Geng-He Chang

Adult deep neck infection (DNI) is a potentially life-threatening condition associated with significant morbidity and mortality. Contemporary large-scale data characterizing long-term microbial evolution and clinical outcome trends in adult DNI remain limited. This study aimed to investigate temporal changes in bacterial pathogens, treatment strategies, and clinical outcomes of adult DNI across an 18-year period. This is a retrospective multicenter cohort study using the Chang Gung Research Database (CGRD) and a de-identified nationwide database from Taiwan’s largest medical system. Hospitalized adult patients (aged ≥18 years) with DNI from 2006 to 2023 were identified and stratified into two consecutive 9-year epochs (Epoch 1: 2006–2014, n = 5512; Epoch 2: 2015–2023, n = 6551). Demographics, comorbidities, treatment modalities, disease severity, and microbiological profiles were analyzed. Bacterial isolates were evaluated at genus and species levels, with methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) assessed separately. Among 12,063 adult DNI patients (Epoch 1: n = 5512; Epoch 2: n = 6551), antibiotic-only treatment increased (77.3% to 83.2%) and surgical intervention decreased (22.7% to 16.9%). Descending necrotizing mediastinitis decreased markedly (2.7% to 0.7%) and in-hospital mortality declined (7.7% to 6.4%). Poly-microbial infections increased substantially (45.3% to 53.7%). Among facultative anaerobic and aerobic isolates, the Streptococcus anginosus group (SAG) emerged as a clinically important pathogen. Among anaerobes, Prevotella displaced Peptostreptococcus as the dominant genus, with Peptostreptococcus micros (Parvimonas micra) and Prevotella buccae emerging as prominent species. Over 18 years, adult DNI in Taiwan demonstrated significant improvements in clinical outcomes, with marked reductions in mediastinitis and in-hospital mortality. Concurrently, poly-microbial infections increased, and the SAG, Peptostreptococcus micros (Parvimonas micra), Prevotella, and anaerobic organisms emerged as clinically important pathogens, underscoring the need for empiric antibiotic regimens providing broad aerobic and anaerobic coverage. Although microbiological profiles vary geographically, these findings provide a contemporary evidence base to guide empiric antibiotic selection, inform surgical decision-making, and identify high-risk adult patients with DNI.

Sudden sensorineural hearing loss (SSNHL) carries unpredictable recovery, and adjunctive therapies beyond systemic corticosteroids are limited. Stellate ganglion block (SGB) and hyperbaric oxygen therapy (HBOT) have each been proposed as adjuncts, yet their combined effect remains poorly characterized. A retrospective three-arm cohort study (IRB No. 202401644B0) enrolled 75 SSNHL patients: Control (standard corticosteroid, n = 39), SGB (n = 21), and SGB+HBOT (n = 15). PTA4 improvement and Siegel recovery categories were assessed at two weeks, one month, and two months. Subgroup analyses stratified patients by baseline PTA4 < 70 dB and ≥70 dB. Groups differed significantly in overall baseline PTA4 (Kruskal–Wallis p = 0.044; SGB group worst at 80.4 ± 17.3 dB) and in diabetes mellitus (DM) prevalence (Control 44% vs. 7% in SGB+HBOT; p = 0.018). Within the ≥70 dB subgroup, baseline PTA4 was balanced across groups (Control 86.5 ± 13.0 dB, SGB 88.2 ± 14.2 dB, SGB+HBOT 90.9 ± 15.3 dB; p = 0.748). In this balanced stratum, SGB+HBOT achieved the greatest two-month PTA4 improvement (+23.6 ± 27.2 dB) and the highest complete recovery rate (43%, 3/7), versus 27% (3/11) in Control and 9% (1/11) in SGB. No statistically significant between-group differences were identified. However, SGB+HBOT demonstrated the numerically greatest audiometric improvement and the highest complete recovery rate in the severe–profound subgroup despite baseline disadvantages, suggesting a possible therapeutic benefit for this population. These exploratory findings support prospective evaluation in an adequately powered randomized controlled trial.

Objectives. The prognostic value of the pretreatment albumin-to-alkaline phosphatase ratio (AAPR) in head and neck cancer (HNC) remains uncertain. This meta-analysis aimed to evaluate the predictive role of AAPR for survival outcomes in patients with HNC.Methods. A comprehensive search of the Cochrane Library, PubMed, and Embase databases was conducted to identify relevant studies published up to July 30, 2024. We included studies on AAPR and survival outcomes in HNC patients.Results. Eight studies comprising 1,737 HNC patients were analyzed using random-effects models. Lower AAPR values were significantly correlated with worse overall survival (hazard ratio [HR], 2.08), progression-free survival (HR, 2.00), and disease-free survival (HR, 2.18). Sensitivity analyses confirmed the robustness of these results, with no significant publication bias detected.Conclusion. Our findings suggest that pretreatment AAPR could serve as a valuable and cost-effective prognostic indicator in HNC, potentially aiding clinicians in risk stratification and treatment decision-making. However, additional validation studies are warranted to confirm its clinical applicability.

