“蚱蜢的生命”
有人在我的部落格留言:
許醫師你好、雅虎要終止部落格了....以後我要去哪裡找你啊! ”
我回答:
我回答:
我現在也找不到很多老友，也看不到我的雙親。
2013年10月10日 星期四
2013年8月29日 星期四
老人記憶喪失有可能恢復
[因為發現如何在實驗室內研究記憶，而得到 2000年諾貝爾獎的
Eric Kandel 又一重要的發現， “不像
Alzheimer's 病人腦內記憶細胞喪失，一般老人記憶細胞並沒消失，因此可能用蛋白質 PbAp48恢復老人的記憶力”。Kandel 現在 84歲，他的傳記在筆者的 “微生物學史”(合記出版社)，長達一頁。他如何發現在實驗室內用鼻涕蟲Aplysia研究記憶，很有趣、很有趣!!]
Eric Kandel 又一重要的發現， “不像
Alzheimer's 病人腦內記憶細胞喪失，一般老人記憶細胞並沒消失，因此可能用蛋白質 PbAp48恢復老人的記憶力”。Kandel 現在 84歲，他的傳記在筆者的 “微生物學史”(合記出版社)，長達一頁。他如何發現在實驗室內用鼻涕蟲Aplysia研究記憶，很有趣、很有趣!!]
2013年8月27日 星期二
2013年8月15日 星期四
Hepatitis C Virus Therapy Update 2013
Curr Opin Gastroenterol. 2013;29(3):243-249.
Abstract and Introduction
Abstract
2013年8月12日 星期一
治療 HIV 感染的新藥，Tivicay (dolutegravir)--integrase inhibitor
U.S. FDA approves GlaxoSmithKline's HIV drug Tivicay
2013年8月8日 星期四
2013年8月4日 星期日
2013年8月1日 星期四
美國眾議院外交委員會無異議一致通過Taiwan Policy Act 台灣政策法案
Formosan Association for Public Affairs
552 7th Street. SE. Washington, DC 20003, USA
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2013年7月30日 星期二
《白樂崎專欄》一個「偉大的國家」？
| 《白樂崎專欄》一個「偉大的國家」？
◎白樂崎
美國總統歐巴馬最近與中國國家主席習近平在加州陽光莊園會面時，習近平強調，中國尋求與美國建立「大國關係的新模式（新型大國關係）」。 |
2013年7月29日 星期一
2013年7月27日 星期六
台灣人公共事務會呼籲台美雙方加速進行美軍售台柴電潛艇軍售案
Formosan Association for Public Affairs
552 7th Street. SE. Washington, DC 20003, USA
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2013年7月26日 星期五
2013年7月23日 星期二
由壁蝨叮咬傳染的新病毒(Heartland Virus)感染症
Heartland Virus Is Carried by Ticks
By Tia Ghose, Staff Writer 3 hours ago
A Lone Star Tick.
2013年7月18日 星期四
新發現巨大的病毒--是否第四類生物?
[還不清楚是否和疾病有關]
Changing View on Viruses: Not So Small After All
Chantal Abergel and Jean-Michel Claverie
Electron microscopy image of a Pandoravirus particle. The virus is 1,000 times bigger than the flu virus and has nearly 200 times as many genes.
2013年7月17日 星期三
2013年7月12日 星期五
台灣還有恙蟲病患死亡!!!
[在台灣，筆者看過好幾個發燒、治療幾天後，燒還不退，而要我這感染專科醫師會診的病例
[我的經歷，簡略地說: 台大畢業，第一年住院醫師後，到美國東岸接受內科學訓練及淋巴球研究七年，之後，到芝加哥西北大學醫學院感染科就職十八年，發表過有關淋巴球免疫學的論文、有關養老院病患MRSA流行的論文、教過如何適當地使用抗生素，然後返台服務十八年，兼任衛生署感染控制諮詢委員、感染控制雜誌主編、醫院評鑑委員，到退休為止]。
[我的經歷，簡略地說: 台大畢業，第一年住院醫師後，到美國東岸接受內科學訓練及淋巴球研究七年，之後，到芝加哥西北大學醫學院感染科就職十八年，發表過有關淋巴球免疫學的論文、有關養老院病患MRSA流行的論文、教過如何適當地使用抗生素，然後返台服務十八年，兼任衛生署感染控制諮詢委員、感染控制雜誌主編、醫院評鑑委員，到退休為止]。
益生菌對憂鬱及焦慮有治療效果?!?!
Are Probiotics the New Prozac?
Probiotics, the healthy bacteria in yogurt and certain fermented foods, may be mind-altering microbes that could be used to help treat depression and anxiety, according to cutting-edge new research.
Probiotics, the healthy bacteria in yogurt and certain fermented foods, may be mind-altering microbes that could be used to help treat depression and anxiety, according to cutting-edge new research.
2013年7月9日 星期二
Hepatitis D virus簡介，D肝病毒
D Is for Delta: A Primer on Hepatitis D Virus
The Identification of Hepatitis D Virus
2013年7月1日 星期一
2013 Hsu family's Disney Fantasy cruise--part 4 of 4
[ Continued from : 2013 Hsu family's Disney Fantasy cruise--part 3 of 4 ]
On 6/21, the ship turned back near Miami, the Castaway Cay, the private island of The Disney. The beach was great, but the sun was hot, and I did not have interest getting wet there. I suppose my weekly swimming made me less attracted to water playing. This plate is mom's. Mine had lox in every breakfast.
2013 Hsu family's Disney Fantasy cruise--part 3 of 4
[ Continued from : 2013 Hsu family's Disney Fantasy cruise--part 2 of 4 ]
On 6/19, the ship was at the port of St. Joseph. Rainy day, saw Kyle Knight and Mistie magic show, Hanh's birthday.
2013 Hsu family's Disney Fantasy cruise--part 2 of 4
[ Continued from : 2013 Hsu family's Disney Fantasy cruise--part 1 of 4 ]
The second day at sea, 6/17, was photo opportunities with Disney Princesses for girls, pirate night, teenagers' fantasy show, and supper at the Royal Court Restaurant.
