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PSA SDM with machine learning suggestions intervention
No full textPSA SDM with machine learning suggestions interventio
Genetic Association Study of Mismatch Negativity and NMDA Receptor Genes in Schizophrenia
No full text背景
失匹配負波(Mismatch negativity，簡稱MMN)是一種聽覺事件誘發電位，和N-methyl-D-aspartic acid (NMDA)受體功能有關，NMDA受體功能異常是精神分裂症核心的病理現象。MMN缺損被證實是慢性精神分裂症顯著的神精生理學現象，其效果大小約為0.99。MMN也是精神分裂症可能的內表現型之一，有助於複雜遺傳疾病的關聯性研究。所以本研究有兩個假說： (1) NMDA受體次單元基因和精神分裂症有關聯； (2) NMDA受體次單元基因和MMN有關聯。
研究方法
本研究為病例對照單核苷酸多型性(single nucleotide polymorphism，簡稱SNP)關聯性研究，研究個案包括138位精神分裂症患者和103位健康受試者。分析的NMDA受體次單元基因包括GRIN1、GRIN2B、GRIN2C、GRIN2D和GRIN3B，另外也探討GRID1這個基因。使用的遺傳標致為haplotype-tagged SNP以及經文獻報告和精神分裂症有顯著關聯的SNP。SNP以MassArray iPLEX SNP genotyping的方式定序；關聯分析以單一SNP及單套體(haplotype-based)為單位。驗證第二個假說時，將先檢查基因型和生病狀態的交互作用對於MMN有無影響。如果交互作用顯著，再分別於個案組和對照組分析MMN和SNP的關聯。對於名義p值小於0.05的結果，用permutation 一萬次的方式得到經驗p值，以減少多重比較的影響。本研究也分析SNP-SNP交互作用對於罹病狀態和MMN的影響。
結果
精神分裂症患者有顯著的MMN 缺損。在48個被定序的SNP中，有40個通過品質檢查標準。這40個SNP和精神分裂症沒有顯著關聯；但是在健康受試者，位於GRIN3B的rs2240158在additive model和dominant model都和MMN有顯著關聯，經驗p值分別為0.039和0.013。單套體分析和SNP-SNP交互作用分析沒有顯著發現。
結論
我們的資料不支持GRIN1、GRIN2B、GRIN2C、GRIN2D、GRIN3B和GRID1為精神分裂症致病基因的假說。在健康受試者GRIN3B的rs2240158與MMN有顯著關聯。GRIN3B的功能以及其和MMN的關聯，需要更多研究去探討證實。Background
Mismatch negativity (MMN) is an auditory event-related potential and is related to the N-methyl-D-aspartic acid (NMDA) receptor function. The NMDA receptor system dysfunction is a core pathology of schizophrenia. MMN deficit is a robust neurophysiological feature in chronic schizophrenia, with effect size around 0.99. It is also a candidate endophenotype for schizophrenia and may be useful for the association analysis of this complex genetic disorder. In this study, we hypothesized that (1) NMDA receptor subunits genes are associated with schizophrenia, and (2) NMDA receptor subunits genes are associated with MMN.
Method
The study is a case-control single nucleotide polymorphism (SNP) association analysis. 138 schizophrenia patients and 103 healthy controls were enrolled. NMDA receptor subunit genes were GRIN1, GRIN2B, GRIN2C, GRIN2D, and GRIN3B and GRID1 were investigated. Haplotype-tagged SNPs and SNPs reported to be significantly associated with schizophrenia were genotyped by MassArray iPLEX SNP genotyping system. Both single-SNP-based and haplotype-based association analyses were conducted. To test the second hypothesis, interaction between SNP and disease status was explored first. If the interaction term was significant, separate analysis would be done in case group and control group respectively. Each nominally significant result was permuted for 10,000 times to get empirical p-value, in order to decrease the influence of multiple comparison. The epistatic effects on affected status and MMN were analyzed as well.
Results
MMN was significantly impaired in schizophrenia patients. 48 SNPs were genotyped, and 40 of them passed the quality control criteria. None of the 40 SNPs were associated with affected status. In healthy subject group, rs2240158 of GRIN3B was significantly associated with MMN in both additive model (empirical p-value 0.039) and dominant model (empirical p-value 0.013). Haplotype-based and epistatical association analysis yielded no significant result.
