2011年2月28日 星期一

No repairs after CTV building damaged in 2010 quake

No repairs after CTV building damaged in 2010 quake


photoThe Canterbury Television building in Christchurch collapsed in the Feb. 22 earthquake. Sources say the building was damaged in an earlier quake. (Shiro Nishihata)photoWorkers remove a pillar on Saturday from the rubble where the Canterbury Television building stood in Christchurch. (Shiro Nishihata)

CHRISTCHURCH, New Zealand--The Canterbury Television building was damaged in a 2010 earthquake, but suggested reinforcements were not conducted before it was flattened last week by another temblor, trapping an estimated 100 people, local people said.

Architectural engineers had warned that some quake-proofing would be necessary for the six-story CTV building after the temblor in September 2010, but the owner of the building apparently decided that it was safe enough.

In addition, Christchurch municipal authorities said they found no problem with the continued use of the building following an inspection after the September quake.

The CTV building, erected in 1975, collapsed in the magnitude-6.3 earthquake on Feb. 22.

Many Japanese studying at the King's Education language school in the building are among those missing in the rubble.

New Zealand police on Sunday asked various countries to collect DNA samples, photographs and other items that could help identify the bodies pulled from the wreckage, according to diplomatic sources.

The Japanese government has started full-fledged efforts to gather information from families of the missing Japanese.

According to Rob Cope-Williams, 61, a CTV producer and newscaster, large cracks, some several meters long, formed on the interior walls of the building following the magnitude-7.0 quake in September.

A three-story building behind the CTV building was severely damaged, and demolition work began in December.

Cope-Williams said shockwaves from the wrecking ball caused many cracks to widen in the CTV building, raising concerns among CTV employees that the building would not survive another quake.

The demolition work was completed Feb. 21, the day before the latest temblor.

A Christchurch resident who provided boarding for an international student studying at King's said many students appeared worried by the fact that the window frames had been left crooked.

Others suggested the building may have shifted off its foundation.

According to a source at an architectural business operating near the CTV building, one of its associates inspected the structure following the September quake after receiving permission from the proprietor of the building.

The associate's report said some reinforcement work would be necessary for the building to withstand future quakes. But the building's proprietor did not seek further detailed information needed to carry out the reinforcement work, the source said.

According to Cope-Williams, no reinforcement work had been done. He said he had heard that the building's owner decided that the building was safe.

Hideki Miyamoto, head of a U.S.-based architectural design office specializing in quake-resistance structures, has dispatched a team of inspectors to survey the latest damage in Christchurch.

He said the inspectors reported that the amount of steel reinforcement in concrete samples collected at the CTV building site fell short of the requirements in the current quake-resistance standards.

The team also noted a lack of horizontal steel braces to bind the steel bars and keep them in place, Miyamoto said.

According to quake experts, New Zealand strengthened its quake-resistance standards in 1976, requiring builders to prepare for seismic motion several times the assumed intensity at the time.

Municipal officials acknowledged that buildings erected before 1976 likely had less than one-third of the required strength under the new standards.

Christchurch officials said that following the September earthquake, the city was in the process of reinforcing buildings built before 1976, but the CTV building had been declared safe in an inspection by the city.

Christchurch Mayor Bob Parker told reporters Saturday that he was confident that appropriate measures had been taken based on the findings of the inspection.

But he added that he was not aware of the cracks in the interior walls, and said his office would check once more on the matter.

(This article was written by Hiroyuki Kamisawa, Tsuyoshi Nagano and Daisuke Igarashi)

2011年2月26日 星期六


漫畫來源: Ted Goff

2011年2月24日 星期四

Melatonin production falls if the lights are on 亮燈會減少製造褪黑激素

《中英對照讀新聞》Melatonin production falls if the lights are on 亮燈會減少製造褪黑激素


Melatonin production falls if the lights are on


Having the lights on before bedtime could result in a worse night’s sleep, according to a study to be published in the Journal of Endocrinology and Metabolism. The research shows that the body produces less of the sleep hormone melatonin when exposed to light.


Sleep patterns have been linked to some types of cancer, blood pressure and diabetes. The US researchers also found lower melatonin levels in shift workers. The pinal gland produces melatonin through the night and starts when darkness falls.


Researchers have shown that switching on lights in the home switches off the hormone’s production. In the study, 116 people spent five days in room where the amount of light and sleep was controlled. They were awake for 16 hours and asleep for eight hours each day. Initially the patients were exposed to 16 hours of room light during their waking hours. They were then moved onto eight hours of room light in the morning and eight hours of dim light in the evening.


The researchers found that electrical light between dusk and bedtime strongly suppressed melatonin levels. With dim light, melatonin was produced for 90 minutes more a day.



shift:名詞,輪班。例句:Are you on the night shift or the day shift(= Do you work during the night period or the day period)?(你是上夜班還是日班?)

switch on/off:片語,開啟/關閉。例句:switch the TV off/on (把電視關起來/打開)

supress:動詞,壓抑。例句:She couldn’t suppress her anger/delight.(她沒辦法壓抑怒氣/喜悅。)

一口氣喝下三分之二瓶的高粱 導致心臟麻痺

3年前 2008

之前報導過,東海大學,有位女學生,和五個男生相約喝酒,因為,她一口氣喝下三分之二瓶的高粱,結果不幸猝死,後來,五個男生被依過失致死罪起訴,女學生 的爸爸,還要求和解金,要提高到六百萬。照片中的女學生。東海大學日文系。清秀的臉龐甜美的笑容。原本有大好的前途。但三年前一個晚上。和五名男大學生相 約喝酒。大夥起鬨打賭如果她喝的完一瓶高。就給她六百塊。女學生一口氣就灌下三分之二瓶。這一瓶高濃度58%。女學生當場臉色發白頭昏想吐。回到宿舍後隔 天就沒再起來。死因是喝酒過量導致心臟麻痺。

當時五名大學生都被依過失致死起訴。其中一名台灣體大學生覺得很冤枉。男大生認為沒有逼迫。女學生沒有評估自 己的酒量。好不容易才和女學生媽媽。達成一百八十萬的和解。還有機會可以判緩刑。但現在又有變數了。法院開庭時。女大生的爸爸從大陸趕回來。表示無法接 受。要求提高和解金到六百萬。雙方和解破局。五名男大學生的刑度輕重可能受到影響。因為好玩拼酒。害死女學生。也害自己可能要被關‧。

Solar Energy Faces Tests On Greenness

Biologists from BrightSource Energy scan vegetation for desert tortoises in the Mojave Desert. Many of the areas planned for solar development in California are in fragile landscapes.
Isaac Brekken for The New York Times

Solar Energy Faces Tests On Greenness

Five solar thermal projects in California are being challenged in court by an assortment of groups. Above, Biologists scan for tortoises in the Mojave Desert.

