控制咳嗽的機制不單純: 安慰藥有減少45%咳嗽的效果!

                    Trip to Sacramento, May-June, 2012

Yui-Li and I decided to visit my second son Ben’s family in Sacramento, and look at the new member, Cassidy, who will be 3 months old by then. We would be staying there from 5/24 till 6/3. I have always enjoyed traveling, while Yui-Li does not, partly because of her work.

This will be another “photo travelogue”. Photographs and the dates printed on it should tell most of the stories.

 

 

This photo of Cassidy was taken on June 5.

 

These two photos were taken before we visited, probably when Cassidy was around 2 months old.

 

Sooo peaceful!

You can understand my very satisfied look, can't you?

Carly would rather practice gymnastics than martial art

We went to Nordstrum inside a shopping mall.

Very gifted painter Kinkade just passed away 1.5 months ago.  His paintings are very captivating.

 

One thing I learned from the shop keeper there is that, now there is a new technique to reproduce oil painting exactly in identical way, and can even make it larger or smaller!! The reproduction can be done only once, but they can make 500 copies of paintings like the one above. I saw two copies of the same painting in the shop, a larger one was about $7500 and a smaller one was about $1100. The original one is said to be worth hundreds of thousands. He could not give me the spelling of the French term of this technique, "jou caise??". I am still looking into the google.

 

Whole family walking to the nearby park.

Obviously the influence of Jeremy Lin!!

Phoen, a sister of Hanh.

 

[Continued to Part-2: http://tw.myblog.yahoo.com/ccshsu-clement/article?mid=9588&prev=9623&next=9532]

 

美國國會議員對台灣民主、自由的關心

Washington D C - June 7th 2012 Contact: (202) 547-3686 US Representative calls for establishment of Congressional Taiwan Commission WASHINGTON (June 7th 2012)-- On June 6, United States Congressman Robert Andrews (D-NJ) introduced HR 5902 legislation in the U.S. House of Representatives to establish a "Congressional Advisory Commission on the Implementation of United States Policy under the Taiwan Relations Act." (See: attachment) The bill calls for the appointment of a five-member commission to be named by the President and leaders of the House and Senate, for the purpose of producing an official report, within one year of convening its first meeting, on the implementation of the 1979 Taiwan Relations Act (TRA) by the U.S. government since 2000. Hewing closely to the language of the TRA, the legislation outlines the areas for review by the Commission, including: - The sufficiency of defense articles made available to Taiwan by the United States - Current and potential threats to the security, social, or economic system of the people on Taiwan, and the extent to which the United States retains the capability to resist any resort to force…that would jeopardize the above - Measures taken by the U.S. government toward the preservation and enhancement of the human rights of the people of Taiwan - Policy options for the United States to advance toward a normalization of the relationship with Taiwan The concept of a Congressional Taiwan commission follows from the testimony of Mr. Randall Schriver, President and Chief Executive Officer of the Project 2049 Institute, before the House Foreign Affairs Committee on June 16, 2011 in a hearing titled "Why Taiwan Matters." On that occasion Schriver highlighted the tendency of successive U.S. administrations to relegate relations with Taiwan to a "sub-issue in U.S.-China bilateral ties." Schriver added: "Objective analysis is important because it remains the legal obligation of this administration to make weapons for self-defense available to our democratic friend Taiwan." FAPA President Mark Kao, Ph.D. says: "The Taiwan Relations Act today stands as a model of legislative leadership in the history of U.S. foreign policy, yet Congress has yet to undertake a comprehensive review of TRA's implementation in the 33 years since its initial passage." Dr. Kao continues: "There is increasing concern about whether the United States government is faithfully executing its obligations under the TRA, which after all is the Law of the Land. The establishment of an objective advisory commission, whose sole purpose is to examine the actual implementation of all of the provisions of the TRA, will contribute greatly to addressing this gap."

眾議員呼籲成立眾議院台灣委員會 [2012年6月7日華府訊] 美國國會安德魯斯眾議員(Robert Andrews, D-NJ)於6月6日星期三，提出H.R 5902法案，於眾議院成立「國會監督委員會」，將在台灣關係法之下，審核美國政策執行效能(詳附件)。 該法案提議由總統、眾議院及參議院的領袖任命委員會的5位成員，並於首次會議後一年內，提出一份針對美國政府自2000年以來對台灣關係法執行效益的官方報告。 該提案與台灣關係法相呼應，提出委員會應審核的範圍: - 美國提供台灣足夠的國防軍備 - 台灣人民在安全、社會及經濟制度上目前及潛在的威脅，及評估美國對上述威脅及武力行動的儲備力 - 美國政府協助維持並加強台灣人權的措施 - 提供美國與台灣關係邁向正常化的政策選項 國會台灣委員會的概念，來自2049計劃協會總裁薛瑞福在2011年6月16日於眾議院外交委員會聽證會「台灣為何重要?」上，所作出的證言。薛瑞福強調，美國政府似乎有把與台灣的關係降級定調為「美中雙邊關係之附屬議題」的傾向。 他補充:「客觀的分析是非常重要的，因為歐巴馬政府仍有法律義務，提供我們的民主盟友台灣防禦性武器。」 台灣人公共事務會會長高龍榮表示:「台灣關係法雖為美國外交政策歷史上，立法機構扮演領導角色的模範，但該法通過33年以來，國會卻從未全面性地檢視台灣關係法執行效益。」 他並指出:「越來越多的人憂心美國政府是否忠實地執行台灣關係法所條列的義務。畢竟，這條法規是為國家大法。此客觀的監督性委員會設立的唯一目的，即為檢驗所有台灣關係法法條是否確實執行，以大大地弭平這樣的疑慮。」 * * * * * * * * * * * * *

Treatment of Chen is a national disgrace

in Taipei Times

By Frank Murkowski /

Thu, Jun 07, 2012 - Page 8

As a former governor of Alaska (2002 to 2006) and also having served for 22 years in the US Senate, I have a strong interest in US relations with East Asia. Within that context, Taiwan is a place close to my heart, because I personally got to know the two men who pushed Taiwan in the direction of democracy, former presidents Lee Teng-hui (李登輝) and Chen Shui-bian (陳水扁).

