維他命B12 過低可能和腦萎縮、認知損傷有關!!

只量血液中B12濃度不很準。要同時量血液中 methyle malonic acie (MMA), homocysteine(這兩者比正常高，表示B12濃度低),及 維他命 B12濃度。

 

(筆者 被發現 B12 血液值低於正常，現在每天服用 500 microgram 之 B12 !! 

維他命 B12 的吸收是靠一種胃壁細胞 = parietal cell 分泌的 gastric intrinsic factor= GIF。

食物中的 B12 進入胃中，先和一種蛋白質 Haptocorin=R factor 結合，到十二指腸時，R factor 被消化，B12 就和 GIF 結合，到迴腸= ileum 末端 ，被吸收入一種特殊的上皮細胞內，B12 再度被釋出，和 transcobalamine II 結合進入血液中，終到肝臟儲藏。

胃切除時、慢性胃炎時、或年老時(胃壁會萎縮)，parietal cell 減少，GIF 分泌就減少，導致 B12 吸收障礙，引起 巨細胞型貧血=megaloblastic anemia。以前以為這時就要用 B12 每月注射治療。但後來發現口服大量 B12 還是可以被吸收，不一定需要  GIF。因此我口服 1000 或 500 microgram，血液中的 B12 還是回升到正常範圍內。)

Low Vitamin B12 Tied to Brain Atrophy, Cognitive Impairment

Megan Brooks

 

September 27, 2011 — A new study provides more evidence that poor vitamin B12 status is a risk factor for brain atrophy and cognitive impairment, and highlights the importance of vitamin B12 metabolites that are not routinely assessed.

The study found that higher levels of several markers of vitamin B12 deficiency, most notably methylmalonic acid (MMA) and homocysteine, were associated with lower global cognitive function scores and lower total brain volume roughly 5 years later. However, the serum vitamin B12 concentration was not associated with either global cognitive function or total brain volume.

The results, from Christine C. Tangney, PhD, from Rush University Medical Center in Chicago and colleagues, were published September 27 in Neurology.

"Practice-Changing" Study

"What this study tells me is that I need to be taking B12 assessment in the elderly patient to a different level," Daniel C. Potts, MD, from Alabama Neurology and Sleep Medicine, PC, in Tuscaloosa, who was not involved in the study, noted in a telephone interview with Medscape Medical News. "I need to be routinely measuring the metabolites, and not just the serum B12," he said.

"With this study, I am probably going to change my practice a bit," added Dr. Potts, associate clinical professor, College of Community Health Sciences, University of Alabama School of Medicine, and member of the American Academy of Neurology.

Dr. Tangney's team studied 121 participants in the Chicago Health and Aging Project, an ongoing cohort study of adults aged 65 years and older living on the south side of Chicago.

They looked for interrelations between baseline levels of serum vitamin B12 and several vitamin B12-related markers, including MMA, homocysteine, 2-methylcitrate, and cystathionine, and brain magnetic resonance imaging and neuropsychological test results obtained an average of 4.6 years later.

According to the investigators, 17.5% of participants had elevated homocysteine levels, defined as higher than 14 μmol/L, and 15.2% had elevated MMA concentrations (>271 nmol/L). Serum homocysteine and MMA concentrations were highly correlated (P < .0001).

After adjusting for age, sex, education, race, and serum creatinine concentrations that can affect homocysteine levels, each of the vitamin B12-related markers, but not vitamin B12 itself, was associated with global cognitive scores.

For example, for each 1 μmol/L increase in homocysteine concentration, global cognitive score decreased by 0.03 standardized units (P = .04).

However, the relationship of the different vitamin B12 markers to the scores of the individual cognitive domains were not consistent.

Serum homocysteine concentration was not associated with any of the individual cognitive domains, although scores for perceptual organization and speed had marginal associations.

Serum concentrations of MMA, cystathionine, and 2-methylcitrate were each associated with lower episodic memory scores: the higher the concentrations, the lower the scores.

Higher MMA concentrations were also associated with lower perceptual speed, and higher cystathionine and 2-methylcitrate concentrations were each associated with poorer semantic memory.

"These associations remained in analyses that adjusted individually for [body mass index], smoking status, lifetime alcohol intake, hypertension, dementia, or APOE4," the authors say.

Similar to the cognitive function findings, serum vitamin B12 levels were not associated with any magnetic resonance imaging measures in adjusted models. Homocysteine concentration was the only vitamin B12 metabolite associated with the volume of white matter hyperintensity; the volume increased by 0.103 units/μmol/L increase in homocysteine level.

Elevated levels of serum homocysteine, MMA, cystathionine, and 2-methylcitrate were significantly associated with decreased total brain volume.

The investigators note that the effect of homocysteine on global cognition was "modified and no longer statistically significant with adjustment for white matter volume or cerebral infarcts." Likewise, the methylmalonate-global cognition effect was modified and no longer significant with adjustment for total brain volume.

Serum B12 Measurement "Not Enough"

Dr. Potts called this is "an important study that sheds some light for the first time on some individual components of cognition and what the B12 metabolites mean for those [components]."

"The global take-home for me," he added, "is that B12 may be playing a more important role than we once thought in terms of brain health in the elderly. I need to be more seriously considering the role of B12 in global cognitive health of an elderly person, and not just think that because they have a normal serum B12 level at their primary care physician that that's enough for me; it's not enough now, and I'm going to dig a little deeper," he said.

