Annexin A2-mediated cancer progression and therapeutic resistance in nasopharyngeal carcinoma.

Nasopharyngeal carcinoma (NPC) is a head and neck cancer with poor clinical outcomes and insufficient treatments in Southeast Asian populations. Although concurrent chemoradiotherapy has improved recovery rates of patients, poor overall survival and low efficacy are still critical problems. To improve the therapeutic efficacy, we focused on a tumor-associated protein called Annexin A2 (ANXA2). This review summarizes the mechanisms by which ANXA2 promotes cancer progression (e.g., proliferation, migration, the epithelial-mesenchymal transition, invasion, and cancer stem cell formation) and therapeutic resistance (e.g., radiotherapy, chemotherapy, and immunotherapy). These mechanisms gave us a deeper understanding of the molecular aspects of cancer progression, and further provided us with a great opportunity to overcome therapeutic resistance of NPC and other cancers with high ANXA2 expression by developing this prospective ANXA2-targeted therapy.

RISK OF RETINAL VEIN OCCLUSION IN PATIENTS WITH PSORIASIS: A Population-Based Cohort Study.

PURPOSE: To investigate the risk of developing retinal vein occlusion (RVO) in patients with psoriasis. METHODS: In this retrospective population-based cohort study, 30,198 patients with psoriasis (Psoriasis((+)) group) and 30,198 controls without psoriasis (Psoriasis((−)) group) between 2001 and 2006 from the Taiwan National Health Insurance Research Database were selected. RESULTS: The incidence of RVO was 1.46 times higher in the Psoriasis((+)) group than in the Psoriasis((−)) group (3.61 vs. 2.47/10,000 person-years) (adjusted hazard ratio = 1.50; 95% confidence interval = 1.07-2.10) calculated using Cox proportional hazard regression. Age was an independent risk factor for RVO (adjusted hazard ratio: 11.9 for patients 65 years or older vs. 1.00 for those 0-49 years old). In the 65 years or older Psoriasis((+)) group, the incidence of developing RVO was 1.97 times higher (95% confidence interval = 1.19-3.26) than in the 65 years or older Psoriasis((−)) group. In Psoriasis((+)) women, the incidence of developing RVO was 1.82 times higher (95% = 1.05-3.14) than in Psoriasis((−)) women. For the subgroup with comorbid hypertension, the incidence of developing RVO was 2.07 times higher (95% confidence interval = 1.22-3.50) in the Psoriasis((+)) group than in the Psoriasis((−)) group. CONCLUSION: Psoriasis was significantly associated with a higher risk of developing RVO.

Hypercholesterolemia is correlated with an increased risk of idiopathic sudden sensorineural hearing loss: a historical prospective cohort study.

OBJECTIVE: Despite the many studies on the associated risk of cardiovascular and cerebrovascular events in patients with hypercholesterolemia (HCh), an association between HCh and the development of idiopathic sudden sensorineural hearing loss (ISSNHL) has been examined in only a few case-control studies. We tested the hypothesis that HCh is a risk factor for developing ISSNHL. DESIGN: Using the Taiwan Longitudinal Health Insurance Database, we conducted a historical prospective cohort study to compare patients diagnosed with HCh from January 1, 2001, through to December 31, 2006 (N = 73,957) with age-matched controls (N = 73,957). We followed each patient until the end of 2009 and evaluated the incidence of ISSNHL for a minimum of 3 years after the initial HCh diagnosis. RESULTS: The incidence of ISSNHL was 1.62 times higher in the HCh cohort than in the non-HCh cohort (10.67 versus 6.61 per 10,000 person-years). Using Cox proportional hazard regressions, the adjusted hazard ratio was 1.60 (95% confidence interval [CI] = 1.39-1.85). An increased risk of developing ISSNHL, with adjusted hazard ratios of 1.48 (95% CI = 1.08-2.04) and 1.69 (95% CI = 1.18-2.43), was observed in HCh patients with newly diagnosed comorbidities of stroke or stroke combined with coronary artery diseases, which are both expected to reflect the severity of HCh. CONCLUSIONS: A diagnosis of HCh may indicate an independent risk for ISSNHL. This finding suggests that an underlying vascular mechanism contributes to the development of ISSNHL. We suggest that physicians counsel patients with HCh to seek medical attention if they have hearing impairments, because they may also have an increased risk of developing ISSNHL.

