2012年2月27日星期一

Air Pollution Linked to Heart and Brain Risks

February 15, 2012, 10:31 am

Air Pollution Linked to Heart and Brain Risks

Keith Meyers/The New York TimesA layer of smog rests over Lower Manhattan.

It may be time to start paying more attention to those local air pollution alerts.

That is the message of three new studies this week that found, collectively, that people exposed to higher levels of air pollution have a greater risk of stroke, heart attacks and cognitive deterioration.

The impact of pollution on the heart and brain was seen over both the short and the long term. One nationwide study that followed nearly 20,000 women over a decade found that breathing in levels of polluted air like those commonly found in most parts of the country greatly accelerates declines in measures of memory and attention span. Another study in Boston found that on days when concentrations of traffic pollutants went up, so did the risk of stroke. The odds climbed by more than 30 percent even on days classified by the federal air quality index as “moderate” pollution days, which is intended to correspond to a minimal danger to health.

“At levels that the Environmental Protection Agency says are safe, we’re seeing real health effects,” said Gregory A. Wellenius, an associate professor of epidemiology at Brown University and lead author of the study linking pollution to stroke. “We saw these effects within 12 to 14 hours of when pollution levels went up.”

Studying the links between pollution and health is difficult, since so many factors are involved and it is difficult to establish a direct cause-and-effect relationship. But a link between pollutants in the air and declines in cardiovascular health has been suspected since at least the 1990s, when epidemiological research suggested that breathing in tainted air drives up rates of heart disease. The possible short-term effects of pollution remained particularly unclear, with some studies showing no immediate short-term risk. And little was known about the impact of inhaling emissions and air particles on brain function and dementia.

Dr. Wellenius and his colleagues tried to better clarify the short-term impact of air pollution by studying 1,705 stroke victims admitted to Beth Israel Deaconess Medical Center in Boston from 1999 to 2008, examining medical records to obtain the precise time a stroke actually occurred. They then cross-checked with the Environmental Protection Agency’s air quality index, which rates pollution levels in six general categories, beginning with “good,” then “moderate” and, at the very worst, “hazardous.” Some earlier studies have looked at daily air pollution levels and the number of hospitalizations for ischemic stroke or heart attacks on the same day, but that practice can be deceiving, since people sometimes wait hours or even days before going to a hospital after a stroke. “We were better able to estimate the patients’ air pollution exposure at the time of their stroke,” Dr. Wellenius said.

After controlling for age, hypertension and a slew of other risk factors for stroke, the researchers found a 34 percent higher risk at times when pollution levels climbed from “good” to “moderate.” (In the Boston area, where the study was conducted, pollution levels rarely climb very high, Dr. Wellenius said.) The effect was particularly strong when the researchers looked at levels of so-called black carbon and nitrogen dioxide, two markers of pollution from traffic.

Reducing air pollution levels by just 20 percent, an “achievable” goal, Dr. Wellenius said, “would have prevented about 6,000 of the 184,000 hospitalizations for stroke in the Northeast region” in 2007 alone, he said. The results were published this week in The Archives of Internal Medicine.

In a separate report published Tuesday in The Journal of the American Medical Association, scientists at the University Paris Descartes in France helped bolster the link between short-term exposure to air pollution and cardiovascular disease. They found that a variety of common pollutants — carbon monoxide, nitrogen dioxide, sulfur dioxide and others — raised a person’s immediate risk of having a heart attack.

Breathing in pollutants may cause harm in a number of ways, the researchers noted. They may cause inflammation linked to heart disease, increase the heart rate and thicken the blood, which can cause blood clots and accelerate atherosclerosis, or hardening of the arteries.

The smallest particles of pollution, those finer than 2.5 microns in diameter — or about one-thirtieth the width of a human hair — are particularly effective at infiltrating the body, the researchers noted. There is some evidence that they can even penetrate the brain through the nasal passages, said Jennifer Weuve, the lead author of a third study, also published in The Archives of Internal Medicine, linking pollution to cognitive decline.

Dr. Weuve’s research followed 19,409 women in the United States between the ages of 70 and 81 for about a decade, looking at changes in cognition every two years. Declines in memory and executive function, including the ability to plan and make or carry out a strategy, are normal as people get older. But the study showed that women with higher levels of long-term exposure to air pollution had “significantly” faster declines in cognition than those with less exposure to pollutants.

