• 期刊

Irbesartan/Hydrochlorothiazide Fixed Combination Therapy in Systemic Hypertension: An Open-Label Uncontrolled Trial

Objective: This open label, uncontrolled study was to assess 24-hour efficacy of once-daily combination of hydrochlorothiazide (HCTZ) plus irbesartan (IRB) in Taiwanese outpatient with mild-to-moderate HTN. Methods: Patients with pre-hypertension, stage I or II hypertension (HTN) (as defined by the Seventh Report of the National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, JNC VII) were eligible to participate. Twenty-four-hr ambulatory BP monitoring (ABPM) was performed twice in each patient before and after 8-weeks combitherapy. If supine DBP still＞95 mmHg at week 4 or 5, the dose was up titrated to high-dose IRB/HCTZ 300 mg/25 mg once daily (or 2 tablets of low-dose combination), or based on the decrease of BP. Results: A total of 25 patients (mean age, 54 years) were enrolled; 21 completed the study. Mean 24-hr systolic/diastolic BP after IRB/HCTZ combitherapy was significantly decreased compared with baseline BP (126±13/80±7 vs 148±14/92±9 mmHg (p＜0.001/0.001). Mean final dose of irbesartan /hydrochlorothiazide was 186±56/16±5mg daiy after 8 weeks of titration period. Mean daytime (6 A.M. to 6 P.M.) BP decreased from 150±14/94±9 to 127±13/ 81±7 mmHg, p＜0.001/0.001. Nighttime (6 P.M. to 6 A.M.) BP decreased from 142±15/89±10 to 125±18/80±11mmHg, p＜0.001/0.001). BP reduction was more pronounced during the day. After treatment, significant BP reduction was observed throughout 22 of the 24-hourly mean points. The circadian rhythm was preserved as indicated by similar BP standard deviations (18.5±3.4/16.0±3.0 vs 20.4±5/8.0±3.0 mmHg). Mean heart rate did not change. Two pts reported having dizziness and one frontal headache. Conclusions: Once-daily IRB/HCTZ combitherapy provided significant BP reduction throughout 22 of the 24 hourly mean points with preserved CR and was generally well tolerated in Taiwanese hypertension patients.

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A Pilot Study: on in Vitro Maturation of CD56+ NK Cells Using the Human Umbilical Cord Blood, Among the Eleven Natural Health Substances Tested, Wheat Grass Extract Orchestrates and Enforces the Naïve Fate of CD56+ NK Cells

目的：自然健康物質的免疫調制的活動和評估。自然健康物質它們對人的臍帶血液之中單核細胞（MNC）的作用顯示它們區別在：一般血液內大多數MNC可能更有機會被暴露在免疫致壓力素下；如果我們考慮這情況，當從人的臍帶血液（hUCB）之中的MNC有很大的不同。在人的懷孕期間，hUCB MNC與生物致壓力素由於在胎盤之間已有滋養母細胞層和它的鄰層：母親子宮內膜層已有隔絕；因此MNC對在這裡受到人的壓力已有很好的被保護了。因為滋養母細胞層防止hUBC的MNCs受各種各樣流通在母親血液因素的暴露，因此那些因素減少對這裡的MNC影響。方法：在使用十一種不同自然物質的處理以後，包括五種草本萃取物和六種純化合物，細胞的免疫表現在某一顯性特徵之生物個體或群體多（單）核細胞MNC是通過熒光啟動排序（FACS）分析的結果。本論文裡的數據報告表明了：麥草萃取物增強了CD56+自然兇手（NK）細胞的數量，而對其他MNC細胞的增強與否是無意義的。結果：NK細胞的分離法用了與正面磁性小珠細胞隔離方法，並且用麥草萃取物顯示了影響細胞改變強大，這改變明顯對人的白血病細胞系，和對K562 karyotype細胞毒性的防護增加。結論：本次中間試驗表示，麥草萃取物可能協調促進體外CD56+NK細胞（在hUCB）的天然命運及其胞內的安排，和促進體外CD56+NK細胞在hUCB的的成熟性。

