疾管署 嚴正回應 社論 ”拿出抗煞精神迎戰禽流感”

防疫視同作戰，疾管署嚴正回應某媒體社論有關某媒體社論今日刊載「拿出抗煞精神迎戰禽流感」一文，內容提及H7N9流感疫情有眾多謬誤，疾管署特此逐點澄清如下： 今年首例H7N9境外移入個案於1月25日經澳門搭機入境高雄國際機場時，即因發燒被疾管署檢疫人員攔檢並開立就醫敬告單建議就醫，同日就醫並於隔日轉診某醫學中心時急診醫師即懷疑H7N9流感輕症，立即採檢送疾管署檢驗，衛生單位亦每日主動聯繫患者瞭解病情。顯示檢疫站和急診醫師均有高度警覺心並善盡監控通報之責，並無社論所謂「機場體溫篩檢沒攔下，又在醫療中心錯診為類流感」。 針對中國大陸此波H7N9流感疫情明顯高於往年，疾管署自去年入秋後已多次主動發佈旅遊疫情警示提升並強化監測，今年元月更多次發佈新聞提醒民眾和醫界注意，在2月4日疾管署確診今年首例H7N9境外移入個案時，亦立即公布確診資訊及接觸者追蹤情形，並無社論所謂「因首長異動遲遲未能張開防疫網，直到新首長上任才展開工作」。根據世衛2013年4月1日發佈之疫情速訊（https://goo.gl/qLijxc），中國大陸H7N9首批病例是上海2例、安徽1例，三位病例發病時間介於2013年2月19日和3月15日之間，所有病例發展為重症肺炎。這些病例至3月29日才獲得中國疾病預防控制中心的實驗室確認H7N9流感，由發病至確診長達13至38天。並無社論所謂「2013年世界H7N9首例出現於上海，當地醫療機構一天即確認，且完成病毒解析」。H7N9流感自2013年起在中國大陸禽鳥和人類疫情持續不斷，我國迄今僅五例境外移入人類病例均在中國大陸感染後返台就醫，接觸者共計追蹤745人均無人感染，我國在衛生和農政單位嚴密監測防控下，無論人類或禽鳥，至今仍保持本土H7N9零病例成果。社論所謂「台灣在東亞候鳥遷徙路徑上，H7N9應防也能防，卻未防」實屬謬誤。全球H7N9流感自2013年迄今已有1,163病例、359死亡。並非社論所謂「H7N9僅十一人死亡」，應為社論誤植中國大陸H5N6死亡人數。 防疫視同作戰，最忌謠言或不實資訊製造民眾恐慌。傳播媒體肩負向大眾提供正確資訊之社會責任，應善盡查證之責。疾管署已根據傳染病防治法第9條：「利用傳播媒體發表傳染病流行疫情或中央流行疫情指揮中心成立期間防治措施之相關訊息，有錯誤、不實，致嚴重影響整體防疫利益或有影響之虞，經主管機關通知其更正者，應立即更正。」要求該媒體立即更正相關內容。

臺灣動藥 編製 小動物腫瘤學 書 !

臺灣動藥 延續寵物新生命 2017年02月15日 04:10 王奕勛 台灣動藥董事長陳建宏表示，公司首支寵物抗癌用藥獲美國FDA肯定，同時也榮獲第六屆行政院農委會「科技農企業菁創獎」－創新研發獎殊榮。成功研發亞洲第一例寵物抗腫瘤藥物，董事長陳建宏甫獲得農委會菁創獎，臺灣動藥肯定是台灣農業生技業的明日之星。為減輕毛小孩病痛的苦楚，陳建宏投入從無到有的20年研發歷程，抗癌能是國內少數自有開發的藥物，陳建宏表示，開發過程必須與藥物做大量溝通，每一個環節都累積了寶貴經驗。當年他親眼見到麻醉師痛失愛犬，甚至悲傷到無法工作；他笑著說，「可見寵物在飼主新中的地位與家人一樣重要。」這段經驗成了他開發寵物新藥的起點。對於新藥在去年3月解盲成功，看好今年可以順利上市，陳建宏表示，臺灣動藥的願景是讓獸醫師發揮醫療專業，照顧飼主與毛小孩的生活品質。身為國內首家寵物新藥開發公司的臺灣動藥，不僅榮獲第六屆行政院農委會「科技農企業菁創獎」－創新研發獎殊榮，也是無化療藥副作用寵物抗癌用藥公司。更重要的是，由於臺灣動藥對於寵物用藥減輕痛苦等方面的實用性、安全性和有效性所扮演的角色已廣受矚目，在新藥甫未上市前就獲得美國FDA高度關注肯定。同時美國FDA看上新藥未來的可塑性，以及台灣的試驗符合美方嚴格的要求，多次讓臺灣動藥減免臨床試驗費用，全心專注於符合安全機制的研發過程，以確保產品滿足不斷更新的最高標準。根據研究指出，寵物對於減輕飼主身心健康及情緒健康扮演了重要的角色，但現代社會中讓許多寵物開始面臨諸多的文明病症問題，因此如何預防保健毛小孩的身體機能正常，是飼主必須關注的。雖然寵物有著不亞於親人間的關係，但過往飼主因對醫療的知識不足情況下，只能放棄治療、或誤判對寵物造成的危險性等，而忽略了治癒的可能性。為提升國內寵物癌症知識，臺灣動藥不惜付出時間、成本，編製彙整寵物疾病醫學知識－小動物腫瘤學一書，目的是透過健全的資對稱，讓飼主與動物醫院獸醫建立正確的觀念及應變處理態度，增加信賴感及黏著度，選擇一個對牠生命品質最好的醫療方式。同時開設專業學習課程、研討會等，不吝嗇地在國外專業機構相關所學的部分，教導分享給所有寵愛毛小孩的飼主，希望帶動民眾重視寵物醫療及許多層面的貢獻及影響。作為台灣生技的明日之星，陳建宏允諾，未來將積極開發寵物新藥、尋覓人才與國際合作，為台灣生技產業奠定穩健實力。(工商時報)