"At the very minimum, measure an MMA level, homocysteine plus a serum B12," he advised, as marginal vitamin B12 status in older adults is often missed by measuring serum vitamin B12 levels alone.

Dr. Tangney said it is too early to say whether increasing vitamin B12 levels in older people through diet or supplements could help prevent cognitive problems and brain atrophy, but it is "an interesting question to explore."

Results of the Vitamins in Cognitive Impairment (VITACOG) study, released 1 year ago and reported by Medscape Medical News at that time, provide some support for vitamin B supplementation.

In the study, treatment with a supplement containing vitamin B6, B12, and folate for 2 years reduced homocysteine levels and slowed brain atrophy in British adults with mild cognitive impairment, although concomitant changes in cognitive scores were not reported.

The current study was supported by the National Institute on Aging, part of the National Institutes of Health. Dr. Tangney has disclosed no relevant financial relationships. Some of the study authors have disclosed relationships with Pfizer, Bayer Schering Pharma, Avanir Pharmaceuticals, and Eli Lily and Company. Dr. Potts has disclosed no relevant financial relationships.

Neurology. 2011;77:1276-1282. Abstract

Medscape Medical News © 2011 WebMD, LLC

更新版鄧小平笑話一則

 

 

八十年代，鄧小平訪美，召開記者招待會，正好翻譯不在，美國記者想考考鄧小平的英語水準，便說：請問美國第一任總統叫什麼名字？鄧小平心想按中國人的習俗，便操著四川口音說：我姓鄧 （Washington）。

美國記者大吃一驚，但轉念一想，這個問題太簡單了，便又說：
請問，您夫人和孩子到美國都作些什麼事？
鄧小平又想問完姓，該問名了吧，就回答說：小平（shopping）

記者們連忙追問：那麼他們是用什麼交通工具？
鄧小平又按中國習俗，認為他們在問年齡，就回答：八十（bus）。

記者譁然，繼續問道：那麼臺灣下一任總統會是誰？
鄧小平等來等去，翻譯還沒有來，便回答說： 你等會兒（李登輝）。
記者再次譁然，這麼敏感的政治問題也回答得如此輕鬆？
便又問：那李登輝後邊呢？ 鄧小平有些不耐煩， 說：隨便（水扁）。

繼著，在大眾底下喧嘩中，有一位就很大聲地再問，更下一位呢? 鄧小平已經很不高興，口中狠狠地罵聲: 他馬的!

記者們看看翻譯快要來了，抓緊時間問最後一個問題：
您覺得21 世紀初世界面臨的最大問題是什麼？
沒完沒了的問個不停，沈下臉反問道： 啥事（SARS）？

看著鄧小平回答這些難題，都不假思索，記者心 中很感震撼，又問: 再下一位台灣總統呢? 這時他的翻譯來了，是細細白白的漂亮年輕女人，鄧小平心情一鬆弛，忘了是在台上，笑咪咪地拉著她的手，向上瞄著她蛋臉，柔聲地說: "妳說   英文兒呀! "

二十多年後，這些美國老記者感慨說：鄧小平真是一代偉人，料事如神。而且似乎對蔡英文，預期會有民主作風，感到心悅了。

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

李筱峰教授政論集《烏鴉不快樂》的序文一節

 

下面標楷體的部份是李筱峰教授政論集《烏鴉不快樂》的序文一節。(http://www.libertytimes.com.tw/2011/new/sep/18/today-o8.htm)

讀來令人好心痛!  台灣過去受KMT蔣政權洗腦，抑制思想言論四十餘年，之後已經有近二十幾年很驕傲地加入民主國家集團了。可是，看看李教授下面列舉的事實，如何解釋??

蔡英文這幾天到美國宣導政見，深受台僑、美國官員、甚至中國留學生的高度欣賞。她的作風也讓絕大多數過去對她的領導能力有些懷疑的人(包括我!)，完完全全改觀，深信她能以不同的風格，帶領台灣重建民主、法治，建立由全體台灣人民決定的
"台灣共識"，成立令人羨慕的台灣民主國，和世界各國和平共存。

儘管蔡英文的美國政見宣導之行如此地成功，可是，最後的結果、最後的決定，還是靠的在台灣的人民，靠的2012年的總統選舉、以及立委選舉。如果兩者都不是由蔡英文領導的民進黨勝出，台灣的將來是極為暗淡的，現在民主的台灣將成為專制中國的附庸 (這將是現代世界歷史上最可恥的記錄 !!)、失去主權、失去民主、失去自由、失去法治，奴才繼續當奴才、KMT權貴繼續貪腐、貧富差距繼續加深、平民的生活更困苦。(其實因為目前網路資訊如此的發達，現在中國人心中響往民主自由的人，可能還比台灣兩千三百萬人多出幾十倍!!)

人民要自由、要民主、要人權，是要有勇氣，是要有智慧。以馬桶迄今的無能無恥政治及其他表現，可以說是台灣人從未有過的、將中國國民黨KMT-台奸從台灣根除的好機會。可是民調竟然還是五五波! 聽來實在可笑，也可恥!!  不相信台灣人的智慧如此的懵昏；最可能的原因是:
幾十年來的KMT賄選文化已經深入社會底層，已成為生活的一部分 (維基解密洩漏:
美國國務院都知道收買選票的賄款從五百元到兩千元新台幣!)。可是，台灣人寧可收取幾百元、幾千元賄款，而不要人權、不要主權、不要民主、不要法制，不知恥地繼續支持馬桶-KMT-台奸的人怎麼會是那麼多!!