“Cognitively speaking, this higher exposure is as if you had aged an extra two years,” said Dr. Weuve, an assistant professor at the Rush Institute for Healthy Aging at Rush University Medical Center in Chicago. That might not sound like much, she added, but if there were a treatment “that could just delay the onset of dementia by two years, that would spare the population millions of cases of disease over the next 40 years.”

Vinegar cleans berries

Subject: Vinegar cleans berries

Subject: Vinegar

Great to know!!

The key to preventing moldy berries? Vinegar!

by Katie

Berries, particularly super-fresh berries, are just wonderful, aren't they?

Image: Healthyfellow.com

But they're also kind of delicate. Raspberries in particular seem like they can mold before you even get them home from the market. There's nothing more tragic than paying $4 for a pint of local raspberries, only to look in the fridge the next day and find that fuzzy mold growing on their insides.

Well, with fresh berries just starting to hit farmers markets, you can tell that we Foodlush writers have berries, and how to keep them fresh, on the brain this week! First Jonna shared this excellent tip on how to salvage berries that are starting to lose their luster. Now I'm here to share a tip on how to prevent them from getting there in the first place:

Wash them with vinegar.

A friend of mine shared this tip with me a few weeks ago, and it really, really works. When you get your berries home, prepare a mixture of one part vinegar (white or apple cider probably work best) and ten parts water. Dump the berries into the mixture and swirl around. Drain, rinse if you want (though the mixture is so diluted I find you can't taste the vinegar,) and pop in the fridge.

The vinegar kills any mold spores and other bacteria that might be on the surface of the fruit, and voila! Raspberries will last a week or more, and I've had strawberries go almost two weeks without getting moldy and soft. So go forth and stock up on those pricey little gems, knowing they'll stay fresh as long as it takes you to eat them.

ENJOY!!

2012年2月25日星期六

不要不必要的健檢

商業利益導向，害人不淺。

> 和信醫院院長黃達夫6日炮轟，醫院不應為牟利而推銷民眾接受這種檢查
>
> 沒事不要亂用斷層掃瞄，我上次照一次胸腔，連續一年都病歪歪的，三天兩頭的感冒不停，感冒藥吃多了，腎臟病跟著來，非必要切莫採用電腦斷層。(大帥12/13)
>
> 難得有有醫德的醫生願挺身而出,說出事情的真相!
>
> 願所有收到這封信的朋友都能平安．健康．幸福．快樂
>
> 宋成龍並說，一般健檢幾乎都少不了的電腦斷層，輻射線劑量是Ｘ光攝影的數十到上百倍，對年輕女性生殖器官傷害尤其驚人。
>
> 「貴的健檢就是好的健檢」實為錯誤觀念。
>
> 快樂不是註定的事，而是一種選擇
>
> 輻射風險高(和信醫院院長黃達夫)
>
> ▲和信醫院院長黃達夫6日炮轟，正子攝影等健檢費用昂貴，且全身掃瞄得承受比Ｘ光高10倍到100倍的輻射劑量，醫院不應為牟利而推銷民眾接受這種檢查。（張鎧乙攝)
>
> 台灣平均每年有七萬多人被診斷為癌症，四萬多人死於癌症，令人聞癌色變。
>
> 不少民眾對以檢查出癌症為號召、動輒數萬元的貴族化健檢趨之若鶩，但和信醫院院長黃達夫說，非必要地使用昂貴篩檢儀器，可能過度暴露在輻射及侵入性檢查的風險下，對多數民眾無益!
>
> 國內癌症專科醫院和信醫院醫師執筆出版《癌症大祕密─醫師很想說、你很想問的六十五個問題》一書。「貴族化健檢真的有必要嗎？」篇章直指國內近年浮濫使用磁振造影或正子攝影健檢的弊端。
>
> 和信醫院院長黃達夫說，近年各大醫學中心大力推廣高價位包套健檢，甚至列舉廿大癌症篩檢指標為號召。但目前國際醫界公認具效益的癌症篩檢項目
>
> 只有大腸癌糞便潛血、腸胃癌內視鏡、子宮頸抹片、乳房攝影及攝護腺抗原檢驗。
>
> 以目前各大健檢中心正夯的正子攝影為例，自費檢查每次三萬多元；且因為實在太精密了，幾乎都能在民眾體內發現可能是癌細胞或腫瘤的「疑點」。
>
> 為了確認，病人又會「逛醫院」反覆檢查，甚至要求切片、穿刺等侵入性檢查，搞得情緒焦慮不已。而正子攝影會釋放巨大輻射量、穿刺可能導致傷口感染、肺切片可能引發氣胸風險，都常被刻意忽略。
>
> 黃達夫說，相關研究顯示，一千名接受正子攝影者中，只有三人真正罹癌，其他人不是偽陽性，就是全無徵兆。正子攝影應用於追蹤確定罹癌者癌細胞是否轉移，而不應作為癌症篩檢工具。
>
> 和信放射診斷科主治醫師宋成龍說，健檢項目應視個人特殊的家族史或生活習慣不同，在醫師專業評估下，量身推荐檢查項目。醫院不應本末倒置，以篩檢工具為中心，忽略了患者的個別差異性。
>
> 宋成龍並說，一般健檢幾乎都少不了的電腦斷層，輻射線劑量是Ｘ光攝影的數十到上百倍，對年輕女性生殖器官傷害尤其驚人。
>
> 「貴的健檢就是好的健檢」實為錯誤觀念。」
>
黃達夫強調，據衛生署統計，國人每年總醫療支出高達七千多億元，自費醫療占卅七％、近三千億元，其中不必要的健檢占相當部分，是醫療資源的浪費。

