輔仁醫學期刊最新文献

{"title":"以台灣版本「繁體中文兒童執行功能量表」(TC-CHEXI)檢驗自閉症類障礙、注意力不足過動症與共病患童之執行功能","authors":"林慧麗 林慧麗, 陳劭芊 Hui-Li Lin","doi":"10.53106/181020932023122104001","DOIUrl":"https://doi.org/10.53106/181020932023122104001","url":null,"abstract":"背景和目的：CHEXI已被證明是一種跨文化、免費下載、方便且心理計量特質合宜的工具，用於評估社區兒童的執行功能。本研究使用台灣版「繁體中文兒童執行功能量表」（TC-CHEXI）評估由兒科精神科醫生診斷患有自閉症類障礙、注意力不足過動症以及兩者共病的兒童的執行功能，以探索該工具如何幫助我們了解臨床樣本的執行功能。方法：共有87名兒童的主要照顧者參加；包括 18名患有自閉症類障礙的兒童（17名男孩）、46名患有注意力不足過動症的兒童（34名男孩）和23名共病診斷的兒童（22名男孩）。本研究使用注意力不足過動症兒童執行功能量表做為效標，檢驗TC-CHEXI在臨床樣本中的效標關聯效度。此外探討了TC-CHEXI與自閉症兒童行為評定量表和修訂版重複行為量表間的相關性。最後在控制了年齡、性別和智商之後比較三組的執行功能。結果：使用TC-CHEXI檢驗臨床樣本的執行功能，顯示與預期相符的執行功能障礙。此外，TC-CHEXI在臨床樣本中，被證實具有良好的效標關聯建構效度。結論：TC-CHEXI是心理計量學上可靠且有效的執行功能評估工具，可用於社區樣本，協助吾人進行自閉症類障礙與注意力不足過動症初步的篩檢。  Background and purposes: The CHEXI has been shown to be a cross-cultural, free-to-download, convenient and psychometrically proper tool to evaluate the exec-utive functioning (EF) of children in community. The present study evaluated the EF of children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and comorbidity of ASD and ADHD as diagnosed by a pediatric psychiatrist by using the Taiwanese Traditional-Chinese CHEXI (TC-CHEXI) in or-der to explore how the tool can help us understand the EF in clinical samples. Methods: In total, the primary caregivers of 87 children participated; they com-prised 18 children with ASD (17 boys), 46 children with ADHD (34 boys), and 23 children with comorbid ASD and ADHD (22 boys). The Executive Functions Rating Scale for Children with ADHD was used to investigate the criterion-related validity of the TC-CHEXI. The correlations of the TC-CHEXI with the Behavioral Rating Scale for Children with Autism and the Repetitive Behaviors Scale-Revised were also explored. Group comparisons on their EF subcomponents were conducted with age, gender, and IQ controlled for. Results: The findings suggest that examining with the TC-CHEXI, the EF of the clinical samples comprised of ASD/ADHD were shown to be dysfunctional as expected. Furthermore, the TC-CHEXI was noted to have criteria-related construct validity in clinical settings. Conclusion: The results showed that the TC-CHEXI is a psychometrically reliable and valid EF assessment tool to be used in community settings for primary screening of ASD/ADHD.","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"128 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139189405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"腦膜瘤切除後原位復發膠質母細胞瘤之病例討論及文獻回顧","authors":"金士翔 金士翔, 謝政達 Shih-Hsiang King, 劉之怡 Cheng-Ta Hsieh, 張志儒 張志儒","doi":"10.53106/181020932023122104005","DOIUrl":"https://doi.org/10.53106/181020932023122104005","url":null,"abstract":"腦膜瘤和膠質母細胞瘤有截然不同之病理生理學特徵。先前曾切除過腦膜瘤且沒有經歷過放療等誘發因素的新生成膠質母細胞瘤在過往文獻很少見，對於其成因或危險因子目前沒有定論。我們報告了一名 78 歲男性，他被診斷出患有腦膜瘤，十三年前接受腫瘤切除術並在追蹤期間保持穩定且無輔助放療。本次入院主訴為近期出現雙下肢肌無力，頭痛和口齒不清。在先前切除的腦膜瘤位置附近發現右側顳葉顱內腫塊。最終病理報告確診為膠質母細胞瘤。本例可能是巧合的結果，或支持先前文獻認為腦實質損傷與高級別膠質瘤形成有因果關係。  