(驚人相似) 乳腺幹細胞 & 三陰性乳腺癌亞型

乳癌研究新突破 墨科學家發現特殊幹細胞 【大紀元2017年02月15日訊】（大紀元記者傑妮墨爾本編譯報導）墨爾本的研究人員最近在乳房結構研究方面又邁進了一步，他們希望該成果能為檢測和治療侵略性乳腺癌提供新視角。 據《太楊先驅報》報導，基於其在2006年的突破性發現，即乳腺幹細胞可產生乳房中的所有細胞，Walter & Eliza Hall醫學研究所（Walter and Eliza Hall Institute of Medical Research，簡稱WEHI）的研究團隊進一步發現了位於乳房不同位置的3組幹細胞。通過使用3D成像技術和運算電腦系統，他們發現了一種存活時間長的干細胞，負責乳頭周圍產乳汁的細胞的生長。這種細胞類型會被受孕激素「喚醒」，但僅限於乳房前部的特定區域。WEHI幹細胞和癌症實驗室的負責人Jane Visvader說，這些細胞與一種三陰性乳腺癌亞型有著「驚人相似」的特徵。該乳腺癌亞型預後極差，死亡風險較高。Visvader教授說：「休眠乳腺幹細胞和這種非常具有侵略性的癌症之間可能有一定聯繫。」 責任編輯：李欣然

(JAMA: UK Biobank 基因揭密) Belly Fat, abdominal adiposity腹部肥胖/ Waist-to-Hip Ratio --糖尿病/心臟病關係

基因傾向「蘋果型」身材 易患糖尿或心臟病 2017-02-15 12:02中央社 邁阿密14日綜合外電報導研究人員今天表示，基因上有腹部容易囤積脂肪的傾向，或「蘋果型」身材的人，罹患第2型糖尿病或心臟病的風險較高。法新社報導，這項刊載在「美國醫學會期刊」（JAMA）的研究認為，人的基因組成可能與未來的健康問題有關。研究資深作者哈佛醫學院醫學副教授凱瑟瑞桑（Sekar Kathiresan）指出：「每個人儲存脂肪的地方各異，有些人在腹部，我們稱為腹部肥胖，有些人則在臀部與大腿。」「我們實驗基因傾向是否與第2型糖尿病及冠狀動脈心臟病有關，結果發現答案為肯定的『是的』。」過去觀察研究已揭露腹部脂肪與第2型糖尿病與心臟病的關連，但缺乏原因與影響的證明。為了進一步了解，研究人員仔細檢查2007到2015年針對約40萬名受測者基因組進行分析的6項研究。研究第一作者麻州綜合醫院（Massachusetts General Hospital）研究人員恩姆丁（Connor Emdin）說：「這些研究結果顯示，可以運用基因的方法，來判斷腹部肥胖等某種特徵，對心血管代謝結果的影響程度。」

