Yen-Ting Lu

Objective(s): Fungus ball (FB) is a unilateral form of fungal rhinosinusitis, but it remains unclear whether associated microbial dysbiosis is restricted to the lesional sinus or extends across the sinonasal cavity. This study aimed to determine whether bacterial and fungal dysbiosis in maxillary sinus FB is spatially localized by comparing paired lesional and contralateral‐normal sites within the same individuals. Methods: This prospective paired‐sample study enrolled 14 adults with surgically confirmed unilateral maxillary sinus FB at a tertiary referral center. Middle‐meatal swabs were obtained from lesional and contralateral‐normal sides during endoscopic sinus surgery. Bacterial and fungal communities were profiled using 16S rRNA gene and internal transcribed spacer (ITS) sequencing. Alpha and beta diversity, taxonomic composition, predicted functional pathways, and bacterial–fungal co‐occurrence networks were analyzed. Results: Lesional sinuses showed significantly reduced bacterial alpha diversity compared with contralateral‐normal sides (Wilcoxon p < 0.001) and distinct bacterial beta diversity (PERMANOVA p = 0.003). Fungal beta diversity also differed between sites ( p = 0.001), whereas fungal alpha diversity was preserved. Lesional communities showed enrichment of anaerobic and pathobiont taxa, including Haemophilus , Enterococcus , and Pseudomonas , with reduced relative abundance of Staphylococcus . Although Aspergillus abundance was similar bilaterally, network analysis suggested altered Aspergillus ‐associated connectivity in lesional samples, consistent with a shift in inferred interaction topology rather than increased Aspergillus abundance. Predicted functional analysis further suggested pathway differences that may reflect altered local metabolic conditions. Conclusion: In this cohort, microbial dysbiosis in maxillary sinus FB appeared to be spatially localized, with patterns suggestive of anaerobe enrichment and ecological reorganization centered on Aspergillus . These findings are compatible with the standard surgical emphasis on fungal mass removal and restoration of sinus drainage/aeration, but the microbiome‐based relevance of aeration requires confirmation in larger studies. Level of Evidence: 3.

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.

Ectopic teeth in the maxillary sinus are an uncommon finding, and when symptomatic, often present as chronic rhinosinusitis. However, concurrent presentation with a fungal ball is exceptionally rare and scarcely documented in the literature. We report a unique case of a 39‐year‐old woman with recurrent maxillary sinusitis, ultimately diagnosed with coexisting ectopic tooth and fungal ball in the left maxillary sinus. The patient underwent successful endoscopic sinus surgery for simultaneous removal of both lesions. Postoperatively, she experienced complete resolution of symptoms without complications. This case highlights the diagnostic importance of imaging in refractory rhinosinusitis and demonstrates that endoscopic management is an effective and minimally invasive approach for this rare dual pathology.

Background: Globus, a non-painful sensation of a lump in the throat, affects nearly half of the population. Its etiology remains uncertain, and standardized treatment is lacking. Ban-Xia-Hou-Pu-Tang (BXHPT, 半夏厚朴湯 ), a classical formula for “Plum Pit Qi” ( 梅核氣 ), closely resembles globus in traditional Chinese medicine. This study investigated the traditional Chinese medicine constitution of patients with globus and evaluated the efficacy and safety of BXHPT combined with western therapy. Methods: A single-blinded, randomized, placebo-controlled trial was conducted in patients with globus pharyngeus. Participants received either fexofenadine, famotidine, and acetylcysteine plus BXHPT (group A) or plus placebo (group B) for 4 weeks. The Constitution in Chinese Medicine Questionnaire, Reflux Symptom Index (RSI), Glasgow Edinburgh Throat Scale (GETS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), and Reflux Finding Score (RFS) were assessed. Hepatic and renal safety were monitored. Results: Ninety-two patients completed the trial. Both groups showed significant improvements in RFS, RSI, GETS, BAI, and BDI-II. Group A had greater RFS reduction at week 2 (8.03 ± 1.57 vs 10.12 ± 1.75; p < 0.001) and week 4 (7.43 ± 1.16 vs 9.17 ± 1.80, p = 0.007). No hepatic or renal adverse effects occurred. Conclusion: BXHPT combined with western therapy provided additional improvement in laryngoscopic findings without safety concerns, supporting its potential as an effective adjunctive treatment for globus sensation.