2012年2月17日星期五

高罹病率/ How Safe Are Ships?

Letters

How Safe Are Ships?

Readers respond to an article on cruise safety.

高轉職率：中高齡轉職比例，5年增加1.27倍。根據勞委會統計，中高齡人（45歲～64歲）的轉職比率，除了在2006年稍降外，每年增加。

高罹病率：2010年，中高年（40歲～59歲）罹癌人數將近20萬人，5年內急速逐年增加3成。中高齡族群的罹病率，根據衛生署統計，各種癌症（惡性腫瘤）、內分泌、精神病患、循環系統及心血管、消化系統等5大疾病，就醫人數都呈現不斷上升的趨勢。

高離婚率：10年來離婚與分居人數，增加2.2倍。2000年，國內中高齡的離婚與分居人數約37萬多人；到了2010年，這個數字已經增加到83萬人，足足增加2.2倍。

工作，被迫重新再找

「趁著過年回台灣看看有什麼機會，」說這話的，是一位已到大陸工作10年的台商。今年52歲的他，原本在一家美國前500大企業擔任中國區總經理。去年9月，這家美商為了配合客戶需求，開始往中國內陸遷移。選擇優退後要展開中年轉業的他，這才發現，過去悶著頭為公司打拚，外面的世界早已非他所想像。

從去年下半年開始，彭光國手邊協助媒介工作中，多了10來位和這位前美商中國老總背景相似的台商。他們中年轉職的原因都是，原任職公司要內遷，或縮編而半自願地去職。

身體，無預警崩壞

很多人在進入中年後，常常都會不經意地感嘆體力大不如前，甚至聽聞周遭親友罹病的次數，突然發生。去年底，在某家半導體廠任職的蔡先生，一天在上班時突然感覺眼睛刺痛，經過醫生診斷後，初步認定是角膜炎，不以為意的他拿著眼藥水後繼續回去上班。

第二天早上，他一如往常起床刷牙洗臉，漱口時竟然無法遏止水從嘴角不斷流出。這時他才感到事態嚴重，趕緊請假就醫後，確定是俗稱「小中風」的顏面神經麻痺。一開始蔡先生實在不能接受，作息與飲食向來正常的自己會中風，直到經過醫生的診斷後，他才接受這項事實。他會生病，原因就在於壓力過大。

婚姻，亮起紅燈

在婚姻上，中年人面臨的挑戰也比以往大得多。在日本，近年常出現妻子主動提出離婚協議的情況。知名心理專家楊聰財說，許多妻子提出離婚的原因，並非結交新歡，或是先生不忠，而是在邁入中年後，照顧了20年的小孩，在此時長大成人，並陸續搬出去住。妻子突然覺得階段性責任已了，決定放手去追尋自己的人生。在歐美、日本出現這類案例，也在你我周遭上演。

一個全球化的新風險社會，讓一個「責任我負、業務我扛、家庭我擔」的中年世代，面臨前所未有的壓力。與企業經營相同，如今，每個人都要懂得管理自己的人生，也要具備風險意識，才能及早預防「新三高」危機的來襲。

2012年2月15日星期三

「準分子雷射層狀角膜成型術」(LASIK)