• 期刊

疾病分類編碼品質對外科住院醫療給付影響之研究

目的：以已申報的回溯性住院資料，模擬改善疾病分類編碼品質後，探討對住院醫療給付的影響。方法：以分層隨機抽樣法選取外科住院樣本病歷，再交由6位疾病分類人員編碼審核，最後實際編碼審核257本。結果：所有257本病歷的CMI值為1.27，經試算系統推估之最佳CMI值為1.95，兩者的差值為0.68，推估後可能增加的醫療給付佔總醫療給付的比率為33.8%。經審核後，共計修正36本，修正前的CMI值為1.24，而修正後則成為1.50。修正個案推估後可能增加的醫療給付佔總醫療給付比率為1.8%，與33.8%相比較，其佔率比為5.3%。結論：透過Tw-DRGs試算系統最佳化推估之醫療給付差額中，大約有5.3%是實際可爭取到的部分。再以實際醫療給付來推估，平均每個外科出院個案可額外爭取到1,158點的醫療給付。建議醫院宜在疾病分類編碼品質方面加強投資，包括疾病分類人員之教育訓練、Tw-DRGs最佳化資訊系統、改善病歷書寫品質等，相信可爭取到更合理的醫療給付。

• 期刊

改良式彼拉提斯核心運動對下背痛患者效果之探討

Objective: The purpose of the study was to investigate the efficacy of twelve weeks modified Pilates training on low back pain patients. Methods: All subjects undertook the modified Pilates training two times (sixty minutes per time) a week during three months. They underwent the following measurements: height (RT), weight (WT), Oswestry Low Back Pain Disability Questionnaire, visual analog scale (VAS). The data were analyzed by descriptive statistics and two-way ANOVA with a=0.05 significant level to examine any changes after the training. Results: Results showed significant improvements in daily life dysfunction (11.7 ± 7.1 vs. 8.1 ± 6.2) and pain severity (6.5 ± 1.5 vs. 2.9 ± 1.4) but no statistically significant changes between two groups on sleeping quality. Conclusions: Twelve weeks modified Pilates training was effective in both groups with reduced the disability of daily life and decreased pain severity.

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Round Block Maneuver for Curing Facial Malignancy: An Innovative Idea

自2004年2月至2008年12月，我們從28例顏面皮膚惡性腫瘤患者中，歸納出19位年齡自39到87歲，平均68歲的病人，共收集使用24次改良的袋線式縫合手術方式重建顏面惡性腫瘤廣泛切除後的缺陷。簡單，省時又快速經濟的步驟始自圓塊式切除，立即用大口徑尼龍線直接自真皮層以袋線逢合法，順著皮膚最小張力線路徑（RSTL），直接包夾關閉傷口缺損，至少靜候六週再將這駐留縫線移除。儘管初期會對五官造成扭曲變形，但最終都得到相當令人滿意的功能與美觀上之治療成效。尤其對應用在高齡族群好發的基底或鱗狀細胞癌之治療重建上，圓筒式根除術式甚至於只要局部麻醉下，速戰速決直接關閉傷口，就能一氣呵成完成重建，且最終都能在保留原有相關解剖方位的立意下，即使須再行二次切除手術，亦能在局部麻醉下，確切得到根治療效。此一改良手術不僅相當簡易快速、有效，也是個安全、值得推廣的術式選擇。

• 期刊

Umbilical Keloid Resulted after Laparoscopically Assisted Vaginal Hysterectomy: A Case Report

蟹足腫是一種皮膚損傷後增生的纖維修補組織，蟹足腫的病因不明，它通常在撕裂傷、擦傷、手術及粉刺等皮膚損傷之後產生，蟹足腫常見於耳垂、肩膀、胸部及上背，蟹足腫發生在肚臍並不常見，腹腔鏡輔助經陰道子宮切除術併發症約0.1%至10%，超過50%以上的併發症發生在手術過程中穿刺套管進入之時，我們提出了一罕見的腹腔鏡輔助經陰道子宮切除術術後臍部蟹足腫的個案報告。

• 期刊

子宮內膜癌的“三明治”式療法

幼早期的子宮內膜癌預後很好，但晚期的患者則治療失敗率很高。因此，對晚期的子宮內膜癌患者，必須積極予術後的輔助治療，即以放射線治療，亦可能合併化學治療。放射線治療可減少骨盆腔病灶的復發，但遠端的病灶須靠化學藥物。現階段，化學藥物以paclitaxel和carboplatin被認為對子宮內膜癌有效，且副作用較少。但以何種方法給予最為理想，根據近期研究，是化學治療－放射線治療－化學治療，即“三明治”式的治療，效果較為理想。