如何選擇醫學美容的醫師? 2012/04/02 by黃翔醫師 妳可能聽過或做過淨膚雷射、脈衝光、飛梭雷射等各種雷射機器，但妳是否知道其實施打雷射是需要醫師的專業評估膚況及膚質，調整適當的機器參數，才能達到雷射的最佳效果嗎? 現代社會的進步，讓許多人越來越重視皮膚的問題。在先進醫學美容技術及儀器的幫忙下，的確能讓許多人得到回春及年輕的效果。近年來，醫學美容診所如雨後春筍般的興起，但是許多問題也因而產生。到底要選擇甚麼樣的醫師，才能提供良好的服務，成了消費者就醫前最大的疑問。就醫師的培養訓練而言，目前衛生署核准的專科醫師，只有皮膚科與整形外科在訓練的過程中，有充分對於醫學美容相關知識的訓練，這個訓練需要數年的時間才有辦法完成。至於民眾常常看到的"醫學美容"專科醫師，其實並不是衛生署核准的專科醫師，這是由對醫學美容感興趣的醫師團體所成立的醫學會而各自認證的，並不是由衛生署官方核准。因此許多醫師之前可能是家醫科、婦產科、耳鼻喉科等等各個專科的醫師，並不是衛生署所認證的皮膚科或整形外科醫師。當然這些並非專科但是從事醫學美容的醫師當中，也有許多優秀的醫師，但是受限於沒有完整的專業訓練，因此專業知識以及技術上的個別差異性很大，民眾可能很難藉由他們的學經歷，得知這個醫師對於醫學美容的專業及熟練程度。有些醫師可能可以處理得不錯，但是遇到技術跟專業度比較不熟練的醫師，產生併發症的機會也就比較大。然而，對於一般民眾來說，要去評估一個非皮膚科專科的醫師對於醫學美容的專業程度，是非常困難的。因此在就醫透明度不高的狀況下，對於一般民眾最保險的方式，就是選擇衛生署認證的皮膚科或整形外科醫師。至少這些專科醫師都經過足夠的訓練，能夠確保就醫上的醫療品質。在醫學美容的領域來說，「安全」應該是最重要的!不要因為貪小便宜而忽略了就醫的安全性，這樣就得不償失了。在安全的情況下再來講求效果，才能達到既安全又有效的治療。
Tuesday, April 3, 2012
使用TNF-Alpha Blockers可能增加結核病感染!!
公告「腫瘤壞死因子阻斷劑類（TNF-Alpha Blockers）藥品之上市後風險管理計畫書（Risk Management Plan；RMP）」相關事宜。(TFDA發布日期2012-04-03)公告「腫瘤壞死因子阻斷劑類（TNF-Alpha Blockers）藥品之上市後風險管理計畫書（Risk Management Plan；RMP）」相關事宜。依據：藥事法第四十八條。
双美勁敵…大江生醫每年進口90公噸膠原蛋白!!
大江生醫股份有限公司
(一)公司簡介1.沿革與背景大江(興櫃代碼：8436)成立於1980年9月，前身為「大江興業股份有限公司」，初期以國、內外各類商品的進出口貿易為主要業務，1999年成立生物醫學事業部後，於2005年更名為「大江生醫股份有限公司」，2012年2月15日登錄興櫃掛牌交易，此外，公司並預計2012年底前由興櫃轉上櫃掛牌交易。2.營業項目與產品結構主要業務是為各大廠研發保健品、美容保養品及飲料有效添加物等，其經營模式以ODM為主，截至2010年營收比重為保健食品(71%)、美容保養品(16%)及飲料有效添加物(8%)。其中，保健食品包含軟硬膠囊、錠劑、粉劑、茶包、油式硬膠、腸溶微粒、機能性飲品及緩釋微粒劑型飲品等多種機能性食品劑型；美容保養品則包括基礎清潔、保養、修護、滋潤等產品開發及品牌性包裝設計等。
(二)產品與競爭條件1.產品與技術簡介公司搜尋全球先進的生物原料，以多年的研發經驗，為客戶進行精細的可行性分析，再由專業研發人員進行配方及製程研發，遵照SOP規範生產製造，最後由品保中心出具產品履歷表後上市；[1]此外，為提升客戶滿意度，公司亦隨時強化製程的精準、搜尋及研發符合產品需求的原物料，提升產品開發的效率，強化市場競爭力，以及積極取得各項專利等。2.重要原物料及相關供應商產品原料主要來自於國內外廠商，其中用於美容保養品、保健品及機能性飲料的膠原蛋白，是由法國進口，其一年進口量超過90公噸，約佔台灣總量的三分之二。3.產能狀況與生產能力公司在國內擁有2座廠房，為五股廠(膠囊錠劑廠)與屏東農科廠(機能性飲品廠)，其中，五股廠主要以生產食品錠劑、膠囊及粉劑包為主；農科廠則以生產機能性飲料為主；海外部份，於大陸地區擁有海南廠(前置處理工廠)、上海閩行廠(食品包裝廠)，以及日本(保養品工廠)等。2010年產能如下：產品單位年產能保健品粉劑仟包1,500膠囊仟粒120,000錠劑仟顆180,000液態機能性飲品仟瓶50保養品固態類仟瓶350油水類仟瓶2,500指甲油仟瓶120面膜仟片500霜乳類仟瓶2,000原料類仟克35,000此外，公司還規劃於屏東設立自有膠原蛋白生產基地，並預計於2012年底展開動工，就近獲取最高等級的黑鮪魚，以萃取保養品與保健品的主要原料「膠原蛋白」等；以及在大陸金山購入約5,000坪工廠用地，該廠已規劃2012年Q2開始動工、2013年底前投產，投產後主要供應大陸市場需求。4.新產品與新技術除現有的產品及技術外，公司與中興大學合作生產瘦體素、與元智大學合作開發快速的基因改造生物(GMO)檢驗產品，並自行開發樹脂面膜與微粒、噴霧型跳動精華液、緩釋微粒果凍、黑鮪魚膠原蛋白萃取物、鰻魚精華萃取液、諾麗果萃取物以及消臭分子飲料等。(三)市場需求與銷售競爭1.