2011年6月30日 星期四

老人最常見的肺炎病原是 肺炎雙球菌

雖然肺炎雙球菌是最常見的細菌病原,但是有較少數病原是更容易致命的革蘭陰性或其他革蘭陽性菌。選用第一線抗生素,切忌只針對肺炎雙球菌選藥。對老年、有多種慢性病、抵抗力弱、感染嚴重病患,一定要有 "降階式抗生素治療"的觀念。


 


Antimicrobial Susceptibilities and Serotypes of Streptococcus pneumoniae Isolates from Elderly Patients with Pneumonia and Acute Exacerbation of Chronic Obstructive Pulmonary Disease.


Antimicrob Agents Chemother.  2011; 55(6):2729-34 (ISSN: 1098-6596)


Pérez-Trallero E; Marimón JM; Larruskain J; Alonso M; Ercibengoa M
Servicio de Microbiología-Instituto Biodonostia, Hospital Donostia, Paseo Dr. Beguiristain s/n, 20014 San Sebastián, Spain. mikrobiol@terra.es.


In the elderly, Streptococcus pneumoniae is the most common cause of pneumonia and one of the most frequently isolated pathogens in cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study was conducted to compare the pneumococcal isolates obtained during episodes of AECOPD and pneumonia in patients of ≥65 years old and to analyze whether in patients with AECOPD and pneumonia within a short interval, the same isolate caused both episodes. This laboratory-based study was performed between 2005 and 2008. Pneumococcal isolates from episodes of pneumonia (n = 401) and AECOPD (n = 398), matched one-to-one by date of isolation, were characterized. The serotypes and genotypes of other pneumococcal isolates causing pneumonia and AECOPD in the same patient were compared. In patients with pneumonia, COPD as an underlying disease was not associated with more-drug-resistant pneumococci. In contrast, isolates causing AECOPD showed higher rates of resistance than those causing pneumonia. Serotypes 1, 3, and 7F were more frequent in pneumonia. The same pneumococcus was involved in 25.7% (9/35 patients) of patients with two consecutive AECOPD episodes but in only 6.3% (2/32 patients) of COPD patients with pneumonia and exacerbation (Fisher's exact test; P = 0.047). Less invasive serotypes were isolated more often in AECOPD and were more resistant to antimicrobials. The presence of a specific pneumococcal serotype in AECOPD does not predict the etiology of subsequent pneumonia.


·         PreMedline Identifier: 21402843


From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.


 


葡萄球菌中對mupirocin、有抗藥性的有多少? (這是美國Houston數據)

Mupirocin resistance in Staphylococcus aureus causing recurrent skin and soft tissue infections in children.


Antimicrob Agents Chemother.  2011; 55(5):2431-3 (ISSN: 1098-6596)


McNeil JC ; Hulten KG ; Kaplan SL ; Mason EO
Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Feigin Center, Suite 1150, 1102 Bates St., Houston, TX 77030, USA.


Staphylococcus aureus resistance to mupirocin is often caused by acquisition of a novel isoleucyl-tRNA synthetase encoded on the plasmid gene mupA. We tested S. aureus isolates from children at Texas Children's Hospital with recurrent skin and soft tissue infections for mupirocin resistance and mupA. Of 136 isolates, 20 were resistant to mupirocin (14.7%). Fifteen isolates (11%) carried mupA, and the gene was more common in methicillin-susceptible S. aureus (21.4%) than methicillin-resistant S. aureus (8.3%; P=0.03). Seven of 20 mupirocin-resistant isolates displayed clindamycin resistance.


PreMedline Identifier:21282426


From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.


治療 MRSA引起的院內肺炎,linezolids 和 glycopeptides 療效差不多

 Glycopetides之類的抗生素包含vancomycin, teicoplanin, telavancin, bleomycin, ramoplanin, 及 decaplanin。是 glycosylated cyclic or polycyclic nonribosomal peptides。這類藥物和(有藥敏性的)細菌壁內的胺基酸(acyl-D-alanyl-D-alanine)結合,阻止細菌細胞壁的pepetidoglycan之形成,抑制細菌。這類抗生素對革蘭陽性菌有效,對 beta-lactam過敏病患很好用。不過,是static agent,要靠白血球殺死細菌 (只對enterococci有直接殺菌作用=cidal effect);也不會穿透腦膜進入CSF。


 Linezolidsoxazolidinone 類的藥物,對多數革蘭陽性菌: streptococci, vancomycin-resistant enterococci (VRE), 及 methicillin-resistant Staphylococcus aureus (MRSA)有效。主要用處在於院內肺炎、skin and soft tissue infection (稱為skin and adjacent tissue infection應該比較適當)。商品名為 Zyvox (United States, United Kingdom, Australia,等國), Zyvoxid (in Europe), 及 Zyvoxam (in Canada and Mexico). 在印度有Generics 稱為 Linospan (Cipla)。它是 protein synthesis inhibitor, 而可以殺死細菌(有cidal effect)。十多年來細菌對它的抗藥性產生得很慢。對老少、有肝病腎臟病的病患都可以用,副作用為頭痛、腹瀉、噁心。使用超過兩星期後,可以引起骨髓抑制= bone marrow suppression,血小板降低。使用更久時 (因為mitochondrial toxicity),可以導致不能復原的周圍神經病變、是神經病變、以及lactic acidosis 。此藥很貴。一個治療過程 (20 tab, 每顆600mg)需要一、兩千美元!! 但病況穩定後,可以由靜脈注射改為口服,門診治療。可以進入CSF,可治療腦膜炎,不過要注意觀察效果如何。




 

Linezolid vs glycopeptide antibiotics for the treatment of suspected methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a meta-analysis of randomized controlled trials.


Chest.  2011; 139(5):1148-55 (ISSN: 1931-3543)


Walkey AJ ; O'Donnell MR ; Wiener RS
Boston University School of Medicine, The Pulmonary Center, 715 Albany St, R-304, Boston, MA 02118, USA. alwalkey@bu.edu


BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of nosocomial pneumonia. Societal guidelines suggest linezolid may be the preferred treatment of MRSA nosocomial pneumonia. We investigated the efficacy of linezolid compared with glycopeptide antibiotics (vancomycin or teicoplanin) for nosocomial pneumonia.


METHODS: This was a systematic review and meta-analysis of English language, randomized, controlled trials comparing linezolid to glycopeptide antibiotics for suspected MRSA pneumonia in subjects > 12 years of age. A highly sensitive search of PubMed MEDLINE and Cochrane Central Register of Controlled Trials databases identified relevant studies.