Cases introduced glioblastoma arises from previously resected meningioma without inducing factors are rare. We reported a 78-year-old male who was diag-nosed with meningothelial meningioma, underwent tumor excision and remained stable during out-patient department follow up without adjuvant radiotherapy ad-ministrated 13 years ago before this admission. An intracranial mass lesion in right temporal lobe was found around the location of previous resected meningioma. Final pathology report confirmed a diagnosis of glioblastoma. This case may be a result of coincidence or supports previous hypothesis of the relationship between parenchy-mal injury and high-grade glioma formation.","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"35 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139191100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"護理人員對出院準備服務之知識、態度、行為相關因素之探討－以北部某區域醫院為例","authors":"鄭鈺郿 鄭鈺郿, 浦啟明 Yu-Mei Jeng, 劉雪玲 劉雪玲, 黃露萩 黃露萩, 洪啓峯 洪啓峯, 郭紋容 Chi-Feng Hung","doi":"10.53106/181020932023122104002","DOIUrl":"https://doi.org/10.53106/181020932023122104002","url":null,"abstract":"目的：探討北部某區域醫院護理人員對出院準備服務知識、態度、行為之相關因素。方法：為橫斷性研究設計，於 2022年 8 月對北部某區域醫院執業滿三個月之臨床護理人員共360位進行結構式問卷調查，包含個人屬性資料、出院準備服務知識量表、服務態度量表、服務行為量表以單因子變異數分析、相關係數與迴歸進行資料分析。結果：護理人員出院準備知識與態度(r = 0.56，p＜.001）、態度與行為(r =0.43，p＜.001），呈現中度正相關；行為與知識(r = 0.71，p＜.001），呈現高度正相關，廻歸分析結果，控制人口學變項後知識總分越高則執行出院準備服務行為也會越高(β=- 0.637，p＜.001）且有無執行服務經驗無論在知識、態度及行為均達統計上顯著差異。結論：從此研究的結果中，我們可得知教育訓練的提供及高參與經驗不但對於了解程度及所抱持的態度有顯著的影響，經常執行出院準備服務經驗者其態度較為正向，因此提供給這些護理人員足夠的教育訓練，並且透過教育訓練來培育增加了解程度。  Objective: Exploring the factors associated with nursing staff’s knowledge, at-titude, and behavior towards discharge planning in a northern regional hospital. Methods: Designed for a cross-sectional study, a structured questionnaire survey was conducted among 360 clinical nurses who had been practicing for three months in a northern regional hospital in August 2022, Data including personal attribute data, discharge planning knowledge scale, attitude scale and behavior scale were analyzed by univariate ANOVA, correlation coefficient and regression. Results: The knowledge and attitude (r = 0.56，p＜.001), attitude and behavior (r =0.43，p＜.001)of nurses’ discharge preparation showed moderate positive correlation., there was a significant positive correlation between behavior and knowledge (r = 0.71，p＜.001 ). The results of regression analysis showed that the higher the total score of knowledge was, the higher the performance of service preparation was (β=- 0.637，p＜.001), and there were statistically significant differences in knowledge, attitude and behavior with or without service experience. Conclusion: From the results of this study, we can see that the availability of educational training and high participa-tion experience not only had a significant effect on the level of understanding and attitude, but also the attitude of those who frequently performed discharge planning was more positive, so provide these nursing staff with sufficient education and training, and through education and training to increase the level of understanding.","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"148 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139189656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"非感染性葡萄膜炎引起囊狀黃斑部水腫合併產生視神經發炎","authors":"彭繼賢 彭繼賢, 陳怡伶 Chi-Hsien Peng","doi":"10.53106/181020932023122104003","DOIUrl":"https://doi.org/10.53106/181020932023122104003","url":null,"abstract":"本文宗旨：報告一位23歲女性和41歲男性罹患非感染性葡萄膜炎，引起囊狀黃斑部水腫並合併產生視神經炎，使用口服類固醇成功治療的兩個病患。方法：回顧性病例報告。結果：病例1是23歲女性主訴雙眼模糊，雙眼呈現玻璃體炎、囊狀黃斑部水腫和視神經炎。病例2是41歲有HLA-B27陽性前房葡萄膜炎病史的男性，主訴打完COVID-19高端疫苗一天後右眼模糊，右眼呈現玻璃體炎、囊狀黃斑部水腫和視神經炎。腦部核磁共振呈現視神經顯影增加，確立視神經炎診斷。