產業結構與供需營養產業是一重對人體健康有益，又能為人體補充營養素的產業，其中包含四大類，如：保健品、天然有機食品、營養強化食品及美容營養品等。保健品是以維他命、礦物質、草本類產品及機能性產品為主，如：魚油、益生菌、CoQ10等；天然有機食品以無添加農藥、防腐劑及其他添加劑的有機成份為主；營養強化食品則是指含有維他命、礦物質、蛋白質等添加劑的食品，如：高鈣牛奶、DHA牛奶、含鐵餅乾等；美容營養品則為內服的保養品。近年來由於科技的進步、保健觀念的提升，以及高齡人口的增加，全球保健品市場已成為一般民眾平日的營養補充品之一，故使保健食品市場成長快速。根據資料顯示，2010年台灣保健食品市場規模為840億元，預估2011年將突破900億元，未來3年年成長率將達10%以上；而全球保健食品市場規模，估計2010~2014年年複合成長率將達6.4%。上下游關係圖：資料來源：大江生醫2.銷售狀況公司產品除在台灣銷售外，亦分銷至大陸、香港、東南亞、美國及歐洲等十幾個國家，其客戶群皆為知名保健食品廠、保養品廠、食品廠及指標性飲料廠等，如黑松及味丹亦為公司客戶之一。截至2010年內外銷比重為45：55，外銷部份以亞洲市場為主。2011年公司積極與英國大廠洽談合作計畫，預計出貨針劑型保健食品。3.國內外競爭廠商同業競爭者為國內的葡萄王、景岳及中天。
(四)轉投資概況大江旗下子公司為「台灣第一新藥」及「大江基因醫學」，其中「台灣第一新藥」是公司為擴大市場，將原料銷售部門切割，在屏東農業生物技術園區設立的100%持股子公司，該公司擁有9千坪廠房、研究室及建構中的發酵萃取廠房，未來預計將擴建自有的生物及綠能培養室，致力於新型機能保健原料及生物試劑開發。
殲滅癌幹細胞
日本研究發現癌幹細胞難以徹底殺死的原因2012年04月03日新華社東京４月３日電（記者藍建中）日本一項新研究發現，對於癌症發病和復發起到重要作用的癌幹細胞，能夠自己分泌其生存必需的各種蛋白質。如果能夠破壞這個機制，就有望防止癌症的復發。癌幹細胞是指具有幹細胞性質的癌細胞，有"自我複製"以及"多細胞分化"等能力。這類細胞被認為有形成腫瘤乃至發展成癌症的潛力。現在的癌症治療主要是通過藥物和放療等殺死癌細胞。但是，如果有癌幹細胞殘留，癌細胞就會再次增殖，而徹底殺死癌幹細胞的技術一直沒有重大進展。東京大學醫學研究所研究人員在新一期美國《國家科學院學報》網絡版上報告說，他們從乳腺癌患者的癌組織中，成功提取出癌幹細胞，研究發現，癌幹細胞能夠自己分泌其生存所必需的各種物質，包括細胞分裂和自我複製時需要的蛋白質等。研究小組還發現，癌幹細胞分泌的物質還會進入血液中。研究人員說，這一發現意味著可以通過血液檢查發現癌幹細胞是否在增加，從而有望對癌症的發病和復發等進行早期診斷。
1691億元!! 台灣65歲以上健保醫療總支出…
台灣老了！1成老人年花1700億 吃掉1/3健保大餅 陳鈞凱2012年3月29日健保支出年年捉襟見肘，台灣人口快速老化是一大主因，根據衛生署最新統計顯示，只佔國內總人口數約1成的65歲以上老年人，花掉健保醫療費用卻接近1700億元，吃掉總醫療費用的三分之一，10年內成長幅度高達8成8，集中用於治療泌尿、骨骼、癌症、事故傷害及腦血管疾病等疾病上，又以男性增幅大於女性。根據衛生署99年統計資料，65歲以上人口的健保醫療費用總計1691億元，佔了當年總醫療費用的34%，過去10年的成長幅度驚人，增幅達到88%，但同期間的65歲以上人口數卻僅成長近3成。值得注意的是，台灣銀髮族男性的健康情況似乎略遜於女性，因為資料顯示，10年來女性65歲以上人口總費用增幅雖大於男性，但平均每一個65歲以上女性的醫療費用則低於男性，10年來男性個人醫療費用增幅亦大於女性。且活得愈久，使用健保的醫療資源愈多，80歲以上的健保醫療費用，10年來更足足成長了219%，全台60萬5000名、80歲以上長者的健保醫療費用，在99年時已達到530億元。衛生署表示，進一步分析99年65歲以上國人健保醫療費用，有4成2集中用於泌尿、骨骼、癌症、事故傷害及腦血管疾病上；而根據內政部老人生活狀況統計結果也發現，男性自評健康及罹病情形雖優於女性，但差距正在縮小中，98年65歲以上人口自評健康尚好的有70%，男性高出女性12個百分點，已較94年縮小近3個百分點。由於人口老化已成趨勢，衛生署預估，未來10年，國內65歲以上人口的健保醫療費用將繼續成長，尤其隨著嬰兒潮世代出生人口已開始進入老年，推估未來老人健保醫療費用佔率將再快速成長，攀升6.2%，正式超過4成以上。
林靜芸…緩刑三年!
違法矽膠隆乳名醫二審獲緩刑2012/04/0312:00綜合報導 整型名醫林靜芸，因違法使用矽膠隆乳違反藥事法，被提起公訴，一審認定林靜芸罔顧衛生署規定偷跑，判處有期徒刑一年，今天高等法院二審判決，依照違反藥事法，判處有期徒刑八個月、緩刑三年。 一審被判1年的時候，林靜芸曾經出面痛哭，表示希望任罪能獲得緩行。提起上訴之後，二審法官認為林靜芸有悔意，判有期徒刑８個月，緩刑三年之外，還附帶保護管束，要到指定機關服一百二十小時義務勞務。林靜芸二十多年前，在衛生署尚未核准矽膠合法前，就率先使用矽膠隆乳，被檢調認定涉嫌違法使用矽膠動隆乳手術，民國九十八年間遭到搜索約談，一度引起輿論撻伐，現在終於全案定讞。
國鼎生技現金增資!
