請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/56060
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 陳韻之(Yunn-Jy Chen) | |
dc.contributor.author | Ching-Yi Huang | en |
dc.contributor.author | 黃瀞儀 | zh_TW |
dc.date.accessioned | 2021-06-16T05:14:19Z | - |
dc.date.available | 2017-10-15 | |
dc.date.copyright | 2014-10-15 | |
dc.date.issued | 2014 | |
dc.date.submitted | 2014-08-18 | |
dc.identifier.citation | 1 Young, T. et al. The occurrence of sleep-disordeded breathing among middle-aged adults. New England Journal of Medicine 328, 1230-1235, (1993).
2 Epstein, L. J. et al. Clinical Guideline for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults. J. Clin. Sleep Med. 5, 263-276 (2009). 3 Kushida, C. A. et al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. SLEEP-NEW YORK THEN WESTCHESTER- 29, 240 (2006). 4 Hui, D. S. C. et al. Prevalence of snoring and sleep-disordered breathing in a group of commercial bus drivers in Hong Kong. Internal medicine journal 32, 149-157, (2002). 5 Young, T., Skatrud, J. & Peppard, P. E. Risk factors for obstructive sleep apnea in adults. JAMA-J. Am. Med. Assoc. 291, 2013-2016, (2004). 6 Schlosshan, D. & Elliott, M. W. Clinical presentation and diagnosis of the obstructive sleep apnoea hypopnoea syndrome. Thorax 59, 347-352, (2004). 7 Kimoff, R. J. Sleep fragmentation in obstructive sleep apnea. Sleep 19, S61-66 (1996). 8 Haraldsson, P. O., Carenfelt, C., Diderichsen, F., Nygren, A. & Tingvall, C. Clinical symptoms of sleep-apnea syndrome and automobile accidents. Orl-Journal for Oto-Rhino-Laryngology and Its Related Specialties 52, 57-62 (1990). 9 Chaouat, A., Weitzenblum, E., Krieger, J., Oswald, M. & Kessler, R. Pulmonary hemodynamics in the obstructive sleep apnea syndrome - Results in 220 consecutive patients. Chest 109, 380-386, (1996). 10 Tkacova, R., Rankin, F., Fitzgerald, F. S., Floras, J. S. & Bradley, T. D. Effects of continuous positive airway pressure on obstructive sleep apnea and left ventricular afterload in patients with heart failure. Circulation 98, 2269-2275 (1998). 11 Mooe, T., Rabben, T., Wiklund, U., Franklin, K. A. & Eriksson, P. Sleep-disordered breathing in men with coronary artery disease. Chest 109, 659-663, (1996). 12 Dyken, M. E., Somers, V. K., Yamada, T., Ren, Z. Y. & Zimmerman, B. Investigating the relationship between stroke and obstructive sleep apnea. Stroke; a journal of cerebral circulation 27, 401-407 (1996). 13 Yaggi, H. K. et al. Obstructive sleep apnea as a risk factor for stroke and death. New England Journal of Medicine 353, 2034-2041, (2005). 14 Guilleminault, C., Connolly, S. J. & Winkle, R. A. Cardiac-arrhythmia and conduction disturbances during sleep in 400 patients with sleep-apnea syndrome. Am. J. Cardiol. 52, 490-494, (1983). 15 Bliwise, D. L., Bliwise, N. G., Partinen, M., Pursley, A. M. & Dement, W. C. Sleep-apnea and mortality in an aged cohort. American journal of public health 78, 544-547, (1988). 16 Britton, T. C., O'Donoghue, M., Duncan, J. S. & Hirsch, N. P. Exacerbation of epilepsy by obstructive sleep apnoea. J. Neurol. Neurosurg. Psychiatry 63, 808-808, (1997). 17 Aarab, G., Lobbezoo, F., Wicks, D., Hamburger, H. & Naeije, M. Short‐term effects of a mandibular advancement device on obstructive sleep apnoea: an open‐label pilot trial. J. Oral Rehabil. 