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Virological Response and Clinical Events in Patients with Chronic Hepatitis B Treated with Nucleotide Analogue

Objective: Nucleotide analogue (NUC) is a potent inhibitors of polymerase/ reverse transcriptase inhibitor of HBV replication. The aims of this study were to identify its effect on occurrence of clinical event (CE). Methods: Clinical events were defined as development of hepatocellular carcinoma (HCC), decompensation or death. 104 CHB patients treated with NUC were classified as chronic hepatitis, compensated cirrhosis and decompensated cirrhosis. We examined differences among groups on virological response (VR) and CE. Baseline factors associated with CE were explored. Results: Overall VR rate was 97.1%. Proportion of CE was 21.2%. We found no significant difference among groups on VR or CE and no significant correlation between VR and CE. A proportion of CE was significant higher among patients with decompensated cirrhosis. In Cox models, CTP classification, score and age were independent predictors for CE. Conclusions: Long-term NUC therapy does not eliminate CE risk. Beneficial effect was especially significant among patients with younger, inactive disease. It should remain under surveillance even virological remission.

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運用Andersen醫療服務行為模式探討醫療資源豐富程度對跨區醫療利用行為之影響

目的：探討醫療資源豐富與否對病人跨區醫療利用行為及其醫療服務利用之影響。方法：將2016年個案醫學中心跨區病人22,947位以所在縣市是否有醫學中心分群（16,678位無醫學中心縣市，6,269位居住在有醫學中心縣市）。依變項分別為跨區門診就醫次數≧12次和跨區住院日數≧7日兩項。利用Logistic Regression Model探討醫療資源豐富與否對醫療服務利用行為之影響。結果：兩群體病人以惡性腫瘤及相關治療跨區就醫。門診跨區醫療利用行為在性別、年齡與醫療服務次數情形上呈現達顯著差異(p＜0.05)；住院跨區醫療利用行為僅年齡達顯著差異(p＜0.05)。經Logistic Regression分析，跨區門診就醫次數≧12次，病人所在無醫學中心是有醫學中心的1.713倍，女性是男性的0.808倍，年齡大於65歲是小於65歲的2.578倍。跨區住院日數≧7日，病人所在地無醫學中心是有醫學中心的1.071倍，女性是男性的0.585倍，年齡≧65歲是小於65歲的1.651倍。結論：病患居住地醫療資源豐富程度對跨區醫療利用行為有顯著影響。本研究據此提出研究建議與相關政策建議。

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Cisplatin併用新抗癌藥物Betulin於非小細胞肺癌之效益

Cisplatin對於很多癌症，包括肺癌都是相當有效果的化療藥物，然而它是屬於非特異性的藥物，在治療上受限於病患體內正常細胞的毒性以及其他的併發症。Betulin屬於三萜類化合物可抑制腫瘤。本研究之目的係利用Betulin與Cisplatin合併使用處理肺癌細胞，增加Cisplatin之抗癌的療效。本研究證實，將Betulin與Cisplatin合併使用，可以抑制肺癌細胞的生長，並增加誘導肺癌細胞凋亡。因此，Betulin與Cisplatin合併使用之初步結果，以期能開啟肺癌治療之合併式療法之新方向。