Weak spot in Christchurch is its brick buildings「地震による死者、92人に」

Weak spot in Christchurch is its brick buildings


photoSearch efforts were temporarily halted Wednesday but later resumed in the building where a group from Toyama College of Foreign Languages was studying. (Shiro Nishihata)photoCars crushed by rubble in the streets of Christchurch (Shiro Nishihata)

For the southern New Zealand city of Christchurch, its stone and brick buildings proved to be its greatest weakness when an earthquake struck Tuesday.

Unable to absorb the energy generated by the shallow temblor, many structures collapsed.

New Zealand officials said at least 75 people died as a result of the magnitude 6.3 earthquake and that 300 others were still unaccounted for, including 24 Japanese.

According to Tomotaka Iwata, a professor specializing in seismology at Kyoto University's Disaster Prevention Research Institute, ground acceleration of 1,800 gals was recorded in some areas, meaning that a force twice that of gravity whipped those locations in an instant.

"If an earthquake that is not large in magnitude occurs at a shallow depth, it can cause strong shaking in a narrow area along a fault line," Iwata said.

Yuki Sakai, a professor of earthquake engineering at the University of Tsukuba, said that in the absence of detailed data, the temblor was likely one called a short-period earthquake "judging from the strong ground acceleration."

Normally, earthquakes that strike directly under an urban area have short periods of less than half a second. Sakai said the Christchurch earthquake may have had much shorter periods of between 0.2 and 0.3 of a second.

Such short-period shaking will produce devastating damage to stone or brick buildings that have little give.

In addition, the area around Christchurch is not known as an earthquake zone, with the only known past example being a magnitude 7 earthquake in September 2010.

While active faults are prevalent along the Alpine Fault that extends for about 600 kilometers from the southeastern portion of North Island to the northern part of South Island, no active faults had been confirmed in and around Christchurch.

Toshikazu Yoshioka, who heads the Active Fault Evaluation Team at the National Institute of Advanced Industrial Science and Technology, said: "Not only does New Zealand have few records of past earthquakes, but it is difficult to locate active faults because there was a lot of sediment in and around the latest temblor site. While there was no basis to think that no major earthquake would hit, I was told that anti-quake measures were not as advanced as in Wellington, where there are many active faults."

Many of Christchurch's buildings were built of stone and brick by settlers from western Europe who moved there in the 19th century.

Kojiro Irikura, professor emeritus at Kyoto University, said, "Compared with wooden structures, buildings made of brick and stone are more susceptible to collapse because they cannot absorb the energy."

After viewing photos of Christchurch, Taiki Saito, a chief research engineer at the International Institute of Seismology and Earthquake Engineering at the Building Research Institute, said, "In many cases, brick buildings facing street corners or intersections collapsed."

He added, "Just by looking at the structures that collapsed, anti-quake measures do not appear to have been taken, and there were many cases in which the floors were wooden (making the interiors susceptible to collapse)."

The earthquake is believed to have occurred along a fault directly under Christchurch.

According to the U.S. Geological Survey, the quake struck only about 5 kilometers below the surface.

According to an analysis by Yuji Yagi, an associate professor of geodynamics at the University of Tsukuba, a fault about 15 kilometers long and 10 kilometers wide in an east-west direction shifted a maximum of 70 centimeters.

Yagi said, "While the scale is only one-tenth that of the Great Hanshin Earthquake, the large shaking occurred directly under the city."

Like Japan, New Zealand has frequent earthquakes. Strong pressure is applied to the Earth's surface by the collision of the Pacific Plate to the east of the nation with the Indo-Australian Plate to the west.

The tectonic plates have a very complicated structure with the Pacific Plate subducted under the Indo-Australian Plate in the northern part of New Zealand, while the Australian Plate is subducted under the Pacific Plate to the south.

For that reason, not only do major earthquakes occur along the boundary of the tectonic plates, but they also occur along the many active faults that lie further inland. Tuesday's earthquake is believed to be of the latter type.

According to the U.S. Geological Survey, there have been four earthquakes with a magnitude of 7 or larger near New Zealand since 2000.

In the earthquake last September, an active fault about 70 kilometers long lying to the west of the active fault where Tuesday's earthquake occurred caused the earthquake that had about 10 times the energy of the latest temblor.

Kunihiko Shimazaki, professor emeritus at the University of Tokyo who chairs the Coordinating Committee for Earthquake Prediction, said, "The latest earthquake may have been related in some way to last year's quake and can be considered an aftershock in a wide sense of the term."

Masanori Hamada, an earthquake engineering professor at Waseda University who conducted research on-site following last year's earthquake, said, "Although soil liquefaction occurred over a wide area last year, it was mainly in the suburbs. The damage this time was probably much greater because it occurred closer to the city center and at a shallow depth of 5 kilometers."




2011年2月22日 星期二

NG TV 的 空中浩劫 系列個案分析 才是比較令人滿意的報導

NG TV 的 空中浩劫 系列個案分析 才是比較令人滿意的報導


2011-02-22 國際在線



2010年4月10日,載有多名波蘭政府高層人士的圖154客機在俄路斯斯摩棱斯克墜毀,包括波蘭總統在內的96名機上人員全部遇難。俄路斯國際航空委員 會曾在1月12日發布了一份報告,指出飛行員的失誤是整個災難的主因,但波蘭方面指責這份報告缺乏充分証據,特別是沒有提到飛行員與空中交通指揮缺乏信息 溝通的因素。(木又)

2011年2月20日 星期日


台大王正一教授: How to have good health


台大醫學院 榮譽 教授




大腸的長度大約 一公尺 ,當我在做大腸鏡時,知道大腸真的是可長可短,非常有彈性,如果做人能像腸子一樣能屈能伸,那真是了不起。






少油少肉多運動 避免息肉轉癌化




我有一大串的「小兄弟」小腸,小腸有五、 六公尺 長,年輕有活力。而我的直徑寬約三至 五公分 ,小腸比較細,直徑寬約 一公分 。






我有又厚又韌的腸壁,但是我也需要營養最害怕的是肉類脂肪,特別是「含高油脂的肉類」,因為這些食物到了小腸以後,哦!油頭粉面小兄弟被迷住,動作變得慢吞吞地,吃得飽飽地完全不想動像人剛吃飽不想做事一樣,也像人喝酒後東倒西歪,五、 六公尺 長的小兄弟都不動了,連帶著,我想動也動不了。


身長 一公尺 的我,身上也會有一個一個小倉庫,叫作「憩室」。有的憩室是先天的,有的是因為我壓力太大、緊張,為了消除緊張,腸壁就向外膨出造成憩室。




如果身體太少攝取纖維質、水分,我這兒的糞便太多太大,我搬不動、排不動之後,就形成醫生們說的「機械性腸阻塞」〈Mechanical ileus腸子前端可能會腫大起來,壓力也越來越大,我也會受不了,最後我會爆炸、腸子穿孔,對身體是很危險的。只要醫師警覺,就會立刻切掉我潰爛的部分,唉,那我真是無辜受罪啊。可是只要平時多吃蔬菜水果,我就會很健康。

我的營養是來自血管,我的腸壁周圍都有很豐富的血管如果血管不暢通,我的外表就會受到傷害,就會出血這就是所謂「缺血性結腸炎」〈Ischemic colitis〉。粘膜表面是很嬌嫩、脆弱,最容易因缺氧,缺血出血。


