2007年10月31日 星期三

My jiggling breasts have a message for all of us

My jiggling breasts have a message for all of us


I didn't really care about my expanding girth until I realized one day that I had grown "breasts" that bounced when I half-ran. And much as I was loathe to admit, my ample belly and buttocks also undulated in unison. In fact, every square inch of blubber on my body was jiggling. But I soon got over the shock of this nasty revelation.

However, hoping I might still be able to mend my ways, I attended as an observer a recent two-day symposium hosted by the Japan Society for the Study of Obesity in Tokyo. The topic of most of the discussion sessions and presentations was metabolic syndrome, a combination of health disorders often typified by the accumulation of excess organ fat that can cause serious diseases.

Some presentations were based on the speaker's own experiences. One diabetes expert shed 6 kilograms--and has since kept them off successfully--by cutting back his daily beer consumption from four cans to one can and snacking only on low-cal kaiware white radish sprouts and wasabi preserved in sake lees.

Another doctor said, "When I have an evening drinking party I can't get out of, I just go and don't fret about it. I make up for it by doing whatever I can with breakfast and lunch to limit calories."

Healthcare professionals or laymen, all middle-aged men seem to think alike.

According to a recent survey by the Ministry of Economy, Trade and Industry, Japanese women of all age groups have slimmed down since the last such survey was conducted 12 years ago, but men have become chubbier. The average Japanese man in his 40s, the survey found, is now "slightly overweight."

The ministry may seem an odd party to be checking the height and weight of Japanese citizens, but the fact is that this data is indispensable to determining the latest industry standards for consumer items such as apparel and cars. Manufactured goods evolve over time in keeping with the changing sizes and shapes of average consumers.

A modern Japanese man won't fit into a suit of armor worn by a warrior during the Sengoku Jidai, or the age of provincial wars, from the 15th to the 16th century, nor will he be able to sleep comfortably in a bed that belonged to an absolute monarch of that era.

We all want to gorge ourselves with good food. If we balloon out as a result, manufacturers are making sure there won't be any problem.

In the light of my own experience, however, buying a bigger chair or roomier clothing is not advisable because that's practically tantamount to telling yourself to grow into it. Let me remind myself and all my chubby friends: We can enjoy good food only if we are healthy.

--The Asahi Shimbun, Oct. 21(IHT/Asahi: October 29,2007)

2007年10月30日 星期二

創傷後壓力症候群post traumatic stress disorder




post traumatic stress disorder (簡寫 PTSD) 創傷後壓力症候群

A psychological disorder affecting individuals who have experienced or witnessed profoundly traumatic events, such as torture, murder, rape, orwartime combat, characterized by recurrent flashbacks of the traumatic event, nightmares, irritability, anxiety, fatigue, forgetfulness, and social withdrawal.

奇美醫學中心表示,梅嶺車禍造成多名孩童受傷,經過評估,到目前為止這些小朋友並沒有出現嚴重的「創傷後壓力症候群」。精神科醫師表示,孩童遭遇重大事故後如果出現退化行為,或者不明原因的病痛,有可能是創傷後壓力症候群。創傷後壓力症 候群會讓孩童在腦海裡面重現創傷畫面。較小的孩子,會重複排演或玩出創傷的場景,或者接連出現可怕的惡夢。外在的症狀包括尿床、吸手指頭、發脾氣等退化行 為﹔對目前的事物失去興趣,注意力不集中,容易受到外界的事物驚嚇,不敢睡覺,以及出現頭痛、腹痛等不明原因的身體疾病。症狀較嚴重的可能持續幾個月甚至 幾年。

家人與親友應該多陪伴他,給予安全感,並且減少過多的感官刺激。對孩童來說,最需要的就是安全感,讓孩童從驚慌中穩定下來。方法包括:家人、學校與朋友的 拜訪、陪伴。給予孩童熟悉的事物,如果他有崇拜的偶像或者玩偶,可以找來陪伴他。避免過多的噪音,減少過多的感官刺激。生活上,讓孩童有事情可作,減少發 呆的時間,藉由活動的安排,轉移注意力。並且允許孩童透過說話、畫畫等方式表達出感受。

近3成乳癌患者 出現創傷後壓力症候群


「乳房是女性性徵,一夕之間要割捨,實在很困難,但是為了活下去,只能接受手術。」51歲的余美英今年初檢出乳癌第3期,立即接受乳房切除手術,人 在病榻上還擔心有家族遺傳,打電話要3個妹妹儘速進行篩檢,及早讓3妹發現罹患乳癌原位期,及早治療,目前2人術後康復狀況良好。

台灣的乳癌死亡率居於女性十大癌症死因的第四位,根據乳癌防治基金會針對「乳癌患者的創傷後壓力症候群 (PTSD)」調查,發現近3成的乳癌患者在手術後會有悲觀的傾向,尤其是50歲以下較年輕的乳癌患者,會有較明顯的創傷後壓力症候群傾向,術後心理健康狀況較差。




此 外,和信治癌中心內科主任劉美瑾表示,目前乳癌患者的術後必須合併放射性、荷爾蒙、化學藥物的輔助治療,才能降低復發率,根據國外研究指出,在乳癌的輔助 治療方面,含有歐洲紫杉醇藥物治療計畫的效果優於傳統化療計畫,可以降低復發率及死亡風險。目前健保給付歐洲紫杉醇用於荷爾蒙受體陰性的乳癌患者,但荷爾 蒙受體陽性的患者尚未給付,若要自費使用,則需新台幣25萬至30萬元。

2007年10月29日 星期一

organic really is better








Official: organic really is better

Ashleigh Cookney at the Yalding Organic Gardens pumpkin day, in Kent (Dwayne Senior)

Have your say on the organic debate by posting your views in the box at the bottom of this page

THE biggest study into organic food has found that it is more nutritious than ordinary produce and may help to lengthen people's lives.

The evidence from the £12m four-year project will end years of debate and is likely to overturn government advice that eating organic food is no more than a lifestyle choice.

The study found that organic fruit and vegetables contained as much as 40% more antioxidants, which scientists believe can cut the risk of cancer and heart disease, Britain’s biggest killers. They also had higher levels of beneficial minerals such as iron and zinc.

