Hualian, Taiwan
Hualian, Taiwan

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Wu H.-P.,Buddhist Tzuchi General Hospital | Wu H.-P.,Tzuchi University | Chou Y.-F.,Buddhist Tzuchi General Hospital Taipei Branch | Yu S.-H.,Tainan University of Technology | And 4 more authors.
Otology and Neurotology | Year: 2011

Objective: The purpose of this study was to determine, through a randomized, double-blind, placebo-controlled trial, whether intratympanic steroid injections (ITSIs) could improve hearing recovery in patients with sudden sensorineural hearing loss (SSHL) who did not respond to initial systemic steroid therapy. Study Design: This was a prospective, randomized, double-blind, placebo-controlled study. Setting: The study was conducted in 2 tertiary referral centers. Patients: A total of 60 patients with idiopathic SSHL who did not respond to an initial round of systemic steroid therapy were included in this study. The subjects were randomized into an ITSI group and an intratympanic normal saline injection (ITNI) group, which were matched by age and sex. A total of 55 subjects completed the study. Intervention:: Participants received either ITSIs or ITNIs. Both groups received 4 injections within a 2-week period. Main Outcome Measures: Pure-tone thresholds were compared between the 2 groups 1 month after injection therapy. Results: In the ITNI group, the pure-tone threshold was 69.9 ± 18.5 dB before intratympanic injection therapy. After therapy, the hearing threshold improved by an average of 4.5 ± 6.5 dB, and 10.7% of subjects improved by 10 dB or more. In the ITSI group, the pure-tone threshold was 64.6 ± 17.7 dB before intratympanic injection therapy. After the therapy, the hearing threshold improved by an average of 9.8 ± 8.5 dB, and 44.4% of subjects improved by 10 dB or more. Both the response rate and the level of hearing improvement were significantly greater in the ITSI group than in the ITNI group. Conclusion: These results demonstrate that ITSIs are beneficial as a salvage therapy for the treatment of patients with idiopathic SSHL who fail to respond to initial systemic steroid therapy. Copyright © 2011 Otology & Neurotology, Inc.


Chen B.-Y.,National Taiwan University | Chan C.-C.,National Taiwan University | Han Y.-Y.,New York Medical College | Wu H.-P.,Buddhist Tzuchi General Hospital | And 3 more authors.
Paediatric and Perinatal Epidemiology | Year: 2012

A questionnaire survey was conducted to examine whether risk factors and allergic rhinitis (AR)-related quality of life (QOL) were different among children with different seasonal patterns of AR. Participants were students enrolled in elementary and middle schools in Taipei County, Taiwan. Using moving average and principal component analysis, children with current AR were grouped by attack seasons. The effects of personal and environmental factors on AR seasonality were assessed by logistic regression models. AR severity and AR-related QOL were compared within AR seasonal subtypes. Among 4221 children who completed the questionnaire, 1144 and 1605 children were current AR cases and healthy controls, respectively. Four AR subtypes were categorised as follows: perennial, spring, summer/fall, and winter. Age, gender, parental education, maternal passive smoking during pregnancy, breast feeding, and mouldy walls were found to contribute differentially to different AR subtypes. Children suffering from perennial and winter AR were found to have more severe symptoms and significantly lower QOL score compared with other subtypes. Specific personal and environmental risk factors could contribute to different AR seasonal subtypes. Active allergen avoidance and symptomatic treatment should be the focus of management aiming to improve the QOL among children with perennial and winter subtype. © 2011 Blackwell Publishing Ltd.


Chen B.-Y.,National Taiwan University | Chao H.J.,Taipei Medical University | Chan G.-C.,National Taiwan University | Lee C.-T.,National Central University | And 5 more authors.
Pediatrics | Year: 2011

