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在refractory這個產品中，有22篇Facebook貼文，粉絲數超過0的網紅，也在其Facebook貼文中提到， 【藥事知多D】一物兩用：維生素A酸 說到維生素A酸(Retinoic Acid)（俗稱「A酸」），很多人便會聯想到暗瘡藥，例如維A酸(Tretinoin)、異維A酸(Isotretinoin)。 對，A酸這類藥的其中一個用途，便是暗瘡。 不說不知道，A酸這類藥原來還有一種鮮為人知的用途…… ...
　同時也有4部Youtube影片，追蹤數超過3萬的網紅[email protected]，也在其Youtube影片中提到，甲狀腺癌 － 陳穎樂臨床腫瘤科專科醫生＠FindDoc.com FindDoc Facebook : https://www.facebook.com/FindDoc FindDoc WeChat : 快徳健康香港 FindDoc FindDoc Instagram：@finddochk ...

refractory 在 Facebook 的最佳解答

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2021-08-25 09:44:55 有 59 人按讚
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【藥事知多D】一物兩用：維生素A酸

說到維生素A酸(Retinoic Acid)（俗稱「A酸」），很多人便會聯想到暗瘡藥，例如維A酸(Tretinoin)、異維A酸(Isotretinoin)。

對，A酸這類藥的其中一個用途，便是暗瘡。

不說不知道，A酸這類藥原來還有一種鮮為人知的用途……

這便是……

停！在揭曉答案前，藥罐子首先不妨在這裡簡單分享一下A酸的作用原理吧！

A酸這門派主要在跟維生素A酸受體(Retinoic Acid Receptors, RARs)、維生素A酸X受體(Retinoid X Receptors, RXRs)這兩類受體結合，然後這些受體便會充當轉錄因子(Transcription Factor)，調控基因的轉錄(Transcription)，從而控制細胞凋亡(Apoptosis)、細胞分化(Cell Differentiation)。[1]

其實這個作用原理便是一個提示了。

這話怎麼解？

因為這門派能夠影響細胞分化、細胞凋亡這兩個過程，所以有時候還可以用來治療癌症。

對，其中一些A酸還可以是一種化療藥，透過抑制細胞分化，干擾細胞周期，抑制癌細胞增殖或者誘發細胞凋亡，誘發體內癌細胞啟動細胞凋亡，導致癌細胞自動消失，達到殺滅癌細胞的效果。

這方面，常見的例子分別是Alitretinoin、Bexarotene。

一、Alitretinoin
　　
在藥理上，Alitretinoin是一種「百搭」致效劑，簡單說，便是一條百合匙，同時能夠跟各種不同的維生素A酸受體、維生素A酸X受體結合，治療癌症。
　　
暫時還是不太清楚具體的作用原理，只是知道Alitretinoin能夠治療卡波西氏肉瘤(Kaposi's Sarcoma)這種癌症。[1]

二、Bexarotene
　　
在藥理上，Bexarotene是一種選擇性維生素A酸X受體致效劑，顧名思義，主要跟維生素A酸X受體結合，治療癌症。
　　
暫時還是不太清楚具體的作用原理，只是知道Bexarotene能夠治療皮膚T細胞淋巴瘤(Cutaneous T-cell Lymphoma)這種癌症。[2]

最後因為A酸這門派能夠控制細胞分化、細胞凋亡，所以還可能會影響體內其他細胞分裂速度較快的正常細胞，例如胚胎(Embryo)，從而能夠干預胚胎進行正常的細胞分裂，干擾胎兒的正常發展。

這就是說，A酸大多擁有致畸性(Teratogenicity)，從而可能會增加孕婦誕下畸胎的風險。

（如欲了解更多用藥資訊，歡迎看看「小小藥罐子」網誌。）

💊💊💊💊💊💊💊
BLOG➡️http://pegashadraymak.blogspot.com/
IG➡️https://www.instagram.com/pegashadraymak/
YT➡️https://www.youtube.com/channel/UCQOMojMd6q7XnESMWwldPhQ

📕📕📕📕📕📕📕
著作➡️藥事知多D、用藥知多D、藥房事件簿、家居用藥攻略（各大書店有售）

Reference:
1. Sporn MB, Lippman SM. Chemoprevention of cancer. In: Kufe DW, Pollock PE, Weichselbaum RR, et al, eds. Cancer Medicine, 6th ed. Hamilton, Ontario, BC Decker, 2003:414-422.
2. Duvic M, Hymes K, Heald P, et al. Bexarotene is effective and safe for treatment of refractory advanced-state cutaneous T-cell lymphoma: multinational phase II-III trial results. J Clin Oncol. 2001;19:2456-2471.