兩位病患使用局部和口服類固醇藥物後逐漸好轉，黃斑部水腫和視神經炎完全改善，6個月後追蹤沒有復發。結論：平坦部炎相關的非感染性葡萄膜炎，可以合併產生視神經炎。有可能因為相同基因例如HLA-DR15介入而造成兩者疾病。  Spinal epidural abscess is an uncommon but critical central nervous infection. It can be life threatening and result in severe morbidity. We presented with a case of pan-spinal epidural abscess with relation to deep neck infection, empyema and shock. He had sudden quadriplegia with numbness below shoulder, unstable hemodynamic status and respiratory failure. Emergency intubation, surgical debridement of the em-pyema and prescription of antibiotics were the initial treatments. His vital signs grad-ually stabilized and then he received surgical decompression of C1-3 laminectomy and debridement of the spinal abscess. After the antibiotic treatment and rehabilitation for 6 weeks his hands and legs weakness got much improving and can have oral intake by himself. Pan-spinal epidural abscess usually involves many other medical problems, therefore resulting poor physical condition and poor prognosis. With interdisciplinary teamwork and critical care medicine there is more and more evidence supporting that surgical intervention with antibiotic treatment and rehabilitation is recommended for the patient with pan-spinal epidural abscess","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"38 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139196320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GABAB受體腦炎患者的康復軌跡個案報告","authors":"廖晏輝 廖晏輝, 陳冠宇 陳冠宇, 姜振華 Guan-Yu Chen, 李耀東 李耀東, 黃立楷 黃立楷","doi":"10.53106/181020932023122104004","DOIUrl":"https://doi.org/10.53106/181020932023122104004","url":null,"abstract":"自體免疫性抗GABAB受體腦炎是一種罕見的疾病，在最初的神經精神症狀發生後，也常伴隨後遺症。我們提出一例經腦脊液檢測證實的抗GABAB受體腦炎病例，並由磁振造影成像 (MRI) 檢測到相應的左顳葉病變。透過長時間追蹤與臨床觀察、多次腦部磁振造影成像和認知功能，持續記錄其康復軌跡，提出縱貫性證據，並且在此個案中，使用重複大劑量皮質類固醇衝擊療法，有效地阻止了患者的疾病惡化並具有良好的反應性。  Autoimmune anti-GABAB receptor encephalitis is a rare form of limbic en-cephalitis that typically has an initial neuropsychiatric presentation followed by se-qualae. Here, we present a case of anti-GABAB receptor encephalitis confirmed by cerebrospinal fluid testing and a corresponding left temporal lobe lesion detected by brain magnetic resonance imaging (MRI). Longitudinal evidence from clinical ob-servation, brain MRIs, and the ascending trajectory of his cognitive performance confirmed that the repeated high-dose corticosteroid pulse therapy effectively halted the patient’s disease progression with favorable responsiveness.","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"91 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139192462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"以PROKERA®成功治療動物消毒劑引起眼表化學性灼傷的個案報告","authors":"廖文賓 廖文賓, 王元聖 王元聖, 胡朝乾 Yuan-Sheng Wang, 鄭成國 Chao-Chien Hu","doi":"10.53106/181020932023062102003","DOIUrl":"https://doi.org/10.53106/181020932023062102003","url":null,"abstract":"\u0000 OMNICIDE®是一種廣效型動物消毒劑，主要成分包含戊二醛(glutaraldehyde)以及苯扎氯銨(cocobenzyl dimethyl ammonium chloride)。動物消毒劑引起的眼表化學性灼傷在過往的文獻中並未被提及過。在此，我們報告一位57歲的男性，因為誤點動物消毒劑至右眼，造成大範圍結膜水腫，角膜上皮缺損，以及輪狀部缺血，符合Dua分類的第三級。除了傳統的藥物治療外，我們利用角膜生物敷料PROKERA®來穩定眼表發炎反應及促進角膜上皮生長。在治療之後的追蹤過程，角膜上皮完全恢復且患者的視力亦獲得改善。