2012年9月28日星期五

中共開除薄熙來黨、公職

China says disgraced leader Bo Xilai expelled from
Communist Party, to face criminal charges

By
Associated Press, Updated: Friday, September 28, 8:31 AM

BEIJING — China’s communist
leadership expelled Bo Xilai from the ruling party Friday and sought to bury
him with charges ranging from corruption to sexual affairs, aiming to sweep
away their most damaging scandal in decades while finally scheduling their
long-awaited leadership transition for November.

A statement from the party’s
Politburo amounted to a surprisingly strong and wide-ranging indictment against
Bo, effectively ending the public of life of the flamboyant 63-year-old
populist who was one of China’s best known politicians and whose ambition was
considered a menace to the country’s top leaders.

The former Politburo member and
regional party chief is to be charged with crimes dating back more than a
decade, including abuse of power, bribe taking and improper relations with
several women — banned by the party because they are considered an inducement
to corruption. He also is accused of involvement in the cover-up of his wife’s
murder of a British businessman, which was instrumental in triggering his
downfall.

“They want to drive a stake through
the heart of his political career, and make it absolutely impossible, not only
for him to reappear but for anyone else who has that idea of trying to create
that sort of personalized, political, charismatic leadership in some part of
China which may challenge the leadership,” said Rana Mitter, professor of
Chinese history and politics at Oxford University.

The Politburo also announced the
party congress would take place Nov. 8.

Dates for the congress, held once
every five years, were overdue and highly anticipated because it will see
President Hu Jintao step down after 10 years as party boss — and China’s
ultimate leader — to be replaced by Vice President Xi Jinping.

The congress had been expected to
take place in mid-October, although the preparations were overshadowed by the
Bo scandal.

“Bo Xilai’s behavior resulted in
serious repercussions and enormous damage to the reputation of the party and
the nation, producing extremely vile effects domestically and overseas, and
causing heavy damage to the cause of the party and the people,” the Politburo
said in a statement issued following its meeting in Beijing.

Speculation swirled for months over
whether the party would harshly punish one of its own for criminal wrongdoing,
or merely allow its own disciplinary arm to deal him a slap on the wrist.

The scandal was set off when a
trusted Bo aide disclosed that his boss’s wife had murdered a British
businessman. Bo was sacked as party chief of the city of Chongqing; his wife,
Gu Kailai, was given a suspended death sentence after confessing to the murder;
and the aide, Chongqing police chief Wang Lijun, received a 15-year prison term
for initially covering up the murder and other misdeeds.

The trials of Wang, which wrapped up
this week, and Gu, which finished earlier, cleared the way for the party to
decide whether to charge Bo with criminal wrongdoing. But his ouster from the
leadership early this year opened a window into the divisive jostling for power
as president and party leader Hu prepares to retire to make way for younger
leaders.

Bo is the first Politburo member to
be purged and handed to prosecutors since Hu had Shanghai party secretary Chen
Liangyu sentenced for corruption in 2007. In that case, more than a year passed
before Chen stood trial, perhaps auguring a long wait before Bo’s case goes to
court.

High-level purges, however, are
almost always more about political power plays than crimes.

Bo was a divisive figure among
Chinese leaders. Self-assured and comfortable with the media, he promoted
populist policies as party chief of Chongqing and rode high-profile campaigns
to bust organized crime gangs and promote communist culture to national
popularity. His ambition was seen as a threat not only by Hu but to Hu’s
soon-to-be-installed successor, Xi Jinping.

Bo’s supporters called the Politburo
decision a political tactic. “I have doubts on any criminal wrongdoings of Bo
Xilai. I need to see the evidence,” said Han Deqiang, an economics professor at
Beijing University of Aeronautics and Astronautics and a leading voice in what
Chinese call the new left. “I think this is a political battle turned into a
criminal one.”

Bo’s detractors, however, were
cheered by the news, though they too saw politics at play in the decision.

“This announcement is long overdue.
This means there is some progress in the rule of law in China. There is more
transparency,” said Li Zhuang, a formidable defense lawyer who found himself
jailed in Chongqing after he accused police of extracting his client’s
confession by torture. “Of course it is also political. In China, politics and
law often go hand in hand.”

The decision by the 25-member
Politburo, of which Bo had been a member, said that “investigations show that
Bo had seriously violated party discipline ... abused his power, committed
grave mistakes and should be held responsible for the Wang Lijun case as well
as Gu’s murder case.”

The mention of Gu’s case appeared to
be a reference to obstruction of justice. Wang testified that Bo ignored him
when he told him of his suspicions, then boxed him in the ears, demoted him,
and detained several of his subordinates.

It was the first direct mention of
Bo in state media in months. His name was not mentioned for both Gu’s and
Wang’s trials.

The Politburo statement said that he
took huge amounts of bribes directly or through his family and “maintained
illicit relationships with numerous females.” It said Bo’s crimes dated from
his time as mayor of the eastern port city of Dalian, through his term as
commerce minister and as leader of Chongqing.

Bo’s removal is seen as strengthening
Xi’s position, leaving him the undisputed leader of the party’s “princelings,”
as the offspring of high-ranking communist elders are known.

“Now Bo is finished, Xi can take
over those supporters from Bo and enlarge his network among the princelings,” said
China politics analyst Willy Lam of the Chinese University of Hong Kong.

Yet his ouster will do nothing to
win over Bo supporters among party hardliners and admirers of Bo, who was
widely popular among working-class Chinese.

“Xi is safer with Bo gone, but the
hardliners will withhold their cooperation at the congress as a sign of their
disapproval,” said China expert Feng Chongyi of the University of Technology in
Sydney, Australia.

Friday’s Politburo meeting sets a
series of events in motion. The 204-member Central Committee, a cross-section
of the national party elite, usually convenes about a week before the congress
to approve decisions already made by the Politburo. Privately, the committee
will also approve the incoming leaders and a policy blueprint for the next five
years.

Associated Press writers Gillian
Wong, Didi Tang and Isolda Morillo contributed to this report.

[薄還是有數十億美元的收賄所得藏在世界各處! 不過中共所有領導人都如此啊!]

中共中央28日宣布開除前重慶市委書記薄熙來的黨職與公職，並將其涉及的犯罪問題移送司法機關處理。中共下重手懲處薄熙來，顯示不願讓薄案影響十八大後新領導人的接班。圖為薄熙來3月出席全國人大會議的檔案照。（歐新社）

重懲薄、18大後人事達成共識

〔編譯陳成良／綜合報導〕中共中央廿八日透過新華社宣布開除前重慶市委書記薄熙來的黨職與公職，且將其涉及的犯罪問題移送司法機關處理；隨後又宣布建議十一月八日召開十八大會議。新華社在不到一分鐘內先後以快訊公布這兩項全球矚目的新聞，顯示中共黨內各派系已就重懲薄熙來與十八大後的人事達成共識，力求在十八大前對薄案做出處置，以免此事成為話題並轉移人民對十八大的注意力。

新華社報導，中國共產黨中央政治局廿八日召開會議，決定對前重慶市委書記薄熙來「雙開」（開除黨職與公職）處分，還公布他與多名女性發生不當性關係等不堪罪名，對其涉嫌犯罪問題移送司法機關處理，同時建議十一月八日召開確定中國新一代領導層的中共十八次全國代表大會（十八大）會議，待黨的十七屆七中全會予以追認。

薄收賄、玩女人官方細數罪名

新華社在稍後發布的詳訊中指出，任何人踐踏黨紀國法都要嚴厲懲處，絕不容腐敗份子逃脫，要體現從嚴治黨與依法治國的執政理念。專家指出，中共中央決定對薄熙來雙開及薄案依法處理，顯示中國國家主席胡錦濤，以及他的接班人、副主席習近平聯手，決定徹底處理黨內問題，薄熙來恐遭重懲。