Conclusions
Our data didn’t support GRIN1, GRIN2B, GRIN2C, GRIN2D, GRIN3B, and GRID1 as candidate genes for schizophrenia. Rs2240158 of GRIN3B was significantly associated with MMN in healthy subjects. The functional significance and the association with MMN need further studies
A Study on Emergency Department Service Quality from the Viewpoint of Operational Management
No full text隨著急診病患就診人數的逐年增加，急診部不僅被視為醫院對外的最前線戰力，於醫療體系的重要性也一再提升。尤其在大型且有名聲的醫院急診部，到處可見人滿為患之景象；在病患及家屬願意來此就診，顯示出其備受肯定之餘，加深急診部管理上的困難，引起病患及家屬就診過程中的不便，進而造成急診部、甚至醫院整體滿意度的大幅下滑。研究以國立臺灣大學醫學院附設醫院急診部為探討對象，由民國96年及97年現行滿意度調查，得知滿意度最低項目為「等候時間」與「環境設施」，彙整為急診目前面臨問題─「作業流程」與「空間配置」問題。續而透過國內外初步文獻回顧，整理出病患及家屬對急診醫療期待之要素，進行問卷調查，調查現場病患及家屬對四項關鍵要素重要性分析，結果顯示「等候時間」與「環境設施」重要性排序相對較低，反應出目前必須改善者為重要性相對較低之問題。解其相對重要性後，藉由服務流程與環境之系列分析，輔以相關數資料，找出「作業流程」與「空間配置」問題根源。「作業流程」方面，檢視臺大醫院急診作業流程，發現相較其他醫院急診部，「等待看診」時間相對較長，屬不正常之現象。然臺大醫院病患人次與其他醫院一般，甚至相對較少，但由於臺大醫院急診觀察床貢獻率與專任醫師生產力偏低，每位病患滯留於急診部時間拉長，造成「等待看診」時間較長。空間配置」方面，「服務環境分析」中探討各醫院之週遭環境、空間/功能、與標誌、符號及人工裝飾等對病患、家屬、及醫事人員可能產生之影響，發覺臺大醫院呈現較吵雜、照明偏昏黃、門廳被空床與暫留病床佔滿、病患隱私較差、座椅不足等環境氛圍。其根源原因除空間設計因素外，由於流程內部之資產與人員作業效率偏低，使病患滯留於急診部時間較長，呈現出較擁擠、吵雜、無隱私之環境氛圍。根除上述問題根源─內部資產與人員效率不彰、空間設計不良，建議臺大醫院強化界面管理，以改善急診暫留狀況並提升作業效率；擴大急診部空間並重新配置，提升正面感受；同時進行硬體與軟體改造，提高等候時間之滿意度。With the increasing number of patients at Emergency Department (ED), not only is ED being regarded as the battlefront of hospital as a whole, the ever-rising significance of EDs in the medical system can also be observed. Especially for EDs in large and renowned hospitals, over-crowdedness occurs all the time. While the impressive records of those EDs are assured by the overwhelming number of patients, difficulties concerning the overall management are augmented, more inconvenience are experienced by patients and their families, and as a result, satisfaction towards the hospitals as well as the EDs drop dramatically.he study was based on our research target, Emergency Department in National Taiwan University Hospital (NTUH). From the satisfaction survey in 2007 and 2008, it can be concluded that “Waiting time” and “Environment/Facility” were the items with lowest satisfaction, and the problems currently faced by ED in NTUH could in turn be consolidated into 2 factors, “Operation process” and “Environmental arrangement”. Followed by an on-site survey conducted in order to reveal the priority of expectation elements for EDs sorted out from literature reviews, the result showed that “Waiting time” as well as “Environment/facility” were of relatively low priorities, reflecting the fact that the problems NTUH needs to deal with now are those in lower level of importance.n order to understand the root causes of “Operation process” and “Environmental arrangement” factors, a series of research on service process and environmental dimensions were conducted following the result of relative importance. Regarding “Operation process” factor, after a thorough diagnosis by the tool of Flowchart and Process chart, “Waiting time for doctors” was found to be longer than other sample EDs, thus categorized as the abnormal condition. And the subsequent root causes for that were analyzed to be the low contribution rate of emergency observation beds as well as the low productivity of doctors in EDs, despite the fact that absolute number of patients for NTUH was equal to or even less than others, resulting in longer stay for each patient in EDs, thus longer average wait for doctors.s to “Environmental Arrangement” factor, a research was conducted to analyze the possible influences of ambient conditions, space/function, and signs, symbols, & artifacts, on patients, families, and