RESULTS: Eight trials encompassing 1,641 subjects met entry criteria. Linezolid was not superior to glycopeptide antibiotics for end points of clinical success (relative risk [RR] linezolid vs glycopeptide, 1.04; 95% CI, 0.97-1.11; P = .28), microbiologic success (RR, 1.13; 95% CI, 0.97-1.31; P = .12), or mortality (RR, 0.91; 95% CI, 0.69-1.18; P = .47). In addition, clinical success in the subgroup of subjects with MRSA-positive respiratory tract culture (RR, 1.23; 95% CI, 0.97-1.57; P = .09) was not significantly different from those without MRSA (RR, 0.95; 95% CI, 0.83-1.09; P = .48), P for interaction, 0.07. The risk for adverse events was not different between the two antibiotic classes (RR, 0.96; 95% CI, 0.86-1.07; P = .48).


CONCLUSION: Randomized controlled trials do not support superiority of linezolid over glycopeptide antibiotics for the treatment of nosocomial pneumonia. We recommend that decisions between linezolid or glycopeptide antibiotics for empirical or MRSA-directed therapy of nosocomial pneumonia depend on local availability, antibiotic resistance patterns, preferred routes of delivery, and cost, rather than presumed differences in efficacy.


PreMedline Identifier:20864609


From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


 


2011年6月17日 星期五

"為什麼台灣重要?" 美國國會議員的討論會

請看下列網站,國會議員開會現場及討論會完整經過:



http://foreignaffairs.house.gov/hearing_notice.asp?id=1310



也可以點下列網站閱讀中文報導:

1.
美議員擬提案 強化台灣關係法

http://www.libertytimes.com.tw/2011/new/jun/17/today-fo2.htm

2.
美議員齊聲要求售台F16戰機
http://tw.news.yahoo.com/article/url/d/a/110617/1/2thiq.html 


3. 美議員:台灣的民主比中國槍桿有力
http://www.taiwannews.com.tw/etn/news_content.php?id=1628816


4. 美議員再施壓 促對台出售戰機
http://www.google.com/hostednews/afp/article/ALeqM5iYkU6VB_bYdRO2IkrX7A87dTcUXQ?docId=top0002.110617005005

5.
國會聽證 兩黨促售台F-16
http://www.worldjournal.com/view/full_news/14355432/article-%E5%9C%8B%E6%9C%83%E8%81%BD%E8%AD%89-%E5%85%A9%E9%BB%A8%E4%BF%83%E5%94%AE%E5%8F%B0F-16?instance=m2


6. 美眾院聽證會 議員促售台戰機
http://udn.com/NEWS/WORLD/WOR6/6404123.shtml


 ******************************************* 


Wallstreet Journal的報導如下:


 


Never Fear, Taiwan — Congress is Here



Richard Chung/Reuters


A U.S.-made Patriot surface-to-air missile is launched during a military exercise in Ilan county, in this July 20, 2006 file photo.


With the Obama administration keeping quiet on what the U.S. should do about weapons sales to Taiwan and a growing number of influential figures calling for a rethink of the U.S. relationship with the island, Taipei could be forgiven for wondering whether it has any allies left in the big country across the pond.


The message from U.S. Congress: We’re still here.


Speaking Thursday at the first full committee hearing of the House of Representative’s Committee on Foreign Relations specifically about Taiwan in seven years, the Republican chairman of the committee, Rep. Ileana Ros-Lehtinen noted a “new spirit of appeasement in the air” as she argued the U.S. must not back down from its relationship with Taiwan due to pressure from China, and that it should support the island with the sale of new F-16s and upgrades to its existing planes.


Congress is among the world’s most stalwart supporters of Taiwan, and has refused to back down in the face of recently shifting political winds. Last month, 45 members of the Senate, representing both sides of the aisle, signed a letter to President Barack Obama urging the administration to sell Taiwan the weapons it has requested.


In addition to reiterating the weapons request, Ms. Ros-Lehtinen also said Thursday that she would push for new legislation to update the Taiwan Relations Act. The act, passed in 1979, requires the U.S. to sell weapons to Taiwan necessary for its defense.


Although the specific details of any new legislation remained unclear, a witness who spoke at the hearing, U.S.-Taiwan Business Council president Rupert Hammond-Chambers, told China Real Time that he understood it would be designed to more specifically address Taiwan’s defensive needs and increase the oversight Congress has on the U.S.-Taiwan relationship.


Speaking at the hearing, four expert witnesses argued that F-16s, although unlikely to tilt the balance of power in the Taiwan Strait, were critical to demonstrating the U.S. commitment to Taiwan’s defense and would also be highly useful in the event of a naval blockade or spats that could break out over neighboring islands.


Taiwanese president Ma Ying-jeou has made repeated calls for the release of the planes along with other weapons, even as Taiwan’s Defense Ministry announced last week it was cutting the budget it set aside to purchase new F-16s.


One witness at the hearing, Armitage International partner Randy Schriver, warned about the “growing influence” of China in U.S. decision making and said it was “absurd” to think China would change its position on key issues like Iran, North Korea or the appreciation of the yuan based on a changed U.S. stance towards Taiwan.


He also questioned concerns voiced within the Obama administration about timing weapons sales correctly: “There’s no right time…these things get backed up and backed up, and then the Chinese are looking at a much larger package. They (the administration) need to just, there’s not a better way to say it, they need to be bolder and more courageous and deal with the fallout, because historical evidence suggests we can absorb the fallout.”


The meeting was also notable for the lack of any State Department representatives. Assistant Secretary of State Kurt Campbell and Derek Mitchell, Principal Deputy Assistant Secretary of Defense for Asian and Pacific Security Affairs, were originally scheduled to testify, but did not attend due to a scheduling conflict, according to a person familiar with the matter. Rep. Dan Burton called the no-show disappointing and said it represented “an absence of concern that is remarkable,” adding: “I think they were afraid because they don’t have the answers.”


With the last F-16s scheduled to roll off the production line in 2013, Mr. Hammond-Chambers warned that new orders might need to come in as early as the end of 2011. Otherwise, he said, the production line might be shut down completely – an outcome, others have pointed out, that would cost the U.S. much needed jobs and lead to even trickier negotiations over the sale of more advanced fighters.


Although he said the potential shutdown of the F-16 line should not dictate whether or not to sell the weapons, Mr. Hammond-Chambers argued it forced a tight timeline on the decision. “It is a consideration for when you make the decision to sell,” he said. “If you leave it too long, the decision is made for you.”


“At what point do you ask whether the administration is violating the Taiwan Relations Act,” he continued. “Only Congress can step in and do something about that.”