深信，以KMT這種從根腐敗貪腐的政黨，在選舉前幾星期，會全力施出所有 "奧步"(台語，dirty trick)、灑出金錢、利益，收買選票。不過， 難道台灣人會如此地容易被收買??
難到台灣人會如此地愚蠢??
 難到台灣人是如此地不知恥??

我已經聽說，過去一直投票給KMT的多數KMT黨員及民眾都已經決定改選民進黨候選人了 (除了KMT權貴，誰願意投降給中國、過沒有人權又困苦的生活??)。支持民主自由人權法治的台灣人民，現在要更積極地影響仍然不知道如何投票的民眾，做正確的選擇，投下神聖的ㄧ票。有人送錢賄選，就不要辭退這些人的
"好意"，錢收了，可是選票還是投給蔡英文領導的民進黨吧!  更好的方法是
"檢舉"，收取檢舉賄選的獎金!!   

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

這是我生命史上的最後一本政論集。

此話並非意味著我的生命即將終了，而是要表明，我不想再多寫政論了！

我為何做此決定？是因為我們的政治清明了嗎？公義彰顯了嗎？政客收斂了嗎？人民覺醒了嗎？都不是！

 

 過去那個厲行白色恐怖統治，殺人無數的政黨，沒有經過轉型正義的過程，依然有眾多台灣人民在支持！

 那個侵佔國家財產近千億元至今仍不歸還的政黨，依然能呼風喚雨！

 那個擁有一大堆掏空台灣數千億元逃亡在外的經濟犯、貪污犯的政黨，依然自命清高，還可以罵別人「貪腐」。

 過去叫囂要「消滅共匪」，動輒用「共匪同路人」的帽子抓人殺人的統治集團，現在正爭先恐後去媚共朝共，成為真正的中共同路人。

 過去發誓要「反共愛國」的人，現在卻以台灣領導人身分，在六四紀念日頌揚中共的血腥政權「人權有進步」！

 一個全家都拿美國籍的人，竟然被台灣人選為總統！

 一個把原住民「當人看」的人，竟受到原住民普遍擁戴！

 一國之尊的總統，竟然喊出「外交休兵」，而人民竟然也無動於衷！

 一句「法院是國民黨開的」，已成台灣社會流行的俗諺，而這個集團不但不思改過，反而變本加厲，拿司法當政治整肅的工具，台灣人敢當總統，統統起訴！

 為了替公務員加薪，亂花國庫毫不手軟；替勞工加薪，卻捨不得放手！

 替財團徵農地，劍及履及；為老農爭年金，索然無趣。

 …

 說不完的例子告訴我，政治沒有清明，公義不得彰顯，政客並未收斂，人民更不覺醒。

 

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

 

美國和台灣的差異--政治人物的醜聞

分類：台灣

2011/09/17 10:06

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請大家邀請朋友們共同欣賞這篇 曹長青 的討論:

長青論壇20110610：馬英九有病，台灣不幸

http://www.youtube.com/watch?v=S6Jl9z05QM4&NR=1

怎樣看馬英九「露私處」

◎曹長青



馬英九被媒體拍到「露私處」，這張極難堪地被稱為「馬英九露蛋」的照片在網上已廣泛流傳。因為全世界的國家領導人，沒有任何一個，會在大庭廣眾面前，被拍到露出私處。

在台灣，有人抱怨媒體過分，強調媒體應檢討，並對批評馬英九的人說：「這種說法跟怪女生穿短裙被強姦活該有什麼兩樣？」當然兩樣！理由是：

第一，拍照和強姦，完全是兩個概念和性質。馬英九露私處被媒體拍到，根本不等於被強姦。強姦是犯罪行為，而拍攝、監督權力者的活動，不僅是合法的，更是媒體的責任。這是根本的不同！所以那種比喻和思路完全錯誤。

第二，總統和女生，是不同的身份。女生是普通人，普通人的隱私應受到保護；而總統是權力者，權力者應受到監督，包括他的私生活。正如探討某個普通人是不是同性戀者，可能侵犯個人隱私。但探討馬英九是不是同性戀，則是監督權力者是否誠實，是否欺騙選民，尤其是欺騙女性選民。

第三，整起事件應該檢討的是馬英九。作為一國之元首，怎麼可以穿那麼短的短褲參加公共活動？而且還是跟學校女生在一起？現在連男運動員都不穿那麼短的運動褲上賽場了；而且再短的運動褲，裡面都會被包得嚴嚴實實，馬英九的「露」實在太怪了。

在美國，如果國務卿希拉蕊穿了三點式，會被媒體修理死。她當然有權利穿，法律沒有禁止條文，但是她的國務卿身份，她的修養等，就使她絕不能那樣做，所以媒體不可能拍到希拉蕊穿三點泳衣的照片。奧巴馬總統更不可能穿短褲參加有女生的學校活動，即使其他公共活動也不可能，都是一個道理。馬英九不僅穿短褲，而且短到快跟女性的三點式差不多了。是不是病態？

前中國國家主席江澤民當年到「死海」仰泳被媒體拍到，結果成為笑料。不僅死海是中國人忌諱之名稱，還因他仰泳時露出富士山般的白花花大肚皮。據說對此連中共高層人士都有微詞。江澤民所以這樣露怯，因為他在中國是「皇帝」，沒有人敢告訴他不可這樣做，這張照片在中國也不能公開發表。但台灣是民主社會，民選總統應該受到監督，媒體則扮演這種角色。台灣有太多人做慣了國民黨專制統治的順民，面對這種事首先想到媒體「應檢討」，而不是權力者應該檢討，更應該檢點。