Risk factors for internal carotid artery injury in adults during simple nasopharyngeal surgeries.

The purpose of this study attempted to analyze the potential risk factors for internal carotid artery injury during simple nasopharyngeal surgeries with or without an endoscopic aid. One hundred and seventy magnetic resonance imaging scans (340 halves) of the brain were retrospectively reviewed and studied. Anatomic variations of carotid arteries were classified, and various distances from the internal carotid arteries to the nasopharyngeal subsites were directly measured on the scans. The mean distances between the internal carotid arteries and nasopharyngeal subsites were significantly shortened in patients with nasopharyngeal internal carotid artery aberrancy, female gender, and lower body weight. The distance to the posterior nasopharyngeal wall was also shortened with age. However, the severity of nasopharyngeal carotid artery variations (kinking and coiling) did not reflect the shortening of mean distances to nasopharyngeal subsites. In conclusion, from multiple linear regression analysis, we found that the risk of an internal carotid artery injury during simple nasopharyngeal surgeries with or without an endoscopic aid is greatest in adult patients with nasopharyngeal carotid artery aberrancy, followed by female gender, lower body weight, and increasing age.

Increased risk of deep neck infection among HIV-infected patients in the era of highly active antiretroviral therapy--a population-based follow-up study.

BACKGROUND: Deep neck infections (DNIs) in HIV-infected patients often produce severe complications, even death. Data on the incidence rates and risks of DNI among HIV-infected patients are scarce, particularly with the widespread use of highly active antiretroviral therapy (HAART). We evaluated the incidence rates and risks for DNI among HIV-infected patients and observed the long-term trends. METHODS: A total of 9888 new HIV-infected patients diagnosed in 2001-2007 were included and matched with 49440 randomly selected subjects. The HIV-infected subjects were offered free access to HAART. All subjects were traced until December 2009. A Kaplan-Meier analysis generated the cumulative DNI incidence rate. The adjusted hazard ratio was computed using Cox proportional hazard regressions. RESULTS: From the HIV-infected and comparison cohorts, 222 individuals (57.01 cases per 10000 person-years) and 735 individuals (35.54 cases per 10000 person-years) developed DNI, respectively. The log rank test indicated that patients with HIV had a significantly higher 8-year incidence rate of DNI than the control group (P < 0.0001). The adjusted hazard ratio for developing DNI after an HIV attack during the mean 3.94 years follow-up period was 1.59. The incidence rate and relative risk of DNI were 74.58 (per 10000 person-years) and 2.05 (P < 0.0001). Both figures were highest in the first follow-up year and decreased year-by-year thereafter. CONCLUSION: The risk of developing DNI is significantly elevated among HIV-infected patients, even with free access to HAART. Additional research is needed to examine the role of HAART in reducing the risk.

Risk of sudden sensorineural hearing loss in patients with systemic lupus erythematosus: a population-based cohort study.

Sudden sensorineural hearing loss (SSHL) may be a manifestation of systemic vascular involvement in systemic lupus erythematosus (SLE) and may have an important impact on the health of patients with SLE. To investigate the risk of developing SSHL in patients with SLE, we conducted a population-based, retrospective cohort study from the Taiwan National Health Insurance Research Database. A total of 7168 patients diagnosed with SLE and 35840 control subjects without SLE were selected from claims made from 2001 to 2006. The incidence of SSHL was assessed and determined at the end of 2010. The incidence of SSHL was 2.22-fold higher in the SLE group than in the non-SLE group (6.52 vs. 2.93 per 10000 person-years), with an adjusted hazard ratio (HR) of 2.253 (95% confidence interval, CI=1.407-3.608) calculated using a Cox proportional hazard regression model. Age was an independent risk factor for SSHL, with adjusted HRs of 2.103 for individuals aged≥35 years compared with those 0-34 years. In the 0-34 age range, the incidence of developing SSHL was 4.27-fold (95% CI=2.11-8.67) higher in the SLE group compared with the non-SLE group. In female patients, the incidence of developing SSHL was 2.19-fold (95% CI=1.73-3.50) higher in the SLE group than in the non-SLE group. Systemic lupus erythematosus was significantly associated with an increased risk of developing SSHL. Scheduled auditory examinations for patients with SLE to assess the presence of chronic hearing impairment are advised to enable the early detection of SSHL.