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refractory 在 Facebook 的最佳解答

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2021-08-19 13:00:35 有 422 人按讚
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#心理學家的面相術 #情緒心理學
#情緒腳本 #不反應期
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　走在懸崖邊緣，即使清楚看見防止人掉下去的欄杆，還是會令人恐懼。即使地面不易滑倒、欄杆非常堅固，心臟還是加速跳動，手掌仍然一直冒汗。光是知道沒有什麼可怕，並不能消除恐懼。雖然大部分人能控制自己的行動，留在懸崖邊的小徑，但可能只敢快速偷瞄一眼美麗的景色。即使客觀上沒有真正的危險，卻還是覺得危險。
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　懸崖邊的小徑顯示知識並不都能勝過產生情緒反應的自動評估群。情緒反應被引發後，我們可能在意識上知道自己不需要有情緒，可是情緒仍然持續。我假設這種誘因大多是演化而來的情緒主題，或是學習來的誘因，但與演化主題非常類似。當學習的誘因與演化主題沒有什麼關聯時，意識的知識較能阻斷情緒經驗。換個方式來說，如果我們擔心的事與演化主題無關，就能透過選擇來克服。
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　還有另一種更嚴重的情形，就是情緒會壓過理智。情緒會讓我們無法運用所有自己知道的事，甚至無法採用原本在沒有情緒時瞭如指掌的資訊。當我們陷入不適當的情緒時，會以符合自身感受的方式來解釋所發生的事，而忽視不符合感受的知識。
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　情緒會改變我們對世界的看法，以及對別人行為的解釋。我們不會質疑自己為什麼感受到一種特殊的情緒，反而會想辦法證實它。我們會以符合自身情緒的方式來評估一件事，於是證明這種情緒是正當的，而保持原有的情緒。在許多處境中，這種方式有助於我們注意如何對即將發生的問題做反應、了解緊急的事，並做出決定。
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　可是，這種反應也能造成問題，因為陷入情緒時，會忽略可以證明自己情緒並不適當的知識，也會忽略周圍不符合當下情緒的新資訊。換句話說，引導我們專注的機制，也會扭曲我們以新知和原有知識處理事情的能力。
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　假設有人在公開場合受侮辱而很生氣，他或她在大發雷霆的當下，很難想到對方的話是否真的是侮辱。不論是過去對這個人的認識，或是對侮辱本質的了解，都只會被選擇性地運用，光記得支持生氣理由的知識，而不會想到與之矛盾的知識。即使侮辱者解釋或道歉，生氣的人可能仍然無法立刻接受新的資訊（道歉的事實）。
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　情緒會有一段不反應期（refractory period），在這段期間無法接受不符合當下情緒、無法持續原有情緒、不能將情緒合理化的資訊。如果不反應期很短，只持續一、兩秒的話，是利多於弊的，可以在這短短的期間，把注意力放在眼前的問題，運用最恰當的知識做出初步的行動，並為接下來的行動做好準備。如果不反應期持續太久，長達數分鐘，甚至數小時的話，可能會引發問題，或有不適當的情緒化行為。過長的不反應期，會使我們看待世界和自己時心存偏見。
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　在幾乎發生車禍的情形中，一旦已閃避來車，就不會一直留在害怕的狀態，我們會很快明瞭剛才的危險，然後等待呼吸和心跳回復正常，時間大約在五到十五秒之間。可是，如果害怕的事無法立刻消除，比如一個人害怕下背的疼痛是肝癌的症狀，就會在不反應期排斥反證的資訊，忘記其實是昨天幫忙朋友搬傢俱才導致背痛。
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#意識你的不反應期
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　試想下述的常見情境：早上出門上班前，吉姆告訴妻子海倫，他很抱歉，因為臨時有事，不能接放學的女兒回家，必須由海倫來接。海倫被惹惱了，語調尖銳、臉上露出怒容地說：「你為什麼不早點告訴我？我已安排那個時段要見一位客戶！」海倫並沒有意識到自己的反應，她是未經選擇就覺得惱怒，因為自動評估群把丈夫的話解釋成沒有為她考慮，會阻礙她達到目標（這是生氣常見的主題）。
.
　吉姆從她的聲音和表情感覺到她的惱怒，質疑她有什麼權利生氣，也對海倫惱火，因為生氣常常會引發對方也生氣。「有什麼好生氣的？我沒辦法事先告訴妳，是因為老闆剛剛才打電話通知要開一個緊急會議，我必須在場。」海倫現在知道吉姆並不是不體貼，因此沒有理由為無法避免、出乎意外的挫折生氣，但她如果還在不反應期的話，就會造成內心的掙扎。由於惱怒之情想要證明自己是合理的，她可能很想批評對方：「你為什麼一開始不說清楚！」但她也可以約束自己，不要繼續生氣。
.
　如果海倫能接收吉姆提供的新資訊，就會改變自己對吉姆的看法，放掉「他不體貼」的想法，惱怒就會逐漸消退。可是有許多原因會讓不反應期變長，使海倫緊抓著怒氣不放，在吉姆提出解釋後，仍不肯讓步。她可能前一天晚上睡眠不足；或是承受極大的工作壓力而無法處理，於是把這些挫折轉到吉姆身上；也許他們為一件重要的事爭執了好幾個月（比如要不要再生小孩），海倫早就因為吉姆自私的態度而心懷怒氣；也可能生氣本來就在海倫的人格型態占有重要的角色（我在第六章會談到一項研究，討論本來就具有敵意的人格特質）；或是海倫把人生中另一部分的腳本「引進」當時的處境，而那份一再重演的腳本充滿強烈的情緒。
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　所謂腳本，會有許多角色，包括當事人和其他重要的人，加上發生在過去的情節。並不是每個人都會把不符合當下的情緒腳本，引進當前的處境。精神分析人格理論的傳統智慧認為，當人過去有尚未解決的感受，這些感受不曾充份表現出來，或是表現出來但沒有得到滿意的結果，就會引進腳本。腳本會扭曲當前的現實處境，造成不適當的情緒反應，並延長不反應期。
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　假設海倫是家中較小的孩子，而哥哥比爾是一直宰制她的惡霸。如果海倫烙印了那種經驗，父母又站在比爾那一國，認為她言過其實的話，她可能常常把「我受到支配」的腳本引進類似的情境（即使只有一點點相似）。海倫最在意的就是不要受人支配，以至於別人即使無意支配她，她也很容易有受到支配的感覺。海倫並不想引進這種腳本，她是個聰明的女人，可以從親近的人給的回饋，了解自己容易有這種誤解和過度反應，可是她在不反應期仍然無法改變情緒，甚至不知道自己處於不反應期。只有在事後反省時，她才了解自己的反應並不適當，而為原先的行為懊悔。她想從情緒警戒資料庫排除「他試圖支配我」的誘因，如果能消除這種誘因，生活就會更美好，不容易長時間生氣，也不會扭曲他人的動機。
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　許多人想要好好控制自己的情緒反應，許多人接受心理治療的理由就是不想再為某些事而情緒化，可是，沒有人想徹底關閉所有情緒，否則生活會變得單調、乏味、無趣，甚至可能較不安全。
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　害怕確實能保護我們，使生命得以保全，因為我們能不經思考就對傷害的威脅做出保護的反應。厭惡的反應使我們小心避免陷入可能有害的活動。失落造成的哀傷和絕望，可能使我們得到他人的協助。甚至最多人想關閉的情緒──生氣，也對我們有用。當受到阻撓時，生氣的情緒可以向別人和自己提出警告，這種警告可能帶來改變，但也可能引發對方的生氣。生氣推動我們改變世界、引發社會公義、為人權奮戰的企圖。
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　我們真的想消除這些動機嗎？沒有興奮的感覺、感官的樂趣、對自身和子孫成就的自豪、生活中許多奇怪和突如其來的事產生的趣味，這種生活還值得過嗎？情緒並不像盲腸，不是用不著而需要割除的累贅。情緒是生活的核心，使生活更有意義。
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--
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本文摘自《心理學家的面相術：解讀情緒的密碼【全新增訂版】》，作者保羅．艾克曼Paul Ekman為加州大學舊金山分校醫學院精神醫學部的心理學教授。1991年獲頒美國心理學會傑出科學貢獻獎，1994年獲頒芝加哥大學人文文學榮譽博士。最近一項關於二十世紀最具影響力的心理學家的研究中，艾克曼名列前一百大。
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　艾克曼的興趣集中在非語言行為與溝通，特別是情緒的臉部表情與生理學，以及人與人之間的欺騙。1970年代，艾克曼與心理學家衛理．弗瑞生發展出一套測量臉部表情的工具──臉部動作編碼系統──目前被世界各地數百位科學家使用。艾克曼是十四本書的作者或編者，包括《說謊》一書，並發表過百篇以上的科學論文。他是政府機構關於情緒的臉部表情的常任顧問，比如聯邦調查局、中央情報局、煙酒槍炮與爆裂物管理局，也是律師、法官、警察，和一些私人公司的諮詢顧問，包括皮克斯動畫工作室與光影魔幻工業公司，也常在英美的電視節目上現身。
.
閱讀本書 👉 https://reurl.cc/noKyrX

