Ming-Yen Hsiao

• M.D., Ph.D.
• Professor (Associate) at National Taiwan University

The blood-cerebrospinal fluid barrier (BCSFB) is another gatekeeper between systemic circulation and the central nervous system (CNS), mainly present at the boundary between choroid plexuses and the ventricular system. This study demonstrates BCSFB opening in rats by single pulse of low-energy focused shockwave (FSW, energy flux density 0.03 mJ/mm²...

Aims This study aimed to investigate the regional modulation effect of low‐intensity focused ultrasound (LIFU) on cerebrospinal fluid (CSF) influx dynamics, focusing on the differential changes between hemispheres in a mouse model of unilateral ischemic stroke. Methods LIFU was administered with a commercial transducer at the unilateral M1 cortex...

Recently, the glymphatic system has been proposed as a mechanism for waste clearance from the brain parenchyma. Glymphatic dysfunction has previously been shown to be associated with several neurological diseases, including Alzheimer's disease, traumatic brain injury, and stroke. As such, it may serve as an important target for therapeutic interven...

Objective: The ultrasound-mediated blood-brain barrier (BBB) opening with microbubbles has been widely employed, while recent studies also indicate the possibility that ultrasound alone can open the BBB through a direct mechanical effect. However, the exact mechanisms through which ultrasound interacts with the BBB and whether it can directly trig...

Transcranial focused shockwave (FSW) is a novel noninvasive brain stimulation that can open blood-brain barriers (BBB) and blood-cerebrospinal fluid barriers (BCSFB) with a single low-energy (energy flux density 0.03 mJ/mm²) pulse and low-dose microbubbles (2 × 10⁶/kg). Similar to focused ultrasound, FSW deliver highly precise stimulation of discre...

Current studies on wearable devices have demonstrated that swallowing can be detected by attaching the sensor to the larynx area. However, most reports only perform demonstration studies, with limited efforts to investigate the correlations between the detected signals and the swallowing process. From the physiology standpoint, the movements of the...

Background The aim of our study was to explore the effect of local corticosteroids on dysphagia in patients undergoing anterior cervical discectomy and fusion (ACDF). To address a gap in the limited research on this topic, we utilized high-resolution impedance manometry (HRIM) and the Eating Assessment Tool-10 (EAT-10) questionnaire to assess the e...

The computed tomography angiography (CTA) spot sign is a validated predictor of 30-day mortality in intracerebral hemorrhage (ICH). However, its role in predicting unfavorable functional outcomes remains unclear. This study explores the frequency of the spot sign and its association with functional outcomes, hematoma expansion, and length of hospit...

Background Primary intracerebral hemorrhage (ICH) accounts for 85% of ICH cases and is associated with high morbidity and mortality rates. Fever can cause secondary injury after ICH; however, relevant studies have reported inconsistent results regarding the effects of fever on functional outcomes after ICH. This study examined the effects of early...

Swallowing is a sophisticated process involving the precise and timely coordination of the central and peripheral nervous systems, along with the musculatures of the oral cavity, pharynx, and airway. The role of the infratentorial neural structure, including the swallowing central pattern generator and cranial nerve nuclei, has been described in gr...

Hyoid bone excursion (HBE) is one of the most critical events in the pharyngeal phase of swallowing. Most previous studies focused on the total displacement and average velocity of HBE. However, HBE during swallowing is not one-dimensional, and the change of velocity and acceleration is not linear. This study aims to elucidate the relationship betw...

Coronavirus disease 2019 (COVID-19) has caused tremendous morbidity and mortality worldwide. The large number of post-COVID survivors has drawn attention to the management of post-COVID condition, known as long COVID. This review examines current knowledge of long COVID, regarding its epidemiology, mechanism, and clinical presentations in both adul...

Objective: The morphological dynamics of the median nerve across the level extracted from dynamic ultrasonography are valuable for the diagnosis and evaluation of carpal tunnel syndrome (CTS), but the data extraction requires tremendous labor to manually segment the nerve across the image sequence. Our aim was to provide visually real-time, automa...

