• 期刊

負壓傷口治療對糖尿病潰瘍傷口之成效：系統性文獻回顧及統合分析

目的：糖尿病潰瘍傷口嚴重時需進行截肢手術，而負壓傷口治療用於慢性傷口已有不錯成效，但用於糖尿病潰瘍傷口之成效如何，國內目前沒有對此議題做相關論述及整理，本研究收集高品質之隨機控制試驗文獻，運用系統性回顧及統合分析，探討負壓傷口治療對糖尿病潰瘍傷口之成效。方法：依關鍵字搜尋：華藝線上圖書館、Cochrane Library、PubMed及Medline，搜尋設定年限為2000年1月至2017年10月，將納入準則之文獻使用Modified Jadad Score及Oxford Centre for Evidence-based Medicine評讀研究品質，並以Review Manager 5統計軟體進行統合分析。結果：納入12篇隨機臨床試驗研究進入統合分析，共1185位個案，研究結果：傷口癒合時間-19.78天(95%CI：-40.05,0.48)、傷口減少面積比例27.72(95%CI：5.65,49.79)、傷口減少面積10.05平方公分(95%CI：4.34,15.77)、傷口減少深度比例39.18(95%CI：28.96,49.39)、傷口完全癒合比例3.01(95%CI：1.64,5.53)、截肢率0.28(95%CI：0.14,0.57)和不良事件1.10(95%CI：0.67,1.78)。結論：實證研究發現負壓傷口治療可顯著減少糖尿病潰瘍傷口的面積及深度、增加傷口完全閉合和降低截肢，這可供醫療人員參考，以提升照護品質。

• 期刊

A Retrospective Study in Outcome of Patients with Colon Cancer and Chronic Viral Hepatitis Treated with Chemotherapy

Objective: In some cancers, patients with viral hepatitis B or C infections have more chemotherapy-related morbidity and mortalities. Methods: Patients' characteristics, included age, gender, stage were similar between patients with chronic viral hepatitis and without hepatitis. Median survival was 1292 days (95% CI, 518-2065 days) in patients with chronic viral hepatitis and 1228 days (95% CI, 968-1487 days) in patient without chronic hepatitis. There were no significant overall survival differences in these two groups (p = 0.793). In subgroup analysis, there were still no survival differences between different stages. Results: Patients who were ≤ 65 years (p ＜ 0.001) and had lower normal urine albumin creatinine ratio (ACR, p = 0.049) had lower chance to become albuminuria. Hypertension (p = 0.021), albuminuria (p = 0.022) and age ＞ 65 years (p = 0.04) would deteriorate renal function but patients under angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) therapy were exceptional. Conclusions: Chronic hepatitis B or C infections did not influence survival in colon cancer patients treated with chemotherapy.

• 期刊

光刺激發光劑量計應用於放射治療低劑量輻射度量之系統調測

目的：使用醫用直線加速器之標稱射源，針對光刺激發光劑量計(Optical stimulated luminescence dosimeter,OSLD)之特性進行量測與校正，以供放射治療照野外正常組織之低劑量輻射度量並提高準確性。方法：評估一批光刺激發光劑量計(In Lightnano Dot^(TM))之批次特徵(batch characteristic)、再現性(reproducibility)、消光性(fading)、劑量率依存性(dose rate dependence)及訊號衰減(signal depletion per read)等特性，並同時建立劑量與計讀值之關係曲線(linearity)。結果：OSLDs於三次不同劑量範圍其平均值和標準差分別為8 0 . 9 4 ± 2 . 16 counts、57.40±1.20 counts及28.14±0.82 counts，準確度均在±3%之內，重複計讀再現性及輻射回應再現性C.V.值分別介於0.54%~2.33%和0.94%~2.95%，消光性穩定於2.1%以內，劑量率依存性於1.12%以內，訊號衰減僅0.25%。劑量回應關係曲線於劑量範圍2至40cGy間， 其關係式為y=2.7158x+1.3979，x為吸收劑量，y為計讀信號值。結論：OSLDs尺寸小、劑量線性、再現性佳、無劑量率依存性，可重複使用、重複計讀，操作便利穩定度佳，除了目前已知應用亦適合於放射治療低劑量度量。

• 期刊

比較傳統換藥與親水性敷料於頭頸癌放射線皮膚損傷成效之回溯性研究

目的：頭頸癌接受放射線治療後嚴重的皮膚損傷會中斷癌症治療，若要完成治療，最好能將皮膚反應維持至第二級以下，本研究目的在比較傳統換藥與親水性敷料於頭頸癌放射線皮膚損傷成效。方法：以病歷回溯2012年1月至2015年12月南部某區域教學醫院放射腫瘤科頭頸癌放射線皮膚損傷，有接受傳統換藥與親水性敷料照護的病患，評估其皮膚反應及疼痛，以描述性及推論性研究進行統計分析。結果：依換藥方式分為傳統換藥組和親水性敷料組各12人，以年齡、BMI、癌別、癌症期別、癌症治療、放射線治療分次劑量和累積劑量、最初RTOG、最初及最終疼痛VAS為變項，兩組無顯著差異(p＞0.05)。以RTOG已降至第二級以下做為研究終點，使用線性迴歸及邏輯式迴歸分析換藥方式與RD的成效之相關性，結果顯示RTOG降至第二級以下的換藥總天數親水性敷料組比傳統換藥組少16.5天(p=0.004)，第9天疼痛VAS親水性敷料組比傳統換藥組少2.34分(p=0.09)。結論：研究發現親水性敷料能有效加速傷口癒合，有減輕疼痛的趨勢，提升中重度放射性皮膚炎照護品質。

