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以模擬肺探討影響氧氣濃度與霧氣治療效率因素的研究

為了解決HL422 PLUS PTT的問題，作者曾惠筠 這樣論述：

經由呼吸道提供藥物治療是臨床上經常使用的方式之一，為肺部疾病病患在治療過程的重要環節，例如慢性阻塞性肺病。氧氣治療與霧氣治療皆屬於經由呼吸道給藥的方式，其中，氧氣鼻導管與手持式振動篩網噴霧器具有方便使用的優勢，被廣泛應用於臨床照護以及居家照護期間。然而，氧氣鼻導管為低流量氧氣治療設備，無法得知病患實際獲得的氧氣濃度。過去的研究大多著重在正常肺模型的情況下討論吸入氧濃度，較少針對不同肺疾病影響吸入氧濃度的相關研究，因此本論文第一部分將以模擬肺的方式，探討正常、阻塞型及限制型肺疾病模型下，影響氧氣鼻導管使用期間吸入氧濃度的因素。目前與振動篩網式噴霧器的研究多與侵入性呼吸器相關為主，極少研究針對手

持式振動篩網式噴霧器合併咬嘴作討論，因此，本論文第二部分將以模擬肺的方式，評估手持式振動篩網式噴霧器合併咬嘴使用的藥物霧化效率，並探討噴霧器相關附屬元件對藥物輸送的影響。研究結果顯示，在正常、阻塞型及限制型的模擬肺皆發現，吸入氧濃度明顯受到氧氣流速與吸氣潮氣容積的影響，其中，低潮氣容積（300 mL）所測得的吸入氧濃度比正常（500 mL）及較大潮氣容積（700 mL）高；相較於呼吸次數為10次/分鐘與30 次/分鐘，若呼吸次數設定為20 次/分鐘時，所測得的吸入氧濃度最高。本實驗選用的五種手持式振動篩網式噴霧器的研究結果發現，Pocket Air® 與APEX PY001具有最佳的藥物吸入質

量，且結束噴霧後兩者沉積在咬嘴連接處的藥物量最少。在氣霧粒徑的分析方面，Omron NE-U22的質量中位數氣動直徑最大，PARI- VELOX®為最小；進一步分析噴霧器效能發現，PARI-VELOX®具有最佳的噴霧器輸出速率以及可被吸入的霧化藥物百分比。氧氣鼻導管以及手持式振動篩網式噴霧器是肺部疾病病患經常選用的呼吸治療設備之一，然而，吸入氧濃度會因病患呼吸型態的變化而受到影響，霧氣吸入的效果也因設備設計的差異而影響藥物吸入劑量。因此，臨床人員需評估病患個別性的需求，以選擇合適的設備，並且配合臨床監測數據，謹慎觀察臨床症狀的變化，以達到高效率治療為目標。

Precision nutrition for children with early puberty: leveraging nutrigenomics and lipidomics analysis

為了解決HL422 PLUS PTT的問題，作者NGAN THI KIM NGUYEN 這樣論述：

Background: Precocious puberty (PP) is puberty occurring at an unusually early age that brings in adverse health outcomes during adolescence and adulthood. Pubertal development is a complex biological process of sexual development and is affected by genetic, nutritional, environmental, and socio-ec

onomic factors. However, the relationship between pre-pubertal intakes of energy, fat, fiber, protein levels and pubertal timing has been debated. In the genomic era, it is necessary to examine the individual response to a specific diet and how diet influences metabolic regulation in children with P

P personally. Limited evidence investigated the timing of pubertal onset by examining the interaction of nutrient intake and PP-related genetic loci. Importantly, endocrine disorders can alter lipid metabolism. The fact that puberty onset requires critical weight and body fat based on the “critical

weight hypothesis” and many lipid species have been noticed in many human obesity and metabolic syndrome studies. However, a lack of evidence works on lipidomes to propose the based-lipid biomarker and lipid metabolism in predicting PP in children.Methods: By performing a systematic review and meta-

analysis of prospective studies, we aimed to disclose the role of pre-pubertal and pubertal nutrient intake in PP development. Thereafter, we conducted a Taiwan Puberty Longitudinal Study (TPLS) in recruiting adolescents from pubertal and pediatric endocrine clinics in the Northern/Southern part of

Taiwan. The buccal samples for deoxyribonucleic acid (DNA) extraction and genotyping were collected from a total of 1404 children. We will examine the nutrient intake on the interaction with PP-related SNPs on pubertal timing using the “interaction term” of logistic regression. Also, lipidomic analy

sis deriving from 178 subjects’ plasma samples was used to identify the critical lipid biomarkers in diagnosing PP and central precocious puberty (CPP).Results: A high intake of protein, particularly animal protein, monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs) among prepu

bertal girls were significantly associated with PP risk. We also found that SNP rs12617311, rs2090409, and rs12148769 were significantly associated with PP in children. Specifically, different genotypes interacted with such food groups and micronutrient intake. A significant interaction was observed

between intake of vegetables, fruits, fructose and menarcheal loci rs12617311 (PCL1). The rs2090409 (TMEM38B) was more likely to interact with vitamin intake. Importantly, rs12148769 (MKRN3) appeared a significant interaction with saturated FA and MUFA intake. Whist, SNP rs10980921 (ZNF483) showed

a significant interaction with total PUFAs intake. The intake of sucrose, MUFAs, and PUFAs was associated with the potential lipid-based biomarkers, such as Cer(d16:1/22:0), PI(18:2/22:1), and PI(18:2/22:2) of girls and Cer(t20:0/18:0), Cer(d18:1/16:0) and Cer(d18:1/18:1) of boys that could predict

PP and CPP onset. In addition, the lipidomic analysis proposed several candidate lipids metabolism pathways, such as sphingolipid metabolism, steroid biosynthesis, and bile acid biosynthesis for an in-depth lipid mechanism that can be linked to PP and CPP pathophysiology.Conclusion: There was an int

eraction between genetic variant, lipid metabolism, and nutrient intake that was convinced to be associated with PP and CPP development in girls and boys. Nutrient intake may be an important factor in modulating early puberty, especially the consumption of sugar, fructose, and specific saturated fat

ty acids, monounsaturated fatty acids, polyunsaturated fatty acids. Additional research is needed to determine the biological causes of individual variability in response to dietary intake. Likewise, understanding the influence of nutrigenetic interactions on dyslipidemia can aid in the development

and implementation of personalized dietary strategies to improve the PP and CPP treatment.