Background Primary intracerebral hemorrhage (ICH) accounts for 85% of ICH and is associated with high morbidity and mortality. Researchers have developed several predictive models for mortality and functional outcomes for ICH since 2001. However, models that predict long-term functional outcomes of activities of daily living (ADL) among ICH survivo...

Background Primary intracerebral hemorrhage (ICH) accounts for 85% of ICH cases and is associated with high morbidity and mortality rates. Fever can cause secondary injury after ICH; however, relevant studies have reported inconsistent results regarding the effects of fever on functional outcomes after ICH. This study examined the effects of early...

Recently, the glymphatic system has been proposed as a mechanism for waste clearance from the brain parenchyma. Glymphatic dysfunction has been associated with several neurological diseases such as Alzheimer’s disease, traumatic brain injury, and stroke. Therefore, it may be an important target for therapeutic interventions. In this study, we demon...

Contrast-enhanced ultrasound (CEUS) uses an intravascular contrast agent to enhance blood flow signals and assess microcirculation in different parts of the human body. Over the past decade, CEUS has become more widely applied in musculoskeletal (MSK) medicine, and the current review aims to systematically summarize current research on the applicat...

Pyriformis syndrome is theoretically caused by compression of the sciatic nerve by the pyriformis muscle. Patients with pyriformis syndrome often report shooting, burning, and numbness in the buttock and down the leg along the sciatic nerve. Sitting, standing, and walking can worsen the symptoms. The diagnosis of pyriformis syndrome is made only af...

Dysphagia is one of the most frequent sequelae of stroke. It can result in various complications such as malnutrition, dehydration, aspiration pneumonia, and poor rehabilitation outcomes. Repetitive transcranial magnetic stimulation (rTMS) has been reported to improve dysphagia after a stroke; however, effective treatment protocols have not been es...

The anterior–superior movement of the hyoid bone plays a significant role in securing the airway and smooth passage of food through the cricopharyngeal muscle. The hyoid bone can be detected easily with instruments such as the videofluoroscopic swallow study (VFSS) and ultrasonography (US), which have made quantitative kinematic analysis possible....

Background The long-term use of an oral corticosteroid suppresses immunity. Here, we describe a case involving a patient with weakness in the bilateral lower extremities due to cytomegalovirus (CMV) lumbosacral polyradiculitis. Case presentation A 64-year-old man visited a university hospital for symmetric motor weakness in both lower extremities...

Dear Editor, A 19-year-old, right-handed male professional baseball pitcher presented with tingling sensation of the ulnar side of the right hand and 4th to 5th fingers when pitching in recent few weeks. He received right ulnar collateral ligament (UCL) reconstruction at a foreign hospital 2 years ago. There was no spontaneous pain or obvious weakn...

Background/Purpose This retrospective study aimed to determine which factors, such as cognition, motor recovery, swallowing function, and bladder and bowel functions, significantly predicted independence in the activities of daily living (ADL) at hospital discharge in a domestic population of patients experiencing post-acute stroke who received in-...

Dear Editor, Polydeoxyribonucleotide (PDRN) was recently introduced as an injection material to reduce pain. It has been reported to exert anti-inflammatory effects by lowering the expression of inflammatory cytokines [1, 2]. Several clinical studies have reported the successful treatment of musculoskeletal pain of varying etiologies with PDRN inje...

Background/purpose: COronaVIrus Disease 2019 (COVID-19) has caused tremendous casualties and morbidities worldwide. Multisystem manifestations, including muscle weakness, dyspnea, cognitive decline, dysphagia, and dysarthria are frequently reported among critically ill patients. The resultant activity limitations and participation restrictions cal...

Aspiration due to dysphagia can lead to aspiration, which negatively impacts a patient’s overall prognosis. Clinically, videofluoroscopic swallow study (VFSS) is considered the gold-standard instrument to determine physiological impairments of swallowing. According to previously published literature, kinematic analyses of VFSS might provide further...

Background The blood-cerebrospinal fluid (CSF) barrier (BCSFB) is critically important to the pathophysiology of the central nervous system (CNS). However, this barrier prevents the safe transmission of beneficial drugs from the blood to the CSF and thus the spinal cord and brain, limiting their effectiveness in treating a variety of CNS diseases....