OBJECTIVES: Studies examining the combined health effects of both have been relatively lacking. We conducted a longitudinal study to investigate whether exposure to air pollutants and fungal spores might exacerbate childhood respiratory health. METHODS: Study participants were 100 elementary and middle-school students in Taipei County, Taiwan. A structured respiratory health questionnaire was administered in September 2007, followed by monthly spirometry from October 2007 to June 2008. During the study period, complete daily monitoring data for criteria air pollutants were obtained from the Environmental Protection Administration monitoring station and Aerosol Supersite. Fungal spores were measured from Sunday to Saturday in the week when lung-function measurements were made for each study month. Lung-function measurements were compared with air pollutants and fungal spores using mixed-effects models with 1-day-lag modeling. RESULTS: The particulate matter with an aerodynamic diameter of 2.5 μm or less level 1 day before the lung function measurements was negatively associated with forced vital capacity. The fungal spore level was negatively associated with both forced expiratory vital capacity and forced expiratory volume in 1 second. O3 level was negatively associated with forced expiratory flow at 25%, 50%, and 75% of forced vital capacity, and average expiratory flow over the middle half of forced vital capacity. CONCLUSIONS: This study suggested that exposure to particulate matter with an aerodynamic diameter of 2.5 μm or less and fungal spores might cause adverse effects on the vital capacity of schoolchildren. Exposure to O3 adversely affected small airway function. Copyright © 2011 by the American Academy of Pediatrics.


Chou Y.-F.,Buddhist Tzuchi General Hospital | Chen P.-R.,Buddhist Tzuchi Medical Center | Chen P.-R.,Tzuchi University | Yu S.-H.,Tainan University of Technology | And 3 more authors.
European Archives of Oto-Rhino-Laryngology | Year: 2012

The purpose of this study was to investigate whether multi-stimulus auditory steady-state responses were capable of estimating hearing thresholds in high-risk infants. A retrospective chart review study. Three tertiary referral centers. Infants born between January 2004 and December 2006 who met the criteria for risk factors of congenital hearing loss were enrolled in the study. While under sedation, the multi-stimulus auditory steady-state response was used to determine multi-channel auditory steady-state response thresholds for high-risk infants younger than 13 months. Conditioned play audiometry was then applied to these children at 23-48 months of age to obtain pure tone audiograms. Auditory steady-state response thresholds and pure tone thresholds were then compared. A total of 249 high-risk infants were enrolled in the study. 39 infants were lost during follow-up. The remaining 216 infants completed both examinations. The Pearson correlation coefficients (r) between the ASSR levels and pure tone thresholds were 0.88, 0.94, 0.94 and 0.97 at 500, 1,000, 2,000 and 4,000 Hz, respectively. The strength of the relationship between the auditory steady-state responses and pure tone thresholds increased with more severe degrees of hearing loss and higher frequencies. We conclude that initial multichannel ASSR thresholds measured under sedation are highly correlated with pure tone thresholds obtained 2 or 3 years later. ASSR can be used to predict the frequency-specific hearing thresholds of high-risk infants and can provide information for early hearing intervention. © 2011 Springer-Verlag.


Tseng K.-C.,Buddhist Dalin Tzu Chi General Hospital | Tseng K.-C.,Tzuchi University | Chen C.-Y.,Chia Yi Christian Hospital | Tsai H.-W.,National Cheng Kung University | And 6 more authors.
Antiviral Therapy | Year: 2014

Background: It is still inconclusive whether chronic hepatitis B (CHB) patients with persistently normal alanine aminotransferase (PNALT) should receive nucleoside/nucleotide analogues. This study is to evaluate the efficacy of entecavir in improving liver histology in CHB patients with PNALT. Methods: In this prospective randomized, double-blind, placebo-controlled study, 380 CHB patients with PNALT were screened, 82 patients received biopsy and 43 patients met the HBV DNA and histology criteria and were randomly assigned to either an entecavir or placebo group for 52 weeks, with 22 and 21 in each group, respectively. The primary objective was to evaluate histological improvement. The secondary objective is to evaluate virological efficacy. Results: A total of eight (38.1%) patients in the entecavir group and eight (44.4%) in the placebo group (P=0.752) showed histological improvement. The decrease in total Knodell scores (±SD) was 1.3 ±1.9 in the entecavir group and 1.5 ±2.2 in the placebo group (P=0.803). The subjects with undetectable HBV DNA at week 52 were 16/21 (76.2%) in the entecavir group and 0/18 (0%) in the placebo group (P<0.001). The mean HBV DNA reduction from baseline to week 52 was 4.73 ±0.83 in the entecavir and 0.25 ±0.81 in the placebo group (P<0.001). Conclusions: CHB patients with PNALT receiving entecavir therapy for one year achieved virological efficacy, but not histological benefit. ©2014 International Medical Press