[驚爆] 眼科名醫蔡瑞芳宣布停作雷射手術

眼睛可不像一般整容那麼單純，一但有後遺症，真的恐怖！！【聯合晚報╱記者林進修/台北報導】2012.02.14

台灣重量級眼科醫師蔡瑞芳認為雷射近視矯正手術後遺症陸續出現，他決定不再做這種手術。雷射近視矯正手術在台非常普遍，但台灣最早引進這項手術的台北醫學大學眼科兼任教授蔡瑞芳，最近突然宣布，今後不再動這種手術。他表示，因長期觀察發現，不少當年接受雷射手術的患者，十多年後視力明顯下降，研判可能和當年動刀後角膜瓣發炎有關。

蔡瑞芳在國內眼科醫學界頗具份量，20年前擔任林口長庚醫院眼科主任期間，引進當時連美國也還沒進入人體臨床試驗的「準分子雷射層狀角膜成型術」(LASIK)，並完成近500例的人體臨床試驗。近年LASIK也成為近視矯正主流，台灣眼科連鎖診所紛起，近視矯正也成了如醫學美容般的超夯行業。蔡瑞芳的宣布，引起國內眼科醫學界討論，也衝擊近視矯正醫學的市場。

蔡瑞芳表示，LASIK是劃時代的醫學創舉，利用雷射刀將近視病患的??分三圈，掀起上層角膜後，接著以雷射刀切去下層角膜，再將上層角膜覆蓋回去。由於角膜變薄，焦距變短，從外進來的光線就可精準對焦在視網膜上，達到矯正近視的目的。雖然LASIK具有雷射刀切割精準、近視矯正準確及角膜沒有結疤反應等優點，卻也有術後易出現眩光、夜間視力減退及眼睛乾澀症候群等併發症，因此眼科醫師施術前要慎選合適病人，並主動告知可能併發症。

但十幾二十年過後，一些當年未想到的併發症陸續出現，蔡瑞芳最近就接到十幾例受不了併發症而就診的個案，大多是四、五十歲的中年人，且視力在短時間內明顯減弱，日常生活及工作都大受影響。突然拋出震撼彈，蔡瑞芳清楚知道此舉可能會擋人財路，甚至引來反彈及攻訐，但他堅持，身為醫者應有責任，既然當年受術患者如今陸續出現未曾料到的併發症，難保未來不會再出現其他併發症。基於醫學良心，也為了病患著想，他只有選擇停開這種手術，不讓傷害擴大。

LASIK - Wikipedia, the free encyclopedia

en.wikipedia.org/wiki/LASIK - 頁庫存檔 - 翻譯這個網頁

LASIK or Lasik (laser-assisted in situ keratomileusis), commonly referred to simply as laser eye surgery, is a type of refractive surgery for correcting myopia, ...

Intraoperative complications

The incidence of flap complications has been estimated to be 0.244%.^[60] Flap complications (such as displaced flaps or folds in the flaps that necessitate repositioning, diffuse lamellar keratitis, and epithelial ingrowth) are common in lamellar corneal surgeries^[61] but rarely lead to permanent visual acuity loss; the incidence of these microkeratome-related complications decreases with increased physician experience.^[62]^[63] According to proponents of such techniques, this risk is further reduced by the use of IntraLasik and other non-microkeratome related approaches, although this is not proven and carries its own set of risks of complications from the IntraLasik procedure.
A slipped flap (a corneal flap that detaches from the rest of the cornea) is one of the most common complications. The chances of this are greatest immediately after surgery, so patients typically are advised to go home and sleep to let the flap heal. Patients are usually given sleep goggles or eye shields to wear for several nights to prevent them from dislodging the flap in their sleep. A faster operation may decrease the chance of this complication, as there is less time for the flap to dry.
Flap interface particles are another finding whose clinical significance is undetermined.^[64] A Finnish study found that particles of various sizes and reflectivity were clinically visible in 38.7% of eyes examined via slit lamp biomicroscopy, but apparent in 100% of eyes using confocal microscopy.^[64]