– Paul Mozur. Follow him on Twitter @paulmozur


**********************************************************


 


新聞: "義美" 遭整肅


Martin Niemöller牧師(1945):


"當納粹帶走共產黨員,我保持緘默,因為我不是共產黨員;
當他們帶走社會黨員,我依然沉默,因為我不是社會黨員;
當他們帶走工會員工,我沒有抗議,因為我並不屬於工會;
當他們帶走猶太人,我還是沒有抗議,因為我不是猶太人。
當他們帶走我時,已經沒有任何人可以為我抗議了。 "


 


2011/6/17 Minjin Kuo <minjinkuo@yahoo.com>






「義美」遭受整肅


「義美」這個行號多年以來在台灣享有盛名,在黑心起雲劑事件爆發後的今天,「義美」的名聲更是蜚聲國際人人稱讚,因為它是台灣食品界的唯一良心。然而,「義美」的正派經營與崇高的信譽並未能使它免於馬政權惡勢力的迫害。


台灣在以前專制獨裁的時代毫無民主,固不待言,雖然在李陳兩位總統任內的二十年間台灣的民主達到空前的程度,但是在國民黨復辟重掌大權之後,台灣的民主每況愈下,整肅之風,席捲各處,馬政權假藉司法之名大舉清算異己,連「義美」這家老字號的特優廠商也難倖免。


昨日(6/16)桃園縣政府出動三百警力進入義美南崁廠,進行拆除線的鑑界量測、架設拆除圍籬,並強行在食品安全研究室所在的廠房頂樓釘界樁。義美在迫不得已的情勢下,簽下拆遷的切結書,於是拆除人員在資源回收場的牆壁打一處大洞,做個「象徵性」的動作之後收工離去。


地方政府動用公家的警力在光天化日之下,明目張膽強行「依法執行」,脅迫人民簽下違反意願的切結書,這種無法無天的行徑比土匪更加可惡。義美秉持做為一個堂堂正正的台灣企業,一切以台灣為優先,拒絕前往支那設廠,其產品銷售國內外,除了每年繳納龐大的稅金給政府之外,其企業為一定數目的員工提供穩定的經濟來源,義美為台灣拼經濟的做為,是政府應該獎勵的模範廠商。今天,特別是黑心起雲劑風波沸騰熾烈之際,照理馬政權應該大力表揚才是,反而藉故為難加以整肅。


原因無他,只因為義美是旗幟鮮明的本土派,是綠營的長期支持者。國民黨之迫害台灣大企業的例子,在過去如高雄的唐榮鐵工廠、高屏地區的香蕉大王吳振瑞等等,可謂罄竹難書。在專制時代,只要是國民黨看上的肥羊,這隻惡獸就會假藉司法之名加以清算鬥爭,活生生的將人民辛苦經營的企業霸占。過去如此現在也是,自馬英九上任以來,就展開赤裸裸的清算鬥爭,上自陳前總統及他的團隊,無一倖免。不僅如此,凡是過去曾經支持民進黨的企業或商家,不管規模大小,一律受到國稅局的無理查帳與刁難。這種以公權力對付善良守法的商家,正坐實馬英九及其集團的土匪本性。


今天,連義美這般優秀的商家,馬英九都要藉故整肅,台灣有何民主可言呢?對於馬政權的這種土匪行徑,台灣人絕不能坐視,大家要挺身而出,抗議馬政權的濫權與司法迫害。今天,如果你不出聲,對不公不義置身事外,明天,當你被不公不義迫害時,就沒有人會為你出聲了!


 


 



High-sensitivity CRP 的高低和心臟病有關

hs-CRP: What Is Proven and Unproven?


Michael H. Davidson, MD


Posted: 05/19/2011

















             
 
 









 


 



Meta-analysis of Genome-Wide Association Studies in >80,000 Subjects Identifies Multiple Loci for C-Reactive Protein Levels




Dehghan A, Dupuis J, Barbalic M, et al
Circulation. 2011;123:731-738


Summary


A recent large meta-analysis of genome-wide association studies from 15 cohort studies comprising 66,185 subjects and a replication sample of 16,540 subjects identified 18 gene loci associated with C-reactive protein (CRP) levels. These 18 gene loci were mostly associated with immune response and metabolic regulatory pathways involved in the regulation of chronic inflammation.


The authors developed a genetic risk score that explains about 5% of the variation in CRP levels, showing that genetic factors are important in determining CRP levels. In comparison, body mass index, the main nongenetic determinant of CRP studied, was reported to explain 5%-15% of the variation in CRP levels.


However, neither the individual genes nor the combined genetic risk score showed consistent or genome-wide significant associations with risk for clinical coronary events.


Viewpoint


A consensus is building that high-sensitivity CRP (hs-CRP) is a great pathophysiologic integrator of factors associated with coronary heart disease (CHD). Indeed, there is no controversy regarding the fact that hs-CRP is a strong independent risk for CHD. The JUPITER trial[1] demonstrated that rosuvastatin treatment significantly reduced major cardiovascular events in men over age 50 and women over age 60 who had hs-CRP > 2.0 mg/dL with 1 additional CV risk factor but low LDL cholesterol (< 130 mg/dL).


The current trial, however, does not appear to implicate CRP as having a causal role in the atherosclerotic process. Rather, it seems to indicate that genetic predisposition to metabolic disorders such as diabetes or chronic inflammation is linked to both higher levels of CRP and higher rates of CHD. Therefore, the genetic factors that predispose the patient to a higher risk for cardiovascular disease are only manifested if environmental factors are triggered, such as weight gain leading to obesity.


More specifically, this study seems to indicate that levels of hs-CRP are determined by both genetic and environmental factors, and that it is this interaction, but not the individual components, that predict increased risk for cardiovascular disease.


Regardless of whether CRP plays a direct causal role in atherosclerotic disease, it is clearly a clinically useful biomarker. It satisfies each of the following stipulations put forth by the American Heart Association for a clinically useful risk marker[2]: (1) demonstrates consistent independence of effect in multiple prospective cohort studies; (2) demonstrates incremental information on utility beyond that of usual risk factors; (3) demonstrates that assessment leads to clinical impact on patient management and outcomes; and (4) is readily assessed with standardized assays.


One of the most appealing aspects of hs-CRP as a biomarker is that therapeutic approaches that lower hs-CRP also decrease cardiovascular events, and that the lower the hs-CRP on treatment, the lower the risk.[1] However, to become a target for therapy, there needs to be clinical trial evidence that lowering hs-CRP without affecting other causative factors, such as apo-B lipoproteins, is associated with a reduction in major atherosclerotic disease. These hypotheses are now being tested with anti-inflammatory agents that lower hs-CRP but do not beneficially modify the lipoprotein profile. These trials will hopefully answer the next important question: whether reducing inflammation independent of modifying the substrate of that inflammation results in improved patient outcomes.


 



2011年6月15日 星期三

Acivated Protein C對嚴重敗血症無療效!

本來還想先詳查一下甚麼是 activated protein C,但既然對嚴重敗血症無效,暫時不查了。


Human recombinant activated protein C for severe sepsis.