Professor Carlo Leifert, the co-ordinator of the European Union-funded project, said the differences were so marked that organic produce would help to increase the nutrient intake of people not eating the recommended five portions a day of fruit and vegetables. “If you have just 20% more antioxidants and you can’t get your kids to do five a day, then you might just be okay with four a day,” he said.

This weekend the Food Standards Agency confirmed that it was reviewing the evidence before deciding whether to change its advice. Ministers and the agency have said there are no significant differences between organic and ordinary produce.

Researchers grew fruit and vegetables and reared cattle on adjacent organic and nonorganic sites on a 725-acre farm attached to Newcastle University, and at other sites in Europe. They found that levels of antioxidants in milk from organic herds were up to 90% higher than in milk from conventional herds.

As well as finding up to 40% more antioxidants in organic vegetables, they also found that organic tomatoes from Greece had significantly higher levels of antioxidants, including flavo-noids thought to reduce coronary heart disease.

Leifert said the government was wrong about there being no difference between organic and conventional produce. “There is enough evidence now that the level of good things is higher in organics,” he said.

Letter from the Food Standards Agency | The Food Standards Agency's current stance on organic food

2007年10月26日 星期五


根據財團法人醫療評鑑暨醫療品質策進會日前最新電話抽樣調查發現,在最近一次探病經驗中,到醫院探病完前有洗手僅 2.2%、探病後有洗手近17%;值得留意的是,會主動提醒醫護人員洗手民眾約5成,認為沒必要的高達7成以上,而醫護人員提高洗手率,也成為近年來醫界 積極推動的方向。


衛 生署串連全國6大醫療區域,2007 年度病人安全週自10月21日起開始展開,分區舉辦病人安全週活動,宣導「洗手運動」,除了加強家屬、民眾探病時對於洗手更加重視,也鼓勵醫療機構醫護人 員參與洗手運動,衛生署指出,希望民眾支持洗手運動,日後打招呼不妨將見面問候語「吃飽未?」改成「洗手沒?」讓洗手成為全民運動。

參考 開刀房裡的沉思: 一位外科醫師的精進

Better: A Surgeon's Notes on Performance by Atul Gawande,

第一章 "禍手"


這本書的十一個故事大都圍繞著一個主題:要創造醫療佳績,醫學知識和技能固然重要,但有「心」、且勇於改變,才能更上層樓。譬如艾卜佳醫師,因為有 心,想出前所未有的評量表,來評估嬰兒的健康狀況,使產科的表現立刻有如脫胎換骨;又如渥偉克醫師,因為全心希望提昇囊腫纖維症的療效,不斷研究改進,他 所屬的費爾維大學兒童醫院在這方面的表現,始終領先全美所有醫院。其他如戮力消滅小兒麻痺、減少前線士兵死亡率、爭取每個早產兒的生存機會……莫不是本於 用心和勇於改變。


2007年10月21日 星期日

快餐“比海鹹”The great salt scandal




这 份由“盐分与健康共识行动组织”(Consensus Action on Salt and Health, Cash HC案:應該是CASH)进行的调查,共对包括汉堡王(Burger King)、肯德基(KFC)、麦当劳(McDonald’s)以及必胜客(Pizza Hut)食品在内的346种食品和饮料进行了调查。


可是,必胜客推出的“四人超级匹萨”(Pizza Plus meal for four)的含盐量高达12.3克,是成人日均食盐最高摄入量的2倍还多。

此外,肯德基“双人炸鸡套餐”(Deluxe Boneless Box)的含盐量也高达10.4克,平均每人5.2克。



必胜客4人套餐 (2个匹萨、小吃、奶酪蛋糕)
必胜客4人套餐 (主菜同上、配不同甜点)
肯德基双人套餐 (8小块炸鸡胸、2包鸡米花、炸薯条、黄豆、沙拉、百事可乐)
肯德基全家桶 (12块炸鸡,炸薯条,黄豆,沙拉、百事可乐)

英国盐分与健康共识行动组织(Cash)主席格雷厄姆•麦格雷戈(Graham MacGregor)教授谴责快餐行业在利益的驱使下,故意使用过量食盐让儿童习惯吃高盐食品。




The great salt scandal
Baked beans
Salt is a killer - we consume vast amounts and the government appears to be failing to force food and drink manufacturers to do anything to cut it down.

For the second time Health Minister Melanie Johnson rejected the food industry's voluntary plans for salt reduction calling them often too short on detail and specific actions.

Salt levels

From the plans submitted, she said, 50% of the products such as pizzas, breakfast cereals sandwiches and ready made meals will continue to contain unacceptably high levels of salt. So think again she said, but gave no sign of getting tough.

Kirsty Wark was joined in the studio by Professor Graham MacGregor from the Consensus Action on Salt and Health, Martin Paterson, the deputy Director General of the Food and Drink Foundation, and Melanie Johnson, the Public Health Minister.

Melanie Johnson, why won't you face the fact that the food industry will not take you seriously until you make a reduction of salt compulsory?


I think they are taking us seriously. Actually, they have been co-operating but we have not achieved enough progress yet. That is what I've gone back to them on. I have not gone back to them twice so far. This is the second time I've gone back to them, I've only gone back to them once before that, which is...

That is twice. We had you on in January when you were saying they had not done well enough.

They haven't done well enough historically. It is not linked up with the meetings with ministers, discussions about these things and an attempt to get clear plans from them.

You say 'attempt to get clear plans from them'. The last time round, you didn't get plans either. I would put to you that perhaps you are enthralled to the food industry, and you are reluctant to take any real, definite action that the voters can be comfortable with.

We are getting progress from them. It is not far enough. We have had only one round of discussions about this so far, the round taking place this year. That has got to the first set of salt plans from them, which I have said don't go far enough. We are going to ask them to come back now in September with a further round. I know some of them are already looking at what they can do in addition to what they have proposed. We believe we can make progress this way. It is in everybody's interests. Your report shows clearly what the damage is that salt is doing to people. It is not something we need in our diet. It is something that we can cut back easily. If there is voluntary co-operation across the industry, it is in their interests for consumers to live longer. It is in our interests for healthier patients.

