Magíster en Educación mención en Currículum y Comunidad Educativa / El concepto de calidad educativa está en el centro de las políticas públicas que el Estado chileno ha diseñado e implementado recientemente con el fin de transformar el sistema de enseñanza.En consecuencia, este trabajo sigue uncurso investigativo que relaciona las políticas educativas (en este caso el marco regulatorio que prescribe la LGE) con las representaciones de los profesores en torno al concepto de calidad educativa que comparten estas políticas. Para lograr esto, se realizó un análisis textual de los documentos relacionados con la implementación de las políticas educativasy se aplicaron 4 entrevistas en profundidad, lo que nos permitió concluir que los profesores sostienen una posición crítica frente al concepto de calidad educativa que fundamenta la LGE

Estudos anteriores mostraram um efeito supressivo do extrato de Ascaris suum (Asc) nas respostas humoral e celular a um antígeno heterólogo. O fracionamento deste extrato por gel filtração possibilitou a identificação de picos distintos, constituídos de proteínas de alto peso molecular (PI) e baixo peso molecular (Plll), sendo o efeito supressivo de Asc restrito aos componentes de PI. Com relação à produção de anticorpos contra estes componentes, verificou-se que PI é capaz de induzir preferencialmente a síntese de lgG1 não-anafilática e baixos títulos de lgE e de lgG1 anafilática. Considerando que estes resultados foram obtidos no 8º día após a imunização dos animais, propusemos-nos a estudar a indução de anticorpos anafiláticos por PI em fases mais tardias da resposta imune e sua regulação por citocinas. Os nossos resultados mostraram que a indução da lgG1 anafilática anti-PI é mais tardia e regulada parcialmente por IL-4, tanto na resposta primária como secundária. A produção de lgE é totalmente dependente de IL-4. Devido à heterogeneidade presente em nossos animais, pudemos constatar apenas uma tendência de regulação negativa de IL-12 e IFN -γ sobre a produção dos anticorpos lgG1 anafiláticos e lgE, no início da resposta primária. Entretanto, nossos resultados mostraram um efeito importante da IL-10, em conjunto com IFN-γ, na inibição da síntese de anticorpos anafiláticos anti-PI, tanto na resposta primária como secundária. Com relação à lgG1 não-anafilática anti-PI, sua indução parece depender de IFN-γ apenas na resposta primária. / Previous studies have shown a suppressive effect of Ascaris suum extract (Asc) on humoral and cell-mediated immune responses to a non-related antigen. After fractionation of this extract by gel filtration, two peaks were identified according to their molecular weights, and the suppressive effect was associated with proteins of high molecular weight (PI). PI induces high levels of non-anaphylactic lgG1 and low levels of lgE and anaphylactic lgG1. Since these results were obtained 8 days after immunization, the aim of this work was to follow the production of anti-PI anaphylactic antibodies during the primary as well as the secondary antibody response. We algo studied the modulation of the anaphylactic antibody production by cytokines. Pl-specific anaphylactic lgG1 was produced lately in the primary response and was partially dependent on IL-4, including the secondary response. lgE was not produced in the absence of IL-4 at any time. IL-12 and IFN- γ exerted a slight negative effect on Pl-specific anaphylactic lgG1 and lgE antibody production in the beginning of the primary response. In contrast, IL-10 together with IFN- γ had a profound inhibitory efíect on the synthesis of these antibodies in the primary and secondary responde. The production of Pl-specific non-anaphylactic lgG1 antibodies depended upon IFN- γ only in the prímary response.