Cochrane Database Syst Rev. 2011; 4:CD004388 (ISSN: 1469-493X) Martí-Carvajal AJ; Solà I; Lathyris D; Cardona AF Universidad de Carabobo and Iberoamerican Cochrane Network, Valencia, Edo. Carabobo, Venezuela.


BACKGROUND: Sepsis is a common and frequently fatal condition. Human recombinant activated protein C (APC) has been used to reduce the high rate of death by severe sepsis or septic shock. This is an update of a Cochrane review (originally published in 2007 and updated in 2008).


OBJECTIVES: We assessed the clinical effectiveness and safety of APC for the treatment of patients with severe sepsis or septic shock. SEARCH STRATEGY: For this updated review we searched CENTRAL (The Cochrane Library 2010, Issue 6); MEDLINE (1966 to June 2010); EMBASE (1980 to July 1, 2010); BIOSIS (1965 to July 1, 2010); CINAHL (1982 to 16 June 2010) and LILACS (1982 to 16 June 2010). There was no language restriction.


SELECTION CRITERIA: We included randomized controlled trials (RCTs) assessing the effects of APC for severe sepsis in adults and children. We excluded studies on neonates. We considered all-cause mortality at day 28, at the end of study follow up, and hospital mortality as the primary outcomes.


DATA COLLECTION AND ANALYSIS: We independently performed study selection, risk of bias assessment and data extraction. We estimated relative risks (RR) for dichotomous outcomes. We measured statistical heterogeneity using the I(2) statistic. We used a random-effects model.


MAIN RESULTS: We identified one new RCT in this update. We included a total of five RCTs involving 5101 participants. For 28-day mortality, APC did not reduce the risk of death in adult participants with severe sepsis (pooled RR 0.97, 95% confidence interval (CI) 0.78 to 1.22; P = 0.82, I(2) = 68%). APC use was associated with an increased risk of bleeding (RR 1.47, 95% CI 1.09 to 2.00; P = 0.01, I(2) = 0%). In paediatric patients, APC did not reduce the risk of death (RR 0.98, 95% CI 0.66 to 1.46; P = 0.93). Although the included trials had no major limitations most of them modified their original completion or recruitment protocols.


AUTHORS' CONCLUSIONS: This updated review found no evidence suggesting that APC should be used for treating patients with severe sepsis or septic shock. Additionally, APC is associated with a higher risk of bleeding. Unless additional RCTs provide evidence of a treatment effect, policy-makers, clinicians and academics should not promote the use of APC.


 


 


2011年6月13日 星期一

自由的秘密是勇氣

星期專論/兩股力量正在改變台灣

◎王美琇


歷經二十年民主洗禮的台灣,正在劇烈變動。脆弱的民主台灣,正在劇烈變動。有兩股力量,強力拉扯著充滿活力、同時又充滿焦慮不安的社會。


一股力量,是由上而下,由馬英九政權所發動的,以龐大的行政權與五權到位的超級權力,將國家方向從經濟、政治、文化和社會各層面,全面性的扭轉往傾斜中國的方向。另一股力量,則是由下而上,在地公民和公民團體的力量開始蠢蠢欲動、八方雲集,對公共議題和國家政策展現出積極參與的強韌力道,不斷企圖改變或扭轉政府的偏差政策。


我認為,這兩股力量,正在劇烈拔河,也正在改變台灣。任何一股力量獲勝,台灣的國家命運、人民福祉和民主前進或後退的可能性,截然不同。


兩岸政策是馬最大敗筆


先來談談馬政權的影響。馬英九總統執政三年來,最津津樂道的唯一政績就是「兩岸經濟與兩岸和平」,然而這恰恰就是馬政府的最大敗筆。不過,就是這股由上而下的政府力量,將台灣逐步帶向危機四伏的險境。


只有我們在憂慮嗎?「維基解密」所公布的二十萬份美國政府與其他國家政府的外交電報中,有兩千多份與台灣有關。其中美國在台協會駐台使館,於二○○九年十月拍給華盛頓的外交電報寫著:「美國對台灣社會的影響力的最大威脅,來自中國在經濟上對台灣的影響。如果我們不積極加強台美關係,我們美國的影響力會逐漸消逝。」顯然,美國政府已經警覺到馬政府與中國的「過熱關係」。


台灣的經濟過度傾斜中國,加上ECFA簽訂後產業更加速外移中國。目前台灣對中國的投資比例,已經佔台灣對外投資的八十%。三年來,馬政府放行近三百億美元、近一兆台幣錢進中國,去年上市櫃公司匯往中國的資金高達台幣一七五○億元,打破歷年紀錄,而匯回台灣的金額卻僅四%不到


以一個正常國家的經濟發展策略而言,這是不可想像的嚴重失策。馬政府等於是將台灣的資金和產業,不斷地往中國的虎口送,其結果就是「壯大中國,台灣萎縮」,以及讓中國以經濟「掐住台灣脖子」的危險性持續升高。


兩岸經貿過熱,固然在經濟成長率的「數字」有上升現象,但結構性失業和低薪化的問題愈來愈嚴重,這就是所謂的「經濟無感復甦」。換句話說,人民無法感受到經濟「數字」成長的效應,只有少數財團和企業家,在馬政府頗為得意的「兩岸經濟」發展中得到好處。


再論所謂的「兩岸和平」,這也是弱智政府的盲點。全世界沒有任何一個民主國家的領導人,會以踐踏自己國家的尊嚴和國格,去換取所謂的「和平」。更何況中國對台灣是「真和平」嗎?一千八百顆飛彈對準台灣是和平嗎?在國際舞台上矮化台灣主權、把台灣去國家化,改為「台灣是中國的一省」是和平嗎?我相信全體國人都看在眼裡,只有馬政府心盲眼盲,還唾面自乾且自得其樂。


換句話說,馬政府最得意的「兩岸經濟和兩岸和平」,所換來的卻是台灣最嚴重的危機,也就是國家主權的流失、經濟發展的險峻和社會貧富的兩極化。


公民力量正在改變台灣


三年來,這股超級大且毫無監督制衡的政府權力,正在改變台灣的現狀。可是,卻也有另一股力量,由下而上的力量,積極介入社會、介入公共議題,企圖改變政府政策。我稱這股力量為「在地公民力量」。


最顯著的例子就是「反恐龍法官白玫瑰運動」、「大埔農地徵收案」、「彰化國光石化案」和「反核運動」。我們看到,許多年輕學子開始積極關懷土地、關懷農民,展開公民行動;我們看到,醫生、詩人、環境工作者、知識份子們,紛紛捲起袖子與基層民眾站在一起,守護土地、強烈發聲、捍衛弱勢人民與在地居民的生存權和環境權。