[edit] Early postoperative complications

The incidence of dry eye varies widely from research studies. A study by Hovanesian et al. reported that 48% of patients experienced dry eye symptoms at 6 months period post surgery.^[65]
The incidence of diffuse lamellar keratitis (DLK),^[66] also known as the Sands of Sahara syndrome, has been estimated at 2.3%.^[67] DLK is an inflammatory process that involves an accumulation of white blood cells at the interface between the LASIK flap and the underlying corneal stroma. It is most commonly treated with steroid eye drops, and sometimes it is necessary for the eye surgeon to lift the flap and manually remove the accumulated cells.
The incidence of infection responsive to treatment has been estimated at 0.4%.^[67] Infection under the corneal flap is possible. It is also possible that a patient has the genetic condition keratoconus that causes the cornea to thin after surgery. Although this condition is screened in the preoperative exam, it is possible in rare cases (about 1 in 5,000)^{[citation needed]} for the condition to remain dormant until later in life (the mid-40s). If this occurs, the patient may need rigid gas permeable contact lenses, Intrastromal Corneal Ring Segments (Intacs),^[68] Corneal Collagen Crosslinking with Riboflavin^[69] or a corneal transplant.
The incidence of persistent dry eye has been estimated to be as high as 28% in Asian eyes and 5% in Caucasian eyes.^[70] Nerve fibers in the cornea are important for stimulating tear production. A year after LASIK, subbasal nerve fiber bundles remain reduced by more than half.^[71] Some patients experience reactive tearing, in part to compensate for chronic decreased basal wetting tear production.
The incidence of subconjunctival hemorrhage has been estimated at 10.5%^[67] (according to a study undertaken in China; thus results may not be generally applicable due to racial and geographic factors).

[edit] Late postoperative complications

The incidence of epithelial ingrowth has been estimated at 0.1%.^[67]
Glare is another commonly reported complication of those who have had LASIK.^[20]
Halos or starbursts around bright lights at night are caused by the irregularity between the lasered part and the untouched part. It is not practical to perform the surgery so that it covers the width of the pupil at full dilation at night, and the pupil may expand so that light passes through the edge of the flap into the pupil.^[72] In daytime, the pupil is smaller than the edge. Modern equipment is better suited to treat those with large pupils, and responsible physicians will check for them during examination.
Late traumatic flap dislocations have been reported 1–7 years post-LASIK.^[73]
Dry eye or in severe cases Chronic Dry eye. Due to nerves that are severed during the Lasik operation (around 70% of corneal nerves are severed), the lubrication system of the eye is affected and nerves may never recover to pre-operative condition. This may leave the patient with potential permanent dry eyes.

[edit] Other

LASIK and other forms of laser refractive surgery (i.e. PRK, LASEK and Epi-LASEK) change the dynamics of the cornea. These changes make it difficult for your optometrist and ophthalmologist to accurately measure your intraocular pressure, essential in glaucoma screening and treatment. The changes also affect the calculations used to select the correct intraocular lens implant when you have cataract surgery. This is known to ophthalmologists as "refractive surprise." The correct intraocular pressure and intraocular lens power can be calculated if you can provide your eye care professional with your preoperative, operative and postoperative eye measurements.

Although there have been improvements in LASIK technology,^[74]^[75]^[76] a large body of conclusive evidence on the chances of long-term complications is not yet established. Also, there is a small chance of complications, such as haziness, halo, or glare, some of which may be irreversible because the LASIK eye surgery procedure is irreversible.

The incidence of macular hole has been estimated at 0.2 percent^[58] to 0.3 percent.^[77] The incidence of retinal detachment has been estimated at 0.36 percent.^[77] The incidence of choroidal neovascularization has been estimated at 0.33 percent.^[77] The incidence of uveitis has been estimated at 0.18 percent.^[78]

Although the cornea usually is thinner after LASIK, because of the removal of part of the stroma, refractive surgeons strive to maintain the maximum thickness to avoid structurally weakening the cornea. Decreased atmospheric pressure at higher altitudes has not been demonstrated as extremely dangerous to the eyes of LASIK patients. However, some mountain climbers have experienced a myopic shift at extreme altitudes.^[79]^[80]

In situ keratomileusis effected at a later age increases the incidence of corneal higher-order wavefront aberrations.^[81]^[82] Conventional eyeglasses do not correct higher order aberrations.

