• 期刊

慢性腎臟病與睡眠障礙

睡眠障礙會影響普通人的生活品質與整體健康。但對於慢性腎臟病與睡眠障礙相關性的研究探討是相對複雜而且缺乏。隨著睡眠障礙分類的確立，讓一線醫護人員可以保持高度警覺，需要時轉介睡眠專科醫師進一步確診與治療。希望藉由早期診斷與早期轉介治療，可以改善慢性腎臟病病人的生活品質與預後。

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Prognostic Validation of Pitt Bacteremia Score, Sequential Organ Failure Assessment and Quick Sequential Organ Failure Assessment Scores in Hospitalized Patients with Invasive Candida Infections

Objective: This study determined the prognostic abilities of the Pitt Bacteremia Score (PBS), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA) in hospitalized adults with invasive candidiasis.. Methods: Adults hospitalized between 2013 and 2016 at Tainan Municipal An Nan Hospital whose sterile body site specimens yielded Candida were retrospectively analyzed. Results: Of 951 patients with Candida infections, 58 (aged 66.2 ± 13.2 years) were included. PBS, SOFA, and qSOFA scores averaged 2.12 ± 3.15 (range 0-14), 4.57 ± 4.45 (range 0-16), and 0.69 ± 0.78 (range 0- 3), respectively. The average PBS, SOFA, and qSOFA scores in nonsurvivors versus survivors were 3.78 versus 1.03 (p ＜ 0.003), 7.17 versus 2.86 (p ＜ 0.001), and 1.09 versus 0.43 (p ＜ 0.005), respectively. The areas under the receiver operating characteristic (ROC) curve predicting in-hospital mortality for PBS, SOFA, and qSOFA scores were 0.78 (95% CI 0.66-0.88), 0.75 (95% CI 0.62-0.86), and 0.70 (95% CI 0.56-0.81), respectively. The area differences in ROCs between PBS and SOFA, SOFA and qSOFA, and qSOFA and PBS were 0.03 (95% CI, -0.09-0.15), 0.09 (95% CI, -0.09-0.21), and 0.06 (95% CI, -0.08-0.19), respectively. Conclusion: PBS was the most accurate predictor among these three systems.

• 期刊

基於人工智慧的皮膚病理影像辨識

目的：人工智慧快速的發展，已經吸引很多人的興趣，關注它在醫學影像問題上的應用。隨著人工智慧時代的來臨，在人工智慧中，深度學習已經變成主要的技術，它在影像處理方面能力很強。我們想藉由深度學習，建立個人化人工智慧助理，可幫助皮膚科醫師在皮膚病理方面做出正確的診斷。此外，病理科醫師在傳送病患病理診斷到健保雲端前，可利用此助理再度確認診斷。方法：在低階深度學習框架中，選擇最常用的Tensorflow框架。在高階深度學習框架（High-Level DL Frameworks）中，則選擇Keras框架。我們訓練了一個卷積神經網路模型來辨識皮膚病理。計算辨識準確率、損失函數值、k-fold cross-validation、精確率、召回率、AUC（area under the ROC curve）值、ROC曲線（Receiver Operating Characteristic curve）來偵測此卷積神經網路模型表現。結果：訓練組準確率及損失函數值分別為86.23%及0.3363。測試組準確率及損失函數值分別為84.60%及0.3957。此結果顯示個人化人工智慧助理表現良好。結論：人工智慧在皮膚病理影像辨識方面是有幫助的。

• 期刊

代謝症候群及組成因子對巴瑞特氏食道症之影響分析

目的：本研究主要探討代謝症候群及組成因子對巴瑞特氏食道症之影響分析。方法：本研究為回溯性研究設計，以2015年1月1日～2019年12月31日期間收集高雄市某區域醫院消化內科病患病歷資料為研究對象。利用病歷個人基本資料、生活習慣、身體理學檢查數據進行資料處理。巴瑞特氏食道症定義以消化內科專科醫師判定為定義。以邏輯斯迴歸分析巴瑞特氏食道症的可能影響因子。結果：本研究計3958名個案。在分析變項時取各變項數據完整者之個案進行分析。結果顯示；病理檢查巴瑞特氏食道症1265人（佔32.0%）。身體質量指數屬於過重及肥胖者，較正常及過輕者，有顯著較高的巴瑞特氏食道症盛行率（p=0.013）。腰圍異常者與空腹血糖異常者均較正常者有顯著較高的巴瑞特氏食道症，比例分別為（36.7% vs. 12.8%, p=0.004），（40.7% vs. 33.8%, p=0.004）。有抽菸者巴瑞特氏食道症比例顯著高於沒有者（37.8% vs. 30.9%, p=0.001）。代謝症候群異常者巴瑞特氏食道症比例高於正常者（37.8% vs. 30.9%），但未達統計顯著差異（p=0.143）。以邏輯斯迴歸分析結果顯示；代謝症候群組成因子之腰圍、血壓是巴瑞特氏食道症影響因子，其異常者是正常者的4.16、3.30倍，95%信賴區間分別為（1.30-13.29、1.05-10.35）。結論：代謝症候群及組成因子之腰圍、血壓還有抽菸是巴瑞特氏食道症的影響因子。

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Left-Sided Hydropneumothorax Caused by Boerhaave Syndrome: A Case Report

Boerhaave's syndrome is one of the most lethal diseases of the gastrointestinal tract and needs early diagnosis and treatment. Symptoms may vary, including vomiting, chest or epigastric pain, subcutaneous emphysema and septic shock. Early diagnosis can be challenging, early management of surgical repair and debridement with antibiotic using was essential to reduce mortality. Herein, we report a 57-year-old mand had epigastric pain with left hydropneumothorax on a x-ray of standing abdomen. Computed Tomograpgy showed esophageal rupture, then he accepted thoracoscopic procedures and antibiotics treatments . He discharged smoothly from our ward 2 months later. We emphasize the importance of history taking and basic image reading.

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Occurrence of Abdominal Compartment Syndrome during Percutaneous Nephrolithotomy: A Case Report

Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgery commonly used to remove large or multiple kidney stones. During PCNL, continuous irrigation is required for satisfactory surgical field visualization and to wash away fine stone fragments and blood clots. However, irrigation fluid may unexpectedly extravasate into the abdominal cavity and induce abdominal compartment syndrome (ACS); it can also penetrate the weak portion of the diaphragm and cause hydrothorax. ACS with or without hydrothorax is a potentially lethal complex pathological state in which an acute increase in intra- abdominal pressure may induce multiple organ failure. To prevent morbidity and mortality caused by ACS, early detection of extravasation is critical, which may be challenging because this procedure is mostly performed with the patient in the prone position. Here, we describe a case, which was detected early and promptly managed, of ACS combined with hydrothorax that occurred during PCNL.

• 期刊

Pseudomyxoma Retroperitonei in an Elderly Male Patient: A Case Report and Review of the Literature

Pseudomyxoma retroperitonei is a rare conditionresulting from appendiceal mucinous cystadenoma or mucinous adenocarcinomas. In this report, we present a case of an elderly man who presented to the hospital with vomiting and poor appetite. After a series of examinations, he was diagnosed with pseudomyxoma retroperitonei. It is worth mentioning that the drainage culture yielded Bacillus cereus, yet the patient did not have the systemic infection signs. Exploratory laparotomy with en bloc resection was performed successfully. Overall, the retroperitoneal cystic lesions are considered pseudomyxoma retroperitonei, a highly recurrent disease,and are managed on a case-by-case basis by the size, location, and surgical risks. En bloc resections are not always perfect; thus, a follow-up approach and perioperative chemotherapy may be necessary.