由下而上的公民力量,開始聚焦土地與環境,逼使執政者面對長久以來的政策失衡,對土地和人民所造成的傷害。來自四面八方的公民力量,透過不斷遊說、運動和累積社會能量,企圖遏阻馬政府的錯誤政策。


然而,這股由下而上的公民力量,能夠發揮在政治運動上,進而扭轉國家危機嗎?我正在觀察,但我相信可以。


馬政府的傾中政策已經對國家造成莫大傷害,我認為,如果再讓馬英九繼續連任,他必將更積極、更大膽地以行政權加速傾中,為「終極統一」全面鋪路。其結果將會形成不可逆轉、無法挽回的局勢,那就是─「台灣成為中國的一省」將成定局。也就是說,台灣做為一個國家,二千三百萬台灣人民擁有國家主權的事實,將會在世界上消失。民主台灣將淪為極權中國的一部分,成為港澳第二。


我相信,有覺醒意識的台灣公民,已經意識到國家危機迫在眉睫。做為


一個負責任的公民和有志之士,應當擔負起重責大任,開始發揮公民力量,全力扭轉危機、搶救台灣!


壯大氣勢全力贏回台灣


二○一二的總統大選,是維護主權或棄守主權的戰役;是堅守民主台灣或走向極權中國的戰役;是選擇經濟主體性或全面傾中的戰役;是要社會公平正義或貧富階級對立的戰役;是民主深化或民主退化的戰役。這一場戰役,不但是守護台灣之戰,更是價值選擇之戰!


我們必須拉出「棄馬保台」的大戰略和氣勢,更要將此氣勢蔓延到全國,形成大環境的氣候;我們更必須壯大氣勢、壯大公民力量、壯大我們前進的隊伍,準備迎向最重要的戰役吧!


這一仗,我們必須贏回台灣;這一仗,不能沒有你!最進步的公民,最堅定守護台灣的朋友們,大家動起來、站出來吧!


只要我們願意,將國家危機意識擴散出去;只要我們願意,將守護台灣的熱情擴散出去;只要我們願意,將公民力量擴散出去,我相信,由下而上的公民力量,最偉大的人民力量,最終一定能夠─改變台灣!


(作者王美琇為專欄作家)


 


致 自由時報


 


敬啟者:


 


今天拜讀貴報"兩股力量正在改變台灣"一文有感。


 


我百分之百支持王女氏的論點,相信30%深綠族群和我一樣,也相信淺藍綠(所謂的中間選民)約40%之中的半數約總選民的20%正在覺醒傾向綠營,然而深綠的30%加上中間選民20% 選民總數的約50%看似藍綠五五波 但綠營還是很脆弱,危險。


 


來自CKMT(中國國民黨)及CCP(Chinese Communist Party)聯合力量來摧毀台灣的民主還是會得逞的。


 


無可諱言的,KMT集台灣行政,司法,軍警情治調,巨額不當黨產及媒體等總資源 再加上世界級最大邪惡勢力,KMT有其絕對優勢,為了把持其利益 可為所欲為,簡單舉幾個近在眼前的例子即可明白:


 


KMT陣營族群貪污,賄選,殺人,羅織異議人士罪名,草菅人命均無罪,其罪行實罄竹難書,翁奇南命案,ALA夜店9人冤死案,319槍擊案(抹成阿扁自導自演),大埔侵佔農地案,五都大選一顆子彈奧步即翻盤,重大工程如捷運,造 路,造橋 ,維修路橋,花博,巨蛋等等包羅萬象的工程,老百姓均知其巨額回扣貪汙刑責等罪行,但自至今無人為其罪行負責下台,慘絕人寰的陳肇敏也能沒事。CKMT有了CCP做靠山,更可肆無忌憚為所欲為。


  


台灣政黨何其脆弱? 反觀DPP族群,手無寸鐵,面對霸凌巨人,無縛雞之力,豪無對抗之能耐。若以相撲做比喻,猶如橫綱與小學生比賽,還沒開賽 三歲小孩也能判斷輸贏。代表台灣人的總統319槍擊案,兇手陳義雄都抓到了 竟然被惡搞至今仍無法澄清真相,把台灣人總統都可羅織不公不義的罪名推進牢裡凌辱,蹂躪到這種地步了,其他台灣人 縣市長,一般百姓又算什麼?


 


要有勇氣才有機會救台灣:DPP如履薄冰,小心翼翼,怕被汙名化,怕被抹黑,只好遁着KMT毫無公平性可言的遊戲規則運作,這樣下去還有希望贏回執政權嗎?就算KMT敗選,他們會甘心交出政權嗎?


 


DPP族群別再做夢吧!CKMT聯合CCP隨便編個奧步劇本,台灣黨就崩盤,要救台灣唯一的辦法是............


 


首先要讓美國領導人認清CKMT(中國國民黨)的本質,既得利益族群 (不分外省籍或是本省籍)均是中國人:然而不分本省籍,外省籍,原住民或外籍新娘,認同台灣的族群才是台灣人(Formosan)。在台的中國人竟然聯合中國大獨裁者來欺壓台灣人,然而崇尚民主自由的台灣人才(Formosan)何不聯合世界最強大的民主自由國家-美國陣營 來抵抗獨裁邪惡勢力呢?


 


正如曹長青先生所引述的:”自由的秘密是勇氣”,就看DPP有沒有勇氣和智慧去聯美制中(CKMT+CCP), 並大聲呼出”台灣人救台灣民主自由,中國人去救中國民主自由,台灣‧中國一邊一國”的口號。


 


Michael Wu (退休教師)


 



2011年6月10日 星期五

台灣何時變成中國的一省了? 荒謬!! 可笑!!








台灣何時變成中國的一省了? 誰講的? 誰同意的?


看馬桶裝模作樣的做抗議狀,國際小丑般,真好笑!!


還是做過校園間諜、會寫不合格的博士論文、講不清有沒有綠卡、用露蛋誘選票、到處欺騙台灣民眾的KMT份子,才會想到企圖附合中國野心,以這種國際騙局,使兩千三百萬民主國民成為專制中國的附屬品! 他們真的以為這種以秘密文件騙人的勾當,會哄得過美國、日本、英法德這種民主國家嗎? 難道中國大聲說台灣是它們的,台灣就成為中國的一省? 真不夠品!!


