碩士 / 國立暨南國際大學 / 生物醫學科技研究所 / 95 / Abstract Light-therapy system has been widely used in medication, and the Full Color LED that assists spectrum modulation in single light-therapy systems can be helpful to the treatments of different dermatosis as well. The present thesis attempts to control the system, and to accomplish the spectrum modulation and the frequency modulation by the Nichia Full Color LEDs integrating to the PIC16F877A microcontrol chip. On the other hand, we utilize the LED semiconductor’s characteristic--- the temperature rises, the forward voltage falls--- to achieve the temperature detection. In this study, 162 LEDs arrayed and light-therapy system, which wavelength and frequency could be modulated, are been utilized. And the temperature detection and compensation could be achieved based on the characteristics of the LED. The wavelength of the spectrum modulation range is from 448 to 608nm. The frequency modulation range is from 62.5Hz to 2.5KHz.The peak power of the LED’s maximum pulse current is approximately 123 mW/cm2 for red light, 27 mW/cm2 for green light, and 95 mW/cm2 for blue light. When the temperature of LED pass over 30℃,then the temperature reduces with the modification of the modulates pulse width by the temperature compensation mechanism. Keywords: full color LED; light-therapy; spectrum modulation; micro-chip; frequency modulation; temperature detection; temperature compensation; pulse width

碩士 / 長庚大學 / 醫療機電工程研究所 / 94 / Psoriasis is a common skin disease affecting affects 2–3% population worldwild. Accordingly, there are approximately 100 thousand individuals having psoriasis in Taiwan. The etiology of psoriasis remains unknown, however, it is believed to be a multifactorial and polygenetically inherited disease. The main features of psoriasis include abnormal epidermal keratinocyte differentiation and proliferation, superficial vascular remodelling and a T-cell-predominant inflammatory infiltrate. Chronic plaque psoriasis, the most common form of psoriasis, is a papulosquamous disease defined by erythematous plaques with a silvery scale involving trunk, extremities, scalp, face, and even whole body surface. Of the severity scoring systems currently available for psoriasis, the PASI scoring system has been most extensively tested. It consists of the involved surface areas of the body and the severity of individual psoriatic lesions, such as erythema, scaling, and thickness. Although it is convenient, the PASI scoring system is a subjective method based on a physician’s experience. Thus, the reliability of the visual grading scoring system is not satisfactory. The marked interindividual variation between physicians may have a significant impact on the medical strategy decision, and accuracy of new medical trial before and after evaluation.Oral medicine, topical medicine and Ultra-Violet phototherapy and have been used successfully for the treatment of psoriasis. Oral medicine, including methotrexate; cyclosporine, oral retinoids, are frequently associated with skin xerosis, itchy, and serious side effects including myelosuppression, impairment of liver/renal function. Phototherapy and topical therapies remain the gold standard of treating psoriasis.Ultraviolet A (UVA, 360nm) and narrow band ultraviolet B (UVB, 310nm) phototherapy are usually administered in specialty centers due to the bulky size of phototherapy devices. The adjustment of therapeutic dosimetry is based on the physicians experience and patients skin response before each light therapy. Optimal therapeutic dosimetry is undetermined because studies on psoriatic skin-light interaction is lacking. Thus, studies focus on the issue of psoriatic skin-light interaction is mandatory to disclose the optimal light therapy dosimetry. In first part of research, a Computer Aided Psoriasis Area and Severity Assessment system had been developed. It involves area assessment module, scaling assessment module, redness assessment module, thickness assessment module, network-based anamnesis database, and clinical verifying psoriasis area and severity assessment. The results show that there is no significant difference in comparison with the data of doctor in area assessment, scaling assessment, and redness assessment, while P>0.05; There is significant difference just in thickness assessment, while P<0.05; There is no significant difference in overall PASI assessment, while P>0.05. In second part, a Computer Aided Skin Assessment optical simulation analysis Integration system had been developed. By optical simulation, respectively, simulating normal and psoriasis skin in 1-6MED (minimal erythema dose, MED), the result shows that the intensity of normal skin is larger than that of psoriasis skin in a unit of area. This is, psoriasis skin has poor absorbing rate. Then, in clinical verification, psoriasis skin still can get effective treatment. In third part, a Computer Aided Skin phototherapy Integration system had been developed. It involves clock circuit module, lamp module, and elevator module. In this research, a Computer Aided Psoriasis Area and Severity Assessment and Skin phototherapy Integration system had been developed, and can immediately be used clinically. It can improve the treatment effect and provide the quantitative degree of psoriasis area and severity Assessment. Therefore, it provides a objective and quantitative assessment for long term assessment. According to the configuration of skin optical parameter, it practically simulates light therapy in 1-6MED (minimal erythema dose, MED), and provides strategies for improving treatment model efficiently and shorten treatment time.