Objective To investigate whether the response to intra-articular facet joint corticosteroid injection can determine the long-term prognosis (at least 5 years after injury) of whiplash injury-related neck pain sustained 3–12 months after injury. Methods Of 65 patients who visited a university hospital for persistent whiplash injury-induced axial ne...

There is an emerging trend to employ dynamic sonography in the diagnosis of entrapment neuropathy, which exhibits aberrant spatiotemporal characteristics of the entrapped nerve when adjacent tissues move. However, the manual tracking of the entrapped nerve in consecutive images demands tons of human labors and impedes its popularity clinically. Her...

Aspiration and pyriform sinus stasis resulting from compromised swallowing might cause aspiration pneumonia, which can have a negative impact on the patient’s prognosis. Clinically, videofluoroscopic swallow study (VFSS) is considered the standard instrument that is able to provide clues that contribute to the physiological impairment of swallowing...

Ultrasonography has gained increasing attention as a non-invasive and radiation-free instrument for the assessment of swallowing function. In the past decades, an extensive repertoire of ultrasonographic techniques, such as, B-mode dynamic scanning, pixel analysis, M-mode, Doppler, 3D reconstruction, and sonoelastography, has been applied in the ev...

Background Glioblastoma multiforme (GBM) is currently the most devastating brain tumor globally and produces a high mortality rate. GBM is also challenging to eradicate using surgery due to its invasive characteristics. Moreover, the blood-brain barrier (BBB) increases the difficulty of transporting most therapeutic drugs to tumor sites. The use of...

Asian Oceanian Congress of Neurology

Entrapment neuropathy (EN) is a prevalent and debilitative condition caused by a complex pathogenesis that involves a chronic compression–edema–ischemia cascade and perineural adhesion that results in excessive shear stress during motion. Despite decades of research, an easily accessible and surgery-free animal model mimicking the mixed etiology is...

Background The computed tomography angiography (CTA) spot sign is a validated predictor of hematoma expansion and 30-day mortality in intracerebral hemorrhage (ICH). However, whether the spot sign predicts worse functional outcomes among ICH survivors remains unclear. This study investigated the frequency of the spot sign and its association with f...

Ultrasound (US) neuromodulation, especially sonogenetics, has been demonstrated with potential applications in noninvasive and targeted treatment of various neurological disorders. Despite the growing interest, the mechanism for US neuromodulation remains elusive, and the optimal condition for eliciting a neural response with minimal adverse effect...

Ultrasound-guided perineural dextrose injection (PDI) has been reported effective for carpal tunnel syndrome (CTS). Higher volume of injectate may reduce adhesion of median nerve from other tissues, but volume-dependent effects of PDI in CTS remain unknown. We aimed to investigate whether PDI with different injectate volumes had different effects f...

In clinical practice, neck pain is one of the most common complaints. Although most of the cervical radicular pain is manifested in the neck and upper extremities, C3 or C4 radicular pain only results in neck pain. It does not produce upper extremity radiating pain. This case report describes a 70-year-old male that presented with a numeric rating...

Objectives: This study aimed to develop an equation model combining physical fitness and anthropometric parameters and compare its results with those of bioelectrical impedance analysis (BIA)-measured lean mass (LM) using dual-energy X-ray absorptiometry (DXA)-measured appendicular muscle mass (AMM) as reference. Design: Observational analysis....

Background The computed tomography angiography (CTA) spot sign is a validated predictor of hematoma expansion and 30-day mortality in intracerebral hemorrhage (ICH). However, whether the spot sign predicts worse functional outcomes among ICH survivors remains unclear. This study investigated the frequency of the spot sign and its association with f...

In the current study, we present a case of an intramuscular ganglion cyst in the flexor hallucis brevis muscle (FHB) that arose secondary to a muscle tear. Through this study, we propose a possible aetiology for the development of intramuscular ganglionic cysts. A 50-year-old woman presented with acute pain and swelling over the right mid-plantar a...