而就在 2007 年,大腸癌的發生率已經突破一萬例。肝癌是第一個突破一萬例的癌症,大腸癌是第二個,而且案例還在持續增加中,這是非常恐怖的。「我不希望健康的我長癌細胞,因為長了癌細胞我就痛苦了,我被害、要被開刀,我要變短了,這些都是我不樂見的。」



長期吃抗生素,就要小心有特別的細菌會跑出來,這些細菌就是偽膜性結腸炎發生的重要原因。已知大約百分之二至三的人身上有這些細菌,現在越來越多,尤其在長期療養院的住客可能多到百分之二十至三十,醫院住院的病人也多到百分之三十,這是所謂的困難腸梭菌〈Clostridium difficile〉。















特別是止痛消炎藥〈NSAID〉,品質差的消炎藥「崩解率」很差,意思是說不容易溶解也不容易吸收,從食道滾啊滾到大腸來,在滾的過程,藥的外表有一部分已經破掉,帶著很強的腐蝕性,NSAID 的成分都是鹽酸,我的內皮被灼傷、潰爛。NSAID 引起的腸壁的問題,是最近十年非常嚴重的事實,會引起出血,醫生用內視鏡檢查可以看的到藥就留在那位置上。








2011年2月19日 星期六



華婦捲入乾洗機 意外事故腦死亡
2011-02-19 05:17:00

(本 報訊)16日,一名華裔女子在一家皇后區的乾洗店裡將毛巾放入一個蒸汽乾洗機時,她脖子上的圍巾被卡在機器裡,導致該女子被捲入乾洗機,造成腦死亡。 據《紐約郵報》17日報道,事故在16日下午4點45分發生,32歲的黃莉敏(Limin Min Huang,譯音)在位於皇后區牙買加的自由大道交Tuckerton街的安環洗衣服務公司(An Huan Laundry Service)工作。經理張洪(Hong Zhang,譯音)說,黃莉敏當時伸頭到乾洗機中查看情況,但是她忘記了脖子上戴著圍巾,機器將她扯進去,隨後機器停了下來。 黃莉敏已婚,她已經在那個洗衣店工作3年,與丈夫住在附近的法拉盛。

2011年2月17日 星期四


金礦業集團股份有限公司(Zijin Mining Group Co., 簡稱:紫金礦業)稱﹐中國廣東省居民已就去年9月份的一次尾礦壩潰壩事故起訴紫金礦業﹐要求該公司賠償原告人民幣1.705億元(合2,580萬美元)。




2011年2月16日 星期三

人命值多少 (公定 約8百萬美元)A Life’s Value May Depend on Agency

A Life’s Value May Depend on Agency

Paul Sancya/Associated Press

Testing a G.M. vehicle. The Transportation Department says each life saved is worth $6 million.

WASHINGTON — As the players here remake the nation’s vast regulatory system, they have been grappling with a subject that is more the province of poets and philosophers than bureaucrats: what is the value of a human life?

Readers' Comments

The answer determines how much spending the government should require to prevent a single death.

To protests from business and praise from unions, environmentalists and consumer groups, one agency after another has ratcheted up the price of life, justifying tougher — and more costly — standards.

The Environmental Protection Agency set the value of a life at $9.1 million last year in proposing tighter restrictions on air pollution. The agency used numbers as low as $6.8 million during the George W. Bush administration.

The Food and Drug Administration declared that life was worth $7.9 million last year, up from $5 million in 2008, in proposing warning labels on cigarette packages featuring images of cancer victims.

The Transportation Department has used values of around $6 million to justify recent decisions to impose regulations that the Bush administration had rejected as too expensive, like requiring stronger roofs on cars.

And the numbers may keep climbing. In December, the E.P.A. said it might set the value of preventing cancer deaths 50 percent higher than other deaths, because cancer kills slowly. A report last year financed by the Department of Homeland Security suggested that the value of preventing deaths from terrorism might be 100 percent higher than other deaths.

The trend is a sensitive subject for an administration that is trying to improve its relationship with the business community, much of which has bitterly opposed the expansion of regulation. The White House said the decisions on the value of life were made by the agencies. The agencies, for their part, referred any questions to the White House.

“This administration utilizes the best available science in assessing the benefits and costs of any potential regulation, drawing on widely accepted methodologies that have been in use for years,” Meg Reilly, a spokeswoman for the Office of Management and Budget, which oversees the rule-making process, said in an e-mail.

Several independent experts, however, said that the increases were long overdue, noting that some agencies had been using the same values for more than a decade without adjusting for inflation. One office at the E.P.A. cut the value of life in 2004.

“Agencies have been using numbers that I thought were just too low,” said W. Kip Viscusi, a professor of economics at Vanderbilt University whose research is cited by most of the federal agencies as the basis for their calculations.

Businesses would prefer to discuss the consequences of the increases — new regulations and higher costs, which they say are hampering economic growth — rather than suggest that the government has overstated the value of life.

But some industry representatives said assigning a value to life was inherently subjective, and that the recent changes were driven by the administration’s pursuit of its regulatory agenda rather than scientific considerations.

“It looks like they just cooked the books — they just doubled the numbers,” said Todd Spencer, executive vice president of the Owner-Operator Independent Drivers Association, a trade group for the trucking industry, which faces higher costs under some of the Transportation Department’s new rules. The Bush administration rejected a plan in 2005 to make car companies double the roof strength of new vehicles, which it estimated might prevent 135 deaths in rollover accidents each year.

At the time, Transportation officials figured that the cost of the roofs would exceed the value of lives saved by almost $800 million. So the agency proposed a smaller increase in roof strength that might save 44 lives a year.

Last year, the Obama administration imposed the stricter and more expensive roof-strength standard, and it published a new set of calculations showing that the benefits outstripped the costs.

Most of the difference came from the increased value of human life. By raising that number to $6.1 million from a figure of $3.5 million in the original study, the Obama administration rendered those 135 lives — and hundreds of averted injuries — more valuable than the roofs.

The pattern of increases is scrambling a long-standing political dynamic. The business community historically has pushed for regulators to put a dollar value on life, part of a broader campaign to make agencies prove that the benefits of proposed regulations exceed the costs.

But some business groups are reconsidering the effectiveness of cost-benefit analysis as a check on regulations. The United States Chamber of Commerce is now campaigning for Congress to assert greater control over the rule-making process, reflecting a judgment that formulas may offer less reliable protection than politicians.

Some consumer groups, meanwhile, find themselves cheering the government’s results but reluctant to embrace the method. Advocates for increased regulation have long argued that cost-benefit analysis understates both the value of life and the benefits of government oversight.

“If analysis is going to be imposed on the rule-making process, we want higher values for injury and for fatalities,” said Robert Weissman, president of Public Citizen, which pushed the Transportation Department to reconsider the roof-strength regulation.

But Mr. Weissman said he still believed that such analysis was an impediment to necessary regulation.