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以病患血紅素探討輸血決策點與輸血目標值

目的：輸血在臨床上是治療貧血的一種方式，判斷病患是否需要輸血常以抽血檢驗病患的血紅素濃度，如何適當地使用成分血品是目前臨床上重視的議題。本研究將以病患輸血前、後的病患平均血紅素濃度來分析成分紅血球血品使用的情況。方法：本研究採用回溯性研究方法，共收集3037筆資料。並收集所有病患在輸血前後一周內最近一次血紅素濃度報告，並以獨立樣本t檢定、單向ANOVA分析進行平均血紅素濃度的差異分析。結果：內、外科系輸血前平均血紅素濃度為7.3±1.5 g/dL及9.6±2.1 g/dL，輸血後平均血紅素濃度8.9±1.7 g/dL及10.3±1.8 g/dL，且有顯著差異(P＜0.01)。急診內科病患輸血前、後平均血紅素濃度為6.9±1.5 g/dL及8.2±1.6 g/dL，低於門診輸血前、後平均血紅素濃度7.4±1.4 g/dL及8.8±1.9 g/dL，和住院病患輸血前、後平均血紅素濃度7.4±1.6 g/d及9.2±1.7 g/dL，三者且有顯著差異(P＜0.01)。內科系81歲以上病患輸血前、後的平均血紅素濃度為7.4±1.3 g/dL及9.1±1.6 g/dL高於17-40歲病患輸血前、後的平均血紅素濃度6.9±1.3 g/dL及8.6±1.1 g/dL，且有顯著差異(P＜0.01)。內、外科男性病患在輸血前、後平均血紅素濃度為7.3±1.7 g/dL、8.8±1.7 g/dL、9.5±2.3 g/dL及10.3±2.0 g/dL和內、外科女性病患在輸血前、後平均血紅素濃度7.3±1.4g/dL、9.1±1.6g/dL、9.7±2.0g/d及10.4±1.6g/dL，無顯著差異(P＞0.05)。結論：內科和外科在輸血決策點和輸血目標值的結果具有差異。本研究發現大部分內科次專科在輸血決策點和輸血目標值具有共識。而內、外科輸血決策點和輸血目標值不會因為性別不同而有所差異，與病患年齡多寡和對貧血的耐受性較具關連性。

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Clinical and Functional Outcome of Revision Anterior Cruciate Ligament Reconstruction by Double-Bundle Technique: 2 Cases Report

The anterior cruciate ligament (ACL) is the most stable structure of the knee. The physical demands associated with the surgical procedure, the time and energy invested in aprolonged rehabilitation program, and the emotional challenges associated with the altered activity level during the sixmonths or longer rehabilitation period can be daunting to apatient who is faced with needing a revision ACL reconstruction (ACLR).The key to successful revision surgery is to find out the real cause of the problem. Revision double-bundle (DB) ACL surgery is a challenging technique that requires consideration of many factors. We have succeeded in using DB ACLR with hamstring tendon autograft techniques to improve the prognosis of these patients and can be evaluated from objective examinations and increased significantly scores. This report describes the 2 cases of revision DB ACLR with hamstrings tendon performed successfully at our institution.

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An Unusual Giant Subepicardial Lipoma: A Case Report

Primary tumors of the heart are rare and mostly benign. We report a case of a 72- year-old woman presenting with progressive dyspnea on exertion and both leg edema for 7 months. Serial examinations with echocardiography and computed tomography identified a cardiac tumor located along the posterior aspect of the heart. Video assisted thoracoscopic surgery was performed and the pathology revealed a lipoma. The patient's postoperative recovery was uneventful. A video-assisted thoracoscopic procedure with minithoracotomy can provide information on the differential diagnosis and therapy of cardiac subepicardial lipomas.

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Massive Bloody Pleural Effusions and Diagnostic Challenges in Epithelioid Type Malignant Mesothelioma: A Case Report

Malignant pleural mesothelioma is relatively rare and characteristic of massive pleural effusions. A 57-year-old male visited our hospital due to progressive exertional dyspnea for two months. The images revealed massive left pleural effusions. After chest tapping, the effusion was bloody. The pleural cytology and cell block showed blood clots and a few degenerative cells. We tried to use CytoRich Red preservative solution (BD Diagnostics) to lyse red blood cells and reduce background materials. After using additives, the bloody background was improved and clusters of atypical mesothelial cells were present. Herein, he received thoracoscopic biopsy and chest tube drainage. The histopathology and immunehistological studies with calretinin led to the diagnosis of malignant mesothelioma, epithelioid type, which was a relatively rare pathology. Because the bloody effusion has been reported as a diagnostic problem for malignant mesothelioma, the preparation and fixation solution may be helpful for making early and correct diagnoses.