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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 張鑾英(Luan-Yin Chang) | |
| dc.contributor.author | Sung-Hsi Wei | en |
| dc.contributor.author | 魏嵩璽 | zh_TW |
| dc.date.accessioned | 2021-06-15T01:13:44Z | - |
| dc.date.available | 2010-09-15 | |
| dc.date.copyright | 2009-09-15 | |
| dc.date.issued | 2009 | |
| dc.date.submitted | 2009-07-29 | |
| dc.identifier.citation | 1. Carapetis JR, Steer AC, Mulholland EK and Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005;5:685-94
2. Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. The Working Group on Severe Streptococcal Infections. Jama 1993;269:390-1 3. Cone LA, Woodard DR, Schlievert PM and Tomory GS. Clinical and bacteriologic observations of a toxic shock-like syndrome due to Streptococcus pyogenes. N Engl J Med 1987;317:146-9 4. Hoge CW, Schwartz B, Talkington DF, Breiman RF, MacNeill EM and Englender SJ. The changing epidemiology of invasive group A streptococcal infections and the emergence of streptococcal toxic shock-like syndrome. A retrospective population-based study. Jama 1993;269:384-9 5. Hribalova V. Streptococcus pyogenes and the toxic shock syndrome. Ann Intern Med 1988;108:772 6. Grayson ML, Jarvie LJ, Martin R, et al. Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Med J Aust 2008;188:633-40 7. O'Loughlin RE, Roberson A, Cieslak PR, et al. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000-2004. Clin Infect Dis 2007;45:853-62 8. Spencer RC. Invasive streptococci. Eur J Clin Microbiol Infect Dis 1995;14 Suppl 1:S26-32 9. Bisno AL. Group A streptococcal infections and acute rheumatic fever. N Engl J Med 1991;325:783-93 10. Johnson DR, Stevens DL and Kaplan EL. Epidemiologic analysis of group A streptococcal serotypes associated with severe systemic infections, rheumatic fever, or uncomplicated pharyngitis. J Infect Dis 1992;166:374-82 11. Carapetis J, Robins-Browne R, Martin D, Shelby-James T and Hogg G. Increasing severity of invasive group A streptococcal disease in Australia: clinical and molecular epidemiological features and identification of a new virulent M-nontypeable clone. Clin Infect Dis 1995;21:1220-7 12. Holm SE, Norrby A, Bergholm AM and Norgren M. Aspects of pathogenesis of serious group A streptococcal infections in Sweden, 1988-1989. J Infect Dis 1992;166:31-7 13. Stevens DL. Invasive group A streptococcus infections. Clin Infect Dis 1992;14:2-11 14. Stevens DL. Invasive group A streptococcal infections: the past, present and future. Pediatr Infect Dis J 1994;13:561-6 15. Kiska DL, Thiede B, Caracciolo J, et al. Invasive group A streptococcal infections in North Carolina: epidemiology, clinical features, and genetic and serotype analysis of causative organisms. J Infect Dis 1997;176:992-1000 16. Musser JM, Kapur V, Szeto J, Pan X, Swanson DS and Martin DR. Genetic diversity and relationships among Streptococcus pyogenes strains expressing serotype M1 protein: recent intercontinental spread of a subclone causing episodes of invasive disease. Infect Immun 1995;63:994-1003 17. Rogers S, Commons R, Danchin MH, et al. Strain prevalence, rather than innate virulence potential, is the major factor responsible for an increase in serious group A streptococcus infections. J Infect Dis 2007;195:1625-33 18. Yan JJ, Liu CC, Ko WC, et al. Molecular analysis