2013年6月30日 星期日
2013 Hsu family's Disney Fantasy cruise--part 1 of 4
From June 15 to June 22 of 2013, Hsu family had another reunion cruise. This time on the Disney Fatasy Line! We have planned this severl months ahead of time, Hanh started making reservations through the Costco Travel. Because of 6 children, and 5-6 months ahead of time, we even made the travel insurance. In case one of us got sick and cannot go, we can get the refund.
2013年6月28日 星期五
十三年間三千萬接受疫苗者的分析結果:疫苗和Guillain-Barre syndrome無關!!
Vaccines Not Linked to Guillain-Barré, Asserts 13-Year Trial
2013年6月26日 星期三
2013 Hsu family's Disney Fantasy cruise--part 2 of 4
今年五月一日，yahoo news 出現一篇文章，由醫學記者報導WHO警告中國最近出現H7N9新禽流感，不僅症狀嚴重，致命率也很高。
"微生物學史--開天闢地的醫學拓荒者" 修訂版的推薦書評
筆者2013年一月出版的 "微生物學史--開天闢地的醫學拓荒者" (微生物學史介紹 http://tw.myblog.yahoo.com/ccshsu-clement/article?mid=10110&prev=10767&next=10078)，已經有修訂版。這一版比初版，除了有些錯誤的修改，還多了三位學者的傳記，以及十位朋友的簡短推薦序文及書評，印在書背或是內封的背面，如下。希望這些書評會讓要評估這本書的人，比較容易看出書的好處。這本書不是一般的教科書，而是有很多歐美歷史故事的傳記集、短篇小說集。相信讀者不會失望。
2013年6月24日 星期一
又新出來 MERS-CoV (Middle East Respiratory Syndrome Coronavirus)
MERS-CoV Hospital Outbreak Causes Significant Morbidity
Person-to-person transmission of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) can occur in healthcare settings and cause significant morbidity, according to a case series report published online June 19 in the New England Journal of Medicine.
2013年6月13日 星期四
包含 telaprevir and boceprevir 的 2013年 C 肝最新治療法
Hepatitis C Virus Therapy Update 2013
Curr Opin Gastroenterol. 2013;29(3):243-249.
2013年6月8日 星期六
Influenza 流行性感冒 教材 -2
[上接: Influenza 流行性感冒 教材-1 ]
History
The presentation of influenza virus infection varies; however, it usually includes many of the symptoms described below. Patients with influenza who have preexisting immunity or who have received vaccine may have milder symptoms.
Influenza 流行性感冒 教材-1
[取自: http://emedicine.medscape.com/article/219557-overview]
Practice Essentials
The US Centers for Disease Control and Prevention (CDC) estimates that seasonal influenza is responsible for an average of more than 20,000 deaths annually. Mortality is highest in infants and the elderly. According to the CDC, the 2012-2013 season was notable for widespread disease and a higher mortality than was recorded in previous years. In addition, the predominant subtype was an H3N2, in contrast to dominance by H1N1 subtypes in recent past years.[1]
2013年6月1日 星期六
預防 ICU 內的 MRSA 感染，Universal Decolonization最有效!
MRSA: Universal Decolonization Beats Screening and Isolation
Washing every patient in intensive care units (ICUs) daily with chlorhexidine-impregnated cloths reduced positive cultures of methicillin-resistant Staphylococcus aureus (MRSA) by 37% and reduced bloodstream infection by any pathogen by 44%, according to a study published online May 29 in the New England Journal of Medicine.
2013年5月31日 星期五
用fMRI 證明益生菌會影響腦部活動、情緒!!!
Probiotics Affect Brain Activity
A new study provides the first evidence in humans that probiotics in the diet can modulate brain activity.
2013年5月30日 星期四
長途飛行途中的緊急醫療
Physicians Should Prepare for In-Flight Medical Emergencies
In-flight medical emergencies occur on 1 in every 604 flights worldwide. Airline passengers who are healthcare professionals should be prepared to respond, advise the authors of a study published in the May 30 issue of in the New England Journal of Medicine.
2013年5月25日 星期六
皮膚發癢的機序
Mystery of why we itch revealed by scientists
By Eric Pfeiffer, Yahoo! News | The Sideshow – 17 hrs ago
A squirrel scratches itself (Wikicommons)Scientists had an itch they just needed to scratch: solving the ages-old mystery as to why, exactly, we scratch ourselves.
2013年5月22日 星期三
Hepatitis C--practice essentials
Practice Essentials
Hepatitis C is
an infection caused by the hepatitis C virus (HCV) that attacks the liver and
leads to inflammation. The World Health Organization (WHO) estimates that about
3% of the world’s population has been infected with HCV and that there are more
than 170 million chronic carriers who are at risk of developing liver cirrhosis
and/or liver cancer.
an infection caused by the hepatitis C virus (HCV) that attacks the liver and
leads to inflammation. The World Health Organization (WHO) estimates that about
3% of the world’s population has been infected with HCV and that there are more
than 170 million chronic carriers who are at risk of developing liver cirrhosis
and/or liver cancer.
2013年5月21日 星期二
利用新的DNA hybridization，在兩三小時內診斷出細菌感染--將來的方向
Bacterial Infections Diagnosed in Hours With New DNA Test
2013年5月20日 星期一
B6, B12,以及葉酸(folic acid) 就可延緩失智症的發生?!!!
Vitamins That Cost Pennies a Day Seen Delaying Dementia
By - May 20, 2013
2013年5月17日 星期五
終於不得不自己承認!
吐痰塗鴉闖紅燈…中國坦承陸客素質低 副總理汪洋點名四大不文明行為 〔編譯林翠儀／綜合報導〕中國出國旅遊人數年年增加，「陸客」的惡形惡狀在全球各地遭到非議，連中國高官都看不下去，中國國務院副總理汪洋十六日點出中國遊客隨地吐痰等「四大不文明行為」，主張立法嚴禁。無獨有偶，日本產經新聞也在日前報導中國人令人不敢恭維的「公德心」事例。 |
2013年5月14日 星期二
醫師應該如何處理臨終病患--新的指引
End-of-Life Care Guidelines Updated
The Hastings Center has updated and expanded its landmark 1987 consensus guidelines for ethical care of terminally ill patients. Oxford University Press published this second edition of The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life.