But the point is that you are not making...if you are making headway, why make that announcement today? Martin Paterson, if you are doing so well, why are the Government very sceptical about your plans, and have said so very publicly today?


We have seen a particularly inept example of attempting to manage Government by headlines. We have been submitting detailed plans in some cases, and commitments in other cases that will have to be fulfilled through detailed work to reduce salt right across the range of foods. On the one hand, we have the Food Standards Agency applauding us and then on the other hand we have a bizarre front page of the Times this morning telling us we are not doing enough.

You've got the Minister there saying that the Food Standards Agency isn't applauding you. That's just nonsense.

The FSA produce the figures which we have used.

The Food Standards Agency have called for a one gram cut up to 2004. It seems even under admittedly wonky figures from this morning's newspapers, two thirds of that has been achieved. So it's all very strange.

Professor MacGregor, is it progress?


No, I'm afraid that Melanie Johnson and the Government, although I'm reluctant to say it, are right on this. The response from the food industry so far quite frankly, and we have looked carefully at it, has been pathetic. For every 10% reduction we would save 7,000 deaths a year from strokes and heart attacks. It could be done tomorrow. You could make a 15% reduction in all of these foods tomorrow; there would be no taste or safety problems, no technological problems. They could do it tomorrow. They haven't. As a result, 7,000 people died last year unnecessarily.

Why don't you do it tomorrow?

Well, I think that the Professor hasn't actually been running a food company. If we reduce salt in products and they stay on the shelf, that's no use to anybody, that does not help anybody's sales. We've got to...

But a 10% reduction, you can't...There are huge experiments in all sorts of things saying that you cannot detect 10% reductions. This is the rubbish we have had from the Food and Drink Federation again and again.

OK. Can I just bring this out...This is a meal deal. You can get these in any supermarket, this just happens to be Safeway. This meal deal here, this one sandwich, one packet of crisps and one bottle, amounts to 7 grams of fat. The Government is heading for six grams. How is that responsible of the food industry to produce sandwiches that have 4.3 grams of fat in them? Of course, at the price of £1.69, they are attractive.

I'm sure you mean salt. Nevertheless, you've got there a packet of crisps, that is a salty snack. You've got there a sandwich which will have salt...

Do you think it is a responsible combination for a retailer to be selling, and to be selling because it is a great deal?


You do? Why?

I would not recommend any individual meal was copied day after day. Over the course of a year, you will eat many things. We can manage our salt. But we do want to bring it down, and we are working towards that.

Melanie Johnson, the specific question is people don't know how much salt they are eating. It is often difficult to work it out. You have been asked this before. You always dodge it. Why are you so against stamping on the front of food what the salt content is?

That is one possible long-term answer to things.

Why long term?

The better answer is that the foodstuffs contain less salt, because a lot of people don't read the labelling, even when it contains more detail. What they do is buy products. A lot of the things that have a lot of salt in them are things that people eat as main staple foods.

But you heard Professor MacGregor saying a 10% cut in salt will be virtually negligible to the palate after about a week. Enforce it now, make it compulsory.

The fact is that we want it across the board. The food industry is in a position to deliver it across the board. It is in their interests to have healthy consumers as well. We believe it is in their interests to move on this. We are giving them one further period here in which they can come back to us with further reductions. I would entirely agree it won't make a difference from the point of view of consumers.

Let's ask you about that. You are so set on this idea that by September you want to see a different plan, a different level of planning, yet you are not saying publicly, after making all the brouhaha about it, you are not saying publicly what the sanction will be if they don't comply. What will the sanction be?

The sort of things that the Food Standards Agency has already done is to come out with some of the levels of salt in some of the products and to name and shame some of the manufacturers and products. We would rather not be going down that line. The main thing is to achieve the gains for people's health. That is the main thing.

Professor MacGregor, it seems to the uneducated ear here about levels of salt that actually the Government is markedly reluctant to make hard and fast rules.

Well, I think they're in a difficult position, because they could be called a nanny state and that. It is ridiculous to say it. People are unaware of the salt content of food, so how can they possibly cut it? I agree we need to label foods clearly, that's an important thing which could be done tomorrow...

So do I.

We need to cut the salt levels. We need the two things, better information to the public and at the same time cutting it. It should be done. I am torn between saying, 'yes we need to legislate', it would be difficult to do that. We need to really name and shame organisations like the Food and Drink Federation that represent things, the supermarkets. Why don't you do something and get there...people like you are in a position, the media, to get them to do it. Let me give you an example. We had a survey of sandwiches a few weeks ago. It highlighted a sandwich that had six grams of salt in it, it contained smoked salmon and crème fraiche. It now contains 2.2 grams. So that's a three-fold reduction in three weeks.

Why can't you make a commitment that no packaged sandwich will have more than 2.5 grams of salt? It is completely unnecessary for it to have more than that. Make a commitment.

Because that's not the case. It is completely unnecessary. First of all, people...

Because the food is not good enough and you have to mask it?

No, because people need to buy it and enjoy the taste. If you leave it on the shelf it's done nobody any good. Nevertheless, let me just make the point...

What you are saying, then, is education is not our role?

No, not at all. We have been calling for an education programme for the Food Standards Agency for two years. We've said we'll play our part. We have already, in the course of the last week, told the minister we would be happy to discuss how to proceed with labelling. We are making moves right across the board. As to naming and shaming the Food and Drink Federation, I'm here on the television, there is no secret. I'm happy to talk about the moves that our industry is making.

I'll ask you a specific question. I went onto the McDonald's website today. Of course it now says we sell this food and that food. It says the ingredients are, and the second one may be salt. It doesn't say how much salt. What is the point of that?

I cannot speak for an individual McDonald's project. What I do know is that we are making an enormous amount of change. It's not just 10%. In soups and sauces, right across the board, last year 10%, this year 10% with the guarantee of another 10%, if consumers accept it. We have made that commitment. It is being overseen by the Food Standards Agency to make sure it is right. In cereals, we have moved from 1998 by 16% and are going to push to 25% down by 2005. These are big figures...

Make it 75%, and they're not that big figures.

They are big figures. Consumers need to be able to accept the product.

OK, very briefly, does this really sound, Melanie Johnson, to you, as if you are getting the kind of commitment you need?