of group A streptococcal isolates associated with scarlet fever in southern Taiwan between 1993 and 2002. J Clin Microbiol 2003;41:4858-61 19. Kao CH, Chen PY, Huang FL, et al. Clinical and genetic analysis of invasive and non-invasive group A streptococcal infections in central Taiwan. J Microbiol Immunol Infect 2005;38:105-11 20. Chiou CS, Liao TL, Wang TH, Chang HL, Liao JC and Li CC. Epidemiology and molecular characterization of Streptococcus pyogenes recovered from scarlet fever patients in central Taiwan from 1996 to 1999. J Clin Microbiol 2004;42:3998-4006 21. Chen YY, Huang CT, Yao SM, et al. Molecular epidemiology of group A streptococcus causing scarlet fever in northern Taiwan, 2001-2002. Diagn Microbiol Infect Dis 2007;58:289-95 22. Lancefield RC. Current knowledge of type-specific M antigens of group A streptococci. J Immunol 1962;89:307-13 23. Beachey EH, Stollerman GH, Johnson RH, Ofek I and Bisno AL. Human immune response to immunization with a structurally defined polypeptide fragment of streptococcal M protein. J Exp Med 1979;150:862-77 24. Polly SM, Waldman RH, High P, Wittner MK and Dorfman A. Protective studies with a group A streptococcal M protein vaccine. II. Challange of volenteers after local immunization in the upper respiratory tract. J Infect Dis 1975;131:217-24 25. Bronze MS, Beachey EH, Seyer JM and Dale JB. Protective and heart-cross-reactive epitopes of type 19 streptococcal M protein. Trans Assoc Am Physicians 1987;100:80-4 26. Bronze MS, Courtney HS and Dale JB. Epitopes of group A streptococcal M protein that evoke cross-protective local immune responses. J Immunol 1992;148:888-93 27. Massell BF, Honikman LH and Amezcua J. Rheumatic fever following streptococcal vaccination. Report of three cases. Jama 1969;207:1115-9 28. Kotloff KL, Corretti M, Palmer K, et al. Safety and immunogenicity of a recombinant multivalent group a streptococcal vaccine in healthy adults: phase 1 trial. Jama 2004;292:709-15 29. Hu MC, Walls MA, Stroop SD, Reddish MA, Beall B and Dale JB. Immunogenicity of a 26-valent group A streptococcal vaccine. Infect Immun 2002;70:2171-7 30. McNeil SA, Halperin SA, Langley JM, et al. Safety and immunogenicity of 26-valent group a streptococcus vaccine in healthy adult volunteers. Clin Infect Dis 2005;41:1114-22 31. Maruyama S, Yoshioka H, Fujita K, Takimoto M and Satake Y. Sensitivity of group A streptococci to antibiotics. Prevalence of resistance to erythromycin in Japan. Am J Dis Child 1979;133:1143-5 32. Seppala H, Nissinen A, Jarvinen H, et al. Resistance to erythromycin in group A streptococci. N Engl J Med 1992;326:292-7 33. Hsueh PR, Chen HM, Huang AH and Wu JJ. Decreased activity of erythromycin against Streptococcus pyogenes in Taiwan. Antimicrob Agents Chemother 1995;39:2239-42 34. Hsueh PR, Liu CY and Luh KT. Current status of antimicrobial resistance in Taiwan. Emerg Infect Dis 2002;8:132-7 35. Hsueh PR, Teng LJ, Lee LN, et al. Increased prevalence of erythromycin resistance in streptococci: substantial upsurge in erythromycin-resistant M phenotype in Streptococcus pyogenes (1979-1998) but not in Streptococcus pneumoniae (1985-1999) in Taiwan. Microb Drug Resist 2002;8:27-33 36. Yan JJ, Wu HM, Huang AH, Fu HM, Lee CT and Wu JJ. Prevalence of polyclonal mefA-containing isolates among erythromycin-resistant group A streptococci in