第四，這不是馬英九的第一次和偶然。馬喜歡炫耀自己肉體，在台灣是公開的秘密。他居然會主動向媒體披露，他騎車沒穿內褲，在南部時洗澡有農家女遞毛巾 [按: 其實這是馬自己杜撰的。可看上面youtube記者訪問該農家女，就很清楚。不過馬談得好可愛哦! 還做出些害羞、不好意思狀呢!] 等等。一個總統可以「三八」到如此地步？（我知道三八是形容女性，但馬英九到底屬男，還是屬女？）別說身份是「總統」，甚至都不像個「成人」的行為。

台灣出現這樣一個總統，是台灣的悲哀。一個今天說不穿內褲，明天被拍到私處的人，如果2012還能連任，那真是台灣人的恥辱——「彈丸之地」有個「蛋頭總統」。

2011-06-02

[哪裡的事喔! 還有好多女選民雀躍想摸他一把，他也為此特別出行麼呢! 建議他五月二十日之後去演藝圈，應該還有人找他合照露蛋吧]

 

蔡英文在美國企業研究所 (AEI )的政策演說

極優秀!!! 

Video請看此網站:

http://www.aei.org/video/101504

 

Speech at American Enterprise Institute (AEI)

Taiwan’s national security challenges and strategies in the next decade

 Tsai Ing-wen September 13, 2011

 

Thank you Dan, and thanks to the American Enterprise Institute for hosting me here today, and for providing me the opportunity to speak to the many American friends who are here. Since I became Chair of the Democratic Progressive Party three years ago, I have made annual trips to Washington, to engage in dialogue on policy and strategies. These annual trips demonstrate the importance that the DPP places on our relations with the United States. Today I come here again, not only as Chair of the DPP, but as a presidential candidate, and a candidate with a good chance of winning! So while I enjoy seeing my friends here in Washington, either the United States will have to change its policy on senior official visits from Taiwan to Washington, or unfortunately, for the next four or eight years, it is not likely that I will be able to come here again, and we can only meet face to face in Taiwan.

That is why I very much cherish this opportunity, and although this is a short trip in the middle of a very intense campaign, I look forward to engaging in profound dialogue with American friends and partners on our bilateral relationship, and our vision for the future.

Ten year platform

A few weeks ago the DPP’s Central Executive Committee passed a ten-year policy platform, which outlines the challenges and circumstances Taiwan faces in the next decade. The platform contains eighteen chapters covering a wide range of issues, from agriculture and environment to technology and industry. It is a product of intense discussions among former DPP cabinet ministers, advisors, academics, NGO’s and party representatives. The formation of this platform adds policy depth and sophistication as the DPP prepares for the opportunity to govern again. It aims at identifying the key challenges Taiwan faces in the next decade and proposes responsible guidelines for responding to those challenges.

We are operating in a far more complex global environment than ever before, where the world is characterized by a web of interconnected transnational challenges such as the current economic crisis, epidemics, poverty, energy shortages, climate change, war, and terrorism. At the same time, we are in the middle of a systemic change, where the post cold-war global structure of US dominance in determining the world order is affected by serious economic and financial problems here as well as the uncertainty of how emerging powers such as China will evolve. Domestically, although our GDP has shown some positive growth numbers since the financial crisis a couple years ago, like here in the US, we have a crisis of escalating government debt, the loss of jobs, and a growing wealth disparity where the average income for the working person is actually declining. There is no doubt that our domestic economic and social challenges are also linked to the global environment, and there are no easy solutions. But the pragmatism, diligence, and creativity of the Taiwanese people have helped our country overcome many challenges in the past, and we have no choice but to be confident that through good governance and responsible leadership, Taiwan will continue to survive and prosper.

I believe our next election outcome will ultimately be determined by social and economic issues, just as it is in many democracies around the world. In recent local and by-elections since 2008, the DPP has successfully defined the agenda for domestic politics by leading the public debate on housing, social services, energy, and industrial adjustment. And gradually we have regained the confidence and trust of the Taiwanese people, tested again and again through successive elections and by-elections. Our rebound is apparent, but we fully understand that when we govern Taiwan again, we must not only respond to the social and economic needs of our people domestically, we must also shoulder responsibilities as a stakeholder in the international community. That would involve having a realistic grasp of the challenges in the international environment, and carrying on with a national security approach that is balanced and stable.

US Relations

In our view, the United States is Taiwan’s most important and reliable partner in international relations. The United States, acting in accordance with the Taiwan Relations Act, is the only country in the world committed to supporting Taiwan in our defense and security. But the relationship is not only one with a legal basis and realist common interests. The friendship extends deep into the emotional sentiments of the Taiwanese people, who value the multiple dimensions of trade, cultural, educational, and historical interactions that we have had. We in the DPP cherish this relationship and seek to continue to reinforce the comprehensive ties with the United States.

On the top of the agenda when engaging with the US is to rebuild strategic confidence and reinforce the strategic partnership. We acknowledge that toward the end of the previous DPP administration there were diverging views on strategic priorities, and our relationship went through a rough period. Indeed, the US is a global superpower with far-reaching global interests and a complex agenda with China, and Taiwan is a smaller state working to consolidate our young democracy internally while facing the threat of marginalization in our external relations. There are times when our interests will merge, and there are also times when we will have different priorities. However, as partners in a strategic relationship, we believe it is important to understand and communicate those priorities, ensuring a degree of strategic confidence that the broader agenda of a common interest for peace and stability is not jeopardized.

