梁靜茹 - 問

誰讓你心動　誰讓你心痛　誰會讓你偶爾想要擁她在懷中 誰又在乎你的夢　誰說你的心思她會懂　誰為你感動 如果女人　總是等到夜深　無悔付出青春　她就會對你真 是否女人　永遠不要多問　她最好永遠天真　為她所愛的人 誰讓你心動　誰讓你心痛　誰會讓你偶爾想要擁她在懷中 誰又在乎你的夢　誰說你的心思她會懂　誰為你感動 只是女人　容易一往情深　總是為情所困　終於越陷越深 可是女人　愛是她的靈魂　她可以奉獻一生　為她所愛的人 如果女人　總是等到夜深　無悔付出青春　她就會對你真 只是女人　容易一往情深　總是為情所困　終於越陷越深 可是女人　愛是她的靈魂　她可以奉獻一生　為她所愛的人

https://www.youtube.com/watch?v=wubvsg1xFNQ

痛風及高尿酸血症的處置 - 成醫藥誌

http://140.116.253.135/NewHomePage/manager/form/periodical/file/%E7%97%9B%E9%A2%A8%E5%8F%8A%E9%AB%98%E5%B0%BF%E9%85%B8%E8%A1%80%E7%97%87%E7%9A%84%E8%99%95%E7%BD%AE.pdf

WHO functional Class

The World Health Organization (WHO) has developed a system to help doctors determine how limited a patient is in their ability to do the activities of daily living. In general, patients with more severe PH tend to have a higher functional class.

Class I: Patients with pulmonary hypertension but without resulting limitation of physical activity. Ordinary physical activity does not cause undue dyspnea of fatigue, chest pain or near syncope.

Class II: Patients with pulmonary hypertension resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity causes undue dyspnea or fatigue, chest pain or near syncope.

Class III: Patients with pulmonary hypertension resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes undue dyspnea or fatigue, chest pain or near syncope.

Class IV: Patients with pulmonary hypertension with inability to carry out any physical activity without symptoms. These patients manifest signs of right heart failure. Dyspnea and/or fatigue may even be present at rest. Discomfort is increased by any physical activity.

資料來源：http://www.georgiahealth.edu/medicine/medicine/pulmonary/pvd/ph/WHO.html

期刊報告-賴金蘭 101.11.7

Inhaled Low-Dose Iloprost for Pulmonary Hypertension: A Prospective, Multicenter, Open-Label Study

Yun-Juan Sun; Chang-Ming Xiong; Guang-Liang Shan; Qing Gu;Wei-Jie Zeng; Xian-Ling Lu; Feng Zhu; Zhi-Hong Liu; Xin-Hai Ni;Jian-Guo He,

報 告 者：賴金蘭

指 導 者：鄭瑞駿

報告日期：101.11.7

Background: Inhaled iloprost (average >30 mg/d) has been considered an effective treatment for severe pulmonary hypertension (PH). Further evidence also showed that low-dose iloprost given intravenously was equally effective as high-dose iloprost in the therapy of systemic sclerosis.

Hypothesis: Patients with pulmonary hypertension will benefit from inhalation of low-dose iloprost.

Methods: Sixty-two patients with PH were enrolled and initiated with neubulizedlow-dose iloprost (2.5 mg per inhalation, 6×daily) for 24 weeks in 13 medical centers in China. Efficacy endpoints included changes in 6-minute walk distance (6MWD), World Health Organization functional class (WHO-FC), and hemodynamic parameters.

Results: Fourteen patients (22.6%) prematurely discontinued the study: 8 due to clinical worsening (6 in WHO-FCIII–IV at baseline), 4 because of protocol change, and 2 patients lost during follow-up. In the remaining 48 patients, 6MWD was increased from 356 ± 98 meters to 414 ± 99 meters (P < 0.001) and WHO-FC improved significantly (P = 0.006) after 24-week inhalation therapy. Cardiac output, cardiac index, and mixed venous oxygen saturation improved significantly compared with baseline (n = 34, P < 0.05). Most of the hemodynamic parameters improved significantly in patients in WHO-FC II (P < 0.05) but not in patients in WHO-FCIII–IV.

Conclusions: Low-dose iloprost inhalation significantly improved exercise capacity and functional status in patients with PH. It was well tolerated. The improvement of hemodynamics was confirmed in patients withWHO-FCI–II but not in patients with WHO-FCIII–IV, suggesting the importance of early treatment in patients with advanced disease stages.

期刊報告-陳紀吏 101.10.17

Tiotropium inhibits pulmonary inflammation and remodelling in a guinea pig model of COPD. 

Eur Respir J 2011, 38, 789-796.

T. Pera*, A. Zuidhof*, J. Valadas*, M. Smit*, R.G. Schoemaker#, R. Gosens*,H. Maarsingh*, J. Zaagsma* and H. Meurs*

ABSTRACT: 
Airway remodelling and emphysema are major structural abnormalities in chronic obstructive pulmonary disease (COPD). In addition, pulmonary vascular remodelling may occur and contribute to pulmonary hypertension, a comorbidity of COPD. Increased cholinergic activity in COPD contributes to airflow limitation and, possibly, to inflammation and airway remodelling.