Southern Taiwan. J Clin Microbiol 2000;38:2475-9 37. Hsueh PR, Teng LJ, Lee CM, et al. Telithromycin and quinupristin-dalfopristin resistance in clinical isolates of Streptococcus pyogenes: SMART Program 2001 Data. Antimicrob Agents Chemother 2003;47:2152-7 38. Hsueh PR, Shyr JM and Wu JJ. Decreased erythromycin use after antimicrobial reimbursement restriction for undocumented bacterial upper respiratory tract infections significantly reduced erythromycin resistance in Streptococcus pyogenes in Taiwan. Clin Infect Dis 2005;40:903-5 39. Hsueh PR, Shyr JM and Wu JJ. Changes in macrolide resistance among respiratory pathogens after decreased erythromycin consumption in Taiwan. Clin Microbiol Infect 2006;12:296-8 40. Thigpen MC, Richards CL, Jr., Lynfield R, et al. Invasive group A streptococcal infection in older adults in long-term care facilities and the community, United States, 1998-2003. Emerg Infect Dis 2007;13:1852-9 41. Factor SH, Levine OS, Harrison LH, et al. Risk factors for pediatric invasive group A streptococcal disease. Emerg Infect Dis 2005;11:1062-6 42. Factor SH, Levine OS, Schwartz B, et al. Invasive group A streptococcal disease: risk factors for adults. Emerg Infect Dis 2003;9:970-7 43. Facinelli B, Spinaci C, Magi G, Giovanetti E and P EV. Association between erythromycin resistance and ability to enter human respiratory cells in group A streptococci. Lancet 2001;358:30-3 44. Beall B, Facklam R and Thompson T. Sequencing emm-specific PCR products for routine and accurate typing of group A streptococci. J Clin Microbiol 1996;34:953-8 45. Graves LM, Swaminathan B. PulseNet standardized protocol for subtyping Listeria monocytogenes by macrorestriction and pulsed-field gel electrophoresis. Int J Food Microbiol 2001;65:55-62 46. Kaplan EL, Johnson DR, Nanthapisud P, Sirilertpanrana S and Chumdermpadetsuk S. A comparison of group A streptococcal serotypes isolated from the upper respiratory tract in the USA and Thailand: implications. Bull World Health Organ 1992;70:433-7 47. Pruksakorn S, Sittisombut N, Phornphutkul C, Pruksachatkunakorn C, Good MF and Brandt E. Epidemiological analysis of non-M-typeable group A Streptococcus isolates from a Thai population in northern Thailand. J Clin Microbiol 2000;38:1250-4 48. Tyrrell GJ, Lovgren M, Kress B and Grimsrud K. Invasive group A streptococcal disease in Alberta, Canada (2000 to 2002). J Clin Microbiol 2005;43:1678-83 49. Ho PL, Johnson DR, Yue AW, et al. Epidemiologic analysis of invasive and noninvasive group a streptococcal isolates in Hong Kong. J Clin Microbiol 2003;41:937-42 50. Ikebe T, Hirasawa K, Suzuki R, et al. Distribution of emm genotypes among group A streptococcus isolates from patients with severe invasive streptococcal infections in Japan, 2001-2005. Epidemiol Infect 2007;135:1227-9 51. Barry JS, Burge JA, Byles DB and Morgan MS. Severe invasive beta haemolytic group A streptococcal cellulitis and eyelid necrosis treated with linezolid. Br J Ophthalmol 2006;90:1204 52. Cleary PP, Kaplan EL, Handley JP, et al. Clonal basis for resurgence of serious Streptococcus pyogenes disease in the 1980s. Lancet 1992;339:518-21 53. Chuang I, Van Beneden C, Beall B and Schuchat A. Population-based surveillance for postpartum invasive group a streptococcus infections, 1995-2000. Clin Infect Dis 2002;35:665-70 54. Chang SJ, Ko YC, Wang