32, 564-570 (2005). 18 Berry, R. B. et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8, 597-619, (2012). 19 Remmers, J. E., Degroot, W. J., Sauerland, E. K. & Anch, A. M. Pathogenesis of upper airway occlusion during sleep Journal of Applied Physiology 44, 931-938 (1978). 20 Ryan, C. M. & Bradley, T. D. Pathogenesis of obstructive sleep apnea. Journal of Applied Physiology 99, 2440-2450, (2005). 21 Bradley, T. D. et al. Pharyngeal size in snorers, nonsnorers, and patients with obstructive sleep apnea. New England Journal of Medicine 315, 1327-1331 (1986). 22 Schwab, R. J. et al. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. American journal of respiratory and critical care medicine 168, 522-530, (2003). 23 Schwab, R. J. et al. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. American journal of respiratory and critical care medicine 152, 1673-1689 (1995). 24 Ferguson, K. A., Ono, T., Lowe, A. A., Ryan, C. F. & Fleetham, J. A. The relationship between obesity and craniofacial structure in obstructive sleep-apnea. Chest 108, 375-381, (1995). 25 Watanabe, T., Isono, S., Tanaka, A., Tanzawa, H. & Nishino, T. Contribution of body habitus and craniofacial characteristics to segmental closing pressures of the passive pharynx in patients with sleep-disordered breathing. American journal of respiratory and critical care medicine 165, 260-265 (2002). 26 Shelton, K. E., Gay, S. B., Hollowell, D. E., Woodson, H. & Suratt, P. M. Mandible enclosure of upper airway and weight in obstructive sleep-apnea. Am. Rev. Respir. Dis. 148, 195-200 (1993). 27 Mixter, R. C. et al. Obstructive sleep apnea in Apert's and Pfeiffer's syndromes: more than a craniofacial abnormality. Plastic and reconstructive surgery 86, 457-463 (1990). 28 Spier, S., Rivlin, J., Rowe, R. & Egan, T. Sleep in Pierre Robin syndrome. CHEST Journal 90, 711-715 (1986). 29 Johnston, C., Taussig, L. M., Koopmann, C., Smith, P. & Bjelland, J. Obstructive sleep apnea in Treacher-Collins syndrome. The Cleft palate journal 18, 39-44 (1981). 30 Palmer, L. J. et al. Whole genome scan for obstructive sleep apnea and obesity in African-American families. American journal of respiratory and critical care medicine 169, 1314-1321 (2004). 31 Palmer, L. J. et al. A whole-genome scan for obstructive sleep apnea and obesity. Am. J. Hum. Genet. 72, 340-350, (2003). 32 Li, K. K., Kushida, C., Powell, N. B., Riley, R. W. & Guilleminault, C. Obstructive sleep apnea syndrome: A comparison between Far-East Asian and white men. Laryngoscope 110, 1689-1693, (2000). 33 Liu, Y. H., Lowe, A. A., Zeng, X. L., Fu, M. K. & Fleetham, J. A. Cephalometric comparisons between Chinese and Caucasian patients with obstructive sleep apnea. American Journal of Orthodontics and Dentofacial Orthopedics 117, 479-485 (2000). 34 Lam, J. C. M. et al. Obstructive sleep apnea and the metabolic syndrome in community-based Chinese adults in Hong Kong. Respir. Med. 100, 980-987, (2006). 35 Riha, R. L., Brander, P., Vennelle, M. & Douglas, N. J. A cephalometric comparison of patients with the sleep apnea/hypopnea syndrome and their siblings. Sleep 28, 315-320 (2005). 36 Sakakibara, H. et al. Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea. European Respiratory Journal 13, 403-410, (1999). 37 Lowe, A. A., Gionhaku, N., Takeuchi, K. & Fleetham, J. A. Three-dimensional CT reconstructions of tongue and airway in adult subjects with obstructive sleep apnea. American Journal of Orthodontics and Dentofacial Orthopedics 90, 364-374 (1986). 38 Young, J. W. & McDonald, J. P. An investigation into the relationship between the severity of obstructive sleep apnoea/hypopnoea syndrome and the vertical position of the hyoid bone. Surg. J. R. Coll. Surg. Edinb. Irel. 2, 145-151 (2004). 39 Cistulli, P. A., Gotsopoulos, H., Marklund, M. & Lowe, A. A. Treatment of snoring and obstructive sleep apnea with mandibular repositioning appliances. Sleep Med. Rev. 8, 443-457, (2004). 40 Cistulli, P. A. & Grunstein, R. R. Medical devices for the diagnosis and treatment of obstructive sleep apnea. Expert Review of Medical Devices 2, 749-763, (2005). 41 Thorpy, M. et al. Practice parameters for the treatment of snoring and obstructive sleep-apnea with oral appliances Sleep 18, 511-513 (1995). 42 Schonhofer, B. et al. A new tongue advancement technique for sleep-disordered breathing: side effects and efficacy. American journal of respiratory and critical care medicine 155, 732-738 (1997). 43 Marklund, M., Franklin, K. A., Sahlin, C. & Lundgren, R. The effect of a mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea. Chest 113, 707-713, (1998). 44 Ferguson, K. A., Cartwright, R., Rogers, R. & Schmidt-Nowara, W. Oral appliances for snoring and obstructive sleep apnea: A review. Sleep 29, 244-262 (2006). 45 Pancer, J., Al-Faifi, S., Al-Faifi, M. & Hoffstein, V. Evaluation of variable mandibular advancement appliance for treatment of snoring and sleep apnea. Chest 116, 1511-1518, doi:10.1378/chest.116.6.1511 (1999). 46 Yoshida, K. Effects of a mandibular advancement device for the treatment of sleep apnea syndrome and snoring on respiratory function and sleep quality. Cranio-the Journal of Craniomandibular Practice 18, 98-105 (2000). 47 Pitsis, A. J., Darendeliler, M. A., Gotsopoulos, H., Petocz, P. & Cistulli, P. A. Effect of vertical dimension on efficacy of oral appliance therapy in obstructive sleep apnea. American journal of respiratory and critical care medicine 166, 860-864, (2002). 48 Rose, E., Staats, R., Schulte-Monting, J. & Jonas, I. E. Treatment of obstructive sleep apnea with the Karwetzky oral appliance. European Journal of Oral Sciences 110, 99-105, (2002). 49 Ng, A. T., Gotsopoulos, H., Qian, J. & Cistulli, P. A. Effect of oral appliance therapy on upper airway collapsibility in obstructive sleep apnea. American journal of respiratory and critical care medicine 168, 238-241, (2003). 50 Sutherland, K. et al. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med 10, 215-227 (2014). 51 Ryan, C. F., Love, L. L., Peat, D., Fleetham, J. A. & Lowe, A. A. Mandibular advancement oral appliance therapy for obstructive sleep apnoea: effect on awake calibre of the velopharynx. Thorax 54, 972-977 (1999). 52 Tsuiki, S., Ono, T. & Kuroda, T. Mandibular advancement modulates respiratory-related genioglossus electromyographic activity. Sleep Breath. 4, 53-57 (2000). 