Well, I am looking forward to seeing more commitment, and that's what I've said in my letter, and I hope the food industry will go away and reflect on their response. The latest salt figures show that salt is continuing to rise in our diets. It is a serious health issue. We won't notice if it's reduced across the board in a stepped process. We want to see more commitment with more reductions over a swift period of time to get where we want to more rapidly.

No, you're pushing on an open door...

Thank you very much indeed. It's enough to harden your arteries.

This transcript was produced from the teletext subtitles that are generated live for Newsnight. It has been checked against the programme as broadcast, however Newsnight can accept no responsibility for any factual inaccuracies. We will be happy to correct serious errors.

2007年10月20日 星期六

the best hope lies in prevention and early detection


Gains Against Cancer

Published: October 20, 2007

Leading cancer organizations reported last week that mortality rates dropped an average of 2.1 percent a year between 2002 and 2004, almost double the average annual decrease from 1993 to 2002. That is a stunning reversal of the relentless increase in cancer death rates seen in the decades before the 1990s. The turnaround appears to be mainly a triumph in prevention and early detection rather than dazzling medical cures.

The main factor in the accelerated decline was a drop in the death rate from colorectal 節腸直腸cancer in men and women, mostly attributable to more widespread colonoscopy screening. The report also noted longer-term declines in the death rates from lung cancer in men, mostly because of reduced smoking; prostate cancer in men, for reasons that are unclear; and breast cancer in women, attributable to screening mammography and a large-scale exodus of women from the use of hormone replacement therapy.

There is clearly room for improvement. Only about half of American adults over 50 have been screened for colorectal cancer, far less than the percentage of women screened for cervical and breast cancer. Welcome as these gains may be, they pale in comparison with the remarkable turnaround in cardiovascular disease. By 2004, the death rate from coronary heart disease was 66 percent lower than in 1950, and the death rate from strokes was 72 percent lower. These gains have been attributed to impressive therapeutic advances and to lifestyle changes.

Although there have been improvements in treating cancer, only a minority of patients can be treated effectively once cancer has spread from its original site to distant points in the body. For now, the best hope lies in prevention and early detection.

2007年10月17日 星期三

In Diabetes, a Complex of Causes

In Diabetes, a Complex of Causes

Richard Perry/The New York Times

Down to the Bones Working with mice, Dr. Gerard Karsenty of Columbia University found that a hormone released from bone may help regulate blood glucose.

Published: October 16, 2007

An explosion of new research is vastly changing scientists’ understanding of diabetes and giving new clues about how to attack it.

Skip to next paragraph

Health Guide

Life Sciences Institute/ University of Michigan

Study Fat tissue from a mouse that was fed a high-fat diet.

The fifth leading killer of Americans, with 73,000 deaths a year, diabetes is a disease in which the body’s failure to regulate glucose, or blood sugar, can lead to serious and even fatal complications. Until very recently, the regulation of glucose — how much sugar is present in a person’s blood, how much is taken up by cells for fuel, and how much is released from energy stores — was regarded as a conversation between a few key players: the pancreas, the liver, muscle and fat.

Now, however, the party is proving to be much louder and more complex than anyone had shown before.

New research suggests that a hormone from the skeleton, of all places, may influence how the body handles sugar. Mounting evidence also demonstrates that signals from the immune system, the brain and the gut play critical roles in controlling glucose and lipid metabolism. (The findings are mainly relevant to Type 2 diabetes, the more common kind, which comes on in adulthood.)

Focusing on the cross-talk between more different organs, cells and molecules represents a “very important change in our paradigm” for understanding how the body handles glucose, said Dr. C. Ronald Kahn, a diabetes researcher and professor at Harvard Medical School.

The defining feature of diabetes is elevated blood sugar. But the reasons for abnormal sugar seem to “differ tremendously from person to person,” said Dr. Robert A. Rizza, a professor at the Mayo Clinic College of Medicine. Understanding exactly what signals are involved, he said, raises the hope of “providing the right care for each person each day, rather than giving everyone the same drug.”

Last summer, researchers at Columbia University Medical Center published startling results showing that a hormone released from bone may help regulate blood glucose.

When the lead researcher, Dr. Gerard Karsenty, first described the findings at a conference, the assembled scientists “were overwhelmed by the potential implications,” said Dr. Saul Malozowski, senior adviser for endocrine physiology research at the National Institute of Diabetes and Digestive and Kidney Diseases, who was not involved in the research. “It was coming from left field. People thought, ‘Oof, this is really new.’

“For the first time,” he went on, “we see that the skeleton is actually an endocrine organ,” producing hormones that act outside of bone.

In previous work, Dr. Karsenty had shown that leptin, a hormone produced by fat, is an important regulator of bone metabolism. In this work, he tested the idea that the conversation was a two-way street. “We hypothesized that if fat regulates bone, bone in essence must regulate fat,” he said.

Working with mice, he found that a previously known substance called osteocalcin, which is produced by bone, acted by signaling fat cells as well as the pancreas. The net effect is to improve how mice secrete and handle insulin, the hormone that helps the body move glucose from the bloodstream into cells of the muscle and liver, where it can be used for energy or stored for future use. Insulin is also important in regulating lipids.

In Type 2 diabetes, patients’ bodies no longer heed the hormone’s directives. Their cells are insulin-resistant, and blood glucose levels surge. Eventually, production of insulin in the pancreas declines as well.

Dr. Karsenty found that in mice prone to Type 2 diabetes, an increase in osteocalcin addressed the twin problems of insulin resistance and low insulin production. That is, it made the mice more sensitive to insulin and it increased their insulin production, thus bringing their blood sugar down. As a bonus, it also made obese mice less fat.

If osteocalcin works similarly in humans, it could turn out to be a “unique new treatment” for Type 2 diabetes, Dr. Malozowski said. (Most current diabetes drugs either raise insulin production or improve insulin sensitivity, but not both. Drugs that increase production tend to make insulin resistance worse.)