TN, Chang FT, Cinkotai FF and Chen CJ. High prevalence of gout and related risk factors in Taiwan's Aborigines. J Rheumatol 1997;24:1364-9 55. Unnikrishnan M, Cohen J and Sriskandan S. Growth-phase-dependent expression of virulence factors in an M1T1 clinical isolate of Streptococcus pyogenes. Infect Immun 1999;67:5495-9 56. Lin HC, Wang SM, Lin YL, et al. Group A streptococcal infection caused by emm1 strains among children in southern Taiwan. Eur J Clin Microbiol Infect Dis 2008;27:1253-6 57. Agarwal BL. Rheumatic heart disease unabated in developing countries. Lancet 1981;2:910-1 58. Martin PR, Hoiby EA. Streptococcal serogroup A epidemic in Norway 1987-1988. Scand J Infect Dis 1990;22:421-9 59. Schwartz B, Facklam RR and Breiman RF. Changing epidemiology of group A streptococcal infection in the USA. Lancet 1990;336:1167-71 60. Scott JR, Pulliam WM, Hollingshead SK and Fischetti VA. Relationship of M protein genes in group A streptococci. Proc Natl Acad Sci U S A 1985;82:1822-6 61. Lancefield RC. Persistence of type-specific antibodies in man following infection with group A streptococci. J Exp Med 1959;110:271-92 62. van de Rijn I, Zabriskie JB and McCarty M. Group A streptococcal antigens cross-reactive with myocardium. Purification of heart-reactive antibody and isolation and characterization of the streptococcal antigen. J Exp Med 1977;146:579-99 63. Kaplan MH, Meyeserian M. An immunological cross-reaction between group-A streptococcal cells and human heart tissue. Lancet 1962;1:706-10 64. Brigante G, Luzzaro F, Bettaccini A, et al. Use of the Phoenix automated system for identification of Streptococcus and Enterococcus spp. J Clin Microbiol 2006;44:3263-7 65. Brigante GR, Luzzaro FA, Pini B, Lombardi G, Sokeng G and Toniolo AQ. Drug susceptibility testing of clinical isolates of streptococci and enterococci by the Phoenix automated microbiology system. BMC Microbiol 2007;7:46 66. Performance standards for antimicrobial susceptibility testing; Eighteenth Informational supplement M100-S18. Wayne, PA: Clinical and Laboratory Standards Institute, 2008 (Institute CaLS, ed. 67. Luca-Harari B, Ekelund K, van der Linden M, Staum-Kaltoft M, Hammerum AM and Jasir A. Clinical and epidemiological aspects of invasive Streptococcus pyogenes infections in Denmark during 2003 and 2004. J Clin Microbiol 2008;46:79-86 68. Jamal F, Pit S, Johnson DR and Kaplan EL. Characterization of group A streptococci isolated in Kuala Lumpur, Malaysia. J Trop Med Hyg 1995;98:343-6 69. Johnson DR, Wotton JT, Shet A and Kaplan EL. A comparison of group A streptococci from invasive and uncomplicated infections: are virulent clones responsible for serious streptococcal infections? J Infect Dis 2002;185:1586-95 70. Brown EJ. The molecular basis of streptococcal toxic shock syndrome. N Engl J Med 2004;350:2093-4 71. Herwald H, Cramer H, Morgelin M, et al. M protein, a classical bacterial virulence determinant, forms complexes with fibrinogen that induce vascular leakage. Cell 2004;116:367-79 72. Ekelund K, Skinhoj P, Madsen J and Konradsen HB. Reemergence of emm1 and a changed superantigen profile for group A streptococci causing invasive infections: results from a nationwide study. J Clin Microbiol 2005;43:1789-96 73. Lamagni TL, Neal S, Keshishian C, et al. Severe Streptococcus pyogenes infections, United Kingdom, 2003-2004. Emerg