在官方公布的雙開理由中，細數薄熙來從擔任大連市長、遼寧省長到商務部部長都有違反紀律情形，甚至說薄熙來與多名女性發生或保持不正當性關係、利用職權為他人牟利、其家人收受他人巨額財物、違反組織人事紀律、用人失察失誤，造成嚴重後果等。此外，調查中還發現了薄熙來其他涉嫌犯罪問題線索，在重慶市原副市長王立軍事件和妻子薄谷開來故意殺人案件中，濫用職權，犯有嚴重錯誤、負有重大責任。

紐約時報與華盛頓郵報的分析都指出，中共宣布了這些嚴重且不堪的罪名，而且從大連市長時期開始追溯，顯示中共領導人已達成共識，必須嚴懲薄熙來。路透引述英國諾丁漢大學當代中國研究副教授賴洪毅看法稱，可能被判重刑，但不致死。依慣例政治局委員不判死刑。北京大學法學教授賀衛方認為，薄熙來可能被處二十年或以上的有期徒刑。

追溯罪名薄熙來可能被判重刑

根據新華社披露的中共中央處理薄案的細節，中央政治局是在四月十日的會議中，聽取了對王立軍私入美國駐成都總領事館滯留事件的調查，和對薄谷開來涉嫌毒殺英國公民海伍德案件覆查的匯報，認為薄熙來在兩案中均存在錯誤和責任，且在兩案調查過程中，還發現了薄熙來的其他違紀線索，中央決定，停止他在政治局、中央委員職務，並由紀委對其立案檢查。

六十三歲的薄熙來是中共元老薄一波之子，是所謂的太子黨成員，在重慶掌權期間大力主張「唱紅打黑」，引發中共黨內路線之爭，他因王立軍事件遭到立案調查，最後斷送政治前途，從三月迄今遭到軟禁，確實下落不明。

早在新華社宣布前，即有風聲傳出中共中央要在十一長假前就薄案或十八大日期做出宣布，不料最後兩者同時定案。

中国、薄煕来氏の刑事訴追決定…党籍・公職剥奪

　【北京＝竹内誠一郎】新華社通信によると、中国共産党は２８日、政治局会議を開き、党中央規律検査委員会の調査を受けていた薄煕来 ( ボーシーライ ) 前重慶市党委書記（６３）について、党籍を剥奪して公職から追放するとともに、司法機関に移送する処分を決めた。

　英国人実業家殺人事件に関する「職権乱用」のほか、「巨額の収賄」などに問われており、厳しい刑事処分が下される見通しだ。胡錦濤 ( フージンタオ ) 政権は第１８回党大会を前に、事件の幕引きを図った。

　これまでの調べによると、薄氏の妻、谷開来 ( グーカイライ ) 服役囚（５３）（猶予付き死刑確定）は、知人の英国人実業家と金銭を巡って対立。２０１１年１１月１３日、この実業家を重慶市内のホテルで毒殺し、部下の王立軍・元同市公安局長（懲役１５年判決）が証拠隠滅を図った。

　２８日、政治局会議に提出された報告は、薄氏が同事件に関し、「職権を乱用し、大きな誤りを犯した重大な責任がある」と指摘した。証拠隠滅などの関与が問われたものとみられる。報告はまた、薄氏が遼寧省大連市長や商務相、重慶市党委書記時代を通じ、「直接、または家族を通して巨額の賄賂を受けた」と認定した。

（2012年9月28日21時39分読売新聞）

再一篇文章說維他命D過低和Alzheimer失智症可能有關

Low Vitamin D Linked to Alzheimer's Disease

Pauline Anderson

September 28, 2012 — Yet another study has linked low vitamin D levels with significant health issues — in this case, poor cognition.

In this latest systematic review of the literature, people with Alzheimer's disease (AD) had lower concentrations of vitamin D than those without AD, and better cognitive test results were linked to higher vitamin D concentrations.

Overall, the results provide sufficient evidence to warrant further investigation to determine whether a cause-and-effect relationship exists, said lead author Cynthia Balion, PhD, a clinical biochemist and associate professor, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.

"I think we have really good data now to make it clear that people need to do the interventional studies and see whether or not giving vitamin D helps people at higher risk for developing cognitive decline," Dr. Balion told Medscape Medical News.

The new review was published in the September 25 issue of Neurology.

Included Studies

Dr. Balion and colleagues searched MEDLINE, EMBASE, AMED, PsychINFO, and the Cochrane Central database for English-language studies of adults that measured vitamin D levels and included validated tests (for example, global function, executive function, psychomotor speed, attention, memory, or intelligence) as a measure of cognitive function. They accepted all recognized diagnostic criteria.

The review encompassed 37 studies, including 21 cross-sectional, 10 case-control, 1 before-after with a comparison group, and 2 prospective cohort studies, as well as 3 randomized, controlled trials (RCTs). The study sample sizes varied from 27 to 17,099 participants.

Thirty studies included only older participants, generally age 65 years or older, whereas 9 studies included only women and 2, only men. Exclusion criteria varied across studies (and included, for example, nutritional supplements, such as calcium and vitamin D; hormonal treatment; and diseases such as kidney disease, liver disease, and osteoporosis.)

All studies measured 25-hydroxyvitamin D [25(OH)D] concentrations except for 1 that measured 1,25-dihydroxyvitamin D [1.25(OH)D]; 4 studies measured both. Various vitamin D cut points were classified as deficient or insufficient (<25 nmol/L, ≥25 to 50 nmol/L, <50 nmol/L) or sufficient (≥25 nmol/L, ≥50 nmol/L, ≥50 to <75 nmol/L, >75 nmol/L).

In 14 studies, the cognition outcome included the diagnosis of dementia, which was most commonly defined according to the Diagnostic and Statistical Manual of Mental Disorders or National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders Association criteria. Of the 24 studies that included a test of cognitive function, the most commonly used test was the Mini-Mental State Examination (MMSE).

In most cases, the relationship between vitamin D and cognition was assessed by comparing mean vitamin D concentrations between patients diagnosed with dementia and controls or mean neuropsychological test scores between vitamin D groups.

2 Meta-Analyses

There were sufficient data to conduct 2 meta-analyses. The first compared the mean 25(OH)D concentration between AD and control groups. Six cross-sectional or case-control studies comparing data from 888 participants demonstrated a lower mean 25(OH)D concentration in patients with AD than in controls. The mean difference was −15.0 nmol/L (95% confidence interval [CI], −26.2 to −3.9 nmol/L).

The researchers found that an important determinant of the statistically significant heterogeneity was the method of 25(OH)D measurement used. The competitive protein-binding assay (CPBA) explained the heterogeneity, but this method has been withdrawn from commercial use because of accuracy issues, said Dr. Balion.

When the analysis was restricted to the 4 studies that used methods other than the CPBA, the overall difference between the AD and control groups was −6.2 nmol/L (95% CI, −10.6 to −1.8 nmol/L), with results consistent across studies. Similar results were found when studies comparing any dementia against a control group used methods other than the CPBA to measure vitamin D.

Dr. Balion stressed the need for standardization of methods of measuring 25(OH)D and noted that relevant organizations are addressing this issue. In the meantime, it's important to consider the type of analytical method being used when comparing results from different studies, she said.

Lack of true standardization is "a big problem in the field right now," commented Raj C. Shah, MD, a geriatrician and associate professor of family medicine, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois. "It's important to realize that all measurements of vitamin D are not equal."

The second meta-analysis compared mean MMSE scores between participants with 25(OH)D concentrations less than 50 mmol/L and those with concentrations of 50 mmol/L or greater; 50 mmol/L is the most common cut-point reported in these studies and is often used to define vitamin D deficiency. Eight cross-sectional and case-control studies, which included data from 2749 participants, contributed to this analysis. Taken together, these studies showed a higher average MMSE score in participants with higher vitamin D concentrations.