Objective: Allergic rhinitis (AR) continues to adversely affect the life quality of a substantial patient population, highlighting the necessity for enhanced treatment modalities. Our research utilized licorice extract (LE) in nasal irrigation for managing this condition, with its therapeutic efficacy gauged against traditional saline nasal irrigation (SNI) through clinical trials. Additionally, the study incorporated traditional Chinese medicine (TCM) principles, measuring not just subjective symptom relief but also the objective shifts in lung meridian electrical conductance (MEC), to provide a comprehensive evaluation of the treatment’s effectiveness. Methods: Based on our previous laboratory and animal studies, we developed an LE solution and applied it through nasal irrigation to treat AR. In a one-month controlled trial, 60 patients with AR received either licorice nasal irrigation (LNI) or SNI daily. We assessed treatment efficacy by subjective questionnaire scores (Total Nasal Symptom Score [TNSS] and 22-item Sino-Nasal Outcome Test [SNOT-22]) and objective lung MEC analysis. Result: In the trial, 30 participants were randomly allocated to each group, and 28 individuals in the LNI group and 24 in the SNI group finished the study without any side effects. The LNI group had better improvements in sneezing, nasal itchiness, and rhinorrhea, along with a greater overall TNSS reduction. On the SNOT-22, the LNI group scored better across most nasal and extra-nasal symptoms, sleep, and physiological and psychosocial well-being. Participants were sorted into low, normal, and high lung MEC subgroups. After treatment, those in the LNI group normalized their lung MEC levels in both the low and high subgroups, which was not observed in the SNI group. Conclusions: LNI markedly improves symptoms in patients with AR, enhancing their quality of life. This treatment method, integrating Western and TCM practices, also normalizes abnormal lung MEC values following therapy. It offers a method of objectively validating the effectiveness of treatments based on TCM theories.

Objective: We evaluated the preoperative Controlling Nutritional Status (CONUT) score—comprising serum albumin, total cholesterol levels, and lymphocyte counts—as a prognostic marker in oral cavity squamous cell carcinoma (OCSCC).Methods: The research involved 352 patients with OCSCC who underwent primary surgical treatment at Chang Gung Memorial Hospital between January 2009 and December 2018. Patients were categorized based on their nutritional risk as determined by the CONUT score: 259 patients (73.6%) had a CONUT score of 0–1 (indicating normal nutrition), while 93 patients (26.4%) had a CONUT score of ≥ 2 (indicating varying degrees of undernutrition). We examined the relationships between the CONUT score, clinicopathological characteristics, and survival outcomes.Results: Higher CONUT scores (≥ 2) were significantly associated with poorer 5‐year overall survival (OS) and disease‐free survival (DFS) (both p < 0.001). Multivariable analysis identified a CONUT score of ≥ 2 as an independent adverse prognostic factor for both OS and DFS, with hazard ratios of 1.963 and 2.026, respectively. The CONUT score remained a significant predictor of OS in subgroup analyses, and a nomogram incorporating the CONUT score provided reliable OS predictions, with a concordance index of 0.772.Conclusion: The preoperative CONUT score holds potential as a prognostic marker for patients with OCSCC undergoing surgery. The CONUT score‐based nomogram could serve as a valuable tool for predicting survival outcomes in OCSCC management.Level of Evidence: IV.

Objective: This study aims to investigate the differences in pathogenic bacterial spectra between patients with deep neck infection (DNI) with and without liver cirrhosis (LC). The goal is to identify specific pathogens prevalent in LC‐DNI to guide the selection of empiric antibiotics, improving treatment outcomes and prognosis. Study Design: This is a retrospective study. Methods: The Chang Gung Research Database (CGRD) is a deidentified medical database encompassing seven hospitals within Taiwan's largest medical system. We analyzed data from 2004 to 2018 on DNI patients hospitalized with or without LC, categorizing them into these two groups. This study primarily focused on comparing the bacterial culture results of these groups, alongside an analysis of their treatment modalities (medication alone or surgery) and prognostic outcomes. Results: From a total of 11,455 DNI patients identified in the CGRD, 76 LC‐DNI patients and 11,178 non‐LC‐DNI patients met the inclusion criteria after exclusions. The LC group had significantly higher rates of surgical debridement (34.2% vs. 19.4%, p = 0.002), ICU admission (22.4% vs. 10.7%, p = 0.004), and mediastinal complications (7.9% vs. 2.1%, p = 0.005). Although the overall mortality rates were not significantly different between the two groups (6.6% vs. 4.6%, p = 0.401), the mediastinitis‐related mortality rate was significantly higher in the LC‐DNI group (2.6% vs. 0.2%, p = 0.015). Bacterial culture analysis revealed that LC‐DNI patients predominantly presented with Klebsiella pneumoniae (KP) as the primary facultative anaerobic pathogen, whereas non‐LC‐DNI patients were most infected with Viridans streptococcus (VS). For anaerobic bacteria, both groups consistently cultured Peptostreptococcus micros and Prevotella intermedia as the predominant species. Conclusions: LC‐DNI patients are predominantly infected with KP, a Gram‐negative bacillus, unlike the Gram‐positive cocci, VS, in non‐LC‐DNI. Anaerobic pathogens were similar in both groups. Empiric antibiotics for LC‐DNI should target KP and anaerobes to improve outcomes. Level of Evidence: 3 Laryngoscope , 135:2299–2305, 2025

