• Journals

運用醫病共享決策實證知識轉譯協助下肢靜脈性潰瘍病人選擇壓力治療輔具之經驗

下肢靜脈性潰瘍（VLUs）為頑固且難癒合的慢性傷口，傷口的發生與靜脈高壓有關，病人需要持續壓力治療，以促進傷口癒合。然而，坊間有關壓力治療輔具的資訊雜亂，導致病人無從選擇。為了解決這個問題，我們團隊使用實證的方法設計了一個病人決策輔助工具（PDA），在整形外科門診進行醫病共享決策（SDM），目的在幫助病人選擇合適的壓力治療輔具。執行時間為2021年5月7日至2023年3月1日，有29位VLUs病人參與，年齡為72.0±13.3歲，傷口持續時間34.8±54.3月。結果表示有89.64%的病人在參與SDM後，對壓力治療輔具選擇有更清楚的了解，後續追蹤發現11位有確實執行壓力治療的病人，傷口大小明顯縮小或完全癒合。結果確認了在協助VLUs病人選擇壓力治療輔具時，介入SDM的重要性，對於提升病人的知識理解，促進傷口癒合具有積極的潛力。

• Journals

經皮椎體成形術治療骨質疏鬆性脊椎骨折預後評估之研究

目的：從病人術後疼痛改善之程度，來評估經皮椎體成形術治療骨質疏鬆性椎體壓迫性骨折之預後變項。方法：本研究利用回溯性資料，收集2015～2019年高雄市某區域醫院執行經皮椎體成形術治療骨質疏鬆性椎體壓迫性骨折病患病歷資料為研究對象。利用病歷資料個人基本資料、生活習慣、骨質疏鬆程度、術前X光等。研究統計分析經皮椎體成形術治療骨質疏鬆性椎體壓迫性骨折病患之預後成效。結果：在骨質密度上，骨鬆者比低骨量者，預後有顯著較高比例持續背痛（62.5% vs. 30.8%）。經皮椎體成形術治療胸椎及胸與腰椎皆骨折者，預後較行腰椎骨折者有顯著較高比例持續背痛（72.7% vs. 68.8% vs. 38.5%），達統計顯著（p<0.05）。利用邏輯斯迴歸分析影響骨質疏鬆性椎體壓迫性骨折病患之預後顯示；經皮椎體成形術在胸節比在腰節骨折之治療，預後明顯著較差，OR=16.73，達統計顯著差異（p=0.035）。結論：經皮椎體成形術治療之骨折部位以及骨質密度之差異是影響椎體成型術預後重要影響因子。

• Journals

穿心蓮內酯調控PTEN/PI3K/AKT抑制腎細胞纖維化研究

目的：穿心蓮內酯（Andrographolide）已證實具有多種藥理活性，在動物實驗中亦證實具有抑制細胞纖維化、清除活性氧自由基與抗發炎等；然而對抑制腎臟纖維化的功效卻尚未有系統化之分析。本研究主要探討Andrographolide是否具有抑制腎纖維化及其相關訊息路徑研究，以腎臟細胞（786-O cell line）進行TGF-β誘發細胞纖維化培養，探討Andrographolide對於抑制腎臟細胞細胞纖維化的影響，我們使用西方墨點法分析相關訊息路徑變化情形與下游蛋白質的表現，以進一步探討Andrographolide抑制腎臟纖維化之機轉。方法：本研究以腎臟細胞（786-O cell line）加入TGF-β培養以誘發細胞纖維化，並測定fibronetin以確認細胞纖維化的程度，然後將腎臟細胞加入不同濃度之Andrographolid共同培養，以西方墨點法分析相關訊息路徑包含PTEN、PI3K、Akt、NF-κB蛋白質變化情形，以進一步探討Andrographolide抑制腎臟細胞纖維化之機轉。結果：研究結果顯示，加入不同濃度之Andrographolid後，發現明顯抑制導致細胞發炎之纖維蛋白fibronetin的濃度，統計分析後顯示隨著Andrographolid濃度上升，fibronetin的濃度呈統計顯著下降（p<0.05），顯示Andrographolid確實具有抑制細胞纖維化之能力；然後經西方墨點法分析PTEN（Phosphatase and tensin homolog）、PI3K（Phosphoinositide 3-kinases）、Akt（protein kinase B）、NF-κB（nuclear factor kappa-light-chain-enhancer of activated B cells）蛋白質濃度後發現，隨著Andrographolid濃度上升，PTEN的濃度呈統計顯著上升（p<0.05），而PI3K、Akt、NF-κB的濃度均呈統計顯著下降（p<0.05）。結論：因此本研究成功證實Andrographolid具有抗腎臟細胞纖維化之能力與其可能之細胞訊息機轉，本研究促進抗細胞纖維化相關機制的瞭解與可能療法的方向。