"As the population ages, more people are living with chronic diseases," Hastings Center President and guidelines working group member Mildred Z. Solomon, EdD, said in a news release. "Advances in medicine have created both benefits and burdens, including problems of quality, safety, access, and cost. We need to help patients and families better navigate their choices, and physicians and healthcare leaders must build systems of care that are wiser and more compassionate."
The guidelines target all healthcare professionals involved in caring for terminally ill patients. They discuss ethical and legal options in the United States for use of life-sustaining technologies, offer comprehensive guidance on informing patients and surrogates of their options, and include detailed strategies to optimize healthcare delivery.
Issues in end-of-life care include confusion and conflict over decision-making, poor patient–clinician communication, insufficient pain and symptom relief, and use of treatments offering minimal benefit. Consequences of poor care include reduced quality of life, greater family stress, and increased costs of healthcare without added value
A physician's offer or a family's request to "do everything" may neither respect the patient's rights nor ensure good care. Recognizing religious, cultural, psychological, and social factors affecting medical decision-making can help clinicians provide appropriate, respectful care, according to the guidelines.
"The guidelines offer a reliable framework for these discussions, and for education, policy-making, and redesign of care," lead author Nancy Berlinger, PhD, a research scholar at the Hastings Center, said in the news release. "They also encourage healthcare leaders and administrators to support better outcomes for patients by building more effective forms of care delivery and integrating care near the end of life into organizational safety and improvement initiatives."
Changes from the 1987 Guidelines
Recommendations based on the past 25 years of "empirical research, clinical innovation, legal and policy developments, and evolution of professional consensus";
discussion of decision-making for and about children near the end of life;
issues specific to patients with disabilities, including the effect of their perspectives on physcian–patient communication and management decisions;
recent evidence regarding brain injuries and neurological states, how they affect prognosis, and laypersons' misperceptions and unrealistic expectations due to media influences;
information regarding physician-assisted suicide and how it differs from treatment refusal;
discussion of controversy regarding palliative sedation;
acknowledgement that cost is an ethical issue in healthcare decision-making;
request that hospitals and healthcare organizations develop transparent policies on cost management to avoid bedside rationing; and
integration of "the insights of ethics and law, medicine and other healthcare professions; the experience of patients and family caregivers; and patient advocacy."
The 1987 edition of the guidelines set the ethical and legal framework for US medical decision-making and was cited in the Supreme Court's 1990 Cruzan decision. This established patients' constitutional right to refuse life-sustaining medical treatments and affirmed that surrogates could make decisions for patients lacking that capacity.
In the news release, Kathleen M. Foley, MD, chair of the Society of Memorial Sloan-Kettering Cancer Center, refers to the new guidelines as "the sourcebook for how the ethics of life-sustaining treatment and care at the end of life should be taught, institutionalized, and translated into clinical teaching and practice."
A distribution from the Albert Sussman Charitable Remainder Annuity Trust and a major grant from the Patrick and Catherine Weldon Donaghue Medical Research Foundation funded the project to produce the Hastings Center Guidelines. Donors to the Anika Papanek Memorial Fund at the Hastings Center and unrestricted donations provided additional support.
Medscape Medical News © 2013 WebMD,
2013年5月1日 星期三
如何偵查出偽造美鈔
Eight Ways to Spot Counterfeit Money
By Samuel Weigley | 24/7 Wall St – 3 hours agoYahoo! Finance/AP Photo/ Lee Jin-man - A U.S. bank note claimed to be counterfeited by North Korea, left and a real U.S. dollar bill, right. (AP Photo/ Lee Jin-man)
<img width=1 height=1 alt="""" src="http://us.bc.yahoo.com/b?P=T5Tl.QrHg2.wsU1WUXdqkgA_a9WhAlGBj3AADYGS&T=1f7lad9hs%2fX%3d1367445361%2fE%3d1183311978%2fR%3dfin-glob%2fK%3d5%2fV%3d2.1%2fW%3dH%2fY%3dYAHOO%2fF%3d1160286087%2fH%3dX2lkPSI2YzVkY2YwNi0yNjRiLTM1N2YtODNjMi1lODdmMWZiMmZjMDYiIGNhbl9zdXBwcmVzc191Z2M9IjEiIGNvbnRlbnQ9ImZpbmFuY2UiIHJlZnVybD0icmVmdXJsX3d3d195YWhvb19jb20iIHJzPSJsbXNpZDphMDc3MDAwMDAwSE9ES2hBQVAiIHNlcnZlSWQ9IlQ1VGwuUXJIZzIud3NVMVdVWGRxa2dBX2E5V2hBbEdCajNBQURZR1MiIHNpdGVJZD0iNDQ1MTA1MSIgdFN0bXA9IjEzNjc0NDUzNjA5OTk2OTAiIHRvcGljPSJwZi1TYXZpbmcgLSBCYW5raW5nIiA-%2fQ%3d-1%2fS%3d1%2fJ%3d68EF8B62&U=12bvavln0%2fN%3d8cHvOmKL5Us-%2fC%3d-1%2fD%3dREC%2fB%3d-1%2fV%3d0">
The new U.S. $100 bill is set to debut in October. Along with a sleeker, more high-tech look, the new bill has new security features designed to thwart counterfeiters. For instance, the new $100 has color-shifting ink that would be difficult for counterfeiters to duplicate. The Liberty Bell on the note will shift from copper to green when the bill is tilted.
These changes to the bill are part of an ongoing effort to help distinguish real from fake currency. “It is a constantly evolving process of putting more and more features on the bill to allow the common citizen to detect counterfeit,” said Ed Lowery, a special agent with the Secret Service.
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Most of the counterfeit notes that change hands are computer-generated, which are easily distinguishable from real bills. “The process utilized to manufacture genuine notes is so detailed that there are very few systems out there that can match that level of detail in the printing,” Lowery said. People who hold both a real bill and a counterfeit bill in their hands should be able to notice a difference in texture between the two notes. From there, they can go on to look at other factors that would separate the two bills, such as the watermark or serial number.