 








 世衛矮化台灣 歐洲議員范巴倫:荒謬





歐洲議會友台小組副主席范巴倫(右,繫紅領帶)議員來台訪問,昨日應台大學生林睿哲邀請前往台灣大學拜會,並與前外交部政務次長楊子葆(左,穿西裝者)開設的國際領導能力發展課程三十幾名學生對談。(記者方賓照攝)

〔記者謝文華/台北報導〕本報昨披露廿名歐洲議會議員,聯名寄信給世界衛生組織(WHO)秘書長陳馮富珍,抗議世衛密件將台灣列為中國一省。歐洲議會友台小組副主席范巴倫(Hans van Baalen)昨接受本報訪問時表示,他人在台灣訪問,不清楚連署的事,但他支持這項連署案內容,無庸置疑!他另在接受中央社專訪時表示,對WHO函件將台灣視為中國的一省,感到「荒謬」,並允諾全力支持中華民國政府的主體性。


指陳馮富珍是中國公民 應該迴避


范巴倫向本報強調,WHO不應為個別國家服務,陳馮富珍是中國公民,立場明顯、路人皆知,她將台灣列為中國一省,身分上非常不適當。「我相信是中國政府要求她這樣做的!」她受到中國政府的壓力,沒有自我決定的能力與獨立思考的空間,就應主動迴避,WHO應指派中立的官員處理爭議,以免影響其公正性和獨立性。


台灣該如何因應打壓?范巴倫說,他建議應運用與台灣友好、具有自由民主等相同價值觀的大國,如美國、歐盟、日本等國去為台灣發聲,遠比台灣獨自面對中國,更能產生效果。


認為台灣若在墨西哥灣 早就獨立


范巴倫獲台大學生林睿哲寫信邀請,昨天與前外交部政務次長楊子葆在台大開設國際領導能力發展課程的卅幾名學生對談。學生發言踴躍、范巴倫也答得直接。


范巴倫答覆提問時比喻,如果台灣在墨西哥灣裡,早就獨立了,偏偏台灣在台灣海峽,旁邊又有個聯合國安理會的常任理事國,在獨特的位置與情境下,導致台灣至今無法成為一個「國家」。


「台灣對外要叫什麼,應由台灣人自己決定,身為朋友,你們做什麼決定,我都會支持,而無論如何,在國際組織之內,都遠比在外好!優先進去,再透過外交技巧提升地位。」


范巴倫提及,中國不斷擴張海軍,說要保護自己,實在是有點可笑,他認為,台灣也應有保護自己的武力,加強整軍備武。此外,如果台灣要跟中國平等談判,中國要先民主化才有可能,當然,台灣若能幫助中國民主化,對中國來說是個好事,「如果我是台灣公民,我會認為談判的先決條件,是中國先民主化,台灣才跟中國談未來。」


他並透露,昨天上午會見馬英九總統時曾建議,若要跟中國談判,必須是在「對台灣有利的條件」下去談判,要促進經濟合作,更要加強國防。


范巴倫已訪台十次,擔任荷蘭國會議員期間,分別於二○○三年及二○○五年,提案連署反對歐盟解除對中國軍售禁令,及支持台灣參與世界衛生組織(WHO)成為世界衛生大會(WHA)觀察員的決議,並獲得通過。


他昨天也提及台灣大選議題表示,過去在荷蘭分別接待過國民黨和民進黨的團體,他認為和民進黨價值觀較接近,因此,「如果我是台灣的公民,我會投蔡英文一票。」





 

美參議員致函世衛組織 抗議「中國省份」密件


 


 


對台灣成為正式會員表支持


 


美國俄亥俄州民主黨參議員布朗(Senator Sherrod Brown),於201162致函世界衛生組織幹事長 陳馮富珍 女士,就最近在台灣揭露的世衛內部密件,指示相關單位稱呼台灣為「中國的省分」乙事,表達抗議。


 


信中,參議員布朗表示,世衛組織將台灣暗指為「中國的省分」,「超過了其身為世界衛生機構的權限,並違反了美國的政策。」


 


他並指出:「我擔憂,世衛組織在不知情的狀況下,進入了危險的政治水域,違背其任務及對推展其目標不利。世衛組織非聯合國之下的政治機構,也不應涉及相關事務。」


 


來自俄亥俄州的參議員布朗,一直以來都支持台灣,在所有國際組織中獲得正式會員資格,包括聯合國及世衛組織。他在信末表示:「身為世衛組織的強力支持者,我總相信世衛組織是一個普世的組織,也因此,它應該要對這個世界村的所有成員表示歡迎,包括台灣。」


 


台灣公共人事務會會長楊英育對此表示:「參議員布朗的話一針見血:世衛組織的內部密件違背其應該代表的基本普世原則。它將台灣貶為次等的地位,成為中國的省分之一,而這違反了美國政策中的台灣關係法。」


 


他並補充:「這份備忘錄將台灣馬政府在台灣參與國際組織上使用的謬誤方法,顯露出來。2009年,馬政府將台灣獲觀察員的,為『重大進展』。但現在我們發現,這是以自由民主國家台灣的主權去換來的。」


 


楊會長最後指出:「我們希望,世衛組織及美國政府從今以後遵守基本普世原則,並支持台灣在國際組織的正式會員資格。台灣是一個自由民主的國家,值得擁有與其他國家平起平坐的待遇。」


l      * * * * * * * * * *


l      US Senator sends letter to WHO protesting “ province of China ” memo


 


Expressing support for Taiwan ’s full membership


 


On June 2nd 2011, US Senator Sherrod Brown (D-OH) sent a letter to World Health Organization (WHO) director general Margaret Chan expressing concern about the internal memo which recently became public in Taiwan , in which the organization instructed its institutions to refer to Taiwan as “ province of China .”


 


In the letter, Senator Brown stated that by implying that Taiwan is a “ province of China ” the WHO “…is going beyond its mandate as the world global health authority and is in violation of US policy.”


 


Senator Brown added: “I am concerned that the WHO has unwittingly entered into dangerous political waters that are contrary to its mission and detrimental to its goals.  The WHO is not a political authority within the UN and should not act as such.”


 


The Ohio senator, who has long advocated Taiwan ’s full membership in all international organizations, including the United Nations and the WHO, concluded: “As a strong supporter of your organization I have always believed that the WHO is a universal organization and that it should therefore open its doors to all members of the world community, including Taiwan .”


 


FAPA President Bob Yang commented in a reaction: "Senator Brown is hitting the nail right on the head: the WHO internal memo is not in keeping with the basic principle of universality for which the WHO should stand.  It relegates Taiwan to a secondary status as a subsidiary of China , which is a violation of US policy as laid down in the Taiwan Relations Act.”


 


Dr. Yang added: “The memo has brought to light the fallacy of the approach by the Ma Ying-jeou administration in Taiwan to participation in international organizations.  In 2009, it presented its observership as a major “breakthrough”, but now we find out that it came at the cost of Taiwan ’s sovereignty as a free and democratic nation.”


 


Dr. Yang concluded: “We hope that both the WHO and the US government will from now on adhere to the basic principle of universality and support Taiwan ’s full membership in international organizations. Taiwan is a free and democratic nation and deserves to be treated like all other nations in the world.”