國鼎生技：國鼎生物科技股份有限公司101年度第1次現金增資發行新股相關事宜公告鉅亨網新聞中心 2012-04-03一、本公司經101年3月2日董事會通過現金增資發行新股乙案，業經呈奉行政院金融監督管理委員會101年3月19日金管證發字第1010009086號函核准在案。二、?依照公司法第273條第2項之規定，將本次現金增資發行新股有關事項公告如後：(一)、公司名稱：國鼎生物科技股份有限公司(二)、所營事業：1.IG01010生物技術服務業。2.F601010智慧財產權業。3.C199990雜項食品製造業。4.F102160輔助食品批發業。5.C802041西藥製造業。6.F108021西藥批發業。7.F208021西藥零售業。8.C802100化粧品製造業。9.F108040化粧品批發業。10.F208040化粧品零售業。11.ZZ99999除許可業務外，得經營法令非禁止或限制之業務。(三)、本公司所在地：新北市淡水區中正東路一段3巷9號10樓。(四)、公告方式：登載於公開資訊觀測站。(五)、董事及監察人之人數及任期：董事11人、監察人2人，任期均為三年，連選得連任。(六)、本公司章程訂立日期：本公司章程訂立於民國91年9月30日，最近一次修訂於100年4月26日。(七)、原股份總額及每股金額︰本公司額定資本總額為新臺幣1,000,000,000元，分為100,000,000股，每股面額新臺幣壹拾元整，分次發行之。(八)、已發行股份總額及每股金額：本公司實收資本總額為661,820,000元，分為普通股66,182,000股，每股面額新臺幣壹拾元整，均為記名式普通股。(九)、本次增資發行新股總額及其發行條件如下：1.現金增資發行新股總數25,000,000股，每股面額新臺幣壹拾元，每股發行價格新臺幣60元，依公司法第267條規定保留15%計3,750,000股供員工認購，其餘85%計21,250,000股由原股東按認股基準日股東名簿記載之持股比例，每仟股認購321.0842827股，員工及原股東放棄認購部分由董事長洽特定人按發行價格認購之。本次現金增資認購不足一股之畸零股份，自認股基準日起五日內由股東自行至股務代理機構辦理拼湊。股東未拼湊購及認購不足一股之畸零股，授權董事長洽特定人按發行價格認購之。2.本次增資發行新股，其權利義務與原已發行之普通股相同。(十)、增資後股份總額及每股金額：本次增資後，實收資本額為新臺幣911,820,000元，分為91,182,000股，每股面額新臺幣壹拾元整，均為記名式普通股。(十一)、增資用途：充實營運資金，以支應新藥各項研發計劃及拓展國際市場等營運成長之資金需求。(十二)、股票簽證機構：不適用。
芳療 刺激大腦活化!!
芳香紓壓輔療 助失智長者活化大腦日期：2012.04.03(優活健康網新聞部／綜合報導)家有失智長輩嗎？沒有壓力，愉快的學習、動動腦與家人的陪伴是重要關鍵，鼓勵失智症患者多接觸人群、維持社交活動，並適度提醒現狀，給予刺激。臺北市大安區健康服務中心開辦「失智症長者樂齡團體系列活動-「香」遇再「憶」起，邀請失智症長者及其家人共同活化大腦。臺北市大安區健康服務中心自96～以來共辦理56場次失智症長者樂齡團體系列活動、共計1,677人次參加，參加長者於注意力、活動能力、與人交往、參與程度及享受小組程度等項目評值顯示提升14.7％～29.4％；而照顧者憂鬱情形及負荷程度明顯改善。家屬來信表示長者從參與活動中學習，透過手腦並用提升認知與記憶，亦改善失眠與情緒問題，家屬學習照護知能與技巧，強化運用資源能力，獲得身心的喘息。許多研究證實，在疾病早期提供藥物治療與非藥物輔助，可以有效改善認知功能、治療憂鬱症、減輕躁動、改善情緒壓力及睡眠等；給予照顧者協助，可以幫助他們持續在家提供照顧，避免或延緩失智者入住機構的時間。今（101）年以「芳香輔療」為主軸，結合「大腦活化」、「陶藝創作」及「園藝」規劃「失智症長者樂齡團體系列活動-『香』遇再『憶』起」，「芳香輔療」可幫助激活長者的感官並改善其記憶能力，對情緒控制也有助益，還可以藉由按摩來放鬆肌肉，達到身心的愉悅及放鬆。根據國際失智症協會(ADI)2011全球失智症報告指出全世界估計有3,600萬失智症患者，其中可能有2,800萬人沒有獲得診斷。大安區65歲以上老人有4萬5,862人，若以失智症盛行率5％推估，其疑似或罹患失智症人口則約有2,293人。另依據臺北市政府社會局101年1月份統計資料，大安區領有失智症身心障礙手冊卻僅有709人，顯示仍有許多失智症患者未被發現而隱身於社區中，且尚未就醫及接受正確診斷與治療，更遑論能受到適當的照護，藉著此活動希望失智症長者及其家人，能利用「香味」搭起溝通與連結記憶的橋樑及舒緩精神壓力。
科妍：海德密絲(笑顏)獲許可證!!
科妍：說明本公司取得行政院衛生署核發皮下填補劑醫療器材許可證。鉅亨網新聞中心 2012-03-30第三十四條 第39款1.事實發生日:101/03/302.公司名稱:科妍生物科技股份有限公司3.與公司關係(請輸入本公司或聯屬公司):無4.相互持股比例(若前項為本公司，請填不適用):無5.發生緣由:本公司所研發生產之第三類醫療器材整形外科手術裝置海德密絲(笑顏)皮下填補劑獲得行政院衛生署核發之醫療器材許可證。6.因應措施:可開始行銷國內市場、並加速國外地區產品銷售許可之查驗登記及營業拓展進度。7.其他應敘明事項:無。
國光疫苗: 亞洲唯一獲得歐盟GMP認證!!