Estudos anteriores mostraram um efeito supressivo do extrato de Ascaris suum (Asc) nas respostas humoral e celular a um antígeno heterólogo. O fracionamento deste extrato por gel filtração possibilitou a identificação de picos distintos, constituídos de proteínas de alto peso molecular (PI) e baixo peso molecular (Plll), sendo o efeito supressivo de Asc restrito aos componentes de PI. Com relação à produção de anticorpos contra estes componentes, verificou-se que PI é capaz de induzir preferencialmente a síntese de lgG1 não-anafilática e baixos títulos de lgE e de lgG1 anafilática. Considerando que estes resultados foram obtidos no 8º día após a imunização dos animais, propusemos-nos a estudar a indução de anticorpos anafiláticos por PI em fases mais tardias da resposta imune e sua regulação por citocinas. Os nossos resultados mostraram que a indução da lgG1 anafilática anti-PI é mais tardia e regulada parcialmente por IL-4, tanto na resposta primária como secundária. A produção de lgE é totalmente dependente de IL-4. Devido à heterogeneidade presente em nossos animais, pudemos constatar apenas uma tendência de regulação negativa de IL-12 e IFN -γ sobre a produção dos anticorpos lgG1 anafiláticos e lgE, no início da resposta primária. Entretanto, nossos resultados mostraram um efeito importante da IL-10, em conjunto com IFN-γ, na inibição da síntese de anticorpos anafiláticos anti-PI, tanto na resposta primária como secundária. Com relação à lgG1 não-anafilática anti-PI, sua indução parece depender de IFN-γ apenas na resposta primária. / Previous studies have shown a suppressive effect of Ascaris suum extract (Asc) on humoral and cell-mediated immune responses to a non-related antigen. After fractionation of this extract by gel filtration, two peaks were identified according to their molecular weights, and the suppressive effect was associated with proteins of high molecular weight (PI). PI induces high levels of non-anaphylactic lgG1 and low levels of lgE and anaphylactic lgG1. Since these results were obtained 8 days after immunization, the aim of this work was to follow the production of anti-PI anaphylactic antibodies during the primary as well as the secondary antibody response. We algo studied the modulation of the anaphylactic antibody production by cytokines. Pl-specific anaphylactic lgG1 was produced lately in the primary response and was partially dependent on IL-4, including the secondary response. lgE was not produced in the absence of IL-4 at any time. IL-12 and IFN- γ exerted a slight negative effect on Pl-specific anaphylactic lgG1 and lgE antibody production in the beginning of the primary response. In contrast, IL-10 together with IFN- γ had a profound inhibitory efíect on the synthesis of these antibodies in the primary and secondary responde. The production of Pl-specific non-anaphylactic lgG1 antibodies depended upon IFN- γ only in the prímary response.

In der vorliegenden Arbeit wurden bisher publizierte Daten über LIE-CT des Myokards in Form einer Metaanalyse systematisch ausgewertet. Das primäre Ziel der Metaanalyse war, bisherige Erkenntnisse über die Treffsicherheit der LIE-CT in Bezug auf infarzierte Myokardabschnitte quantitativ zusammenzufassen. Nach Entfernung der Duplikate ergab die Suche in den vier Datenbanken insgesamt 914 unterschiedliche Treffer. Letztlich wurden 12 Studien eingeschlossen (336 Patienten; 268 männlich, 68 weiblich; das mittlere Alter der Patienten variierte zwischen 55 und 67,7 Jahren). Die AUC (area under the curve) der SROC-Kurve (summary receiver operating characteristic curve) als Maß für die Treffsicherheit der LIE-CT für infarzierte Segmente beträgt 0,95 (95 % CI: 0,93 - 0,97). Die gepoolte Sensitivität der LIE-CT beträgt 0,81 (95 % CI: 0,75 - 0,87) und eine gepoolte Spezifität von 0,97 (95 % CI: 0,95 - 0,98). Fünf der eingeschlossenen 12 Studien (mit insgesamt 126 Patienten) haben zusätzlich den transmuralen