Increased risk of psychiatric disorder in patients with hearing loss: a nationwide population-based cohort study.

BACKGROUND: Hearing loss has been shown to be a risk factor for psychiatric disorders. In addition, long-term hearing loss is associated with increased hospitalization and mortality rates; however, the increased risk and duration of effect of hearing loss in combination with other chronic diseases on each psychiatric disorder are still not clearly defined. The purpose of this article is to clarify the risk of hearing loss for each disorder over time. METHODS: This was a retrospective cohort study, and a national health insurance research database in Taiwan was utilized. All (n = 1,949,101) Taiwanese residents who had a medical visit between 2000 and 2015 were included. Patients with hearing loss and a comparative retrospective cohort were analyzed. Every subject was tracked individually from their index date to identify the subjects who later received a diagnosis of a psychiatric disorder. The Kaplan‒Meier method was used to analyze the cumulative incidence of psychiatric disorders. Cox regression analysis was performed to identify the risk of psychiatric disorders. RESULTS: A total of 13,341 (15.42%) and 31,250 (9.03%) patients with and without hearing loss, respectively, were diagnosed with psychiatric disorders (P < 0.001). Multivariate analysis indicated that hearing loss significantly elevated the risk of psychiatric disorders (adjusted HR = 2.587, 95% CI 1.723-3.346, p < 0.001). CONCLUSION: Our findings indicate that patients with hearing loss are more likely to develop psychiatric disorders. Furthermore, the various psychiatric disorders are more likely to occur at different times. Our findings have important clinical implications, including a need for clinicians to implement early intervention for hearing loss and to pay close attention to patients' psychological status. Trial registration TSGHIRB No. E202216036.

Impact of Foodborne Disease in Taiwan during the COVID-19 Pandemic.

Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic originated in Wuhan, China, in December 2019, the first case diagnosed since January 2020 in Taiwan. The study about the potential impact of the COVID-19 pandemic on event, location, food source, and pathogens of foodborne disease (FBD) is limited in Taiwan. Our aim in this study is to investigate FBD in the context of the COVID-19 pandemic. Materials and Methods: We collected publicly available annual summary data from the FBD dataset in the Taiwan Food and Drug Administration and Certifiable Disease on reported FBD in Taiwan from 2019 to 2020. We used logistic regression to evaluate changes in the occurrence or likelihood of FBD cases and Poisson regression to examine the relative risk (RR) between FBD and climate factors. Results: Similar events occurred in 2019 and 2020, but the total number of FBD cases decreased from 6935 in 2019 to 4920 in 2020. The places where FBD decreased were in schools, hospitals, outdoors, vendors, and exteriors. The top place in FBD shifted from schools to restaurants. The top food source for FBD has changed from boxed food to compound food. Bacillus cereus and Salmonella emerged as the top two observed bacterial pathogens causing FBD. The risk of FBD cases increased with a higher air temperature, with an RR of 1.055 (1.05-1.061, p < 0.001) every 1 °C. Conclusion: The incidence of FBD decreased significantly during the COVID-19 pandemic in Taiwan. This decline may be attributed to protective measures implemented to control the spread of the virus. This shift in locations could be influenced by changes in public behavior, regulations, or other external factors. The study emphasizes the importance of understanding the sources and effectiveness of severe infection prevention policies. The government can use these findings to formulate evidence-based policies aimed at reducing FBD cases and promoting public health. Consumers can reduce the risk of FBD by following safe food handling and preparation recommendations.

Underestimated Subsequent Sensorineural Hearing Loss after Septicemia.

Background and Objectives: Hearing loss after septicemia has been found in mice; the long-term risk increased 50-fold in young adults in a previous study. Hearing loss after septicemia has not received much attention. The aim of this study was to assess the relationship between septicemia and subsequent hearing loss. Materials and Methods: Inpatient data were obtained from the Taiwan Insurance Database. We defined patients with sensorineural hearing loss and excluded patients under 18 years of age. Patients without hearing loss were selected as controls at a frequency of 1:5. The date of admission was defined as the date of diagnosis. Comorbidities in the 3 years preceding the date of diagnosis were retrieved retrospectively. Associations with hearing loss were established by multiple logistic regression and forward stepwise selection. Results: The odds ratio (OR) for the association between sepsis and hearing loss was 3.052 (95% CI: 1.583-5.884). Autoimmune disease (OR: 5.828 (95% CI: 1.906-17.816)), brain injury (OR: 2.264 (95% CI: 1.212-4.229)) and ischemic stroke (OR: 1.47 (95% CI: 1.087-1.988)) were associated with hearing loss. Conclusions: Our study shows that hearing loss occurred after septicemia. Apoptosis caused by sepsis and ischemia can lead to hair cell damage, leading to hearing loss. Clinicians should be aware of possible subsequent complications of septicemia and provide appropriate treatment and prevention strategies for complications.