Microfolding has been reported as "an almost unavoidable complication of LASIK" whose "clinical significance appears negligible."^[64]

Blepharitis, or inflammation of the eyelids with crusting of the eyelashes, may increase the risk of infection or inflammation of the cornea after LASIK.^{[citation needed]}

Myopic (nearsighted) people who are close to the age (mid- to late-forties) when they will require either reading glasses or bifocal eyeglasses may find that they still require reading glasses despite having undergone refractive LASIK surgery. Myopic people generally require reading glasses or bifocal eyeglasses at a later age than people who are emmetropic (those who see without eyeglasses), but this benefit may be lost if they undergo LASIK. This is not a complication but an expected result of the physical laws of optics. Although there is currently no method to completely eradicate the need for reading glasses in this group, it may be minimized by performing a variation of the LASIK procedure called "slight monovision." In this procedure, which is performed exactly like distance-vision-correction LASIK, the dominant eye is set for distance vision, while the non-dominant eye is set to the prescription of the patient's reading glasses. This allows the patient to achieve a similar effect as wearing bifocals. The majority of patients tolerate this procedure very well and do not notice any shift between near and distance viewing, although a small portion of the population has trouble adjusting to the monovision effect. This can be tested for several days prior to surgery by wearing contact lenses that mimic the monovision effect. Recently, a variation of the laser ablation pattern called PresbyLASIK, has been developed to reduce or eliminate dependence on reading glasses while retaining distance vision

There are reports of decrease in the number of corneal keratocytes (fibroblasts) after LASIK.^[83]

2012年2月14日星期二

荷蘭其實沒那麼環保/ PHILIPS 竹北廠在清理污染善後

荷蘭大廠商PHILIPS 在台灣的竹北廠在清理污染善後

荷蘭其實沒那麼環保

2012-02 天下雜誌 490期作者：經濟學人

相關關鍵字：

環保組織最近的報告，披露了荷蘭的環保真相：它的空氣、土壤和地表水，在全歐洲是最髒的。

冷冽的清晨，薄霧從運河上升起，飄向平原與林間。此刻的荷蘭，絲毫不像是藏污納垢的地方。

事實上，結冰的河水早已被過量的硝酸鹽、磷酸鹽污染，空氣中也充滿了懸浮微粒。

環保組織「自然與環境」最近彙整的一份報告，披露了荷蘭環保紀錄的真相：它的空氣、土壤和地表水，在全歐洲是最髒的。

報告還引用了耶魯大學的「環保表現指標」評比，荷蘭在歐盟二十七國中，排名二十。表現最糟的指標是土壤，因為累積了大量硝酸鹽和磷酸鹽，而這些化合物滲入地表水，又造成了水體污染。另外，荷蘭的一氧化氮排放是歐盟平均的三倍，二氧化碳排放也在過去二十年，增加了一五％。

污染這麼嚴重，有幾個明顯的原因。一，荷蘭擁有全歐最高的每人平均牲畜量，這些動物的糞便會污染土壤和水源。二，荷蘭是交通樞紐，貨車和駁船都用柴油當燃料，產生了大量懸浮微粒。三，荷蘭有許多高耗能的產業，例如煉油業、鋼鐵業和化工業。這些原因，再加上地狹人稠，不污染也難。

報告出爐後，荷蘭官方並未加以反駁，但對於這些污染的影響，似乎沒那麼擔心。畢竟經濟不景氣，政府不想為難那些可以增加稅收、提供就業的企業。而且，就算荷蘭被環保人士取了個「歐洲排污口」外號，這裡的生活品質可不差。

2012年2月12日星期日

各年齡層心跳、呼吸、血壓的正常值

心跳過快的自我救護

http://www.enorth.com.cn　 2008-11-06 16:17

各年齡層心跳、呼吸、血壓的正常值

年　齡　層	心跳(次/分)	呼吸(次/分)	血壓（mmHg）
新生兒期	130-150	36-60	收縮壓 20-60
嬰兒期	125-135	40-46	收縮壓 70-80
幼兒兒童期	65-105	20-24	90-100/60-64
青少年期	65-100	16-22	100-120/70-80
成年期	60-100	12-20	100-120/70-80
老年期	60-100	12-18	130-140/90-95

　在正常情況下，心臟的跳動是由起搏和傳導系統的最高"司令部"──竇房結發動的，所以叫竇性心律。正常成人的心跳每分鍾60 ─ 100次，如果超過100次，就是心跳過快，醫學上叫作心動過速。　　竇性心動過速頗為常見。顧名思義，此種心動過速是由竇房結發動的。發作時，成人心跳頻率每分鍾在100?150次之間，幼兒每分鍾可達200 次。其特點是逐漸發生、逐漸消失。竇性心動過速可見於正常人，常見的誘發因素有情緒激動、過度疲勞、惡夢、飲酒、喝濃茶、飲咖啡以及大量吸煙等。一般無需特殊治療，只要消除誘發因素就會自行恢復。

