• 期刊

Potentially Fatal Physical Diseases in Patients with Schizophrenia

Compared to the general population, life expectancy for patients with schizophrenia is reduced by 15 to 30 years. More than 60% of this excess mortality is due to physical disorders. Healthcare professionals often overlook physical disorders when examining patients with schizophrenia. In this article, we focused on potentially fatal physical diseases in patients with schizophrenia. Risk factors for metabolic syndrome in patients with schizophrenia include schizophrenia itself, unhealthy dietary habits, sedentary lifestyle, smoking, and adverse effects of antipsychotics and related medications. Fifty percent of patients with schizophrenia are overweight; about 20% appear to have significant hypertension or hyperglycemia, and at least 40% have lipid abnormalities. Patients with schizophrenia have an almost fourfold increased risk of insulin resistance compared to the general population. Cardiovascular disease is the leading cause of death among these patients, who have a higher incidence of and mortality from cardiovascular disease than the general population. Patients with schizophrenia also have significantly elevated risk of and mortality from strokes. From 1.3% to 22.9% of schizophrenic patients have HIV infections, significantly more than the general population. A number of studies support increased risk of tuberculosis in patients with schizophrenia. These patients also have an approximately threefold greater risk of developing hepatitis B and C, possibly due to increased exposure to substance abuse and/or unsafe sexual behaviors. Data show an increased incidence of lung, breast, and colon cancers among schizophrenic patients. Health care professionals should incorporate early prevention and active treatment with reversible fatal physical diseases in patients with schizophrenia.

• 期刊

高壓氧於泌尿科疾病之潛在臨床應用

高壓氧治療在臺灣已發展四十多年，目前健保適應症包含有氣體栓塞症、減壓症、燒燙傷、放射線組織壞死、復發性骨髓炎等。該治療是患者處在大於1.4個絕對大氣壓的壓力艙中，間歇地接受100%的純氧。高壓氧具有增加組織氧含量、縮小氣泡體積、增加血管新生、加速纖維母細胞再生以及傷口恢復等多種機轉，藉此能幫助疾病的治療。現有文獻在泌尿科疾病的運用，包含有急性腎損傷、糖尿病腎病變、輸尿管阻塞、出血性膀胱炎、間質性膀胱炎、產氣性膀胱炎、尿道下裂術後、攝護腺癌、龜頭急性缺血壞死、陰莖截斷、睪丸扭轉、陰莖異常勃起、勃起功能障礙、男性不孕症等，都有正向的評價。但這些疾病的運用可能因為高壓氧自費的考量及鮮為人知，使得臨床個案數有限。雖然現有的實證醫學等級不高，但臨床醫師經與患者討論高壓氧的風險及益處後，仍可考慮結合主要的常規治療，以期提升治療的效果。希望藉由本文推廣高壓氧在泌尿科疾病的運用，增加醫師及患者在治療上的選擇。

• 期刊

The Effects of Fermented Wheat Germ Extract on Cancer-Related Fatigue

Objective: This study aimed to investigate the effects of fermented wheat germ extract for improving fatigue in patients receiving chemoradiotherapy. Methods: The study conducted with outpatient cancer patients from the oncology department. Institutional Review Board evaluation and approval were obtained before conducting the study. Using a clinically prospective randomized study design, fermented wheat germ extract was administered to the experimental group (n = 11). The control group received routine nutritional care (n = 12). All the patients (n = 23) received dietary counselling and advice. EORTC QLQ-C30 and EORTC QLQ-FA12 were used to assess the quality of life and the impact of cancer-related fatigue. The nutritional status was assessed using the Patient Generated-Subjective Global Assessment (PG-SGA), and biochemical data on indicators was related to the nutritional status. Results: The results showed that post-intervention PG-SGA scores and QLQ-FA12 scores were significantly lowered compared with the pre-intervention scores. In both the groups, the nutritional status and degree of cancer-related fatigue were significantly improved. The QLQ-C30 score was significantly lower on the symptom scale, indicating a significant improvement in clinical symptoms or side effects. In the global health status, the scores were increased significantly, indicating a good quality of life, and the intervention group demonstrated significant improvement compared to the control group (p = 0.034). Conclusion: The fermented wheat germ extract is an effective intervention to improve appetite in cancer patients receiving chemotherapy, and to reduce the symptoms of cancer-induced fatigue and improve the quality of life.