Infect Dis 2008;14:202-9 74. Pahlman LI, Malmstrom E, Morgelin M and Herwald H. M protein from Streptococcus pyogenes induces tissue factor expression and pro-coagulant activity in human monocytes. Microbiology 2007;153:2458-64 75. Pahlman LI, Olin AI, Darenberg J, et al. Soluble M1 protein of Streptococcus pyogenes triggers potent T cell activation. Cell Microbiol 2008;10:404-14 76. Soehnlein O, Oehmcke S, Ma X, et al. Neutrophil degranulation mediates severe lung damage triggered by streptococcal M1 protein. Eur Respir J 2008;32:405-12 77. Weineisen M, Sjobring U, Fallman M and Andersson T. Streptococcal M5 protein prevents neutrophil phagocytosis by interfering with CD11b/CD18 receptor-mediated association and signaling. J Immunol 2004;172:3798-807 | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/42435 | - |
| dc.description.abstract | 背景: 自1980年代開始，侵襲性的Streptococcus pyognes (S. pyogenes)在許多國家，特別是西方國家，發生率明顯增加。以M protein為基礎的疫苗目前正在開發中。台灣地區沒有完整的S. pyogenes感染的M protein 流行病學資料。
方法: 自2008年四月一日到十二月三十一日，收集來自馬偕醫院，長庚醫院，台中榮民總醫院，中國醫藥學院附設醫院，埔里基督教醫院，高雄醫學大學附設醫院，花蓮慈濟醫院的病人所分離出來的侵襲性及非侵襲性S. pyogenes感染的菌株和臨床資料。作菌株的抗藥性分析及emm型別分析及菌株生長速度，以得到流行病學資料，並分析侵襲性S. pyogenes感染的危險因子分析。 結果: 在研究期間，總計由醫院收集並鑑定211株菌株為S. pyogenes。最盛行的emm型別是emm1 (27.1%)，emm102.2 (9.5%)，emm11.0 (9.5%)，emm12.0 (9.0%)。目前開發中的26價疫苗對台灣地區S. pyogenes的emm型別涵蓋率是60.0%，其中對侵襲性及非侵襲性感染的涵蓋率分別是70.7%及54.1%。台灣地區S. pyogenes對erythromycin及tetracycline的抗藥性分別是15%及48%。Tetracycline在北區較其它區有較低的抗藥性，達到統計上的顯著性(36% v.s. 64%, p<0.001)。酗酒，菌株型別emm 1.0，年長者與女性是侵襲性感染的危險因子 (各別的p=0.05，<0.001，<0.001，0.012)。此外，高齡亦和侵襲性感染有顯著相關。病患有痛風石，菌株型別為emm 1.0，與腎功能不全是壞死性肌膜炎的危險因子 (各別的p=0.005，0.01，0.029)。女性，菌株型別emm 1.0及emm 22是鏈球菌毒性休克症候群的危險因子(各別的p=0.046，0.006，0.022)。 造成侵襲性感染的菌株生長速度顯著地較造成非侵襲性感染的菌株生長速度為快(p<0.001)，型別emm 1.0 菌株的生長速度較型別非emm 1.0的菌株生長速度更快(p<0.001)。57株型別為emm 1.0 菌株中，有48株 (84%)是屬於同一個PFGE 型別。其餘的9株中，有八株是由中部地區分離出來。 結論: S. pyogenes 會造成嚴重的感染症，造成顯著的致病性和致命性。 型別emm1的菌株與侵襲性感染、壞死性肌膜炎、鏈球菌毒性休克症候群有顯著的相關。型別emm1.0的菌株生長速度較型別非emm1.0的菌株生長速度為快，且別emm1.0的菌株中84%是屬於同一個PFGE 型別。 | zh_TW |
| dc.description.abstract | Background. The incidence of invasive Streptococcus pyogenes (S. pyogenes) infection had increased since 1980s, especially in western countries. Few report in epidemiologic characteristics of invasive and noninvasive S. pyogenes infection was available in Taiwan.
Methods. From April 2008 through October 2008, we collected S. pyogenes strains and clinical data from 7 medical centers in Taiwan. The enrolled strains were characterized by the emm types, drug susceptbility profiles and growth rate. Logistic regression model was used to identify the risk factors associated with invasive infection, necrotizing fasciitis (NF) and streptococcal toxic shock syndrome (STSS) caused by S. pyogenes. Results. During the study periods, we collected and identified 211 strains of S. pyogenes. The most prevalent emm types were emm1 (27.1%), emm102.2 (9.5%), emm11.0 (9.5%), and emm12.0 (9.0%). The 26-valent S. pyogenes vaccine covered 60.9% (126/207) of these strains, including those from invasive cases (70.7%, 53/75) and noninvasive cases (54.1%, 73/135). The resistant rates against erythromycin and tetracycline were 15% (31/211) and 48% (102/211), respectively. Alcohol abuse, isolates with emm 1.0, older age and female were risk factors for invasive infection. Tophaceous gout, isolates with emm 1.0 and renal function impairment