                         
                              * * * * * * * * * * * * * * * * *



 


 



 


2011年6月9日 星期四

哈佛史上最差勁的學位論文



觀察迄今馬統的能力,一直覺得他怎會是哈佛的博士?  令人懷疑這學位是怎麼得來的? 果然是錯誤百出、被人評不及格、令人驚訝的 "博士論文" !!


會聯想到KMT巨額黨產,是很自然的事吧?!


 


馬英九'一路走來始終如騙' 哈佛史上最差勁的博士論文,真丟臉



【外電】退休的教師給馬總統的哈佛論文評價:不及格
Boston-Progressive-Examiner
by Michael Richardson
200936

一位退休的教師,因為好奇台灣總統馬英九對釣魚台群島(Senkaku Islands)的見解,找了一份馬英九的哈佛大學法學院有關海底界線的博士論文來看。她所看到的並非是她原先所期待的,而是一份充滿了差錯,失誤,拼錯的字詞,漏寫的字,不當的註腳,和查不到的註腳的文件。

拿著紅鉛筆,這位前教師開始給馬英九的論文打分數;很顯然的是,1980年當這份論文被提交作為學分時,並沒有人有這樣做過。這位教師後來找到了一千個以上的錯誤或違反哈佛大學所發布的大一學生寫作指南的規定。
當這位堅定的教師和哈佛法學院接觸時,她甚至無法發現任何願意跟她談此事的人。最後,她才找到了馬英九的系上指導教授,他就是儘管裡面有許多的錯誤,還是批准該論文的人。退休的教授Detlev Vagts 駁斥:「這些都只是拼寫打字的錯誤」,他後來也告訴哈佛Crimson日報說:「錯字真的不是什麼問題。

然而,這些錯誤不僅已經超出了頻繁的間隔差錯和可笑的語法,它還包括找不到來源的註腳,這甚至已有剽竊的問題了。 Vagts並不在乎,他覺得馬英九有法律的基本概念就夠了。

這位老師不退縮,繼續給Vagts壓力要他對馬英九犯的許多錯誤提出聲明,後來獲得下列關於馬的論文的書面答覆;Vagts的錯誤也包括在內(註:原文內有好幾個錯誤。)。

「這個論文是由已故教授Louis Sohn和我自己共同監督的。基本上他負責監督管理海上邊界的海洋法方面的問題。我的責任則是有關開採近海石油資產的起草和執行協定的問題,我們對SJD 論文的批准都有很高的標準,而且我們都完全滿意馬英九有符合這些標準。我現在已經不記得當時牽涉的政治了,但我知道,我們堅持他要盡可能的客觀,因為他研究的是一個很敏感的國際問題。任何人都應該要記住,在1981年的時候中國大陸和其他島嶼之間的關係和現在非常不同。 [所有間距和語法的錯誤是來自Vagts 教授的]

撇開國際政治的部份,這位教師仍不服氣,並對哈佛大學的低標準感到不滿意。今年的一月,她又再次去函詢問Vagts ,這一次並引用哈佛大學自己的規定。


「從你的答覆看來,我認為你沒有讀過他論文的最後版本你不覺得他騙了你嗎?

這位退休的教師仍在等待美國哈佛大學給她答案。

原文網址http://www.examiner.com/x-1969-Boston-Progressive-Examiner~y2009m3d...


 


Retired schoolteacher gives Taiwan ruler Ma Ying-jeou a failing grade on his Harvard thesis



  • March 6th, 2009 2:47 pm ET







Michael Richardson









A page from Ma Ying-jeou's Harvard thesis with schoolteacher's commentary


A retired schoolteacher, curious about Republic of China in-exile President Ma Ying-jeou's views on the Senkaku Islands, looked up Ma's Harvard Law School doctoral thesis about seabed boundaries. What she found was something she wasn't expecting, a paper riddled with errors, mistakes, misspellings, missing words, improper footnoting, and footnotes that did not check out.


Red pencil in hand, the former schoolteacher graded Ma's thesis, something that apparently was not done in 1980 when it was submitted for academic credit. The teacher tallied over 1000 errors or violations of the freshman student writing guide issued by the university.


When the determined teacher approached Harvard Law School, she had trouble getting anyone to talk with her. Finally, she ended up with Ma's faculty advisor who had approved the paper despite the many mistakes. Retired Professor Detlev Vagts dismissed "all of the typos" later telling the Harvard Crimson that, "Typos don't really matter that much."


However, the mistakes went beyond the frequent spacing errors and grammatical goofs and included footnotes that do not check out raising a plagiarism concern. Vagts didn't care, Ma got the basic concepts of the law.


Not to be put off, the teacher pressed Vagts about Ma's many errors and got the following written response about Ma's paper, errors included.


"The thesis was jointly supervised by the late Professor Louis Sohn and myself.Basically he took responsibility for supervision with respect to issues of the law of the sea governing the setting of maritime boundaries. I took responsibility for issues concerning the drafting and enforcing of agreements relating to the exploitation of offshore oil assets Both of us had high standards for approval of an S.J.D. thesis and both of us were fully satisfied that Ma Ying Jeou met those standards. I have now no recollection of the politics involved but I know that we would have insisted on his being as objective as possible with respect to the rather sensitive international issues that played a role in his work. One needs to remember that relations between mainland and island China were very different in 1981." [Spacing and grammar errors are those of Professor Vagts]


International politics aside, the schoolteacher remains unconvinced and unimpressed with Harvard's low standards. In January, she again queried Vagts, this time citing Harvard's own rulebook.


"From your response I assumed you did not read his final copy….don't you think he cheated on you?"


The retired schoolteacher is still waiting for her answer from Harvard University.




Continue reading on Examiner.com Retired schoolteacher gives Taiwan ruler Ma Ying-jeou a failing grade on his Harvard thesis - Boston Progressive | Examiner.com http://www.examiner.com/progressive-in-boston/retired-schoolteacher-gives-taiwan-ruler-ma-ying-jeou-a-failing-grade-on-his-harvard-thesis#ixzz1OllKofuh


 


 


2011年6月7日 星期二

選舉一到,蛋與頭易位了

馬英九穿短褲露蛋 李登輝前隨扈:丟國家的臉


 2011年6月2日 15:34



 




記者林修卉/台北報導

馬英九總統日前參加小學生接力賽,抬腿暖身、雙腳打開下蹲時,不慎露出白色內褲。曾擔任前總統李登輝隨扈多年的群策會秘書長王燕軍今(2)日直斥,馬英九的幕僚太不成熟,安排和小學生跑步非常不應該。他說,國家的元首是國家的資產,維護的不是個人而是國家的資產,「丟的是國家的臉」!