Making a counterfeit note has never been easier since technology is so readily available for counterfeiters to print fake money at home. However, these notes are usually of low quality and should be unable to pass muster with an informed merchant. Nevertheless, “most people don’t realize that they have counterfeit [money] until they try to make a deposit at the bank or [with] a merchant,” said Joe DeSantis, an assistant special agent with the Secret Service.
Bars and nightclubs are easy places to exchange counterfeit money since they are not well lit, said Jason Kersten, an expert on counterfeiting and the author of “The Art of Making Money: The Story of a Master Counterfeiter.” In order to combat this problem, many of these establishments are looking at notes with ultraviolet lights, which can help to detect phony bills.
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Stopping counterfeits can often be as easy as knowing what to look for. To find out the features one should look for when trying to detect bad notes, 24/7 Wall St. talked to DeSantis, Lowery and Kersten, in addition to using information from the U.S. Secret Service’s “Know Your Money” campaign.
These are eight ways to spot counterfeit money. Note: In the images below, the genuine bill is on the left.
1. Portrait
2. Federal Reserve and Treasury Seals
3. The Border
4. Serial Numbers
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5. The Paper
6. Starch
At many grocery and convenience stores, clerks will use an iodine-based counterfeiting pen. The pen reacts to the starch in the paper. If the bill is real, the ink turns yellow. But if the bill is counterfeit, it will turn a dark blue or black. “Most counterfeiters don’t bother to use starch-free paper. They just use paper that simulates the color, thickness and look of real currency,” Kersten said. “But if your counterfeiter is good, they will use starch-free paper.”
7. The Feel
The feel is probably the most common way that people detect counterfeit, Kersten said. Real currency has a “raised texture” to it because of the type of press used to produce the bills. Counterfeit bills feel flat because they are often made digitally or on an offset press. People who handle a lot of cash “can just notice that something doesn’t feel right,” Kersten said. From there, other factors can be used to determine whether a bill is counterfeit.
8. The Watermark
The watermark is the shadow of the portrait that appears when you hold the bill up to light. “That is one of the easiest ways for the common citizen to identify counterfeit versus genuine,” DeSantis said. Periodically, there are people who attempt to recreate the watermark, he added, but it tends to be of very poor quality. The people who do try to imitate the watermark use bleaching, Kersten said. People at stores usually only care that there is a watermark within the bill, he noted, but the watermark portrait must actually match the printed portrait to be genuine.
安全的血中維他命D濃度
Safe Upper Limit of Vitamin D Identified for First Time
A new study examining more than a million individuals aged older than 45 years has, for the first time, verified an upper, safe limit for vitamin D in terms of mortality and cardiovascular events. The researchers also confirm the increased risk of death from suboptimal levels of the vitamin, corroborating the findings of many previous trials.
"In our large comprehensive database, we have determined the safe range of calcidiol blood levels and suggested a threshold for excess vitamin D, beyond which [our study participants] are at increased risk for…all-cause mortality and/or cardiovascular events. We defined a safe range of serum calcidiol of 20 to 36 ng/mL, and we found a U-shape association of the risk for [mortality or acute coronary syndrome] MACS and serum calcidiol," write Yosef Dror, PhD, from the Hebrew University of Jerusalem, Rehovot, Israel, and colleagues in their paper published online in the Journal of Clinical Endocrinology & Metabolism.
Dr. Dror told Medscape Medical News, "There is a crucial need to monitor serum calcidiol for the majority of the population."
"The amount of supplementation needs to be tailored specifically to individuals based on the range their vitamin-D blood level falls into," he and his colleagues assert. For example, in subjects with serum calcidiol levels of 20 ng/mL, supplementation of 30 µg (1200 IU) per day might suffice to attain serum calcidiol of 32 ng/mL, "while those whose blood level is 30 ng/mL may require only 5 µg (200 IU) per day, which would raise their serum calcidiol to a level of 32 ng/mL, which is still in the safe range."
The issue of whether to measure vitamin D and/or supplement it at the population level is a subject of intense interest and was debated most recently at the 2013 European Congress of Endocrinology.
Three Percent of Study Population Exceeded "Safe" Limit of Vitamin D
Dr. Dror and colleagues performed a large population-based historical prospective cohort study comprising more than 1,200,000 members of Clalit Health Services (CHS), an Israeli health maintenance organization, using electronic health records to identify CHS members who were tested for vitamin D between 2007 and 2011.
The risk of MACS was examined by vitamin-D levels, adjusted for a wide range of potential confounders.
During the 54-month study period, 422,822 CHS members were tested for calcidiol, of whom 12,280 died of any cause (905 with acute coronary syndrome) and 3933 were diagnosed with acute coronary syndrome.
Compared with those with levels of 20 to 36 ng/mL, the adjusted hazard ratios among those with levels of less than 10, 10 to 20, and greater than 36 ng/mL were 1.88, 1.25, and 1.13 (P < .05), respectively.
To Medscape Medical News, Dr. Dror noted that 3% of the studied population were at a significant risk because of high calcidiol levels (> 36 ng/L). The small size of this sample size limits the ability to perform any further analysis of this group, however, he and his colleagues note.
In contrast, "62% of our population was at significant risk for heart attack and death because of low serum calcidiol (<20 ng/mL)," he said, adding, "This…has been shown formerly by many studies."
Evidence "Not Convincing"
But in a letter published online in response to the paper by Dr. Dror et al, William B. Grant, MD, from the Sunlight, Nutrition and Health Research Center, San Francisco, California, and colleagues say this new work "is not convincing."
"Those with high serum 25(OH)D levels at the time of enrollment in the studies were most likely supplemented with vitamin D, possibly due to diagnosis of a vitamin-D-deficiency disease. Thus, their health could be undermined by years of vitamin-D deficiency, which vitamin-D supplementation late in life may not correct," they observe.
However, Dr. Dror and his team reply: "We started our study in mid-2007, due to the fact that prior to this date very few vitamin-D blood tests were taken in our [health maintenance organization]. We gathered the very first blood tests of each subject/patient during this study period, thus making it highly unlikely that these levels were influenced by supplementation.