\u0000 OMNICIDE® is a broad-spectrum animal health disinfectant containing glutaral-dehyde and cocobenzyl dimethyl ammonium chloride. Ocular chemical injury caused by animal health disinfectant has never been described in the previous literature. Herein, we presented a 57-year-old man who mis-instilled animal health disinfectant into his right eye. Extensive conjunctival chemosis, large corneal epithelial defect, and limbal ischemia were noted in his right eye with Dua classification grade III. In addition to the conventional medical therapy, we used the biologic corneal bandage device, PROKERA®, to stabilize the ocular surface inflammation and promote corneal re-epithelialization. The corneal epithelial defect healed completely, and the visual acuity improved and remained stable during the follow-up period.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"2014 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128946607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"施打新冠肺炎疫苗後新診斷的葛瑞夫茲氏病併甲狀腺風暴","authors":"羅學榮 羅學榮, 蘇彥伯 蘇彥伯, 林慶齡 林慶齡, 黃天祥 Ching-Ling Lin","doi":"10.53106/181020932023062102004","DOIUrl":"https://doi.org/10.53106/181020932023062102004","url":null,"abstract":"\u0000 目前有案例報告在使用新冠滅活或mRNA疫苗後出現葛瑞夫茲氏病，但其中在使用腺病毒載體新冠疫苗後，新診斷的葛瑞夫茲氏病併甲狀腺風暴卻是從未被報告。我們報告一名女士在接受腺病毒載體新冠疫苗六天後，根據其臨床病況診斷為甲狀腺風暴，進一步檢驗得知甲促素結合體抗體陽性和高濃度甲狀腺刺激免疫球蛋白，其甲狀腺超音波亦與診斷葛瑞夫茲氏病相符合。目前對於腺病毒載體新冠疫苗是否能引起葛瑞夫茲氏病並不明確，但疫苗賦形劑成分中的聚山梨醇酯80（Polysorbate 80）被認為是對此案例引起葛瑞夫茲氏病最可能的原因。至目前為止，這是第一次描述接受腺病毒載體新冠疫苗後，引發的葛瑞夫茲氏病併甲狀腺風暴。\u0000 A few cases of Graves’ disease after inactivated or messenger RNA(mRNA) vaccine had been reported. However, new onset of Graves’ disease with thyroid storm after adenovirus-vectored vaccination had not been reported in the literature. We de-scribed a case of newly onset of Graves’s disease with thyroid storm after adenovi-rus-vectored coronavirus disease 2019(COVID-19) vaccination (Vaxzevria) 6 days later. Thyroid storm was diagnosed based on thyrotoxicosis and clinical manifestations. Positive anti-thyroid-stimulating hormone receptor antibody, higher titer of thyroid-stimulating immunoglobulin and thyroid ultrasound competitive with the di-agnosis of Graves’ disease. How adenovirus-vectored COVID-19 vaccine can induce Graves’ disease remained unanswered. The excipient with polysorbate 80 of adenovi-rus-vectored COVID-19 vaccine may act as the key which induced Graves’ disease on top of our patient’s genetic background of hyperthyroidism. To our knowledge, this is the first case of Graves’ disease with thyroid storm secondary to adenovirus-vectored COVID-19 vaccine.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"24 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130638110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"影響居家護理個案之照顧者對居家醫療整合照護使用意願之探討－以北部某區域醫院附設某居家護理所為例","authors":"呂美卿 呂美卿, 劉翠瑤 IMei-Ching Liu, 洪啓峯 Tsui-Yao Liu","doi":"10.53106/181020932023062102001","DOIUrl":"https://doi.org/10.53106/181020932023062102001","url":null,"abstract":"\u0000 目的：探討北部某區域醫院附設居家護理所之個案，影響參加居家醫療服務的相關因素。方法：橫斷性研究設計，使用Andersen所提出醫療利用性模式為架構，於2021年9至10月對居家護理個案主要決策之照顧者共91位進行結構式問卷，內容為：被照顧者及照顧者基本資料、居家醫療整合照護認知、照顧者知覺量表、照顧者負荷量表。統計方法為描述性統計、t檢定、Anova檢定、卡方檢定、皮爾森積差相關分析與多元邏輯斯迴歸分析。結果：不同的固定就醫場所與參加居家醫療呈統計上顯著差異。照顧者壓力生理負荷對壓力心理與社會負荷有高度正相關，壓力財務負荷對壓力生理、心理與社會負荷有中度正相關，壓力心理負荷與壓力社會負荷有高度正相關。影響居家醫療整合照護之預測因子為固定就醫場所。結論：本研究結果促使因素中個案有固定就醫場所，參加居家醫療整合照護服務達顯著相關。有無固定的就醫場所是消費者對組織易接近或熟悉的地方，常被用來預測醫療服務利用度的高低，有固定就醫地點、醫師，能有連續性及協調性的照護。