碩士 / 朝陽科技大學 / 幼兒保育系碩士班 / 102 / Background：Neonatal jaundice is a common problem affecting newborns. Neonatal readmission, typically caused by hyperbilirubinemia, occurs within 2 weeks after birth, and phototherapy, a major neonatal jaundice treatment, is subsequently administered. A study reported that baby massages are beneficial for ameliorating neonatal hyperbilirubinemia in full-term infants undergoing phototherapy. This study explored the effect of massages on newborns with jaundice undergoing phototherapy. Methods：A experimental design and purposive selection sampling of 56 infants with jaundice (total serum bilirubin levels above 15 mg/dL) were admitted for phototherapy, and the infants were randomly assigned to a control group (n = 29) and an experimental group (n = 27). The participants in the massage group received 15-minute infant massages twice daily for 3 days. The participants in the control group did not receive massages. During the study period, the 2 groups received the same nursing routine care and phototherapy. On Day 1, Day 2, and Day 3, 0.5 mL of blood was drawn from a clinical heelstick blood sample. Infants’ medical records, which included total feeding amount, stool frequency, body weight, microbilirubin data, total phototherapy duration, and hospital days. Results：The results of this study suggested that the stool frequency of the massaged infants on Day 3 was significantly higher than that of the infants in the control group (p = 0.045). The serum total bilirubin levels on the third day significantly decreased in the massage group compared with the control group (p = 0.03), excluding intravenous infusion. No significant differences between the 2 groups in feeding amount, body weight, total phototherapy duration, and length of hospital stay were observed. Conclusions：Infant massage can reduce the serum total bilirubin level and increase the stool frequency of newborns with jaundice.