At the moment one of our priorities is to maintain the strategic balance across the Taiwan Strait, and this would involve the Taiwan military receiving adequate support from the US to defend ourselves. While peace and development appear to be the common lingo across the Strait at the moment, we understand that peace must be backed by a commitment to security. Despite the conciliatory attitude of our current government toward China, the military buildup across the Strait has not ceased. Instead recent developments of the PLA in advanced weapons systems and naval capabilities have tipped the balance in China’s favor, and Taiwan’s ability to deter and defend against the use of force will no longer be credible unless we demonstrate our commitment to investing in Taiwan’s self defense.

We would welcome a decision by the US to provide Taiwan with advanced defense systems that are deemed necessary through a process of mutual consultation between our militaries and defense experts. The DPP, and in particular our legislative caucus, has expressed disappointment in the Ma administration’s lack of dedication to a strong defense in the apparent declining budget proposals submitted. When we come back to government, the situation must be rectified by a stronger demonstrated commitment. But we understand it is not only a matter of budgeting and acquisitions of highly publicized items like the F16’s. Our general preparedness, and the intensity of the day to day operational interactions between our militaries and defense experts, are also crucial. In addition, we must also re-examine the value of our conscription service, seek the right balance between a professional voluntary force and conscripted servicemen, and put in place policy incentives for the development of a domestic industry that is capable of developing and supplying our military with some of the systems needed.

Another important priority in our strategic relations with the US is to ensure regional peace and stability, and this involves expanded cooperation and coordination with regional countries, especially the US and its allies. Taiwan is willing and able to play a constructive role in dealing with transnational security issues, such as humanitarian relief, non-proliferation, counter-terrorism, and cyber security. Already, intelligence cooperation led to the intervention in a shipment of sensitive materials to North Korea a few years ago, and Taiwan has cooperated in controlling the export of dual-use technology products to Iran. On the matter of disputes in the South China Sea, to which Taiwan also has our stakes and claims, the DPP has a position that supports the freedom of navigation and the settlement of disputes through a multilateral framework and international law. We emphasize aspects of maritime cooperation and sustainable development in our policy, and we are willing to engage in dialogue to ensure international cooperation on this matter.

While we expect support from the US for Taiwan to be more proactive in regional security affairs, it is not a one-way scenario. We believe it is within our mutual interests, and we have been ready to reciprocate as a responsible stakeholder. As we commemorate ten years after the 911 tragedy, I want to remind you that it was during our DPP administration that Taiwan stepped forward as one of the largest foreign donors to the post-Afghanistan war-on-terror reconstruction effort. We stood ready without hesitation to provide logistical support to US efforts in Iraq, and our government also contributed significantly to the Pentagon memorial. When I was the Deputy Premier, I was personally involved in coordinating efforts with American friends to enhance our export control regulations to curtail the flow of sensitive materials to dangerous areas.

For decades US support for Taiwan has been critical for the peaceful environment that has enabled prosperity and development. The people of Taiwan and the DPP will continue to play our part in nurturing the strategic partnership. From the US, we hope that our friends will recognize the anxieties that Taiwanese people feel about regional balance and marginalization, and while preoccupied with other interest around the world, we expect the US should keep Taiwan on the agenda as a reliable and committed partner relationship that requires reinforcement.

China Policy

Now let me turn to China, which is always a subject of interest in our dialogue with the United States. Some of our policy challenges regarding China overlap with those facing the United States, and we have a common interest in dealing with these challenges in a coordinated manner. For example, we both face the issue of a more aggressive Chinese military in the region, with “core interest” claims that threaten the freedom of navigation and regional stability. However, our relationships with China are fundamentally different in nature, and some of our policy responses may not be entirely the same. That is why it is absolutely important that we constantly communicate our objectives and our strategies, to ensure a norm of predictability and consistency in our relationship that serves as a foundation for confidence when we deal with China.

For Taiwan, China is the most complex policy challenge that is manifested in economic, social, political and security realms. Since interaction across the Strait began in the late eighties, systemic changes on a global level, as well as profound interaction between the people on two sides on a micro level, have complicated the relationship to the extent that stated ideology and political positions are not sufficient to handle the complexity of the challenge. So while we must be clear about our strategic goal and approach, we must also allow adequate flexibility for more sophisticated management of the relationship.

In the party’s ten-year policy platform, there are two chapters that lay out the guidelines for dealing with China: a chapter on national security strategy, and one on economic relations with China. I have on many occasions presented my thoughts on this subject matter. In case there is any doubt, let me again share with you our strategic goal, approach, and policy toward China.

The overarching goal of managing relations with China is to maintain a peaceful and stable environment so that the Taiwanese people can have the opportunities to develop a prosperous economy, while preserving our hard-won political freedoms and way of living. Ultimately, we want to ensure that the right to determine Taiwan’s future rests in the hands of the people of Taiwan, and any change of the status quo must be agreed by the people of Taiwan through democratic means.