"A substantial percentage of our patients had low or very low levels of this vitamin, and only a very small percentage exceeded the safe upper limit that we defined," they add. "Assuming that only those high-level cases were supplemented would therefore be quite improbable."
Reason for U-Shaped Curve Not Clear
"Our findings also corroborated the expected association between typical risk factors (and potential confounders), such as age, gender, ischemic heart disease history, hypertension, serum cholesterol, diabetes, smoking, and body mass index, and the risk of MACS," say the Israeli researchers. While each risk factor bears an independent risk by itself, "none of them obscured the U-shape correlation effect of serum calcidiol on MACS," they observe.
"The reason for a U-shape correlation between calcidiol blood concentration and all-cause mortality and cardiovascular morbidity that we found in our study is unclear," they add. "Vitamin D regulates the activity of more than 3000 different genes and there are at least 5 or more distinct forms of this vitamin in the circulation.
"The main activity of vitamin D is attributed to the absorption of calcium. This may explain our observation that high concentrations of this vitamin accelerate coronary calcification, an assumption that was also suggested by multiple other studies."
However, "it appears that calcitriol intervenes in more than 100 different biological functions, and at present, we do not have sound biological evidence regarding the mode of operation of vitamin D and in particular the deleterious effect of high concentrations," they conclude.
The authors have reported no relevant financial relationships. Dr. Grant receives funding from Bio-Tech Pharmacal and the Sunlight Research Forum and has received funding from the UV Foundation, the Vitamin D Council, and the Vitamin D Society.
J Clin Endocrinol Metab. Published online March 26, 2013. Abstract
Medscape Medical News © 2013 WebMD
2013年4月30日 星期二
精神科診斷標準出了新版
中國發佈的死亡率，毫不可靠! (一定要參看自由時報這篇報導: http://tw.myblog.yahoo.com/ccshsu-clement/article?mid=10766&prev=10769&next=10764&l=a&fid=83) 我將下列comment寄到ProMED digest (ISID發行的免費報導世界各地動植物傳染病狀況的，很有用newsletter) 負責人，但其主編回信寫了一大堆不相干的話，似乎是說我寄錯人了。我又再看到Medscape Daily Medical Newletter [http://www.medscape.com/viewarticle/804596?nlid=31385_1661&src=wnl_edit_dail&uac=131220CK] 報導同樣文章之後，再寫一篇回應如下。
*******************************
My understanding is that in China, they only test those
who developed pneumonia for the presence of H7N9 infection. And
those tested positive are counted as the infected, and used as the denominator
to figure out the "mortality rate". Those who are infected but
asymptomatic, or have minor symptoms were not even tested for the H7N9. So the denominator will be erroneously low in
number, and the mortality rate is erroneously "very high". No wonder 97.3% of those patients in this
report had findings consistent with pneumonia on chest radiography.
This
is not a matter of whether H7N9 infection has high mortality or not. The issue is how mortality rate of an infection
should be calculated.
Shouldn't
the mortality rate of H7N9 infection derived by the number of those who died
from H7N9 infection (the numerator), divided by the number of people who were
infected regardless of whether they developed pneumonia or not (the
denominator) ?
This
highly irregular, if not irresponsible, way of "enumerating the mortality
rate of H7N9 infection" was reported by two Taiwan epidemiologists who
were officially sent to visit Shanghai Health Bureau and two Infectious Disease
Hospitals for 4 days to understand the status of H7N9 infection the first-hand
in early part of April, this year. Their
report was on the first page of the Liberty Times, with their photo, after
their return to Taiwan.
Please
check it out with the health officials in charge in China. Some basic concepts
need to be clarified with them. I have
known from other sources that the medical management in China is still some
distance behind the US standard.
If
what those epidemiologists found after visiting Chinese health officials was
correct, I do have a question. Why these
Taiwanese epidemiologists voice was not heard? Whether Taiwan is a member country of WHO or
not, this is a matter that involves epidemics that know no boundary.
*******************************
WHO Says New Bird Strain Is 'One of Most Lethal' Flu Viruses
(Reuters) - A new bird flu strain that has killed 22 people in China is "one of the most lethal" of its kind and transmits more easily to humans than another strain that has killed hundreds since 2003, a World Health Organization (WHO) expert said on Wednesday.
The H7N9 flu has infected 108 people in China since it was first detected in March, according to the Geneva-based WHO.
Although it is not clear exactly how people are being infected, experts say they see no evidence so far of the most worrisome scenario - sustained transmission between people.
An international team of scientists led by the WHO and the Chinese government conducted a five-day investigation in China, but said they were no closer to determining whether the virus might become transmissible between people.
"The situation remains complex and difficult and evolving," said Keiji Fukuda, the WHO's assistant director-general for health security.
"When we look at influenza viruses, this is an unusually dangerous virus for humans," he said at a briefing.
Another bird flu strain - H5N1 - has killed 30 of the 45 people it infected in China between 2003 and 2013, and although the H7N9 strain in the current outbreak has a lower fatality rate to date, Fukuda said: "This is definitely one of the most lethal influenza viruses that we've seen so far."
Scientists who have analyzed genetic sequence data from samples from three H7N9 victims say the strain is a so-called "triple reassortant" virus with a mixture of genes from three other flu strains found in birds in Asia.
Recent pandemic viruses, including the H1N1 "swine flu" of 2009/2010, have been mixtures of mammal and bird flu - hybrids that are more likely to be milder because mammalian flu tends to make people less severely ill than bird flu.
Pure bird flu strains, such as the new H7N9 strain and the H5N1 flu, which has killed about 371 of 622 the people it has infected since 2003, are generally more deadly for people.
UNSETTLING
The team of experts, who began their investigation in China last week, said one problem in tracking H7N9 is the absence of visible illness in poultry.
Fukuda stressed that the team is still at the beginning of its investigation, and said that "we may just be seeing the most serious infections" at this point.
Based on the evidence, "this virus is more easily transmissible from poultry to humans than H5N1", he said.
Besides the initial cases of H7N9 in and around Shanghai, others have been detected in Beijing and five provinces. On Wednesday, Taiwan's Health Department said a businessman had contracted H7N9 while travelling in China and was in a serious condition in hospital.