國光生技訂5/3上市掛牌嬌生子公司流感疫苗大單當賀禮鉅亨網 2012-04-03疫苗大廠國光生技(4112-TW)今天召開上市前法說會，國光生技預定5月3日上市掛牌，國光生技董事長詹啟賢今天也在法說會中透露，國光生技不僅是亞洲唯一獲得歐盟GMP認證的流感疫苗製造公司，同時也接獲嬌生子公司Crucell的流感疫苗原液訂單，而這筆訂單的數量，比起去年多了「2、3倍」，而首批出貨國家包括義大利、瑞士、英國、德國等4個國家，同時後續訂單也將逐年成長。國光生技目前主要產品包括流感疫苗、日本腦炎疫苗、破傷風疫苗等，去年以流感疫苗占營收比重51%最高，日本腦炎、破傷風疫苗約占營收18%，其餘為外銷。同時國光生技目前的產能，除了供應國內需求外，新廠完工後，年產能可達2500萬劑，將可提供較大的外銷產能。國光生技主要合作伙伴包括全球第6大流感疫苗製造商Crucell，日本第一大流感疫苗製造商Kitasato Insititute，而Crucell嬌生公司合併，成為嬌生旗下疫苗製造廠，而國光生技取得歐盟GMP認證的流感疫苗製造公司，也是亞洲第一家有能力銷歐的疫苗廠，加上新廠產能挹注，預估每年銷歐數量將可達2000萬劑，對整體營收與獲利也將帶來顯著貢獻。詹啟賢指出，國光生技獲得歐盟GMP認證，具有相當重要的意義，一家疫苗廠從製程確認、建廠、確效到取得藥證，前後約需耗時7-10年，這些都是疫苗廠的價值，換句話說，國光生技也領先其他疫苗廠約7-10年，因此國光生技在產業界更具競爭力。根據國光生技的規劃，今年底前H5N1禽流感疫苗將可研發完成，其他包括腸病毒71型疫苗、登革熱疫苗，也都是正在研發中的產品。法人預估國光生技去年營收為2.9億元，去年每股虧損2.87元，但今年下半年在Crucell的流感疫苗原液訂單挹注下，產能利用率可望拉升至7-8成，單季將有機會轉虧為盈，明年產能利用率拉升至9成以上，獲利也將同步跳升。
承業生醫上興櫃2012.05.04!!
「承業生醫投資控股」更名換發新股於2012.05.04上興櫃2012/4/4鉅亨網提供承業生醫投資控股股份有限公司（證券代號：4164；原名承業投資控股股份有限公司）因更名全面換發新股，停止股東名簿記載之變更（即暫停股票過戶），暨新股票開始換發及開始興櫃買賣日期。一、停止股東名簿記載變更之事由：更名全面換發股票。二、換發內容：承業投資控股股份有限公司更名為承業生醫投資控股股份有限公司。三、停止股東名簿記載變更起訖日期：民國101年4月24日至101年5月3日。四、新股票換發基準日：民國101年4月28日。五、公司新股票開始換發日期：自民國101年5月4日起受理。六、公司新股票開始興櫃買賣日期：民國101年5月4日。七、其他：本次換發之新股其權利義務與舊股票相同，自新股票開始興櫃買賣之日起，舊股票不得作為買賣交割之標的。
歐盟FP7處長訪問台灣!!
歐盟科技部生物處Stephane Hogan處長訪台行程報告byncp,2012-04-02 Health NCP Taiwan邀請歐盟科技部生物處Stephane Hogan處長訪台促進國際合作之交流報告2012年3月16至20日，Health NCP Taiwan團隊十分榮幸的邀請到負責審核每年歐盟國際合作計畫，生醫研究主題(FP7、Horizon 2020)的最高負責人Stephane Hogan處長來台，進行為期四天之參訪。此次交流主要包含：1.)與台灣優秀生醫中小企業廠商互動、2.)與國內生醫專家、學者、官員交流國際生醫研究趨勢及台灣競爭力、3.)至27th生醫年會進行大會特別演說、4.)至台大基因體中心進行學術參訪、5.)於台大醫學院進行特別演講、6.)至國科會拜會陳副主委以及生物處長、國合處長。
鄭永齊院士中藥國際化事業!!
Chinese Medicine Goes Under the Microscope April 2, 2 012 ET. By SHIRLEY S. WANG.. There's growing acceptance that herbal medicines could be effective for medical conditions, but the scientific evidence to vault such a treatment into an approved drug is often lacking. As Shirley Wang explains on Lunch Break, researchers are making progress on a cancer treatment based on a common herbal combination in Chinese medicine. . Scientists studying a four-herb combination discovered some 1,800 years ago by Chinese herbalists have found that the substance enhances the effectiveness of chemotherapy in patients with colon cancer. Early studies show a traditional four-herb combination has cancer-treatment benefits. The herbs are Chinese peony (pictured), Chinese jujube, Chinese licorice and baikal skullcap. . The mixture, known in China as huang qin tang, has been shown in early trials to be effective at reducing some side effects of chemotherapy, including diarrhea, nausea and vomiting. The herbs also seem to bolster colon-cancer treatment: Tests on animals with tumors have shown that administering the herbs along with chemotherapy drugs restored intestinal cells faster than when chemo was used alone. The herb combination, dubbed PHY906 by scientists, is a rare example of a plant-based product used in traditional folk medicine that could potentially jump the hurdle into mainstream American therapy. A scientific team led by Yung-Chi Cheng, an oncology researcher at Yale University, and funded in part by the National Cancer Institute, is planning to begin Phase II clinical trials to study PHY906's effectiveness in people with colon cancer. . Many conventional medications are derived from individual chemical agents originally found in plants. In the case of huang qin tang, however, scientists so far have identified 62 active chemicals in the four-herb combination that apparently need to work together to be effective. "What Dr. Cheng is doing is keeping [the herbal combination] as a complex entity and using that as an agent," says Josephine Briggs, head of the federal National Center for Complementary and Alternative Medicine, which is helping fund some of the PHY906 research. "It's polypharmacy," or the equivalent of several drugs being administered at once. Dr. Cheng began his research on huang qin tang about a dozen years ago when he sought a better way of dealing with the chemotherapy's side effects. A variety of medications are currently used to treat these symptoms, but with varying success. A more effective technique could improve patients' quality of life and possibly allow them to tolerate a larger dose of chemo, which might speed up their course of treatment, he says. Dr. Cheng, who grew up in Taiwan, turned to Chinese traditional medicine, which often touts holistic treatments and multiple health claims for a single herb. In herbal literature he found mention of huang qin tang, a herbal combination traditionally used in China for gastrointestinal problems, and decided to test whether it could help cancer patients without compromising the effectiveness of the chemotherapy. . The research team began by giving mice with colon cancer high doses of irinotecan, a chemotherapy drug. Some of the mice also received varying doses of PHY906, the herbal combination. After four days, the animals that got the herbs seemed to experience fewer side effects. The herbs also appeared to improve the efficacy of the chemo, restoring damaged intestinal cells faster than with chemo alone and allowing the mice to tolerate doses of the drug that otherwise might have been lethal. They followed with another experiment treating animals in four groups. One group received just the chemotherapy drug, another received just PHY906, a third group got both and the last group got nothing. The herb and drug combination worked the best at reducing side effects. As the researchers expected, PHY906 had no impact on the cancer when used by itself. Further testing showed that PHY906's effectiveness was diminished if any of the four herbs was eliminated, indicating that there is an apparent synergistic effect between them. This finding "got me serious about [PHY906]," says Dr. Cheng. The work was published in the journal Science and Translational Medicine in 2010. By submitting PHY906 to the scientific rigor of clinical trials, Dr. Cheng aims to win regulatory approval for the compound's use in cancer treatment. One challenge with using herbal medicines is that the ratio of the chemicals they contain isn't consistent when plants are grown under different conditions. After testing various suppliers, Dr. Cheng ended up creating a biotechnology company sponsored by Yale called PhytoCeutica to carefully monitor growing conditions to ensure plants from different batches were pharmacologically consistent and to continue clinical development of the compound. . Why PHY906 works isn't entirely clear, Dr. Cheng says. The herbal combination appears to have an anti-inflammatory effect on the gastrointestinal tract, according to work the group published in the journal BMC Medical Genomics last year. Dr. Cheng says he believes PHY906 works in at least three different ways