The average difference in MMSE score was 1.2 (95% CI, 0.5 to 1.9), although there was statistically significant heterogeneity. None of the subgroup analyses (for example, percentage of female participants, adjustment for at least age and sex) explained this heterogeneity.

Dr. Balion noted that except for 2 studies, the average MMSE score of the groups was very similar. When 4 studies that used another type of cognitive screening tool were added, the results did not change substantially.

Of the 2 cohort studies included in the analysis, the 1 that included only men reported no significant association between vitamin D and baseline cognitive impairment; in the other, however, participants with a deficiency in vitamin D had an increased risk for substantial cognitive decline over 6 years compared with those who had sufficient concentrations of the vitamin. As for the RCTs, the only study to use a supplement of vitamin D alone found no significant between-group differences for the single cognitive measure used.

Comprehensive Analysis

According to Dr. Balion, the results of this current review differ from those of 2 earlier ones because it was more comprehensive in its search strategy and in its inclusion criteria, which resulted in more articles screened (3229 vs 99 for a previous review). It also included more studies (37 vs 5 for the previous reviews). "We decided not to be limited in what we looked at," she said.

Dr. Balion pointed out that some factors affecting vitamin D concentrations, including skin pigmentation, age, genetics, and time of sun exposure and testing, were not considered by some studies. As well, she said, reverse causation can't be ruled out because older people may have poor nutrition and spend less time exposed to sunlight, a major source of vitamin D. Despite these limitations, "I'm pretty happy saying that vitamin D plays a role in brain health," she said.

How exactly vitamin D protects the brain is not clear, but research suggests that vitamin D acts as a neurosteroid, said Dr. Balion. At the molecular level, the brain can synthesize the active form of vitamin D [1,25(OH)D] within several cell types and regions, predominantly in the hypothalamus and large neurons in the substantia nigra. Many genes are regulated by vitamin D, which contributes to neuroprotection by modulating the production of such things as nerve growth factor, and regulating neurotransmitters.

The ideal concentration of vitamin D is also not really known, said Dr. Balion. "We tried to assess that with the data that we had from all these papers, and some studies show there might be this magic cut point and other studies did not really find a cut point. Most studies aren't designed to look for that because they're not outcome studies."

However, she noted that 2 cut points are recommended worldwide: 50 and 75 nmol/L. Canada, for example, recommends the upper level for bone health.

Physicians should recommend supplements for patients not getting sufficient vitamin D, said Dr. Balion. Many jurisdictions, including Canada, recommend 600 IU of vitamin D daily for older children and adults; recommendations differ for younger children and pregnant women.

Vitamin D Testing

Ontario's universal healthcare system does not provide for vitamin D testing except for certain conditions (osteoporosis, osteopenia, rickets, malabsorption syndrome, renal disease, or taking medications that affect vitamin D metabolism) because the evidence is not yet established, said Dr. Balion.

The United States has recommendations similar to Canada's, Dr. Shah notes. Americans are becoming more aware of vitamin D's health benefits and are taking more supplements; however, although the vitamin is fat soluble, and so may be safer than some other vitamins when taken at higher doses, Dr. Shah noted that it can still lead to muscle pains and gastrointestinal tract problems.

When asked to comment on this review, Dr. Shah said, "it helps clinicians like me and researchers to understand where the state of science is in this field, and it tells us we have a lot more work to do." He noted that of the 37 papers included in the review, only a few were clinical trials.

However, that may be changing. VITAL (VITamin D and OmegA-3 TriaL), a large 5-year clinical trial sponsored by the National Institutes of Health, is randomly assigning 20,000 people across the United States. The placebo-controlled trial will investigate whether vitamin D or omega fatty acid affects various aspects of health, including cognition.

Dr. Shah raised several important issues pertaining to the analysis. For one thing, results of vitamin D studies may depend on where participants live and the time of the year that testing was done.

He also noted that most studies were probably not done in diverse populations. "I suspect that subjects were mainly Caucasian," but because the United States has an increasingly diverse population, "we need to have measures of these effects in various older adults."

Dr. Shah said that as with any meta-analysis, some publication bias probably exists, with negative studies not being published or available for review.

He also questioned whether intervening through supplementation to arrive at a target vitamin D level would affect outcomes. He used the example of high-density lipoprotein, where experts believed that raising levels would reduce risks for heart disease. Preliminary research suggests that such efforts not only might not produce the expected result but also may cause some harm in terms of adverse effects.

The study was funded by the Ontario Research Coalition of Research Institutes/Centers on Health & Aging, Ontario Ministry of Long-Term Care. Dr. Balion receives research support from the Canadian Institutes of Health Research, the Agency for Healthcare Research and Quality, the Canada Foundation for Innovation (CFI), and the Ontario Ministry of Health and Long-Term Care. For disclosures for other authors, see original paper. Dr. Shah has disclosed no relevant financial relationships.

Neurology. 2012;79:1397-1405. Abstract

2012年9月23日星期日

基因研究發現乳癌有四類!!

美研究︰乳癌分四種發現基因標記

美國衛院大型研究

〔國際新聞中心／綜合報導〕美國國家衛生研究院領導的大型研究顯示，乳癌其實可根據基因類型不同細分為四種，而且這四種乳癌中，也發現有其他癌症的基因標記，換言之，其他癌症藥物或許也能用於治療乳癌。

歷來對乳癌最廣泛的基因分析

這是歷來針對乳癌最廣泛的基因分析，重新塑造了我們對乳癌的了解，也可望為乳癌療法開啟新道路；但研究團隊表示，目前還需要更廣泛的臨床研究才能證實相關成果，因此可能還要數年時間，此份研究成果才能真正應用在乳癌治療上。

這份研究觀察最常見的、乳腺管引起的乳癌，著重觀察尚未擴散到身體其他部位的初期乳癌，藉此判定可攻擊的基因改變，以在癌細胞轉移前加以阻止。研究辨識出至少四十種藥物可攻擊的基因變異，而其中多數是已有藥物可供治療、其他癌症的基因變異。

研究最驚人的發現，就是找到腫瘤細胞與皮膚以及汗腺基底癌細胞類似的乳癌。這種乳癌罹患率最低，與其他乳癌也截然不同，反而比較像是卵巢癌與一種肺癌。

也就是說，未來這種乳癌或許能以卵巢癌用藥、例如新型的ＰＡＲＰ抑制劑來治療。

第二與第三種乳癌最常見，其表面有蛋白質，會攫取雌激素，加速癌細胞成長。由於此種乳癌產生自乳腺的管細胞，因此稱為管狀Ａ型與管狀Ｂ型乳癌。管狀Ａ型預後佳，管狀Ｂ型則否，因此管狀Ａ型乳癌或許能以荷爾蒙療法，來抑制雌激素刺激癌細胞生長，管狀Ｂ型乳癌則需化療。

第四種癌症稱為HER2陽性乳癌，這類乳癌患者通常擁有兩對HER2基因，一種稱為賀癌平（Herceptin）的藥物可阻止這種基因，並改變病患預後。

這份二十三日刊登於「自然」期刊的研究，是分析八百二十五名乳癌病患的腫瘤後得出的成果。此份研究是大型聯邦計畫癌症基因組地圖（Cancer Genome Atlas）的一部分，同一計畫內針對肺癌與大腸癌的基因分析最近也已公布。

Genetic Study Divides Breast Cancer Into 4 Distinct Types

By GINA KOLATA

NYT 2012-9-23

In findings that are fundamentally reshaping the scientific understanding of breast cancer, researchers have identified four genetically distinct types of the cancer. And within those types, they found hallmark genetic changes that are driving many cancers.

These discoveries are expected to lead to new treatments with drugs already approved for cancers in other parts of the body and new ideas for more precise treatments aimed at genetic aberrations that now have no known treatment.

The study, published online on Sunday in the journal Nature, is the first comprehensive genetic analysis of breast cancer, which kills more than 35,000 women a year in the United States. The new paper, and several smaller recent studies, are electrifying the field.