At the moment, most Taiwanese seem to accept the status quo where Taiwan is by all practical definitions already an independent country, and although people are frustrated by international discrimination, the desire to maintain political separation from China is commonly apparent. At the same time, China’s growing economic significance and relevance for Taiwan is also a reality, and the Taiwanese people desire stability where business interests can be pursued in a predictable and fair environment, and where the government will help them shoulder and manage the potential risks involved. This will most likely be the mainstream sentiment in Taiwan for at least the next decade. Anyone who governs Taiwan must have an accurate understanding of the practical realities as well as the wishes of the Taiwanese people, and major policy must be formulated through democratic procedures. I have raised the concept of a Taiwan consensus, which highlights the democratic process of decision-making and emphasizes the fact that policy is only sustainable when it is a realistic response to the consensus and needs of the people. Any political precondition that is not democratically agreed upon is fragile at most and will not withstand the test of time.

To achieve our goal of maintaining a peaceful and stable environment across the Taiwan Strait, the DPP’s approach toward China will be stable and balanced. As a responsible political party, our policy must be in line with the mainstream consensus in our society as well as international expectations, and therefore we will refrain from extreme or radical approaches. The current stalemate across the Strait is a product of the evolution of history, but the future of relations does not have to be a zero-sum situation, and we are willing to take a strategic approach that benefits the people of both sides.

We would seek to achieve a strategic understanding that is based on reality, where the two sides across the Strait can interact in a stable and peaceful manner. We acknowledge that Beijing insists on the “one China principle” as its fundamental position toward Taiwan. However, Beijing must also understand the reality that the Taiwanese people, having gone through the historical processes of freeing themselves from foreign rule and seeking democratization, are opposed to a one-party system and committed to upholding the independence of their sovereignty. The distinct positions, however, should not prevent the two sides from reaching a mutually beneficial arrangement where we can also pursue common interests, mainly, common interests in peace and development. We believe that reaching a strategic understanding of our existing differences, and agreeing to engage based on a desire to achieve common interests and mutual benefits, is the most realistic way forward. This is what I mean by “peaceful but recognizing differences, peaceful and seeking commonalities.”

With an understanding of our differences and common objectives, we need to build a stable framework for interaction. This framework, gradually built through multiple levels, is to provide a mechanism for not only the day-to-day interactions and exchanges across the Strait, but also for conflict management and dispute settlement.

The doors of the DPP have been open to those Chinese interested in dialogue and in genuinely understanding our views. Historically, there may have been wars and conflicts between the CCP and the KMT parties, but the DPP carries no fundamental animosity toward the people of China. We are willing to play a proactive and constructive role in the development of a vibrant civil society and market economy in China, as long as it serves our common interests, which we understand to be peaceful development.

In addition to welcoming Chinese visitors to our party and our think tank, a number of DPP elected officials and local government administrations have also organized trips to China. We believe such interaction contributes to further mutual understanding.

To manage differences and to build on common interests in our interactions, we have proposed a number of policy guidelines which we will adopt when we come into government again. I have already outlined our political and security approaches abroad. Given the limitation in time, I will not go over all the other policy guidelines in detail, but let me share with you some policy points in the economic and cultural areas which may be of interest.

First, one of the most commonly asked questions I get is what the DPP would do about ECFA when we come into government. The DPP had many reservations about ECFA when it was initially proposed: Procedurally the lack of transparency in the negotiation process was unacceptable. And in terms of substance, we were concerned that the rapid opening process with China would have a dramatic impact on Taiwan’s economy which our government and people were not prepared to handle. We voiced our objections, and we ensured that no political preconditions were written into the language of the agreement. Now that ECFA is already signed into reality, when in government we will conduct regular examinations of its impact on our economy, and if and when revisions are necessary we would follow democratic procedures for handling trade agreements and international obligations.

Second, the handling of economic relations with China is not a simple matter of yes or no. The intensity of economic ties is a reality, and China has already become Taiwan’s largest investment destination and trading partner. Economic relations have evolved to an extent where continuing interaction cannot be stopped by either side, regardless of who is in government. Turning a blind eye to this reality is just as impractical as the threat to discontinue ties with changing political circumstances.

The market and the private sector have already taken the lead in this intense economic relationship. But we know that the future of China, while containing tremendous opportunities, also has its risks and uncertainties, particularly as long as the political system remains opaque, and its economy continues in a direction of state-driven capitalism. So from our perspective, the role of the government in cross-strait economic relations must contain at least the following dimensions: managing and reducing risks; ensuring a fair environment for businesses to operate; proactive global diversification efforts; and balancing interests between the sectors that profit from cross-strait trade and sectors that suffer. This is where we differ in philosophy from the KMT, which has formulated policy based on the one-dimensional assumption that opening to China is the solution to all economic problems.

My third point is in regards to the traveling and interaction between the peoples on both sides. When we were in government, we initiated negotiations on direct flights across the Strait, and we do not fundamentally object to transportation arrangements that reduce the cost of traveling, as long as security risks are controlled and the resulting profit is adequately shared. With the direct flights there is the issue of Chinese tourists. In principle we welcome Chinese tourists. However, the influx of Chinese tourists must be accompanied by a preparation with adequate infrastructure, so that overcrowding in some sites does not reduce the quality of tourism or turn away tourists from other countries.

In short, the DPP has invested a lot of time and energy into formulating a workable approach as well as specific policies toward China that are consistent with the interests of the Taiwanese people. We have conducted serious discussions with experts, academics, private sector leaders, NGO’s, and our party grassroots, to build a strong consensus that is sustainable as we deal with the complexities of the cross-strait relationship.