Introduction: Numerous studies have shown the ability of low-energy acoustic waves such as focused ultrasound or shockwave to transiently open blood-brain barrier (BBB) and facilitate drug delivery to the brain. Preclinical and clinical evidences have well demonstrated the efficacy and safety in treating various brain disorders. However, the molec...

Focused extracorporeal shockwave (FSW), one kind of focused high-intensity pulsed ultrasound, has been shown to induce blood-brain barrier (BBB) opening in targeted brain areas in rat animal models with minimal detrimental effects below threshold intensity levels or iterations. In the current study, we found that the thresholds could be further red...

Background: We imaged the corticospinal tract (CST) and corticoreticular pathway (CRP) using diffusion tensor tractography (DTT) to evaluate the cause of muscle weakness in a patient who was exposed to high-voltage electricity. Case presentation: A 39-year-old man presented with quadriparesis after high-voltage electrical shock from power lines...

Background: We report a patient with unusual occipital neuropathic pain (at-level neuropathic pain) due to a small central cervical spinal cord injury (SCI). Case presentation: A 50-year-old man presented with severe bilateral occipital pain after falling from a height of 2 m, 2 weeks ago. The degree of pain was evaluated to be 9 out of 10 using...

Background: PRF stimulation has been safely and effectively applied for controlling various types of pain. Purpose: We reviewed the literature on the efficacy of pulsed radiofrequency (PRF) for controlling pain in joint disorders. Methods and materials: We searched PubMed for papers published until Sep 7, 2019 that used PRF to treat pain due t...

Dysphagia associated with the cricopharyngeus muscle (CPm) dysfunction negatively influences the quality of life. This high-pressure region must relax and the lumen must open for smooth food passage. The CP muscle is therefore a common target of chemodenervation with botulinum toxin (BTX). Here we presented a patient with severe left lateral medull...

In this article, we report unusual findings of multiple accessory limb muscles (ALMs) in a single individual: bilateral tensor fascia suralis, bilateral flexor digitorum accessorius longus, and bilateral peroneus tertius. https://journals.lww.com/ajpmr/Pages/videogallery.aspx

The oxidised hyaluronic acid/adipic acid dihydrazide hydrogel (oxi-HA/ADH) is a biocompatible and biodegradable hydrogel that has been applied in tissue engineering in musculoskeletal medicine. The present study investigated the feasibility of using oxi-HA/ADH as a drug carrier to incorporate cytoprotective medications for possible tendinopathy tre...

A 26‐year‐old man visited the physical medicine and rehabilitation department of a university hospital because of tingling pain in his left buttock and posterior thigh that spontaneously occurred 1 month before. His numeric rating scale score was 4 of 10 and was aggravated on sitting and standing positions. On physical examination, hypoalgesia and...

Because of limitations in the current understanding of the exact pathogenesis of tendinopathy, and the lack of an optimal experimental model, effective therapy for the disease is currently unavailable. This study aims to prove that repression of oxidative stress modulates the differentiation of tendon-derived cells (TDCs) sustaining excessive tensi...

A 33‐year‐old woman visited our hospital for recurrent dull pain at right upper back, and posterior shoulder. She noted it was aggravated by raising her arm with referred pain at her wrist and 5th fingers. On physical examination, taut bands were found in the muscles of the right posterior axillary fold and subscapular fossa, and the muscles were t...

13th International Society of Physical and Rehabilitation Medicine World Congress, Kobe, Japan

Resulting from accumulative microtrauma, impaired healing and oxidative stress, tendinopathy is a debilitating and relentlessly deteriorating disease that greatly affects daily function and quality of life. Current therapy usually provides symptomatic relief only. Sufferers undergo repetitive and protracted treatment courses that rarely alter the d...

Objective: To investigate the effectiveness of noninvasive neurostimulation therapies in patients with poststroke dysphagia. Data sources: Electronic databases, including Embase, PubMed, Scopus, and the Cochrane Library, were searched up to May 31, 2018. Study selection: All published randomized controlled trials (RCTs) comparing neurostimulat...