employees in each of the sample EDs. Result showed that ED in NTUH elicits unpleasant feelings from noisiness, dim lighting, lobby occupied with observation beds, lack of privacy, not enough chairs, and etc. Probing the root causes revealed that on top of the environmental design factor, lack of asset and employee efficiency lengthened patents’ average stay in EDs, thus creating negative impressions.ome suggestions raised to eradicate above root causes, “Lack of asset and employee efficiency” and “Inferior facility design”, were reinforcement of interface management to improve observation condition in EDs and promote operation efficiency, site expansion and rearrangement of EDs to enhance patients’ pleasant feelings, and lastly, reconstruction of hardware and software to raise the satisfaction of inevitable waits.口試委員會審定書………………………………………………………………………i辭……………………………………………………………………………………ii文摘要……………………………………………………………………………iii文摘要………………………………………………………………………………iv一章 緒論…………………………………………………………………………1一節 研究動機…………………………………………………………………1二節 研究對象與時間………………………………………………………2三節 研究設計…………………………………………………………………2四節 研究流程架構……………………………………………………………4二章 文獻探討……………………………………………………………………5一節 急診病患就醫的考量因素………………………………………………5二節 影響病患滿意度之構面…………………………………………………6三節 醫療服務品質指標………………………………………………………7四節 文獻探討總結……………………………………………………………8三章 現行滿意度調查分析………………………………………………………9一節 研究方法─現行滿意度調查分析………………………………………9二節 民國96年第二次(3月至11月)急診病人滿意度調查結果…………9三節 民國97年第一次(3月至6月)急診病人滿意度調查結果…………12四節 小結─現行滿意度調查分析…………………………………………14四章 服務關鍵要素重要性分析………………………………………………15一節 研究方法─服務關鍵要素重要性分析………………………………15二節 研究結果─服務關鍵要素重要性分析………………………………19三節 小結─服務關鍵要素重要性分析……………………………………22五章 服務現場流程與環境分析………………………………………………23一節 服務現場流程分析………………………………………………23二節 服務現場環境分析………………………………………………32六章 結論與建議………………………………………………………………37一節 急診表面問題整理暨歸類………………………………………37二節 問題根源之探討分析………………………………………………37三節 改善建議……………………………………………………………40四節 後續研究……………………………………………………………42考文獻………………………………………………………………………………44錄一 臺大醫院急診病人滿意度調查問卷(民國97年最新修訂版)……………46錄二 服務關鍵要素重要性分析調查問卷 版本一………………………………48錄三 服務關鍵要素重要性分析調查問卷 版本二………………………………54錄四 「急診觀察床使用率」之詳細原始數據……………………………………60錄五 「急診專任醫師生產力」之詳細原始數據…………………………………6
Study of solidification characteristics about energy-saving amorphous steel
No full text在研究平面流鑄製造非晶質薄帶中，以分析流體動力相關之操作參數為主，缺少對於熱傳效應方面的研究，但在薄帶固化過程中熱傳效應極為重要，所以本研究操控熱傳的操作參數(輥輪熱傳係數、進料溫度) ，利用熱流分析軟體Ansys-Fluent探討其對非晶質薄帶固化過程的影響。本研究設定鑄造材料為 ，設定進料壓力為41125Pa與輥輪速度為20m/s時，分析輥輪熱傳係數的範圍為120 至1 和進料溫度的範圍為1501K至1684K。
分析改變輥輪熱傳係數之模擬結果，發現影響薄帶厚度的因素可能為熔潭長度與冷卻速率，當輥輪熱傳係數在120至400 ，薄帶厚度會由39.8μm降低至36.3μm；當輥輪熱傳係數在400至1000 ，薄帶厚度會由36.3μ升高至37.2μm。在輥輪熱傳係數低於400 ，此時冷卻速率的差異不大，固化線會沿著熔潭長度延伸，熔潭長度越長，固化線越高，所以薄帶厚度會隨著輥輪熱傳上升而下降。當輥輪熱傳係數較高時，因為冷卻速率上升，熔潭長度影響不大，所以薄帶厚度會逐漸上升。
分析改變進料溫度之模擬結果，發現影響薄帶厚度的因素可能為液體黏度與冷卻速率，當進料溫度在15001~1548K，薄帶厚度由36.3μm升高至36.6μm；當進料溫度在1548~1683K，薄帶厚度由36.6μm降低至36.2μm。此外，也發現進料溫度較高時會造成下游熔潭區有較多的渦流產生，進而使薄帶厚度變化率較大。
經由此研究可歸納出當輥輪熱傳係數在400 以上，進料溫度介於1500K至1548K，熔潭流場與薄帶厚度皆有較穩定之情形，可供給未來平面流鑄相關實驗做參考。In the previous studies, the manufactured of amorphous ribbons by planar flow casting, which is mainly analyzed by operating parameters based on fluid dynamics but is seldom studied in the effect of heat transfer. However, the effect of heat transfer is extremely important in the process of ribbon solidification, thus this study focuses on the operating parameters of heat transfer (wheel heat transfer coefficient, molten jet temperature) and researches the effect of amorphous ribbon solidification with different operating parameter by Ansys-Fluent. The casing material is , molten jet pressure is 41125 Pa and the speed of wheel is 20 m/s in this study. The wheel heat transfer coefficient is set from 120 to 1 and molten jet temperature is set from 1501 K to 1684 K.