I want to reiterate here that our broader goal is to ensure a peaceful and stable environment where the people on both sides of the Strait and in the broader region can pursue development and prosperity. We will work on our goals in a way that is responsible and in line with international expectations of a maturing democracy.

When we win the presidential election next year, it will be Taiwan’s third transition. In a democratic society, when a party loses elections it reflects and rebuilds. If it is successful it will govern again and if not there will always be new parties and forces in a society that will propel progress and change. Since March of 2008, the DPP has gone through a very painful process of reflection, all the while facing internal and external challenges. And during my leadership of the party, I have insisted on the need for refining our policy discourse and broadening the content of political debate in Taiwan that traditionally has been more confined to ideological differences. The public has responded to our transformation with enthusiasm. Our supporters will constantly compel us to reflect and respond, and in turn they provide the fuel for our progress.

We hope that the international community, including China, will develop an understanding, if not appreciation, of how our democracy functions. The DPP’s return to government is inevitable and will happen hopefully sooner rather than later. The DPP has evolved and matured along with the development of Taiwan’s democracy, and today we are far more experienced and prepared than ever for the opportunity to govern again. I am sure our American friends here will find us to be reliable partners, and the Taiwanese people will work with us to build an accountable and responsible government.

兩劑HPV疫苗似乎就有效，三劑時對其他三種HPV菌株都有效

From Medscape Medical
News

Two Doses of HPV Vaccine May Be Enough
for Protection

Emma Hitt, PhD

September 12, 2011 — Efficacy against HPV strains that can
cause cervical cancer is still seen when fewer than the recommended 3 doses of
bivalent human papillomavirus (HPV) vaccine (Cervarix, GlaxoSmithKline)
are received, according to a randomized vaccine trial conducted in Costa Rica.

Aimée Kreimer, MD, from the National Institutes of Health's
National Cancer Institute in Rockville, Maryland, and colleagues reported their findings online September 9 in the Journal
of the National Cancer Institute.

Conclusions from the current study are based on analysis of
data from a phase 3 clinical investigation designed to evaluate the efficacy of
the standard 3-dose regimen of the HPV vaccine.

About 20% of the enrolled participants received fewer than
the 3 vaccine doses recommended by the Centers for Disease Control and
Prevention's Advisory Committee on Immunization Practices, primarily for
unintentional reasons including pregnancy and colposcopy referrals.
Investigators were therefore able to examine protection against HPV infection
achieved after administering only 1 or 2 doses of the vaccine.

The randomized, double-blinded Costa Rica Vaccine Trial
included 7466 women ranging in age from 18 to 25 years. Participants were
randomly assigned to receive either the HPV vaccine (HPV group) or a control
hepatitis A vaccine (control group) at 0, 1, and 6 months. Women were observed
annually during a median follow-up of 4.2 years.

The full 3 doses of vaccination were administered to 5967
women, 802 women received 2 doses, and 384 women received only 1 dose of
vaccine. No statistically significant difference was observed in the number of
women receiving HPV vaccine vs control in the 3 groups (P = .23).

Vaccine efficacy was determined based on incident HPV16/18
infections that persisted for at least 1 year. Viral presence was detected
through testing for HPV DNA by polymerase chain reaction.

Vaccine efficacy was similar for women who received 2 or 3
doses of the vaccine. Three HPV doses showed an efficacy of 80.9% (95%
confidence interval [CI], 71.1% - 87.7%), whereas vaccine efficacy for 2 doses
was 84.1% (95% CI, 50.2% - 96.3%).

Even 1 dose of HPV vaccine offered protection, with a
vaccine efficacy of 100% (95% CI, 66.5% to 100%). However, the researchers
note that this result, although encouraging, must be taken with caution because
of limited follow-up and the small number of detected infections. They also
suggest that this unexpected result might be a result of previous exposure to
the HPV16/18 virus, as women participating in the trial were predominantly
sexually active (aged 18 - 25 years).

Participants had a similar risk of contracting HPV
infections regardless of the number of vaccine doses they received, confirming
the validity of the vaccine efficacy results. The proportion of new infections
during the 4 years of the study, referred to as the attack rate, was 4.4%,
4.5%, and 5.3%, respectively, for women receiving 3, 2, or 1 dose of the
vaccine.

Bivalent HPV16/18 vaccine administration has previously been
shown to offer some protection against 3 additional types of high-risk HPVs
(HPV31, HPV33, and HPV45) when the standard 3-dose regimen is applied. A similar result for the 3-dose regimen was observed in
this study, but not among those receiving only 2 doses, suggesting that
the full regimen may be needed for added protection against these HPVs.

"If vaccination with fewer than three doses were to
retain the high efficacy of the standard regimen, the ability to vaccinate more
women for the same cost could translate to a greater public health benefit in
underserved areas," Dr. Kreimer and colleagues state.

In a related editorial, Cosette Wheeler, PhD, from the
University of New Mexico Health Sciences Center, in Albuquerque, states that
"it remains unknown...whether HPV vaccine protection, with fewer than
three doses, will be sustainable even for homologous HPV vaccine types 16 and
18. Additional larger studies that are specifically designed to evaluate the
efficacy of one-, two-, and three-dose regimens in young adolescent girls, with
long-term follow-up and more stringent endpoints, could prove critical."

