and age-matched healthy volunteers.
A total of 29 heels in 18 diabetic patients and 28 heels in 16 age-matched healthy participants were examined by a loading device consisting of a 10-MHz compact linear-array ultrasound transducer, a Plexiglas cylinder, and a load cell. Subjects in both groups were on average about 55 years old with a body mass index of approximately 25 kg/m(2). A stepping motor was used to progressively load the transducer on the tested heels at a velocity of 6mm/s from zero to the maximum stress of 78 kPa. Unloaded thickness, strain, and elastic modulus in microchambers, macrochambers and heel pads were measured.
Microchambers strain in diabetic patients was significantly greater than that in healthy subjects (0.291 (SD 0.14) vs. 0.104 (SD 0.057); P<0.001). Macrochambers strain in diabetic patients was significantly less than that in healthy subjects (0.355 (SD 0.098) vs. 0.450 (SD 0.092); P=0.001). Microchambers stiffness in diabetic patients was significantly less than that in healthy persons (393 (SD 371)kPa vs. 1140 (SD 931)kPa; P<0.001). Macrochambers stiffness in diabetic patients was significantly greater than that in healthy persons (239 (SD 77)kPa vs. 181 (SD 42)kPa; P=0.001).
Heel pad tissue properties are altered heterogeneously in people with diabetes. Increased macrochambers but decreased microchambers stiffness may cause diminished cushioning capacities in diabetic heels.
[Show abstract][Hide abstract] ABSTRACT: In patients with malignant external otitis (MEO), mortality was not related to age, sex, degree of glucose tolerance, duration of diabetes mellitus (DM), microorganism, comorbid disease, or involvement of a single cranial nerve. Severe complications such as skull base osteomyelitis, intracranial extension, and involvement of multiple cranial nerves were correlated with mortality.
To analyze the factors that affect the survival of patients with MEO in today's era of advanced antibiotics.
Patients with a diagnosis of MEO from 1993 to 2005 were collected.
A total 26 patients with a mean age of 63.7+/-10.2 years were included. All had a history of DM. Pseudomonas aeruginosa (26.9%), Klebsiella pneumoniae (19.2%), and fungus (15.4%) were most frequently found in pus cultures. Cranial nerves were involved in 11 patients: the facial nerve was most frequently (38.46%) involved. Complications such as osteomyelitis (11 patients) and intracranial involvement (3 patients) were noted in this series. Mastoidectomy was performed in 12 patients. A total of five patients died.
[Show abstract][Hide abstract] ABSTRACT: Facial palsy in children might be an alarming sign of serious underlying disease such as tumor, systemic disease or congenital anomalies and the recovery is poor in those cases. Therefore, careful investigation and differential diagnosis are essential in children. Prednisolone does not make a significant difference in the outcome in the treatment of children with Bell's palsy. The prognosis of Bell's palsy in the pediatric group is good; patients usually recover within 3 months.
To review and analyze the etiology, management, and outcome of facial palsy in children.
Using a retrospective chart review, patients under the age of 15 years with a diagnosis of facial palsy were collected from 1996 to 2002.
A total of 56 cases (29 male, 27 female) with a mean age of 6.9±4.5 years were included in this analysis. Causes of facial palsy were Bell's palsy (44 patients, 78.6%), neoplastic (4 patients, 7.1%), head injury (3 patients, 5.4%), congenital (3 patients, 5.4%), or infectious (2 patients, 3.6%). In Bell's palsy there was no significant difference in the recovery rate between the groups with or without prednisolone treatment and between the groups that received medication within 1 week of syndrome onset or after more than 1 week.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the prognostic factors of unknown primary head and neck squamous cell carcinoma (HNSCC).
Patients with unknown primary HNSCC from 1980 to 2000 were included.
Forty-eight patients, predominantly male and with a mean age of 63.3+/-11.6 years, were recruited. The median survival time (MST) was 44 months. The overall survival rate was 60.4 percent at three years and 39.6 percent at five years. Forty-two patients receiving intervention regimens had a MST of 45 months, while six patients receiving palliative therapy had a MST of 8.5 months (log rank test, P=0.016). With multivariate Cox regression analysis, age (per year), higher nodal stage (N3 vs N1 or N2), and treatment (operation vs nonoperation) had a hazard ratio of 1.081 (P<0.0001), 5.852 (P=0.010), and 0.4 (P=0.042), respectively.
Older age, higher nodal stage, and palliative treatment indicated poor prognosis. Survival time might be prolonged if surgical treatment is tolerable.
Otolaryngology Head and Neck Surgery 10/2008; 139(3):429-35. · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to investigate the chronologic changes of nitric oxide (NO) concentration in the cochlear lateral wall and to explore its possible role in permanent threshold shift (PTS) after intense noise exposure.