\u0000 Objective: To investigate a case of a home care center attached to regional hos-pital in northern Taiwan, and to explore the relevant factors affecting participation in home medical integrated care. Methods: Using cross-sectional study design, a struc-tured questionnaire was administered to 91 caregivers who were the primary decision makers in home care cases from September 2021 to October 2021 using the model proposed by Andersen as a framework, with the following content: basic information about the care recipient and caregiver, home health integrated care perception, care-giver perception scale, caregiver burden scale. The statistical methods were descriptive statistics, t-test, ANOVA, chi-square, Pearson’s product correlation analysis, and multivariate logistic regression analysis. Results: Statistically significant differences were found between different fixed health care settings and participation in integrated home health care. Caregivers stress physiological load was highly positively correlated with stress psychological and social load, stress economic load was moderately positively correlated with stress physiological, psychological and social load, and stress psychological load was highly positively correlated with stress social load. The predictor of integrated home medical care is the fixed location. Conclusion: The re-sults of this study showed that there was a significant correlation between the pres-ence of a fixed medical site and the participation of home medical integrated care. The availability of a fixed health care site is a site that is familiar to consumers and is often used to predict the level of health care utilization. The presence of a regular home medical integrated care.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128764089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"幼年型僵直性脊椎炎與薦髂關節炎","authors":"陳嘉容 陳嘉容","doi":"10.53106/181020932023062102005","DOIUrl":"https://doi.org/10.53106/181020932023062102005","url":null,"abstract":"\u0000 幼年型僵直性脊椎炎是一種表現周邊、薦髂關節發炎，以及接骨點炎之疾病；其表現與成人僵直性脊椎炎不同。雖然，HLA-B27在兒童及成人的僵直性脊椎炎都佔有重要的角色，但是其在兒童方面僅有38%的低盛行率。這個在中軸骨疾病的不同面向，使得青少年過度至成人的照護更顯困難。此外，幼年型僵直性脊椎炎也無法納入國際風濕病組織對於兒童特發性關節炎的其中一個次分類中。然而，薦骨關節炎是兒童特發性關節炎的一個不良預後因子，並且對於傳統疾病修飾抗風濕藥物療效不佳。生物製劑已被建議為非類固醇抗發炎藥物之後的第二線用藥。基於以上的情況，進一步的更新分類條件應有助於及早診斷與治療。\u0000 Juvenile spondyloarthritis (SpA) has features of arthritis, sacroiliitis and enthesitis, and its presentation is different from adult SpA. Although HLA-B27 is a prominent marker both in juvenile and adult spondyloarthritis, the low prevalence is associated with juvenile spondyloarthritis. In addition, the spine and sacroiliac joint involvement is an unusual presentation in children and adolescents at diagnosis. The progression to axial skeletal disease would be a crucial point for adolescence transition to adult care. Furthermore, SpA could not be defined well in the International League of Association for Rheumatology (ILAR) classification system for juvenile idiopathic arthritis. The different diagnostic criterion from adult SpA is also a challenge. These review summarized the clinical features, pathogenesis, treatment and outcomes of juvenile SpA, and emphasis on sacroiliitis. Sacroiliitis is a poor prognostic factor of juvenile idiopathic arthritis, and the response to conventional DMARDs is poor. Biological DMARDs are suggested for second line therapy after NSAIDs. Among these situations, the advanced classification should be renewed for early diagnosis and treatment.