“This is the road map for how we might cure breast cancer in the future,” said Dr. Matthew Ellis of Washington University, a researcher for the study.

Researchers and patient advocates caution that it will still take years to translate the new insights into transformative new treatments. Even within the four major types of breast cancer, individual tumors appear to be driven by their own sets of genetic changes. A wide variety of drugs will most likely need to be developed to tailor medicines to individual tumors.

“There are a lot of steps that turn basic science into clinically meaningful results,” said Karuna Jaggar, executive director of Breast Cancer Action, an advocacy group. “It is the ‘stay tuned’ story.”

The study is part of a large federal project, the Cancer Genome Atlas, to build maps of genetic changes in common cancers. Reports on similar studies of lung and colon cancer have been published recently. The breast cancer study was based on an analysis of tumors from 825 patients.

“There has never been a breast cancer genomics project on this scale,” said the atlas’s program director, Brad Ozenberger of the National Institutes of Health.

The investigators identified at least 40 genetic alterations that might be attacked by drugs. Many of them are already being developed for other types of cancer that have the same mutations. “We now have a good view of what goes wrong in breast cancer,” said Joe Gray, a genetic expert at Oregon Health & Science University, who was not involved in the study. “We haven’t had that before.”

The study focused on the most common types of breast cancer that are thought to arise in the milk duct. It concentrated on early breast cancers that had not yet spread to other parts of the body in order to find genetic changes that could be attacked, stopping a cancer before it metastasized.

The study’s biggest surprise involved a particularly deadly breast cancer whose tumor cells resemble basal cells of the skin and sweat glands, which are present in the deepest layer of the skin. These breast basal cells form a scaffolding for milk duct cells. Such cancers are often called triple negative but the study researchers call them basal-like.

Basal-like cancers are most frequent in younger women, in African-Americans and in women with breast cancer genes BRCA1 and BRCA2.

And, the researchers report, their genetic derangements make these cancers a much closer kin of ovarian cancers than of other breast cancers. Basal-like breast cancers also resemble squamous cell cancer of the lung.

“It’s incredible,” said Dr. James Ingle of the Mayo Clinic, one of the study’s 348 authors, of the ovarian cancer connection. “It raises the possibility that there may be a common cause.”

The study gives a biologic reason to try routine treatments for ovarian cancer — platinum drugs, for example — in basal-like breast cancer, the investigators said. And a common class of drug used in breast cancer, anthracyclines (adriamycin or epirubicin), might be dropped from the basal-like cancer treatment regimen because they do not increase help in ovarian cancer.

Anthracyclines, Dr. Ellis said, “are the drugs most breast cancer patients dread because they are associated with heart damage and leukemia.”

A new type of drug, PARP inhibitors, that seems to help squelch ovarian cancers, should also be tried in basal-like breast cancer, Dr. Ellis said.

Two other types of breast cancer, accounting for most cases of the disease, arise from the luminal cells that line milk ducts. These cancers have proteins on their surfaces that grab estrogen, fueling their growth. Just about everyone with estrogen-fueled cancer gets the same treatment. Some do well. Others do not.

The genetic analysis divided luminal cancers into two distinct subtypes. The luminal A subtype had good prognoses while luminal B did not, suggesting that perhaps patients with luminal A tumors might do well with just hormonal therapy to block estrogen from spurring their cancers while luminal B patients might do better with chemotherapy in addition to hormonal therapy.

In some cases, genetic aberrations were so strongly associated with one or the other luminal subtype that they appeared to be the actual cause of the cancer, said Dr. Charles Perou of the University of North Carolina, who is the lead author of the study. And he called that “a stunning finding.”

“We are really getting at the roots of these cancers,” he said.

After basal-like cancers, and luminal A and B cancers, the fourth type of breast cancer is what the researchers called HER2-enriched. Breast cancers often have extra copies of a gene, HER2, that drives their growth. A drug, Herceptin, can block the gene and has changed the prognosis for these patients from one of the worst in breast cancer to one of the best.

Yet although Herceptin is approved for every breast cancer patient whose tumor makes too much HER2, the new analysis finds that not all of these tumors are alike. The HER2-enriched should respond readily to Herceptin; the other type might not.

The only way to know is to do a clinical trial, and one is already being planned. Herceptin is expensive and can occasionally damage the heart. “We absolutely only want to give it to patients who can benefit,” Dr. Perou said.

For now, despite the tantalizing possibilities, patients will have to wait for clinical trials to see whether drugs that block the genetic aberrations can stop the cancers. And it could be a massive undertaking to get all the drug testing done. Because there are so many different ways a breast cancer cell can go awry, there may have to be dozens of drug studies, each focusing on a different genetic change.

One of Dr. Ellis’s patients, Elizabeth Stark, 48, has a basal-type breast cancer. She has gone through three rounds of chemotherapy, surgery and radiation over the past four years. Her disease is stable now and Dr. Stark, a biochemist at Pfizer, says she knows it will take time for the explosion of genetic data to produce new treatments that might help her.

“In 10 years it will be different,” she said, adding emphatically, “I know I will be here in 10 years.”

標準的治療C肝藥物將是: peginterferon+ribavirin+protease inhibitors

MEDLINE Abstract

Protease inhibitors for the treatment of chronic hepatitis C genotype-1 infection: the new standard of care.

Lancet Infect Dis. 2012; 12(9):717-28 (ISSN: 1474-4457)

Pearlman BL
Center for Hepatitis C, Atlanta Medical Center, Atlanta, GA, USA; Medical College of Georgia, Augusta, GA, USA; Emory School of Medicine, Atlanta, GA, USA.

For the past decade, the standard treatment for chronic hepatitis C infection has been pegylated-interferon plus ribavirin. With US Food and Drug Administration approval of boceprevir and telaprevir-two protease inhibitors-the standard-of-care treatment for genotype-1 infection, the main genotype worldwide, is now peginterferon plus ribavirin and a protease inhibitor. Rates of sustained virological response or cure with triple combination treatment have improved substantially, both in patients who have had previous treatment and in those who have not. Improvements have been most substantial in populations regarded as difficult to treat, such as individuals with cirrhosis. However, despite improved response rates, protease inhibitors have incremental toxic effects, high costs, increased pill burden, and many drug interactions. Moreover, because new antiviral drugs directly inhibit hepatitis C virus, viral resistance has become an important issue, essentially precluding use of protease inhibitor monotherapy, and potentially restricting future treatment options for patients who consequently do not achieve sustained virological response. Protease inhibitors are the first of many antiviral medications that will probably be combined in future interferon-free regimens.

PreMedline Identifier:22647717

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

Daclatasvir for previously untreated chronic hepatitis C genotype-1 infection: a randomised, parallel-group, double-blind, placebo-controlled, dose-finding, phase 2a trial.

Lancet Infect Dis. 2012; 12(9):671-7 (ISSN: 1474-4457)

Pol S; Ghalib RH; Rustgi VK; Martorell C; Everson GT; Tatum HA; Hézode C; Lim JK; Bronowicki JP; Abrams GA; Bräu N; Morris DW; Thuluvath PJ; Reindollar RW; Yin PD; Diva U; Hindes R; McPhee F; Hernandez D; Wind-Rotolo M; Hughes EA; Schnittman S
Hôpital Cochin, Paris, France.

BACKGROUND: Several direct-acting antivirals for chronic hepatitis C virus (HCV) infection are available, but they are limited by tolerability and dosing schedules. Once-daily daclatasvir, a potent NS5A replication complex inhibitor, was generally well tolerated in phase 1 studies. We assessed daclatasvir in combination with pegylated interferon (peginterferon) and ribavirin for chronic HCV.