Osborne P.G.,Baongong Agri Science Center | Chou T.-S.,National Taiwan University | Shen T.-W.,TzuChi University
PLoS ONE | Year: 2011

Betel quid use and abuse is wide spread in Asia but the physiological basis of intoxication and addiction are unknown. In subjects naïve to the habit of betel quid intoxication, the psychological and physiological profile of intoxication has never been reported. We compared the effect of chewing gum or chewing betel quid, and subsequent betel quid intoxication, on psychological assessment, prospective time interval estimation, numerical and character digit span, computerized 2 choice tests and mental tasks such as reading and mathematics with concurrent monitoring of ECG, EEG and face temperature in healthy, non-sleep deprived, male subjects naïve to the habit of chewing betel quid. Betel quid intoxication, dose dependently induced tachycardia (max 30 bpm) and elevated face temperature (0.7°C) (P<0.001) above the effects observed in response to chewing gum (max 12 bpm and 0.3°C) in 12 subjects. Gross behavioral indices of working memory such as numerical or character digit span in 8 subjects, or simple visual-motor performance such as reaction speed or accuracy in a two choice scenario in 8 subjects were not affected by betel quid intoxication. Betel quid intoxication strongly influenced the psychological aspects of perception such as slowing of the prospective perception of passage of a 1 minute time interval in 8 subjects (P<0.05) and perceived increased arousal (P<0.01) and perceived decreased ability to think (P<0.05) in 31 subjects. The EEG spectral profile recorded from mental states associated with open and closed eyes, and mental tasks such as reading and eyes closed mental arithmetic were significantly modified (P<0.05) relative to chewing gum by betel quid intoxication in 10 subjects. The prevalence of betel quid consumption across a range of social and work settings warrants greater investigation of this widespread but largely under researched drug. © 2011 Osborne et al.


Tseng K.-C.,Buddhist Dalin Tzu Chi General Hospital | Tseng K.-C.,Tzuchi University | Ho Y.-C.,National Chung Cheng University | Hsieh Y.-H.,Buddhist Dalin Tzu Chi General Hospital | And 6 more authors.
Journal of Gastroenterology | Year: 2012

Background: Regulatory T cells (Tregs) play a pivotal role in the persistence of hepatitis C virus infection. The aim of this study was to evaluate the frequency and function of Tregs in patients with chronic hepatitis C (CHC). Methods: We enrolled 44 CHC patients with elevated alanine aminotransferase (ALT) levels (CH group), 13 CHC patients with persistent normal ALT levels (PNALT group), and 14 age-matched healthy subjects (HS group; controls). Tregs were identified as CD4+, CD25+, and forkhead box P3 (Foxp3)+ T lymphocytes, using threecolor fluorescence-activated cell sorting (FACS). The frequency of Tregs was determined by calculating the percentage of CD4+CD25 high T cells among CD4 T cells. CD127 and CD45RA were also analyzed for subsets of Tregs. The levels of serum transforming growth factor (TGF)-β and interleukin (IL)-10 in immunosuppressive assays were detected by enzyme-linked immunosorbent assay (ELISA). The immunosuppressive abilities of Tregs were evaluated by measuring their ability to inhibit the proliferation of effector cells. Results: Higher proportions of Tregs were found in the CH and PNALT groups compared with the HS group. The populations of CD127 low/negative and CD45RA negative cells were higher in the CH group than in the PNALT group. The expressions of IL-10 and TGF-β in the CH and PNALT groups were significantly higher than those in the HS group. In addition, the immunosuppressive ability of Tregs from the CH group was increased relative to that in the PNALT and the HS group. Conclusions: CHC patients, irrespective of liver function, had higher frequencies of Tregs than healthy subjects; however, only CHC patients with inflammation showed enhanced immunosuppressive function of Tregs. © Springer 2012.