Samples from chickens, ducks and pigeons from poultry markets have tested positive for H7N9, but those from migratory birds have not, suggesting that "the likely source of infection is poultry", said Nancy Cox, director of the influenza division at the U.S. Centers for Disease Control and Prevention.
John Oxford, a flu virologist at Queen Mary University of London, said the emergence of human H7N9 infections - a completely new strain in people - was "very, very unsettling".
"This virus seems to have been quietly spreading in chickens without anyone knowing about it," he told Reuters in London.
Flu experts say it is likely that more cases of human infection with H7N9 flu will emerge in the coming weeks and months, at least until the source of infection has been completely confirmed and effectively controlled.
Anne Kelso, the Melbourne-based director of the WHO Collaborating Centre for Reference and Research on Influenza said there has been a "dramatic slowdown of cases" in the commercial capital of Shanghai, which has recorded most of the deaths, something she described as "encouraging".
After Shanghai closed down its live poultry markets in early April, there was an almost immediate decline in new H7N9 cases, she said. "The evidence suggests that the closing of the live poultry markets was an effective way to reduce the risks."
Even so, the WHO's China representative, Michael O'Leary, issued figures last week showing that half of the patients analyzed had no known contact with poultry.
(Editing by Louise Ireland)
******************
H7N9 Influenza: Most Patients Critically Ill
Most of the 82 patients studied who developed H7N9 became critically ill and were epidemiologically unrelated, according to an analysis of data obtained from field investigations of cases that occurred in China before April 17, 2013. Human-to-human transmission between close contacts has not been confirmed but could not be ruled out in 2 families in an analysis by a group of researchers from China and the Centers for Disease Control and Prevention.
Qun Li, MD, from the Public Health Emergency Center in China, and colleagues present their findings in an article published online April 24 in the New England Journal of Medicine.
The researchers defined a confirmed case as one verified by H7N9 virus presence by positive real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR), viral isolation, or serologic testing. Close contacts were observed for 7 days. The investigators obtained throat swabs from symptomatic contacts and tested for the H7N9 virus by real-time RT-PCR.
Among the 82 confirmed cases, the median age was 63 years (range, 2 - 89 years): 38 cases (46%) occurred in patients aged 65 years or older and 2 (2%) in children younger than 5 years. Both children had clinically mild upper respiratory illness. Two suspected cases were also found.
Of the confirmed cases, 73% were male, and 84% were urban residents. Of the 71 patients with available data, 54 (76%) had underlying medical conditions. Cases were reported in 6 areas of China.
Eighty-one patients with confirmed disease (99%) were hospitalized and 17 (21%) confirmed cases, and a single suspected case died of acute respiratory distress syndrome or multiorgan failure. A total of 60 confirmed cases and 1 suspected case remained critically ill as of April 17; 4 patients were discharged from the hospital, and 1 child was never hospitalized.
Animal Exposure
Animal exposure data were available for 77 of the confirmed cases. Of these patients, 59 (77%) had recent animal exposure: 45 (76%) to chickens, 12 (20%) to ducks, and 4 (7%) to swine. The individuals had either worked at or visited a live animal market. These patients also reported exposure to pigeons, geese, quail, wild birds, pet birds, cats, and dogs. History of animal exposure was unclear for the remaining 5 patients, in whom investigations were still ongoing.
The researchers estimated the median incubation period was 6 days in 23 patients for whom detailed data were available.
Of the 1689 close contacts, 1251 completed the 7-day monitoring period. A few (19; 1.5%) developed respiratory symptoms, but they all tested negative for the H7N9 virus.
There were 2 family clusters in which human-to-human transmission could not be ruled out. In one, a brother and his father were in prolonged, close contact with the index case. The father and brother cared for the index case and ate meals together. The index case had contact with live poultry, but the father and brother did not.
In the other family, a father had suspected illness and his daughter had prolonged, close, unprotected contact with him. She was later confirmed to have H7N9 illness. The father had contact with live poultry, but the daughter had no contact with poultry or pigs.
The investigators had data regarding oseltamivir administration for 64 patients, of whom 41 (64%) received oseltamivir starting a median of 6 days after illness onset.
"Although the risk of human-to-human transmission of H7N9 virus appears to be low, the actual risk is currently unknown, and the Chinese national guidelines recommend implementing control measures, such as prompt isolation of the patient, active monitoring of close contacts, and implementation of standard, contact, and droplet precautions by health care personnel in hospitals," the authors write.
"In addition, national guidelines recommend that antiviral treatment with oseltamivir should be administered as soon as possible in patients with suspected or confirmed cases of H7N9 virus infection," they conclude.
The China–US Collaborative Program on Emerging and Re-emerging Infectious Diseases provided financial support to a number of individuals and institutions for travel and accommodation fees for fieldwork, attendance at an investigator meeting, equipment, and fees for manuscript preparation. Two researchers reported employment at Jiangsu Provincial Center for Disease Control and Prevention. Two researchers received consulting fees from and 2 researchers reported employment by the China–US Collaborative Program on Emerging and Re-emerging Infectious Diseases. Two researchers reported receiving fees for travel to major meetings for the past 3 years.
N Engl J Med. Published online April 24, 2013.
**************************
Confirmed: New H7N9 Bird Flu Comes From Chickens
By Kate Kelland
LONDON (Reuters) Apr 25 - Chinese scientists have confirmed for the first time that a new strain of bird flu that has killed 23 people in China has been transmitted to humans from chickens.
In a study published online today in the Lancet, the scientists echoed previous statements from the World Health Organization (WHO) and Chinese officials that there is as yet no evidence of human-to-human transmission of this virus.
The H7N9 strain has infected 109 people in China since it was first detected in March. The WHO warned on Wednesday that this strain is "one of the most lethal" flu viruses and is transmitted more easily than the H5N1 strain of bird flu, which has killed hundreds around the world since 2003.
Kwok-Yung Yuen of the University of Hong Kong, who led the study, said its findings that chickens in poultry markets were a source of human infections meant that controlling the disease in these places and in these birds should be a priority.