in the body to control the side effects of chemotherapy, whereas conventional treatments work in just a single way. So far, research data seem to support Dr. Cheng's hunch about traditional medicine. "If it's still in use after a thousand years there must be something right," he says. When cancer researcher Yung-Chi Cheng set out some 12 years ago to study a traditional Chinese medicine, the initial reaction from colleagues and other experts in the field was "pretty bad," he says. Colleagues worried that Yale University's Dr. Cheng, a mainstream, respected professor of pharmacology, was taking a professional risk by delving into possible herbal treatments for cancer. It wasn't possible to get separate batches of herbs containing chemical compounds that were consistent, they told him. And there wasn't evidence to support the claim that the herbs had any benefit. "It was rejectionist and narrow-minded," Dr. Cheng says. Born in Britain and raised in Taiwan, the 67-year-old Dr. Cheng mainly works at developing better cancer and antivirus compounds. He says he decided to move forward with the work on Chinese herbs on a part-time basis because he felt that whether the medical claims were true or not, they needed to be evaluated closely. Over the years, the field's view of this type of work has changed, says Dr. Cheng. With clinical evidence and data showing that the herbal product can be made to be consistent, he has experienced more acceptance from colleagues in the U.S. and internationally. In 2003, he started a global consortium of researchers and pharmaceutical companies studying traditional Chinese medicine. Dr. Cheng, who earned his doctorate in biochemical pharmacology from Brown University in Rhode Island, has also found it easier over time to get published and to receive funding for the work with herbs, including as a potential treatment for the side effects induced by cancer chemotherapy. Anticipating the skepticism he might face in developing a plant-based drug, Dr. Cheng didn't publish his work in a journal until two years ago when he had consistent, clinical evidence and some understanding of the mechanism. "I might as well wait until the whole comprehensive story develops," says Dr. Cheng. "Now I feel it's about time."
Neuronal stem cells generated directy from skin cells
By Brian Dodson 23:03 April 2, 2012 Researchers at the Max Planck Institute for Molecular Biomedicine in Munster, Germany, have broken new ground by reprogramming skin cells from mice into neurons without regressing the cells through a pluripotent stage. The skin cells were reprogrammed directly into multipotent neuronal stem cells - that is, into cells which could only turn into new neurons. This procedure avoids the significant risk that pluripotent stem cells, which can grow into any type of tissue, may accidentally form tumors rather than the desired replacement tissue. One major theme of stem cell research has been the reprogramming of ordinary cells in the body into pluripotent stem cells. These are cells that, given the right environmental clues, can differentiate into any tissue within the body. This flexibility limits the application of pluripotent stem cells for many potential therapeutic uses, as some portion may grow into undesired tissue types. Hans Scholer and his research team have succeeded in reprogramming skin cells into stem cells which are multipotent, rather than pluripotent. Such stem cells cannot give rise to all cell types, but only to a select subset, which usually share a common role within the body. In the study reported here, the multipotent stem cells can only grow into various types of neuronal tissue. A growth factor was found that very effectively guided skin cells toward conversion into neuronal somatic stem cells. As the reprogrammed cells divide, they gradually lose their molecular memory (residual structures) and forget that they were once skin cells. After a few cycles of cell division (stimulated by growth factors and media), the new stem cells are practically indistinguishable from normal stem cells. The ability to use multipotent stem cells for regeneration or replacement of damaged or diseased tissues dramatically reduces the risk of cancer, which is a significant risk when using pluripotent stem cells. The new therapeutic approach still must be reproduced using human cells, and questions remain about the long-term stability of the identity of the newly reprogrammed tissues, but Scholer feels the approach offers substantial potential for new and highly effective medical treatments, given the appropriate political climate. "The blueprints for this framework are all prepped and ready to go - all we need now are for the right political measures to be ratified to pave the way towards medical applicability," he said.
Taiwan, France step up industrial cooperation
Publication Date：04/03/2012 ‧Source： Taiwan Today ‧By Meg Chang Taiwan and France agreed to expand exchanges across a broad spectrum of manufacturing and R&D sectors following the annual bilateral Industrial Cooperation Consultation Meeting March 28 in Paris. The one-day forum, which is organized by the Industrial Development Bureau under the Ministry of Economic Affairs and its French counterpart, focused on joint development of key industries such as aviation, biotechnology, design, electric vehicles, energy and textiles. Officials and business leaders from both sides also brought each other up to speed on respective policymaking, regulations and development strategies. "This has been a first-class platform for sharing information on business trends and policy ideas," a bureau official said. "We look forward to following up on a raft of leads emerging from the sessions." High on the agenda at this year's meeting was energy policy discussions, with representatives from state-run Taiwan Power Corp. and several French public utility firms presenting the results of their business operations. As part of efforts to further cement Taiwan-France economic ties, a delegation comprising more than 60 local business leaders visited a number of top French companies and later explored business opportunities at JEC Europe, the region's biggest composite materials trade show. The meeting saw a memorandum of understanding on developing electric vehicle industry standards and testing technology inked by Changhua County-headquartered Automotive Research and Testing Center and the French Technical Union for the Automobile, Motorcycle and Cycle Industries. Other highlights include Taoyuan-based Advanced Lithium Electrochemistry Co. Ltd. agreeing to sell electric buses worth 300 million euros (US$400 million) over the next five years to Monaco's Venturi Automobiles. (JSM)
Herbal Medicines Get Some More Respect.