“The bigger picture is absent,” he said. “How do you do cost-benefit analysis on global warming? It constrains the imagination. It really is a constraint in terms of bounding what is given serious consideration.”

The current rise in the value of life is based on the work of Professor Viscusi, who wrote his first paper on cost-benefit analysis as a Harvard undergraduate in the early 1970s. He won a prize and found a career.

The idea he and others have since developed in a long string of studies is that differences in wages show the value that workers place on avoiding the risk of death. Say that companies must pay lumberjacks an additional $1,000 a year to perform work that generally kills one in 1,000 workers. It follows that most Americans would forgo $1,000 a year to avoid that risk — and that 1,000 Americans will collectively forgo $1 million to avoid the same risk entirely. That number is said to be the “statistical value of life.”

Professor Viscusi’s work pegs it at around $8.7 million in current dollars.

Before the current administration, only the E.P.A. had fully embraced this methodology. Other agencies relied instead on the results of surveys asking Americans how much they would spend to avoid a given risk. This technique tends to produce significantly lower results. An even older technique, which yields even lower numbers, is to sum the wages lost when a worker dies. In 2000 the E.P.A set a baseline of $7.8 million, updated to current dollars. But in 2004, the office that issues clean air regulations reduced that baseline by $500,000 in an analysis of proposed limits on emissions from industrial boilers.

Last year, the E.P.A. directed its various offices to return to the 2000 baseline, adjusting that figure for inflation and wage growth. In some recent studies, the E.P.A. has used a figure of $9.1 million after making those adjustments.

The agency said at the same time that it was working to set a new standard. In a white paper issued in December, it raised the possibility that people might place a higher value on avoiding a slow death from cancer than a quick death in a car accident. It also broached a concept it described as “altruism,” the idea that people may place a higher value on the common good than on their own survival.

John D. Graham, who oversaw the use of cost-benefit analysis during the George W. Bush administration, said that the scientific justification was “quite strong” for raising the values used by the Transportation Department, but he cautioned that the E.P.A. was going too far.

“Why should the same clinical condition be valued differently at different federal agencies?” Mr. Graham, now dean of the School of Environmental and Public Affairs at Indiana University, asked in an e-mailed response to questions.

Many experts similarly ask why life itself should be valued differently. Agencies are allowed to set their own numbers. The E.P.A. and the Transportation Department use numbers that are $3 million apart. The process generally involves experts, but the decisions ultimately are made by political appointees.

The Office of Management and Budget told agencies in 2004 that they should pick a number between $1 million and $10 million. That guidance remains in effect, although the office has more recently warned agencies that it would be difficult to justify the use of numbers under $5 million, two administration officials said.

Close observers of the process point to two reasons for the variation in numbers. First, they say that setting a single standard is not worth the high-stakes battle that would be required with advocates on both sides. The Obama administration, like its predecessors, has preferred to deal with the issue informally, on an agency-by-agency basis.

Second, they say the lack of a standard preserves flexibility.

The Food and Drug Administration issued a rule in 2009 requiring new warning labels on packages and bottles of acetaminophen and other drugs. Its justification valued life at $5 million. A few months later, the agency acknowledged that it had calculated the cost of adding one new label, while requiring two new labels. However, the agency continued, the benefits still exceeded the costs because the value of life was $7 million.

A few months later, in an unrelated rule regarding salmonella, the agency once again cited a value of $5 million, which it said best reflected the available research. And in its recent study on cigarette labels, the agency cited a value of $7.9 million.

“The reality is that politics frequently trumps economics,” said Robert Hahn, a leading scholar of the American regulatory process who is now a professor at the University of Manchester in England. But he said that putting a price tag on life still was worthwhile, to help politicians choose among priorities and to shape the details of their proposals.

“Even small changes,” he said, “can save billions of dollars.”


11 點.....台大校園施工工人切割水泥路面竟然不戴口罩

新月台前有人招手計程車 兩輛對面的同時轉過來 僵持數十秒 第一輛揚長而去 過紅綠燈又有一輛

PREDICT is a game-changing program at Vanderbilt

這種基因改變的"個人(心臟)醫學" 是從紐約時報的"廣告"中進入的

See more videos about personalized medicine at Vanderbilt here.

What is PREDICT?

Who is this test for?
Can a DNA test tell anything else?
How will this information be used?
Where can I get information on clinical trials for new drugs?

Prescribing Blood Thinners

Each person responds differently to medicines. Making sure you receive the right medicine at the right dose is one way Vanderbilt offers personalized medicine for you.

In fact, Vanderbilt University Medical Center can now use your genetic information to predict and help prevent bad drug side effects. We call this PREDICT.

What is PREDICT?

PREDICT is a game-changing program at Vanderbilt that applies personalized medicine with automated decision support in real-time – we believe for the first time ever at an academic medical center in the United States.

Background: When heart disease is suspected, patients usually get a cardiac catheterization, an X-ray test that can tell if arteries in the heart are too narrow. If that’s the case, often a small tube called a stent is put inside the troubled artery to keep it open. After that, a drug called Plavix is often prescribed to keep blood from clotting around the stent.

About 25% of heart patients have a genetic variation that makes Plavix less effective for them. The variation prevents the body from effectively processing the drug. In about 3% of people, the variation is very serious, and Plavix doesn’t work at all. In these cases, if a patient is prescribed Plavix, blood clots could form around the stent. That can result in a heart attack or even death.

Process: PREDICT involves taking a blood sample from all patients who get a cardiac catheterization. The sample is tested for the genetic variation related to Plavix, and the results are stored confidentially in the secure electronic medical record and made available when needed. If the patient has the genetic variation that means Plavix may not work, an alert will pop up when his or her doctor tries to order Plavix.

Effects: PREDICT will let the patient’s doctor know ahead of time to prescribe a different drug. We believe this program and others like it will improve safety and save patients’ lives.

Who is this test for?

Right now, only patients in the cardiac catheterization lab are included in the program. As soon as next year, we hope to roll out a similar program for other drugs. The goal will be the same: To tell ahead of time whether a patient will benefit from a drug, and to tailor his or her medical care on an individual level.

Can a DNA test tell anything else?

Yes. Right now, we can test for about 200 genetic variations known to affect many medicines.

How will this information be used?

Currently, the information gathered is used specifically for heart patients who may be prescribed Plavix. In the future, other genetic information will be used to tailor other medication selection and dosing for patients.

Where can I get information on clinical trials for new drugs?

Visit the Vanderbilt Heart website.

2011年2月15日 星期二

Singing fosters intelligence, improves health

Music | 13.01.2011

Singing fosters intelligence, improves health, study shows

Whether in tune or not, singing cultivates human development, with kids profitting most from the activity. Those who sing also get sick less soften, a study shows.

They've played, painted pictures and had breakfast. Now it's time for their favorite stuffed animal to wake up. So the children in this German and French-language pre-school in the western German city of Wuppertal wrap frog Noah up in a blue cloth and begin to rock him. They quietly sing a French song and their singing slowly gets louder as the kids begin to shake the cloth - until the frog begins to hop around.