Charakter der Myokardnarben ausgewertet. In Bezug auf transmurale infarzierte Myokardsegmente beträgt die AUC 0,94 (95 % CI: 0,91 - 0,95). Die gepoolte Sensitivität der LIE-CT für transmurale Infarkte beträgt 0,81 (95 % CI: 0,74 -0 ,86) und die gepoolte Spezifität 0,96 (95 % CI: 0,93 - 0,98). Das diagnostische Odds Ratio der gepoolten Daten war 146 (95 % CI: 65 - 331). I2 beträgt 97,95 % (95 % CI: 94 - 99 %), vereinbar mit einer hohen Heterogenität. Die Ergebnisse des Deeks-Tests (als Maß für die Publikationsbias) waren nicht statistisch signifikant (p = 0,08 beziehungsweise p = 0,84). Zu den Limitationen der Arbeit gehören die Verwendung anderer bildgebender Verfahren als Referenzstandard, die Heterogenität der eingeschlossenen Studien, den Einschluss sowohl von Patienten mit subakuten als auch mit alten Myokardinfarkten und die geringe Anzahl von Studien, die Angaben zum transmuralen Charakter der Infarkte machen. Insgesamt sprechen die Ergebnisse dafür, dass die LIE-CT eine relativ hohe Sensitivität und eine sehr hohe Spezifität für Myokardinfarkte hat. Die Sensitivität ist niedriger als die Referenzmethode LGE-MRT, während die hohe Spezifität darauf hindeutet, dass beide Methoden zumindest in dieser Hinsicht ähnlich gut sind. Anhand der vorliegenden Daten kann die LIE-CT nicht als Ersatz für die LGE-MRT empfohlen werden, wenn die Myokardvitalität die primäre diagnostische Fragestellung ist. Dagegen könnte die LIE-CT eine sinnvolle Erweiterung des CT-Protokolls bei Patienten sein, bei denen im Rahmen der CT-Koronarangiographie hochgradige Stenosen oder Verschlüsse gefunden werden.:Abkürzungsverzeichnis 1 Einleitung 1.1 Pathophysiologie und Epidemiologie der Myokardischämie 1.2 Therapie des chronischen Koronarsyndroms 1.3 Myokardvitalität und bildgebende Diagnostik 1.3.1 Echokardiographie 1.3.2 Einzelphotonen-Emissionscomputertomographie (SPECT) 1.3.3 Positronenemissionstomographie (PET) 1.3.4 Magnetresonanztomographie (MRT) 1.3.5 Computertomographie (CT) 1.4 Fragestellung 2 Material und Methoden 2.1 Studiensuche und -selektion 2.2 Ethikvotum 2.3 Datenextraktion 2.4 Statistische Auswertung 2.4.1 Heterogenität 2.4.2 Publikationsbias 2.4.3 Methodische Qualität 3 Ergebnisse 3.1 Literaturrecherche 3.2 Eingeschlossene Studien 3.2.1 Studiendesign und Patientenzahlen 3.2.2 akute vs. chronische Infarkte 3.2.3 Referenzstandard 3.2.4 CT-Untersuchungstechnik 3.2.5 Heterogenität der Studien 3.3 Publikationsbias 3.4 Methodische Qualität 4 Diskussion 4.1 LIE-CT in der Metaanalyse und in den eingeschlossenen Einzelstudien 4.2 Transmuralität der Infarktareale 4.3 Strahlenbelastung 4.4 LIE-CT und LGE-MRT 4.5 LIE-CT und andere Verfahren zur Beurteilung der Myokardvitalität 4.5.1 SPECT 4.5.2 PET 4.5.3 Dobutamin-Stressechokardiographie (DSE) 4.6 LIE-CT bei nicht-ischämischen Fragestellungen 4.7 Methodische Qualität 4.8 Limitationen 4.9 Optimierungspotential der LIE-CT und Ausblick Zusammenfassung Summary Tabellenverzeichnis Abbildungsverzeichnis Literaturverzeichnis / We performed a meta-analysis of published data on late iodine enhancement computed tomography (LIE-CT) in patients with myocardial infarction. The aim of the meta-analysis was to evaluate the accuracy of LIE-CT in detecting infarcted myocardial segments. After removal of duplicates the initial search of the four databases identified 914 potentially matching articles. After further selection based on article titles, abstracts and then full texts, 12 studies were finally included in the meta-analysis (336 patients; 268 male, 68 female; median patient age between 55 und 67.7 years). The AUC (area under the curve) of the SROC curve (summary receiver operating characteristic curve) as a measure of the accuracy of LIE CT for infarcted segments is 0.95 (95 % CI: 0.93 - 0.97). The pooled sensitivity of LIE-CT was 0.81 (95 % CI: 0.75 - 0.87) and the pooled specificity was 0,97 (95 % CI: 0.95 - 0.98). Five of the 12 included studies