April 3, 2012, 9:48 AM. By Shirley S. Wang Some patients and doctors swear by the healing power of herbs and other plants, but their chemical complexity makes them notoriously difficult to study. Some headway is being made, however, as WSJ's In The Lab column reports. New research suggests a four-herb combination long used in traditional Chinese medicine helps curb some side effects of chemotherapy. Another example of an herbal treatment breaking into the halls of Western medicine is that of ingenol mebutate, a skin cream that is extracted and purified from the dried Euphorbia peplus plant, commonly known as petty spurge. The cream gets rid of precancerous skin lesions and prevents their recurrence, according to recent research published in the New England Journal of Medicine. Denmark-based LEO Pharma produces the cream, which was approved in January by the FDA, under the brand name Picato. The plant itself was used as a home remedy for skin conditions in Australia, says Mark Lebwohl, first author on the study and chairman of the dermatology department at the Mount Sinai School of Medicine. It grows everywhere, "including the sidewalks of Manhattan," he tells the Health blog. While there are many treatments to get rid of precancerous skin lesions, Lebwohl says, other creams tend to take much longer to work and seem to be more irritating to the skin than ingenol mebutate. Freezing lesions off tends to leave scars and the rate at which they come back is fairly high.
NARL unveils sensor technology to make smaller, powerful chips
The National Applied Research Laboratories (NARL) yesterday unveiled technology that allows semiconductor companies to produce smaller and more powerful sensor chips. The technology enables the integration of vibrating microelectronic systems into a regular complementary metal-oxide semiconductor (CMOS) chip, and will help Taiwan's integrated circuit (IC) players to design, manufacture, test and package sensor chips made from this technology, NARL said. According to NARL, the design, manufacture, testing and packaging of sensor chips are currently monopolized by a handful of large multinational conglomerates, a situation that has prevented Taiwan IC firms from entering the sensor chip market. With this technology, Taiwan IC companies will have an bigger presence in the increasingly important sensor chip market, which is expected to have a production value of US$20 billion in 2016, a rise from the current US$10 billion, NARL said. Sensor chips can detect variations in temperature and breathing and have applications in various industries. They can be incorporated into handsets, necklaces, rings and medical pads to detect various physiological data such as blood pressure, blood sugar levels, heartbeat and the concentration of oxygen in blood, NARL said. "Incorporating Taiwan-developed sensor chips into electronic, biotechnology and green energy products will raise Taiwan IC firms' visibility in the global sensor chip industry and strengthen the island's intelligent lifestyle electronics sector," NARL said.
NORMALES A SIMPLE VISTA
Los ratones disenados y creados por el grupo de Ortega, directora de la Unidad de Ratones Transgenicos del CNIO, parecen normales a simple vista. Pero los animales tienen varios genes adicionales, que se expresan en las paredes de los vasos linfaticos bajo el control de las senales reguladoras del gen Vegfr3, el primer marcador de vasos linfaticos identificado. Uno de estos genes es el de la proteina luciferasa, responsable de que las luciernagas emitan luz. En el insecto, la luciferasa oxida su sustrato natural, la luciferina, en una reaccion quimica que produce fotones. Asi, los vasos linfaticos en estos ratones emiten luz cuando se les inyecta luciferina, completamente inocua para el animal. La luz emitida es captada en la oscuridad por camaras especiales. El otro gen expresado en estos ratones es el de la proteina fluorescente verde (GFP) que permite visualizar los vasos linfaticos a nivel celular. "La generacion y caracterizacion de este modelo ha sido un gran esfuerzo pero ha merecido la pena" dice Ines Martinez-Corral, primera autora firmante del trabajo de 'PNAS' y para quien este proyecto ha sido el trabajo de su tesis doctoral.
Crean ratones modificados geneticamente para visualizar 'in vivo' la progresion del cancer
3/04/2012 11:18 | lainformacion.com Investigadores del Centro Nacional de Investigaciones Oncologicas (CNIO) han creado ratones en los que se puede visualizar, por primera vez en el animal vivo, el crecimiento de los vasos linfaticos (principal via de diseminacion) a medida que progresa el tumor. Asi, esperan poder estudiar mejor este proceso "aun poco comprendido" y averiguar que tumores lo usan mas y como bloquearlo. La tecnica, que publica este martes en 'Proceedings of the National Academy of Sciences' ('PANS'), es tan sensible que permite visualizar cuando los ganglios linfaticos van a ser invadidos por las celulas tumorales. Los vasos linfaticos tienen como principal funcion recoger el fluido extravasado de los tejidos y reconducirlo al torrente sanguineo. Este sistema es esencial para el correcto drenaje de los tejidos y su disfuncion conduce a la acumulacion de fluido o linfedema. El sistema linfatico participa tambien en varias enfermedades relacionadas con la respuesta inmune y con la inflamacion, y juega un papel "muy importante" en la diseminacion de las celulas tumorales que, a traves de la vasculatura linfatica, alcanzan primero los ganglios y despues se diseminan a organos distantes generando metastasis. Las celulas tumorales producen senales que inducen la linfangiogenesis no solo en la periferia del tumor, sino tambien en los ganglios linfaticos y ello facilita, por un mecanismo hasta ahora poco comprendido, la diseminacion de las celulas cancerigenas y la formacion de metastasis. Este puede ser un nuevo paso hacia el desarrollo de nuevas terapias, ya que, segun senala la principal investigadora, Sagrario Ortega, "estos procesos se detectan en los ratones por un aumento en la emision de luz y en una etapa muy temprana, incluso antes de la invasion de los ganglios por las celulas tumorales". "Estos ratones proporcionan una herramienta muy valiosa para el estudio de la inflamacion y la metastasis y para el desarrollo y ensayo de nuevas terapias antimetastasicas", explica Ortega, quien recuerda que "es la primera vez que se logra ver este proceso en el animal vivo". Para algunos tumores, como el melanoma o el carcinoma de mama, es muy importante la via linfatica para la generacion de metastasis. Pero, en general, la relacion entre la formacion de nuevos vasos linfaticos y la diseminacion del tumor esta muy poco estudiada. Por ello esta tecnica es especialmente util. Los nuevos ratones transgenicos ya estan siendo utilizados para buscar marcadores que identifiquen a los tumores que mas generan metastasis por la via linfatica, y tambien para investigar como bloquear el proceso farmacologicamente. Uno de los primeros tumores para los que ya se estan utilizando es el melanoma, en colaboracion con el grupo de Maria S. Soengas, directora del Programa de Patologia Molecular del CNIO.