Underestimated Ischemic Heart Disease in Major Adverse Cardiovascular Events after Septicemia Discharge.

Background and Objectives: Sepsis increases cardiovascular disease and causes death. Ischemic heart disease (IHD) without acute myocardial infarction has been discussed less, and the relationship between risk factors and IHD in septicemia survivors within six months is worthy of in-depth study. Our study demonstrated the incidence of IHD and the possible risk factors for IHD in septicemia patients within six months. Materials and Methods: An inpatient dataset of the Taiwanese Longitudinal Health Insurance Database between 2001 and 2003 was used. The events were defined as rehospitalization of stroke and IHD after discharge or death within six months after the first septicemia hospitalization. The relative factors of major adverse cardiovascular events (MACEs) and IHD were identified by multivariate Cox proportional regression. Results: There were 4323 septicemia survivors and 404 (9.3%) IHD. New-onset atrial fibrillation had a hazard ratio (HR) of 1.705 (95% confidence interval (C.I.): 1.156-2.516) for MACEs and carried a 184% risk with HR 2.836 (95% C.I.: 1.725-4.665) for IHD by adjusted area and other risk factors. Conclusions: This study explored advanced-aged patients who experienced more severe septicemia with new-onset atrial fibrillation, which increases the incidence of IHD in MACEs within six months of septicemia. Therefore, healthcare providers must identify patients with a higher IHD risk and modify risk factors beforehand.

Correction to: Risk reduction of long-term major adverse cardiovascular events after endoscopic thoracic sympathectomy in palmar hyperhidrosis.

There is a typographical error in the International Classification of Disease Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code used for palmar hyperhidrosis. The published manuscript wrongly reports that the ICD-9-CM code used for palmar hyperhidrosis was 708.8 (which indicates a diagnosis of "Other specified urticaria"), when, in actuality, the correct code 780.8 ("Hyperhidrosis") was applied. The authors regret this typographical error.

Associated with Ischemic Stroke Risk Reduction after Endoscopic Thoracic Sympathectomy for Palmar Sweating.

BACKGROUND: Endoscopic thoracic sympathectomy (ETS) was performed to cure palmar hyperhidrosis (PH). After ETS, blood pressure decreased, and cerebral flow velocity increased within 1 month. However, no studies distinguish between subsequent ischemic and hemorrhagic stroke following ETS for PH. The association between stroke type and PH after ETS must be evaluated. METHODS: We surveyed newly diagnosed patients with PH using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code 780.8 from the Taiwan Longitudinal National Health Insurance Database. We matched patients with PH who underwent ETS (procedure code 05.29) and without surgery in the database between 2000 and 2010. We defined events as ischemic stroke (ICD-9-CM codes from 433 to 437) or hemorrhagic stroke (ICD-9-CM codes from 430 to 432). Patients were followed up until the first event or December 31, 2010. Risk factors for ischemic stroke and hemorrhagic stroke were analyzed using multivariable Cox proportional hazard regression. RESULTS: The incidence of ischemic stroke was significantly lower in patients who underwent ETS (.22%) than in patients without surgery (.65%). The patients with PH who received ETS exhibited a reduced risk of ischemic stroke (adjusted hazard ratio [HR] .3; 95% confidence interval [CI] .12-.77). ETS treatment was not associated with a reduction in hemorrhagic stroke (adjusted HR .81; 95% CI .22-3; P = .755). CONCLUSIONS: ETS in patients with PH was associated with reduced subsequent ischemic stroke risk. This additional ischemic stroke preventive effect should encourage health-care supporters to perform ETS in patients with severe PH.

Risk reduction of long-term major adverse cardiovascular events after endoscopic thoracic sympathectomy in palmar hyperhidrosis.