METHODS: In this double-blind, parallel-group, dose-finding, phase 2a study, treatment-naive patients with HCV genotype-1 infection (without cirrhosis) from 14 centres in the USA and France were randomly assigned (1:1:1:1) to receive peginterferon alfa-2a (180 μg per week) and ribavirin (1000-1200 mg daily) plus placebo or 3 mg, 10 mg, or 60 mg of daclatasvir taken once daily, for 48 weeks. The primary efficacy endpoint was undetectable HCV RNA at 4 weeks and 12 weeks after start of treatment (extended rapid virological response, eRVR). Analysis was of all participants who received one dose of study drug. We used descriptive analyses to compare results. This study is registered with ClinicalTrials.gov, number NCT00874770.

FINDINGS: 48 patients were randomly assigned (12 per group); all received at least one dose of study drug. 15 patients discontinued treatment before week 48. Five of 12 patients (42%, 80% CI 22-64%) who received 3 mg daclatasvir achieved eRVR, compared with ten of 12 (83%, 61-96%) who received 10 mg daclatasvir, nine of 12 (75%, 53-90%) who received 60 mg daclatasvir, and one of 12 (8%, 1-29%) who received placebo. Adverse events and discontinuations as a result of adverse events occurred with similar frequency across groups.

INTERPRETATION: Daclatasvir seems to be a potent NS5A replication complex inhibitor that increases the antiviral potency of peginterferon and ribavirin. Our findings support the further development of regimens containing 60 mg daclatasvir for the treatment of chronic genotype-1 HCV infection.

FUNDING: Bristol-Myers Squibb.

PreMedline Identifier: 22714001

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

2012年9月22日星期六

Hilarious!!! 笑破肚皮!!!

Subject: FW: Indian student

It was the first day of a school in USA and a new Indian student named
Chandrasekhar Subramanian entered the fourth grade.

The teacher said:
"Let's begin by reviewing some American History. Who said 'Give me
Liberty, or give me Death'?"

She saw a sea of blank faces except for Chandrasekhar who had his hand up:
â€™Patrick Henry, 1775' he said.

'Very good!

Who said 'Government of the People, by the People, for the People,
shall not perish 'from the Earth?''

Again, no response except from Chandrasekhar.
'Abraham Lincoln, 1863' said Chandrasekhar.

The teacher snapped at the class:
'Class, you should be ashamed. Chandrasekhar, who is new to our
country, knows more about our history than you do.'

She heard a loud whisper: 'F*** the Indians,'

'Who said that?' she demanded.

Chandrasekhar put up his hand.
'General Custer, 1862.'

At that point, a student in the back said:
'I'm gonna puke.'

The teacher glares around and asks: 'All right! Now, who said that?'
Again, Chandrasekhar says: 'George Bush to the Japanese Prime Minister, 1991.'

Now furious, another student yells:
'Oh yeah? Suck this!'

Chandrasekhar jumps out of his chair waving his hand and shouts to the teacher:
'Bill Clinton, to Monica Lewinsky, 1997'

Now with almost mob hysteria someone said:
'You little shit. If you say anything more, I'll kill you.'

Chandrasekhar frantically yells at the top of his voice:
'Michael Jackson to the child witnesses testifying against him, 2004.'

The teacher fainted. And as the class gathered around the teacher on the floor,
someone said: 'Oh shit, we're screwed!'

And Chandrasekhar said quietly:
'I think it was Lehmann Brothers, November 4th, 2008'

2012年9月18日星期二

陸客眼中真實的台灣

[寫得真差!]

台灣（真實）

zhangking119 於 2012/7/20 19:34:19 發布在凱迪社區 > 貓眼看人

從台灣回來才短短的一周時間我就好像過了一個世紀這麼長久，居然許多的感觸出現了模糊的現象，看來環境會改變人而不是人改變環境的哲理是多麼的正確。

收回我的思路，回到去台灣旅遊的開端，居然是老婆看到報紙上臺灣旅遊雙飛8天才4千元的廣告，算了算說就去台灣吧。當時我腦袋都轉不過來，台灣給我的印象是落後的街道，農民賣些小吃攤，景色也不如祖國的大好河山，這麼貴的旅行還不如到香港買點打折貨來得實在。但是老婆的個性就是要做就必須做而且不管如何做到，胳膊終究扭不過大腿，憋得我只能從最初的台灣通行證開始辦起，其中的艱辛可以寫一本指導手冊了，最大的困難還在於費用，還沒有踏出家門一步，費用已經超出了旅行社的費用總和還要多得多，真的搞不懂旅行社是怎麼賺錢的。

當然千辛萬苦去台灣有我的目的，我是帶著疑問去的，要解開我多年心中的不解之謎。為什麼台灣這麼“窮”？為什麼台灣人都騎摩托車不買車？為什麼台灣人都帶口罩？為什麼台灣人都討厭大陸客？香港和台灣到底區別在什麼地方？帶著這些疑問在出門之前我專門買了一本《我們台灣這些年》從1949年台灣島所發生的事情，跟隨作者經歷了台灣過去發生的點點滴滴的瑣碎、轟動、熱鬧、美麗島的事情，對台灣島有了一個初步的認識。下麵就伴隨我進入真實台灣吧。

環境

說實話進入台灣的臺北、高雄一定會讓你見過大陸大都市的人失望到極點，可以說基本上都是4層到5層的小樓房，低矮斑駁的馬路和牆面，就算偶爾的大商場也是不高的。但是當你真正融入到這些街頭巷尾的時候你就會發現他的獨特之處：幹淨、精緻、文化、隨和、熱情、真誠的本質。到臺北的第一天晚上12點在臺北的街頭找不到預定的旅店，好不容易看到一個騎著摩托回家的眼鏡男，拿著地圖去問酒店的地址，他不慌不忙給我說得清清楚楚，一點都不擔心花了多少時間，細心的給我解釋要過幾條街是什麼鋪面然後是什麼，非常的熱心，在這12點臺北街頭的晚上，給我感覺溫馨而深刻。至於精緻你會發現小巷子裡會種上各類植物、小草，給人的感覺並不雜亂。店面各有特色，絕對不是千篇一律，好溫馨精緻，看久了適應了感覺的是來自肺腑的舒服，比高樓大廈舒服多了。

謝謝

在台灣從臺北到台中到台南聽到最多的就是謝謝，離開的那天在SOGO關門時有店長站在門口給我鞠躬說謝謝，真的感覺很爽。才到臺北我的行李沒有隨機托運過來需要辦理手續第二天給我送到酒店，本來憋著一肚子的火，要在國內早就吵起來了，但是面對航空公司一聲又一聲的謝謝，謝謝，對不起，你又能發什麼火呢。謝謝已經融入到台灣人的生活，在到處都是謝謝的聲音中你也不得不學會感謝，什麼都不是理所當然的，別人給你服務了你得說謝謝，哪怕是你買的單你花的錢也得說謝謝。坐車到站下車時司機會給你說謝謝，你也得說謝謝。回來已經聽不到謝謝了，我給別人說謝謝，會用吃驚的眼光盯著我，真的環境改變人啊。

摩托

台灣的摩托車上至老太婆、老大媽、下至中學生，包括員警也騎著小排量的摩托車，當路口綠燈響起時摩托車的轟鳴聲響徹大地，頗有些壯觀。起初我是無法理解的，為什麼台灣會有這麼多的摩托車，後來明白了，摩托車是沒有人偷的，摩托車停車是不收費的，摩托車穿街過巷是方便的。總之摩托車是親民的低成本的運輸工具，所以台灣的道路上車輛並不多，公交車的人也很少，隨時都有座位，加上便利的捷運地鐵，交通基本上沒有什麼瓶頸問題。一句話摩托車雖然看起來不環保、不安全、但是降低了生活成本、方便了大家的出行。而且開摩托的台灣人大部分品行還不錯，在去故宮博物院的路上老婆去買小吃，我就站在路口等著，看到老婆回過頭沖著對我說著什麼，我也沒有聽到。至少等了一分鐘的時間，我才明白老婆讓我看後面，結果是一個送貨的摩托車在我背後，我擋住了去路，這個台灣人就這麼小聲的一遍又一遍的重複說著：“請讓一讓，謝謝！” “請讓一讓，謝謝！” “請讓一讓，謝謝！”。。。至少一分鐘，卻不肯按喇叭。真的感覺很好，要是在國內不但喇叭滿天響，弄不好又是一場口水戰了。