Since that time, Taiwan has gone through some more cycles of change of government, which is an inherent part of a democratic system.

Indeed, in January, I headed the observer mission of the International Committee for Fair Elections in Taiwan (ICFET), an international group of 19 academics from eight countries.

Our report on our findings is scheduled to come out in the next few weeks and I can already say that our conclusion is that the elections were mostly free, but only partly fair. You can read more details when the report comes out.

However, my comments here are not about the elections, but about the overall direction of the country.

It is undoubtedly clear that Taiwan lives in the shadow of an aggressive neighbor, but it should not allow that to determine its future as a free and democratic nation.

Taiwanese have worked long and hard for their democracy, and they need to continue to work hard to preserve and nurture their freedom and liberty. This work needs to be done internally, when they assess the functioning of the system of checks and balances — the legislature needs to be a stronghold of democracy where people with vision look after the longer-term interests of their constituents.

Freedom and liberty also need to be nurtured in the judicial system.

Many observers say that the judiciary is still strongly influenced by the politics of the ruling party and that there is a strong need for judicial reform. The legal community needs to champion the democratic process in Taiwan.

This brings me to a very specific issue of injustice — the way Chen is being treated. I am not discussing whether he was or was not guilty — although a number of international observers, such as Jerome Cohen, question whether he received a fair trial.

I am specifically focusing on his need for adequate medical treatment and the conditions under which he is being detained.

Most recently, on May 23, Chen was allowed to go to Cheng Kung Memorial Hospital for only six hours. Doctors said that they would need much more time to treat him adequately and that the six-hour time span had been a “political condition” imposed by the authorities.

The right thing to do would be for the authorities to release him on medical parole.

The second aspect is the conditions under which he is being detained — a small cell, with no bed, chair or desk.

If he wants to write, he has to lie down on the floor. Such treatment is unconscionable and reminiscent of the Soviet Union more than 45 years ago, not Taiwan in 2012.

The least that needs to be done is to give him an adequate cell, with a chair, desk and regular bed. Like other prisoners, he should be allowed to work outside his cell in the daytime, engaging in some physical activity. Finally, he should have full access to his lawyer and comprehensive medical care.

Dealing with controversial issues like this is not easy, but a fair and humanitarian resolution is essential if Taiwan wants to be considered a full democracy, worthy of international respect.

Frank Murkowski is a former governor of Alaska and a US senator

1980-2012年間被發現的最重要的新細菌

 

Authors and Disclosures

Author

John G. Bartlett, MD

Professor of Medicine, Johns Hopkins University School of Medicine; Faculty Member, Division of Infectious Diseases, The Johns Hopkins Hospital, Baltimore, Maryland Disclosure: John G. Bartlett, MD, has disclosed no relevant financial relationships.

From Medscape Infectious Diseases

The Medscape Awards in Infectious Diseases: Bacterium

1980-2012

John G. Bartlett, MD

Posted: 06/01/2012

The Medscape Awards in Infectious Diseases is a new series that will honor the greatest achievements in the field of infectious diseases during 1980-2012. John G. Bartlett, MD, Professor of Medicine, Johns Hopkins University School of Medicine, identified 8 key categories for these infectious disease awards. Within each category are several candidates for the honor of "greatest achievement." Readers will be asked to select the candidate that they believe is most worthy of this title, and then Dr. Bartlett will reveal his personal choice and the reasons for that choice. Obviously, the process will have an element of subjectivity, and opinions will differ. The goal is to credit great achievements, learn from those achievements, and pass these lessons down to succeeding generations.

This series will include the major discoveries or achievements since 1980 in the following categories:

1. Bacterium
2. Virus
3. Vaccine
4. Antiviral agent
5. Antibacterial agent
6. The infectious disease most likely to be the second eliminated from Earth
7. Consumer award
8. Demon award

Category: Bacterium

Candidates for the Most Important Discovery of a New Bacterium: 1980-2012

Questions answered incorrectly will be highlighted.

What do you believe was the most important discovery of a new bacterium during the time period 1980-2012?

1982: Borrelia burgdorferi (Lyme disease)

1982: Escherichia coli O157:H7 (hemorrhagic colitis)

1983: Helicobacter pylori (peptic ulcer disease)

1986: Chlamydia pneumoniae (atypical pneumonia)

1999: Bartonella henselae (cat-scratch disease)

2000: Tropheryma whipplei (Whipple disease)

2000: Methicillin-resistant Staphylococcus aureus (USA 300 strain)

2000: Clostridium difficile NAP-1 strain (C difficile epidemic)

Other: If not listed here, tell us about your choice in the Discussion

The Most Important Discovery of a New Bacterium (1980-2012)

My choice for the greatest achievement in the discovery of a new bacterium is Helicobacter pylori. The story of this organism and its etiologic roles in peptic ulcer disease and gastric cancer is a prime example of a relationship that was long suspected but resisted bitterly by the medical establishment, with eventual victory and a Nobel Prize.

Early history relevant to the role of H pylori in peptic ulcer disease includes the 1868 recommendation by Kussmaul to use bismuth agents to treat peptic ulcer disease, although the antibacterial properties of bismuth were yet to be discovered.¹ In 1939, A. Stone Freedberg reported H pylori in the human stomach but abandoned this research when he was ordered to move on to other subjects.^2,3 Barry Marshall later speculated that Freedberg would have won the Nobel Prize for his discovery in 1951 if his mentor had allowed him to continue his work.⁴ In 1964, John Lykoudis⁵ recommended antibiotic treatment for peptic ulcer disease at a meeting of the Medico-Surgical Society of Greece, but the manuscript was rejected and Lykoudis was subsequently fined 4000 drachmas for administering this treatment.

The roles of Robin Warren (Figure 1) and Barry Marshall (Figure 2) in the discovery of H pylori began in 1981, when Dr. Marshall, a young gastroenterologist, joined Dr. Warren, a pathologist, in the Royal Perth Hospital in Australia.⁶

Figure 1. Dr. Robin Warren, self-portrait. Used with permission.

Figure 2. Dr. Barry Marshall. Courtesy of The Office of the Nobel Laureates, University of Western Australia, Perth.