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refractory 在 甲狀腺醫者 Facebook 的精選貼文

甲狀腺醫者 By 甲狀腺醫者

2021-05-25 23:46:24 有 419 人按讚
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2021 世界甲狀腺日: COVID-19 紛紛擾擾疫情下談分化型甲狀腺癌的回顧與展望

五月25日(525)是世界甲狀腺日,以往每年的525都會有針對病友的專題演講,今年剛好遇到新冠病毒的疫情, 只能以簡單文字淺談甲狀腺癌的一些點點滴滴。

甲狀腺是內分泌的器官，雖然是個僅有20公克的腺體，但是因為其甲狀腺荷爾蒙影響幾乎全身代謝功能，而且腺體位置就在頸部(恰好是許多身體重要路徑通過的要道)，鄰近氣管和影響腦部的頸動靜脈，又和發聲的聲帶及神經比鄰而居， 再者就是和多數頸部淋巴脈絡相通，所以甲狀腺一旦生病就常有多重的症狀，甲狀腺的疾病可以約略分成幾類，包括(1)功能異常(如甲亢或甲低症)，(2)發炎(如急性、亞急性或慢性發炎)，(3)長東西(如結節、囊腫、腺瘤或癌症)，其中癌症相對比其他疾病更令人恐懼。甲狀腺癌最大宗(超過95%)是分化型甲狀腺癌(又可分為乳突癌和濾泡癌)，比較少見的是未分化癌和髓質癌，從分化型到未分化甲狀腺癌存在一個過渡的情形，也就是分化不良癌。以預後而言，未分化癌最差(通常診斷後不到1年)，分化型甲狀腺癌就相對讓人放心許多，存活通常超過10年，而且近八成可以超過15-20年，所以才會被「美名」成「最友善的癌」，分化不良癌則介在兩者之間。其實從分化到分化不良再到未分化癌有點像是逐漸惡化的感覺，分化癌吸收放射碘，分化不良和未分化癌不吸收放射碘，反而吸收葡萄糖，這就是為什麼用葡萄糖正子影像(FDG PET)偵測分化不良和未分化癌；以基因突變的角度也印證了未分化癌因為累積許多異常基因而呈現其複雜性及易侵犯和轉移的特質，因此未分化癌治療上就會有如果手術切不乾淨，就幾乎無法控制的情形；相對而言，分化型甲狀腺癌在適當的手術切除、放射碘治療、甲狀腺素抑制治療下可以有痊癒的機會(也就是所謂的沒有疾病跡象 no evidence of disease: 血液呈現理想的甲狀球蛋白Tg和甲狀球蛋白抗體anti-Tg ab值，影像學也沒有發現腫瘤的跡象)，就算沒有痊癒也別太擔心，即便沒有理想的腫瘤指數，如果影像學沒有明顯腫瘤惡化的跡象，也可以算是穩定；但值得注意的是還是有約一成的分化型甲狀腺癌在初步治療後仍然不穩定(也就是有疾病持續或惡化跡象，簡單說就是血液呈現上升的甲狀球蛋白Tg或甲狀球蛋白抗體anti-Tg ab值，影像學發現疑似腫瘤的跡象)。

分化型甲狀腺癌令人困擾的是腫瘤復發，保守估計有10~30%的復發率，而復發的發現可以是初診斷後5~10年以上，為什麼腫瘤會復發? 有一部分是因為初步治療其實並沒有清除所有的甲狀腺癌，而生長緩慢的殘餘甲狀腺癌會在5~10年後才變得明顯。復發的甲狀腺癌通常也比較棘手，一方面是經過歲月的淬鍊，腫瘤可能會累積更多異常基因而有利於腫瘤的生長，另一方面殘存的甲狀腺癌經過初步治療後能夠存活並生長其實也意涵其惡性度提高了，臨床上不乏復發後的分化型甲狀腺癌已經變身成分化不良，甚至是未分化癌。分化不良與未分化癌通常是不吸收放射碘或者具有輻射抗性且生長快速的甲狀腺癌，因此臨床上只能使用更先進的治療方法，通常需要標靶藥物，甚至是免疫治療，此時就絕對不是「最友善的癌」了。