53 Horiuchi, A. et al. Measurement techniques predicting the effectiveness of an oral appliance for obstructive sleep apnea hypopnea syndrome. Angle Orthodontist 75, 1003-1011 (2005). 54 Meurice, J.-C., Marc, I., Carrier, G. & Series, F. Effects of mouth opening on upper airway collapsibility in normal sleeping subjects. American journal of respiratory and critical care medicine 153, 255-259 (1996). 55 Ayuse, T. et al. Mouth-opening increases upper-airway collapsibility without changing resistance during midazolam sedation. Journal of dental research 83, 718-722 (2004). 56 Vroegop, A. V., Vanderveken, O. M., Van de Heyning, P. H. & Braem, M. J. Effects of vertical opening on pharyngeal dimensions in patients with obstructive sleep apnoea. Sleep Med. 13, 314-316 (2012). 57 Gao, X. et al. Effect of titrated mandibular advancement and jaw opening on the upper airway in nonapneic men: a magnetic resonance imaging and cephalometric study. American journal of orthodontics and dentofacial orthopedics 125, 191-199 (2004). 58 de Almeida MSc, F. R., de Almeida PhD, C. I. R. & Tufik, S. Effects of mandibular posture on obstructive sleep apnea severity and the temporomandibular joint in patients fitted with an oral appliance. Sleep 25, 505 (2002). 59 Marklund, M., Stenlund, H. & Franklin, K. A. Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring. Chest 125, 1270-1278, (2004). 60 吳權倫. 下顎位置與上呼吸道三維型態關係之研究, 臺灣大學, (2008). 61 韓松穎. 以舌支撐下顎前突口內裝置治療阻塞性睡眠呼吸中止症患者:成功與失敗病例之探討, 臺灣大學, (2012). 62 Barnes, M. et al. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. American journal of respiratory and critical care medicine 170, 656-664 (2004). 63 Engleman, H. M. et al. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. American journal of respiratory and critical care medicine 166, 855-859 (2002). 64 Sutherland, K. & Cistulli, P. A. Mandibular advancement splints for the treatment of sleep apnoea syndrome. Swiss Medical Weekly 141, (2011). 65 Tsuiki, S. et al. Optimal positive airway pressure predicts oral appliance response to sleep apnoea. European Respiratory Journal 35, 1098-1105, (2010). 66 Strobel, R. J. & Rosen, R. C. Obesity and weight loss in obstructive sleep apnea: A critical review. Sleep 19, 104-115 (1996). 67 Cartwright, R. D. Effect of sleep position on sleep apnea severity. Sleep: Journal of Sleep Research & Sleep Medicine (1984). 68 Peppard, P. E., Young, T., Palta, M., Dempsey, J. & Skatrud, J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA-J. Am. Med. Assoc. 284, 3015-3021, (2000). 69 Kirkness, J. P. et al. Contribution of male sex, age, and obesity to mechanical instability of the upper airway during sleep. Journal of Applied Physiology 104, 1618-1624, (2008). 70 Tsai, H.-H., Ho, C.-Y., Lee, P.-L. & Tan, C.-T. Cephalometric analysis of nonobese snorers either with or without obstructive sleep apnea syndrome. The Angle orthodontist 77, 1054-1061 (2007). 71 Denbar, M. A. A case study involving the combination treatment of an oral appliance and auto-titrating CPAP unit. Sleep & breathing 6, 125-128, (2002). 72 El-Solh, A. A., Moitheennazima, B., Akinnusi, M. E., Churder, P. M. & Lafornara, A. M. Combined oral appliance and positive airway pressure therapy for obstructive sleep apnea: a pilot study. Sleep Breath. 15, 203-208, (2011). 