"Aggressive intervention to block further animal-to-person transmission in live poultry markets, as has previously been done in Hong Kong, should be considered," he said.
He added that temporary closure of live bird markets and comprehensive programs of surveillance, culling, biosecurity and segregation of different poultry species may also be needed "to halt evolution of the virus into a pandemic agent."
"The evidence ... suggests it is a pure poultry-to-human transmission and that controlling (infections in people) will therefore depend on controlling the epidemic in poultry," he said.
Yuen's findings do not mean all cases of human H7N9 infection come from chickens, or from poultry, but they do confirm chickens as one source.
The WHO has said 40% of people infected with H7N9 appear to have had no contact with poultry.
Other types of birds or mammals may be acting as so called "reservoirs" of the flu virus and investigators in China are working hard to try to find out.
CASE STUDIES
Yuen's team conducted detailed case studies on four H7N9 flu patients from Zhejiang, an eastern coastal province south of the commercial hub Shanghai.
All four patients had been exposed to poultry, either through their work or through visiting poultry markets.
To find out whether there was transmission of the virus from poultry to humans, the researchers took swabs from 20 chickens, four quails, five pigeons and 57 ducks, all from six markets likely to have been visited by the patients.
Two of the five pigeons and four of the 20 chickens tested positive for H7N9, but none of the ducks or quails.
After analyzing the genetic makeup of H7N9 virus in a sample isolated from one patient and comparing it to a sample from one of the chickens, the researchers said similarities suggest the virus is being transmitted directly to humans from poultry.
The team also checked more than 300 people who had had close contact with the four patients and found that none showed any symptoms of H7N9 infection within 14 days from the beginning of surveillance. This suggests the virus is not currently able to transmit between people, they said.
But they noted that previous genetic analysis shows H7N9 has already acquired some gene mutations that adapt it specifically to being more able to infect mammals - raising the risk that it could one day spread more easily between people.
"Further adaptation of the virus could lead to infections with less severe symptoms and more efficient person-to-person transmission," the scientists wrote.
Lancet 2013.
2013年4月26日 星期五
Boston Marathon Bombers and inescapable(?) human nature
When we see those Boston
Marathon Bombers, we start to wonder how could there be such a deviation in human minds
and behaviours. Those young men who committed the evil act (2 bombs resulting in 3 dead, near 200 injured, and about 10 amputations) had loving and
caring parents. They are not from broken families with psychological problems
during their childhood. They are the product of human hatreds out of religious
fanaticism.
I kept wondering what is the
religious fanaticism, the definition. Most of us are part of a religion. People
who believe in their own form of "god", may feel that they believe in
"true god", and most may feel that theirs is superior to other
"gods". And here comes the difference. Most will keep the feeling to
themselves, because the religion is to heal one's own soul. There should not be
any comparisons with others. Why should you care? However, some will be more
vocal: loud chanting, persuasion of others that "you have been mistaken",
"repent and believe in our god", start calling others infidels,
pagan, or scoff with disdain, perhaps out of some feeling of inferiority deep
inside their own minds. And, the religious extremism is the kind that put the
religious superiority into action and devote their lives to these actions,
hurting the other's soul or body.
Christian crudades in the past
continues into Islamic Jihad's terrorism in recent decades, the latter
probably mixed with some feelings out of jealousy of the Western prosperity, I
believe. Religious persecution has been going on for centuries in history.
Development of medicine has been hampered for more than 13-15 centuries because
of it. And behind all those religious superiority, there is the human ambition.
All religious leaders are humans and have the human instinct "to be better
than others", obviously or insidiously, consciously or unconsciously. As
long as we are human, we cannot escape from this "survival of the
fittest" instinct that came with the creation of the individualized life form.
However, there is still hope. We
have seen the amazing, heart-warming social advance during our lives. We saw
flagrant racial and sexual discrimination, and the discrimanation of the
physically handicapped, before 1960's, gradually disappear. The sympathy for the poor
and those stricken by natural disasters has been put into active
assistance by many organizations around the world. Though equality is not
universal yet, but it will be, sooner than we think because of the advance in
communicaiton technologies.
My classmate, dentist Johanna, has been working as a missionary in the underdeveloped part of Northen China for decades, soon after the passing of her husband, our classmate Francis. She is one of the best models of unending human endeavor to do good for fellow human beings! Hope for the future!
While we feel happy to be in the most advanced society in the world, we should help to eliminate this inequality in the world, bigotry of religion, as much as we can and as soon as possible.
To talk of models, here are the
Korean models competing to be a Miss Korea. Look at their pictures. You would
think they are from identical twins. Just cannot tell who is who. Though I feel
regret that they have lost their individuality, I can understand those ladies's
wish to have facial reconstrustion, which is so advanced in Korea. Which young
women do not want to look beautiful?
That is also a human nature.