Celulas madre y los Infartos
3 abril, 2012 7:42 pm0 commentarios Para la mayoria de los seres humanos la busqueda de alternativas que ayuden al buen funcionamiento del corazon siempre resultan atractivas, sobretodo cuando las personas han sufrido un infarto, es por ello, que los nuevos hallazgos en este tema resultan alentadores para millones de pacientes. En febrero de este ano, The Lancet publico los resultados de un ensayo clinico que se llevo a cabo en el Instituto de Cardiologia del Cedars Sinai, Los Angeles, el cual revelo que tras practicar una terapia con celulas madre cardiacas, se logra la regeneracion del corazon. El estudio fue aplicado a mas de 20 pacientes en edad promedio de 53 anos que habian sufrido un infarto, el cual habia dejado danos en el musculo cardiaco. Los pacientes recibieron el tratamiento en el Instituto Cardiologico Cedars-Sinai, Los Angeles y en el hospital Johns Hopkins de Baltimore. De estos pacientes, ocho siguieron un tratamiento convencional incluyendo medicamentos tradicionales, ejercicio y dieta. El resto de los 17 pacientes, recibio la innovadora terapia con celulas madre del corazon, obtenidas de su propio tejido, a traves de una biopsia en la que con un cateter que se inserto en una vena en el cuello, los medicos extirparon pequenos trozos del tejido de este organo. El tejido se envio al laboratorio especializado del Dr. Marban en el Hospital Cedars Sinai, Los Angeles, donde se aplicaron los metodos que el creo para cultivar y multiplicar las celulas. Entre 12 y 15 millones de estas celulas cardiacas fueron reintroducidas con un cateter en las arterias coronarias de los pacientes. Despues de un ano, los pacientes que se sometieron al procedimiento con celulas madre mostraron una reduccion del 50 por ciento en el tamano de la cicatriz provocada por el ataque, tambien reportaron un aumento considerable en el musculo del corazon sano despues de este tratamiento, mientras que los pacientes tratados de manera convencional no presentaron reduccion del tejido danado. "Luego de una decada en la que se habian realizado ensayos de tratamientos con terapias celulares, se logro este hallazgo, los resultados son considerables y han funcionado mejor en las pruebas que se han realizado con los seres humanos en comparacion con los ensayos aplicados en animales", afirmo el Dr. Eduardo Marban, director del Instituto de Cardiologia del Cedars Sinai, Los Angeles. Estos resultados senalan que en el futuro se experimentaran cambios significativos en la forma de atencion de los pacientes con infartos, asi lo comento el Dr. Shlomo Melmed, decano del cuerpo docente de medicina del Hospital Cedars Sinai, Los Angeles "Antes lo que los medicos haciamos era tratar de minimizar el dano del corazon, destapando la arteria ocluida, ahora con estos resultados posiblemente existira una tratamiento que regenere y revierta el dano causado por el infarto". El ensayo clinico fue parte de un estudio de investigacion en fase 1 aprobado por el Departamento de Control de Alimentos y Medicamentos de los Estados Unidos y respaldado por el Instituto Nacional del Corazon, los Pulmones y la Sangre (National Heart, Lung and Blood Institute). Con este estudio se muestra que las consecuencias de un infarto se pueden revertir mediante una infusion de celulas madre y, en probablemente en poco tiempo, habra nuevas esperanzas para los pacientes mexicanos y del mundo. Reconocido por brindar atencion al corazon a traves de las mejores innovaciones y servicios integrales de diagnostico y tratamiento para ninos y adultos. Este centro garantiza que los pacientes se beneficien con los ultimos avances y estudios de investigacion mas nuevos. Cuenta con un programa de diagnostico, prevencion, tratamiento, control e investigacion dentro de una gama diversa de enfermedades, trastornos y problemas del corazon.
Surgeon escapes prison term for illegal implants
By Rich Chang Cosmetic surgeon Lin Ching-yun, who the Taiwan High Court yesterday sentenced to three years' probation for performing illegal silicone gel breast implants between 2004 and 2008, talks to reporters outside the Taipei District Court on July 5, 2010. The Taiwan High Court yesterday gave celebrity cosmetic surgeon Lin Ching-yun (林靜芸) three years' probation for performing illegal silicone gel breast implants. In its verdict, Lin was sentenced to eight months in prison, which was then commuted to three years' probation. She is also required to perform 120 hours of community service within two years. Lin, a former director of the Taiwan Society of Aesthetic Plastic Surgery, was found guilty of violating the Pharmaceutical Affairs Act (藥事法). The ruling said Lin and a surgeon surnamed Hsieh (謝), now deceased, performed silicone gel breast implants from March 2004 through 2008. Silicone gel breast implants were illegal until late 2008, when they gained Department of Health approval. Prosecutors had seized files on 11 patients from Lin's clinic, saying the documents provided evidence that Lin and Hsieh had performed the implants, the ruling said. Lin had told the judges that she had performed liquid silicone implants, rather than silicone gel implants. However, in the latest hearing, Lin told the High Court that the Taipei District Court's sentence of one year in prison was too heavy. She admitted she broke the law and pleaded for probation. Cosmetic surgeons had for years been calling for the approval of silicone gel implants, which they said were safer than liquid silicone implants. As a leading campaigner, Lin had told the media that since gel silicone implants were not liquid, but rather a cohesive mass, there was less danger associated with their use. There was no risk of leakage, even in the event of a rupture, she said.