73 Isono, S. Obesity and obstructive sleep apnoea: Mechanisms for increased collapsibility of the passive pharyngeal airway. Respirology 17, 32-42, (2012). 74 Borel, J. C. et al. Obesity hypoventilation syndrome: From sleep-disordered breathing to systemic comorbidities and the need to offer combined treatment strategies. Respirology 17, 601-610, (2012). 75 Susarla, S. M., Thomas, R. J., Abramson, Z. R. & Kaban, L. B. Biomechanics of the upper airway: Changing concepts in the pathogenesis of obstructive sleep apnea. Int. J. Oral Maxillofac. Surg. 39, 1149-1159, (2010). | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/56060 | - |
dc.description.abstract | 目的:
本論文的研究目的,在於針對無法耐受陽壓呼吸器的中重度阻塞型睡眠呼吸中止症為主的患者,以舌支撐下顎前突裝置(tongue backing mandibular advancement device, t-MAD)治療,探討口內裝置在治療上述患者中所扮演的角色,分析其治療成效及預測因子,以期臨床上得以精準預估治療的成功率。 實驗材料與方法: 於西元2011年01月至2014年05月間,至國立台大醫院睡眠中心特別門診就診的病患中,經臨床檢查及PSG測定後,判定為輕度以上之阻塞型睡眠呼吸中止症(睡眠呼吸中止指數apnea-hypopnea index,AHI≧5)者。這些病患都先完成了陽壓呼吸器之壓力測量(CPAP titration),但卻不適應、無法接受陽壓呼吸器或不能忍受其輸出的高壓,因而轉介至台大醫院牙科部睡眠特別門診接受舌支撐下顎前突口內裝置(t-MAD)治療,實驗對象共71位。 上述患者於治療前先紀錄其年齡、性別、身高、體重等基本資料,並計算身體質量指數(BMI),並於口內裝置治療後三個月再度至睡眠中心回診,接受PSG之測量。 成功率以治療前睡眠呼吸中止(OSA)的嚴重度:輕度(5≤AHI<15)、中度(15≤AHI<30)、重度(30≤AHI<50)與極重度(AHI≥50);睡眠呼吸中止指數降低(AHI reduction)的百分比;以及治療後的睡眠呼吸中止指數(AHI)作區分。 不同條件下的成功率定義如下: Criterion 1為:「治療後AHI改善比率大於50%」 Criterion 2為:「治療後AHI改善比率大於50%,且2nd AHI小於15/小時」 Criterion 3為:「治療後AHI改善比率大於50%,且2nd AHI小於10/小時」 Criterion 4為:「治療後AHI改善比率大於50%,且2nd AHI小於5/小時」 實驗結果: t-MAD對於阻塞性睡眠呼吸中止症有顯著地治療效果: (1) 輕度OSA患者之成功率依據criterion 1∼4皆為100%(2/2);中度OSA之成功率依據criterion 1、2皆為80%(12/15),依據criterion 3為73.3%(11/15),依據criterion 4為46.7%(7/15);重度OSA之成功率依據criterion 1為76%(19/25),依據criterion 2為68%(17/25),依據criterion 3為44%(11/25),依據criterion 4為32%(8/25);極重度之成功率依據criterion 1為65.5%(19/29),依據criterion 2為34.5%(10/29),依據criterion 3為31%(9/29),依據criterion 4為24.1%(7/29)。 (2) 關於影響口內裝置效果之預測因子,陽壓呼吸器之測量壓力越低、身體質量指數越低者,t-MAD治療後成為responder的機會越高。 總結: 對於中度以下之阻塞型睡眠呼吸中止症患者,配戴t-MAD能夠有效降低呼吸中止指數,是治療阻塞性睡眠呼吸中止症極為有效的方式;然而對重度睡眠呼吸中止的嚴重病患而言,在臨床上根據若干特徵,能有助於治療前病患的篩選以及成功率之評估。 | zh_TW |
dc.description.abstract | Objectives:
Oral appliances have been claimed to be indicated to those OSA patients who can’t tolerate continuous positive airway pressure (CPAP). However, the outcomes, limitation, and indication of such usages have never been documented. The aim of this study was to explore the using of the tongue-backing mandibular advancement device (t-MAD) in treating the above-mentioned OSA patients. Materials and Methods: 71 subjects who had related symptoms and signs, diagnosed as OSAS (AHI≧5) by polysomnography(PSG), were included from Janurary 2011 to May 2014, retrospectively. All of the patients were received CPAP titration first, however, they could not tolerate it. Thus, patients above were transfer to Dental Department of National Taiwan University for tongue-backing mandibular advancement device fabrication. Baseline demographic data were recored, so the BMI were derived. After taking oral appliance treatment for three months , patients then received third PSG at Sleep Center of NTU. Treatment response was classified according to OSA severity, percent of AHI reduction, and residual AHI after treatment.The OSA severity was classified into mild(5≤ AHI<15) ,moderate (15≤AHI <30),severe (30≤AHI<50),and extremely severe(AHI ≥50). The response to t-MAD was defined as criterion 1( ≥ 50% reduction in AHI) ; criterion 2(≥ 50% reduction and residual AHI less than 15/h) ;criterion 3( ≥ 50% reduction in AHI and residual AHI less than 10/h); and criterion 4( ≥ 50% reduction in AHI and residual AHI less than 5/h). Results: t-MAD plays an important role in treating patients of OSA: (1) For the mild OSA patients, the good response occurred in 100%(2/2) according to criterion 1 to 4. For the moderate OSA patients, the good response occurred in 80%(12/15) according to criterion 1 and 2 ; 73.3% (11/15) according to criterion 3, and 46.7%(7/15) according to criterion 4. For the severe OSA patients, the good response occurred in 76%(19/25) according to criterion 1; 68%(17/25) according to criterion 2 ; 44% (11/25) according to criterion 3, and 32%(8/25) according to criterion 4. For the extremely severe OSA patients, the good response occurred in 65.9%(19/29) according to criterion 1 ; 34.5% (10/29) according to criterion 2, 31%(9/29) according to criterion 3,and 24.1%(7/29) according to criterion 4. (2) CPAP titration pressure and BMI were found to be significant predictors of good t-MAD treatment outcome. The lower CPAP pressure and BMI were, the higher chance to become a responder after t-MAD treatment. Conclusion: t-MAD is an effective appliance in treating mild to moderate OSA patients. For the severe ones, certain demographic data and PSG parameters can be utilized in patient selection and outcome assessment. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T05:14:19Z (GMT). No. of bitstreams: 1 ntu-103-R00422007-1.pdf: 8976646 bytes, checksum: f6a8788cf9e8b25a68dc880cbdbdb8f2 (MD5) Previous issue date: 2014 | en |
dc.description.tableofcontents | 口試委員會審定書 i
誌謝 ii 中文摘要 iii ABSTRACT v 總目錄 vii 圖目錄 ix 表目錄 x 第壹章 緒論 1 第一節 研究背景 1 第二節 文獻回顧 2 一、 阻塞性睡眠呼吸中止症之盛行率 2 二、 阻塞性睡眠呼吸中止症之臨床特徵 2 三、 阻塞性睡眠呼吸中止症之診斷 3 四、 阻塞性睡眠呼吸中止症之解剖特徵及生理機轉 3 五、 阻塞性睡眠呼吸中止症之治療方式與作用機制 4 六、 口內裝置之治療效果與作用機制 5 七、 研究目的 9 第貳章 實驗材料與方法 10 第一節 實驗對象 10 第二節 實驗儀器與設備 11 第三節 實驗流程 14 第四節 實驗資料處理及分析 15 第參章 實驗結果 18 第一節 實驗對象之基本資料分析 18 第二節 陽壓呼吸器對於實驗對象之治療效果 19 第三節 口內裝置對於實驗對象之治療效果 21 第四節 影響口內裝置治療效果之因素分析 27 第五節 失敗案例之改善 30 第肆章 討論 31 第一節 口內裝置對於中重度睡眠呼吸中止症患者之治療效果 31 第二節 口內裝置治療效果之預測因子探討 34 第三節 失敗案例之改善 39 第伍章 總結 42 第陸章 未來展望 43 圖 44 表 68 參考文獻 95 | |
dc.language.iso | zh-TW | |
dc.title | 以舌支撐下顎前突口內裝置對無法耐受陽壓呼吸器之中重度睡眠呼吸中止症患者的治療成效與預測因子的探討 | zh_TW |
dc.title | Effects and predictors of using tongue-backing mandibular advancement device in treating moderate to severe obstructive sleep apnea patients with CPAP intolerance | en |
dc.type | Thesis | |
dc.date.schoolyear | 102-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 許明倫(Ming-Lun Hsu),李佩玲(Pei-Lin Lee) | |
dc.subject.keyword | 阻塞性睡眠呼吸中止症,口內裝置,陽壓呼吸器, | zh_TW |
dc.subject.keyword | obstructive sleep apnea,oral appliance,continuous positive airway pressure (CPAP), | en |
dc.relation.page | 100 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2014-08-18 | |
dc.contributor.author-college | 牙醫專業學院 | zh_TW |
dc.contributor.author-dept | 臨床牙醫學研究所 | zh_TW |
顯示於系所單位: | 臨床牙醫學研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-103-1.pdf 目前未授權公開取用 | 8.77 MB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。