Seventeen guinea pigs were subjected to a single continuous exposure to broadband white noise at 105 +/- 2 dB sound pressure level (SPL) for 40 hours and were divided into four groups according to various postnoise recovery periods. Another 12 guinea pigs were not exposed to noise and served as controls. The hearing status of all animals was evaluated with auditory brainstem responses (ABR) evoked by condensation "click" sounds. ABR were recorded both prior to noise exposure and immediately before killing the animal. After death, NO concentration in the cochlear lateral wall was directly measured with an NO/ozone chemiluminescence technique.
An approximately 1.7-fold increase in NO concentration was observed immediately postnoise exposure, which persisted for up to 28 days. The threshold of ABR elevation (mean, 30 dB SPL) peaked immediately after cessation of noise exposure and gradually resolved to a PTS (mean, 14.5 dB SPL) 56 days after noise exposure when NO concentration had returned to its prenoise exposure level.
Noise-induced threshold shift, which resolved to a mild PTS, can be partially attributed to NO elevation in the cochlear lateral wall. Our results revealed a nonlinear correlation between ABR recovery and depletion of NO, indicating that the mechanisms of NO changes in the cochlear lateral wall may be more complicated than previously conceived and that other pathophysiologic mechanisms may also play important roles in noise-induced PTS.
The Laryngoscope 06/2008; 118(5):832-6. · 2.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aims of this study were to evaluate the effect of a high dose (160 mg/kg) of methylprednisolone sodium succinate (MPSS) on the formation of endogenous nitric oxide (NO) in the brainstem after facial nerve transection and to explore whether this effect has relevance to the survival of facial motor neurons. Guinea pig facial nerves were transected at the tympanic segment, and half were administered with MPSS, while the other half were given a vehicle of saline solution. Post operation NO formation in the brainstem at different time points was directly measured with a NO/ozone chemiluminescence technique. The surviving motor neurons were counted in histological coronal frozen sections of facial motor nuclei. The present results revealed that facial nerve transection induced a significant increase in NO formation in the brainstem by 1 week in both MPSS and saline treated groups and lasted to the end of the study (4 weeks). Compared to the saline treated group, it appeared that MPSS administration could delay the increase of nitric oxide synthase (NOS) expression and NO formation during the first 1 approximately 2 weeks after facial nerve transection. The survival rate of facial motor neurons was significantly higher in the MPSS treated group than in the saline treated group when examined at 3 or 4 weeks after facial nerve transection. These results indicate that a high dose of MPSS elicited a delayed increase of NO formation and thus may concomitantly enhance the survival time of motor neurons after facial nerve transection.
Brain Research 04/2008; 1197:23-31. · 2.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of the study was to evaluate the differences in the clinical characteristics of thyroglossal duct cysts (TGDC) between children and adults and to find a method for optimizing management of TGDC.
This study consisted of a retrospective chart review of patients with a diagnosis of TGDC from 1997 to 2002. All records were reviewed for age and sex, season of first visit, diagnostic methods, sizes and locations of cysts, surgical management, and recurrences. Differences between children and adults were analyzed.
A total of 84 patients (32 children, 52 adults) were recruited. There were no significant differences in sex in either group. Compared with children, more adult patients had left-sided and infrahyoid cyst locations. The cyst sizes were significantly larger in adults. In this review, 90.4% of adults and 75% of children underwent a Sistrunk operation, whereas the others underwent cyst excision. There was a total of 5 recurrences, 2 in children and 3 in adults.
Although the recurrence rates between children and adults and between different surgical managements were not significantly different, a Sistrunk procedure is recommended as the main operation of choice, especially in adults in whom a more extended tract resection should be performed.
American Journal of Otolaryngology 03/2008; 29(2):83-7. · 1.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hypernatremic myopathy was rarely reported in the literature and its clinical features have never been well-described. We present a 22-year-old man who had adipsic hypernatremia manifested with progressive proximal muscle weakness and remarkably high creatine kinase level that has never been reported in the cases of hypernatremic myopathy. His initial presentations were similar to that of polymyositis without the evidence of central nervous system dysfunction and hypopituitarism. The serum level of sodium at the beginning of myopathy is the lowest known in the literature. All the clinical presentations in this patient resulted from a hypothalamic mixed germ cell tumor with sub-acute intra-tumoral hemorrhage.
[Show abstract][Hide abstract] ABSTRACT: To evaluate risk factors for postoperative facial palsy in patients with parotid carcinoma.
We conducted a retrospective chart review of patients with parotid carcinoma who underwent parotidectomy at National Taiwan University Hospital from 1980 to 2000.