Chen Y.-L.,National Yang Ming University | Wang C.-Y.,Cheng Hsin General Hospital | Yang F.-Y.,National Yang Ming University | Wang B.-S.,National Yang Ming University | And 8 more authors.
Cell Death and Disease | Year: 2014

Stimulation of the host immune system is crucial in cancer treatment. In particular, nonspecific immunotherapies, when combined with other traditional therapies such as radiation and chemotherapy, may induce immunity against primary and metastatic tumors. In this study, we demonstrate that a novel, non-toxic immunoadjuvant, glycated chitosan (GC), decreases the motility and invasion of mammalian breast cancer cells in vitro and in vivo. Lung metastatic ratios were reduced in 4T1 tumor-bearing mice when intratumoral GC injection was combined with local high-intensity focused ultrasound (HIFU) treatment. We postulate that this treatment modality stimulates the host immune system to combat cancer cells, as macrophage accumulation in tumor lesions was detected after GC-HIFU treatment. In addition, plasma collected from GC-HIFU-treated tumor-bearing mice exhibited tumor-specific cytotoxicity. We also investigated the effect of GC on epithelial-mesenchymal transition-related markers. Our results showed that GC decreased the expression of Twist-1 and Slug, proto-oncogenes commonly implicated in metastasis. Epithelial-cadherin, which is regulated by these genes, was also upregulated. Taken together, our current data suggest that GC alone can reduce cancer cell motility and invasion, whereas GC-HIFU treatment can induce immune responses to suppress tumor metastasis in vivo. © 2014 Macmillan Publishers Limited All rights reserved.


Wang Y.-C.,Chung Shan Medical University | Sung W.-W.,Chung Shan Medical University | Wu T.-C.,Chung Shan Medical University | Wang L.,Chung Shan Medical University | And 6 more authors.
PLoS ONE | Year: 2012

IL-10 is associated with tumor malignancy via immune escape. We hypothesized that IL-10 haplotypes categorized by IL-10 promoter polymorphisms at -1082A>G, -819C>T, and -592C>A might influence IL-10 expression and give rise to non-small cell lung cancer (NSCLC) patients with poor outcomes and relapse. We collected adjacent normal tissues from 385 NSCLC patients to determine IL-10 haplotypes by direct sequencing and polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Of the 385 tumors, 241 were available to evaluate IL-10 mRNA expression levels by real-time RT-PCR. The influence of IL-10 haplotypes on overall survival (OS) and relapse free survival (RFS) were determined by Kaplan-Meier and multivariate Cox regression analysis. The results showed that IL-10 mRNA levels were significantly higher in tumors with the non-ATA haplotype than with the ATA haplotype (P = 0.004). Patients with the non-ATA haplotype had shorter OS and RFS periods than did patients with the ATA haplotype. This may be associated with the observation that the number of tumor-infiltrating lymphocytes was decreased in the tumors with higher levels of IL-10. Consistently, T cells from the peripheral blood of the patients with non-ATA haplotype were more susceptible to apoptosis and less cytotoxic to tumor cells, compared to those from the patients with ATA haplotype. The results suggest that IL-10 can promote tumor malignancy via promoting T cell apoptosis and tumor cell survival, and IL-10 haplotype evaluated by PCR-RFLP or direct sequencing may be used to predict survival and relapse in resected NSCLC, helping clinicians to make appropriate decisions on treatment of the patients. © 2012 Wang et al.


Coxiella burnetii is an obligate bacterial pathogen that causes Q fever. Cytomegalovirus (CMV) commonly exists as a latent infection in healthy people. Co-infection with both pathogens is rare.We report an immunocompetent 53-year-old male farmer who presented with fulminant hepatic failure and acute renal failure. Empiric antibiotic treatment with intravenous penicillin G and levofloxacin were given, but hepatic and renal functions continued to deteriorate. A subsequent test of serum immunoglobulin M was positive for CMV, and administration of gancyclovir led to gradual recovery. A diagnosis of acute Q fever was confirmed by indirect immunofluorescence assay (IFA) on paired serum samples to demonstrate a significant rise in antibody titers. Antibiotic treatment was adjusted accordingly.CMV co-infection should be considered in patients with acute Q fever when they do not respond to standard antimicrobial agents.

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