also have evaluated the performance of LIE-CT for differentiating between transmural and non-transmural infarctions. In this case the AUC was 0.94 (95 % CI: 0.91 - 0.95). The pooled sensitivity of LIE-CT for transmural Infarctions was 0.81 (95 % CI: 0.74 - 0.86) and the pooled specificity 0.96 (95 % CI: 0.93 - 0.98). The diagnostic odds ratio of the pooled data was 146 (95 % CI: 65 - 331). I2 was 97.95 % (95 % CI: 94 - 99 %), consistent with high heterogeneity. The results of the Deek`s test, which served as a measure for publication bias were not statistically significant (p = 0.08 and p = 0.84, respectively). Among the limitations of the current study are the use of other imaging modalities as a reference standard, the heterogeneity of included studies, the inclusion of both subacute and chronic infarct cases and the low number of studies which have evaluated the transmurality of the infarctions. The results of this meta-analysis confirm that LIE-CT has a relatively high sensitivity and a very high specificity for myocardial infarctions. The sensitivity is lower compared to the reference standard LGE-MRI, while the high specificity shows that both methods are comparable at least in this regard. Based on the data summarized in this meta-analysis, LIE-CT cannot be recommended as a replacement for LGE-MRI when evaluating myocardial viability is the main purpose of the imaging examination. LIE-CT can be a helpful addition to cardiac CT exam protocols, when a high-grade stenosis or occlusion is found on coronary CT angiography.:Abkürzungsverzeichnis 1 Einleitung 1.1 Pathophysiologie und Epidemiologie der Myokardischämie 1.2 Therapie des chronischen Koronarsyndroms 1.3 Myokardvitalität und bildgebende Diagnostik 1.3.1 Echokardiographie 1.3.2 Einzelphotonen-Emissionscomputertomographie (SPECT) 1.3.3 Positronenemissionstomographie (PET) 1.3.4 Magnetresonanztomographie (MRT) 1.3.5 Computertomographie (CT) 1.4 Fragestellung 2 Material und Methoden 2.1 Studiensuche und -selektion 2.2 Ethikvotum 2.3 Datenextraktion 2.4 Statistische Auswertung 2.4.1 Heterogenität 2.4.2 Publikationsbias 2.4.3 Methodische Qualität 3 Ergebnisse 3.1 Literaturrecherche 3.2 Eingeschlossene Studien 3.2.1 Studiendesign und Patientenzahlen 3.2.2 akute vs. chronische Infarkte 3.2.3 Referenzstandard 3.2.4 CT-Untersuchungstechnik 3.2.5 Heterogenität der Studien 3.3 Publikationsbias 3.4 Methodische Qualität 4 Diskussion 4.1 LIE-CT in der Metaanalyse und in den eingeschlossenen Einzelstudien 4.2 Transmuralität der Infarktareale 4.3 Strahlenbelastung 4.4 LIE-CT und LGE-MRT 4.5 LIE-CT und andere Verfahren zur Beurteilung der Myokardvitalität 4.5.1 SPECT 4.5.2 PET 4.5.3 Dobutamin-Stressechokardiographie (DSE) 4.6 LIE-CT bei nicht-ischämischen Fragestellungen 4.7 Methodische Qualität 4.8 Limitationen 4.9 Optimierungspotential der LIE-CT und Ausblick Zusammenfassung Summary Tabellenverzeichnis Abbildungsverzeichnis Literaturverzeichnis

Structural barriers can promote discordant action potential (AP) duration alternans, T wave alternans (TWA) and tachyarrhythmia in animal hearts and simulation studies. We hypothesized that heterogeneous scar (gray zone) and dense midwall scar (midwall core) would promote TWA in patients with cardiomyopathy by slowing conduction and uncoupling transmural APs, respectively. Scar core and gray zone were quantified in 40 cardiomyopathy patients using late gadolinium enhanced cardiac magnetic resonance imaging and related to the results of a clinically validated TWA test. The percentages of gray zone, epicardial core and midwall core were greater in the +TWA group, correlated with TWA magnitude and related to a lower heart rate onset for TWA. These specific scar patterns contribute to the genesis and severity of TWA in cardiomyopathy. Greater knowledge of the substrates that promote TWA in cardiomyopathy patients is valuable in determining those at risk of lethal ventricular arrhythmias.

