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Taipei, Taiwan

Tseng C.-L.,Taipei Hospital | Chou C.-H.,National Taiwan University Hospital | Young Y.-H.,National Taiwan University Hospital
Otology and Neurotology | Year: 2010

Objective: This study applied ocular vestibular-evoked myogenic potential (oVEMP) tests in healthy subjects of various ages to measure the effect of aging on oVEMPs quantitatively. Study Design: Prospective study. Setting: University hospital. Subjects: Seventy healthy subjects with the ages ranging from 24 to 76 years were divided into 6 groups by decade. Each group consisted of 10 subjects in 1 decade except 20 subjects in the group of 60 to 69 years. Main Outcome Measures: All subjects underwent oVEMP tests using bone-conducted vibration stimuli. Results: All subjects in groups of 20-59 years showed 100% response rates of clear oVEMPs, while 22 (55%) of 40 eyes in group of 60-69 years and 8 (40%) of 20 eyes in group of ≥ 70 years had clear oVEMPs, exhibiting significant differences between those below and over 60 years of age. The mean nI and pI latencies also showed significantly prolonged in those over 60 years, whereas the mean nI-pI amplitude reduced significantly in subjects over 40 years. However, the asymmetry ratios of oVEMPs did not differ significantly among the age groups. Analyses between the age factor and characteristic parameters revealed that significant correlations existed between the age factor and the nI latency, pI latency and nI-pI amplitude, but not the nI-pI interval. Conclusion: Aging effect (> 60 years old) on the oVEMPs includes reduced response rate, prolonged nI and pI latencies, and decreased nI-pI amplitude. Thus, age factor should be taken into consideration when interpreting the oVEMP results. © 2010, Otology & Neurotology, Inc.

Wang C.-H.,National Taiwan University Hospital | Wang C.-H.,National Taiwan University | Chang W.-T.,National Taiwan University Hospital | Huang C.-H.,National Taiwan University Hospital | And 5 more authors.
Resuscitation | Year: 2014

Objective: Studies have shown the detrimental effect of hyperoxia in animals with return of spontaneous circulation (ROSC) after cardiac arrest. To maximize the value of existing clinical studies, we performed the systemic review and meta-analysis of human observational studies to examine the effect of hyperoxia on outcomes of post-ROSC patients. Methods: We searched PubMed and Embase from the inception to October 2013. We selected adult observational studies that compared different levels of partial pressure of arterial oxygen (PaO2) in post-ROSC patients with mortality or neurological status at hospital discharge as outcome. Studies comparing hypoxia with normoxia only were excluded. Results: Fourteen studies were identified from 2982 references. Odds ratio (OR) was used as effect estimate. OR was reconstructed if not provided in original articles. Hyperoxia was defined as a PaO2 >300mmHg. Meta-analysis indicated that hyperoxia appeared to be correlated with increased in-hospital mortality (OR, 1.40; 95% CI, 1.02-1.93; I2, 69.27%; 8 studies) but not worsened neurological outcome (OR, 1.62; 95% CI, 0.87-3.02; I2, 55.61%; 2 studies). However, the results were inconsistent in subgroup and sensitivity analyses. Conclusions: Hyperoxia appears to be correlated with increased in-hospital mortality of post-ROSC patients. This result should be interpreted cautiously because of the significant heterogeneity and limited number of studies analyzed. However, because exposure to hyperoxia had no obvious benefits, clinicians should monitor PaO2 closely and titrate oxygen administration cautiously. © 2014 Elsevier Ireland Ltd.

Liao W.-W.,National Taiwan University | Wu C.-Y.,Chang Gung University | Hsieh Y.-W.,National Taiwan University | Lin K.-C.,National Taiwan University | And 2 more authors.
Clinical Rehabilitation | Year: 2012