碩士 / 國立臺灣大學 / 預防醫學研究所 / 97 / Background Psoriasis is a kind of chronic diseases which cannot be cured at present. Patients may need lifelong treatment. Moreover, patients in serious conditions may require long-term use of systemic drugs or phototherapy to ease the condition. Several studies have shown that psoriasis patients who do not receive systemic treatment have slightly higher risks of getting cancer than the general population. Although psoriasis is not confirmed to lead to cancer, it is worthwhile to discuss the issue more deeply concerning whether using systemic treatment proved or suspected to be carcinogenic increases the risks of getting cancer for psoriasis patients. Study Purpose The study was aimed at discovering the Indirect Standardized Incidence Ratio (SIR) of nonmelanoma skin cancer (NMSC), lymphoma and melanoma happening on patients with various disease severity of psoriasis. The study would also explore the relevance between different treatment types and the occurrence of NMSC by means of Time-dependent Cox regression mode. Material and Method The cohort of psoriasis was defined based on the administrative claims data of a randomly sampled cohort (n = 1,000,000) of National Health Insurance beneficiaries in Taiwan with the diagnostic column of ICD-9 code being 696, 696.0 or 696.1. Cases of NMSC, melanoma or lymphoma were defined when patients were diagnosed with the above diseases after getting into the cohort and treated with compatible treatment. Psoriasis patients were then divided into two groups: severe or mild in accordance with the experience of receiving systemic treatment. We calculate SIR of cancer for each study group. After adjusting the age, gender, Charlson comorbidity index and arsenic-exposure, Time-dependent Cox regression model was then applied to analyze variables of treatments such as PUVA therapy, UVB therapy, Methotrexate, Cyclosporin, Retinoids, Azathioprine and Tar to discover how the timing of different events and the accumulated times of treatment as well as the amount of doses affected NMSC. The study also conducted sensitivity analysis of the timing of the accumulated doses of Retinoids. Results There were 7061 patients defined as the generation of psoriasis, among which 870 were severe psoriasis patients and 6191 mild were ones. After adjusting age and gender, the SIR of NMSC was 4.29 (95% CI 2.90-6.35) while the SIR of mild psoriasis was 3.72 (95% CI 2.34-5.90) and 7.08 (95% CI 3.38-14.85) of the SIR of severe psoriasis. The SIR of melanoma was 3.75 (95% CI 0.94-14.99) while the SIR of mild psoriasis was 2.26 (95% CI 0.32-16.04) and 11.01 (95% CI 1.55-78.16) of the SIR of severe psoriasis. The SIR of lymphoma was 2.30 (95% CI 1.15-4.60) while the SIR of mild psoriasis was 1.75(95% CI 0.73-4.20) and 4.85 (95% CI 1.56-15.04) of the SIR of severe psoriasis. There were 6737 patients newly diagnosed with psoriasis, among which 22 cases were diagnosed with NMSC in the Time-dependent Cox regression model of discovering the effects of variables of treatments on the occurrence of NMSC. In addition to age and arsenic-exposure, the more the accumulated doses of Azathioprine were, the higher risks of the occurrence of NMSC would be. There was no statistical significance of how the accumulated times and doses of the other treatment affected the occurrence of NMSC. Discussion Mild psoriasis patients had higher risks of getting NMSC than the reference group which implied psoriasis itself was carcinogenic. The occurrence rate of NMSC, melanoma and lymphoma was slightly higher for severe psoriasis patients, which was possibly related to the severity of psoriasis or its treatments. Studies concerning the risks of getting NMSC with Azathioprine were mainly about patients with rheumatoid arthritis, organs transplantation or inflammatory bowel disease. There were still no large scale researches regarding NMSC caused by psoriasis treated with Azathioprine. PUVA therapy was significantly carcinogenic in getting NMSC in the West literatures while its risks were comparatively lower in Asian studies. The risk of getting NMSC with PUVA therapy in our study is not significant. In addition to the difference of races and skin types, the accumulated times of treatment tend to being low may be also a critical factor. As for the treatment of NMSC with Methotrexate and Cyclosporin, the risks of getting cancer were not significant, which may be the result of insufficient tracing time. Conclusion The risks of getting NMSC, melanoma and lymphoma for severe psoriasis patients were higher than the reference group. The risks of getting NMSC for mild psoriasis patients were higher than the reference group. Therefore, psoriasis itself was carcinogenic of getting NMSC. The study had proved that the occurrence of NMSC was related to psoriasis patients’ using Azathioprine. Consequently, psoriasis patients should use the drugs cautiously and avoid being exposed to the ultra light.

碩士 / 中原大學 / 醫學工程研究所 / 94 / Psoriasis is a non-contagious, chronic, and recurrent skin disorder which appears as inflamed lesions and is covered with silvery scale. Up to now, psoriasis still cannot be completely cured, but can only be controlled by treatment. Narrow band ultraviolet-B phototherapy and psoralen with ultraviolet-A photochemotherapy have become popular treatment of psoriasis because of their long recurrent period. The dose of ultraviolet entering skin tissue is determined by the absorption of medication and the scattering on skin surface. In order to measure ultraviolet transmission through applied medication, an acrylic skin model was made in this study to mimic the optical scattering property of skin surface. The results show that ultraviolet transmission increases only when a small amount of translucent medication is applied. This is due to the reduction of surface scattering by matching the refraction index between skin and medication. When more medication is applied, the ultraviolet transmission decreases again because of the absorption by medication. By using the model with skin surface profile, the ultraviolet dose can be more accurately estimated. The amount of medication to increase the ultraviolet transmission in phototherapy should be carefully controlled.