Dr. Warren had observed the bacterium in gastric biopsies and autopsies, and Dr. Marshall advocated antibiotic therapy, which proved successful.⁶ Despite the early successes of these 2 eventual Nobel laureates, the road they traveled was not always smooth. Marshall and Warren reported "unidentified curved bacilli on gastric epithelium in active chronic gastritis" in The Lancet in 1983⁷ and a more comprehensive description of this association based on a review of 100 gastric biopsies in 1984.⁸ The field of gastroenterology, however, was not ready for this challenge to long-held beliefs about peptic ulcer disease and its treatment.

The backlash was brutal.¹ Dr. Larry Altman, medical correspondent for The New York Times, who reported these results, later wrote, "I have never seen the medical community more defensive or critical of a story."⁹ I spoke with Dr. Altman about these events, and to this day, he recalls that "this was the review that got me the most heat for misleading the public" (Personal communication. May 16, 2012).

To defend his thesis, in 1984 Marshall intentionally drank cultured H pylori and developed gastric symptoms, which were relieved with antibiotics.¹⁰ Another health professional who was similarly frustrated by the rejection of the theory of an association between H pylori and gastritis leading to peptic ulcer disease also consumed the putative agent. Multiple gastric biopsies before and after ingestion nicely demonstrated the resulting disease; however, Marshall's colleague was less fortunate because antibiotics were unsuccessful in eradicating his disease, and he had debilitating symptoms for 3 years.^11,12

My experience with this disease was brief but telling. In 1986, I was invited to present a summary of the science of a bacterial cause of peptic ulcer disease at the annual meeting of the American Gastroenterology Association in San Francisco. I reviewed the data and submitted my abstract, but was somewhat shocked by the response from those who had invited me because they insisted on an editorial rebuttal. Their concern was that some attendees listening to my talk "might actually believe a bacterial cause." The "Editor's Note" for the program read:

Dr. Bartlett has summarized results from a number of reports dealing with gastric campylobacter-like organisms (GCLO) and gastritis. While intriguing, these reports (most of which are letters or abstracts) have done no more than call attention to an association between gastritis and GCLO. What remains completely unsettled, in our opinion, is whether GCLO are the cause of gastritis or present as a result of gastritis (ie, organisms colonize only in the presence of inflamed mucosa of some other etiology).

Despite this relatively rude treatment of an invited guest, I braced for the encounter and showed slides of the gastric biopsies from before and after self-ingestion of H pylori by Arthur Morris.¹¹ I then placed a glass of water (that I claimed to have seeded with H pylori but which was actually plain water) on the podium and invited skeptics to drink after my presentation. There were skeptical comments, but no one drank from the chalice.

It is not possible to identify a specific data set or a particular report that changed conventional teaching about peptic ulcer disease to a recognition that it was a bacterial infection rather than a consequence of gastric acidity. The period between 1987 and 1990 was particularly important because during this time, antibiotics to eradicate H pylori resulted in high rates of cure and prevention of relapses.¹³ Subsequent work implicated H pylori as a cause of gastric cancer¹⁴ and gastric lymphoma.¹⁵

The citation at the presentation of the Nobel Prize in 2005 is particularly important in terms of recognizing the importance of both the pathogen and the disease it causes:

Against prevailing dogmas, you [Drs. Warren and Marshall] discovered that one of the most common and important diseases of mankind, peptic ulcer disease, is caused by a bacterial infection of the stomach. Your discovery has meant that this frequently chronic and disabling condition can now be permanently cured by antibiotics, to the benefit of millions of patients. Your pioneering work has also stimulated research all around the world to better understand the link between chronic infections and diseases such as cancer.

The rationale for this selection as the most important discovery of a bacterium and its role in human disease is based on several observations that contribute to the weight of H pylori as an important and unusual pathogen.

• It is one of the most common infections, on the basis of serology studies that imply not simply colonization but an immune response to microbial infection. Most serologic studies show prevalence rates of 20%-90%; which vary substantially by age (with rates greater than 50% in persons older than 50 years) and by social class or national patterns of hygiene.¹⁶ In the United States, approximately 30% of people are colonized with H pylori, and colonization persists unless the person takes antibiotics directed against H pylori.
• H pylori is the major cause of peptic ulcer disease, which affects 15%-20% of those colonized or approximately 10% of the population at a cost of approximately $3.4 billion per year for healthcare in the United States.¹⁷
• H pylori is an unusual infection because it causes a chronic inflammatory response without the usual findings to suggest infection, such as elevation of C-reactive protein level, erythrocyte sedimentation rate, or procalcitonin level.¹⁸ As a traditional infectious disease model, H pylori violates all the rules.
• H pylori is a recognized carcinogen, presumably by its association with chronic inflammation (chronic gastritis).¹⁴ Thus, it is the only bacterium listed as a class 1 carcinogen,¹⁹ and it is also implicated in gastric lymphoma.¹⁵

The long battle to legitimize H pylori as a human pathogen was the classic example of the difficulty our profession has with unconventional theories. For this and the other reasons cited above, the discovery of H pylori receives my vote for the greatest achievement in discovery of a bacterium in the past 30 years.

Timeline: Historical Highlights -- Gastric Ulcer as a Chronic Bacterial Infection Caused by Helicobacter pylori Infection

1586: First report of gastric ulceration.¹

1825: Classic description of gastric function based on observations in a patient with a war wound that resulted in a gastric-cutaneous fistula.²

1857: Symptoms of peptic ulcer disease reported in detail.³

1881: Billroth provides the first report of upper gastrointestinal endoscopy.⁴

1906: Spirochetes reported in gastric biopsy specimens.⁵

1910: Peptic ulcer was attributed to gastric acid,⁶ and antacids became standard treatment.

1915: The "Sippy diet" is reported, using milk and cream throughout the day and much of the night.⁷ This became a favored therapy for the next 6 decades.

1924: Urease activity reported in human stomachs.⁸ This was thought to be generated from gastric mucosal cells because the stomach was thought to be sterile.

1966: Report of the gastric histamine receptor,⁹ and the first report of H₂-receptor therapy followed quickly.¹⁰

1973: The proton pump was described¹¹; this was immediately followed by proton pump inhibitor treatment.¹²

1975: Spirochetes and chronic gastritis are shown on gastroscopy in 80% of patients with gastric ulcers.¹³

1979: Robin Warren detected bacteria growing in gastric biopsy specimens, but the findings were apparently uninteresting to fellow pathologists. Two years later he met Barry Marshall, a young gastroenterologist, and the men spent the next 7 years studying what is now known as H pylori.