"He's finally awake now!" a few of the kids yell and intone their favorite song: "Frere Jacques." The kids hug and kiss the cute little stuffed frog as it wanders from child to child, and they decide - without fighting - who gets to hold it longer on this particular day before it goes down for a nap again. This ritual is repeated nearly every day and is accompanied by music.

Learning a language through music

Director Holland drumming with kids in pre-schoolBildunterschrift: Großansicht des Bildes mit der Bildunterschrift: Holland also drums with the kids during jam sessions

"We sing a lot in French," says teacher Francoise Ruel. "The kids get to know the language in a playful way, and get a sense for proper pronunciation." But more than anything, the children have a lot of fun, the French native stresses, since the singing always goes hand-in-hand with games and movement. Along with another French-speaking colleague, Ruel is responsible for teaching the children the foreign language. The rest of the time, she and her four other colleagues speak and sing in German.

"Singing is extremely important for language development because it fosters expression," said Heike Holland, director of the German-French pre-school. It also helps to improve memory since a melody helps people memorize texts and lyrics, she added. The kids in her school have not only learned French very quickly, they've also improved their German - an important aspect since many of the children come from families with an immigrant background. In addition to German, some of the pre-schoolers speak Turkish, Spanish, Italian or Portuguese at home.

Singing prepares kids for school

While this kind of multilingualism may be rare in German pre-schools, more and more of the kids who attend are growing up bilingually. That's reflected in the pre-schools' musical repertoire, Holland said. She often visits other pre-schools to train teachers in early childhood development and educational methods.

Sheet musicBildunterschrift: Großansicht des Bildes mit der Bildunterschrift: Kids don't have to read music to sing

"Many of the children whose parents are immigrants or have an immigrant background bring their Oriental-influenced music with them into the schools," she said. The kids also often like to sing songs they hear on the radio or television, and many of them are in English.

Sociologist Thomas Blank of the University of Muenster encourages teachers and parents to expose children to music as much as possible, especially the music the kids prefer. In a study of 500 pre-school kids, Blank found that kids who sing a lot are much better prepared for school than children who sing only seldom. "They can express themselves better, empathize more easily with others and get sick with colds or the flu less often."

Singing connects logic and emotions

Blank is not surprised by the results of his study. "The connection between the left and right brain hemispheres - between logic and feeling - can be fostered and shaped particularly well between the ages of one and six," and that's exactly what happens when people sing, the sociologist stressed.

Hitting the right note or sounding good while singing isn't important, he said. On the contrary: Children should not be pressured to perform and sing well, Blank suggests. "Kids should have fun and be allowed to experiment," he said, and that's when singing is a really healthy activity. "Singing reduces stress and aggression and encourages a sense of community."

Author: Sabine Damaschke / als
Editor: Kate Bowen

2011年2月10日 星期四


Tobacco-Free Hiring in Workplaces

Smokers now face another risk from their habit: it could cost them a shot at a job.

Readers' Comments

More hospitals and other medical businesses in many states are adopting strict policies that make smoking a reason to turn away job applicants, saying they want to increase worker productivity, reduce health care costs and encourage healthier living.

The policies reflect a frustration that softer efforts — like banning smoking on company grounds, offering cessation programs and increasing health care premiums for smokers — have not been powerful-enough incentives to quit.

The new rules essentially treat cigarettes like an illegal narcotic. Applications now explicitly warn of “tobacco-free hiring,” job seekers must submit to urine tests for nicotine and new employees caught smoking face termination.

This shift — from smoke-free to smoker-free workplaces — has prompted sharp debate, even among antitobacco groups, over whether the policies establish a troubling precedent of employers intruding into private lives to ban a habit that is legal.

“If enough of these companies adopt theses policies and it really becomes for difficult for smokers to find jobs, there are going to be consequences,” said Dr. Michael Siegel, a professor at the Boston University School of Public Health, who has written about the trend. “Unemployment is also bad for health.”

Smokers have been turned away for jobs in the past — prompting more than half the states to pass laws banning the practice — but the recent growth in the number of companies adopting no-smoker rules has been driven by a surge of interest among health care providers, according to academics, human resources experts and antitobacco advocates.

There is no reliable data on how many businesses have adopted such policies. But people tracking the issue say there are enough to examples to suggest the policies are becoming more mainstream.

For example, hospitals in Florida, Georgia, Massachusetts, Missouri, Ohio, Pennsylvania, Tennessee and Texas, among others, stopped hiring smokers in the last year and more are openly considering the option.

“We’ve had a number of inquiries over the last 6 to 12 months about how to do this,” said Paul Terpeluk, a director at Cleveland Clinic, which stopped hiring smokers in 2007 and has vigorously championed the policy. “The trend line is getting pretty steep and I’d guess that in the next few years you’d see a lot of major hospitals go this way.”

A number of these organizations have justified the new policies as advancing their institutional missions of promoting personal wellbeing and finding ways to reduce the growth in health care costs.

About 1 in 5 Americans still smoke, which remains the leading cause of preventable deaths. And employees who smoke cost, on average, $3,391 more a year each in increased health care costs and lost productivity, according to federal estimates.

“We felt it was unfair for employees who maintained healthy lifestyles to have to subsidize those who do not,” Steven C. Bjelich, chief executive of St. Francis Medical Center in Cape Girardeau, Mo., which stopped hiring smokers last month. “Essentially that’s what happens.”

Two decades ago — after large companies like Alaska Airlines, Union Pacific and Turner Broadcasting adopted such policies — 29 states and the District of Columbia passed laws, with the strong backing of the tobacco lobby and the American Civil Liberties Union, that prohibit discrimination against smokers or those who use “lawful products.” Some of those states, like Missouri, make an exception for health care organizations. But in other states courts have upheld the legality of refusing to employ smokers.

A spokesman for Philip Morris said the company was no longer actively working on the issue, though it remained strongly opposed to the policies.

Meghan Finegan, a spokeswoman for the Service Employees International Union, which represents 1.2 million health care workers, said the issue was “not on our radar yet.”

One concern voiced by groups like the National Workrights Institute is that such policies are a slippery slope — that if they prove successful in driving down health care costs, employers might be emboldened to crack down on other behavior by their workers, like drinking alcohol, eating fast food and participating in risky hobbies like motorcycle riding. Indeed, the head of Cleveland Clinic was both praised and criticized when he mused in an interview two years ago that, were it not illegal, he would expand the hospital policy to refuse employment to obese people.

“There is nothing unique about smoking,” said Lewis Maltby, president of the Workrights Institute, who has lobbied vigorously against the practice. “The number of things that we all do privately that have negative impact on our health is endless. If it’s not smoking, it’s beer. If it’s not beer, it’s cheeseburgers. And what about your sex life?”

Many companies add their own wrinkle to the smoking ban. Some prohibit all tobacco use — not just cigarettes — including cigars, pipes, chewing tobacco and even nicotine patches. Some companies test urine for traces of nicotine, while others operate on the honor system.