碩士 / 崑山科技大學 / 電子工程研究所 / 95 / Jaundice is a common condition in newborns. There are two types of this condition: physiological (normal) and pathological.Physiological jaundice generally appears at 2 to 4 days of age and disappears by 1 to 2 weeks of age. This is normal and no treatment needed. When jaundice appears too long (more than a week) or Bilirubin level appears over the normal range (>20mg), immediate treatment is needed to prevent permanent damages. Physiological jaundice is most often treated with phototherapy (treatment with a special light by alternating Bilirubin and making it easier for baby’s liver to get rid of it). Currently in hospital, phototherapy is using the light with only single intensity of illumination (a fluorescent light) and timer to control manually for each course (cycle) of the treatment. You cannot adjust the intensity of illumination or the duration of treatment time for each individual case. This may cause some unnecessary damages to the newborn that have to receive the high intensity of illumination when starting phototherapy. For better controlled and satisfied result of phototherapy, we developed this multiple operating system to help achieve a safe and effective phototherapy result for newborns.This system is using LED which wavelength has been set in a specific range to execute illumination. The medical personnel can adjust the intensity of illumination and duration of treatment time specifically base on individual condition. They can even set different intensity with different time table in one treatment cycle, making adjustment and monitoring the phototherapy progress accordingly as planned.

碩士 / 慈濟大學 / 醫學研究所 / 95 / Background: Diabetic scleredema (DS) is a nonpitting, woody, peau d’orange quality of skin characters. It involved the upper back and neck with insidious onset of painless, symmetric induration of the skin, and caused neck stiffness and limitation of neck rotation. DS was dermal connective tissue disorder of skin, associated with diabetes mellitus (DM). The histopatholgic findings revealed abnormal accumulations of collagen and mucin in skin dermis. The past epidemiology showed that the prevalence was 2.5 to 14 percentages of patients with type 2 DM. The treatment for DS was usually unsuccessful in the past. Design: In our study, we defined a new grading system for DS severities. We applied UVA1 phototherapy for DS patients. The efficacy of UVA1 phototherapy was evaluated by grading system, skin echography, and skin elasticity. We sought to investigate the pathogenesis of DS and mechanism of UVA1 phototherapy by immunohistochemical stains of Matrix Metalloproteinase (MMP) system with MMP-1, MMP-3, and tissue inhibitor of Matrix Metalloproteinase-1(TIMP-1). We also sought possible risk factors of DS by epidemiology. Result: Following UVA1 phototherapy on DS patients, we detected clinical improvement by grading system, significantly decreased dermal thickness in skin echography, and significantly increased skin elasticity. The immunohistochemistry stains showed decreased intensities of MMP-1 and MMP-3 and increased intensities of TIMP-1 compared to normal control specimens. The prevalence of DS in western Taiwan was 13.3 percentage of diabetic patients and relative to high bloody total cholesterol, lower-density lipoprotein and insulin insufficiency. No significant statistical difference of diabetic complications was found in DS patients. Conclusion: We set a new grading system of DS to define clinical severity. UVA1 phototherapy is an effective and safe treatment for DS. We can effectively evaluate the efficacy of UVA1 phototherapy on DS by clinical grading system, skin echography, and skin elasticity. We assumed that the pathogenesis of DS was decreased MMP-1 and MMP-3 and icreased TIMP-1 to impair the metabolism of collagen and mucin resulting in thicken collagen bundles and mucin deposition. We supposed that the mechanism of UVA1 phototherapy on DS induced the increase of MMP-1 and MMP-3 and the decrease of TIMP-1 to accelerate the metabolism of collagen and mucin.