誠品書店

說到台灣人說到台灣就不得不說到誠品書店，據說誠品書店代表了台灣的精神。好在我在臺北的酒店旁邊不遠就是誠品書店的一個總店，在晚上11點帶著兒子親自去誠品書店感受一下臺灣人的生活，到了誠品書店發現燈火通明，到處都是席地而坐的讀書的年輕人，有的找了個座位，書桌上是一摞准備夜讀的書籍。出門的結帳櫃檯居然有排成長隊的人結帳買書，這樣的場面別說在夜裡，就是在解放碑書店的白天也沒有見過這麼多人買書啊。誠品書店不僅僅是買書，是在夜裡給大家一個讀書的去處，而且是免費的，沒有管理員出來說這不能做那不能做，任何人都可以在一個角落裡席地而坐，看自己的書看自己的世界。反正從台灣從北到南沒有見到過網吧這個東西，可見台灣人是喜歡學習和進步的。

小吃

台灣人的小吃據說是很有名的，這次去基本上大的夜市都去過了，說實話從開始什麼都想吃到最後不知道吃什麼。首先台灣的食材說實話非常的好，原汁原味，很少放鹽和味精。特別是在墾丁的牧場鮮奶每天必喝，冰水泡過喝起來爽口解暑又營養，爽啊。但是小吃的口味偏甜了，對於吃慣了辣椒的我來說新鮮勁一過，就到處找辣椒，可以沒有啊，最辣的就是豆瓣了：-（

陸客

現在去台灣旅遊的人也越來越多了，台灣人對大陸觀光旅行團的稱呼就是陸客。對于我這個自由行身份的人來說也從另外的角度去看陸客這個概念。首先就是陸客的鬧，高聲說話，目無紀律，自我為尊。到國父紀念館看到陸客穿著短褲岔開一雙大腿，大聲的打著電話—一看就是陸客。面對國軍換崗的時候指指點點，說沒有解放軍的好看等等陸客。面對孫中山的座像說國軍有什麼了不起還不是被打起跑了陸客。在101大廈正准備登上大廈的時候來了幾個旅行團估計有上百人瞬間就把101大廈給圍了個水泄不通，我瞬間一點想上大廈看一看的念頭就沒有了，心裡想要是沒這群陸客多好，多清淨啊。在故宮博物院遊玩累了把鞋脫出來放在凳子上的也是陸客。總之別說台灣人潑煩，我自己看久了也覺得潑煩，陸客除了有錢，買東西大方以外，素質的確有些問題。說到底我也是一個陸客，不知道我在台灣人眼裡我是一個什麼樣的陸客。（下圖台階上的陸客）

大方

我也不知道該如何來說這個詞了，到了臺北忘記了買傳說中的變壓器，手機、相機如何充電？在逛街的路上隨便沖進一家電器商店，問有沒有手機、相機的變壓器，店員問我你的手機是什麼手機呢？IPHONE還是HTC？我說是華為的國內手機，在台灣無法充電。店員忙帶著我走到賣手機的櫃檯拿出一個手機充電器對我說，你回去看看你的手機充電器上面應該是110V～220V的寬電壓輸入，要是這樣的話不需要買什麼變壓器的，如果不是再來買吧。在台灣各式各樣的店裡面，服務基本上就是這樣，不強行推銷，服務態度極好。進商店沒有人把你當小偷看，坐著吹冷氣也沒人管你。甚至買個東西還得主動的找服務員在哪裡，感覺很大方，難道服務員不是銷售找錢嗎？當銷售送上門的時候不騙你不說，還主動做不是他的服務。酒店不需要押金，走的時候把鑰匙往櫃檯一放就可以走了，沒有人來查房的。租個電瓶車、自行車不需要押金，把身份證壓上就可以了。簡直是怪啊怪，甚至匪夷所思。

辛苦的台灣人

如果你以為台灣人都有錢都富有，這就錯了。我在淡水的購物街看到一家5口，3個小孩其中最小的小孩穿的衣服明顯的是哥哥門留下來的，因為是剪刀剪過的背心，還是破的。老大排隊買了一個餅，媽媽說先給哥哥吃，哥哥排的隊最辛苦，哥哥吃了一口，給弟弟吃一口然後再給最小的弟弟吃一口，感覺畫面很溫馨，很有家庭的人情味，就在我的眼前發生。看看爸爸、媽媽也不是太窮的人，普普通通吧。現在國內已經看不到這樣的景象了，我甚至懷疑我這是在台灣嗎，人均GDP 2萬美金的台灣嗎？大熱的天，台灣人守著自己的小吃攤揮汗如雨，還帶著塑膠手套和口罩，揮汗如雨的台灣人也是吃得苦的啊。高雄到臺北的高鐵上一個清潔工，一個服務員，打掃衛生間幹幹淨淨的，來回服務從來沒有多少停息，工作效率也不低啊！看來台灣人也不是懶惰的台灣人啊，並不是效率不高，好吃懶做，經濟才下滑的吧。

口罩

到臺北的第一天早上睡不著興奮早早起來看臺北人上班，發現許多的人都帶著口罩，而且還不是一個兩個，我回到酒店問大堂的小姐為什麼臺北的人都戴著口罩呢？給我的答覆是臺北人如果感冒了怕傳染給別人就帶個口罩出來。有些女孩子臉上長痘痘怕不好看也有帶口罩的。在阿里山回嘉慶的路上一個小女孩戴著漂亮的小口罩特別的可愛，偶爾咳嗽幾聲，感冒了知道自己帶個小口罩，好喜歡的小妹妹。

寫了這麼多，實際上只寫了牛毛這點點感受，許多的東西是無法寫出來的，例如感覺、舒服、溫馨、服務、清爽、乾淨等等是寫不出來，只有自己去自己去用心感受。路上老婆一直笑我說我學高鐵上賣吃的的服務生甜美的台灣聲音說：“只有麵包，沒有便當，哦”。這口純正的台灣音，註定會在我的餘生不斷的回味起來。可愛的台灣音！

最後我不得不說，我帶去台灣的疑問是否找到了答案？我從來不研討做到的結果，而是不斷的研究緣由。為什麼台灣人會不斷的說謝謝？為什麼台灣人不怕你帶走酒店的東西而不收一分錢的押金？為什麼台灣人不亂丟垃圾？為什麼台灣人會有免費的24小時誠品書店？為什麼台灣人明明我擋住了去路，卻不斷的說著請讓一讓的敬語？為什麼見到的每一個服務員都是這麼不功利卻這麼吃苦敬業？太多的疑問我一直都找不到答案，唯一知道的有一個原因就是日本的影響，50年的台灣日據時代，台灣人受到了日本人不小的影響，精緻的、乾淨的街道，修剪精緻的花花草草。下一次旅行我決定去日本看看，看看日本和台灣的區別。