The effect of lexical tone experience on English intonation perception in Mandarin-speaking cochlear-implanted children.

To examine the effect of lexical tone experience on English intonation perception in Mandarin-speaking cochlear-implanted children during second language acquisition in Taiwan. A retrospective cohort study. A tertiary referred center. Fourteen children with cochlear implant (CI) in the experimental group, and 9 normal hearing children in the control group were enrolled in this study. Cochlear implantation and hearing rehabilitation. Two speech recognition accuracies were examined: (1) Lexical tone recognition (4-alternative forced choice, AFC), (2) English Sentence Intonation (2AFC). The overall accuracies for tone perception are 61.13% (standard deviation, SD = 10.84%) for CI group and 93.82% (SD = 1.80%) for normal hearing group. Tone 4 and Tone 1 were more easily to be recognized than tone 2 and tone 3 in the pediatric CI recipients (cCI) group. In English intonation perception, the overall accuracies are 61.82% (SD = 16.85%) for CI group, and 97.59% (SD = 4.73%) for normal hearing group. Significant high correlation (R = .919, P ≦ .000) between lexical tone perception and English intonation perception is noted. There is no significant difference for English intonation perception accuracies between Mandarin-speaking cCI (61.82%) and English-speaking cCI (70.13%, P = .11). Mandarin-speaking cochlear-implanted children showed significant deficits in perception of lexical tone and English intonation relative to normal hearing children. There was no tonal language benefit in Mandarin-speaking cochlear-implanted children's English intonation perception, compared to the English-speaking cochlear-implanted peers. For cochlear-implanted children, better lexical tone perception comes with better English intonation perception. Enhancing Mandarin prosodic perception for cochlear-implanted children may benefit their command of intonation in English.

Voice emotion recognition by Mandarin-speaking pediatric cochlear implant users in Taiwan.

OBJECTIVES: To explore the effects of obligatory lexical tone learning on speech emotion recognition and the cross-culture differences between United States and Taiwan for speech emotion understanding in children with cochlear implant. METHODS: This cohort study enrolled 60 cochlear-implanted (cCI) Mandarin-speaking, school-aged children who underwent cochlear implantation before 5 years of age and 53 normal-hearing children (cNH) in Taiwan. The emotion recognition and the sensitivity of fundamental frequency (F0) changes for those school-aged cNH and cCI (6-17 years old) were examined in a tertiary referred center. RESULTS: The mean emotion recognition score of the cNH group was significantly better than the cCI. Female speakers' vocal emotions are more easily to be recognized than male speakers' emotion. There was a significant effect of age at test on voice recognition performance. The average score of cCI with full-spectrum speech was close to the average score of cNH with eight-channel narrowband vocoder speech. The average performance of voice emotion recognition across speakers for cCI could be predicted by their sensitivity to changes in F0. CONCLUSIONS: Better pitch discrimination ability comes with better voice emotion recognition for Mandarin-speaking cCI. Besides the F0 cues, cCI are likely to adapt their voice emotion recognition by relying more on secondary cues such as intensity and duration. Although cross-culture differences exist for the acoustic features of voice emotion, Mandarin-speaking cCI and their English-speaking cCI peer expressed a positive effect for age at test on emotion recognition, suggesting the learning effect and brain plasticity. Therefore, further device/processor development to improve presentation of pitch information and more rehabilitative efforts are needed to improve the transmission and perception of voice emotion in Mandarin. LEVEL OF EVIDENCE: 3.

Nutrient deficiencies as a risk factor in Taiwanese patients with postherpetic neuralgia.

Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ). The aim of the present study was to compare the nutritional status of PHN patients with that of healthy controls, and then to identify risk factors for PHN using multivariate multiple logistic regressions. In the present cross-sectional study, we prospectively enrolled fifty PHN patients for at least 3 months and fifty healthy controls. We selected nine circulating nutrients including ionised Ca, Zn, retinol, folic acid, vitamin B12, vitamin C, α-tocopherol, γ-tocopherol and lycopene associated with both immunity and the modulation of neuropathic pain, and measured their concentrations in plasma/serum. Concentrations of ionised Ca, Zn, vitamin C and vitamin B12 were significantly lower in PHN patients than in controls after excluding those patients receiving supplements since the outbreak of HZ. The prevalence of either mild/marginal or severe deficiencies for any of the nine selected circulating nutrients in PHN patients (92 %) was much higher than that in controls (46 %) (P < 0·001). Lower concentrations of vitamin C ( ≤ 45·0 µmol/l), ionised Ca ( ≤ 1·05 mmol/l) and Zn ( ≤ 0·91 g/l) were found to increase independently the risk of PHN using binary variable (dichotomy) analyses with both PHN patients and controls in a multivariate logistic regression analysis. No significant correlations existed between the risks of PHN and the concentrations of retinol, folic acid, vitamin B12, lycopene or α:γ-tocopherol ratios. Thus, lower concentrations of circulating nutrients, namely vitamin C, ionised Ca or Zn, are probably a risk factor in Taiwanese patients with PHN.

Discrepancy of the effects of zinc supplementation on the prevention of radiotherapy-induced mucositis between patients with nasopharyngeal carcinoma and those with oral cancers: subgroup analysis of a double-blind, randomized study.

The purpose of this study was to determine the effect of zinc supplementation on radiation-induced mucositis in patients with nasopharyngeal carcinoma (NPC) and those with oral cancers (OC). A total of 100 patients with head and neck cancers engaged in a randomized double blind study. All participants were placed into two randomized groups (experimental and control). The experimental group received a standard dose of zinc supplements, and the control group was given a placebo. Subgroup analyses were performed between 40 NPC and 43 OC patients. It was found that patients with OC in the control group developed Grade 2 and Grade 3 mucositis sooner than those in the experimental group. However, the benefits were not found to extend to patients with NPC. The results indicated that zinc supplementation prescribed in conjunction with radiotherapy postponed the development of severe mucositis solely for patients with OC. The pretreatment oral mucosa condition and areca chewing habit might account for such discrepancy.

The prevalence of chronic otitis media and its complication rates in teenagers and adult patients.

OBJECTIVE: To determine the annual complication rates of chronic otitis media (COM) and its management. STUDY DESIGN: Retrospective. SUBJECTS AND METHODS: Data were extracted from 3,223 adult patients, aged 15.1 years and older, under the diagnosis of COM from 1998 to 2007. Complications secondary to COM were identified in a total of 115 patients. RESULTS: The incidence of COM in adults decreased from 407 to 145 cases per year (R(2) = 0.845, P < 0.001) from 1998 to 2007. The mean age of patients with COM increased from 44.67 to 49.43 years (R(2) = 0.896, P < 0.001). The prevalence of COM decreased considerably during the study period. However, the annual extracranial complication rate (R(2) = 0.109, P = 0.352) and intracranial rate (R(2) = 0.382, P = 0.057) did not reduce during the past 10 years. CONCLUSION: The complication rate for COM remained steady in the past 10 years, regardless of the overall reduction in the prevalence of COM with use of antibiotics. A high index of suspicion and imaging studies for early identification are recommended. Pneumococcal vaccination is recommended, particularly for the elderly patients who are treated conservatively because of relatively poor general health conditions.

Processing of Acoustic Information in Lexical Tone Production and Perception by Pediatric Cochlear Implant Recipients.