個人在核子醫學從事甲狀腺腫瘤臨床和研究超過30年，見證到近年臨床分化型甲狀腺癌診療方式改變最多也趨向更複雜，長久以來甲狀腺全切除加上放射碘治療一直是唯一的法寶，復發後的甲狀腺癌也是手術切除(如果還能切除的話)加上放射碘治療(累積到數千毫居里)，但是10多年前的研究發現有些極為早期的微小甲狀腺乳突癌其實不用甲狀腺全切除，也無須放射碘治療，甚至有些研究主張「純觀察」(美其名為「積極監測 active surveillance」)就好，而近代的研究也發現持續使用放射碘治療其實對某些復發後的甲狀腺癌是沒有用的(尤其是具備 bRAFV600E基因異常陽性的腫瘤)，因此提出放射碘治療無效或頑固性甲狀腺癌(RAI-refractory DTC)的新名詞，因應而生的是標靶藥物與免疫治療；還有一些正在觀察中的治療方法也被提出，例如對於微小甲狀腺乳突癌或復發性腫瘤(尤其是淋巴結復發)進行射頻消融(Radiofrequency ablation簡稱 RFA)。這些治療方式的改變對醫生和患者其出發點可能是好的，避免過度與無效治療帶來的傷害，也提供新科技產品或藥物改善以往「一招半式(手術+放射碘)就行遍江湖」的治療法，但是這些診療方式改變給了醫生和患者更多的選擇，也帶來相當的衝擊，有人問我難道分化型甲狀腺癌診療沒有定則 (protocol)或指引(guidelines)嗎? 當然有! 但是條文是簡單的卻也存在一些爭議和灰色地帶，譬如最常被病友諮詢的是甲狀腺全切除的必要性，尤其在腫瘤大小1~4cm時需要更多的討論(只切單葉的復發率和未來追蹤方式、全切除的風險和終身甲狀腺素服藥必要性)，又譬如令病友困擾的放射碘治療的劑量活度(A醫生說100毫居里，B醫生主張150毫居里)，劑量活度選擇一直都沒有標準(醫生主觀意識加上疾病風險評估)，復發後如何判定放射碘治療無效或頑固性甲狀腺癌的標準仍在研議中(即便全球會議也沒有一致的結論)，至於何時啟動標靶藥物治療或是否應該進行腫瘤基因檢測也是很難達到所謂的共識。對此我相當認同歐盟主張的多專科團隊照護(multi-disciplinary team)再加上醫病共享決策(shared decision making)，不同專科醫師共同討論幾個可行方案，再由主責醫師和病友就疾病風險與診療選擇的利害關係討論診斷與治療方法，這樣的理想不知是否能在台灣健保制度與醫療環境下實現。或許我正在籌畫成立的台灣甲狀腺照護衛教協會未來可以推動這樣的目標，希望有志於甲狀腺疾病診療的專業同仁和正在受甲狀腺疾病(尤其是腫瘤)困擾的病友一起來打拼！

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在FB或網路上，甲狀腺醫者不願意介入病友與原主治或責任醫師的關係，在這裡分享行醫經驗和病友的故事，除了心情抒發，也是期盼關心甲狀腺健康的病友或者是同道朋友能夠藉由「他山之石可以攻錯」的想法，利用這些故事和經驗啟發對甲狀腺疾病的進一步了解和關心，醫者建議路過此FB的甲狀腺病友如果想要問問題，一定要先請教您原來的主治醫師，如果需要找我，也希望能夠透過原主治醫師轉介。由於甲狀腺醫者的體力有限，資質駑鈍，無法妥善回復每一個問題，有時遇到簡答題或是值得探索的問題，或許就在那個當下簡單回應，留下一點訊息只是抱著期待甲狀腺病友的照顧更有品質，在此寫些心得希望能夠拋磚引玉，給病友更多一些想法。
醫者不願意介入病友與原責任醫師的關係，這裡分享病友的故事，除了抒發，也期盼關心甲狀腺健康的病友或同道能夠藉由「他山之石可以攻錯」，啟發對甲狀腺疾病的進一步了解和關心
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refractory 在 [email protected] Youtube 的精選貼文

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（一）甲狀腺癌有什麼類型？ 00:06

（二）甲狀腺癌有什麼治療方法？ 00:42

（三）患者有機會對放射治療無反應嗎？ 01:45

（四）何時展開標靶藥物治療可得到最佳效果呢？ 03:00

(本短片作健康教育之用，並不可取代任何醫療診斷或治療。治療成效因人而異，如有疑問，請向專業醫療人士諮詢。)

參考資料：
1. 香港癌症資料統計中心. (2020). 2018 年香港癌症統計概覽. Retrieved from https://www3.ha.org.hk/cancereg/pdf/overview/Overview%20of%20HK%20Cancer%20Stat%202018_tc.pdf
2. 醫院管理局. (2020). 甲狀腺癌. Retrieved from https://www21.ha.org.hk/smartpatient/SPW/zh-hk/Disease-Information/Disease/?guid=1163a3df-86db-4b3b-a325-45741fcb04be
3. Cabanillas, M. E., & Habra, M. A. (2016). Lenvatinib: Role in thyroid cancer and other solid tumors. Cancer treatment reviews, 42, 47–55. https://doi.org/10.1016/j.ctrv.2015.11.003
4. Cabanillas, M. E., & Takahashi, S. (2019). Managing the adverse events associated with lenvatinib therapy in radioiodine-refractory differentiated thyroid cancer. Seminars in oncology, 46(1), 57–64. https://doi.org/10.1053/j.seminoncol.2018.11.004
5. Sugino K, et al. Endocr J 2018;299-306

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香港最全面醫療資訊影片平台，超過200位專科醫生、中醫、物理治療師、營養師等解答你的健康問題。搜尋全港各區醫生資料，即上FindDoc.com! At FindDoc, we aim to increase general public health awareness through our FindDocTV videos. Patients can make doctors’ appointments online using our platform Anytime Anywhere. FindDoc is Free and open to both patients and doctors.
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refractory 在 [email protected] Youtube 的最佳解答

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2020-12-30 15:00:07 有 48,002 人看過 有 0 人喜歡
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益生菌 － 黃世豪腸胃及肝臟科專科醫生＠FindDoc.com