PURPOSE: Palmar hyperhidrosis (PH) is excessive sweating of the palms resulting from sympathetic overactivity, and patients who undergo endoscopic thoracic sympathectomy (ETS) show reduced cardiac demand after 1 year and improved cerebral perfusion within 2-4 weeks. However, the long-term risks of major adverse cardiovascular events (MACE) following ETS remain unclear. METHODS: We searched the Longitudinal National Health Insurance Database in Taiwan and identified PH patients (International Classification of Disease, Ninth Revision, Clinical Modification diagnostic code 708.8) from the outpatient database and patients who underwent ETS (procedure code 05.29) from the inpatient database between 2000 and 2010; furthermore, we excluded patients younger than 18 years of age or older than 65 years of age. We defined MACE as stroke (diagnostic codes 430-437), myocardial infarction (diagnostic code 410), or death. Patients followed until the first cardiac event or December 31, 2010. Risk factors were identified using a multivariable Cox proportional hazards regression. RESULTS: The incidence of MACE was significantly lower in patients with ETS (0.76%) than without (1.67%). In PH patients, ETS significantly reduced the risk of MACE (adjusted hazard ratio 0.473; 95% confidence interval 0.277-0.808). CONCLUSION: PH patients who underwent ETS showed a reduced risk of MACE over a long-term follow-up period. This result could provide support for patients with PH who are considering undergoing ETS because of its additional cardiovascular benefits.

An Analysis of Long-Term Ischemic Stroke Risk in Survivors of Septicemia.

INTRODUCTION: Sepsis increases the long-term incidence of ischemic stroke (IS). The chances for long-term IS in patients who are discharged after sepsis are unclear. Our aim was to demonstrate long-term risk chances of IS after septicemia discharge. We used a nomogram to identify those septicemia survivors with the higher risk of developing IS. METHODS: Inpatient data were used from the Taiwan Longitudinal Health Insurance Database, from 2001 to 2003. The event was IS rehospitalization after discharge of septicemia. We used multivariate Cox proportional regression of the risk factors for IS in septicemia survivors to create a nomogram. RESULTS: There were 642 IS incidents in this study. The risk factors for IS in survivors of septicemia were advanced age (hazard ratio [HR] 1.035 [95% confidence interval (CI) 1.029-1.042]), new-onset atrial fibrillation (HR 1.875 [95% CI 1.327-2.651]), hypertension (HR 2.042 [95% CI 1.687-2.471]), diabetes mellitus (HR 1.735 [95% CI 1.469-2.05]), coronary artery disease (HR 1.661 [95% CI 1.408-1.96]), chronic kidney disease (HR 1.264 [95% CI 1.071-1.49]), chronic obstructive pulmonary disease (HR 1.201 [95% CI 1.016-1.421]), and local hospital admission (HR 1.414 [95% CI 1.155-1.731]). The model showed good calibration and discrimination, with a bootstrap-corrected concordance index of .785. CONCLUSION: With this prognostic nomogram, we found age with the strongest factor for IS. There was increased IS incidence with more comorbid conditions in advance-aged septicemia survivors. Physicians must identify high IS-risk patients and control risk factors to prevent adverse events in the clinical setting.

Acute Onset of Parkinsonism an End-Stage Renal Disease Patient.

PURPOSE: The osmotic demyelination syndrome (ODS) has been identified as a neurological complication of the rapid correction of hyponatremia. In recent years, however, various medical conditions have been associated with the development of ODS, irrelevant to changes in serum sodium. We present a rare case of a eunatremic patient who developed ODS with manifestation of parkinsonism. CASE: A 55 years old woman who has hypertension, type 2 diabetes nephropathy in end-stage renal disease under maintenance hemodialysis came to us with complaint about newly developed resting tremor of bilateral upper limbs, slowness of movements and small shuffling steps. Brain magnetic resonance imaging (MRI) showed bilateral lentiform nuclei demyelination. ODS was diagnosed concerning the comorbidities and her medical history. Her neurological deficits improved dramatically after treatment of Ropinirole. CONCLUSION: ODS may develop in patient with risk factors regardless of change in serum sodium concentration. Brain MRI could help in early detection of the demyelination. Secondary parkinsonism may occur as a rare manifestation of ODS. Supportive treatment, monitoring of vital signs and neurological deficits are warranted. Dopaminergic agent may be beneficial in symptomatic control.

Refractory Facial Paralysis: A Case Report.