• 期刊

居家施打長效針劑對思覺失調症患者主要照顧者生活品質之影響

目的：為瞭解居家訪視的思覺失調症病人，當病人施打抗精神病長效針劑相較於口服精神病藥物，主要照顧者生活品質是否有所差異。期望依據研究成果，提供思覺失調症病人及其家屬都能獲得較高品質的醫療照護，並提升其生活品質。方法：本研究採橫斷式研究設計，研究對象為居家規則訪視思覺失調症病人，採便利取樣，研究對象共90人。於居家訪視時收集資料，研究工具採結構式問卷填答。結果：結果顯示居家思覺失調症主要照顧者生活品質在病人施打抗精神病長效針及口服藥物間的生活品質並無顯著差異。結論：為維持思覺失調症病人病情穩定，施打長效針劑對病人有其必要性，讓病人規則用藥，達到穩定病人病情的效果。因此，避免病人用藥中斷，不僅提升精神科病人的照顧品質，同時也提升主要照顧者生活品質。

• 期刊

肺部腫瘤立體定位全身放射治療設定靶體積外擴緣範圍之經驗評估

目的：研究中收集4D錐狀斷層掃描（4-Dimensional Cone Beam Computed Tomography, 4DCBCT）影像導引的位移量數據，來分析並計算出更符合本科治療靶體積外擴緣範圍的參考值。方法：回溯由2013年至2018年共21位肺部轉移且完整接受SBRT治療的病患，收集直線加速器影像軟體XVI（X-Ray Volume Imaging）數據，計算擺位誤差，22最後以公式M=2.5Σ+β√σ^2+σ^2_p-βσ_p推估靶體積外擴緣之參考值。結果：由XVI數據結果分析出系統誤差Σ為0.07、0.12、0.09 cm分別代表Tx，Ty，Tz；而0.24、0.3、0.31度則分別代表Rx，Ry，Rz。隨機誤差σ方面為0.13、0.28、0.15 cm分別代表Tx，Ty，Tz；而0.46、0.5、0.55度則分別代表Rx，Ry，Rz，以公式演算後靶體積外擴緣計算結果分別為0.20、0.35、0.24 cm分別代表R-L，S-I，A-P平面方向，0.72、0.89、0.94度則分別代表Rx，Ry，Rz旋轉方向。結論：臨床上SBRT治療的過程中之擺位誤差，能借此公式推算出日後所有治療SBRT病患靶體積外擴緣為ITV+0.35 cm為最理想的安全範圍，最終能減少正常肺部組織的傷害。

• 期刊

A Huge Atypical Meningiom: A Case Report and Literature Review

Atypical meningioma(AM) belong to WHO Grade II tumors and account for 5% of the most common extra-axial primary cerebral neoplasm. We reported a 69-year-old woman with a normal healthy records in the past 30 years. The patient was present to the emergent department owing to consciousness disturbance on 22nd Feb. 2021. Under the impression of stroke, head computerized tomogram revealed a huge right frontal meningioma (6.5x4.1cm) with adjacent cerebral edema, resulting in leftward shift and deformed left ventricle. Surgical procedures enrolled right frontal-temporal craniotomy and Echo guided tumor removal. The post-operative improvement included increased muscle power within four days and regained spontaneous respiration after weaning profile. Ten days later, the patient was discharged with slight limited fine motion of left forearm. The therapeutic program includes rehabilitation and adjuvant radiotherapy. This report lends credence to support accurate diagnosis of AM, optimal surgical management and adjuvant radiotherapy offers a better result in an AM case.

• 期刊

具雙腭側五根管之上顎第二大臼齒：病例報告

處理複雜的根管系統時，臨床醫師必須具備對每顆牙齒牙根與根管之數目與形態有正確的認知，才能避免遺漏根管導致根管治療失敗。典型的上顎第二大臼齒通常有三個牙根每個牙根各含一個根管，多篇文獻證實其牙根與根管之形態與數目容易有變異，除了吾人所熟知近心頰側牙根常有第二個根管外，對腭側牙根具雙根管較少論述。本案例藉由顯微鏡與錐狀射束電腦斷層技術，探討具五個根管之上顎第二大臼齒腭側單牙根具雙根管及牙根融合的影響，解析腭側單牙根具雙根管與牙根融合伴隨發育溝的形成，及其所導致臨床醫療應注意表徵，並對少見的腭側單牙根具雙根管盛行率加以討論。