A deficiency in osteocalcin could also turn out to be a cause of Type 2 diabetes, Dr. Karsenty said. Another recent suspect in glucose regulation is the immune system. In 2003, researchers from two laboratories found that fat tissue from obese mice contained an abnormally large number of macrophages, immune cells that contribute to inflammation. The finding piqued the curiosity of researchers. “I remember reading the paper and thinking: ‘Wow, look at all those macrophages. What are they doing?’” said Dr. Jerrold M. Olefsky of the University of California, San Diego, School of Medicine.

Scientists have long suspected that inflammation was somehow related to insulin resistance, which precedes nearly all cases of Type 2 diabetes. In the early 1900s, diabetics were sometimes given high doses of aspirin, which is an anti-inflammatory, Dr. Olefsky said.

Only in the past few years has research into the relationship of obesity, inflammation and insulin resistance become “really hot,” said Dr. Alan R. Saltiel, director of the Life Sciences Institute at the University of Michigan.

Many researchers agree that obesity is accompanied by a state of chronic, low-grade inflammation in which some immune cells are activated, and that that may be a primary cause of insulin resistance. They also agree that the main type of cell responsible for the inflammation is the macrophage, Dr. Saltiel said.

But major questions remain, he said: “Why are these macrophages attracted to fat, liver and muscle in the first place? What are they doing? What are they secreting? What other immune cells are in there?”

New research also suggests that “not all macrophages are created equal,” added Dr. Saltiel. There appear to be “good ones and bad ones” competing in fat tissue, with potentially large consequences for inflammation and diabetes.

Meanwhile, the promise of anti-inflammatory compounds as treatment continues to attract attention. “Certain cellular anti-inflammatory proteins may now be important new targets for drug discovery for diabetes treatment,” Dr. Olefsky said. But damping down the immune system is also potentially risky, he noted, adding: “If you’re inhibiting the macrophage inflammatory pathway, that’s good for insulin resistance and diabetes. But it might not be so good for your susceptibility to infections.” A major goal is to develop a drug that quashes only the specific component of macrophage inflammation that leads to insulin resistance, without causing other side effects.

One class of current medications, called thiazolidinediones, may work in part by reducing inflammation, which may in turn improve insulin sensitivity. But an example from this class, the drug Avandia, was also found to increase the risk of heart attacks.

Another participant in the glucose conversation is the brain. Its role has long been suspected. More than a century ago, the French physiologist Claude Bernard suggested that the brain was important in blood sugar regulation. He punctured the brains of experimental animals in specific areas and managed to derange their blood sugar metabolism, making them diabetic.

But for years, virtually no one followed up on this finding, said Dr. Kahn, of Harvard.

People thought about glucose as a critical fuel for the brain, Dr. Kahn said, but did not explore the brain’s role in glucose regulation.

Only recently, with more advanced laboratory techniques, has this role been definitively established and expanded upon.

Today’s genetic techniques, said Dr. Rizza, at the Mayo Clinic, are what have “really driven the process.”

For instance, once scientists developed the ability to manipulate mice so that they lacked particular receptors in specific tissues, they could show that mice without insulin receptors in the brain could not regulate glucose properly and went on to develop diabetes, said Dr. Kahn, whose laboratory published this groundbreaking work in 2000.

Other researchers have shown that free fatty acids, as well as the hormone leptin, produced by fat tissue, signal directly to a part of the brain called the hypothalamus, which also regulates appetite, temperature and sex drive.

And several recent papers suggest that direct signaling by glucose itself to neurons in the hypothalamus is also crucial to normal blood sugar regulation in mice.

“If the brain is getting the message that you have adequate amounts of these hormones and nutrients, it will constrain glucose production by the liver and keep blood glucose relatively low,” said Dr. Michael W. Schwartz, a professor at the University of Washington. But if the brain senses inadequate amounts, he continued, it will “activate responses that cause the liver to make more glucose, and new evidence suggests that this contributes to diabetes and impaired glucose metabolism.”

The brain, therefore, appears to be listening to — and weighing and making sense of — a chorus of signals from insulin, leptin, free fatty acids and glucose itself. In response, it appears to send signals to liver and muscle cells by way of several nerves, though additional mechanisms are probably involved. The gut also seems to chime in, said Dr. Rizza, adding that for him, this aspect of sugar regulation came as “the biggest gee whiz of all.”

“Food comes in through the gut, so of course you should look there” for molecules involved in glucose regulation, he said. “But few people realized this until very recently.”

Hormones from the small intestine called incretins turn out to talk directly with the brain and pancreas in ways that help reduce blood sugar and cause animals and people to eat less and lose weight, Dr. Rizza said.

Numerous molecules that mimic incretins or prevent them from being degraded are in clinical trials. Two such drugs have been approved by the Food and Drug Administration: Byetta, an incretin mimic, from Amylin Pharmaceuticals and Eli Lilly; and Januvia, from Merck, which inhibits the destruction of the incretin GLP1. (Dr. Rizza is an adviser to Merck but says all consulting fees go to the Mayo Clinic for education and research.)

Still, it can be hard to predict how different drugs will interact in the body. And many promising candidates will turn out to have side effects — chattering helpfully with one organ, but problematically with another.

“The picture is becoming more and more complicated,” Dr. Saltiel said. “And let’s face it, it was pretty complicated before.”

2007年10月14日 星期日

嬰兒猝死病cot death



文章指出,這項由英國布裡斯托大學兒童生命與健康研究所完成的報告,是在21項嬰兒猝死 國際研究項目的基礎上完成的。


cot Show phonetics
noun [C]
1 UK (US crib) a small bed for a baby or young child with high bars round the sides so that the child cannot fall out

2 US FOR camp bed

cot death noun [C or U] (SPECIALIZED SIDS)
the sudden death of a baby while it is sleeping for no obvious reason

Unlocking the secrets of cot death

Exclusive: A major new report seen by the IoS has revealed that smoking holds the key to a mystery that has baffled doctors and brought heartache to thousands. By Roger Dobson and Senay Boztas

Published: 14 October 2007

Nine out of 10 mothers whose babies suffered cot death smoked during pregnancy, according to a scientific study to be published this week. The study, thought to be one of the most authoritative to date on Sudden Infant Death Syndrome (SIDS), says women who smoke during pregnancy are four times more likely than non-smokers to see their child fall victim to cot death.