While most of the companies applied their rules only to new employees, a few eventually mandated that existing employees must quit smoking or lose their jobs. There is also disagreement over whether to fire employees who are caught smoking after they are hired. The Truman Medical Centers, here in Kansas City, for example, will investigate accusations of tobacco use by employees. In one recent case a new employee returned from a lunch break smelling of smoke and, when confronted by his supervisor, admitted that he had been smoking, said Marcos DeLeon, head of human resources for the hospital. The employee was fired.

Even antismoking advocates have found the issue tricky to navigate. The American Lung Association, the American Cancer Society and the World Health Organization do not hire smokers, citing their own efforts to reduce smoking.

But the American Legacy Foundation, an antismoking nonprofit group, has warned that refusing to hire smokers who are otherwise qualified essentially punishes an addiction that is far more likely to afflict a janitor than a surgeon. (Indeed of the first 14 applicants rejected since the policy went into effect in October at the University Medical Center in El Paso, Tex., one was applying to be a nurse and the rest for support positions; none were doctors.)

“We want to be very supportive of smokers, and the best thing we can do is help them quit, not condition employment on whether they quit,” said Ellen Vargyas, chief counsel for the American Legacy Foundation. “Smokers are not the enemy.”

Taking a drag of her cigarette outside the University of Kansas School of Nursing, just beyond the sign warning that smoking is prohibited on campus, Mandy Carroll explained that she was well aware of the potential consequences of her pack-a-day habit: both her parents died of smoking-related illnesses.

But Ms. Carroll, a 26-year-old nursing student, said she strongly opposed any effort by hospitals to “discriminate” against her and other smokers.

“Obviously we know the effects of smoking, we see it every day in the hospital,” Ms. Carroll said. “It’s a stupid choice, but it’s a personal choice.”

Others do not mind the strict policy. John J. Stinson, 68, said he had been smoking for more than three decades when he decided to apply for a job at Cleveland Clinic, helping incoming patients, nearly three years ago.

It turned out to be the motivation he needed: he passed the urine test and has not had a cigarette since. “It’s a good idea,” Mr. Stinson said.

Alain Delaquérière contributed research.

新一代快速全國互通無線寬頻 : 美國公共安全用


WASHINGTON—President Barack Obama unveiled a plan to spend $18 billion on mobile broadband, as House Republicans questioned how the administration has spent more than $7 billion in stimulus funding already set aside for new high-speed Internet services.

During a speech in Michigan, Mr. Obama proposed spending $5 billion on new mobile broadband networks in rural areas. He proposed spending $10.7 billion on a separate, new mobile broadband network for police and firemen and $3 billion for government research on new wireless technologies.

The proposal reflects the president's State of the Union pledge to ensure 98% of Americans have high-speed wireless access within a few years.

The president's plan faces an uncertain future in Congress, where Republican lawmakers Thursday debated how to cut federal spending broadly, and questioned the administration's handling of the broadband stimulus money.

"Before we target any more of our scarce taxpayer dollars for broadband, it is critical to examine whether the money already spent is having an impact," said Rep. Fred Upton (R., Mich.), chairman of the House Energy and Commerce Committee, which oversees the Federal Communications Commission and airwaves auctions, in response to the president's announcement. "Let's ensure our resources are being used wisely."

Mr. Obama proposed that all of the funding for the new wireless plans come from future auctions of airwaves, which the White House estimated would raise more than $27 billion.

Some of the auctioned airwaves would be voluntarily given up by TV-station owners, who would get a cut of the revenue. The government is also considering auctioning off some airwaves currently used by the Defense Department and other agencies.

But it's not clear that the administration would realize as much as it projects from the auctions—even if Congress approves the plan to divert the proceeds to a broadband-development program instead of using the money to reduce the deficit.

House Communications and Technology subcommittee Chairman Rep. Greg Walden (R., Ore.) circulated draft legislation for ensuring any unused or reclaimed stimulus money is returned to the treasury.

During a hearing Thursday, Mr. Walden applauded the White House's goal of improving broadband availability across the U.S., but said "we must be cost-efficient about how we go about it and be realistic in our expectations of what taxpayers can afford."

In 2009, Congress gave the Commerce Department $4.7 billion and the Agriculture Department $2.5 billion to dole out in grants or loans to improve high-speed Internet availability, particularly in rural areas. The government estimates about 24 million households don't have access to broadband service, mostly in rural areas.

By the end of September, the agencies had awarded all of the money to about 550 companies and organizations.

Only $400 million of the broadband stimulus funds have been used so far, according to government watchdogs. The Government Accountability Office says that some of the stimulus projects are not expected to be completed until 2013.

During the hearing, Todd Zinser, the Commerce Department's Inspector General said he considers the broadband grant program "high risk" and said more funding for oversight was needed.

Next week, the government is scheduled to release the first national map of broadband availability in the U.S. It is expected to show where broadband isn't available and broadband speeds in areas that have it.

During the hearing, some Republican lawmakers questioned why the government handed out $7 billion for new broadband lines before they had a map of where high-speed Internet isn't currently available.

Spina Bifida(脊椎披裂)之研究開啟胎兒手術之門

Spina Bifida Research Opens Fetal Surgery Door

Spina Bifida

  • [spáinə bífidə]


Spina bifida is a birth abnormality in which the spine is malformed and lacks its usual protective skeletal and soft tissue coverings.

紐約時報: Success of Spina Bifida Study Opens Fetal Surgery Door

For years, surgeons have been trying to find ways of operating on babies in the womb, reasoning that medical abnormalities might be more easily fixed while a fetus is still developing. But with tremendous risks to babies and mothers, and a mixed record of success, fetal surgery is mostly used when babies are likely to die otherwise.

Jeffrey D. Allred for The New York Times

Doctors say prenatal surgery made a significant difference for Tyson Thomas, with his mother, Jessica.

Jeffrey D. Allred for The New York Times

He wears braces, but is getting close to walking, his mother says.

Now, for the first time, a rigorous clinical trial shows that fetal surgery can help babies with a condition that is not usually life-threatening. Babies with a form of spina bifida, a debilitating spinal abnormality, were more likely to walk and experience fewer neurological problems if operated on before being born rather than afterward.

The $22.5 million study, long awaited by experts and published online Wednesday in The New England Journal of Medicine, is likely to galvanize interest in trying to address problems before birth, including operating on serious heart defects and bladder blockages, and potentially using fetal bone marrow or stem cell transplants for sickle cell anemia and immune disorders.

“It’s a good start, a step in the right direction,” said Dr. Joe Leigh Simpson, an obstetrician and geneticist at Florida International University, who wrote an editorial that accompanied the research. “It showed improvement and that there’s reason to continue looking for a better mousetrap.”

Still, he said, “the improvement that was hoped for, the home run or the holy grail” of eliminating all major problems “obviously did not occur.”

And as technology increasingly allows doctors to diagnose problems in a developing fetus, the study underscores remaining risks and hurdles, including developing less-invasive techniques to avoid creating other problems for babies or mothers.