Structural barriers can promote discordant action potential (AP) duration alternans, T wave alternans (TWA) and tachyarrhythmia in animal hearts and simulation studies. We hypothesized that heterogeneous scar (gray zone) and dense midwall scar (midwall core) would promote TWA in patients with cardiomyopathy by slowing conduction and uncoupling transmural APs, respectively. Scar core and gray zone were quantified in 40 cardiomyopathy patients using late gadolinium enhanced cardiac magnetic resonance imaging and related to the results of a clinically validated TWA test. The percentages of gray zone, epicardial core and midwall core were greater in the +TWA group, correlated with TWA magnitude and related to a lower heart rate onset for TWA. These specific scar patterns contribute to the genesis and severity of TWA in cardiomyopathy. Greater knowledge of the substrates that promote TWA in cardiomyopathy patients is valuable in determining those at risk of lethal ventricular arrhythmias.

Submitted by Hiolanda Rêgo (hiolandarego@gmail.com) on 2014-07-23T17:41:42Z No. of bitstreams: 1 Dissertação_ICS_ Gabriela de Sales Guerreiro Britto.pdf: 1677695 bytes, checksum: 4fb745911831e57d13c8725d6f4e2689 (MD5) / Made available in DSpace on 2014-07-23T17:41:42Z (GMT). No. of bitstreams: 1 Dissertação_ICS_ Gabriela de Sales Guerreiro Britto.pdf: 1677695 bytes, checksum: 4fb745911831e57d13c8725d6f4e2689 (MD5) / A asma é uma enfermidade crônica, que afeta cerca de 235 milhões de pessoas no mundo. Em uma pesquisa realizada através do ISAAC fase I (International Study of Asthma and Allergies in Childhood), o Brasil está entre os oito países do mundo que demonstraram prevalência mais alta de asma. Helmintos, principalmente aqueles que habitam a intimidade do corpo do hospedeiro, têm sido relatados como fortes moduladores do sistema imune em humanos e animais experimentais, e associados com a redução de doenças alérgicas e autoimunes. Crianças que vivem em áreas sem "higiene" são mais propensas a ter, não só uma, mas várias infecções por helmintos, ao mesmo tempo, mas a maneira como eles afetam atopia e asma ainda é controversa. O objetivo do presente trabalho foi investigar como coinfecções por parasitos intestinais (A. lumbricoides e T. trichiura) e Toxocara spp. afetam os seguintes desfechos: eosinofilia, IgE total e específica, reatividade cutânea a aeroalérgenos, sibilância atópica e não atópica e produção de citocinas por células sanguíneas das crianças estudadas, estimuladas ou não estimuladas por A. lumbricoides. O estudo foi realizado em 1.271 crianças de um grande centro urbano do Nordeste, Brasil. Os dados sobre sintomas de sibilância foram coletados por um questionário adaptado do ISAAC fase II. O sangue foi coletado para detectar IgE total e alérgeno específica, eosinofilia, anticorpos anti-IgG de Toxocara e produção de citocinas (IFN-γ, IL-5, IL-13 e IL-10). Outras avaliações foram realizadas, incluindo testes de puntura cutâneo (SPT) para aeroalérgenos, além disso, as infecções por helmintos intestinais foram diagnosticadas através do exame microscópico das amostras fecais. Considerando a prevalência de infecções helmínticas, 36,4% das crianças tinham apenas uma infecção, 12,7% tinham duas e 5,2% tinham três infecções. Eosinofilia >4% e >10% foi encontrada em 74,3% e 25,5% das crianças, respectivamente. IgE total >0,2 ug/mL ocorreu em 59,7%. IgE específica (sIgE) ≥0,70 kU/L e positividade para SPT, para pelo menos um alérgeno, foram encontrados em 37,1% e 30% das crianças, respectivamente. Um total de 22,7% das crianças apresentava sibilo em geral, 12% apresentaram sibilância não atópica, 10,7% tinham sibilo atópico e 26% eram não-sibilantes atópicas. A infecção por uma espécie de helminto foi associada com aumento de eosinofilia e IgE total e menor SPT e coinfecções mostraram uma associação dose- dependente com esses resultados. Helmintos, especialmente em coinfecções, foram associados com uma típica resposta imune Th2 modificada (evidenciada pela produção de IL-5; IL- 13 e