Apples and Pears: Genetic Analysis Points to Causal Role for Belly Fat in Heart Disease and Diabetes One study author recommends greater use of the waist-to-hip ratio in practice to prevent disease in high-risk patients. By Yael L. Maxwell February 14, 2017 Apples and Pears: Genetic Analysis Points to Causal Role for Belly Fat in Heart Disease and Diabetes New genetic evidence is supporting the idea that people who are predisposed to carrying fat in their belly as opposed to their hips and thighs are also at greater risk for developing heart disease and type 2 diabetes. Prior observational studies have linked abdominal adiposity with cardiometabolic disease, but it has remained unclear whether it plays a causal role. For their analysis published today in JAMA, Connor Emdin, DPhil (Massachusetts General Hospital, Boston, MA), and colleagues constructed a polygenic risk score of 48 single-nucleotide polymorphisms (SNPs) for waist-to-hip ratio adjusted for body mass index (BMI). Applying this score to individual-level data from the UK Biobank, they found higher risks of type 2 diabetes (OR 1.77; 95% CI 1.57-2.00) and coronary heart disease (OR 1.46; 95% CI 1.32-1.62) associated with each standard deviation increase in waist-to-hip ratio. As for why this might be, those with higher waist-to-hip ratios seemed to have higher levels of triglycerides, 2-hour glucose, and systolic blood pressure (P < 0.001 for all). "The relationship to heart disease and diabetes did not surprise us," senior author Sekar Kathiresan, MD (Massachusetts General Hospital), told TCTMD, noting however that he and his colleagues "were a little surprised" that the level of triglycerides in the blood could explain the relationship between belly fat and disease risk. There are a number of different theories that could clarify this, he said, but "the abdominal fat cells seem to secrete a lot of bad factors that go into the blood and that actually lead to delayed clearance of the fat from the blood, which [leads] to higher levels of triglyceride-rich lipoproteins." While there is definitely "something about the visceral fat is different from the fat that is in the thighs and hips," further research is needed to clarify it, Kathiresan observed. "It's a completely fertile ground, because there's very little known about what the factors are that lead to the apple shape versus the pear shape. And it's hard to model in organisms, like mice for example, because they just have a totally different body fat distributions than humans." In his experience, physicians often focus more on overall weight or BMI in their patients, and not specifically where the fat is stored. But the waist-to-hip ratio is "an easily available marker for who is at particularly [high] risk for diabetes and heart disease," Kathiresan said, advising clinicians to pay more attention to it in practice. For the long term, understanding the genetics "that actually change the body fat distribution away from abdominal adiposity . . . may actually be as beneficial as focusing on the overall weight," potentially leading to the development of safe and effective medications for weight loss, he said.

Championing Mendelian Randomization In an accompanying editorial, George Davey Smith, MD, DSc, Lavinia Paternoster, PhD, and Caroline Relton, PhD (University of Bristol, England), suggest that the current study could serve as an example for future avenues of investigation. Mendelian randomization—the reliance on how genes are randomly assigned without bias as a basis for clinical research and what Emdin et al used in their study—"can be considered analogous to randomization in an RCT," they argue. Early studies "tended to use single genetic variants and focus on a specific risk factor-disease association within a single study population," they explain. Now, however, "large numbers of genetic variants [are] being identified for many exposures." Given the causal relationship between abdominal adiposity and heart disease/diabetes shown in this study, "such conditional measures are likely to become increasingly adopted in studies in the future, as more complex aspects of disease causation are investigated," the editorialists predict. Smith, Paternoster, and Relton point out that reducing obesity through public health efforts and interventions has proven to be difficult, so it would make sense that specifically targeting belly fat would be even more challenging. "Abdominal adiposity is shown to influence several such mediators in the report by Emdin et al, and triglyceride levels were demonstrated to be potentially important with respect to CHD risk," they write. "A formal Mendelian randomization mediation analysis could be applied that would more robustly quantify the contribution of potentially treatable intermediaries, and targeting such could have important public health benefit." Looking at recent studies, the editorialists suggest that attention to Mendelian randomization could have "prevented very expensive late-stage clinical trial failures. . . . Indeed, the adoption of Mendelian randomization to prioritize (or deprioritize) major investment in RCTs before their inception should be actively encouraged."

Sources Emdin CA, Khera AV, Natarajan P, et al. Genetic association of waist-to-hip ratio with cardiometabolic traits, type 2 diabetes, and coronary heart disease. JAMA. 2017;317:626-634. Smith GD, Paternoster L, Relton C. When will Mendelian randomization become relevant for clinical practice and public health? JAMA. 2017;317:589-591. 

Genetic Association of Waist-to-Hip Ratio With Cardiometabolic Traits, Type 2 Diabetes, and Coronary Heart Disease JAMA. 2017;317(6):626-634. doi:10.1001/jama.2016.21042 Question Is genetic evidence consistent with a causal relationship among waist-to-hip ratio adjusted for body mass index (a measure of abdominal adiposity), type 2 diabetes, and coronary heart disease? Findings In this mendelian randomization study, a polygenic risk score for increased waist-to-hip ratio adjusted for body mass index was significantly associated with adverse cardiometabolic traits and higher risks for both type 2 diabetes and coronary heart disease. Meaning These results provide evidence supportive of a causal association between abdominal adiposity and the development of type 2 diabetes and coronary heart disease.