Eighty-eight patients with a mean age of 53 +/- 17 y were recruited. Sixty patients (68.2%) experienced postoperative facial palsy. Tumor size of larger than 4 cm was associated with an increased incidence of facial palsy (P = 0.0422). Facial palsy was noted in 95.5 percent of patients with facial nerve involvement and 51.3 percent of patients without facial nerve involvement (P = 0.0004). Of 42 patients with tumor over the deep lobe, 37 (88.1%) had facial palsy but only 50 percent (23 of 46) of those with tumor over the superficial lobe had facial palsy (P = 0.0001).
There were no significant associations between histopathology and facial palsy. Increasing tumor size, deep lobe tumor location, and tumor invasion of facial nerve increased the incidence of postparotidectomy facial palsy.
By paying attention to these risk factors a reduction of postoperative facial nerve palsy my be achieved.
Otolaryngology Head and Neck Surgery 06/2007; 136(5):778-82. · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Physician characteristics might determine the quality of diabetes care. This study evaluated the effects of physician specialty on the use of antidiabetes drugs, process and outcomes of diabetes care.
In 2002, 12,023 diabetes patients visited outpatient clinics more than four times at National Taiwan University Hospital. One-tenth of the patients were randomly sampled out. A retrospective chart review was conducted for those who were regularly cared for by endocrinologists (EN), other specialists in internal medicine (IM) and family medicine (FM) physicians. The use of antidiabetes drugs was assessed. Effects of physician specialty on the process or outcome indicators were analyzed by logistic or linear regression, accordingly.
A total of 875 diabetes patients (477 men, 398 women) with a mean age of 62.3 +/- 12.7 years were recruited. EN patients had the highest rate of being prescribed insulin, metformin or nonsulfonylurea insulin secretagogues, and the lowest rate of being given sulfonylureas. EN patients showed a significantly better adherence to glucose checkup, glycosylated hemoglobin A1C measures and urinalysis than IM patients. EN patients also showed better adherence to glucose checkup and urinalysis than FM patients. EN patients had the lowest mean fasting plasma glucose (FPG) and lowest mean postprandial plasma glucose (PPG). The difference in PPG between EN and IM patients and the difference in FPG between EN and FM patients were persistently significant following adjustment by patient and physician characteristics.
The use of antidiabetes drugs differed among patients cared for by EN, internists or generalists. Physician specialty had significant effects on the process and outcomes of diabetes care.
Journal of the Formosan Medical Association 11/2006; 105(10):821-31. · 1.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Broad-spectrum antibiotics are advocated for treating deep neck infection. Anaerobic coverage is necessary, especially in odontogenic cases. The presence of diabetes, infection of the parotid space and an obvious odontogenic source of infection can aid in determining the causative organisms.
This study aimed to analyze the bacteriology in deep neck infections and identify the factors that influenced the causative pathogens.
The records of 212 patients who were diagnosed as having deep neck infections at the National Taiwan University Hospital between 1997 and 2003 were reviewed; 128 patients with bacterial isolation from their pus cultures were enrolled.
The cultures of 46 patients (35.9%) were polymicrobial. Viridans Streptococcus was the most commonly isolated organism (38.3%), followed by Klebsiella pneumoniae (32.0%) and Peptostreptococcus (17.2%). The most common organism in 44 diabetic patients was K. pneumoniae (54.5%), versus viridans streptococcus (48.8%) in 84 nondiabetic patients. In patients with dental sources of infections, the culture rate of anaerobes was 59.3%; in upper airway infections and other sources of infections they were 22.7% and 21.5%, respectively (Chi(2) test, p = 0.0008). The differences in age, sex, and climate did not show any significant changes in the common causative pathogens. Common pathogens in the infection of parapharyngeal, submandibular, and extended spaces were the same as viridans streptococcus, but in the parotid space K. pneumoniae was the most common pathogen.
[Show abstract][Hide abstract] ABSTRACT: Neuropsychiatric or cognitive disturbances are common complications after traumatic brain injury. They are commonly regarded as irreversible sequelae of organic brain injuries. We report a case of hypopituitarism in a 77-year-old man who presented with long-term neuropsychiatric disturbances, including cognitive impairment, disturbed sleep patterns, personality change, loss of affect, and visual and auditory hallucinations after a traumatic subdural hemorrhage. The treatment response to hormone replacement therapy was nearly complete. Hypopituitarism is rarely considered in patients who sustain traumatic brain injury and the neuropsychiatric manifestations of posttraumatic hypopituitarism have rarely been reported. This case highlights the importance of hypopituitarism as a potential reversible cause of neuropsychiatric disturbances after traumatic brain injury.