IL-10), mas não foi encontrada associação com sibilo (atópico e não atópico). Coinfecções por helmintos induziram uma resposta imune Th2 melhorada e dose-dependente, evidenciada pela produção de IL-5, IL-13, o que explica a associação com o aumento de IgE total e de eosinofilia. No entanto, eles também ativaram uma rede regulatória conduzindo a uma resposta Th2-modificada, com a produção de IL-10 que, juntamente com a ativação de IgE policlonal, pode ter suprimido a reatividade na pele. No entanto, eles não foram capazes de afetar nem sibilo atópico, nem não atópico. Estudos adicionais devem ser realizados para elucidar os mecanismos moleculares da presente imunomodulação exercida pelos helmintos sob a atopia.

Myocardial scar, a non-viable tissue which occurs on the myocardium due to the insufficient blood supply to the heart muscle, is one of the leading causes of life-threatening heart disorders, including arrhythmias. Analysis of myocardial scar is important for predicting the risk of arrhythmia and locations of re-entrant circuits in patients’ hearts. For applications, such as computational modeling of cardiac electrophysiology aimed at stratifying patient risk for post-infarction arrhythmias, reconstruction of the intact geometry of scar is required. Currently, 2D multi-slice late gadolinium-enhanced magnetic resonance imaging (LGEMRI) is widely used to detect and quantify myocardial scar regions of the heart. However, due to the anisotropic spatial dimensions in 2D LGE-MR images, creating scar geometry from these images results in substantial reconstruction errors. For applications requiring reconstructing the intact geometry of scar surfaces, 3D LGE-MR images are more suited as they are isotropic in voxel dimensions and have a higher resolution. While many techniques have been reported for segmentation of scar using 2D LGEMR images, the equivalent studies for 3D LGE-MRI are limited. Most of these 2D and 3D techniques are basic intensity threshold-based methods. However, due to the lack of optimum threshold (Th) value, these intensity threshold-based methods are not robust in dealing with complex scar segmentation problems. In this study, we propose an algorithm for segmentation of myocardial scar from 3D LGE-MR images based on Markov random field based continuous max-flow (CMF) method. We utilize the segmented myocardium as the region of interest for our algorithm. We evaluated our CMF method for accuracy by comparing its results to manual delineations using 3D LGE-MR images of 34 patients. We also compared the results of the CMF technique to ones by conventional full-width-at-half-maximum (FWHM) and signal-threshold-to-reference-mean (STRM) methods. The CMF method yields a Dice similarity coefficient (DSC) of 71 +- 8.7% and an absolute volume error (|VE|) of 7.56 +- 7 cm3. Overall, the CMF method outperformed the conventional methods for almost all reported metrics in scar segmentation. We present a comparison study for scar geometries obtained from 2D vs 3D LGE-MRI. As the myocardial scar geometry greatly influences the sensitivity of risk prediction in patients, we compare and understand the differences in reconstructed geometry of scar generated using 2D versus 3D LGE-MR images beside providing a scar segmentation study. We use a retrospectively acquired dataset of 24 patients with a myocardial scar who underwent both 2D and 3D LGE-MR imaging. We use manually segmented scar volumes from 2D and 3D LGE-MRI. We then reconstruct the 2D scar segmentation boundaries to 3D surfaces using a LogOdds-based interpolation method. We use numerous metrics to quantify and analyze the scar geometry including fractal dimensions, the number-of-connected-components, and mean volume difference. The higher 3D fractal dimension results indicate that the 3D LGE-MRI produces a more complex surface geometry by better capturing the sparse nature of the scar. Finally, 3D LGE-MRI produces a larger scar surface volume (27.49 +- 20.38 cm3) than 2D-reconstructed LGE-MRI (25.07 +- 16.54 cm3).