From the simulated results of different wheel heat transfer coefficient, it is found that puddle length and cooling rate may affect thickness of ribbon. When the wheel heat transfer coefficient is set from 120 to 400 , the thickness of ribbon decreases from 39.8μm to 36.3μm; however, when the wheel heat transfer coefficient is set from 400 to 1000 , the thickness of ribbon increase from 36.3μm to 37.2μm. The cooling rate is no apparently different when wheel heat transfer coefficient lower than 400 , at this time the thickness of ribbon becomes thinner while the puddle length get shorter. When wheel heat transfer coefficient higher than 400 , puddle length has no significant influence on the thickness of ribbon, which gets thicker as cooling rate rises.
From the simulated results of different molten jet temperature, it is found that viscosity of fluid and cooling rate may affect thickness of ribbon. When molten jet temperature is set from 1501K to 1548K, the thickness of ribbon rises from 36.3μm to 36.6μm. The thickness of ribbon decreases from 36.3μm to 36.2μm when molten jet temperature is set from 1548K to 1683K. In addition, it is found that molten jet temperature causes more eddy currents in downstream of puddle, which leads the changing rate of thickness of ribbon increase.
From this study it can be summed up that the velocity field of puddle and the thickness of ribbon become stable when wheel heat transfer coefficient higher than 400 and molten jet temperature between 1500K and 1548K. This study could provide associated studies of planar flow casting as reference
Functional Analysis of the Promoter of Epstein-Barr Virus BBLF2/3
No full textRta與Zta蛋白質為Epstein-Barr virus (EBV)溶裂期的極早期蛋白質，為轉錄活化子，可以活化早期與晚期基因表現。Rta蛋白質可以直接結合到Rta response element (RRE)上，活化BMRF1、BHRF1、BHLF1與BMLF1等病毒早期基因的表現。另外，Rta也可以形成Sp1-MCAF1-Rta複合體，藉由Sp1結合序列活化自身的表現。Rta蛋白質亦可與Zta蛋白質形成Zta-MCAF1-Rta複合體，結合到啟動子上的Zta response element (ZRE)序列造成協同作用，大量地活化BHLF1、BMRF1與BRLF1等基因的表現。BBLF2/3為EB病毒溶裂期早期基因，可以轉譯出引子酶結合因子 (primase-associated factor)，參與EB病毒溶裂期DNA複製。然而，目前對於Rta與Zta活化早期基因BBLF2/3的機制尚不清楚，因此本研究的目的在於探討Rta與Zta蛋白質對於BBLF2/3啟動子的調控。首先利用冷光酵素分析發現BBLF2/3啟動子可以被Rta活化，同時轉染Rta與Zta蛋白質時會產生協同作用，大量活化BBLF2/3的表現，而Zta蛋白質則無法單獨活化BBLF2/3啟動子。利用TESS網站分析BBLF2/3啟動子，發現該啟動子-74到-80的序列具有可能的AP-1結合序列。將該位置進行點突變後進行冷光酵素分析，發現Rta對BBLF2/3啟動子的活化大幅降低。將BBLF2/3可能的AP-1結合序列接到具有TATA box的pTATA質體進行冷光酵素分析，發現細胞內Rta或ATF2蛋白質的含量越多時，對於該質體的活化能力就越高。另外，以DNA親和沉澱分析證實BBLF2/3啟動子-74到-80的序列可以與ATF2蛋白質結合，而透過凝膠電泳位移實驗也發現Rta蛋白質可以與該序列結合。因此，本篇研究發現BBLF2/3啟動子上具有AP-1結合序列，而Rta蛋白質可以藉由此序列促進BBLF2/3的轉錄。Rta and Zta, two transcription factors expressed during the immediate-early stage of the Epstein-Barr virus (EBV) lytic cycle, are required for lytic activation. Rta activates many EBV early genes, including BMRF1, BHRF1, BHLF1 and BMLF1, through direct binding to Rta response elements (RRE). Rta also enhances SP1-mediated transcription through the interaction with MBD1-containing chromatin-associated factor 1 (MCAF1) and Sp1. In addition, the binding of Rta-MCAF1-Zta complex to Zta response elements (ZRE) activates BHLF1, BMRF1 and BRLF1 synergistically. The EBV BBLF2/3 gene encodes a primase-associated factor that is indispensable for EBV lytic DNA replication. However, the mechanism that activates the transcription of BBLF2/3 remains unclear. The purpose of this study is to elucidate how Rta and Zta activate BBLF2/3 transcription. This study finds that the BBLF2/3 promoter is activated by Rta, but not by Zta. Moreover, Rta and Zta activated the BBLF2/3 promoter synergistically. Sequence