The comprehensive report will make a strong case for the Government to increase the scope of anti-smoking legislation. It even suggests a possible move to try to ban pregnant women from getting tobacco altogether.

The study, produced by Bristol University's Institute of Child Life and Health, is based on analysis of the evidence of 21 international studies on smoking and cot death. The report, co-authored by Peter Fleming, professor of infant health and developmental physiology, and Dr Peter Blair, senior research fellow, will be published this week in the medical journal Early Human Development.

The report urges the Government "to emphasise the adverse effects of tobacco smoke exposure to infants and among pregnant women". It also warns that this year's ban on smoking in public places must not result in an increased exposure of infants or pregnant woman at home – smoking in their presence should be seen as being "anti-social, potentially dangerous, and unacceptable".

The study points out that many mothers and mothers-to-be have not heeded warnings about smoking and may need to have their access to tobacco restricted. "Given the power that tobacco addiction holds over its victims, there is grave concern as to whether it will be a successfully modifiable risk factor without fundamental changes in tobacco availability to vulnerable individuals," it states.

Scientists are working to the theory that exposure to smoke during the pregnancy or just after birth has an effect on brain chemicals in the foetus or in infants, increasing the risk of SIDS.

The Government is considering whether it should change its advice on smoking. It recommends that pregnant women should not drink alcohol at all, but simply recommends that mothers and fathers "cut smoking in pregnancy".

These findings will add weight to calls from doctors earlier this year for a ban on parents smoking indoors where children are present. Professor Robert West, of University College London, the Government's most senior smoking adviser, said: "We can apply powerful social pressure on parents not to smoke in the house."

Speaking about the new report, Dr Blair said: "If smoking is a cause of SIDS, and the evidence suggests it is, we think that if all parents stopped smoking tomorrow more than 60 per cent of SIDS deaths would be prevented."

According to the Foundation for the Study of Infant Deaths (FSID), at least 300 babies in the UK each year die suddenly and unexpectedly, mostly between the ages of one month and four months. SIDS is the biggest killer of babies over a month old, claiming more deaths than traffic accidents, leukaemia and meningitis put together.

The issue has prompted a number of high-profile criminal convictions against mothers such as Angela Cannings and Sally Clark. Mrs Cannings suffered the deaths of three babies who died in their cribs. Mrs Clark had two infants who were taken by SIDS. Both women were jailed but later had their convictions overturned and were released in 2003. Mrs Cannings, whose family smoked, was too upset by personal matters to comment yesterday on the findings of this latest study. Mrs Clark, a non-smoker, died last March.

Although scientists are still trying to understand precisely why babies die so young, medical research is providing effective steps that parents can take to reduce the risk of it happening.

Anti-smoking messages have provided some benefits: in the past 15 years, researchers found that the proportion of smokers among all pregnant mothers in the UK has fallen from 30 to 20 per cent.

Nevertheless, according to another study, in 1984 57 per cent of babies who died from SIDS had mothers who smoked during pregnancy. This had increased to 86 per cent by 2003. It is thought that the huge rise in the proportion of SIDS mothers who smoke is at least to some degree a result of the Back to Sleep campaign which was launched in 1991, and which appears to have had a dramatic effect in reducing cot death.

The key message of this campaign was that parents should put their baby on its back to sleep. Since then, the number of SIDS deaths has fallen by three-quarters. The proportion of SIDS babies found lying face down has fallen from 89 per cent to 24 per cent.

The campaign has also changed the social profile of parents whose infants have died from SIDS. Before the Back to Sleep campaign, fewer than half were from lower socio-economic classes, considered to be "deprived". Now, this proportion has risen to 74 per cent.

The researchers now believe that laying babies face down has been largely removed as the main reason for SIDS. The remaining primary dangers are exposure to tobacco smoke and other factors possibly linked to deprivation.

"The risk of unexpected infant death is greatly increased by both prenatal and postnatal exposure to tobacco smoke," said Dr Blair. "We should aim to achieve a 'smoke-free zone' around pregnant women and infants.

"Reduction of prenatal exposure to tobacco smoke, by reducing smoking in pregnancy, and of postnatal exposure to tobacco, by not allowing smoking in the home, will substantially reduce the risk of SIDS."

There are a number of theories to explain how smoking could affect the baby. Babies exposed to tobacco could have breathing problems. Lung development in the growing foetus could be hindered. Another theory is that levels of brain chemicals are affected by smoke exposure.

"Exposure to tobacco smoke, either prenatally or postnatally, will lead to a complex range of effects upon normal physiological and anatomical development in foetal and postnatal life, together with an increased incidence of acute viral infection that places infants at greatly increased risk of SIDS," says the Bristol University study.

Deborah Arnott, the director of ASH, the anti-smoking charity, said that this report should provoke a strong government campaign to highlight the risks of women smoking while pregnant, and of parents smoking in the home.

"Because of other advice on avoiding cot death, smoking has become an increasingly important trigger and we are very concerned that there is a lack of understanding of how important it is," she said.

A YouGov poll commissioned for ASH at the end of August showed only 17 per cent of respondents thought second-hand smoke had a big impact on cot-death risk, and 26 per cent that it had "some impact". But Ms Arnott does not believe the public ban will necessarily increase smoking at home. She added: "About 85 per cent of smoke is invisible and people think it isn't having an impact if they smoke in a room where the baby isn't, but it moves around the house. Our advice is, if you have a baby and cannot give up, don't smoke in the home or car and use nicotine gum or patches for cravings. Being realistic, banning smoking in the home isn't something we can do."

Catherine Parker-Littler, a midwife and founder of midwivesonline.com, said that her confidential service has received emails from smokers who lost infants to cot death. "In our 'Ask a Midwife' service, we have definitely had emails from a small number of parents who smoke about their experience in terms of a cot death," she said. "Some are about feelings of guilt."

A spokeswoman from the Department of Health said: "This is an interesting report which we will study carefully and consider whether we need to change our advice. At the moment, our advice on how best to reduce the chances of cot death is based on the best available scientific evidence. We advise parents to cut out smoking in pregnancy and not to share a bed with your baby if you are a smoker."

Falsely accused: Bereaved – and then tried for murder

The court cases of Angela Cannings and Sally Clark became bywords for miscarriages of justice after both were wrongly convicted of murdering their children.