Importance: Nasopharyngeal carcinoma (NPC) is closely linked to microorganisms, especially intra-tumoral microbiota. However, the role of commensal microbiota in NPC remains underexplored, with implications for understanding disease mechanisms. Objective: This study aims to analyze and compare the bacterial microbiota in the nasopharynx and middle meatus (MM) of individuals with NPC and those without NPC. Additionally, the study seeks to identify potential microbial biomarkers that can distinguish between NPC and non-NPC (nNPC) individuals. Design: Cross-sectional study. Setting: Study conducted in a clinical setting with NPC and non-NPC participants to evaluate microbial diversity relevant to NPC. Participants: Ten NPC cases and 15 non-NPC controls were recruited based on clinical eligibility. Main Outcome Measures: Bacterial microbiota sampling from the nasopharynx and MM was analyzed by 16S rRNA sequencing. Microbiota diversity (alpha and beta diversity indices), presence of bacterial taxa with biomarker potential, and prediction model accuracy [area under the curve (AUC)]. Results: Microbiota diversity was significantly lower in NPC patients versus controls. In nasopharyngeal samples, alpha diversity (Chao1 index, P = .02) and beta diversity (PERMANOVA, P = .001) differed notably between groups, though MM samples showed no significant difference (Chao1 index, P = .23). Machine learning identified Pseudomonas, Cutibacterium, and Finegoldia as potential NPC biomarkers (AUC = 0.86). Conclusions and Relevance: This pioneering study highlights dysbiosis in nasopharyngeal microbiota among NPC patients. Findings suggest that Pseudomonas, Cutibacterium, and Finegoldia may be useful biomarkers for NPC diagnosis, warranting further investigation into microbial roles in NPC pathogenesis.

Obstructive sleep apnea (OSA) yields intermittent hypoxia, hypercapnia, and sleep fragmentation. OSA is associated with chronic medical conditions such as cardiovascular diseases, metabolic syndrome, and neurocognitive dysfunction. However, the risk of infertility in OSA remains unclear due to limited data and lack of long-term population-based studies. The study aims to assess the risk of infertility in obstructive sleep apnea (OSA) by means of a population-based cohort study. The data was utilized from the Taiwan National Health Insurance Research Database (NHIRD) to conduct a population-based cohort study (1997–2013). Compared with the Non-OSA group, the male with OSA and surgery group has the OR (odds ratio) of infertility of 2.70 (95% CI, 1.46–4.98, p = 0.0015), but no significance exists in females with OSA. When the data was stratified according to age and gender, some associations in the specific subgroups were significant. Respectively, males aged 20–35 years old and aged 35–50 years old with a history of OSA and surgery both had a positive association with infertility. (aOR: 3.19; 95% CI, 1.18–8.66, p = 0.0227; aOR: 2.57; 95% CI, 1.18–5.62 p = 0.0176). Male patients with OSA suffer from reduced fertility, but no significant difference was noted in females with OSA. The identification of OSA as a risk factor for male infertility will aid clinicians to optimize long-term medical care. Furthermore, more studies will be encouraged to clarify the effect of OSA on female fertility.

The most important cause of treatment failure of nasopharyngeal carcinoma (NPC) patients is metastasis, including regional lymph nodes or distant metastasis, resulting in a poor prognosis and challenges for treatment. In the present study, we investigated the in vitro anti- tumoral properties of morusin on human nasopharyngeal carcinoma HONE-1, NPC-39, and NPC-BM cells. Our study revealed that morusin suppressed the migration and invasion abilities of the three NPC cells. Gelatin zymography assay and Western blotting demonstrated that the enzyme activity and the level of matrix metalloproteinases-2 (MMP-2) protein were downregulated by the treatment of morusin. Mitogen-activated protein kinase proteins were examined to identify the signaling pathway, which showed that phosphorylation of ERK1/2 was inhibited after the treatment of morusin. In summary, our data showed that morusin inhibited the migration and invasion of NPC cells by suppressing the expression of MMP-2 by downregulating the ERK1/2 signaling pathway, suggesting that morusin may be a potential candidate for chemoprevention or adjuvant therapy of NPC.

Fungal rhinosinusitis is a unique phenotype of chronic rhinosinusitis with unique clinical and histological characteristics. The role of bacterial microbiota in various phenotypes chronic rhinosinusitis is not thoroughly understood. Therefore, we conducted 16s rRNA amplification sequencing to determine differences in bacterial communities between phenotypes (fungal vs. non- fungal) and anatomical sites (middle meatus vs. nasopharynx). Endoscope-guided swabs were used to collect samples from the middle meatus and nasopharynx of seven consecutive patients with fungal and 18 consecutive patients with non-fungal rhinosinusitis. DNA was extracted and investigated through 16S rRNA amplification. Among samples from the middle meatus, Shannon diversity was significantly lower in those from the fungal rhinosinusitis group (p = 0.029). However, no significant differences in diversity were noted between nasopharynx samples (p = 0.85). Fungal rhinosinusitis samples exhibited a distinct distribution of taxon relative abundance, which involved not only the absence of rhinosinusitis-associated commensal Corynebacterium and Fusobacterium in the middle meatus but also a significant increase in Haemophilus prevalence and abundance. This is the first study to compare bacterial communities in fungal and non-fungal rhinosinusitis samples. Our findings demonstrated that bacterial community dysbiosis was more apparent in fungal rhinosinusitis samples and was limited to the middle meatus.