Importance In observational studies, abdominal adiposity has been associated with type 2 diabetes and coronary heart disease (CHD). Whether these associations represent causal relationships remains uncertain.

Objective To test the association of a polygenic risk score for waist-to-hip ratio (WHR) adjusted for body mass index (BMI), a measure of abdominal adiposity, with type 2 diabetes and CHD through the potential intermediates of blood lipids, blood pressure, and glycemic phenotypes.

Design, Setting, and Participants A polygenic risk score for WHR adjusted for BMI, a measure of genetic predisposition to abdominal adiposity, was constructed with 48 single-nucleotide polymorphisms. The association of this score with cardiometabolic traits, type 2 diabetes, and CHD was tested in a mendelian randomization analysis that combined case-control and cross-sectional data sets. Estimates for cardiometabolic traits were based on a combined data set consisting of summary results from 4 genome-wide association studies conducted from 2007 to 2015, including up to 322 154 participants, as well as individual-level, cross-sectional data from the UK Biobank collected from 2007-2011, including 111 986 individuals. Estimates for type 2 diabetes and CHD were derived from summary statistics of 2 separate genome-wide association studies conducted from 2007 to 2015 and including 149 821 individuals and 184 305 individuals, respectively, combined with individual-level data from the UK Biobank.  

Results Among 111 986 individuals in the UK Biobank, the mean age was 57 (SD, 8) years, 58 845 participants (52.5%) were women, and mean WHR was 0.875. Analysis of summary-level genome-wide association study results and individual-level UK Biobank data demonstrated that a 1-SD increase in WHR adjusted for BMI mediated by the polygenic risk score was associated with 27-mg/dL higher triglyceride levels, 4.1-mg/dL higher 2-hour glucose levels, and 2.1–mm Hg higher systolic blood pressure (each P < .001). A 1-SD genetic increase in WHR adjusted for BMI was also associated with a higher risk of type 2 diabetes (odds ratio, 1.77 [95% CI, 1.57-2.00]; absolute risk increase per 1000 participant-years, 6.0 [95% CI, CI, 4.4-7.8]; number of participants with type 2 diabetes outcome, 40 530) and CHD (odds ratio, 1.46 [95% CI, 1.32-1.62]; absolute risk increase per 1000 participant-years, 1.8 [95% CI, 1.3-2.4]; number of participants with CHD outcome, 66 440).

Conclusions and Relevance A genetic predisposition to higher waist-to-hip ratio adjusted for body mass index was associated with increased risk of type 2 diabetes and coronary heart disease. These results provide evidence supportive of a causal association between abdominal adiposity and these outcomes.

(辭董事) 台達電 無法給 環瑞醫 營運意見/ 供應鏈仍維持 !

台達電辭環瑞醫董事 持股19.55%不會出脫 2017-02-15 11:53經濟日報 記者劉怡妤╱即時報導 台達電（2308）公告辭任轉投資公司環瑞醫（4198）董事，公司表示，由於台達電在生醫領域不嫻熟，無法提供環瑞醫專業意見，因此辭任董事；短期內持股不會出脫維持股權，轉為純財務投資。台達電表示，公司仍會持續拓展生醫領域布局，退出環瑞醫董事，主要是因為無法提供協助，因董事一職須進入董事會針對營運提出專業意見，而台達電在該領域無法提供協助因此決定辭任。另外，目前持股環瑞醫19.55%股權將持續持有，不會因為退出董事而出脫。台達電指出，雖然公司辭任環瑞醫董事，但公司在持股不會變動之外，台達電仍是環瑞醫重要合作夥伴，由於產品獲得認證，環瑞醫產品製造仍將委由台達電負責，雙方關係不因退出董事而起變化。後續台達電對於環瑞醫將為單純財務投資，以及供應鏈合作關係。另外，台達電與持股約二成的轉投資公司泰達進行股權交易，台達電子公司DEN將收購泰達旗下四家公司股權，並出售位於斯洛伐克的Eltek SK給泰達子公司，有利於泰達強化通訊電源系統業務，交易案第1季即可完成。公司表示，由於台達電並未完全持股泰達，透過彼此間子公司股權交易重新規劃彼此產品線整合，透過旗下子公司交易移轉整合資源並提升營運綜效。台達電表示，交易案將有助於公司強化電源系統以及在EMEA（歐洲、中東、非洲）與美洲等區域業務拓展，由於近年EMEA區域市場快速成長，而擬併購的四家公司主要業務即為EMEA及美洲區的電源系統銷售，預期台達電可藉由交易案加快區域電源系統布局。另外，預計今年營收將因併購創高。