Despite extensive efforts in recent years, the blood-brain barrier (BBB) remains a significant obstacle for drug delivery. This study proposes using a clinical extracorporeal shockwave instrument to open the BBB, combined with a laser assisted bi-axial locating platform to achieve non-invasive, controllable-focus and reversible BBB opening in the b...

Thank you for the constructive comments on our article, in which we evaluated the efficacy of intra-articular steroid injection and distension in patients with frozen shoulder.1 Regarding the stages of frozen shoulder, we totally agree that there were limitationsto subgroup analysis with categorization of earlier and later stages of frozen shoulder...

Objective To investigate the reliability and correlations of Kinect-derived valuables of forward reach distance and velocity with the traditional functional reach distance, scores on posturography, and other measures of physical fitness. Design Observational study. Setting Community hospital. Subjects Individuals >65 years who attended a geriatr...

Objective: To compare the efficacy of intra-articular (IA) steroid injection and distension in patients with frozen shoulder. Data sources: Databases, including MEDLINE (via PubMed), EMBASE, Scopus and Cochrane Library, were searched for studies published up to November 2016. Study selection: We included all published randomized controlled tri...

Background/purpose: To compare shear modulus of heel pad microchamber and macrochamber layers between young and elderly people using shear wave ultrasound elastography (SWUE), with the intent to clarify age-related changes. Methods: This single-center prospective cross-sectional study was conducted between March, 2014 and March, 2016. Shear modu...

The pertinent literature lacks overt technical data for optimal lower limb muscle botulinum toxin injections using ultrasound (US) imaging. Therefore, this guide is prepared for the commonly injected muscles of the lower limb and the pelvic girdle mainly in spasticity. It includes clinical information, anatomical description and explanation regardi...

Patients with coronary heart disease or acute myocardial infarction after cardiac catheterization with stenting referred for phase II cardiac rehabilitation (CR) were grouped according to their preference. Cardio-pulmonary exercise testing (CPET) was used to determine oxygen uptake () at peak exercise and anaerobic threshold (AT). The control patie...

The pertinent literature lacks overt technical data for optimal upper limb muscle botulinum toxin injections using ultrasound (US) imaging. Therefore, this guide is prepared for the commonly injected muscles of the upper limb and the shoulder girdle mainly in spasticity. It includes clinical information, anatomical description and explanation regar...

Current clinical evaluations of post-stroke upper limb spasticity are subjective and qualitative. We proposed a quantitative measurement of post-stroke spastic muscle stiffness by using shear-wave ultrasound elastography and tested its reliability. Acoustic radiation force impulse with shear wave velocity (SWV) detection was used to evaluate stiffn...

Background: Timely and adequate laryngeal elevation along with hyoid bone movement is an essential component of the swallowing movement under normal physiological conditions. The purpose of this study was to verify the reproducibility of using ultrasonography to evaluate hyoid bone displacement during swallowing through the assessment of inter- and...

2-methacryloyloxy ethyl trimethyl ammonium chloride (TMA) is a potent polymeric plasma DNA (pDNA) carrier. The present study shows that TMA/pDNA polyplexes could be internalized into cells efficiently, but could not mediate gene transfection on its own. The transfection process of TMA/pDNA polyplexes is turned on only when ultrasound (US) was appli...

Dear Editor, A 36-year-old lady was seen for pain at the right lateral hip and thigh lasting for the last two months. She mentioned that the discomfort usually occurred after prolonged walking, and it was most painful when walking on the stairs. There was no weakness or paresthesia over her thigh or leg. She had a sedentary job and denied any ante...

Background Increasing evidence has supported the use of dextrose prolotherapy for patients with osteoarthritis. However, the real benefits may be affected by differences in injection protocols, comparative regimens, and evaluation scales. Methods PubMed and Scopus were searched from the earliest record until February 2016. One single-arm study and...

Dear Editor, A 54-year-old female presented with progressive dull pain in her left posterolateral shoulder for the last six months. There were no specific exacerbating/relieving factors regarding the pain, nor did she have any numbness or subjective weakness in the ipsilateral arm. She denied any systemic disease or related antecedent injury. Phy...