Support for this study was provided by the Ministry of
Health of Costa Rica and GlaxoSmithKline. Vaccine was provided for the trial by
GlaxoSmithKline Biologicals under a Clinical Trials Agreement with the National
Cancer Institute. Dr. Kreimer and Dr. Wheeler have disclosed no relevant
financial relationships.

J Nat Cancer Inst.
Published online September 9, 2011. Abstract

 

醫護人員的制服常有病原汙染

醫護人員的手、制服都可能傳染病原，應該是很早就知道的吧!

下提這個調查只是在一家大學醫院。不知道是否能由衛生署主導，在台灣做五、六家、大中小醫院的 random (隨機)調查? 雖然結果很明顯，可是也可以了解台灣的狀況，令醫護人員警惕，加強院內感染的預防，可在醫院評鑑時做為評鑑項目之一，是病人之福、也是醫護人員的責任。

 

Healthcare Workers Uniforms Often Contaminated

Emma Hitt, PhD

September 2, 2011 — A large proportion of hospital staff's
uniforms may be colonized with potentially pathogenic bacteria, including
drug-resistant organisms, that may represent an important source of nosocomial
infections, new research suggests.

A
single-institution study conducted in Jerusalem, Israel, was reported by Yonit Wiener-Well, MD, and colleagues from
the Shaare Zedek Medical Center, Hebrew University–Hadassah Medical School,
Jerusalem. The study was published in the September issue of the American
Journal of Infection Control.

"Several studies have demonstrated bacterial
contamination of the uniforms and clothing of health care workers (HCWs) during
patient care activities," Dr. Wiener-Well and colleagues write.
"Nevertheless, few organizations have made recommendations for provision
and exchange of HCWs' clothing," they add.

The current study evaluated the bacterial load on uniforms
worn by nurses and physicians in a
550-bed, university-affiliated hospital, in Jerusalem. A total of 135
physicians and nurses from the medical and surgical wings were included in the
analysis.

Each participant responded to a questionnaire asking how
long the participant had been wearing his or her current uniform, how clean
they thought it was, and how often they changed it. In addition, 238 standard blood agar plates were made
from cultures obtained in the abdominal area, the ends of sleeves, and pockets
taken from 135 personnel, of whom 55% were nurses and 45% were physicians.

Of the participants, 58%
stated that they changed their uniform daily, and 77% described the hygiene of
their attire as "fair to excellent." However, in 63% of participants'
uniforms, potentially pathogenic bacteria were isolated from at least 1 site,
making up 50% of the samples taken.

Of
the samples with antibiotic-resistant bacteria, 14% came from nurses' gowns,
and 6% came from physicians' gowns, which is not significantly different. There was also no significant difference between staff from
medical departments and those from surgical departments.

According to the researchers, the "high prevalence of contaminated uniforms might be related to
inadequate compliance with hand hygiene, given that the sampled sites (ie,
abdominal zone, sleeve ends, and pockets on the dominant side) are
characterized by frequent hand touches."

Study limitations include the estimation of number of days
that uniforms were worn before sampling, use of only 4 clean samples from
hospital laundry as controls, lack of information regarding whether hospital
personnel washed uniforms at home or via hospital laundry services, and
possible selection bias.

"Wearing a clean uniform daily, providing adequate
laundering, improving hand hygiene practices, and using plastic aprons when
performing tasks that may involve splashing or contact with body fluids likely
will decrease the bacterial load on uniforms,"
the authors conclude.

"Wearing short-sleeved coats or even having physicians
discard their white coats could further reduce the cloth-borne transmission of
pathogens," they add.

The authors have disclosed no relevant financial
relationships.

Am J Infect Control.
2011;39:555-559. Abstract

Medscape Medical News
© 2011 WebMD, LLC

 

Marco Polo ’never went to China’ 馬可波羅「從未去過中國」

 

◎管淑平

Marco Polo, one of history’s greatest
explorers, may in fact have been a conman, it was claimed.

Far from being a trader who spent years in
China and the Far East, he probably never went further east than the Black Sea,
according to a team of archaeologists.

They suspect the Venetian adventurer picked
up stories about the mysterious lands of the Orient from fellow traders around
the Black Sea who related tales of China, Japan and the Mongol Empire in the
13th century. He then cobbled them together in a book which purports to be his
account of his travels between 1271 and 1291.

Professor Daniele Petrella of the
University of Naples said that there were many inconsistencies and inaccuracies
in Marco Polo’s description of Kublai Khan’s invasions of Japan in 1274 and
1281.

‘He confuses the two, mixing up details
about the first expedition with those of the second,’ he said. Marco Polo’s

description of the Mongol fleet did not square with the remains of ships they
excavated in Japan.

有說法指稱，名列史上最偉大探險家之一的馬可波羅，其實也許是個騙子。

根據一支考古團隊的說法，他大概從沒去到黑海以東的地方，更別說是曾在中國待過幾年的商人了。

他們懷疑，這名威尼斯冒險家是13世紀在黑海附近從講述當時中國、日本和蒙古帝國見聞的商旅同伴那裡，蒐集有關這些神秘東方國度的故事。然後他再把這些故事拼湊成書，當作他自己在1271年到1291年之間的旅行經驗談。

義大利那不勒斯大學教授佩特雷拉說，馬可波羅對忽必烈1274和1281年入侵日本的描述，有許多不一致、不正確之處。

「他把這兩次搞混了，第一次遠征和第二次遠征的細節混在一起了。」佩特雷拉教授說。馬可波羅口中的蒙古艦隊，也與他們在日本發掘的船隻殘骸不符。