analysis from the TESS website predicts that BBLF2/3 promoter contains a putative AP-1-binding sequence, TGACACG, which is located at -74 to -80 in the BBLF2/3 promoter. Reporter assay showed that mutating the site lowers the transcription activity. Meanwhile, Rta and ATF2 activate a promoter in a reporter plasmid, pBBLF2/3-3AP1, which contains three copies of AP-1 site from the BBLF2/3 promoter, in a dose-dependent manner. In addition, ATF2 binds to the AP-1 site as demonstrated by DNA-affinity precipitation assay. Rta also interacts with the AP-1 site as shown by electrophoretic mobility shift assay. Taken together, this study demonstrates that the BBLF2/3 promoter contains an AP-1 binding site from -74 to -80. Rta activates the BBLF2/3 transcription via an indirect binding to the AP-1 site
Functional Analysis of SPARC Gene Expression in Nasopharyngeal Carcinoma and Hepatocellular Carcinoma
No full text為了研究鼻咽癌的腫瘤形成機制 (tumorigenicity)，我們使用互補去氧核糖核酸微矩陣分析 (cDNA microarray analysis) 訊息核糖核苷酸 (mRNA) 在鼻咽癌細胞和正常鼻黏膜上皮細胞之間的表現量。我們找出了一些有差異性表現的基因。SPARC (也稱做骨連接蛋白) 是在這些非常有趣的基因群的其中一個。用及時定量聚合酶連鎖反應 (quantitative real-time RT-PCR) 和西方墨點法分析SPARC的訊息核糖核苷酸及蛋白質在鼻咽癌、肝癌和其他腫瘤細胞株、正常上皮細胞的表現情況，並用外科手術取下的檢體做免疫染色，我們發現SPARC的訊息核糖核苷酸及蛋白質在鼻咽癌和肝癌細胞株及外科手術檢體的腫瘤細胞表現相當的少，但在正常上皮細胞及一些間質細胞有適當的表現。當藉由四環黴素 (Tetracyclin) 去誘導的 (Tet-On) 載體 (pBIG2i) 含有SPARC的互補去氧核糖核酸建構，去感染鼻咽癌和肝癌的細胞而建立之穩定細胞株，去研究SPARC的蛋白質在這些細胞株的功能。可以發現這個基因在體外培養及動物體內實驗都會部分的抑制腫瘤細胞的生長、侵犯和誘導死亡。然而，在帶有SPARC基因表現的免疫不全老鼠中，這個基因只能輕微的抑制腫瘤轉移的活性。SPARC會抑制腫瘤細胞的生長及轉移的調控是藉由提高RECK基因表現，及降低bFGF基因的表現。由此可下個推論，SPARC基因在鼻咽癌和肝癌的腫瘤形成機制中扮演一個類似抑制制癌基因的角色。To investigate nasopharyngeal carcinoma (NPC) tumorigenicity, we used cDNA microarray analysis of mRNA expression between NPC cell lines and normal nasal mucosa epithelial cells. We have identified some altered expressed genes. In which one of the very interested genes is SPARC (also called osteonectin). By quantitative real-time RT-PCR and Western blot analysis of SPARC mRNA and protein expressions in NPC, HCC and other tumor cell lines, normal epithelial cell types, and immunostaining of surgical specimens, we found that SPARC mRNA and protein expressions are relatively weakly expressed in NPC and HCC cell lines and tumor cells in surgical specimens, but well expressed in normal epithelial cells and some stromal cells. When a tet-on plasmid (pBIG2i) containing SPARC-cDNA was constructed and transfected to the NPC and HCC cells to establish the stable lines, the function of SPARC protein in these lines were investigated. It was found that this gene could partially inhibit tumor cell proliferation, invasion and induce apoptosis in vitro and in vivo. However, in SCID mice bearing SPARC (+) NPC xenograft, tumor metastatic activity was mildly inhibited by this gene. The regulation of suppressive effect of SPARC on tumor cell proliferation and invasion is due to up-regulation of RECK and down-regulation of bFGF gene expression. It is concluded that SPARC gene play a role as an oncosuppressor-like gene in NPC and HCC tumorigenesis.中文摘要…1
ABSTRACT…2
INTRODUCTION…3
MATERIALS & METHODS…11
RESULTS…17
DISCUSSION…24
FIGURES…30
REFERENCE…5
Tumor Diagnosis of Shear Wave Breast Elastography