Background: With growing evidence linking lipid profile changes to tumor development and cancer prognosis, we investigated the prognostic significance of preoperative serum total cholesterol (TC) levels in patients with oral cavity squamous cell carcinoma (OSCC) undergoing surgical treatment. Methods: We conducted a retrospective observational study involving 310 patients with primary OSCC who received surgery at our hospital from January 2009 to December 2018. Receiver operating characteristic curve analysis was performed to determine the optimal preoperative TC cutoff value, with the Youden Index employed as the optimization criterion to maximize the sum of sensitivity and specificity. Variables with p < 0.1 in the univariable analysis were included in the multivariable Cox regression model, and stepwise selection was used to identify the optimal subset of prognostic factors for overall survival (OS) and disease-free survival (DFS). Results: An optimal TC cutoff of 157 mg/dL was established. Patients with TC < 157 mg/dL exhibited significantly lower 5-year rates of OS and DFS (p < 0.001 and p = 0.006, respectively). Multivariable analysis confirmed that TC < 157 mg/dL represented an independent prognostic factor for reduced OS and DFS rates. Subgroup analyses reinforced the consistent prognostic significance of TC. We also constructed a nomogram (concordance index: 0.74) to provide personalized OS predictions, enhancing the clinical utility of TC. Conclusions: Preoperative TC appears to be a significant prognostic factor for OS and DFS after OSCC surgery. Routine TC assessment facilitates the development of nomograms for personalized survival predictions, supports clinicians in tailoring treatment strategies, and guides nutritional or metabolic interventions to enhance patient outcomes. Further multicenter prospective studies are needed to validate our findings.

Background/Objectives: Chronic inflammation significantly contributes to human malignancies. We investigated the prognostic significance of the preoperative modified systemic inflammation score (mSIS) in patients with primary oral cavity squamous cell carcinoma (OCSCC). Methods: We retrospectively reviewed data from 320 OCSCC patients who underwent curative surgery between 2007 and 2017. Based on preoperative lymphocyte-to-monocyte ratio (LMR) and serum albumin levels, patients were classified into three groups: mSIS = 2 (LMR < 3.4 and albumin < 4.0 g/dL), mSIS = 1 (LMR < 3.4 or albumin < 4.0 g/dL), and mSIS = 0 (LMR ≥ 3.4 and albumin ≥ 4.0 g/dL). We explored the associations between the preoperative mSIS and overall survival (OS) and disease-free survival (DFS). We developed a nomogram based on mSIS for OS prediction. Results: The distribution was mSIS = 0 (n = 197, 61.6%), mSIS = 1 (n = 99, 30.9%), and mSIS = 2 (n = 24, 7.5%). Kaplan–Meier estimated OS and DFS for the mSIS = 0, mSIS = 1, and mSIS = 2 groups demonstrated a sequential decrease (both p < 0.001). The prognostic significance of mSIS was consistent across subgroup analyses. Multivariable analysis revealed that mSIS = 1 and mSIS = 2 were independent negative prognostic indicators. The mSIS-based nomogram effectively predicted OS (concordance index: 0.755). Conclusions: The mSIS reliably predicts OS and DFS in OCSCC patients undergoing surgery, with the nomogram providing individualized OS estimates, enhancing mSIS’s clinical utility.

Studies have found that in healthy individuals without nasal disease, changes in posture cause an increase in nasal resistance, especially in the prone posture. Many patients with obstructive sleep apnea syndrome (OSAS) sleep in a prone posture, but no studies have examined the effect of this change in posture on nasal resistance in patients with OSAS. Therefore, we conducted this study to investigate this posture-related physical phenomenon in individuals with OSAS. We evaluated the nasal patency of 29 patients diagnosed with OSAS using the visual analog scale (VAS), acoustic rhinometry, and video-endoscopy in the sitting, supine, and prone postures. In the OSAS group, both supine and prone postures significantly influenced subjective nasal blockage and led to a notable reduction in the minimal cross-sectional area (mCSA) as determined by acoustic rhinometry, compared to the sitting posture. The prone posture exhibited a more pronounced effect than the supine posture. Endoscopic evaluations further revealed increased hypertrophy of the inferior turbinate in the supine posture for the right nasal passage and the prone posture for the left. However, no significant differences were observed between the prone and supine postures. In OSAS patients, nasal resistance significantly increased in supine and prone postures compared to sitting, with the prone posture showing a greater effect. Clinicians should consider a patient’s habitual sleep posture and the effects of postural changes when assessing OSAS severity and devising treatment plans. 4.