Ms Cannings, from Salisbury in Wiltshire, was jailed for life in April 2002 after she was found guilty of smothering her two sons, seven-week old Jason in 1991 and 18-week-old Matthew in 1999.

Ms Cannings, 43, maintained her babies died from Sudden Infant Death Syndrome (SIDS) and was eventually freed in 2003. Her marriage has since broken down and she has left the family home. During her appeal, Professor Robert Carpenter, a medical statistics expert, said the babies had been at a "substantially increased risk" of cot deaths because they may have been exposed to cigarette smoke.

"The Cannings family smoked and the children slept prone," he told the Court of Appeal in 2003.

But the link between smoking and cot death is not a certainty, as the case of Sally Clark shows.

Mrs Clark, who died in March at the age of 42, was jailed for life in 1999 for murdering her two sons, eight-week old Harry and 11-week-old Christopher. Her conviction was finally overturned in 2003.

The Clarks were affluent non-smokers, factors that led Professor Sir Roy Meadow, a consultant paediatrician and expert witness in both trials, to wrongly conclude that the chances of two cot deaths in such a family was "one in 73 million".

Mrs Clark was released after a second appeal found her children had died of natural causes. She never recovered from her ordeal.

Ian Griggs

2007年10月11日 星期四


How Data on Cancer Are Collected and Used

Published: October 10, 2007 紐約時報

Every state has a law requiring it to have a cancer surveillance program and collect specific information about every patient whose cancer was diagnosed by a doctor in that state.

Although most patients are not aware of the programs, doctors and hospitals are. They provide the patient data, which include the name, address, age and race of every patient, as well as information on the type of tumor and its spread. The federal government helps pay for the registries and coordinates the aggregation of state data but does not have the legal authority to collect the data itself.

Seventeen regions, covering 26 percent of the population, also provide detailed information to the National Cancer Institute, which uses the data to provide a snapshot of the nation’s cancer rates and to track cancer nationally.

This program follows patients from the time their cancers are diagnosed until the time they die, and is the way survival rates are calculated. The cancer institute program also follows patients to see whether they develop a second cancer. And the data are used to identify differences in care and outcomes among people of different racial, ethnic and socioeconomic groups.

Different state registries use their data in different ways. Some just count cancer cases and provide summary reports. Others, including the 17 regions that are part of the cancer institute’s network, do much more, investigating cancer risk factors and outcomes. They provide data to academic researchers who are doing studies and need to interview patients or need genetic information. But first, the registries review the studies for scientific merit and make sure the study has been approved by at least one ethics panel.



2007年10月9日 星期二


October 7, 2007
Carbophobia By GINA KOLATA
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Challenging the Conventional Wisdom on Diet, Weight Control, and Disease.
By Gary Taubes.
601 pp. Alfred A. Knopf. $27.95.
Gary Taubes is a brave and bold science journalist who does not accept conventional wisdom. In “Good Calories, Bad Calories,” he says what he wants is a fair hearing and rigorous testing for ideas that might seem shocking.
His thesis, first introduced in a much-debated article in The New York Times Magazine in 2002 challenging the low-fat diet orthodoxy, is that nutrition and public health research and policy have been driven by poor science and a sort of pigheaded insistence on failed hypotheses. As a result, people are confused and misinformed about the relationship between what they eat and their risk of growing fat. He expands that thesis in the new book, arguing that the same confused reasoning and poor science has led to misconceptions about the relation between diet and heart disease, high blood pressure, cancer, dementia, diabetes and, again, obesity. When it comes to determining the ideal diet, he says, we have to “confront the strong possibility that much of what we’ve come to believe is wrong.” The best diet, he argues, is one loaded with protein and fat but very low in carbohydrates.
Taubes spent five years working on the book, which runs to more than 450 pages. The bibliography alone goes on for more than 60 pages. He also says he interviewed more than 600 doctors, researchers and administrators, though he adds that “the appearance of their names in the text ... does not imply that they agree with all or even part of the thesis set forth in this book.” Taubes does not bow to the current fashion for narrative nonfiction, instead building his argument case by case, considering the relationship between dietary fat and heart disease, carbohydrates and disease, diet and obesity. As a result, the book can be hard to read, tedious in many places and repetitious.
Yet much of what Taubes relates will be eye-opening to those who have not closely followed the science, or lack of science, in this area. (Disclosure: At one point he approvingly cites my articles on the lack of evidence that a high-fiber diet protects against colon cancer.) For example, he tells the amazing story of how the idea of a connection between dietary fat, cholesterol and heart disease got going and took on a life of its own, despite the minimal connection between dietary cholesterol and blood cholesterol for most people. He does not mince words. “From the inception of the diet-heart hypothesis in the early 1950s, those who argued that dietary fat caused heart disease accumulated the evidential equivalent of a mythology to support their belief. These myths are still passed on faithfully to the present day.” The story is similar for salt and high blood pressure, and for dietary fiber and cancer.
In fact, Taubes convincingly shows that much of what is believed about nutrition and health is based on the flimsiest science. To cite one minor example, there’s the notion that a tiny bit of extra food, 50 or 100 calories a day — a few bites of a hamburger, say — can gradually make you fat, and that eating a tiny bit less each day, or doing something as simple as walking a mile, can make the weight slowly disappear. This idea is based on a hypothesis put forth in a single scientific paper, published in 2003. And even then it was qualified, Taubes reports, by the statement that it was “theoretical and involves several assumptions” and that it “remains to be empirically tested.” Nonetheless, it has now become the basis for an official federal recommendation for obesity prevention.
But the problem with a book like this one, which goes on and on in great detail about experiments new and old in areas ranging from heart disease to cancer to diabetes, is that it can be hard to know what has been left out. For example, Taubes argues at length that people get fat because carbohydrates in their diet drive up the insulin level in the blood, which in turn encourages the storage of fat. His conclusion: all calories are not alike. A calorie of fat is much less fattening than a calorie of sugar.
It’s known, though, that the body is not so easily fooled. Taubes ignores what diabetes researchers say is a body of published papers documenting a complex system of metabolic controls that, in the end, assure that a calorie is a calorie is a calorie. He also ignores definitive studies done in the 1950s and ’60s by Jules Hirsch of Rockefeller University and Rudolph Leibel of Columbia, which tested whether calories from different sources have different effects. The investigators hospitalized their subjects and gave them controlled diets in which the carbohydrate content varied from zero to 85 percent, and the fat content varied inversely from 85 percent to zero. Protein was held steady at 15 percent. They asked how many calories of what kind were needed to maintain the subjects’ weight. As it turned out, the composition of the diet made no difference.
As I read Taubes’s book, I kept wondering how he would deal with an obvious question. If low-carbohydrate diets are so wonderful, why is anyone fat? Most people who struggle with their weight have tried these diets and nearly all have regained everything they lost, as they do with other diets. What is the problem?
On Page 446, he finally tells us. Carbohydrates, he says, are addictive, and we’ve all gotten hooked. Those who try to break the habit start to crave them, just as an alcoholic craves a drink or a smoker craves a cigarette. But, he adds, if they are addictive, that “implies that the addiction can be overcome with sufficient time, effort and motivation.”
I’m sorry, but I’m not convinced.
Gina Kolata is a medical reporter for The Times and the author of “Rethinking Thin: The New Science of Weight Loss and the Myths and Realities of Dieting.”