• 期刊

轉診病人意願同意醫療資訊給轉介醫師之研究

目的：轉診醫療是目前醫療重要政策之一，病人醫療資訊自主權年年日升，病人醫療資料保護及病人權利是要倍加重視。因此轉診醫師是否需要病人同意將受轉診醫院診治後之醫療資料回覆原照護之轉介醫師的意願探討及分析。方法：本研究2011年7月至2012年12月間收集持轉診單轉診至本醫院就診的個案共9,917人，針對病人醫療資訊隱私保密的內容簽署狀況做分析，內容包括：同意、不同意此次轉診之各項病歷資料可供回覆原轉介之醫療院所，探討影響病人醫療資訊自主的年齡,性別及科別等相關因素之橫斷性研究。結果：於本醫院就診時收集所持之轉診單收集的個案共9,917人次中，有簽署者有4991(50.3%)，簽署「同意」和「不同意」者分別有4459(89.3%)和532(10.7%)，其中不同意的男性有207(38.9%)及女性有325(61.1%)，女性簽屬不同意有統計上顯著意義(p=0.004)；在年齡＜40歲、41~60歲及＞60歲簽屬不同意個案分別159,227,146佔29.9%、42.7%、27.4%，年齡對於簽屬不同意有統計上沒有顯著意義(p=0.126)。簽署不同意的男性中，年齡的部分＜40歲、41~60歲及＞60歲個案分別佔4.7%、5.3%、4.3%，男性簽署不同意的個案對於年齡上無統計上顯著意義(p=0.547)。而簽署不同意的女性，年齡的部分＜40歲、41~60歲及＞60歲個案分別佔7.0%、6.4%、4.2%，女性簽署不同意的個案對於年齡較高者比較不會不同意而具有統計上顯著意義(p=0.019)，女性就診婦產科及乳房外科簽署不同意的女性分別為5.3%及23.3%,是具有統計上顯著意義(p＜0.0001)。結論：醫護人員日常醫療工作時，對病人資料的保密，轉診資料的回覆已有既定模式，雖然大多數轉介病人會同意其資料轉出轉入，但在尊重病患醫療資訊自主和隱私保密的前提下，醫療人員須更重視病人權利及病患資料的保護，以免造不必要的觸法困惱。

• 期刊

Isolated Tricuspid Valve Infective Endocarditis with Multiple Pulmonary Nodules Not Identified on Chest X Ray: A Cases Report

Infective endocarditis is a potential life-threatening disease. Unlike other viridans streptococci, Streptococcus anginosus infection is often associated with abscess formation, but rarely causes infective endocarditis. Because of the vague nature of symptoms, isolated tricuspid valve infective endocarditis may take several months to diagnose. We report a previously healthy 36-year-old man who developed 6 months of intermittent fever and 2 days of pleuritic chest pain. As the initial computed tomographic images suggested the possibility of tuberculosis or cryptococcosis, lung and pleural biopsy was planned. However, subsequent blood cultures grew Streptococcus anginosus and echocardiography also revealed vegetations on tricuspid valve. Eventually, we came to the final diagnosis of isolated tricuspid valve infective endocarditis complicated with multiple pulmonary septic emboli. We emphasized the important role of computed tomography in this patients, and also concluded that it is very important to establish an early diagnosis.

• 期刊

Undetectable Hemoglobin A1c in a Patient with Co-Inheritance of α-Thalassemia and Hb G-Taichung: A Case Report

Hemoglobin A1c (Hb A1c) is routinely used to monitor glycemic control over past 2-3 months in patients with diabetes. As recommended by the American Diabetes Association in 2010, a value of 6.5% for HbA1c is a diagnostic criterion for diabetes. We present a 32-year-old male patient whose HbA1c was undetectable using ion exchange high-performance liquid chromatography. DNA sequencing identified the co-inheritance of Hb H disease and Hb G-Taichung. Thus, if the HbA1c value cannot be measured, such patients should be screened for hemoglobinopathy and alternative methods for glucose assessment should be considered.

• 期刊

Myxofibrosarcoma in Varicose Vein: A Cases Report

Myxofibrosarcoma (MFS) is a rare soft tissue neoplasmscharacterized by a high frequency of local recurrence due to an infiltrative growth property. Most common presents in the extremities of elderly people. The clinical presentation is not pathognomonic and the histological aspects are highly heterogenous, frequently delaying the diagnosis or leading to misdiagnosis. Complementary histochemical and immune-histochemical staining are mandatory to achieve the diagnosis of MFS. A 54-year-old female patient is presented with myxofibrosarcomain varicose vein on right calf. Local recurrent mass lesion was found three months later after excision of thrombosis varicose veins. Wide excision of right calf mass lesion was done and pathology showed myxofibrosarcoma. Wide excision with adequate safe margin should be recommended to prevent a local recurrence. The overall risk of distant metastases is significant which makes worse prognosis.