The spina bifida procedure was considered beneficial enough that an independent safety monitoring board stopped the study early so babies scheduled to receive surgery after birth could have access to prenatal surgery.

But there were medical downsides for the women and infants: greater likelihood of being born several weeks earlier than the postnatal group, related breathing problems, and thinning or tearing at women’s surgical incisions, requiring Caesarean sections for later births.

“While this is a very promising and quite exciting result,” said a study author, Dr. Diana Farmer, surgeon in chief at the Benioff Children’s Hospital at the University of California, San Francisco, “not all the patients were helped here, and there are significant risks. This procedure is not for everyone.”

Conducting the study was itself challenging. Prenatal spina bifida surgery gained attention in the late 1990s when some medical centers, like Vanderbilt University, began performing it. A photograph in which a fetus’s hand appeared to be gripping the finger of a surgeon who had lifted the hand out of the womb was circulated by opponents of abortion rights, further raising the profile.

Leading experts suggested a clinical trial to determine if prenatal surgery was better than postnatal. They insisted on an unusual agreement: that all but three hospitals, in Philadelphia, San Francisco and Nashville, stop doing the procedure.

“There were lots of places that wanted to do it” amid pressure from eager patients, said Dr. Michael Harrison, who pioneered fetal surgery at the University of California, San Francisco, and was a principal investigator for the spina bifida trial before retiring. “But we wanted to make sure it wouldn’t become a freak show. And if you offer treatment outside the trial, you’ll never have a trial because no mother would agree to flip a coin.”

Ultimately the other hospitals acceded.

One reason spina bifida researchers wanted a trial was the experience with prenatal surgery for a condition in which the diaphragm has life-threatening abnormalities.

After early efforts to repair the condition prenatally, “we thought we were heroes,” Dr. Harrison said, but realized it worked only for milder cases. Another prenatal approach, forcing the lungs to grow, worked, but caused significantly premature births, making it no better than postnatal treatment, he said. He added that prenatal techniques had improved, becoming less harmful.

The spina bifida study involved the most severe form, myelomeningocele (MY-ell-oh-men-NING-guh-seal), in which the spine does not close properly and the spinal cord protrudes. Children may experience lower-body paralysis, fluid on the brain, bladder problems and learning disabilities. About one in 3,000 children have that form, said Dr. Alan Guttmacher, director of the National Institute of Child Health and Human Development, which financed and helped conduct the study.

Many babies now receive surgery to close the spinal opening after birth, but nerve damage from the spinal cord exposure to amniotic fluid remains. Also, the brainstem may be pulled into the spinal column. Excess fluid in the brain may require draining with implanted shunts, which can lead to infection or need repeated surgical replacement.

In the study, about 80 babies were randomly selected for surgery after birth; another 80 had the spinal opening surgically closed in utero, between 19 and 26 weeks of pregnancy. Two in each group died.

Before surgery, babies in the prenatal group had more severe spinal lesions than the postnatal group, but more in the prenatal group had better results, said a co-author, Dr. Scott Adzick, chief of pediatric surgery at Children’s Hospital of Philadelphia.

Those who received prenatal surgery were half as likely to have a shunt, and eight times as likely to have a normally positioned brainstem. There was “much better motor function of the legs,” Dr. Adzick said, and at 30 months old, nearly twice as many walked without crutches or orthotics.

Although they were born at 34 weeks of pregnancy on average, compared with 37 weeks for the postnatal group, there was no difference in cognitive development, said Dr. Catherine Spong, chief of pregnancy and perinatology at the child health institute.

Dr. Adzick said prenatal surgery may “stop exposure of the developing spinal cord and perhaps avert further neurological damage” or stop the leak of spinal fluid that causes brainstem problems.

Results were dramatic for Tyson Thomas, of Stansbury Park, Utah, now 22 months old. His mother, Jessica Thomas, a study participant, said doctors had described his brain malformation as “the worst they had ever seen” and said “it would be likely that he wouldn’t be able to breathe on his own.”

Since birth at 35 weeks gestation, she said, Tyson breathes independently, shows no brainstem malformation and is starting to talk. Bladder nerve damage will require him to urinate through catheters all his life. He now uses a walker and a foot brace, but is “getting really close to walking” on his own, said Ms. Thomas, a nurse.

Researchers will follow the children from ages 6 to 9 to see if benefits continue.

Several experts said they would now mention prenatal surgery as one option for some women. But since many women were excluded from the study, including those who were severely obese or whose babies’ conditions did not fit certain specifications, many may be ineligible.

The study should not propel surgeons to “run around and start doing this” for other conditions, said Dr. Terry Buchmiller, a fetal medicine expert at Children’s Hospital Boston who was not involved in the research. “I can go in utero right now and fix a cleft lip, but I don’t think anybody is saying we ought to do that, because of the risk.”

But she called the study “a wonderful, almost several-decade journey of trying to improve the outcomes of a debilitating condition,” adding, “This looks to be potentially life-changing.”

2011年2月9日 星期三

上帝對你最大的祝福就是擁有健康/一氧化碳中毒/【怪醫豪斯 第三季】

"拜四晚在台北校園書房逛,偶然一行文字映入眼簾:. 「上帝對你最大的祝福,就是擁有健康。」"
每年冬季 總會多聽到一氧化碳中毒事件
記注 瓦斯熱水氣等等一定放室外通風處

怪病何其多 「外星人幻覺」竟是「DNA作怪」?

【怪醫豪斯 第三季】豪斯與卡麥容、柴斯、佛曼三人小組將面臨全新考驗! 挑戰醫療紀錄,一名起死回生、體重破兩百公斤的病患,醫療團隊該如何進行MRI(核磁共振檢查)?顛覆人體常態,消防隊員盲目往高溫火場前進,是因為異常 體溫導致全身凍僵?一連串的怪病席捲而來!外星人也造訪?一名叫「克蘭斯」的小男孩幻想自己被外星人綁架,卻還有出血異常問題,才七歲大的他,把外星人綁 架的經歷說得詳細,爸媽說他不看科幻影集、也不看漫畫,靈異描述卻越來越多,豪斯在他脖子上裝上追蹤晶片,繁複的診斷治療,終於發現小男孩體內有兩組不同 的DNA!外來DNA在腦中的位置,使他以為自己被綁架了!


「豪斯」不死 必有後福?

Lymph Node Study Shakes Pillar of Breast Cancer Care

リンパ水腫(: lymphedema)とは局所のリンパ増多に起因する水腫リンパ管系の発達異常を原因とする原発性リンパ水腫と腫瘍、外傷等でリンパ管系が閉塞することを原因とする続発性リンパ水腫に分類することができる。四肢に生じることが多く、細菌の感染や創傷治癒の遅延の原因となることがある。

Lymph Node Study Shakes Pillar of Breast Cancer Care

A new study finds that many women with early breast cancer do not need a painful procedure that has long been routine: removal of cancerous lymph nodes from the armpit.



Readers' Comments

The discovery turns standard medical practice on its head. Surgeons have been removing lymph nodes from under the arms of breast cancer patients for 100 years, believing it would prolong women’s lives by keeping the cancer from spreading or coming back.