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（一）食物補充益生菌可行嗎？ 00:06

（二）益生菌是什麼？ 00:42

（三）益生菌有什麼功用？ 01:23

（四）醫生如何選擇適合病人的益生菌？ 01:54

(本短片作健康教育之用，並不可取代任何醫療診斷或治療。治療成效因人而異，如有疑問，請向專業醫療人士諮詢。)

參考資料：
1. Lisko, D. J., Johnston, G. P., & Johnston, C. G. (2017). Effects of Dietary Yogurt on the Healthy Human Gastrointestinal (GI) Microbiome. Microorganisms, 5(1), 6. https://doi.org/10.3390/microorganisms5010006
2. Kechagia, M., Basoulis, D., Konstantopoulou, S., Dimitriadi, D., Gyftopoulou, K., Skarmoutsou, N., & Fakiri, E. M. (2013). Health benefits of probiotics: a review. ISRN nutrition, 2013, 481651. https://doi.org/10.5402/2013/481651
3. Hill, D., Sugrue, I., Tobin, C., Hill, C., Stanton, C., & Ross, R. P. (2018). The Lactobacillus casei Group: History and Health Related Applications. Frontiers in microbiology, 9, 2107. https://doi.org/10.3389/fmicb.2018.02107
4. Akatsu H., Iwabuchi N., Xiao J., Matsuyama Z., Kurihara R., Okuda K., et al. (2013). Clinical effects of probiotic Bifidobacterium longum BB536 on immune function and intestinal microbiota in elderly patients receiving enteral tube feeding. J. Parenter Enteral Nutr. 37 631–640. 10.1177/0148607112467819
5. Yang, G., Liu, Z. Q., & Yang, P. C. (2013). Treatment of allergic rhinitis with probiotics: an alternative approach. North American journal of medical sciences, 5(8), 465–468. https://doi.org/10.4103/1947-2714.117299
6. Uronis, J. M., Arthur, J. C., Keku, T., Fodor, A., Carroll, I. M., Cruz, M. L., Appleyard, C. B., & Jobin, C. (2011). Gut microbial diversity is reduced by the probiotic VSL#3 and correlates with decreased TNBS-induced colitis. Inflammatory bowel diseases, 17(1), 289–297. https://doi.org/10.1002/ibd.21366
7. Fedorak R. N. (2010). Probiotics in the management of ulcerative colitis. Gastroenterology & hepatology, 6(11), 688–690.
8. Dale, H. F., Rasmussen, S. H., Asiller, Ö. Ö., & Lied, G. A. (2019). Probiotics in Irritable Bowel Syndrome: An Up-to-Date Systematic Review. Nutrients, 11(9), 2048. https://doi.org/10.3390/nu11092048
9. Mimura, T., Rizzello, F., Helwig, U., Poggioli, G., Schreiber, S., Talbot, I. C., Nicholls, R. J., Gionchetti, P., Campieri, M., & Kamm, M. A. (2004). Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut, 53(1), 108–114. https://doi.org/10.1136/gut.53.1.108



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香港最全面醫療資訊影片平台，超過200位專科醫生、中醫、物理治療師、營養師等解答你的健康問題。搜尋全港各區醫生資料，即上FindDoc.com! At FindDoc, we aim to increase general public health awareness through our FindDocTV videos. Patients can make doctors’ appointments online using our platform Anytime Anywhere. FindDoc is Free and open to both patients and doctors.
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refractory 在 [email protected] Youtube 的最讚貼文

FindDocTV@FindDoc.com By [email protected]

2020-12-02 15:00:00 有 42,930 人看過 有 0 人喜歡
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益生菌專題 － 張世華腸胃及肝臟科專科醫生＠FindDoc.com

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（一）什麼時候需要益生菌？ 00:06

（二）益生菌會與藥物相衝嗎？由醫生處方較好？ 01:53

（三）腸道狀況有異樣應怎辦？ 03:20

(本短片作健康教育之用，並不可取代任何醫療診斷或治療。治療成效因人而異，如有疑問，請向專業醫療人士諮詢。)

參考資料：
1. Uronis, J. M., Arthur, J. C., Keku, T., Fodor, A., Carroll, I. M., Cruz, M. L., Appleyard, C. B., & Jobin, C. (2011). Gut microbial diversity is reduced by the probiotic VSL#3 and correlates with decreased TNBS-induced colitis. Inflammatory bowel diseases, 17(1), 289–297. https://doi.org/10.1002/ibd.21366
2. Fedorak R. N. (2010). Probiotics in the management of ulcerative colitis. Gastroenterology & hepatology, 6(11), 688–690.
3. Dale, H. F., Rasmussen, S. H., Asiller, Ö. Ö., & Lied, G. A. (2019). Probiotics in Irritable Bowel Syndrome: An Up-to-Date Systematic Review. Nutrients, 11(9), 2048. https://doi.org/10.3390/nu11092048
4. Mimura, T., Rizzello, F., Helwig, U., Poggioli, G., Schreiber, S., Talbot, I. C., Nicholls, R. J., Gionchetti, P., Campieri, M., & Kamm, M. A. (2004). Once daily high dose probiotic therapy (VSL#3) for maintaining remission in recurrent or refractory pouchitis. Gut, 53(1), 108–114. https://doi.org/10.1136/gut.53.1.108
5. Toscano M, et al. A consumer’s guide for probiotics: 10 golden rules for a correct use. Dig Liver Dis
(2017), http://dx.doi.org/10.1016/j.dld.2017.07.011


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香港最全面醫療資訊影片平台，超過200位專科醫生、中醫、物理治療師、營養師等解答你的健康問題。搜尋全港各區醫生資料，即上FindDoc.com! At FindDoc, we aim to increase general public health awareness through our FindDocTV videos. Patients can make doctors’ appointments online using our platform Anytime Anywhere. FindDoc is Free and open to both patients and doctors.
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refractory 在 Refractories at Work - YouTube 的推薦與評價

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#1. refractory中文(繁體)翻譯：劍橋詞典

refractory 的例句 ... Pharmacological modulation of the refractory period of retinal spreading depression. 來自Cambridge English Corpus. Genetic mapping and ...