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"138 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123798045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"慢性B型肝炎患者服用Tenofovir Alafenamide治療之療效和安全性—系統性回顧和統合分析","authors":"羅雲碩 羅雲碩, 陳瀅迪 Yun-Shuo Lo, 蔡珮玲 Ying-Ti Chen, 魏偲涵 Pei-Ling Tsai, 許心瑜 Si-Han Wei, 賴尚宏 Hsin-Yu Hsu, 陳詠宸 Shang-Hong Lai, 陳凱倫 Yong-Chen Chen","doi":"10.53106/181020932023062102002","DOIUrl":"https://doi.org/10.53106/181020932023062102002","url":null,"abstract":"\u0000 背景與目的：慢性B型肝炎（chronic hepatitis B, CHB）患者若未接受治療，很可能會併發嚴重的併發症。目前治療CHB患者療效最佳的藥物為Tenofovir disoproxil fumarate（TDF），但長期服用會有較高骨密度流失及腎毒性反應。Tenofovir alafenamide（TAF）為Tenofovir的新型藥物，過去用以治療HIV患者的臨床試驗中，顯示與TDF相比，效果相似但安全性較佳。TAF已經開始用於治療一般族群的慢性B型肝炎，安全性需要有更robust的實證資料。本研究旨在探討在治療CHB患者時，TAF是否較TDF，有較好的療效以及更佳的安全性。研究方法：利用PubMed、Cochrane和Embase進行TDF和TAF比較的隨機對照試驗文獻搜尋，搜尋日至2022年3月前出版之英文文獻。統合分析以random-effects model估算療效和安全性，統計軟體選用Review Manager Version 5.4。研究結果：本研究共收錄4篇文獻，在療效部分，TAF相較於TDF在HBV DNA<29 IU/ml (RR=1.00, 95%CI= 0.96-1.03)和HBeAg消失(RR=1.19, 95%CI= 0.95-1.50)未達統計上顯著差異；HBeAg血清學轉換則有統計顯著差異(RR=1.39，95%CI= 1.04-1.83)。在髖骨密度與脊骨密度變化，和血清肌酸酐濃度變化之安全性指標，TAF變化程度皆較TDF小，TAF較TDF有較佳的安全性。結論：本研究結果顯示在治療CHB患者上TAF與TDF相比，在療效結果具非劣性，安全性結果則為TAF優於TDF。因此TAF有機會可以作為臨床上的另一種選擇，未來也建議應使用真實世界的資料進行長期慢性副作用的驗證。\u0000 Background and purpose: Nowadays, the most effective drug for the treatment of chronic hepatitis B (CHB) patients is Tenofovir disoproxil fumarate (TDF), how-ever long-term use will lead to high bone density loss and nephrotoxicity. Tenofovir alafenamide (TAF) is a noval drug of Tenofovir. In the past clinical trials for the treatment of HIV patients, it has shown similar effects but better safety than TDF. TAF has been used to treat CHB in the general population, but more robust evidence is needed for safety. This study aims to investigate whether TAF has better efficacy and better safety than TDF in the treatment of CHB patients. Methods: PubMed, Cochrane and Embase were used to conduct a literature search of randomized con-trolled trials comparing TDF and TAF, and the English language literature published by March 2022 was searched. Meta-analysis used random-effects model to estimate efficacy and safety, and the statistical software was Review Manager Version 5.4. Results: A total of four articles were included in this study. In the efficacy, TAF com-pared with TDF in HBV DNA<29 IU/ml (RR=1.00, 95%CI=0.96-1.03) and HBeAg loss (RR=1.19, 95 %CI=0.95-1.50) was not statistically significant; HBeAg serocon-version was statistically significant (RR=1.39, 95%CI=1.04-1.83). In the safety indi-cators of changes in hip BMD and spine BMD, and changes in serum creatinine con-centration, the degree of change in TAF was smaller than TDF, and TAF had better safety than TDF. Conclusion: The results of this study show that TAF is non-inferior to TDF in the treatment of CHB patients in terms of efficacy outcomes and TAF is superior to TDF in safety outcomes. Therefore, TAF has the opportunity to be used as another clinical option.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"914 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132794770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}