PURPOSE: To present a case of salivary gland malignancy initially mimicking Bell's palsy. CASE REPORT: A 75-year-old woman with hypertension visited our neurological outpatient department,complaining of persistent right facial paralysis for more than a year after oral glucocorticoid therapy with recent development of vertigo and unsteady gait. She was previously diagnosed as having Bell's palsy and was prescribed oral glucocorticoid. However, her right facial muscles were still completely paralyzed, with no signs of improvement. The patient visited the outpatient department of neurology for 3 weeks, seeking treatment for the recent onset of vertigo and ataxia. Brain contrast magnetic resonance imaging (MRI) revealed the right mastoid air cells to be filled with high T2 signal intensity and low T1 signal, with destruction of the bony structure of mastoid, extending to the right jugular bulb. Results obtained from excisional biopsy and pathological analyses were used to diagnose the patient with adenoid cystic carcinoma of the salivary gland. The patient then received a thorough cancer workup and chemoradiotherapy, with the malignancy being under control. However, after a 1-year follow-up, the patient still had permanent right facial palsy. CONCLUSION: Salivary gland malignancy should be considered in patients with acute and subacute facial nerve paralysis, in addition to Bell's palsy. Brain imaging with contrast agents should be performed for differential diagnosis.

Occipital Condyle Syndrome as an Initial Presentation of Lung Cancer: A Case Report.

PURPOSE: Occipital condyle syndrome (OCS) is a rare cause of headache. This study herein reports a case in which a unique headache and tongue deviation appear as symptoms of the first presentation of a malignant tumor. CASE REPORT: A healthy 67-year-old male presented with a unilateral shooting pain in the occipital region, accompanied by slurred speech and difficulty swallowing. Neurological examinations later revealed atrophy and mild fasciculation of the tongue. The clinical symptoms and MRI results suggested OCS. Screening for tumor markers showed an elevated CEA. The chest CT revealed a lobulated soft-tissue mass in the lower left lobe, and a CTguided biopsy confirmed the diagnosis of adenocarcinoma. A whole body bone scan found multiple foci. The adenocarcinoma was graded pT2bN3M1b, stage IV. The headache improved with a prescription of prednisone, 60 mg to be taken daily. With three months of treatment, clinical examinations showed that the patient was free of pain and that there had been no progression of the atrophy or deviation of the tongue. CONCLUSION: The possible etiology of OCS includes a primary tumor or metastatic lesion that directly invades the base of the skull. Determining the underlying causes of OCS can be challenging, but MR imaging is currently the diagnostic tool of choice. An awareness of the features of OCS in healthy adults may be able to lead to earlier diagnosis of the underlying etiology and efficient relief of the symptoms.

The Influence of Fine Particulate Matter and Cold Weather on Emergency Room Interventions for Childhood Asthma.

(1) Background: Children are the most vulnerable to pollution due to their decreased stature, heightened respiratory rate, and frequent outdoor engagement. PM2.5, nitrogen dioxide (NO2), ozone, and cold weather are associated with pediatric asthma. In this study, we investigated the nexus between air pollution, climate factors, and pediatric asthma emergency room visits (ERVs). (2) Method: Pediatric asthma ERV data for healthcare quality from the Taiwanese National Insurance in the Taipei area were obtained from 2015 to 2019. Air pollution and climate factor data were also collected. Poisson regression was employed to determine the relationships with relative risks (RRs). (3) Results: The incidence of pediatric asthma ERVs decreased, with a crude RR of 0.983 (95% CI: 0.98-0.986, p < 0.001). Fine particulate matter (PM2.5) had an adjusted RR of 1.102 (95% CI: 1.037-1.172, p = 0.002) and a 7.7 µg/m3 increase, and air temperature had an adjusted RR of 0.813 (95% CI: 0.745-0.887, p < 0.001) comparing between the highest and lowest quarter air temperature associated with pediatric asthma ERVs. (4) Conclusions: This inquiry underscores the positive associations of PM2.5 and cold weather with pediatric asthma ERVs. The findings could guide the government to establish policies to reduce air pollution and promote children's health.

Analyzing COVID-19 and Air Pollution Effects on Pediatric Asthma Emergency Room Visits in Taiwan.