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refractory · 查看更多. KK[rɪˋfræk͵torɪ]; DJ[riˋfræktəri]. 美式. adj. 執拗的；有抵抗力的. n. 耐火物質；（常複數）耐火磚；倔強的人 ...

#3. Refractory - Wikipedia

A refractory material or refractory is a material that is resistant to decomposition by heat, pressure, or chemical attack, and retains strength and form at ...

#4. refractory period - 不應期 - 國家教育研究院雙語詞彙

出處/學術領域, 英文詞彙, 中文詞彙. 學術名詞 動物學名詞, refractory period, 無反應期；缺乏興奮期. 學術名詞 獸醫學, refractory period, 惰期，不應期. 學術名詞

#5. Refractory Definition & Meaning - Merriam-Webster

Choose the Right Synonym for refractory. Adjective. unruly, ungovernable, intractable, refractory, recalcitrant, willful, headstrong mean not submissive to ...

#6. Refractory Definition & Meaning | Dictionary.com

refractory · hard or impossible to manage; stubbornly disobedient: a refractory child. · resisting ordinary methods of treatment. · difficult to fuse, reduce, or ...

#7. refractory中文 - 查查在線詞典

adj. 1.不聽話的，難駕馭的，倔強的，執拗的。 2.加工困難的；難處理的；【醫學】難醫的，難治療的(病、傷等)；無刺激反應的(神經)；不感受病毒的，能抵抗(疾病等)的。 3.

#8. refractory - 維基詞典，自由的多語言詞典 - Wiktionary

英語編輯. 發音編輯. (英國、美國) IPA：/ɹɪˈfɹæk.təɹ.i/. 音頻（美式）. （文檔）. 音頻（澳式）. （文檔）. 形容詞編輯 · 耐火的. 名詞編輯 · 主格. refractory >> ...

#9. Definition of refractory cancer - NCI Dictionary of Cancer Terms

refractory cancer. Listen to pronunciation. (reh-FRAK-tor-ee KAN-ser). Cancer that does not respond to treatment. The cancer may be resistant at the ...

#10. Carfilzomib or bortezomib in relapsed or refractory multiple ...

Carfilzomib or bortezomib in relapsed or refractory multiple myeloma (ENDEAVOR): an interim overall survival analysis of an open-label, randomised, phase 3 ...

#11. A Global Refractory Leader - Calderys

凱得力保持正常營運並每天監控新冠病毒的疫情動態。我們將每一位員工及商業夥伴的健康及安全擺在第一位，並持續展開嚴格的防疫措施。

#12. refractory在線翻譯- 用法_例句 - 海词词典

refractory 的英文翻譯是什麼意思，詞典釋義與在線翻譯：. 英英釋義. Noun: lining consisting of material with a high melting point; used to line the inside ...

#13. Idecabtagene Vicleucel in Relapsed and Refractory Multiple ...

Abstract Background Idecabtagene vicleucel (ide-cel, also called bb2121), a B-cell maturation antigen–directed chimeric antigen receptor ...

#14. International Journal of Refractory Metals and Hard Materials

Read the latest articles of International Journal of Refractory Metals and Hard Materials at ScienceDirect.com, Elsevier's leading platform of peer-reviewed ...

#15. Refractory definition and meaning | Collins English Dictionary

refractory in American English · 1. hard or impossible to manage; stubbornly disobedient · 2. resisting ordinary methods of treatment · 3. difficult to fuse, ...

#16. refractory | industrial material | Britannica

refractory, any material that has an unusually high melting point and that maintains its structural properties at very high temperatures.

#17. refractory - Dictionary Definition : Vocabulary.com

refractory Add to list Share · adjective. stubbornly resistant to authority or control · adjective. not responding to treatment · adjective. temporarily ...

#18. Refractory Factory - RHI Magnesita

You want to be a future leader and/or expert in the world's leading refractory company… and of course, you want to be a part of the world's hottest trainee ...

#19. Refractory Seizures | Epilepsy Foundation

Refractory seizures typically require that the person living with them take an active role in their own care and wellbeing. Learn more about seizures at the ...

#20. Refractory Services | Pyrotek

Refractory Services. TABfurnace TABfurnaceFire. Pyrotek is the largest global installer of furnace refractory linings in the aluminium industry, having ...

#21. Refractory Products Manufacturing: National Emissions ...

Refractory Products Manufacturing: National Emissions Standards for Hazardous Air Pollutants (NESHAP) · Rule Summary · Rule History · Additional Resources ...

#22. 38 Synonyms & Antonyms for REFRACTORY | Thesaurus.com

Find 38 ways to say REFRACTORY, along with antonyms, related words, and example sentences at Thesaurus.com, the world's most trusted free thesaurus.

#23. refractory Topic - American Concrete Institute

Refractory concrete is heat-resistant concrete made with high alumina or calcium-aluminate. Typically used in high heat applications such as furnaces, ...

#24. NORSE (New Onset Refractory Status Epilepticus) and FIRES ...

NORSE (New Onset Refractory Status Epilepticus) and FIRES (Febrile Infection-Related Epilepsy Syndrome). NORD gratefully acknowledges Nicolas Gaspard, MD, PhD, ...

#25. 耐火材料(REFRACTORY MATERIALS) - 中央炭素股份有限公司

石墨粉(ARTIFICIAL GRAPHITE POWDER) · 相關連結 · 聯絡我們 · 回首頁 >; 產品介紹 >; 耐火材料(REFRACTORY MATERIALS). 耐火材料(REFRACTORY MATERIALS) ...

#26. What is Refractory symptom - Meaning and definition

The term "refractory" can be applied to symptoms that cannot be adequately controlled despite aggressive efforts to identify a tolerable therapy that does not ...

#27. Refractory Standards - ASTM International

ASTM's refractory standards are instrumental in specifying, testing, and evaluating the chemical, physical, and mechanical properties of various materials ...