2007年10月4日 星期四


(Gas Chromatograph:GC)/質量分析法(GC/MS)--日本似乎已有產品


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GCMS(ガス・クロマトグラフを直結した質量分析計)は、有機物が混合した物質の組成を検討するのに、きわめて有力な分析装置である。 ガスクロマトグラフ GCは、 ...

GC-MS // ガスクロマトグラフ質量分析計 :島津製作所

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英國開放大學和倫敦衛生和熱帶醫學院共同承擔的這個科研項目,將使用一個為"獵犬二號"(Beagle 2)火星探測器製造的微型檢測裝置。










Marital Spats, Taken to Heart

Nola Lopez

Published: October 2, 2007

Arguing is an inevitable part of married life. But now researchers are putting the marital spat under the microscope to see if the way you fight with your spouse can affect your health.

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Tara Parker-Pope blogs daily about health.

Go to Well »

Recent studies show that how often couples fight or what they fight about usually doesn’t matter. Instead, it’s the nuanced interactions between men and women, and how they react to and resolve conflict, that appear to make a meaningful difference in the health of the marriage and the health of the couple.

A study of nearly 4,000 men and women from Framingham, Mass., asked whether they typically vented their feelings or kept quiet in arguments with their spouse. Notably, 32 percent of the men and 23 percent of the women said they typically bottled up their feelings during a marital spat.

In men, keeping quiet during a fight didn’t have any measurable effect on health. But women who didn’t speak their minds in those fights were four times as likely to die during the 10-year study period as women who always told their husbands how they felt, according to the July report in Psychosomatic Medicine. Whether the woman reported being in a happy marriage or an unhappy marriage didn’t change her risk.

The tendency to bottle up feelings during a fight is known as self-silencing. For men, it may simply be a calculated but harmless decision to keep the peace. But when women stay quiet, it takes a surprising physical toll.

“When you’re suppressing communication and feelings during conflict with your husband, it’s doing something very negative to your physiology, and in the long term it will affect your health,” said Elaine Eaker, an epidemiologist in Gaithersburg, Md., who was the study’s lead author. “This doesn’t mean women should start throwing plates at their husbands, but there needs to be a safe environment where both spouses can equally communicate.”

Other studies led by Dana Crowley Jack, a professor of interdisciplinary studies at Western Washington University in Bellingham, Wash., have linked the self-silencing trait to numerous psychological and physical health risks, including depression, eating disorders and heart disease.

Keeping quiet during a fight with a spouse is something “we all have to do sometimes,” Dr. Jack said. “But we worry about the people who do it in a more extreme fashion.”

The emotional tone that men and women take during arguments with a spouse can also take a toll on their health. Utah researchers have videotaped 150 couples to measure the effect that marital arguing style has on heart risk. The men and women were mostly in their 60s, had been married on average for more than 30 years and had no signs of heart disease. The couples were given stressful topics to discuss, like money or household chores, and the comments made during the ensuing arguments were categorized as warm, hostile, controlling or submissive. The men and women also underwent heart scans to measure coronary artery calcium, an indicator of heart disease risk.

The researchers found that the style of argument detected in the video sessions was a powerful predictor for a man or woman’s risk for underlying heart disease. In fact, the way the couple interacted was as important a heart risk factor as whether they smoked or had high cholesterol, says Timothy W. Smith, a psychology professor at the University of Utah, who presented the study last year to the American Psychosomatic Society.

For women, whether a husband’s arguing style was warm or hostile had the biggest effect on her heart health. Dr. Smith notes that in a fight about money, for instance, one man said, “Did you pass elementary school math?” But another said, “Bless you, you are not so good with the checkbook, but you’re good at other things.” In both exchanges, the husband was criticizing his wife’s money management skills, but the second comment was infused with a level of warmth. In the study, a warm style of arguing by either spouse lowered the wife’s risk of heart disease.

But arguing style affected men and women differently. The level of warmth or hostility had no effect on a man’s heart health. For a man, heart risk increased if disagreements with his wife involved a battle for control. And it didn’t matter whether he or his wife was the one making the controlling comments. An example of a controlling argument style showed up in one video of a man arguing with his wife about money. “You really should just listen to me on this,” he told her.

What’s particularly notable about the study is that the men and women filled out standard questionnaires about the quality of their relationships, but those answers were not a good predictor of cardiovascular risk. The difference in risk showed up only when the quality of the couple’s bickering style was assessed.

“Disagreements in a marriage are inevitable, but it’s how you conduct yourself,” Dr. Smith said. “Can you do it in a way that gets your concerns addressed, but without doing damage at the same time? That’s not an easy mark to hit for some couples.”

2007年10月3日 星期三














慢性疲勞綜合症,又稱肌痛性腦脊髓炎(myalgic encephalomyelitis,ME)是指疲勞引起的一種長期疲乏無力狀態,而且不能通過臥床休息而緩解,在精神或體能勞動之後更為明顯。