No full text乳癌一直是全球女性的十大死因之一，而腫瘤的硬度也已經被證實為分辨良性與惡性腫瘤的主要特徵。過去幾年來，醫師普遍使用乳房彈性超音波來評估病患的腫瘤彈性硬度。這項技術需人為壓迫乳房腫瘤來求得腫瘤彈性硬度。不同於傳統的乳房彈性超音波，本次實驗使用的橫波乳房彈性超音波只需利用聲波輻射便可取得腫瘤彈性硬度。在傳統的乳房彈性超音波上，腫瘤診斷是基於腫瘤內部的彈性資訊，而在橫波乳房彈性超音波上，重要的診斷資訊卻是來自於腫瘤外部而非內部的彈性硬度。此篇論文的目的為針對影像做自動切割輪廓並擷取出特徵來診斷腫瘤良惡性。首先，我們會藉由Level set切割方法自動地切割出腫瘤的輪廓，比起利用醫生的手動圈選腫瘤更能維持切割結果的一致性。接著，藉由腫瘤輪廓與影像資訊來擷取出B-mode與彈性特徵。最後，除了利用B-mode與彈性特徵分別來診斷腫瘤良惡性，也結合兩者來加以診斷腫瘤。本實驗中由112個經過病理驗證的病例進行測試，其中包含個58良性與54個惡性的病例。經由實驗結果，當使用B-mode特徵時，腫瘤分辨的準確度為84.82%；當使用彈性特徵時，腫瘤分辨的準確度為91.07%；當結合B-mode與彈性特徵時，腫瘤分辨的準確度為94.64%。根據實驗結果的統計分析，將B-mode與彈性特徵結合時，腫瘤分辨的準確度會有顯著的提升。The breast cancer is always one of the ten leading death causes for women around the world. The strain of the tumor has been confirmed to be the main feature of distinguishing benign and malignant tumors. In the past years, the physician has used the sonoelastography with manual compression to obtain the tumor strain. Different from the conventional sonoelastography, this study adopts the new shear wave elastography which uses the acoustic radiation to generate the tumor strain. In the conventional sonoelastography, the tumor diagnosis is based on the elasticity information inside the tumor. However, in the new shear wave elastography, the important diagnostic information is outside the tumor rather than inside the tumor. The purposes of this paper are automatically segmenting the tumor contour for the image and extracting the features to diagnose benign and malignant tumors. First, we use the level set segmentation method to automatically cut out the tumor contour. Comparing with the manually circled tumor, our scheme can maintain the consistency of the segmentation results. Then, the tumor contour and image information are applied to extract the B-mode and elastographic features. Finally, in addition to use either B-mode or elastographic features to diagnose benign and malignant tumors, a combination of both feature set is also utilized for diagnosis. In this study, we use 112 biopsy-proved breast tumors composed of 58 benign and 54 malignant cases. The experimental results illustrate that the accuracy in distinguishing tumors using B-mode features is 84.82%, whereas 91.07% using elastography features, and 94.64% combining B-mode and elastographic features. Based on statistical analyses of experimental results, the accuracy of classifying tumors using the combined feature set is significantly improved
Effects of oils on physicochemical properties and starch digestibility of cooked rice
No full text本研究目的旨在探討油脂（三酸甘油酯），包括：棕櫚油、大豆油及亞麻仁油其不飽和程度，對米飯理化特性及澱粉消化性之影響。實驗選用台稉9號精白米，添加油脂烹煮之米飯穀粉，經示差熱掃描分析 (DSC) 可於90℃至115℃間，觀察到直鏈澱粉－脂質複合物 (ALC) 之解離吸熱峰，解離溫度以棕櫚油最高 (95.3℃)，對照組白米飯則最低 (90.4℃)，在X射線繞射 (XRD)下，米粒經烹煮後晶體圖譜由A-type 轉變為V-type，添加油脂後其特徵波峰強度間並無明顯差異；米飯體外澱粉消化性，隨油脂飽和程度增加，棕櫚油具有最低的預估升糖指數 (eGI) (85.6) 和含量最高的抗性澱粉 (RS) (11.2%)，其次依序為大豆油 (87.1 和 8.5%)、亞麻仁油 (90.3 和 3.8%) 及白米飯 (92.4 和 0.8%)，結果顯示棕櫚油可形成較穩定之複合物，對酵素水解抗性較佳。三酸甘油酯主要針對澱粉的短期回凝進行延緩，僅於4℃貯藏第一天回凝熱焓值 (ΔH) 有下降，但對於澱粉之長期回凝（3至5天）則無影響。回凝米飯之消化性隨米飯貯藏時間延長而降低，以亞麻仁油增加RS之量最多。於XRD之圖譜，可觀察到米飯澱粉於回凝過程中，由V-type 轉變成 B-type，經復熱後再次轉變為V-type，結構間具熱可逆之特性。米飯經回凝復熱後，ALC之解離溫度提高；復熱之米飯澱粉消化性與新鮮米飯比較，RS含量間並無顯著差異，顯示由於ALC熱可逆性，仍可保留複合物維持其酵素之抗性。經由實驗結果得知，不飽和程度越低之油脂，其形成ALC之結構也越安定，可顯著降低米飯澱粉之消化性，將有助餐後血糖之控制，並且獲得較多的RS，作為飲食之參考。This study was to understand effects of oils with different unsaturation, including palm oil (PO), soybean oil (SO), and flax oil (FO), on physicochemical properties and starch digestibility of cooked rice. Polished rice grains of variety japonica, Taikeng 9, were used for the study. After cooking with the oils (10%, d. b.), there existed in DSC thermograms for cooked rice flours, amyplose-lipid complex (ALC) dissociation peaks from 90℃ to 115℃. Adding PO exhibited the highest dissociation temperature (95.3℃). The XRD patterns changed from A-type to V-type after cooking. In vitro starch digestibility and resistant starch (RS) contents