1983: Warren and Marshall report on bacteria associated with gastritis and peptic ulcer disease from their initial collaboration.¹⁴

1984: The seminal report¹⁵ from the Warren/Marshall collaboration showed the association of curved bacteria in the lesions of patients with chronic antral gastritis and ulcers.

Some of the observations in the seminal report are interesting, convincing, and even compelling, because the investigators found typical spiral or curved bacteria in antral specimens from 58 of 100 patients who underwent endoscopy with gastric biopsy.

We found a close association between pyloric campylobacter and antral gastritis. When polymorphonucleocytes (PMNs) infiltrated the mucosa, the bacteria were almost always present (38/40). In the absence of inflammation they were rare (2/31), suggesting they are not commensals. We know of no other disease state where, in the absence of complicating factors such as ulceration, bacteria and PMNs are so intimately related without the bacteria being pathogenic.

Conventional wisdom at the time was that the stomach is normally sterile owing to the acid environment, but the investigators opined that the bacteria were not in gastric fluid but rather on gastric cells.

1985: Self-inoculation experiment by Dr. Marshall was reported.¹⁶ This was a failed attempt to satisfy the Koch postulates because the result was gastritis, but he never developed a gastric ulcer.

1987: Eradication of H pylori shown to be associated with long-term cure of duodenal ulcer.^17,18

1987: Report of the urea breath test.¹⁹

1987: The antibacterial activity of bismuth against H pylori is reported.²⁰

1989: Campylobacter pylori is renamed Helicobacter pylori.^21,22

1994: H pylori is named a grade 1 ("definite") carcinogen.²³

1994: H pylori is implicated as the cause of gastric non-Hodgkin lymphoma.²⁴

1994: A National Institutes of Health consensus report endorses antibacterial therapy for peptic ulcer disease.²⁵

1997: Management guidelines for peptic ulcer disease recommend antibacterial treatment for the first time.²⁶

2005: The Nobel Prize is awarded to Drs. Barry Marshal and Robin Warren.

References

1. Donati M. Demedica historia mirabilt. Mantuae per fr. Osanam, Lib. IV, Cap iii:1586;196.
2. Beaumont W. A case of wounded stomach. Med Record. 1825;8:14-9, 840.
3. Brinton W. On the Pathology, Symptoms, and Treatment of the Stomach. With an Appendix of Cases. London: Churchill Livingston; 1857.
4. Billroth CA. Offenes Schreiben an Herrn Dr. L. Wittelshöfer. Wien Med Wochenschr. 1881;31:161-165, 1427.
5. Krienitz U. Ueber das Auftreten von Spirochaeten verschiedener Form im Mageninhalt bei Carcinoma ventriculi. Dtsch Med Wochenschr. 1906;22:872.
6. Schwarz K. Ueber penetrierende Magen- und Jejunalgeschwure. Beitr Klin Chir. 1910;67:96-128.
7. Sippy BW. Gastric and duodenal ulcer. Medical cure by an efficient removal of gastric juice corrosion. JAMA. 1915;64:1625-1630.
8. Luck JM, Seth TN. The physiology of gastric unease. Biochem J. 1924;18:357-365.
9. Ash AS, Schild HO. Receptors mediating some actions of histamine. Br J Pharmacol Chemother 1966;27:427-439.
10. Black JW, Duncan WA, Durant CJ, Ganellin CR, Parsons EM. Definition and antagonism of histamine H2-receptors. Nature. 1972;236:385-390. Abstract
11. Ganser AL, Forte JG. K+-stimulated ATPase in purified microsomes of bullfrog oxyntic cells. Biochim Biophys Acta. 1973;307:169-180. Abstract
12. Lindberg P, Brändström A, Wallmark B, et al. Omeprazole: the first proton pump inhibitor. Med Res Rev. 1990;10:1-54. Abstract
13. Steer HW. Ultrastructure of cell migration through the gastric epithelium and its relationship to bacteria. J Clin Pathol. 1975;28:639-646. Abstract
14. Warren JR, Marshall BJ. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet. 1983;1:1273-1275. Abstract
15. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet. 1984;1:1311-1315. Abstract
16. Marshall BJ, Armstrong JA, McGechie DB, Glancy RJ. Attempt to fulfill Koch's postulates for pyloric Campylobacter. Med J Aust. 1985;142:436-439. Abstract
17. Rauws EA, Tytgat GN. Cure of duodenal ulcer associated with eradication of Helicobacter pylori. Lancet. 1990;335:1233-1235. Abstract
18. Coghlan JG, Gilligan D, Humphries H, et al. Campylobacter pylori and recurrence of duodenal ulcers -- a 12-month follow-up study. Lancet. 1987;2:109-111.
19. Bell GD, Weil J, Harrison G, et al. 14C-urea breath analysis; a non-invasive test for Campylobacter pylori in the stomach. Lancet. 1987;1:1367-1368.
20. Marshall BJ, Armstrong JA, Francis GJ, Nokes NT, Wee SH. Antibacterial action of bismuth in relation to Campylobacter pyloridis colonization and gastritis. Digestion. 1987;37 Suppl 2:16-30. Abstract
21. Luning G. Campylobacter pylori becomes Helicobacter pylori. Lancet 1989;2:1019-1020.
22. Goodwin CS, Armstrong JA, Chilvers T, et al. Transfer of Campylobacter pylori and Campylobacter mustelae to Helicobacter gen. nov. as Helicobacter pylori comb. nov., respectively. Int J Syst Bacteriol. 1989;39:397-405.
23. International Agency for Research on Cancer. Schistosomes, liver flukes and Helicobacter pylori. In: IARC Monographs on the Evaluation of Carcinogenic Risk to Humans. vol 6. Lyon: IARC; 1994.
24. Parsonnet J, Friedman GD, Vandersteen DT, et al. Helicobacter pylori infection and risk for gastric cancer. N Engl J Med. 1991;325:1127-1131. Abstract
25. Thamer M, Ray NF, Henderson SC, Rinehart CS, Sherman CR, Ferguson JH. Influence of the NIH Consensus Conference on Helicobacter pylori on physician prescribing among a Medicaid population. Med Care. 1998:36:646-660. Abstract
26. Current European concepts in the management of Helicobacter pylori infection. The Maastricht Consensus Report. European Helicobacter pylori Study Group. Gut. 1997;41:8-13. Abstract