馬英九日前參加東園國小百年校慶,他也下場跟小學生比賽800公尺接力賽。當馬英九抬腿暖身、雙腳打開下蹲時,被攝影鏡頭捕捉到短褲裡的白內褲,甚至些微露出疑似「蛋蛋」的物體。

王燕軍今日與媒體話敘時指出,國家元首的形象也是維安的一環,總統的領帶打歪了,也不能讓他走出去,因為「總統領帶打歪,丟的是國家的臉」!

王燕軍舉例說,李登輝擔任總統時,有一次搭車把車窗搖下來,但隨扈立刻把車窗關上,李登輝又把窗戶打開,隨扈又關上,來回二、三次,李登輝怒斥「現在是怎樣?」隨扈回說,「抱歉,長官,規定就是不可以」。

王燕軍表示,國家的元首是國家的資產,總統的幕僚與隨扈維護的不是個人,而是國家的資產。

王燕軍指出,馬英九當天只要去鳴槍起跑就好,根本不該下場和小朋友賽跑,「跑贏了小學生,又如何?」他說,「跑贏小學生不光彩,跑輸小學生很丟臉。」

王燕軍強調,國家元首對外代表的是國家形象,不能因個人喜好自行決定,幕僚必須提供專業維安意見,尤其馬英九參加賽跑讓維安風險暴增,實在不該這樣安排。



 


 



2011年6月5日 星期日

腸出血性大腸桿菌 EHEC 十幾年前就流行過

現在威脅歐洲十幾國的致命性腸出血性大腸桿菌流行,在1996-1997年左右也流行過!現在流行的血清型是E. coli O104:H4;當時流行的是O157:H7,因為和Shigella 一樣,只需十來隻細菌就會引起正常人的感染(Salmonella 是至少要七、八百隻細菌才會引起感染),所以容易流行。以下這篇是我當時寫的一篇review,記得好像是在年度醫學會年會演講過。


Shiga toxin-producing E. coli (志賀毒性大腸桿菌;STEC) (院內感染控制雜誌1997;6:349-356


    l  以前稱為Enterohemorrhagic (腸出血性) E. coli (EHEC)


l  因會產生對African green monkey kidney cell (Vero cell)有毒性之cytotoxin,又稱為verocytotoxic E. coli (VTEC);又因此verotoxin可以anti-Shiga toxin (S. dysenteriaeexotoxin)中和﹐又稱為Shiga-like toxin-producing E. coli (SLTEC)(Tarr, Clin Infect Dis,1995;20:1-10)﹐現已改稱為Shiga toxin-producing E. coli (STEC)﹔血清檢驗分類有O157及其他serotypes,如O26:H11O111:H8O104:H21等。E. coli O157:H7常為大流行主要病原,澳洲則其他血清型較常見。毒素由質體(plasmid)產生。有Shiga toxin 12 (Stx1Stx2)


l  因傳染性極高,可致命,世界各國都曾有大流行,所以很受注意,研究眾多。在台灣是報告傳染病。已知台灣牛群有此細菌。


l  儲主:牛(cattle) 。可以引起人對人的感染。


l  感染原最常見的是未煮熟的牛肉或有牛糞污染的各種食物飲料。牛奶、青菜、水果汁、游泳池都曾傳播過感染。


l  感染菌量少到10-100個細菌,和Shigella相同。因此傳染性很高!


l  細菌可以70°C一分鐘殺死。


l  潛伏期:3-8天。


l  STEC被排出在糞便中之期限可長達三週。


病變:


l  在約十歲以下之小孩引起bloody diarrhea,且在約10% 之病人(尤其是五歲以下者)引起可致命之hemolytic uremic syndrome (HUS;溶血性尿毒症候群)thrombotic thrombocytopenic purpura (TTP;血栓性血小板缺乏性紫斑)及其他合併症。


l  成人之感染較輕微﹐不一定有血便(Rodrigue et al, J Infect Dis, 1995;172:1122-5),無法和其他腸炎區別。


l  shigellosisEIEC infectionCampylobacter感染不同處為STEC感染很少發燒。


診斷﹕目前檢出E. coli O157之方法利用以下幾點﹕


1.       E. coli O157:H7O157:H- 不能使sorbitol發酵(ferment),而絕大部E.coli則可。因此﹐將MacConkey media中之lactose換成sorbitol (sorbitol-MacConkey agar)﹐則E. coli O157成無色之菌叢,而一般E. coli呈紅色。


2.       E. coli O157:H7O157:H- beta-glucuronidase, 而其他E.coli92%有之。因此﹐如培養劑中加4-methylumbelliferyl beta-D-glucuronide (MUG),則一般E. coli可分解MUG而產生有螢光之產物﹐可用紫外線偵測(MUG assay)。


3.       利用附著有O157抗體 (lipopolysaccharide antigen)之乳膠粒,可引起乳膠凝聚(latex agglutination)者應該是E. coli O157 (Wellcolex E. coli O157)。但它可以和Escherichia hermannii (sorbitol-negative)Salmonella group NCitrobacter freundiiYersinia enterocolitica等交叉反應。另外﹐還可以用O157抗體和糞便檢體直接作用﹐以螢光免疫法檢測E. coli O157 。不過﹐這些利用抗體的方法都要用細菌培養來証實。細菌培養本身是相當不敏感的方法,而且大便中病菌的排泄也可能時有時無。


4.       其他方法有﹕利用mitomycin (bacteriophage-inducing effect)來增加STEC之毒素產量﹐以檢測糞便中之STEC;以ELISA檢查血清中E. coli O157抗體(血清中之IgAIgMdiarrhea開始後4-8週內降到正常值)﹔以DNA probes測糞便中之毒素﹔以PCR測糞便中之Stx1Stx2等毒素。最後,因為STEC不一定都是O157型﹐甚至其他種細菌也可產生Shiga toxin而導致HUS,以ELISAmonoclonal antibody測糞便中之Stx是最合理、最可推行的方法


防治:


l  可能變成大流行、會致命。要通報。


l  病患要腸胃道隔離。


l  糞便可倒入沖水馬桶,然後消毒馬桶。


l  和腹瀉病患接觸者不應處理食物、及照顧幼兒。


l  調查感染原時只需培養育幼院託兒所安親班之工作者、育幼院託兒所安親班之小孩、及接觸過病患之處理食物者。環境培養一般無用。


l  治療病患普通只需補充水份及電解質。止瀉劑可能會促進毒素之吸收而觸發HUS。也有一點證據顯示使用TMP/SMZ會觸發HUSAmpicillinfluoroquinolones似乎不會。


l  要調查感染原。必要時公共游泳池要關閉到池水有氯的消毒,無腸內菌污染為止;懷疑有污染的飲食品要從市場收回。


l  要教育民眾洗手的重要性。


l  預防性抗生素不需要。