were affected by oils. With increasing saturation of oils, PO yielded the least estimated glycemic index (eGI) of 85.6 and the greatest RS content of 11.2% among all samples. respectively. The results indicated PO could form stable ALC structure, which was resistant to enzymic hydrolysis. Triglycerides mainly retard the short-term 1 day storage starch retrogradation., but did not affect the long-term starch retrogradation (3-5 days storage). Digestibility of reotrograded rice decreased with the storage time, FO had increased the most RS content. In XRD patterns, it could be find structure between V-type and B-type is thermoreversible in the process of storage and reheating. After reheating of retrograded rice, the dissociation temperature of ALC increased. Because of thermal reversibility of ALC, RS contents of reheated rices compared with fresh rices did not have significant different. This study showed that the extend of unsaturation affected the stability of ALC. The less unsaturation, the more stable of ALC. With lower starch digestibility and higher RS content, rice cooking with oils would be a good way to control postprandial blood glucose and get more RS.口試委員會審定書 I
謝誌 II
中文摘要 III
Abstract IV
目次 V
圖表索引 VIII
圖次 VIII
表次 X
壹、研究目的 1
貳、文獻回顧 3
2.1稻米之簡介 3
2.1.1 稻米之分類 3
2.1.2 稻米之產量及概況 5
2.1.3 稻米之結構 7
2.1.4 稻米之組成 7
2.2 澱粉之結構及糊化特性 10
2.2.1 澱粉之結構 11
2.2.2 澱粉之糊化 11
2.3 米飯之老化 15
2.3.1 澱粉之回凝 15
2.3.2 澱粉回凝之測定方法 18
2.4 米飯之消化性 18
2.4.1 抗性澱粉 19
2.4.2 升糖指數 20
2.5 澱粉與脂質之交互作用 21
2.5.1 澱粉－脂質複合物 21
2.5.2 影響澱粉－脂質複合物形成之因子 23
2.5.3 脂質對澱粉回凝之影響 24
2.5.4 脂質對澱粉消化性之影響 25
參、實驗架構 26
肆、材料與方法 27
4.1 材料 27
4.2 方法 27
4.2.1 米粒組成分分析 27
4.2.2 直鏈澱粉含量 30
4.2.3 米粒浸漬過程之水分含量 31
4.2.4 米粒浸漬過程之糊化度 31
4.2.5 米飯烹煮之方式 34
4.2.6 回凝及復熱米飯之製備 34
4.2.7 質地分析 35
4.2.8 示差掃描熱分析 35
4.2.9 傅立葉轉換紅外線光譜 35
4.2.10 X-射線繞射分析 36
4.2.11體外澱粉消化性 36
4.2.12 統計分析 38
伍、結果與討論 39
5.1米粒基本組成分 39
5.2米粒於65℃浸漬過程之水分含量及糊化度變化 39
5.3 添加油脂對米飯理化特性及消化性之影響 41
5.3.1米飯穀粉之熱性質分析 41
5.3.2米飯穀粉之傅立葉轉紅外線光譜分析 44
5.3.3米飯穀粉之結晶型態分析 46
5.3.4米飯之體外澱粉消化性 46
5.4回凝米飯之理化特性及消化性 52
5.4.1回凝米飯之質地分析 52
5.4.2回凝米飯穀粉之熱性質分析 52
5.4.3回凝米飯之結晶型態分析 59
5.4.4回凝米飯之體外澱粉消化性 59
5.5回凝復熱米飯之理化特性及消化性 64
5.5.1回凝復熱米飯穀粉之熱性質分析 64
5.5.2回凝復熱米飯穀粉之結晶型態分析 64
5.5.3回凝復熱米飯之體外消澱粉化性 68
陸、結論 72
柒、參考文獻 7
Robot-Assisted Therapy Combined With Task-Oriented or Impairment-Oriented Training in Chronic Stroke
No full text背景與目的：中風為國人第二大死因，常伴隨動作控制障礙等問題。過去研究顯示，高密集訓練可促進中風病人動作功能恢復。機器輔助治療優點為高密度、高強度、任務專一性與使用方式彈性，但針對特定關節訓練，但對日常生活功能的提升尚無一致性結論。因此，若結合其它復健手法，如：任務導向訓練、損傷導向訓練，則能提供更全面的醫療復健。本研究目的為探討機器輔助療法合併任務導向訓練、機器輔助療法合併損傷導向訓練、常規復建訓練於慢性中風病人之成效比較。
方法：受試者隨機分配到機器輔助治療合併任務導向訓練組、機器輔助治療合併損傷治療訓練組、常規復健組，接受為期4週，每週5天，每天90~95分鐘的療程。
結果：目前結果顯示IMTT在上肢損傷與動作功能、降低肌肉張力、患側手於日常生活使用量、生活品質等方面最具優勢；CI組在近端肌力、日常生活獨立性等方面較有優勢。建議未來研究擴大研究樣本，拉長合併療法時間，進一步探討合併療法於中風復健之成效。Background and purpose: Stroke is the second leading cause of death in Taiwan, usually accompanied by postured control disorder. According to past studies high intensity of training encourages stroke patient’s function recovery. Robot-assisted therapy provides high intensity, task specificity, and higher flexibility of manipulation, but specifically for joint training, and inconsistence with improvement of ADL. Hence, when combine with other approach, such as task-oriented training, impairment-oriented training, provides complete rehabilitation program. This study’s goal is to discuss the effect of robot-assisted therapy and task-oriented training combination, robot-assisted therapy and impairment-oriented training combination, regular rehabilitation training of chronic stroke patients.