Purpose: This study examined the utilization of multiple types of acoustic information in lexical tone production and perception by pediatric cochlear implant (CI) recipients who are native speakers of Mandarin Chinese. Methods: Lexical tones were recorded from CI recipients and their peers with normal hearing (NH). Each participant was asked to produce a disyllabic word, yan jing, with which the first syllable was pronounced as Tone 3 (a low dipping tone) while the second syllable was pronounced as Tone 1 (a high level tone, meaning "eyes") or as Tone 4 (a high falling tone, meaning "eyeglasses"). In addition, a parametric manipulation in fundamental frequency (F0) and duration of Tones 1 and 4 used in a lexical tone recognition task in Peng et al. (2017) was adopted to evaluate the perceptual reliance on each dimension. Results: Mixed-effect analyses of duration, intensity, and F0 cues revealed that NH children focused exclusively on marking distinct F0 contours, while CI participants shortened Tone 4 or prolonged Tone 1 to enhance their contrast. In line with these production strategies, NH children relied primarily on F0 cues to identify the two tones, whereas CI children showed greater reliance on duration cues. Moreover, CI participants who placed greater perceptual weight on duration cues also tended to exhibit smaller changes in their F0 production. Conclusion: Pediatric CI recipients appear to contrast the secondary acoustic dimension (duration) in addition to F0 contours for both lexical tone production and perception. These findings suggest that perception and production strategies of lexical tones are well coupled in this pediatric CI population.

A tonal-language benefit for pitch in normally-hearing and cochlear-implanted children.

In tonal languages, voice pitch inflections change the meaning of words, such that the brain processes pitch not merely as an acoustic characterization of sound but as semantic information. In normally-hearing (NH) adults, this linguistic pressure on pitch appears to sharpen its neural encoding and can lead to perceptual benefits, depending on the task relevance, potentially generalizing outside of the speech domain. In children, however, linguistic systems are still malleable, meaning that their encoding of voice pitch information might not receive as much neural specialization but might generalize more easily to ecologically irrelevant pitch contours. This would seem particularly true for early-deafened children wearing a cochlear implant (CI), who must exhibit great adaptability to unfamiliar sounds as their sense of pitch is severely degraded. Here, we provide the first demonstration of a tonal language benefit in dynamic pitch sensitivity among NH children (using both a sweep discrimination and labelling task) which extends partially to children with CI (i.e., in the labelling task only). Strong age effects suggest that sensitivity to pitch contours reaches adult-like levels early in tonal language speakers (possibly before 6 years of age) but continues to develop in non-tonal language speakers well into the teenage years. Overall, we conclude that language-dependent neuroplasticity can enhance behavioral sensitivity to dynamic pitch, even in extreme cases of auditory degradation, but it is most easily observable early in life.

Mutlifunctional nanoparticles prepared from arginine-modified chitosan and thiolated fucoidan for oral delivery of hydrophobic and hydrophilic drugs.

Self-assembled nanoparticles (NPs) from arginine-modified chitosan (CS-N-Arg) and thiolated fucoidan (THL-fucoidan) were synthesized to enhance the transport of dextran and curcumin across intestinal epithelial cell layer. CS-N-Arg/THL-fucoidan NPs exhibited a pH-sensitive assembly-disassembly and drug release property. Evaluations of the NPs in enhancing the transport of a hydrophilic macromolecule (FITC-dextran) and a hydrophobic drug (curcumin) were investigated in Caco-2 cell monolayers. The cationic CS-N-Arg in the NPs induced disruption of intestinal epithelial tight junctions as indicated by the decrease of transepithelial electrical resistance (TEER). Permeation studies revealed that the NPs enhanced the paracellular permeation of macromolecular dextran through the monolayer barrier. In addition, the multifunctional NPs increased the permeability of rhodamine 123 because the thiomer THL-fucoidan in the NPs inhibited P-glycoprotein. Cellular uptake and permeability of curcumin encapsulated in the NPs were improved due to increasing their water solubility and stability.

Continuous improvement in Mandarin lexical tone perception as the number of channels increased: a simulation study of cochlear implant.