直到我離開的前一天夜裡當逛完了商店回酒店的路上突然我看到了大廈的樓上巨大的廣告牌閃動著廣告，不知道是什麼廣告卻打這這麼幾個字：我們不是窮，我們只是缺錢。一切的一切疑問一掃而光，難道不是這樣嗎，台灣人有付出，有努力，有堅持，生活壓力巨大，一方水土養一方人，這一方人不願意犧牲責任、犧牲環境、犧牲人品、犧牲人性、犧牲信任、犧牲一切人類美好的品質而去迷惘的追求-錢！美國難道不是嗎，有個笑話說美國其實要還清負債很簡單，全美國人取消醫療、取消免費教育、取消免費校車，這點負債又算什麼呢？當然台灣不是美國沒有霸權的美元，也沒有霸權的航空母艦去強勢。但是台灣人卻用自己的高效、低成本的政府、完好的環境保護、對中華優秀品德的堅持，保持著一個小富即安，精緻的小家。在這旅遊的幾天中台灣馬總統的秘書長叫林義士的才貪汙了區區幾千萬台幣，也就是幾百萬人民幣的事情在電視台，天天播，天天放，在國內卻一點消息也沒有，想一想也是，一個秘書長就幾百萬就進了牢房，要在我們這裡估計全國的監獄都不夠啊。

台灣人堅持著自己的堅持、奮鬥著自己的奮鬥、過著自己想要的生活，台灣是台灣人的台灣，是他們奮鬥，是他們選擇，是他們曾經的犧牲，是他們堅持的台灣，他們不是窮，他們缺的只是錢。-但願台灣人在陸客的沖擊下，永遠保持住自己台灣的原汁原味和台灣的堅持！台灣加油！！！

2012年9月15日星期六

魚油之類 omega-3脂肪酸對健康效益不大!!

Meta-Analysis Finds No CV Benefit of Omega-3 Fatty Acids

Michael O’Riordan

September 13, 2012 (Ioannina, Greece) — A new meta-analysis looking at the effects of omega-3 fatty acids in patients at high risk for cardiovascular events has shown that the supplements have no effect on hard clinical outcomes, including all-cause mortality, cardiac death, sudden death, MI, or stroke [1]. There was a trend toward benefit in the prevention of sudden death, but the reduction failed to reach statistical significance, a finding the researchers believe refutes any supposed antiarrhythmic-mediated effect of omega-3 fatty acids.

"The meta-analysis, taking into account the recent and previously published trials, showed that omega-3 fatty acids did not significantly reduce the incidence of cardiovascular events," senior investigator Dr Moses Elisaf (University Hospital of Ioannina, Greece) told heartwire. "However, there was a trend toward benefit in terms of sudden death, about a 13% reduction, and myocardial infarction, about a 10% reduction, but the decrease was not statistically significant. So, we can conclude from this meta-analysis and other recently published trials that the effect of omega-3 fatty-acid supplementation in high-risk patients is rather low. They are without side effects, but without significant efficacy."

The study is published in the September 12, 2012 issue of the Journal of the American Medical Association.

Some clinical guidelines, including those of the European Society of Cardiology (ESC), recommend omega-3 polyunsaturated fats, either through supplements or dietary changes, after MI. Despite the recommendations, there is a large degree of controversy and uncertainty regarding the benefits of omega-3 polyunsaturated fats on the risk of major cardiovascular events. Currently, the US Food and Drug Administration (FDA) has approved high-dose omega-3 fatty acids for the treatment of high triglyceride levels in patients with overt hypertriglyceridemia.

Speaking with heartwire, Elisaf said few trials included in the meta-analysis used the high-dose omega-3 fatty-acid supplements, that being 2 to 4 g per day as approved by the FDA, so more studies are needed to study the benefit of using the high-dose supplements to lower triglyceride levels and prevent cardiovascular events. "We need more data to clearly define the role of omega-3 fatty acids in clinical practice," said Elisaf.

Efficacy of Omega-3 Fatty Acids Across Clinical Outcomes

Outcome	Relative risk (95% CI)
All-cause mortality	0.96 (0.91–1.02)
Cardiac death	0.91 (0.85–0.98)*
Sudden death	0.87 (0.75–1.01)
MI	0.89 (0.76–1.04)
Stroke	1.05 (0.93–1.18)

*Reduction in cardiac death events not significant after corrected for multiple comparisons

The meta-analysis included 20 clinical trials of 68 680 patients. Some of the studies were published as early as 1989, but more than half of the clinical trials were published when statins were routinely recommended for the reducing the risk of cardiovascular disease. The mean omega-3 dose used in the trial was 1.5 g/day, or 0.77 g/day eicosapentaenoic acid (EPA) and 0.60 g/day docosahexaenoic acid (DHA). The median treatment duration was two years, and the maximum was 6.2 years.

Given the negative results, Elisaf said that one of the reasons can be explained by contemporary treatment of patients at high risk for cardiovascular disease. One of the pivotal trials that first suggested omega-3 fatty acids could reduce the risk of cardiovascular disease, GISSI, was undertaken before patients were regularly treated with other cardiovascular medications, including cholesterol-lowering agents. "Today, our high-risk patients take aspirin and statins," he said. "So, we have patients with much lower levels of LDL cholesterol, and the potential benefits of reducing mortality further with other agents, including omega-3 fatty acids, might be marginal."

While many patients might take omega-3 fatty acids over the counter, Elisaf said the present trial included only doses and formulations recommended by FDA and other medical authorities around the world. Low-dose formulations purchased over the counter were not included in the analysis. Elisaf noted that the meta-analysis included clinical trials with varying methodologies and clinical hypotheses, as well as different prevention settings, in order to provide a big-picture assessment of the evidence.

[ CLOSE WINDOW ]

References

Rizos EC, Ntzani EE, Bika E, et al. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events. JAMA 2012; 308: 1024-1033. Abstract

2012年9月14日星期五

紐約時報報導精神科泰斗林宗義教授逝世

September 6, 2010

Tsung-yi Lin, 89, Psychiatrist With Global Approach, Dies

By BENEDICT CAREY

He was a non-Western doctor who helped give a Eurocentric, introspective field of medicine a global presence that it sorely lacked. He all but built the mental health system from the ground up in his native Taiwan, later helping governments in developing nations to do the same.

And he pushed for research that would, for the first time, rigorously document the prevalence of mental disorders worldwide, demonstrating that people from far-flung lands had many emotional struggles in common, whatever their cultural or economic differences.

Dr. Tsung-yi Lin, a psychiatrist who rose to become the director of mental health at the World Health Organization, died on July 20 at 89, his daughter Dr. Elizabeth Lin said, adding that the family had not made the death public until last week.

For decades, Dr. Lin was one of the world’s most persuasive and effective advocates for psychiatry as a centerpiece of public health, on par with infectious diseases and chronic medical conditions.

“It all makes sense today, but in the 1960s and 1970s the whole idea of doing epidemiology in psychiatry was outré, out there; it just didn’t seem logical to people,” said Dr. Arthur Kleinman, a psychiatrist and medical anthropologist at Harvard. Dr. Lin changed that.

“He saw that psychiatry could not develop on a global stage without a presence in public health, and he was one of the early leaders who really framed that presence,” Dr. Kleinman added.

Dr. Lin was not long out of medical training when, in 1953, he published a scientific survey of mental disorders in Taiwan, the first of its kind. Later, at the W.H.O., he began a far more extensive effort, the International Pilot Study of Schizophrenia, an inventory of that mental disorder in developing as well as Western countries.

The study showed striking similarities in the symptoms and prevalence of schizophrenia among many countries, and revealed differences in quality of care. It set a standard for psychiatric epidemiology and led to decades of subsequent research into other disorders, like depression and anxiety, as well as interventions for treatment.

Dr. Lin continued to develop research methods throughout most of his career, at universities in Europe, the United States and finally Canada, at the University of British Columbia.

In Taiwan, where in the 1950s and 1960s he devised and helped establish a modern mental health care system, Dr. Lin was seen as more than a medical figure. His father, a prominent intellectual, was killed in the infamous 2-28 massacre, in which Nationalist Chinese troops fired on native Taiwanese protesters in 1947, setting off a wave of violence that left thousands of Taiwanese dead. In 1998, Dr. Lin edited a book, “An Introduction to the 2-28 Tragedy in Taiwan: For World Citizens,” which in part laid out a blueprint for reconciliation between the native population and the island’s mainland Chinese.