Methods: patients randomly distributed to IMTT group, IMTI group, and CI group, received an intervention for 4 weeks, 5 days a week, 90~95minutes per day.
Results: results shows that IMTT has higher advantages in upper extremity impairment and motor function, decrease of muscle tone, impaired limb usage in daily life, and quality of life; in the other hand, CI has the higher advantage independence in daily life. Suggestion of future study is to enlarge the number of sample, higher duration of intervention, further discuss of the stroke rehabilitation outcome.目次
第一章、 前言
1. 中風 ----------------------------------------------------------------------------------p 1
2. 機器輔助治療
2.1機器輔助治療簡介與分類-----------------------------------------------------p 1
2.2機器輔助治療之特性-----------------------------------------------------------p 2
2.3機器輔助治療之文獻回顧-----------------------------------------------------p 2
2.4 Interactive Motion Technologies 3.0 (InMotion 3.0) 介紹----------------p 3
3. 神經機制探討療效
3.1 單側訓練--------------------------------------------------------------------------p 4
3.2 動作學習理論--------------------------------------------------------------------p 4
4. 任務導向訓練 (Task-Oriented Training, TOT) ---------------------------------p 5
5. 損傷導向訓練 (Impairment-Oriented Training, IOT) -------------------------p 6
5.1 The Arm BASIS training (ABT) ----------------------------------------------p 6
5.2 The Arm Ability training (AAT) ----------------------------------------------p 6
6. 機器輔助治療合併任務導向訓練與損傷導向訓練文獻回顧----------------p 8
第二章、 研究目的與假設-------------------------------------------------------------------p 9
第三章、 研究方法、進行步驟
1. 受試者--------------------------------------------------------------------------------p 10
1.1收案條件-------------------------------------------------------------------------p 10
1.2排除條件-------------------------------------------------------------------------p 10
2. 實驗設計-----------------------------------------------------------------------------p 11
3. 介入方法-----------------------------------------------------------------------------p 11
3.1 機器輔助治療合併任務導向訓練組 (IMTT) ----------------------------p 11
3.2 機器輔助治療合併損傷治療訓練組 (IMTI) -----------------------------p 12
3.3 常規復健組 (C-----------------------------------------------------------------p 13
4. 成效評估-----------------------------------------------------------------------------p 13
4.1 人口學基本資料---------------------------------------------------------------p 13
4.2臨床評估-------------------------------------------------------------------------p 13
4.2.1身體功能與構造層級 (Body function and structure/ impairment)
--------------------------------p 13
4.2.2活動層級 (Activities/ Limitation) ------------------------------------p 15
4.2.3參與層級 (Participation/ Restriction) --------------------------------p 15
4.2.4 不良反應 (Adverse effect)--------------------------------------------p 16
5. 資料分析----------------------------------------------------------------------------- p 16
第四章、 結果
1. 受試者------------------------------------------------------------------------------- p 17
2. 臨床評估
2.1 身體構造與功能層級結果--------------------------------------------------- p 17
2.2 活動層級結果------------------------------------------------------------------ p 18
2.3 參與層級結果------------------------------------------------------------------ p 18
2.4 不良反應結果-------------------------------------------------------------------p 18
第五章、 討論
1. 身體構造與功能層級成效
1.1 FMA----------------------------------------------------------------------------- p 19
1.2 MRC----------------------------------------------------------------------------- p 19
1.3 MAS----------------------------------------------------------------------------- p 20
1.4 腕動計--------------------------------------------------------------------------- p 20
2. 活動層級成效
2.1 FIM------------------------------------------------------------------------------- p 20
2.2 WMFT--------------------------------------------------------------------------- p 21
3. 參與層級成效----------------------------------------------------------------------- p 21
4. 不良反應-----------------------------------------------------------------------------p 21
5. 研究限制與未來建議--------------------------------------------------------------p 21
第六章、 結論--------------------------------------------------------------------------------------- p 23
第七章、 參考文獻--------------------------------------------------------------------------------- p 24
第八章、 附錄----------------------------------------------------------------------------------------p3
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