[ CLOSE WINDOW ]

References

1. Buckley MJ, O'Morain CA. Helicobacter biology -- discovery. Br Med Bull. 1998;54:7-16. Abstract
2. Freedberg AS. An early history of human stomach bacteria. In: Marshall B, ed. Helicobacter Pioneers. Hoboken, NJ; Wiley-Blackwell Press; 2002: 105-118.
3. Freedberg AS, Baron LE. The presence of spirochaetes in human gastric mucosa. Am J Dig Dis. 1940;7:443-445.
4. Altman LK. A scientist, gazing toward Stockholm, ponders "what if?" New York Times. December 6, 2005. http://www.nytimes.com/2005/12/06/health/06docs.html?pagewanted=all Accessed April 26, 2012.
5. Rigas B, Papavassiliou ED. John Lykoudis: the general practitioner in Greece who discovered the etiology of, and treatment of, peptic ulcer disease. In Marshall B, ed. Helicobacter Pioneers. Hoboken, NJ; Wiley-Blackwell Press; 2002:75-84.
6. Marshall BJ. The discovery of Helicobacter pylori. In Marshall B, ed. Helicobacter Pioneers. Hoboken, NJ; Wiley-Blackwell Press; 2002:165-202.
7. Unidentified curved bacilli on gastric epithelium in active chronic gastritis. Lancet. 1983;1:1273-1275. Abstract
8. Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet. 1984;1:1311-1315. Abstract
9. Altman LK. New bacterium linked to painful stomach ills. New York Times. July 31, 1984. http://www.nytimes.com/1984/07/31/science/new-bacterium-linked-to-painful-stomach-ills.html?pagewanted=all Accessed April 26, 2012.
10. Marshall BJ, Armstrong JA, McGechie DB, Glancy RJ. Attempt to fulfill Koch's postulates for pyloric Campylobacter. Med J Aust. 1985;142:436-439. Abstract
11. Morris A, Nicholson G. Ingestion of Campylobacter pyloridis causes gastritis and raised fasting pH. Am J Gastroenterol. 1987;82:192-199. Abstract
12. Morris AJ, Ali MR, Nicholson GI, Perez-Perez GI, Blaser MJ. Long-term follow-up of voluntary ingestion of Helicobacter pylori. Ann Intern Med. 1991;114:662-663. Abstract
13. Rauws EA, Tytgat GN. Cure of duodenal ulcer associated with eradication of Helicobacter pylori. Lancet. 1990;335:1233-1235. Abstract
14. Jiang SJ, Liu WZ, Zhang DZ, et al. Campylobacter-like organisms in chronic gastritis, peptic ulcer, and gastric carcinoma. Scand J Gastroenterol. 1987;22:553-558. Abstract
15. Parsonnet J, Hansen S, Rodriguez L, et al. Helicobacter pylori infection and gastric lymphoma. N Engl J Med. 1994;330:1267-1271. Abstract
16. Sitas F, Forman D, Yarnell JW, Burr ML, Elwood PC, Pedley S, Marks KJ. Helicobacter pylori infection rates in relation to age and social class in a population of Welsh men. Gut. 1991;32:25-28. Abstract
17. Yuan Y, Padol IT, Hunt RH. Peptic ulcer disease today. Nat Clin Pract Gastroenterol Hepatol. 2006;3:80-89. Abstract
18. Saribas S. Kocazeybek B, Aslan M, et al. Do procalcitonin and C-reactive protein levels have a place in the diagnosis and follow-up of Helicobacter pylori infections? J Med Microbiol. 2004;53:639-644.
19. Jones J. What is the role of bacteria in cancer carcinogenesis? J Natl Cancer Inst. 2000;92:1713.

Medscape Infectious Diseases © 2012 WebMD, LLC

這個有第一多頭銜的 "總統"

[他還是 "第一個"上任後，自己降格為 "區長"的 "總統"]

奇怪耶，你就是「第一」！

…詳全文馬英九的第二任，他說自己沒有選票的壓力，但有「歷史定位」的壓力。老實說，馬英九的「歷史定位」不必等蓋棺，也不必等卸任，現在就已論定：「他，馬的」就是「第一」。

馬英九奪下的「第一」，真是洋洋灑灑，令人叫絕。

■陳冲是「第一」個不能到國會做報告的行政院長；馬英九任命的。

■劉憶如是「第一」個在任十天就下台的部長，創下就任最短命的閣員紀錄。劉憶如當財政部長雖然有三個多月，比誤入叢林的前經濟部長宗才怡的一個半月長，但是，劉是總辭之後，五二○重新任命，所以任期是十天，不是一百多天。此外，行政院還發送史上「第一」短的新聞稿。