This study aimed to investigate the role of acetylcholine in pulmonary inflammation and remodelling using an animal model of COPD. To this aim, guinea pigs were instilled intranasally with lipopolysaccharide (LPS) twice weekly for 12 weeks and were treated, by inhalation, with the long-acting muscarinic receptor antagonist tiotropium. Repeated LPS exposure induced airway and parenchymal neutrophilia, and increased goblet

cell numbers, lung hydroxyproline content, airway wall collagen and airspace size. Furthermore, LPS increased the number of muscularised microvessels in the adventitia of cartilaginous airways. Tiotropium abrogated the LPS-induced increase in neutrophils, goblet cells, collagen deposition and muscularised microvessels, but had no effect on emphysema.

In conclusion, tiotropium inhibits remodelling of the airways as well as pulmonary inflammation

in a guinea pig model of COPD, suggesting that endogenous acetylcholine plays a major role in

the pathogenesis of this disease.

讀書筆記：

• Low free-fat mass (低度無脂體重)：是指上臂肌圍<10%百分位。
• 肺復健運動療程
• 每次療程30分鐘(一個循環為1分鐘腳踏車運動，最大做功的140%；1分鐘休息；2分鐘IMT訓練，先從Pimax的30%開始；休息1分鐘；合計6個循環)，然後追加5%-10%/每次，直到70%的Pimax。
• IMT(inspiratory muscle traIning)吸氣肌肉訓練
• HRQoL(health related quality of life)健康相關生活品質
• 可用CRQ、MRF-28、SRI問卷來評。
• CRQ(chronic respiratory questionnaire)慢性呼吸衰竭問卷，21-147分，分數愈高代表愈健康。分四個面向：dyspnea(5-35分)、fatigue(4-28分)、emotion(7-49分)、mastery(5-35)
• ST GEORGE’S RESPIRATORY QUESTIONNAIRE(SGRQ)：The SGRQ is designed to measure health impairment in patients with asthma and COPD. It is also valid for use in bronchiectasis and has been used successfully in patients with kyphoscoliosis and sarcoidosis.
• MRF-28(Maugeri Respiratory Failure questionnaire)呼吸失效問卷
• SRI(severe respiratory insufficiency)questionnaire嚴重呼吸失效問卷
• HADS(hospital anxiety and depression scale)醫院焦慮和憂鬱量表，(0)好--(42)差。
• MRC(medical research council,醫療研究會議)呼吸困難評分表，(1)好--(5)差。
• 6MWD(6-minute walking distance)：6分鐘走路距離
• GARS(Groningen Activity and Restriction Scale)：活動與限制評分量表，(18)好--(72)差。

期刊報告 : 洪琪馥 2012 - 9 - 5

兩年期慢性肺病病人在家夜間使用非侵入性通氣合併肺部復健：一個隨機對照試驗

Two-year home-based nocturnal noninvasive ventilation added to rehabilitation in chronic obstructive pulmonary disease patients: A randomized controlled trial

Marieke L Duiverman, Johan B Wempe, Gerrie Bladder, Judith M Vonk, Jan G Zijlstra, Huib AM Kerstjens and Peter J Wijkstra..

Respiratory Research 2011, 12:112-122

報 告 者 : 洪琪馥

指 導 者 : 鄭瑞駿
報告日期 : 2012 - 9 - 5

背景

由於缺少長期數據，慢性高碳血症呼吸衰竭之阻塞性肺部疾病(COPD)患者間歇使用非侵入性正壓通氣(NIPPV)仍有爭議。

本研究目的是在比較兩年期慢性高碳血症呼吸衰竭之COPD患者在家夜間間歇使用非侵入性通氣合併肺部復健和單獨使用肺部復健治療(PR)結果。

方法

對66位病人在家使用兩年的追蹤進行分析。使用截距隨機效應之線性混合效應模式與以及基準值的調整評估非侵入性正壓呼吸器(NIPPV)加上肺部復健(PR)治療和單獨使用肺部復健治療(PR)之間的差異。主要結果為健康相關生活品質( HRQoL)；次要結果是情緒狀態，呼吸困難，氣體交換，功能狀況，肺功能，以及惡化頻率。

結果

比較單獨使用肺部復健治療(PR)和合併非侵入性正壓通氣(NIPPV)並沒明顯改善慢性呼吸問卷量表(CRQ)( 群組間平均差異變化為-1.3分【 95％CI：-9.7～7.4 】)，使用Maugeri呼吸衰竭問卷量表評估顯示肺部復健治療(PR)合併非侵入性正壓通氣(NIPPV)可改善健康相關生活品質 (HRQoL) (-13.4％【-22.7 ～ -4.2；p=0.005】)，情緒狀態(醫院焦慮和憂鬱量表-4.0【-7.8～0.0；p=0.05】)，呼吸困難分數(醫學研究委員會MRC -0.4【-0.8 ～-0.0；p=0.05】)，日間動脈血液氣體(PaCO2：-0.4 KPa【-0.8～-0.2；p=0.01】；PaO2：0.8 KPa【 0.0～1.5；P=0.03】)，6分鐘步行距離 (77.3公尺【46.4～108.0；P＜0.001】)，Groningen 活動和限制量表(-3.8【-7.4～-0.4；p=0.03】)，和第一秒用力吐氣容積FEV1 (115ml【19～211；p=0.019】)，惡化率頻沒有改變。

結論

慢性高碳血症呼吸衰竭COPD患者使用非侵入性通氣合併肺部復健兩年可改善健康相關生活品質( HRQoL)，情緒狀態，呼吸困難，氣體交換，運動耐受力和肺功能衰退，好處可隨時間增加。