碩士 / 中山醫學大學 / 生物醫學科學學系碩士班 / 100 / Exposition of solar ultraviolet (UV) radiation has been identified as one of the major risk factors for skin cancer development in Americans. UV radiation induces two of the most abundant mutagenic and cytotoxic DNA lesions such as cyclobutane–pyrimidine dimmers (CPDs) and 6-4 photoproducts (6-4PPs) and their Dewar valence isomers. However, cells have developed a number of repair mechanisms to counteract the DNA damage caused by UV. Although skin cancer is a common in Taiwan, the pathogenesis is still incompletely studied. In this proposal, we would like to study the role of DNA repair mechanisms in skin tumorgenesis pathway by exposing UV radiation. Our preliminary results showed that differential susceptibility to UV radiation exposure between a spontaneously immortalized human keratinocyte HaCaT cell line and a human skin basal cell carcinoma (BCC) cell line. We investigated numerous candidate genes in different DNA repair mechanisms affected by UV radiation. Including of OGG1, MGMT, MPG, TDG, UNG, XPA, XPC, RAD51, XRCC4 from different DNA repair mechanisms .Our data indicated that treatment with UVB in HaCaT cells base excision repair (BER) is higher than BCC cells. Similarly results were also observed in mRNA, measured by Real-time polymerase chain reaction (Real-time PCR) method. Our data suggest that BER may be involved in the development of skin carcinogenesis. Furthermore, UV-B phototherapy maybe is a helpful strategy to skin cancer patients as a pretreatment for radiation therapy. This study is valuable for the understanding the role of functional protein plays in the progression of skin cancer and for the development of new therapeutic modality in the future.

碩士 / 國防醫學院 / 生物及解剖學研究所 / 100 / Osteoarthritis is a complex degenerative disease, that disrupts the articular cartilage and collagenous matrix of the joint, includes chondrocytes loss, cartilage fibrillation, cartilage hyalinization, total cartilage thickness loss, subchondral bone sclerosis, bone cysts and spur formation. The treatment of osteoarthritis includes anti-inflammatory drugs, surgical treatment or physical therapy such as phototherapy. Recent studies about light emitting diode light (LED) showed that LED light irradiation has some effects similar to laser irradiation on tissue such as enhanced fibroblasts proliferation and tissue repair. It is not clear about the effects to LED irradiation on cartilage metabolism. Therefore, the aim of this study was explore the effects of LED light irradiation on surgical induced osteoarthritis cartilage metabolism. 58 male SD rats of 10 weeks old were divided into four experiment groups and baseline group. LED irradiation duration was 3 and 6 weeks. Experimental OA model of rats was induced with transverse meniscus ligament transection surgery in trauma groups. In sham groups, only incision on the skin was made. All rats were administered bone markers (calcein) by intraperitoneal (IP) injections, 8 and 1 day before sacrifice. After sacrifice, femur and tibia were collected. Femur and tibia was further processed with decalcified and undecalcified method respectively. Histological observation and measurement of the articular cartilage and subchondral bone was done by histomorphometry. Results: The histological results in 3 weeks groups, showed that LED light irradiation enhanced cartilage metabolism parameters, such as longitudinal growth rate, growth plate thickness, chondrocyte mean height, articular cartilage thickness, calcified cartilage volume and osteoclasts number. In 6 weeks groups, the articular cartilage Area superficial flaking ratio of trauma irradiation group was lower than that of trauma control group. Conclusion: Irradiation with 630 nm wavelength LED light, on OA rats enhanced chondrocytes proliferation and increased chondrocyte mean height, growth plate thickness, articular cartilage thickness and calcified cartilage volume, osteoclasts number in the subchondral bone to cope with the inflammatory process shown in the experimental induced OA model.

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