■張盛和是「第一」個事務官出身且退休僅一百多天，馬上又被擢升為部長的；甚至被任命了，他還被蒙在鼓裡，是看了新聞才知道。

■馬英九是「第一」個尚未就職，民調就掉到十五％的總統。

■馬英九是「第一」位藍綠媒體都一致痛罵的總統；也是藍綠媒體從沒有的「第一」次共識現象。

■馬英九是「第一」個被「老朋友」記者在自己召開的記者會中，像罵孩子般，被罵了三分鐘的總統。

■馬英九連任，是「第一」個沒有蜜月期，連股市也沒有慶賀行情的總統。

■馬英九是「第一」個還沒有上任，就變成跛腳的總統。

■馬英九是「第一」個被自家立委連續霸凌的總統，而且完全沒有部勒的力量，遑論反制。

■馬英九是「第一」個政策出不了府的總統。號稱「改革」的證所稅行政院版本，兩度遭自家立委打槍、推翻。

■馬英九是「第一」個被立院黨團爬到頭上的黨主席。

■馬英九是解嚴後，總統貢獻度排行「第一」︱︱倒數︱︱的總統。

馬英九拿下的「第一」，不可勝數，此處只大略言之。但他馬的「第一」，也是有歷史的，犖犖大者，如：

■馬英九是「第一」個、也是最後一個反直選卻靠直選取得大位的反動派。

■馬英九是「第一」個當職業學生卻選上總統的「抓耙仔」。

■馬英九是「第一」個有綠卡還騙人沒有的準美國人。至於是不是有美國籍？還得等維基解密；要問的是不是還會再添一個「第一」？

馬英九的無能「第一」，則是「第一」中的「第一」，不說也罷。（作者金恒煒，政治評論者）

【李筱峰專欄】中共贊成台獨的歷史傳統

【李筱峰專欄】中共贊成台獨的歷史傳統

蘇貞昌在當選民進黨主席後表示，不迴避與中國接觸，對於訪問中國態度保持開放。中國國台辦發言人楊毅則回話「民進黨堅持一邊一國的台獨主張，是雙方交往的最大障礙，我們的大門始終敞開，關鍵是民進黨何時拆除他們給自己設置的障礙」。中共的意思是：「只要依照我們的內定結論（台灣是我們中國的一部分），我們的大門就永遠對你們開放。如果你們不接受我們的內定結論，那就是你們設置了障礙。」

我們要提醒中國當局，回顧中共歷史，你們原本對台灣獨立的態度是敞開的，贊成台獨是中共的歷史傳統，今天設障的是你們，不是台灣的民進黨。請看中共贊成台獨的歷史：

一九二八年在中共的建議下，謝雪紅、林木順等台籍左翼人士籌組台灣共產黨，四月十五日台灣共產黨在上海法國租界成立，楬櫫的政治大綱第二條就表明「台灣人民獨立萬歲」、第三條「建立台灣共和國」。當時的中共不但沒有反對，還派代表彭榮參加台共的成立大會。

一九三六年七月十六日，親中共的美國學者斯諾（Edgar
Snow）到延安訪問毛澤東。斯諾問：「中國人民是否要從日本帝國主義者手中收復所有失地？」毛回答：「不僅要保衛長城以南的主權，也要收復我國全部的失地。這就是說滿洲必須收復。但我們並不把中國以前的殖民地朝鮮包括在內。當我們收回中國的失地，達成獨立以後，如果朝鮮人民希望掙脫日本帝國主義者的枷鎖，我們將熱烈支援他們爭取獨立的戰鬥。這一點同樣適用於台灣。」（詳見“Red Star over China”）

一九三八年十月，毛澤東在中共中央政治局擴大會議上提出〈抗日民族戰爭與抗日民族統一戰線發展的新階段〉的報告，鼓勵「朝鮮、台灣等被壓迫民族」爭取獨立。他呼籲「中、日兩大民族的人民大眾及朝鮮、台灣等被壓迫民族…共同努力，建立共同的反侵略統一戰線」。很明顯毛澤東認為中國人和台灣人應該以平等的國際友誼來合作。

一九四一年六月，周恩來在〈民族至上與國家至上〉一文中明白表示中國除了要追求自己的獨立自主，也要支持其他民族國家的獨立解放運動。這些運動包括：朝鮮、台灣的反日運動，巴爾幹與非洲民族國家的反德、義侵略，以及印度、南洋等地的民族獨立運動。

二戰即將結束前，中共召開第七次全國代表大會（1945.4.23-6.12），曾刊載一份有台灣名號的文件〈台灣等國留延黨員致中共七大大會祝賀詞〉，簽發賀詞的「台灣等國」包括台灣、菲律賓、越南、泰國、馬來亞、荷印、緬甸。賀詞中明確地提到中共長期支持東方各民族（包括台灣）的獨立運動。（見1945.5.1《解放日報》）

更有意思的是，戰後國民政府接管台灣，一九四七年台灣爆發二二八事件，中共的《解放日報》還在三月八日發表「支持台灣獨立」的言論。

回顧過去中共支持台獨的歷史，再看看今天中共卻對台獨充滿敵意，這是中共自設的心理障礙。勸中共拆除心中的障礙，回到當年毛主席所揭示的「中國人和台灣人應該以平等的國際友誼來合作」，兄弟之邦，共存共榮，有何不好？

（作者李筱峰現任國立台北教育大學台灣文化研究所教http://www.jimlee.org.tw）

越南戰爭中最憾動人心的一張相片!

[這張相片令人哭泣，以後的故事更令人萬感交集!!]

• FILE - In this June 8, 1972 file …

  
  

• In this March 29, 2012 photo, Associated …

  
  

• FILE - In this May 25, 1997 file …

  
  

• FILE - In this June 8, 1992 file …

  
  

• FILE - In this Aug. 17, 1989 file …

  
  

• In this March 29, 2012 photo, a …

  
  

• FILE - In this May 25, 1997 file …

  
  

• FIEL - In this May 25, 1997 file …

  
  

• FILE - In this May 25, 1992 file …

  
  

• In this 1992 photo provided by …

  
  

TRANG BANG, Vietnam (AP) — In the picture, the girl will always be 9 years old and wailing "Too hot! Too hot!" as she runs down the road away from her burning Vietnamese village.

She will always be naked after blobs of sticky napalm melted through her clothes and layers of skin like jellied lava.

She will always be a victim without a name.

It only took a second for Associated Press photographer Huynh Cong "Nick" Ut to snap the iconic black-and-white image 40 years ago. It communicated the horrors of the Vietnam War in a way words could never describe, helping to end one of the most divisive wars in American history.

But beneath the photo lies a lesser-known story. It's the tale of a dying child brought together by chance with a young photographer. A moment captured in the chaos of war that would be both her savior and her curse on a journey to understand life's plan for her.

"I really wanted to escape from that little girl," says Kim Phuc, now 49. "But it seems to me that the picture didn't let me go."

____

It was June 8, 1972, when Phuc heard the soldier's scream: "We have to run out of this place! They will bomb here, and we will be dead!"

Seconds later, she saw the tails of yellow and purple smoke bombs curling around the Cao Dai temple where her family had sheltered for three days, as north and south Vietnamese forces fought for control of their village.