CONCLUSION: With reference to English phoneme recognition, where performance usually does not improve after six or eight channels in cochlear implants (CIs), increasing total channel numbers continuously improved perception of Mandarin tones. OBJECTIVE: To test our hypothesis that current CI strategies might be modified to improve Mandarin lexical tonal perception. MATERIALS AND METHODS: Lexical tonal perception tests using 48 monosyllables in Mandarin Chinese were conducted in 32 native Mandarin speakers with normal hearing. The performance of tonal perception was compared among the controlled factors, which were total channel number, number of channels allocated to the F0 spectrum, and whether there were spectral shifts in the electrode configuration. The experimental condition that preserves fine structure was used as a comparison. RESULTS: The signal processing strategy using 16 channels--which is technically possible with current CI devices--produced better tonal perception than those using 12 or 8 channels. Increasing the number of fundamental channels did not improve tonal perception, and spectral shifts did not change tonal perception. An experimental condition (FiC12) that preserves the fine structure produced significantly better overall scores for tone perception than other experimental conditions with envelope strategies.

Processing of Acoustic Cues in Lexical-Tone Identification by Pediatric Cochlear-Implant Recipients.

Purpose: The objective was to investigate acoustic cue processing in lexical-tone recognition by pediatric cochlear-implant (CI) recipients who are native Mandarin speakers. Method: Lexical-tone recognition was assessed in pediatric CI recipients and listeners with normal hearing (NH) in 2 tasks. In Task 1, participants identified naturally uttered words that were contrastive in lexical tones. For Task 2, a disyllabic word (yanjing) was manipulated orthogonally, varying in fundamental-frequency (F0) contours and duration patterns. Participants identified each token with the second syllable jing pronounced with Tone 1 (a high level tone) as eyes or with Tone 4 (a high falling tone) as eyeglasses. Results: CI participants' recognition accuracy was significantly lower than NH listeners' in Task 1. In Task 2, CI participants' reliance on F0 contours was significantly less than that of NH listeners; their reliance on duration patterns, however, was significantly higher than that of NH listeners. Both CI and NH listeners' performance in Task 1 was significantly correlated with their reliance on F0 contours in Task 2. Conclusion: For pediatric CI recipients, lexical-tone recognition using naturally uttered words is primarily related to their reliance on F0 contours, although duration patterns may be used as an additional cue.

Dermoscopic features of livedoid vasculopathy.

Livedoid vasculopathy (atrophie blanche) is a form of thrombotic vasculopathy. It is characterized by small ulcers that become crusted, and heal after several months to produce white atrophic scars. The most commonly affected sites are the lower legs, in particular the dorsum of the feet and ankles. To date, the dermoscopic features of livedoid vasculopathy have not been clearly described in the literature. In this observational study, we sought to evaluate the dermoscopic patterns of livedoid vasculopathy and determine whether the dermoscopic features are associated with certain histopathological characteristics. We evaluated 9 patients with livedoid vasculopathy by dermoscopy. Skin biopsy specimens were stained with hematoxylin and eosin for histopathologic examination, and dermoscopic features were correlated with histopathological characteristics. In the majority of patients with livedoid vasculopathy, examination with dermoscopy revealed central crusted ulcers or ivory white areas associated with peripheral pigmentation in a reticular pattern. In addition, increased vascular structures including linear and glomerular vessels were found. On histopathological examination, the central ivory white areas correlated with dermal fibrosis, the reticular pigmentation corresponded to epidermal basal layer hyperpigmentation or melanin within melanophages in the dermal papillae, and the vascular structures correlated with dilatation and proliferation of capillaries in the upper dermis. In summary, the most common dermoscopic features of livedoid vasculopathy identified in this study were central crusted ulcers or ivory white scar-like areas associated with peripheral reticular pigmentation and increased vascular structures. The characterization of dermoscopic criteria for livedoid vasculopathy may improve the accuracy in the clinical diagnosis and follow-up of this disease.

Effect of comorbid diabetes and hypercholesterolemia on the prognosis of idiopathic sudden sensorineural hearing loss.