• Journals

Spinal Schwannoma Induced Cauda Equina Syndrome and Conus Medullary Syndrome: Cases Report and Literature Review

Cauda equina syndrome(CES) and Conus medullary syndrome(CMS) were neurological disasters owing to lumbar and sacral nerve roots compression. Spinal schwannoma(SW) is implicated as an intradural extramedullary lesion to engender CES or CMS. This study aimed to verdict a therapeutic paradigm of SW patients with CES and CMS. Two cases, mean age = 56±3 years, were enrolled. Gender(1:1); one lumbar spinal intramedullary neoplasm presented paraplegia, lumbodynia and stool incontinence as well as perianal numbness; the other had monoplegia, lumbodynia and perianal numbness. Both the patients had post-operative CSF leakage, healed thru tight closure(2/2). Stool and urinary incontinence was amended later. The neurologic deficits resumed postoperatively. This study lends credence to reinforce precise diagnosis, surgical remedy ameliorates CES and CMS in SW patients. Amid the predictive elements, SW removal shortly after the commencement of CES and CMS becomes a promising factor to cure neurologic sequel in SW patients.

• Journals

Double-Level Partial Rupture of Unilateral Achilles Tendon: An Unusual but Disabling Injury

We present the case of a 43-year-old female with a partial Achilles tendon rupture. The patient experienced a popping sensation while running and a painful weakness while walking, both indicative of a rupture. However, physical examination showed no gap during palpation and a negative Thompson test, suggesting a partial tear. This case's features are discussed with its implications, including the possibility of progress to complete rupture. The patient underwent surgical repair of the Achilles tendon due to high functional demand. It is crucial to consider the risks associated with such a procedure, in this case, including the possibility of progression to a full rupture, as well as the potential for complications. Partial Achilles tendon ruptures require imaging (ultrasound/MRI) for diagnosis, and often surgery for large tears to prevent progression and ensure tissue re-approximation.

• Journals

Pott's Puffy Tumor Presenting as an Eyelid Lump: A Case Report

Pott puffy tumor (PPT) is osteomyelitis of the frontal bone with associated subperiosteal abscess giving rise to swelling and edema over the forehead and scalp region. It is usually associated with frontal sinusitis or trauma. In this case, we described a Pott's puffy tumor over right frontal region and eyelid.

• Journals

Scrotal Flap Reconstruction for Penile Abscess: A Case Report and Literature Review

Penile and periurethral abscesses are rare but can pose serious risks of morbidity and mortality. Delayed diagnosis can exacerbate treatment challenges, leading to septic complications. We present a case of penile abscess complicated with necrotizing fasciitis. Despite aggressive intervention, including multiple debridement sessions and antibiotic regimens, a significant penile skin defect and urethral fistula persisted. We successfully managed this condition with scrotal flap reconstruction. Our literature review explores the multifaceted aspects of penile abscess management, associated risk factors, diagnostic imaging modalities, and treatment options. To identify the timely and accurate interventions, we highlight various reconstruction techniques for penile skin defects, such as scrotal flap reconstruction and penile skin grafting. Awareness of risk factors for graft failure is essential for optimizing patient care.