Journal of the Formosan Medical Association 03/2006; 105(2):172-6. · 1.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined the performance of diabetes care measures in Taiwan and evaluated the influencing factors for professional accountability. We analyzed the year 2001 claims data from National Health Insurance (NHI) program in Taipei Branch. Professional accountability for diabetes care was measured by the adherence for laboratory monitor, either from patient- or hospital-viewpoint. Identifying the major care unit for each patient, a multiple logistic regression model was used to further assess the mixed effects of patient and hospital characteristics. The percentage of patients ever received measures in the year for plasma glucose, A(1C), urinalysis, renal function test, lipid profile, liver function test, and eye ground was 76.3, 42.7, 40.2, 59.7, 59.2, 53.2, and 16.8% respectively. About 19.2% patients never received any one of the measures. Patients with hypoglycemic, anti-hypertensive or anti-hyperlipidemic agents, hospitalization, emergency service visit and frequent visits were more likely to receive exams. Hospitals with different levels, ownerships, locales or qualifications as diabetes care institutions presented different accountability for diabetes care measures. After regression, counts of visits and levels of hospitals had persistently effects on all the measures. Our analysis revealed sub-optimal diabetes care in Taiwan and concluded the importance of enhancing care quality from primary settings.
Diabetes Research and Clinical Practice 03/2006; 71(2):192-201. · 2.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Papillary thyroid carcinoma (PTC) is often asymptomatic and rarely presents as a painful goiter. Further, the thyroid gland is not easily infected. Therefore, acute suppurative thyroiditis (AST) is unusual. PTC is also seldom combined with AST. We report a case of painful PTC with secondary infection after fine needle aspiration (FNA).
A 19-year-old girl complained of a painful goiter without skin change after an episode of upper airway infection. PTC was diagnosed according to the FNA cytology (FNAC) at another hospital. The goiter became more painful after FNA. The patient's second FNAC at our hospital revealed only many polymorphonuclear leukocytes (PMNs). Antibiotic treatment ameliorated the pain, but the goiter persisted. The third FNAC revealed some PMNs and papillary carcinomatous cells. After total thyroidectomy, pathology revealed ischemic necrosis with a focal PMN aggregation around the needle track and papillary carcinomatous cells nearby. According to the time sequence, secondary infection after FNA was suspected.
A painful goiter is an unusual presentation of PTC. Although FNAC is feasible for studying a thyroid lesion, malignant cells might be missed when secoandary injection and ischemic necrosis occur after FNA. Therefore, aseptic procedures are necessary to prevent bacteria from seeding into the thyroid.
[Show abstract][Hide abstract] ABSTRACT: Clinical studies of sudden sensorineural hearing loss (SSNHL) rarely focus on diabetic patients. We attempted to elucidate the clinical features of SSNHL in diabetic patients and to evaluate the factors influencing hearing deficits.
A retrospective review of diabetic patients with SSNHL was conducted at National Taiwan University Hospital from 1984 to 2003. The demographic and clinical characteristics, audiometries, and course of hearing recovery were reviewed.
Sixty-seven patients (38 men and 29 women) with a mean age of 60.1 +/-11.9 years were recruited. The mean duration of diabetes was 7. 5 +/- 7.7 years. The mean fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and glycosylated hemoglobin (HbA1C) at admission were 12.4 +/- 5.3 mmol/L, 14.5 +/- 5.4 mmol/L, and 9.9 +/- 2.9 mmol/L, respectively. Profound hearing loss was very common in this series (44.8%). Hearing impairment was also noted in the opposite ear, especially in the high frequencies. Presenting symptoms, the duration of diabetes, the FPG, and the HbA1C had no significant correlations with the severity of hearing loss. After adjusting for sex and age, a high PPG level was significantly associated with opposite-ear hearing deficits in the middle frequencies. In follow-up, the low and middle tone hearing thresholds in the lesion ears improved more than that at high frequencies, but they still did not return to baseline. Hearing consistently improved within 2 months after disease onset, but improvements were rare thereafter. With suitable treatment, optimal glycemic control could be achieved even under high-dose steroid regimens.
In diabetic patients with SSNHL, hearing loss in the contralateral ear and the profound type hearing loss in the lesion ear were commonly noted. The age and PPG level had significant correlations to contra-ear hearing loss. The poor prognosis of sudden deafness in diabetes patients may be caused by preexisting microvascular lesions in the inner ear, and the PPG level could be a risk factor indicator for cochlear dysfunction in diabetic patients. High-dose glucocorticoid should not be contraindicant in diabetic patients with SSNHL. Whether a longer duration of treatment will result in more hearing improvement is worthy of further study.
The Laryngoscope 10/2005; 115(9):1676-80. · 2.03 Impact Factor