Objective: To compare the outcome of robot-assisted therapy with dose-matched active control therapy by using accelerometers to study functional recovery in chronic stroke patients.Design: Prospective, randomized, controlled trial.Setting: Stroke units in three medical centres.Subjects: Twenty patients post stroke for a mean of 22 months.Intervention: Robot-assisted therapy (n = 10) or dose-matched active control therapy (n = 10). All patients received either of these two therapies for 90-105 minutes each day, 5 days per week, for four weeks.Main measures: Outcome measures included arm activity ratio (the ratio of mean activity between the impaired and unimpaired arm) and scores on the Fugl-Meyer Assessment Scale, Functional Independence Measure, Motor Activity Log and ABILHAND questionnaire.Results: The robot-assisted therapy group significantly increased motor function, hemiplegic arm activity and bilateral arm coordination (Fugl-Meyer Assessment Scale: 51.20 ± 8.82, P = 0.002; mean arm activity ratio: 0.76 ± 0.10, P = 0.026; ABILHAND questionnaire: 1.24 ± 0.28, P = 0.043) compared with the dose-matched active control group (Fugl-Meyer Assessment Scale: 40.90 ± 13.14; mean arm movement ratio: 0.69 ± 0.11; ABILHAND questionnaire: 0.95 ± 0.43).Conclusions: Symmetrical and bilateral robotic practice, combined with functional task training, can significantly improve motor function, arm activity, and self-perceived bilateral arm ability in patients late after stroke. © SAGE Publications 2011.

Liau J.-Y.,National Taiwan University Hospital | Liau J.-Y.,National Taiwan University | Liao S.-L.,National Taiwan University Hospital | Hsiao C.-H.,Cheng Hsin General Hospital | And 3 more authors.
Human Pathology | Year: 2014

Periocular sebaceous carcinoma is an aggressive neoplasm with significant morbidity and mortality. Its pathogenesis is poorly understood. It is only rarely associated with Muir-Torre syndrome. Previous studies from Asian countries, have suggested that human papillomavirus (HPV) infection plays a role in the pathogenesis and overexpression of p16INK4a, a surrogate marker of HPV infection, have also been reported. However, data from western countries seem contradictory. In order to clarify and explore the molecular and epigenetic basis of HPV, CDKN2A status and role of microsatellite instability in the development of periocular sebaceous carcinoma, 24 cases of periocular sebaceous carcinoma were analyzed for the expression of p16INK4a and mismatch repair proteins (MLH1, MSH2, MSH6 and PMS2) via immunohistochemistry. Nested polymerase chain reaction (PCR) and genechip HPV typing were used to detect HPV infection and decide its genotype when present. PCR amplification using a consensus primer pair was also performed to detect β-HPV. The methylation status of CDKN2A promoter region was studied by methylation-specific polymerase chain reaction. HPV-positivity was demonstrated in only one of our cases (HPV 16), while another case showed p16INK4a overexpression. All cases showed preserved expression of mismatch repair proteins. CDKN2A promoter hypermethylation was noted in nearly half of our cases (11/24) and was associated with younger patient age (P =.013). Our results showed that periocular sebaceous carcinoma is rarely associated with HPV and microsatellite instability. Higher frequency of CDKN2A promoter hypermethylation in younger patients implies a significant epigenetic role in tumor development in this age group. © 2014 Elsevier Inc. All rights reserved.

Background: Olfactory dysfunction is a non-motor feature of Parkinson's disease (PD) that appears at an early stage. The University of Pennsylvania Smell Identification Test (UPSIT) is the most widely used test for olfactory dysfunction, with multiple language versions available, including one in Traditional Chinese (UPSIT-TC). However, the UPSIT-TC has rarely been applied to the elderly population or patients with PD in Taiwan. Objective: The present study aimed to establish normative data in a Taiwanese cohort and evaluate the efficacy of the UPSIT-TC for detecting olfactory deficits in early PD. Methods: The UPSIT-TC was administered to 161 healthy Taiwanese subjects divided into four age groups: 40-49, 50-59, 60-69, and 70-79 years. Furthermore, 30 patients with PD with less than 2 years disease duration were examined with the UPSIT-TC. Results: The normative data from this cohort were lower than expected, deviating from North American norms by 2.5 to 5 points. The deviation was more prominent with advanced age. The PD group had a significantly lower mean UPSIT-TC score than the age-and gender-matched control group (p < 0.0001). With a cutoff score of 29.5, the sensitivity and specificity of the UPSIT-TC for the diagnosis of olfactory dysfunction in early PD was 86% and 70%, respectively. The subjects with PD, advanced age, and shorter education had significantly lower UPSIT-TC scores (p < 0.0001). Conclusions: The UPSIT-TC effectively detected hyposmia in early PD in the Taiwanese cohort. Despite the modification of UPSIT-TC items, a discrepancy was found between the Taiwanese and North American norms. © 2014-IOS Press.

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