were risk factors for ncerotizing fasciitis. Female, isolates with emm 1.0, isolates with emm 22 were significant risk factors of STSS. Isolates obtained from cases with invasive infection possess faster growth rate than those from cases with non-invasive infection. Isolates with emm type 1.0 possess significantly faster growth rate than those with other emm types. Among the 57 isolates with emm type 1.0, 48 (84%) have the same PFGE type. Conclusion. S. pyogenes infection caused significant morbidity and mortality in Taiwan. Isolates with emm type 1 are associated with invasive infection, STSS and NF. Penicillin and otherβ-lactams tested still exerted high levels of activity against S. pyogenes isolates. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-15T01:13:44Z (GMT). No. of bitstreams: 1 ntu-98-P96421021-1.pdf: 1121342 bytes, checksum: 9a1415110bd8a1aad8058fe3ebf9fa43 (MD5) Previous issue date: 2009 | en |
| dc.description.tableofcontents | 口試委員審定書 1
誌謝 2 中文摘要 3 英文摘要 5 目錄 7 緒論 10 Streptococcus pyogenes的歷史及特性 10 M protein及其它內毒素、外毒素 11 S. pyogenes的疫苗 13 對Macrolide及其它藥物的抗藥性 14 對Macrolide及其它藥物抗藥性的機轉 15 侵襲性感染的危險因子 16 研究目的與假說 16 研究方法與材料 17 病例定義 17 菌株及臨床資料收集方式 17 細菌鑑定與抗生素敏感性試驗 18 emm 分型實驗 18 生長速度實驗 20 Pulses Field Gel Electrophoresis (PFGE) 21 統計方法 21 結果 23 菌株及病例資料 23 基本資料與臨床表現 23 emm 型別 24 藥物敏感性檢驗 25 生長速度實驗 25 emm 1 菌株的PFGE 分型 26 侵襲性感染的危險因子分析 26 討論 28 展望 33 英文簡述 34 Introduction 34 Material and Method 37 Collection of isolates and clinical data 37 Case definition 38 Strain identification and antimicrobial susceptibility test 39 emm Typing 39 Statistical analysis. 40 Results 42 Demography and clinical presentation. 42 Underlying disease and Treatment setting 43 Isolates characterization. 44 Drug susceptibility. 45 Risk factor analysis. 45 Discussion 47 Reference 52 附表 60 表一 侵襲性和非侵襲性感染病例在各年齡層的臨床表現 60 表二 S. pyogenes的抗藥性情況 62 表三 erythromycin與tetracycline 抗性菌株的地理分佈 63 表四 宿主的因子與臨床表現的關聯性之單變項分析 64 表五 S. pyogenes的emm 型別、抗藥性因子與臨床表現的關聯性 67 表六 侵襲性感染的危險因子多變項分析 69 表七 壞死性肌膜炎的危險因子多變項分析 70 表八 鏈球菌毒性休克症候群的危險因子多變項分析 72 附圖 73 圖一、侵襲性與非侵襲性感染病例的年齡分佈圖。 73 圖二菌株的emm 別分佈和疫苗含蓋分佈。 74 圖三 S. pyogenes菌株的生長速度的箱形圖 75 圖四 emm1.0 S. pyogenes的PFGE分析 77 圖五 主要PFGE 型別與非主要PFGE型別emm 1.0 菌株的生長速度比較 78 附件 病歷資料記錄格式 79 | |
| dc.language.iso | zh-TW | |
| dc.subject | 生長速度 | zh_TW |
| dc.subject | 化膿性鏈球菌 | zh_TW |
| dc.subject | emm 型別 | zh_TW |
| dc.subject | 藥物敏感性 | zh_TW |
| dc.subject | drug resistance | en |
| dc.subject | growth rate | en |
| dc.subject | pulse field gel electrophoresis | en |
| dc.subject | S. pyogenes | en |
| dc.subject | emm type | en |
| dc.title | 侵襲性及非侵襲性的Streptococcus pyogenes的危險因子分析
-M protein是侵襲性的關鍵嗎? | zh_TW |
| dc.title | Risk Factor Analysis for Severe Streptococcus pyogenes infection
-Is M type the Pivot of Invasiveness? | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 97-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 黃玉成(Yhu-Chering Huang),陳祈玲(Chi-Ling Chen) | |
| dc.subject.keyword | 化膿性鏈球菌,emm 型別,藥物敏感性,生長速度, | zh_TW |
| dc.subject.keyword | S. pyogenes,emm type,drug resistance,pulse field gel electrophoresis,growth rate, | en |
| dc.relation.page | 83 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2009-07-29 | |
| dc.contributor.author-college | 醫學院 | zh_TW |
| dc.contributor.author-dept | 臨床醫學研究所 | zh_TW |
| 顯示於系所單位： | 臨床醫學研究所 | |
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