2013年4月25日 星期四
美國眾議院亞太事務小組委員會無異議通過「台灣政策法」
Formosan Association for Public Affairs 552 7th Street. SE. Washington, DC 20003, USA | |
For Immediate Release Washington D C - April 25th 2013 Contact: (202) 547-3686 FAPA Applauds Unanimous Passage of Taiwan Policy Act (TPA) in House Subcommittee (Washington, D.C. – April 25th 2013) -- Today the Subcommittee on Asia and the Pacific of the United States House of Representatives unanimously passed HR419, aka the Taiwan Policy Act (TPA). The TPA was introduced on January 25, 2013 by Rep. Ileana Ros-Lehtinen (R-FL) and co-chairs of the Congressional Taiwan Caucus Reps. Mario Diaz-Balart (R-FL), Gerald Connolly (D-VA), John Carter (R-TX) and Albio Sires (D-NJ) "to strengthen and clarify the commercial, cultural, and other relations between the people of the United States and the people of Taiwan." It is a comprehensive bill that addresses over a dozen different aspects of the U.S.-Taiwan relationship, and updates the 1979 Taiwan Relations Act (TRA) to reflect the new realities in this U.S.-Taiwan relationship. The TPA builds on the TRA (which has functioned effectively as the cornerstone of US-Taiwan relations over the past three decades). It does not amend or supersede the TRA. The TPA had been introduced during the previous 112th Congress, was passed by the House Foreign Affairs Committee but did not make it to the floor by the time Congress adjourned for the year in the fall of 2012. During the April 25 markup hearing, the following 8 Representatives attended the hearing: Steve Chabot (R-OH), Eni Faleomavaega (D-SA), Ileana Ros Lehtinen (R-FL), Mo Brooks (R-AL), Dana Rohrabacher (R-CA), Doug Collins (R-GA), Scott Perry (R-PA), Ami Bera (D-CA). Chairman Chabot stated: "This bill strengthens the relations of our two nations. And I want to emphasize "Two Nations" for Taiwan is a democracy, an old friend and ally, and it deserves to be treated as such by the U.S. government." Rep. Faleomavaega said: "Reason why we pass this Act, is that we want to achieve that the leaders of Taiwan can continue to practice their democracy." Rep. Rohrabacher emphasized that Taiwan is a free and independent country. Rep. Perry: "I believe we should break through the barrier of conventional wisdom in our relations with Taiwan and work towards the normalization of relations." Rep. Ros-Lehtinen concluded: "Taiwan continues to be such an essential alley to the United States. This bill reiterates our support, and tells the Taiwanese people just how deeply we value that friendship." FAPA President Mark Kao, Ph.D. says: "This bill is one of the most significant pieces of legislation to address U.S.-Taiwan relations over the past decade and, if passed, will greatly bolster Taiwan's ability to preserve its freedom of action in the international community." Dr. Kao concluded: "Next, the bill has to pass the House Foreign Affairs Committee, then the floor of the House to be followed by introduction in the Senate where the bill has to follow a similar path. We at FAPA will mobilize all our members all over the United States on the grassroots level to help ensure that this critically important bill becomes law at the earliest opportunity."
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台灣人公共事務會讚許美國眾議院亞太事務小組委員會無異議通過「台灣政策法」 美國眾議院亞太事務小組委員會於4月25日無異議通過編號H.R.419的「台灣政策法」（Taiwan Policy Act, TPA）。 台灣政策法於1月25日由佛州共和黨眾議員羅斯雷提能（Ileana Ros-Lehtinen）及眾院台灣連線四位共同主席：佛州共和黨議員迪亞茲巴拉特（Mario Diaz-Balart）、維州民主黨議員康納利（Gerald Connolly）、德州共和黨議員卡特（John Carter），以及紐澤西州民主黨議員席瑞斯（Albio Sires），共同提出。 該法案包括台美關係中十幾項不同的議題，並更新1979年的「台灣關係法」（Taiwan Relations Act, TRA），使其更能反映台美關係的真實現況。台灣政策法是建基於過去三十年來台美關係的重要基石─台灣關係法─上，但並未修改，也不會凌駕於其上。 「台灣政策法」曾在第一百一十二屆美國國會中被提出，並通過外交事務委員會審查，但截至該屆國會於2012年秋天散會之前，該項法案並未送交眾院表決。 俄亥俄州共和黨議員夏波（Steve Chabot）、美屬薩摩亞民主黨代表法里歐馬維加（Eni Faleomavaega）、羅斯雷提能議員（Ileana Ros-Lehtinen）、阿拉巴馬州共和黨議員布魯克斯（Mo Brooks）、加州共和黨議員羅拉巴克（Dana Rohrabacher）、喬治亞州共和黨議員柯林斯（Doug Collins），以及賓州共和黨議員裴瑞（Scott Perry）等八位眾議員出席4月25日的審議聽證會。 小組委員會主席夏波議員說道：「此法案將強化我等兩國的關係，而在此我要特別強調『兩國』，因為台灣是一個民主國家及一個長期的美國盟友，而它也應該受到美國政府如是的對待。」法里歐馬維加代表說：「我們通過這項法案的原因，是因為我們要讓台灣可以持續保有其民主。」羅拉巴克議員強調台灣是一個民主自由之邦，而裴瑞議員則說：「我認為我們需要突破現有台美關係的框架，進而將台美關係正常化。」羅斯雷提能議員總結道：「台灣是美國重要的友邦，通過這項法案代表著我們的支持，也向台灣人重申我們是多麼重視台美友誼。」 台灣人公共事務會會長高龍榮博士表示：「這個法案是過去十年中，關於台美關係最重要的一件法案。若此法案通過，將更加保障台灣在國際社會的自由空間。」 高博士總結道：「法案通過小組委員會後，必須通過外交事務委員會，接著由眾議院投票表決，才能送交參議院，並在參院中再經過相似的程序。台灣人公共事務會將會動員全美的會員，發揮草根力量，確保這項重要的法案盡速通過立法。」 * * * * * * * * * * * * 113th CONGRESS SECTION 1. SHORT TITLE. SEC. 2. FINDINGS. SEC. 3. RULE OF CONSTRUCTION. TITLE I--POLITICAL RELATIONS SEC. 101. RELATIONS WITH THE PEOPLE OF TAIWAN. SEC. 102. VISITS BY CABINET LEVEL OFFICIALS. SEC. 103. REVISION OF GUIDELINES FOR CONTACTS WITH TAIWAN. SEC. 104. REQUIREMENT FOR SENATE CONFIRMATION OF AN INDIVIDUAL SEC. 105. EXTRADITION AGREEMENT. SEC. 106. CONTINUATION OF THE SIX ASSURANCES AS GUIDELINES IN SEC. 107. INTERNATIONAL ORGANIZATIONS. SEC. 108. REPORT ON TAIWAN'S PARTICIPATION IN ICAO. TITLE II--SECURITY RELATIONS SEC. 202. ADVANCED COMBAT AIRCRAFT FOR TAIWAN. SEC. 203. CONSULTATIONS ON TAIWAN ARMS SALES. SEC. 204. ANNUAL REPORT ON DEFENSE TRANSFERS TO TAIWAN. SEC. 205. REPORT ON IMPLEMENTATION OF TAIWAN RELATIONS ACT. SEC. 206. NAVAL VESSEL TRANSFER AUTHORITY. TITLE III--ECONOMIC AND TRADE RELATIONS |
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