Neue Stammzellentherapie mit geringerem Krebsrisiko
Munster (dpa) - Deutsche Wissenschaftler haben offensichtlich einen Weg gefunden, das Krebsrisiko einer Stammzelltherapie deutlich zu senken. Bei den Versuchen an Mausen geht es um unerwunschte Effekte der sogenannten pluripotenten Stammzellen. Pluripotente Zellen konnen sich in jedes Gewebe verwandeln, aber auch Krebs erzeugen. ?Sie konnen einfach zu viel?, erlauterte ein Sprecher des Max-Planck-Instituts fur molekulare Biomedizin am Donnerstag. Ein Team um den bekannten Forscher Prof. Hans Scholer aus Munster gewann jetzt aus Hautzellen von Mausen direkt ?multipotente? Stammzellen. Es wurden also bewusst keine Alleskonner erzeugt, sondern direkt Gewebe fur bestimmte Zwecke. ?Die Regeneration bestimmter Gewebetypen kann mit unserem Verfahren deutlich zielgerichteter und sicherer werden.? Doch bis zum medizinischen Einsatz am Patienten muss noch viel geforscht werden. Ihre Ergebnisse veroffentlichten die Max-Planck-Wissenschaftler am Donnerstag im Fachjournal ?Cell - Stem Cell? (Online). Fur die Reprogrammierung benutzten sie einen ?Mix an Wachstumsfaktoren?, also Proteinen, die das Zellwachstum im Korper steuern. Die Umwandlung sei umso wirkungsvoller, je ofter sich die Zellen unter Einfluss der Wachstumsfaktoren und der richtigen Kulturbedingungen teilten, erlauterte Scholer: ?Die Zellen verlieren immer mehr ihre molekulare Erinnerung daran, dass sie mal eine Hautzelle waren.? Bisher seien pluripotente Zellen noch das ?Nonplusultra? der Forschung, so Scholer. In der gangigen Therapie am Menschen werden Patienten eigene Zellen entnommen und zu sogenannten induzierten pluripotenten Stammzellen umgewandelt. Aus den Multitalenten lasst sich jedes Korpergewebe zuchten, das etwa zur Behandlung von Parkinson, Herzinfarkt oder Diabetes dient. ?Uns ist (...) der Nachweis gelungen, dass eine Reprogrammierung von Korperzellen nicht zwingend uber pluripotente Stammzellen erfolgen muss?, sagte Scholer. ?Pluripotente Stammzellen sind so entwicklungsfahig, dass sie sich auch in Krebszellen verwandeln konnen - anstatt ein Gewebe zu regenerieren, verursachen sie unter Umstanden einen Tumor.? Die von Scholers Team jetzt beschriebenen Korperstammzellen weisen laut MPI einen Ausweg. ?Sie sind "nur" multipotent, konnen also nicht alle, sondern nur bestimmte, genau definierte Gewebetypen wie im vorliegenden Falle ganz unterschiedliche Nervengewebe bilden. Ein enormer Vorteil im Hinblick auf den therapeutischen Einsatz.? Auf lange Sicht sieht Scholer erhebliches medizinisches Potenzial. ?Dadurch, dass die Korperstammzellen multipotent sind und die Gefahr der Tumorbildung dramatisch reduziert ist, konnten die Zellen in einigen Jahren zur Geweberegenerierung bei Krankheiten oder im Alter eingesetzt werden?, hofft der Forscher. Bis es soweit sei, mussten aber noch ?erhebliche Forschungsanstrengungen? unternommen werden. Im nachsten Schritt sind laut Scholer entsprechende Untersuchungen mit menschlichen Zellen erforderlich. Zudem sei es ?unerlasslich, das Langzeitverhalten der Korperstammzellen im Detail zu untersuchen?. Forscher der Universitat Bonn publizierten am Donnerstag in der ?Cell - Stem Cell? zeitgleich sehr ahnliche Ergebnisse eigener Versuche. ?Ganz bewusst zielten wir (...) auf die Herstellung von neuralen Stammzellen oder Gehirnstammzellen, nicht auf die pluripotenten iPS-Alleskonnerzellen, ab?, sagte der Bonner Forscher Frank Edenhofer uber seine Arbeit mit Bindegewebszellen von Mausen.
Fenwal recoit l'autorisation de la FDA pour l'echange de plasma therapeutique sur son systeme AmicusR Separator
April 02, 2012 06:56 PM Eastern Daylight Time LAKE ZURICH, Illinois--(BUSINESS WIRE)--L'Agence americaine des produits alimentaires et pharmaceutiques a autorise Fenwal a commercialiser un protocole d'echange de plasma therapeutique sur le separateur AmicusR de la Societe, selon un communique publie aujourd'hui par Fenwal. ? L'autorisation d'EPT sur le separateur Amicus permet aux hopitaux d'effectuer deux procedures therapeutiques sophistiquees : l'EPT et des collectes de cellules souches a partir d'un seul appareil ? . Le separateur Amicus de Fenwal est aujourd'hui l'un des systemes de separation des cellules les plus sophistiques disponibles pour l'echange de plasma therapeutique et la collecte de cellules mononucleisees, qui sont utilisees pour traiter une grande variete de maladies et pour la recherche clinique. L'echange de plasma therapeutique, ou EPT, elimine les substances du sang pour reduire les symptomes associes a certaines maladies. La procedure est effectuee dans les hopitaux principalement pour traiter les maladies auto-immunes, y compris les troubles hematologiques, neurologiques et renaux. Dans les essais cliniques, l'EPT sur le separateur Amicus a affiche un taux eleve d'elimination du plasma et de faibles pertes de plaquettes, tout en maintenant un controle precis de l'equilibre des fluides. En plus de ses protocoles therapeutiques, le separateur Amicus de Fenwal est aujourd'hui utilise partout dans le monde pour prelever des plaquettes ainsi que le plasma et les globules rouges concomitants. ? L'autorisation d'EPT sur le separateur Amicus permet aux hopitaux d'effectuer deux procedures therapeutiques sophistiquees : l'EPT et des collectes de cellules souches a partir d'un seul appareil ?, a declare William H. Cork, directeur de la technologie chez Fenwal. ? C'est le genre de polyvalence dont ont besoin les hopitaux attentifs aux couts et, avec le systeme Amicus, il n'y a pas de compromis en termes de performances. ? Le separateur Amicus offre une efficacite elevee et garantit la purete. Pour la separation du sang et des cellules, c'est vraiment l'une des technologies les plus sophistiquees disponibles. ?. Le separateur Amicus pour l'EPT utilise un kit de prelevement a usage unique configure pour prelever le sang des patients, retirer le plasma contenant des proteines nocives, et restituer au patient ses propres cellules rouges, ses plaquettes et une solution de remplacement du plasma a partir d'eau saline, d'albumine humaine ou d'autres composants. Le protocole EPT a flux continu sur le separateur Amicus a ete concu pour simplifier la procedure et automatiser certaines etapes manuelles, ce qui permet a l'operateur de se concentrer davantage sur le patient. Le protocole EPT sur le separateur Amicus est egalement disponible en Europe et en Amerique latine.