(1) Background: An asthma exacerbation that is not relieved with medication typically requires an emergency room visit (ERV). The coronavirus disease 2019 (COVID-19) pandemic began in Taiwan in January of 2020. The influence of the COVID-19 pandemic on pediatric ERVs in Taiwan was limited. Our aim was to survey pediatric asthma ERVs in the COVID-19 era; (2) Methods: Data were collected from the health quality database of the Taiwanese National Health Insurance Administration from 2019 to 2021. Air pollution and climatic factors in Taipei were used to evaluate these relationships. Changes in the rates of pediatric asthma ERVs were assessed using logistic regression analysis. Poisson regression was used to evaluate the impact of air pollution and climate change; (3) Results: The rate of pediatric asthma ERVs declined in different areas and at different hospital levels including medical centers, regional and local hospitals. Some air pollutants (particulate matter ≤ 2.5 µm, particulate matter ≤ 10 µm, nitrogen dioxide, and carbon monoxide) reduced during the COVID-19 lockdown. Ozone increased the relative risk (RR) of pediatric asthma ERVs during the COVID-19 period by 1.094 (95% CI: 1.095-1.12) per 1 ppb increase; (4) Conclusions: The rate of pediatric asthma ERVs declined during the COVID-19 pandemic and ozone has harmful effects. Based on these results, the government could reduce the number of pediatric asthma ERVs through healthcare programs, thereby promoting children's health.

Complete resolution of a solitary pontine abscess in a patient with dental caries.

A solitary brainstem abscess is a rare fatal intracranial infection, which can be mistaken for an acute stroke complicated with a systemic infection. Dental caries without abscess formation can be a possible source of infection. Herein, we describe the case of a 59-year-old man with dental caries who presented with a 4-day history of progressive dizziness, double vision, gait ataxia, emesis, and left facial and body numbness. Fever, suboccipital headache, and difficulties in urinating and defecating were noted on admission. Acute brainstem infarction and suspected aspiration pneumonia were then diagnosed. Magnetic resonance spectroscopy and diffusion-weighted imaging demonstrated a solitary pontine abscess. The neurologic deficits continued improvement after he completed 8 weeks of intravenous antibiotics. The successful nonsurgical treatment of the brainstem abscess in this case was based on high clinical suspicion, early diagnosis, and early combination of corticosteroids and broad spectrum antibiotics.

Panspinal epidural abscess concomitant with meningitis.

Panspinal epidural abscess is an extremely rare condition that can potentially lead to major permanent neurological deficits if treatment is delayed or suboptimal. Most patients with spinal epidural abscess have a short segment of vertebrae involved and classically present with fever, low back pain, and focal neurologic deficit. In severe cases, meningitis and septic shock may occur and lead to death. Therefore, the condition requires prompt recognition and proper intervention. Herein, we report the case of a 41-year-old diabetic man who presented at our hospital with the symptoms of headache, quadriplegia with respiratory distress and low back pain. Panspinal epidural abscess and meningitis were diagnosed by carrying out detailed neurologic examinations and neuroimaging studies, which expedited the correct diagnosis and treatment.

Intrasinus thrombolysis by mechanical and urokinase for severe cerebral venous sinus thrombosis : a case report.

PURPOSE: Cerebral venous and sinus thrombosis (CVST) is a rare stroke disorder, which requires prompt recognition and appropriate intervention to prevent a devastating outcome. Intrasinus thrombolysis is an alternative and effective method to anticoagulant therapy for the treatment of CVST, but is rarely used in Taiwan. CASE REPORT: A 46-year-old man presented with a one-week history of intractable headache and progressive weakness of his right lower limb. Magnetic resonance venography of the brain confirmed a diagnosis of extensive venous sinus thrombosis. The patient was successfully treated by direct intrasinus thrombolysis with urokinase. CONCLUSION: This case highlights the benefit of early intrasinus thrombolysis for the treatment of CVST.

Short-Term Exposure Effect of Ambient Fine Particulate Matter, Ozone and Cold Temperature on Emergency Room Visits for Asthma Patients.

(1) Background: The acute effects of ozone, cold temperature and particulate matter less than 2.5 µm (PM2.5) in size related to asthma attacks are well known worldwide. The adverse effects of ozone and cold temperature on asthma morbidity in Taiwan are still inconclusive. (2) Methods: This retrospective study included patients who had asthma emergency room visits (ERVs) from 1 January 2016 to 31 December 2019 in a regional hospital in Taiwan. The short-term negative effects were estimated using Distributed Lag Non-Linear Models (DLNMs) for the relative risks (RRs) of asthma ERVs associated with PM2.5, ozone and cold temperature exposures within 5 days. (3) Results: There was a significant association between a 10 ppm increase in PM2.5 exposure and asthma ERVs at a 2-day lag (RR 1.166, 95% confidence interval (C.I.): 1.051-1.294). There was a significant association between ozone and asthma ERVs at a 1-day lag (RR 1.179, 95% C.I.: 1.034-1.345). The ambient temperature in cold weather compared with the temperature of minimum asthma ERV showed an RR of 1.214, 95% C.I.: 1.009-1.252 at a 1-day lag. (4) Conclusions: This study provides evidence that short-term exposure to fine suspended particulates, ozone and inverse temperature is associated with asthma exacerbation.