2012年2月7日星期二

台中大里毒米恐下肚

農地重金屬超標大里毒米恐下肚

台中市大里區28公頃農田驗出遭鎳、鉻重金屬污染，環保局立告示牌要求休耕，但遭公告污染區域的二期稻作早在去年11月就已收割，部分賣給民間糧商的稻米，恐已被民眾吃下肚。（記者陳建志攝）

驗出含鎳鉻 28公頃緊急休耕

〔記者陳建志、蔡淑媛、張菁雅、劉力仁／綜合報導〕台中市大里區二十八公頃農田被驗出遭鎳、鉻重金屬污染，中市環保局一月底通知農民休耕，但遭污染農田的二期稻作早在去年十一月就已收割，除部分公糧繳回農會糧倉外，其餘已被民間米商碾成白米流入市面，但量有多少？官員也不知道。食用過量鎳、鉻恐影響肝、腎功能，若稻米受污染，民眾吃下肚健康堪慮。

中市環保局水質及土壤保護科長范群彬表示，去年底向環保署申請擴大調查大里區詹厝園、大突寮、中興段受污染情形，總數八百六十筆調查丘塊中，發現一百九十筆重金屬污染超標，結果在一月中旬出爐，夏田里附近約二十八公頃農田驗出鎳、鉻重金屬污染超標，環保局緊急要求農民休耕，並剷除田裡的蔬菜、果樹。

檢驗空窗期收割稻作早流出

有稻農表示，每公頃農地約可收成六千公斤乾穀，若受污染的二十八公頃農田全部種稻，白米產量可達一百零七噸。大里區農會表示，該區域種植多少稻米目前尚未確定，上繳公糧的部分，目前都存放在農會糧倉，沒有外流風險，農民自行賣到民間糧商則無法掌握。

夏田里的蘇姓農民表示，去年種植二期稻作已賣給烏日溪南的米廠，附近農戶若非交給農會，就是賣給烏日等地的米廠，擔心早就碾成白米流入市面，抱怨環保單位通知太慢。范群彬則解釋，土壤檢測、採樣須等收割後才能進行。

多少流市面中市官員也不知

截至昨天為止，包括中市農業局、環保局都未掌握稻米流向，流入市面的米有多少也不知道。台中市農業局作物生產科長張豐勝解釋，土壤受污染，稻米也不一定受污染，若要追查受污染稻米流向，須直接向所有農戶調查，但因工程浩大，需和農糧署研究後才能決定處理方式。

中國醫藥大學附設醫院毒物科主任洪東榮表示，如果是工廠鉻污染廢水排放到農田，農夫在耕作時經呼吸和皮膚接觸，會腐蝕呼吸道和造成皮膚發炎等症狀。遭鉻污染的稻米被人體食用，會造成腸胃病變，隨尿液排出時影響泌尿道系統；鎳會引發肺癌、咽喉腔的癌症，也會造成皮膚過敏，長紅疹、蕁麻疹等，有小動物實驗也會造成腎、肝和內分泌病變，或影響神經系統。

疑灌溉渠道遭工廠廢水污染

不過，環保署土污基管會執行秘書蔡鴻德表示，鎳、鉻主要造成農作物死亡，稻米對於鎳、鉻的吸收並不好，因此目前相關法令管制農作物重金屬含量部份，並沒有針對鎳、鉻訂定管制標準。

環保署研判，污染來源是周圍工業區工廠排放廢水污染到農地灌溉渠道，導致農地污染，估計需要一年整治，休耕的農地每公頃每期將補助四萬五千元。

中市農業局作物生產科長張豐勝表示，農業局去年十一月二期稻作收割前曾採樣送檢，其中三件是這次遭公告污染的地區，檢驗結果都符合食用標準，並未發現遭重金屬污染；另外，中市衛生局食品藥物科長陳淑惠表示，去年抽檢市面上稻米，並未發現遭污染情形。

2012年2月6日星期一

蘋果供應商富士康：工作機械單調﹐而且壓力巨大

概言之﹐《紐約時報》的文章指出﹐蘋果已經對富士康等供應商形成的全球供應鏈形成依賴。富士康是台灣電子產品製造巨頭﹐在中國多個城市都設有大型工廠﹐每家工廠都擁有數萬名工人。富士康生產了全世界約40%的消費電子產品﹐服務對象包括戴爾(Dell)、惠普(Hewlett-Packard)、微軟 (Microsoft)和索尼(Sony)等公司。