The little girl heard a roar overhead and twisted her neck to look up. As the South Vietnamese Skyraider plane grew fatter and louder, it swooped down toward her, dropping canisters like tumbling eggs flipping end over end.

"Ba-boom! Ba-boom!"

The ground rocked. Then the heat of a hundred furnaces exploded as orange flames spit in all directions.

Fire danced up Phuc's left arm. The threads of her cotton clothes evaporated on contact. Trees became angry torches. Searing pain bit through skin and muscle.

"I will be ugly, and I'm not normal anymore," she thought, as her right hand brushed furiously across her blistering arm. "People will see me in a different way."

In shock, she sprinted down Highway 1 behind her older brother. She didn't see the foreign journalists gathered as she ran toward them, screaming.

Then, she lost consciousness.

___

Ut, the 21-year-old Vietnamese photographer who took the picture, drove Phuc to a small hospital. There, he was told the child was too far gone to help. But he flashed his American press badge, demanded that doctors treat the girl and left assured that she would not be forgotten.

"I cried when I saw her running," said Ut, whose older brother was killed on assignment with the AP in the southern Mekong Delta. "If I don't help her — if something happened and she died — I think I'd kill myself after that."

Back at the office in what was then U.S.-backed Saigon, he developed his film. When the image of the naked little girl emerged, everyone feared it would be rejected because of the news agency's strict policy against nudity.

But veteran Vietnam photo editor Horst Faas took one look and knew it was a shot made to break the rules. He argued the photo's news value far outweighed any other concerns, and he won.

A couple of days after the image shocked the world, another journalist found out the little girl had somehow survived the attack. Christopher Wain, a correspondent for the British Independent Television Network who had given Phuc water from his canteen and drizzled it down her burning back at the scene, fought to have her transferred to the American-run Barsky unit. It was the only facility in Saigon equipped to deal with her severe injuries.

"I had no idea where I was or what happened to me," she said. "I woke up and I was in the hospital with so much pain, and then the nurses were around me. I woke up with a terrible fear."

Thirty percent of Phuc's tiny body was scorched raw by third-degree burns, though her face somehow remained untouched. Over time, her melted flesh began to heal.

"Every morning at 8 o'clock, the nurses put me in the burn bath to cut all my dead skin off," she said. "I just cried and when I could not stand it any longer, I just passed out."

After multiple skin grafts and surgeries, Phuc was finally allowed to leave, 13 months after the bombing. She had seen Ut's photo, which by then had won the Pulitzer Prize, but she was still unaware of its reach and power.

She just wanted to go home and be a child again.

___

For a while, life did go somewhat back to normal. The photo was famous, but Phuc largely remained unknown except to those living in her tiny village near the Cambodian border. Ut and a few other journalists sometimes visited her, but that stopped after northern communist forces seized control of South Vietnam on April 30, 1975, ending the war.

Life under the new regime became tough. Medical treatment and painkillers were expensive and hard to find for the teenager, who still suffered extreme headaches and pain.

She worked hard and was accepted into medical school to pursue her dream of becoming a doctor. But all that ended once the new communist leaders realized the propaganda value of the 'napalm girl' in the photo.

She was forced to quit college and return to her home province, where she was trotted out to meet foreign journalists. The visits were monitored and controlled, her words scripted. She smiled and played her role, but the rage inside began to build and consume her.

"I wanted to escape that picture," she said. "I got burned by napalm, and I became a victim of war ... but growing up then, I became another kind of victim."

She turned to Cao Dai, her Vietnamese religion, for answers. But they didn't come.

"My heart was exactly like a black coffee cup," she said. "I wished I died in that attack with my cousin, with my south Vietnamese soldiers. I wish I died at that time so I won't suffer like that anymore ... it was so hard for me to carry all that burden with that hatred, with that anger and bitterness."

One day, while visiting a library, Phuc found a Bible. For the first time, she started believing her life had a plan.

Then suddenly, once again, the photo that had given her unwanted fame brought opportunity.

She traveled to West Germany in 1982 for medical care with the help of a foreign journalist. Later, Vietnam's prime minister, also touched by her story, made arrangements for her to study in Cuba.

She was finally free from the minders and reporters hounding her at home, but her life was far from normal. Ut, then working at the AP in Los Angeles, traveled to meet her in 1989, but they never had a moment alone. There was no way for him to know she desperately wanted his help again.

"I knew in my dream that one day Uncle Ut could help me to have freedom," said Phuc, referring to him by an affectionate Vietnamese term. "But I was in Cuba. I was really disappointed because I couldn't contact with him. I couldn't do anything."

___

While at school, Phuc met a young Vietnamese man. She had never believed anyone would ever want her because of the ugly patchwork of scars that banded across her back and pitted her arm, but Bui Huy Toan seemed to love her more because of them.

The two decided to marry in 1992 and honeymoon in Moscow. On the flight back to Cuba, the newlyweds defected during a refueling stop in Canada. She was free.

Phuc contacted Ut to share the news, and he encouraged her to tell her story to the world. But she was done giving interviews and posing for photos.

"I have a husband and a new life and want to be normal like everyone else," she said.

The media eventually found Phuc living near Toronto, and she decided she needed to take control of her story. A book was written in 1999 and a documentary came out, at last the way she wanted it told. She was asked to become a U.N. Goodwill Ambassador to help victims of war. She and Ut have since reunited many times to tell their story, even traveling to London to meet the Queen.

"Today, I'm so happy I helped Kim," said Ut, who still works for AP and recently returned to Trang Bang village. "I call her my daughter."

After four decades, Phuc, now a mother of two sons, can finally look at the picture of herself running naked and understand why it remains so powerful. It had saved her, tested her and ultimately freed her.

"Most of the people, they know my picture but there's very few that know about my life," she said. "I'm so thankful that ... I can accept the picture as a powerful gift. Then it is my choice. Then I can work with it for peace."

 

A New Class of Cancer Drugs May Be Less Toxic

By ANDREW POLLACK   2012-5-31

Fern Saitowitz’s advanced breast cancer was controlled for about a year by the drug Herceptin and a toxic chemotherapy agent. But her hair fell out, her fingernails turned black and she was constantly fatigued.