#28. Refractory | Inspectioneering

Refractory is a heat resistant material often used to line high temperature equipment utilized in the petroleum refining process.

#29. New Chicago-based design firm Refractory launches

Launched in Chicago, Refractory is a new American design brand offering exquisitely crafted furniture, lighting and objects.

#30. Seven Refractories - Sevenrefractories

We develop, produce and install advanced refractory materials. to support the steel, iron, cement, and other key industries with high temperature and ...

#31. 49-9045 Refractory Materials Repairers, Except Brickmasons

Build or repair equipment such as furnaces, kilns, cupolas, boilers, converters, ladles, soaking pits, and ovens, using refractory materials.

#32. Refractory Management | Veolia Australia and New Zealand

Refractory materials are essentially heat-resistant materials, such as refractory bricks, castables, ramming or gunning materials, which are designed to ...

#33. SAIL Refractory Company Limited

The Salem Refractory Unit of Burn Standard Company Limited (BSCL) became a wholly-owned subsidiary of SAIL w.e.f. December 16, 2011.

#34. International Journal of Refractory Metals and Hard Materials

Refractory metals are defined as metals with melting points higher than 1800 °C. These are tungsten, molybdenum, chromium, tantalum, niobium, hafnium, and ...

#35. Imerys Refractory Minerals - Alumino-silicate Materials

The broadest mineral portfolio for high-performance refractories. Imerys Refractory Minerals offers the most complete range of materials for the Refractory, ...

#36. Medical Definition of Refractory - MedicineNet

Refractory : Not yielding, or not yielding readily, to treatment. CONTINUE SCROLLING OR CLICK HERE · SLIDESHOW. Heart Disease: Causes of a Heart ...

#37. Approach to refractory gastroesophageal reflux disease in adults

This topic will review an approach to patients with refractory GERD. The clinical manifestations, diagnosis, and initial medical management ...

#38. Diamond Refractory: Refractory Maintenance & Refractory ...

We are a refinery maintenance company of refractory contractors offering refractory turnarounds, refinery installation, and refractory maintenance.

#39. Refractory products - Horn & Co. Group

Refractory products · Converter · Pig-iron application · Arc furnace mixes · Steel ladles mixes · Tundish · Vacuum systems (VOD / RH) · Allrounder · NE-Metallurgic.

#40. Refractory - The Free Dictionary

Not submitting to discipline or control: disorderly, fractious, indocile, intractable, lawless, obstinate, obstreperous, recalcitrant, uncontrollable, ...

#41. What Are Refractories

Then, there are refractory ceramic fibers, which resemble residential insulation, but insulate at much higher temperatures. Bricks and shapes are the more ...

#42. High-Quality Minerals for Refractories | Imerys

Each refractory application is unique and requires the right solution to face extreme temperatures and harsh physical and chemical conditions.

#43. Relapsed and Refractory Disease: What It Means for Blood ...

Refractory disease means a cancer has stopped responding to treatment. “Most hematologic cancers, like leukemia, lymphoma, and multiple myeloma, ...

#44. Refractory - Testing - Orton Ceramic

Orton provides pyrometric cones and other tools for thermal process verification, dilatometers and thermo-analytical instruments and materials testing.

#45. Understanding Refractory Failure—A New Perspective

Gary Bases is the President of BRIL Inc., an independent consulting firm specializing in brick, refractory, insulation, and lagging. He is also the author of ...

#46. Relapsed and Refractory | Leukemia and Lymphoma Society

For patients with relapsed or refractory Ph-negative ALL, there are several treatment options. One option is to use different drugs than those used during ...

#47. Refractory - KAEFER

Refractory works to withstand extreme heat. KAEFER specialises in minimising disruption to steel plants, oil and gas facilities, cement factories and power ...

#48. Refractory Linings - Dominion

Tradition and technology go hand in hand in the installation and maintenance of refractory linings.

#49. 56th Annual St. Louis Section / Refractory Ceramics Division ...

Louis Section and the Refractory Ceramics Division of The American Ceramic Society sponsored the 56 th Annual Symposium on Refractories Virtual Meeting on the ...

#50. Controlling thermal emission with refractory epsilon-near-zero ...

In contrast, here, we demonstrate a refractory W-HfO2 metamaterial, which controls thermal emission through an engineered dielectric ...

#51. Refractory Epilepsy | Cedars-Sinai

What is refractory epilepsy? People with epilepsy have seizures. During a seizure, the nerve cells in the brain don't communicate like they should.

#52. Our Refractory | AGC Ceramics Company

Refractory bricks inside the kiln are constantly affected by many different degrading processes, where chemical attach together with thermal shock are ...

#53. Refractory Status Epilepticus: Frequency, Risk Factors, and ...

Background Refractory status epilepticus (RSE) is a life-threatening condition in which seizures do not respond to first- and second-line anticonvulsant drug ...

#54. What Is Refractory Organic Matter in the Ocean? - Frontiers

DIC: dissolved inorganic carbon, DOC, dissolved organic carbon; POC, particulate organic carbon; urDOC, ultra-refractory DOC; rDOC, refractory ...

#55. Refractory Services - BrandSafway

Refractory Services | Refractory Work. BrandSafway's highly trained team can provide complete industrial services for your next project.

#56. Resco Products | Refractory Product Manufactuer | Full ...

Resco Products, Inc. is a full line global refractory manufacturer supported by unparalleled refractory applications expertise.

#57. Refractory Epilepsy: Causes, Symptoms, Treatment, and More

The causes, symptoms, and treatment of refractory epilepsy, which develops when your seizures aren't brought under control by medicine.

#58. SEFPRO | Leading Refractory Manufacturer for the Glass ...

SEFPRO provides glassmakers with innovative Refractory Solutions & Services adapted to each glass furnace's applications and constraints.

#59. Toxic substances list: refractory ceramic fibres - Canada.ca

Refractory ceramic fibres (RCFs) are amorphous man-made fibres produced from the melting of calcined kaolin clay or a combination of alumina ...

#60. What is Refractory Cancer? - News Medical

Refractory cancer is typically treated by second-line or third-line treatment, usually with a combination of more harsh drugs, or by enrollment ...