Now, researchers report that for women who meet certain criteria — about 20 percent of patients, or 40,000 women a year in the United States — taking out cancerous nodes has no advantage. It does not change the treatment plan, improve survival or make the cancer less likely to recur. And it can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.

Removing the cancerous lymph nodes proved unnecessary because the women in the study had chemotherapy and radiation, which probably wiped out any disease in the nodes, the researchers said. Those treatments are now standard for women with breast cancer in the lymph nodes, based on the realization that once the disease reaches the nodes, it has the potential to spread to vital organs and cannot be eliminated by surgery alone.

Experts say that the new findings, combined with similar ones from earlier studies, should change medical practice for many patients. Some centers have already acted on the new information. Memorial Sloan-Kettering Cancer Center in Manhattan changed its practice in September, because doctors knew the study results before they were published. But more widespread change may take time, experts say, because the belief in removing nodes is so deeply ingrained.

“This is such a radical change in thought that it’s been hard for many people to get their heads around it,” said Dr. Monica Morrow, chief of the breast service at Sloan-Kettering and an author of the study, which is being published Wednesday in The Journal of the American Medical Association. The National Cancer Institute paid for the study.

Doctors and patients alike find it easy to accept more cancer treatment on the basis of a study, Dr. Morrow said, but get scared when the data favor less treatment.

The new findings are part of a trend to move away from radical surgery for breast cancer. Rates of mastectomy, removal of the whole breast, began declining in the 1980s after studies found that for many patients, survival rates after lumpectomy and radiation were just as good as those after mastectomy.

The trend reflects an evolving understanding of breast cancer. In decades past, there was a belief that surgery could “get it all” — eradicate the cancer before it could spread to organs and bones. But research has found that breast cancer can begin to spread early, even when tumors are small, leaving microscopic traces of the disease after surgery.

The modern approach is to cut out obvious tumors — because lumps big enough to detect may be too dense for drugs and radiation to destroy — and to use radiation and chemotherapy to wipe out microscopic disease in other places.

But doctors have continued to think that even microscopic disease in the lymph nodes should be cut out to improve the odds of survival. And until recently, they counted cancerous lymph nodes to gauge the severity of the disease and choose chemotherapy. But now the number is not so often used to determine drug treatment, doctors say. What matters more is whether the disease has reached any nodes at all. If any are positive, the disease could become deadly. Chemotherapy is recommended, and the drugs are the same, no matter how many nodes are involved.

The new results do not apply to all patients, only to women whose disease and treatment meet the criteria in the study.

The tumors were early, at clinical stage T1 or T2, meaning less than two inches across. Biopsies of one or two armpit nodes had found cancer, but the nodes were not enlarged enough to be felt during an exam, and the cancer had not spread anywhere else. The women had lumpectomies, and most also had radiation to the entire breast, and chemotherapy or hormone-blocking drugs, or both.

The study, at 115 medical centers, included 891 patients. Their median age was in the mid-50s, and they were followed for a median of 6.3 years.

After the initial node biopsy, the women were assigned at random to have 10 or more additional nodes removed, or to leave the nodes alone. In 27 percent of the women who had additional nodes removed, those nodes were cancerous. But over time, the two groups had no difference in survival: more than 90 percent survived at least five years. Recurrence rates in the armpit were also similar, less than 1 percent. If breast cancer is going to recur under the arm, it tends to do so early, so the follow-up period was long enough, the researchers said.

One potential weakness in the study is that there was not complete follow-up information on 166 women, about equal numbers from each group. The researchers said that did not affect the results. A statistician who was not part of the study said the missing information should have been discussed further, but probably did not have an important impact.

It is not known whether the findings also apply to women who do not have radiation and chemotherapy, or to those who have only part of the breast irradiated. Nor is it known whether the findings could be applied to other types of cancer.

The results mean that women like those in the study will still have to have at least one lymph node removed, to look for cancer and decide whether they will need more treatment. But taking out just one or a few nodes should be enough.

Dr. Armando E. Giuliano, the lead author of the study and the chief of surgical oncology at the John Wayne Cancer Institute at St. John’s Health Center in Santa Monica, Calif., said: “It shouldn’t come as a big surprise, but it will. It’s hard for us as surgeons and medical oncologists and radiation oncologists to accept that you don’t have to remove the nodes in the armpit.”

Dr. Grant W. Carlson, a professor of surgery at the Winship Cancer Institute at Emory University, and the author of an editorial accompanying the study, said that by routinely taking out many nodes, “I have a feeling we’ve been doing a lot of harm.”

Indeed, women in the study who had the nodes taken out were far more likely (70 percent versus 25 percent) to have complications like infections, abnormal sensations and fluid collecting in the armpit. They were also more likely to have lymphedema.

But Dr. Carlson said that some of his colleagues, even after hearing the new study results, still thought the nodes should be removed.

“The dogma is strong,” he said. “It’s a little frustrating.”

Eventually, he said, genetic testing of breast tumors might be enough to determine the need for treatment, and eliminate the need for many node biopsies.

Two other breast surgeons not involved with the study said they would take it seriously.

Dr. Elisa R. Port, the chief of breast surgery at Mount Sinai Medical Center in Manhattan, said: “It’s a big deal in the world of breast cancer. It’s definitely practice-changing.”

Dr. Alison Estabrook, the chief of the comprehensive breast center at St. Luke’s-Roosevelt hospital in New York said surgeons had long been awaiting the results.

“In the past, surgeons thought our role was to get out all the cancer,” Dr. Estabrook said. “Now he’s saying we don’t really have to do that.”

But both Dr. Estabrook and Dr. Port said they would still have to make judgment calls during surgery and remove lymph nodes that looked or felt suspicious.

The new research grew out of efforts in the 1990s to minimize lymph node surgery in the armpit, called axillary dissection. Surgeons developed a technique called sentinel node biopsy, in which they injected a dye into the breast and then removed just one or a few nodes that the dye reached first, on the theory that if the tumor was spreading, cancer cells would show up in those nodes. If there was no cancer, no more nodes were taken. But if there were cancer cells, the surgeon would cut out more nodes.

Although the technique spared many women, many others with positive nodes still had extensive cutting in the armpit, and suffered from side effects.

“Women really dread the axillary dissection,” Dr. Giuliano said. “They fear lymphedema. There’s numbness, shoulder pain, and some have limitation of motion. There are a fair number of serious complications. Women know it.”

After armpit surgery, 20 percent to 30 percent of women develop lymphedema, Dr. Port said, and radiation may increase the rate to 40 percent to 50 percent. Physical therapy can help, but there is no cure.

The complications — and the fact that there was no proof that removing the nodes prolonged survival — inspired Dr. Giuliano to compare women with and without axillary dissection. Some doctors objected. They were so sure cancerous nodes had to come out that they said the study was unethical and would endanger women.

“Some prominent institutions wouldn’t even take part in it,” Dr. Giuliano said, though he declined to name them. “They’re very supportive now. We don’t want to hurt their feelings. They’ve seen the light.”