Semantic Visualization in Functional Recovery Prediction of Intravenous Thrombolysis following Acute Ischemic Stroke in Patients by Using Biostatistics: An Exploratory Study.

(1) Background: Intravenous thrombolysis following acute ischemic stroke (AIS) can reduce disability and increase the survival rate. We designed a functional recovery analysis by using semantic visualization to predict the recovery probability in AIS patients receiving intravenous thrombolysis; (2) Methods: We enrolled 131 AIS patients undergoing intravenous thrombolysis from 2011 to 2015 at the Medical Center in northern Taiwan. An additional 54 AIS patients were enrolled from another community hospital. A modified Rankin Score ≤2 after 3 months of follow-up was defined as favorable recovery. We used multivariable logistic regression with forward selection to construct a nomogram; (3) Results: The model included age and the National Institutes of Health Stroke Scale (NIHSS) score as immediate pretreatment parameters. A 5.23% increase in the functional recovery probability occurred for every 1-year reduction in age, and a 13.57% increase in the functional recovery probability occurred for every NIHSS score reduction. The sensitivity, specificity, and accuracy of the model in the validation dataset were 71.79%, 86.67%, and 75.93%, respectively, and the area under the receiver operating characteristic curve (AUC) was 0.867; (4) Conclusions: Semantic visualization-based functional recovery prediction models may help physicians assess the recovery probability before patients undergo emergency intravenous thrombolysis.

Self-Reported Beneficial Effects of Chinese Calligraphy Handwriting Training for Individuals with Mild Cognitive Impairment: An Exploratory Study.

BACKGROUND: Dementia is a common disease in aging populations. The treatment has mainly focused on memory decline prevention and behavior control. Nonpharmacological treatments, such as cognition training, physical exercise, and music therapy have been effective in slowing memory decline. Chinese calligraphy handwriting (CCH) through breath regulation and fine hand control involves high concentration levels, emotion regulation, and self-awareness. CCH is a mind and body activity that is culturally relevant to older Chinese adults. This study evaluated the beneficial effects of CCH on mild cognitive impairment. METHODS: In 2018, we conducted 8 weeks of CCH training at the Tri-Service General Hospital. The participants were asked to copy a regular script. At the end of the course, they gave oral presentations and showed their work. Self-report questionnaires on emotion, memory, upper limb coordination, attention, and language were collected before and after training. RESULTS: The five questionnaires showed significantly positive feelings after CCH training. The conditions of emotional stability, concentration, hand movement, memory, and speech improved. CONCLUSIONS: CCH training stimulated the brain and improved cognition, psychological symptoms, and hand stability. It is inexpensive and worthwhile for elderly Chinese individuals with mild cognitive impairment to take time daily to practice calligraphy.

An Input-Current Shaping and Soft-Switching Drive Circuit Applied to a Piezoelectric Ceramic Actuator.

Piezoelectric ceramic actuators utilize an inverse piezoelectric effect to generate high-frequency vibration energy and are widely used in ultrasonic energy conversion circuits. This paper presents a novel drive circuit with input-current shaping (ICS) and soft-switching features which consists of a front AC-DC full-wave bridge rectifier and a rear DC-AC circuit combining a stacked boost converter and a half-bridge resonant inverter for driving a piezoelectric ceramic actuator. To enable ICS functionality in the proposed drive circuit, the inductor of the stacked boost converter sub-circuit is designed to operate in boundary-conduction mode (BCM). In order to allow the two power switches in the proposed drive circuit to achieve zero-voltage switching (ZVS) characteristics, the resonant circuit of the half-bridge resonant inverter sub-circuit is designed as an inductive load. In this paper, a prototype drive circuit for providing piezoelectric ceramic actuators was successfully implemented. Experimental results tested at 110 V input utility voltage show that high power factor (PF > 0.97), low input current total harmonic distortion (THD < 16%), and ZVS characteristics of the power switch were achieved in the prototype drive circuit.