#61. Definition of Refractory Symptoms - Palliative Care

Most patients requiring palliative sedation demonstrate more than one refractory symptom (Cowan 2002; Cowan 2001). Palliative medicine experts reported that 34% ...

#62. Medical Definition of Refractory - RxList

Refractory : Not yielding, or not yielding readily, to treatment. QUESTION. What causes tooth decay? See Answer.

#63. New-onset super-refractory status epilepticus | Neurology

Objective To better understand the heterogeneous population of patients with new-onset refractory status epilepticus (NORSE), we studied the ...

#64. FDA approves brexucabtagene autoleucel for relapsed or ...

for adult patients with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL). Efficacy was evaluated in ZUMA-3 ( ...

#65. Refractory Meaning | Best 17 Definitions of ... - YourDictionary

Resistant to treatment. · The definition of refractory is stubborn or hard to manage, or heat resistant. · Showing or characterized by obstinate resistance to ...

#66. Refractory Solutions

Saint-Gobain Performance Ceramics & Refractories has curated a range of refractory solutions for key metallurgical and high-temperature processes.

#67. The refractory period: What to know, and can you shorten it?

The refractory period occurs after sex and may mean a person cannot have sex again for a while. Learn about the refractory period in males and females.

#68. Refractory Period in Males, Females - Healthline

The refractory period occurs right after you reach your sexual climax. It refers to the time between an orgasm and when you feel ready to be sexually ...

#69. Refractory Engineers: Refractory Materials, Products and ...

Refractory Engineers and Ceramic Technology provide high quality refractory products and refractory construction services throughout the Midwest.

#70. What Are Refractory Bricks and What Are They For? | ArchDaily

Refractory materials are those that can withstand high temperatures without damage to their structure, resistance, or thermal conductivity.

#71. Refractory products - ANDRITZ GROUP

Applications for refractory products. Pre-fabricated insulating shells for skid pipe systems in walking beam furnaces and pusher-type furnaces; Functional ...

#72. Refractory Materials Repairers, Except Brickmasons - O*NET ...

Build or repair equipment such as furnaces, kilns, cupolas, boilers, converters, ladles, soaking pits, and ovens, using refractory materials.

#73. Refractory Epilepsy | Johns Hopkins Medicine

About 1/3 of those with epilepsy will eventually develop refractory epilepsy. This means medicines don't work well, or at all, to control the seizures.

#74. Refractory Metals - MetalTek International

Refractory metals are a group of elements that are highly resistant to heat and wear. It is generally accepted that tungsten, molybdenum, ...

#75. refractory 的中文翻譯 | 英漢字典

refractory (a.)不聽話的,執拗的,難治療的.

#76. Refractory Testing - Metso Outotec

Select the most suitable refractory grade for your smelting process by measuring the chemical durability of the refractory lining material in laboratory ...

#77. What is Refractory Cancer and How Is It Treated? | Dana-Farber

Refractory cancer refers to cancer that may be resistant at the beginning of treatment, or becomes resistant during treatment.

#78. Refractory - Digitalfire

In the ceramic industry, refractory materials are those that can withstand a high temperature without deforming or melting. Refractories are used to build ...

#79. RAI – REFRACTORY ANCHORS

Refractory Anchors (RAI) Specializes in the Manufacture of High Temperature Alloy and Stainless Fasteners Used to Anchor Refractories in Furnaces and ...

#80. Refractory Fiber Products - FibreCast

Our refractory products are the best in the industry. Produced with expertise, refractories from FibreCast are top of the line.

#81. Refractory gold ores: Challenges and opportunities for a key ...

Refractory gold reserves, which require more sophisticated treatment methods in order to achieve oxide-ore recovery rates, correspond to 24 ...

#82. Refractories Worldforum

Imerys to Increase Prices for the Refractory Market Effective 1 January 2022. For the last 18 months, the global supply chain crisis has created unique ...

#83. Thermbond® Refractory Products - Thermbond® Refractory ...

Thermbond Refractory Solutions has reinvented the way that refractories are used and viewed. For more information, contact us at (561) 330-9300.

#84. refractory - APA Dictionary of Psychology

refractory adj. 1. resistant to control, as in a disease or disorder that fails to respond to a typically efficacious therapy.

#85. Refractories at Work - YouTube

Precast Refractory Shapes Webinar - Allied Mineral Products. Allied Mineral ... FCC Refractory Lined Pipe ...

#86. Occupational Exposure to Refractory Ceramic Fibers | NIOSH

This criteria document is derived from reviews of information from human and animal studies of the toxicity of refractory ceramic fibers (RCFs) and is ...

#87. Upstate Refractory Services

Upstate Refractory Services is deditcated to providing our customers with cost-effective solutions to refreactory related problems.

#88. Targeted Therapy Directed by Genetic Testing in Treating ...

Targeted Therapy Directed by Genetic Testing in Treating Patients With Advanced Refractory Solid Tumors, Lymphomas, or Multiple Myeloma (The MATCH Screening ...

#89. Refractory Technology: Fundamentals and Applications

Refractory Technology: Fundamentals and Applications [Sarkar, Ritwik] on Amazon.com. *FREE* shipping on qualifying offers. Refractory Technology: ...

#90. Refractory linings - Altrad Group

Altrad Services is able to undertake maintenance services on refractory linings which are installed to protect industrial assets against the effect of heat, ...

#91. Thermbond® Refractory Solutions | Products | Unifrax

Thermbond Refractory Products are a complete line of engineered refractory materials using the unique patented Thermbond Binder System.

#92. Respect Your Refractory - POWER Magazine

Because refractory is out of sight inside the gas flow path of a steam generator and its auxiliaries, it's also often out of mind.

#93. Refractory Ceramics | American Elements | Products

Refractory Ceramics search results at American Elements. ... refractory ceramic materials have numerous other assets such as excellent resistance to ...

#94. Refractories | Zircon Industry Association

What properties make zircon ideal for refractory applications? · Low solubility in molten silica and molten metal · Chemical inertness · Resistance to corrosion ...