The president of Taiwan at the time of its publication, Lee Teng-hui, “basically implemented the plan that Tsung-yi proposed,” said Richard H. Solomon, president of the United States Institute of Peace. “It was a seminal contribution to a society that was deeply wounded and divided.”

Tsung-yi Lin was born on Sept. 19, 1920, in Tainan, Taiwan. Both his father, Mo-seng Lin, a professor, and his mother, Chai-Hwang Wang, received higher education in Japan, as did their son. He graduated from Tokyo Imperial University School of Medicine, now the University of Tokyo, in 1943, and his postgraduate training included stints in the 1950s at Harvard Medical School and later at the Maudsley Institute of Psychiatry in London.

He was director of mental health at the W.H.O. from 1964 to 1969, then moved to the University of Michigan, where he stayed through 1973 before joining the faculty at the University of British Columbia, retiring from his full-time position in 1985. He served as president of the World Federation for Mental Health from 1974 to 1979.

Dr. Lin was the author, co-author or editor of a number of influential books, including “Mental Health Planning for One Billion People: A Chinese Perspective,” with Leon Eisenberg, and “Normal and Abnormal Behavior in Chinese Culture,” with Dr. Kleinman. He founded the psychiatry department at National Taiwan University in Taipei and trained many of its leading graduates.

Dr. Lin is survived by his wife, Mei-chen Lin; five children, Dr. Siong-chi Lin, Lillian Lin Miao, Dr. Elizabeth Lin, Joy Lin Salzberg and Dr. David Lin; 11 grandchildren; and one great-grandson.

The killing of his father was a defining event in Dr. Lin’s life, those who knew him said. But it was not politics or conflict that animated his later work.

“He was not insensitive” to looking at cultural differences in psychiatry, Dr. Kleinman said. “But he was asking a bigger question: What is similar in mental illness around the world? What is it that we all have in common?”

This article has been revised to reflect the following correction:

Correction: September 8, 2010

An obituary on Tuesday about the psychiatrist Tsung-yi Lin, a former director of mental health at the World Health Organization, referred incorrectly to Dr. Lin’s age at the time his father was killed in 1947. He was 26; he was not a teenager. The obituary also misstated the given name of the president of the United States Institute of Peace, who commented on the effect of Dr. Lin’s work in Taiwan. He is Richard H. Solomon, not Robert.

2012年9月4日星期二

多運動、多交友、不抽菸、有休閒活動，可以延長性命

From Medscape Medical News

Healthy Lifestyle May Improve Longevity Even Into Old Age

Laurie Barclay, MD

September 4, 2012 — A healthy lifestyle may improve longevity even into old age, according to a population-based cohort study published online August 30 in the British Medical Journal.

"Lifestyle, social networks, and leisure activities have been studied individually in relation to longevity in several studies and others have examined the possible association of these factors with longevity while taking into account their coexistence and interactions," Debora Rizzuto, a PhD student from the Aging Research Center, Department of Neurobiology, Health Care Sciences and Society at Karolinska Institutet and Stockholm University in Sweden, and colleagues write. "Only a few studies, however, have examined the relation between the combinations of various modifiable factors and longevity. Among the previous studies that have included the oldest old population (≥85 years), only four had an observational period longer than 10 years."

The purpose of this study was to examine modifiable characteristics associated with longevity among adults at least 75 years of age, using a prospective cohort of 1810 such adults enrolled in the Kungsholmen Project in Stockholm. During the 18-year follow-up, the investigators studied median age at death, based on vital status records from 1987 through 2005.

Most of the participants (1661; 91.8%) died during follow-up. Life span exceeded 90 years in half of the participants. Age at death was 1.0 year younger in the current smokers than in nonsmokers (95% confidence interval [CI], 0.0 - 1.9 years). However, survival in former smokers was similar to that of never-smokers, suggesting that smoking cessation in middle age could lessen the effect of smoking on mortality.

Physical activity, such as regular swimming, walking, or gymnastics, was the leisure activity most strongly linked to longevity. Those participants who regularly engaged in these activities had a median age at death 2.0 years older (95% CI, 0.7 - 3.3 years) than participants who did not.

The investigators defined a low-risk profile as healthy lifestyle behaviors, taking part in 1 or more leisure activity, and having a rich or moderate social network. They defined a high-risk profile as unhealthy lifestyle behaviors, no leisure activities, and a limited or poor social network. Compared with participants who had a high-risk profile, those who had a low-risk profile had an increase in median survival of 5.4 years.

A subgroup analysis of the oldest old (aged at least 85 years) and of participants with chronic conditions showed that those with a low-risk profile had a median age at death that was 4 years greater than those with a high-risk profile.

Other factors associated with increased survival were female sex and higher educational level.

"Even after age 75 lifestyle behaviours such as not smoking and physical activity are associated with longer survival," the study authors write. "A low risk profile can add five years to women's lives and six years to men's. These associations, although attenuated, were also present among the oldest old (≥85 years) and in people with chronic conditions."

Limitations of this study include survival selection, information bias regarding alcohol intake, assessment of exposures only at baseline, and failure to examine dietary quality or overall quality of life.

"Our results suggest that encouraging favourable lifestyle behaviours even at advanced ages may enhance life expectancy, probably by reducing morbidity," the authors conclude.

The Swedish Council for Working Life and Social Research, Swedish Research Council for Medicine, Swedish Brain Power, Karolinska Institutet's Faculty funding for postgraduate students, and Stiftelsen Ragnhild och Einar Lundstr¨ms Minne funded this study. The study authors have disclosed no relevant financial relationships.

BMJ. Published online August 30, 2012. Full text

2012年9月3日星期一

新發現的tick-born virus infection

New
Tick-Borne Disease Found

Daniel
J. DeNoon

August
29, 2012 — A new virus, dubbed "Heartland virus," is being spread to
people by ticks common in the Southeast, the CDC reports.

The
only known cases are two northwestern Missouri men who fell ill in 2009. Ticks
had bitten both men, but they did not get better after treatment with
antibiotics. Tests later showed that the men did not have any tick-borne
bacterial diseases.

But
CDC researcher Laura K. McMullan, PhD, and colleagues did find something else:
a previously unknown virus in the patients' blood.

"This
virus could be a more common cause of human illness than is currently
recognized," they suggest in the New England Journal of Medicine.

The
two men, one age 57 and the other age 67, lived on different farms. The first
had only a single tick bite. The second said that over a two-week period he'd
received some 20 tick bites a day.

Both
men had fever, fatigue, diarrhea, and low levels of blood platelets and
white blood cells. The symptoms are similar to those of ehrlichiosis, a
relatively common tick-borne disease that is caused by bacteria.

The
first patient spent 10 days in the hospital. Two years later, he's still
feeling tired and often has headaches. At first he had memory problems and loss
of appetite, both of which slowly got better.

The
second patient was in the hospital for 12 days. Over the next four to six weeks
he had memory problems, fatigue, and loss of appetite. All of these symptoms
went away and did not come back over the next two years.

Questions
Remain

The
new virus is related to a tick-borne virus recently discovered in central and
northeastern China. That virus, called SFTSV, causes fever and loss of blood
platelets.

The
most common ticks in northwestern Missouri, where the two men were infected
with Heartland virus, are lone star ticks. These ticks
are found throughout the Southeast and up the Atlantic coast to Maine.

No
ticks carrying Heartland virus have been found. It's not clear whether a person
infected with the new virus can spread it to another person, or whether a tick
bite is necessary.

"Although
these two patients had severe disease, the incidence of infection with the
novel virus and range of disease severity are currently unknown," McMullan
and colleagues write.

They
warn health professionals to be on the lookout for people who fall ill after
getting tick bites and who do not get better after antibiotic treatment.

SOURCE:

McMullan,
L.K. The New England Journal of Medicine, Aug. 30, 2012.

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2012年9月28日 星期五