No description available.

自從美國最高法院在廣達與LGE案中作出解釋後，便將權利耗盡理論亦稱為第一次銷售理論帶往另一個層次。此案已被普遍認為對於美國過去的判例影響甚鉅，對於產業界的商業活動發展更是具有深遠的影響。智慧財產權旨在保護發明及創造公眾利益間取得一平衡點，權利耗盡理論長久以來已被視為專利法中重要的一環，並藉以杜絕專利權人的過當控制。而最高法院對於第一次銷售理論的解釋，則進而撼動專利權人長此以往對限制性銷售策略的仰賴。 即便銷售後限制(Post-sale restriction)確實提供了專利權人避免耗盡其權利的好方法，但專利權範圍則限縮了專利權人所享有的權利控制範圍，換言之，專利權人僅能擁有專利法所賦予的權利，且其加諸於被授權人的購買條件限制僅限於該專利之功能及使用目的。而超越該專利功能及使用目的的過分限制，則可能導致專利權濫用。而在開放WTO框架下，國際貿易的頻繁也使得權利耗盡衍生出了在散佈等方面的相關討論，平行輸入/輸出的議題亦隨著跨國交易的興盛而隨之重要。 故此篇論文的研究目的不僅僅探討權利耗盡理論及其相關議題，更旨在藉由廣達案的啟發，提供台灣的IT產業一有效的專利授權策略，並提供不論專利權人或被授權人於制定授權契約時，能有一更具有策略性的思考方向。 / The Supreme Court’s current decision in Quanta Computer, Inc. v. LG Electronics, Inc. brings the exhaustion doctrine also known as first sale doctrine up to a new phase. This case is believed significantly overcome quite a lot of past precedents and will effectively influent industry business operations in the future. The core goal of intellectual property right aims to find a balance between protecting the incentives to create and innovate, and providing the benefits to public interests. Exhaustion doctrine has been long standing as part of patent law to prevent patentees’ over control. The interpretation made by Supreme Court regarding the first sale doctrine does vibrate the conditional sale strategies long believed by patentees. Now the Supreme Court brings the issue from the phase of patent law down to the contract law level. Subsequently, the litigations of antitrust and fair trade are therefore involved while patentees are tempting to make an “end-run” control over the downstream purchasers. Though applying post-sale restriction provides a way out for intellectual property owner from triggering the exhaustion, however, the scope of the patent claims determine how far the privilege is given to the inventors. A patent owner or licenser can only enforce its patent right while the right is truly granted by the patent law. Subsequently, the restriction set forth to limit the licensees or purchasers must be accordance with the function or feature of the patent claims for. On the contrary, the patentee intends to restrict its purchasers by holding the exclusive right which beyond the scope of the patent granted may result to patent misuse, for instance, the resale price maintenance, prohibition of manufacturing the competing products, the conditional license which incorporates another license, and overwhelming royalties on the price of the whole product instead of the actual usage of the patented article. Under WTO, the concern of intellectual property protection has become more critical in the perspective of international trade, different issues and disputes regarding exhaustion have also been generated. Not alike the traditional domestic exhaustion, the discussion regarding distribution has therefore been derived. Moreover, the issues related to parallel import/export are generated in accordance with the frequent cross-border transaction. The purpose of this research does not merely lead us look into the doctrine and restriction patentees used to impose for avoiding exhaustion. But I intend to further illustrate a guideline based on the inspiration from Quanta and the explanation of the Courts. This guideline should provide both patentees and licensees an orientation while considering making a licensing agreement.