用fMRI 證明益生菌會影響腦部活動、情緒!!!

Probiotics Affect Brain Activity

Megan Brooks

May 30, 2013
A new study provides the first evidence in humans that probiotics in the diet can modulate brain activity.

長途飛行途中的緊急醫療

Physicians Should Prepare for In-Flight Medical Emergencies

Jenni Laidman

May 30, 2013
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.

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.

Hepatitis C treatment

Hepatitis C treatment

Approach Considerations

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.

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

Ricki Lewis, PhD

沙烏地阿拉伯出現SARS似的病毒性院內感染!

SARS-Like Virus Spreads From Patient to Nurse: WHO

May 16, 2013
By Kate Kelland

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 Andrea Gerlin - May 20, 2013

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。

精神科診斷標準出了新版

Psychiatry’s revamped DSM guidebook fuels debate

By Lena H. Sun, Published: May 16

吃回扣102億元???

[這才是正牌的KMT貪汙!   難怪林益世被輕判，貪得還不夠啦!  繼續讓KMT執政吧!! ] 拉艦弊案/郭力恆判15年 追繳102億回扣

醫師應該如何處理臨終病患--新的指引

End-of-Life Care Guidelines Updated

Laurie Barclay, MD

May 13, 2013

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,

如何偵查出偽造美鈔

Eight Ways to Spot Counterfeit Money

By Samuel Weigley | 24/7 Wall St – 3 hours ago

 

Yahoo! 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
SecretService.govThe portraits on counterfeit money can sometimes look different from the portraits on real bills. On a real bill, the portrait tends to stand out from the background. However, on a counterfeit bill, the portrait’s coloring tends to blend too much with the rest of the bill. In addition, the portrait tends to look “lifeless and flat” on counterfeit bills, according to the Secret Service. Both DeSantis and Lowery pointed out that this difference is due to the different printing processes between real and counterfeit money. They noted that real currency uses printing methods that cannot be replicated by anyone else.

2. Federal Reserve and Treasury Seals
SecretService.govA real dollar bill will have Federal Reserve and Treasury Seals that are “clear, distinct and sharp,” according to the Secret Service. The agency points out that the seals on a counterfeit bill “may have uneven, blunt, or broken saw-tooth points.” One way to detect a counterfeit is by looking at the coloring. If the color of the Treasury Seal does not match the color of the serial number, the bill is fake.

3. The Border
SecretService.govThe outside border on real paper currency are “clear and unbroken,” according to the Secret Service. However, the agency notes the edges on a counterfeit bill can be “blurred and indistinct.” Because of the difference in printing methods between genuine and counterfeit bills, the border ink can sometimes bleed on a phony. However, he added this was n0t among the most common way to detect counterfeit.

4. Serial Numbers
SecretService.govLooking at the serial numbers is another way to detect counterfeit money. The Secret Service points out that the serial numbers on a note must be the same color as the Treasury Seal. The agency also notes that the numbers on counterfeit bills “may not be uniformly spaced or aligned,” although Kersten believes these counterfeit identifying marks are rare. One sure way, however, to spot counterfeit bills is if several bills have the same serial number. “Face it, if you are running off thousands of those things, you aren’t going to bother changing the serial numbers,” he said.

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5. The Paper
SecretService.govReal bills have tiny red and blue fibers embedded in the paper, and counterfeiters have tried to replicate those. Ink marks can be printed onto the paper to look like hairs, Kersten said. He also noted that people have used cat or human hair that is dyed red or blue to embed into the bill. At close inspection, however, it is clear that the hairs are on the surface of the fake bill and not embedded into the paper. “But most people don’t even look for the hairs anymore because you have to look really closely,” Kersten said. “That is why the government put bigger things to look for in [the bills].”

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

Lisa Nainggolan

May 01, 2013

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