She switched to an experimental treatment, which also consisted of Herceptin and a chemotherapy agent. Only this time, the two drugs were attached to each other, keeping the toxic agent inactive until the Herceptin carried it to the tumor. Side effects, other than temporary nausea and some muscle cramps, vanished.

“I’m able to live a normal life,” said Ms. Saitowitz, 47, a mother of two young children in Los Angeles. “I haven’t lost any of my hair.”

The experimental treatment, called T-DM1, is a harbinger of a new class of cancer drugs that may be more effective and less toxic than many existing treatments. By harnessing antibodies to deliver toxic payloads to cancer cells, while largely sparing healthy cells, the drugs are a step toward the “magic bullets” against cancer first envisioned by Paul Ehrlich, a German Nobel laureate, about 100 years ago.

“It’s almost like we’re masking the chemotherapy,” said Dr. Edith Perez, a breast cancer specialist at the Mayo Clinic in Jacksonville, Fla.

One such drug, Adcetris, developed by Seattle Genetics, was approved last August to treat Hodgkin’s lymphoma and another rare cancer. T-DM1, developed by Genentech, could reach the market next year. Data from a large clinical trial of T-DM1 is expected to attract attention at the annual meeting of the American Society of Clinical Oncology this weekend in Chicago.

Numerous other companies, from pharmaceutical giants to tiny start-ups, are pursuing the treatments, which are known variously as antibody-drug conjugates, armed antibodies or empowered antibodies. “I don’t think there is a major pharma or a midsized pharma with interest in cancer that doesn’t have a program or isn’t scrambling to put one together,” said Stephen Evans-Freke, a managing general partner at Celtic Therapeutics, an investment firm that recently committed $50 million to create a new company, ADC Therapeutics, to develop antibody-drug conjugates.

About 25 such drugs from a variety of companies are in clinical trials, according to Alain Beck, a French pharmaceutical researcher who closely tracks the field. Genentech alone has eight in clinical trials besides T-DM1, and another 17 in earlier stages of development.

Many of the drugs use technology from either Seattle Genetics, based in Bothell, Wash., or ImmunoGen of Waltham, Mass., which supplied the toxin and linker used in T-DM1.

The armed antibodies do not work for all patients and they are not totally free of side effects. T-DM1, for instance, can lower blood platelet levels. The drugs are also likely to be expensive. Adcetris costs more than $100,000 for a typical course of treatment.

Biotechnology drugs called monoclonal antibodies, like Herceptin, Rituxan and Erbitux, are already mainstays of what is called targeted cancer therapy. These laboratory-produced molecules mimic the antibodies made by a person’s immune system to fight infection. But instead of attacking pathogens these antibodies attach to specific proteins on the surface of cancer cells.

But antibodies by themselves have a limited ability to kill tumors. So the antibodies are usually given with more conventional cell-killing chemotherapy drugs, which cause side effects because they can also attack healthy cells.

The new approach chemically attaches a toxin to the antibody, increasing its killing power while reducing the need to give toxic drugs separately. After the antibody binds to a cancer cell, it is taken inside the cell like a Trojan horse, and the toxin is released.

While armed antibodies are sometimes likened to guided missiles with toxic warheads, they actually cannot guide themselves to tumors.

Rather, they float through the bloodstream, bumping against various cells. But they stick only to the cells bearing the target protein.

“These are like floating sea mines,” said K. Dane Wittrup, a professor of chemical and biological engineering at the Massachusetts Institute of Technology. “But when they end up in a particular harbor, they blow up.” Less than 1 percent of the drug actually makes it to the tumor, he estimated.

The antibody used in Adcetris, which binds to a protein on malignant cells called CD30, had little effect on cancer when tested alone, even at doses 20 times as high as used now. But when linked to a toxin, it shrank tumors in 75 percent of those with Hodgkin’s lymphoma.

Aimee Blaine, a petroleum engineer from Bakersfield, Calif., who has had Hodgkin’s lymphoma since 2004, was virtually out of options after traditional chemotherapy and a stem cell transplant failed to cure her disease.

But four days after taking Adcetris in a clinical trial, the unbearable itching that accompanied her disease vanished, she said.

Eventually, so did the cancer. Ms. Blaine, 40, has been in remission since her last dose in January 2011 and recently returned to work for the first time in seven years.

Like Herceptin, T-DM1 binds to what is known as the HER2 protein and is meant to treat only the roughly 20 percent of breast cancer cases characterized by an abundance of that protein.

In one trial involving 137 women, including Ms. Saitowitz, T-DM1 proved both more effective and less toxic than a combination of Herceptin and the chemotherapy drug docetaxel as an initial treatment for metastatic breast cancer.

Those who received T-DM1 went a median of 14.2 months before their disease worsened, compared with 9.2 months for those getting the two-drug combination. Yet only 46 percent of the T-DM1 patients suffered a severe side effect, half the rate of the other group.

At the cancer conference, researchers will present results of a pivotal trial involving nearly 1,000 women. Though armed antibodies are easy to envision, it has taken more than three decades to make them practical, with many failures along the way.

With the first armed antibody to reach the market, Mylotarg, the toxin sometimes fell off the antibody prematurely, causing side effects. Approved in 2000 to treat acute myeloid leukemia, Mylotarg was removed from the market by its manufacturer, Pfizer, in 2010 after new studies showed it did not prolong lives and had safety problems.

Since then, two antibodies linked to radioactive isotopes have been approved to treat non-Hodgkin’s lymphoma — Bexxar from GlaxoSmithKline and Zevalin from Spectrum Pharmaceuticals. These drugs, while effective, are more cumbersome to use than antibodies linked to chemical toxins.

Researchers first tried to use existing chemotherapy drugs as the payloads, but they were simply not toxic enough. That is because less of a drug gets to the tumor when carried on an antibody than when the drug floods the body by itself.

Seattle Genetics and ImmunoGen use toxins that are hundreds of times as potent as typical chemotherapy agents. They are too toxic to be given by themselves.

The linkers have proved even trickier to develop since they must keep the toxin attached to the antibody while in the bloodstream, but then release the toxin inside the cancer cell.

Dr. John Lambert, executive vice president for research and development at ImmunoGen, will be in the audience at the cancer conference as the fruits of 30 years of work are presented.

“To get to this point is an indescribable feeling, actually,” he said.