OBJECTIVES: We tested the hypothesis that comorbid diseases significantly affect the prognosis of sudden sensorineural hearing loss (ISSNHL). STUDY DESIGN: A retrospective cohort study. METHODS: The records of patients newly diagnosed with ISSNHL and treated with steroid prednisolone in a tertiary referral center between January 2003 and December 2013 were retrospectively reviewed. Pretreatment and posttreatment hearing levels were evaluated using pure-tone average (PTA) and word recognition score (WRS). The comorbidities of diabetes, hypertension, coronary artery disease, hypercholesterolemia, cerebrovascular disease, chronic kidney disease, and anemia were identified. We examined the effects of these comorbid diseases on the prognosis of ISSNHL 2 months posttreatment. RESULTS: Regression analyses adjusted for gender, age, pretreatment hearing, treatment delay time, and all the comorbidities showed that the probability of major improvement in the PTA was significantly higher in patients without diabetes compared to those with diabetes (univariate odds ratio [OR], 1.90; 95% confidence interval (CI), 1.25-2.90; multivariate OR, 1.69; 95% CI, 1.03-2.77). Major (≥ 90%) and moderate (50%-89% improvement of the PTA, but with a remaining hearing loss of > 10 dB) improvement in the PTA was significantly higher in patients without hypercholesterolemia compared to those with hypercholesterolemia (univariate OR, 1.78; 95% CI, 1.13-2.80; multivariate OR, 1.70; 95% CI, 1.02-2.84). There was, however, no significant difference in the distribution of major (≥ 90%), moderate (50%-89%), and minor (< 50%) improvement in the posttreatment WRS for these comorbid diseases. CONCLUSIONS: Comorbid diabetes or hypercholesterolemia may indicate a smaller probability of major or moderate PTA improvement for patients with ISSNHL.

Radial forearm and forehead flap reconstruction following resection of a nasal arteriovenous malformation: A case report.

Arteriovenous malformation (AVM) is a structural vascular abnormality in which the arterial vasculature connects with the venous vasculature without capillary connections. AVM confined to the nasal cavity is considerably rare. Blurred vision can be one of the associated symptoms. A combined approach of complete surgical resection with prior superselective embolization is the treatment of choice. Following resection, the reconstruction of facial defects, particularly in the nasal area, is challenging. The present study reports the rare case of a patient with an AVM in the nasal cavity, in which embolization, resection and flap reconstruction were performed. Embolization and complete surgical resection were used to avoid recurrence. Subsequently, a combination of free radial forearm and forehead flaps was used for the reconstruction of the nasal defect, without prosthesis. To the best of our knowledge, this is the first report of AVM confined to the nasal cavity, managed by a combination of free radial forearm and forehead flap reconstruction following complete resection. The cosmetic results of the procedure were acceptable.

Higher risk of developing sudden sensorineural hearing loss in patients with chronic otitis media.

IMPORTANCE: Several sources have suggested an association between chronic sensory hearing impairment and chronic otitis media (COM). However, to our knowledge, no studies have evaluated the risk of sudden sensorineural hearing loss (SSNHL) in patients with COM (COM-positive). OBJECTIVE: To examine the risk of developing SSNHL in COM-positive patients. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study; we compared 10 248 patients with newly diagnosed COM from January 1, 2001, through December 31, 2008, with 30 744 age- and sex-matched controls using data from Taiwan's National Health Insurance Research Database. METHODS: We followed each patient and evaluated the incidence of SSNHL. MAIN OUTCOMES AND MEASURES: The incidence of SSNHL at the end of 2011. RESULTS: The incidence of SSNHL was 3 times higher in the COM-positive cohort than in the COM-negative cohort (14.47 vs 4.83 per 10 000 person-years). Cox proportional hazard regressions showed that the adjusted hazard ratio (AHR) was 3.02 (95% CI, 2.30-3.98). A stratified analysis showed that the highest risk of developing SSNHL was in the first follow-up year (incidence rate ratio [IRR], 3.87; 95% CI, 1.93-7.79). Thereafter, the risk declined during years 1 to 5 and then peaked (IRR, 3.01; 95% CI, 1.89-4.79). Patients who needed surgery had a higher incidence of SSNHL (AHR, 2.69; 95% CI, 1.62-4.48) compared with patients who needed only medication and observation. CONCLUSIONS AND RELEVANCE: Chronic otitis media was significantly associated with a higher risk of developing SSNHL.