工作環境很殘酷。工人通常每周工作六天﹐12小時兩班倒﹐每天工資不到20美元（約合人民幣140元）。很多人居住在擁擠不堪的宿舍里﹐有些人擠在沒有空調的小房間里。有許多報道稱﹐富士康還僱傭童工﹐不過最近蘋果出爐的供應商審計報告發現童工數量已經有所下降。

工作機械單調﹐而且壓力巨大：近幾年來富士康在中國共有17名工人自殺。因此﹐富士康給大樓拉上了巨大的防自殺網。

工人們還受到有毒化學物質和高濃度粉塵的危害﹐去年成都一家富士康工廠就因粉塵發生爆炸﹐造成人員傷亡。

那麼﹐既然富士康及其他供應商為那麼多其他公司製造產品﹐為何單單拿蘋果來做文章？

摩根士丹利資本國際 (MSCI) 專門研究科技和電信業公司的高級環境、社會及治理分析師伊士曼(Meggin Thwing Eastman)說﹐從紙面上看﹐蘋果設立了很好的制度﹐這一點與在社會責任上表現較好的企業是相同的。但我對執行情況存有疑慮﹔我們在蘋果看到了在其他公司沒有看到的東西。

需求大﹐週轉快﹐供應商被壓榨

2012年2月1日星期三

Prostate cancer

春節時我聽妹婿許博士說他的一位同事年紀輕就因Prostate cancer而離去.....

NICE: Prostate cancer drug too costly for NHS

By Smitha Mundasad BBC News

Abiraterone has been shown to extend life for more than three months

A drug that can extend the life of men with advanced prostate cancer by more than three months has provisionally been rejected for NHS use.

The health watchdog for England and Wales says the drug's benefits are not enough to justify the price the NHS has been asked to pay.

Cancer charities have been angered by the decision about abiraterone, one of the few drugs available to men in the final stages of prostate cancer.

A final decision is yet to be made.

Prostate cancer is the most common cancer to affect men in the UK.

The chief executive of the National Institute for Health and Clinical Excellence (NICE), Sir Andrew Dillon, said the drug was effective, and one of its key benefits was that it could be taken orally in the patient's own home.

"We are therefore disappointed not to be able to recommend it for use on the NHS, however it is an expensive drug," Sir Andrew added.

'Bitter blow'

Abiraterone costs just under £3,000 for one month's supply but has been offered at a undisclosed discounted price to the NHS.

Cancer charities have criticised the health regulator's decision.

"Quite simply, abiraterone prolongs the life of men with incurable prostate cancer. The draft decision is a bitter blow to thousands of men and their families and must be overturned," said Owen Sharp, chief executive of The Prostate Cancer Charity.

Case study: Ron McCoo, Blackpool

Ron, 59, was diagnosed with prostate cancer in 2010. He has been using abiraterone for three months. His local health provider currently allows the drug to be used on an individual basis. He says it has changed his life.

"I have my life back. I have a lot more energy and no pain. My quality of life is excellent. I wouldn't even know I have cancer now, it's that good.

"I know it doesn't work for everybody but it certainly works for me. I would be devastated if it was no longer available on the NHS."

Ron's wife Terri says: "We know NICE has to take a lot of things into consideration, but when you have a terminal illness an extra fourth months is very precious."

Prof Peter Johnson, Cancer Research UK's chief clinician, said: "Only one other drug is available on the NHS that has been shown to prolong survival but it has more severe side-effects than abiraterone and is effective in fewer men."

Cancer Research UK, which provided support in the development of the drug and could benefit from its royalties, said it believed that NICE might have overestimated the number of people who needed the drug.

It said that if the regulator rethought the criteria used to calculate the cost-effectiveness of the drug, there is a chance it could be made available under special arrangements for treating people at the end of their lives.

NICE said it had already used the appropriate methods in its review, and concluded that the number men who would need the drug was too large to consider such agreements.

Almost 500 men have successfully applied for abiraterone in the past nine months through the alternative route of the Cancer Drugs Fund in England, an initiative designed to increase access to drugs.

Until final guidelines are issued by the health regulator, decisions can continue to be made locally about the use of abiraterone.

Each year 37,000 men are diagnosed with prostate cancer, and more than 10,000 die from it.

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