【用藥知多D】用藥個人化:我的藥 = 你的藥?
〈嗄?用藥又關DNA咩事?〉
《美國獨立宣言》裡說:
「人皆生而平等。(All men are created equal.)」
《史記.陳涉世家》裡說:
「王侯將相寧有種乎!」
不論何時何地,在所有人眼裡,平等「是人之所生而有也(《荀子.榮辱》)」的權利。
奈何《動物農莊(Animal Farm)》裡同時又說:
「所有動物生來平等,但有些動物比其他動物更平等。(All animals are equal, but some animals are more equal than others.)」
唔……其他事情,藥罐子倒是不敢說,不過說到用藥治病,在相當程度上,這點倒是不無道理。
舉例說……
「咦?藥罐子,同一種病,我就服這種藥,為什麼人家就服那種藥呢?」
哦,答案其實很簡單……
「因為你是你,他是他,用藥者不一樣,用藥當然不一樣喇!」
藥罐子相信大家一定會破口大罵道:
「嗄?這算是什麼答案?」
唔……對,對,對,這句話看來真的好像說了等於沒說一樣,儼如一句廢話……聽來還可能會帶點官腔,不過可是千真萬確!
不信?
好,藥罐子首先不妨跟各位看倌一同認識「用藥個人化(Personalized Medicine)」這個用藥概念。
顧名思義,「用藥個人化」是指根據用藥者的個別情況度身訂造用藥策略。
跟過往的「用藥大眾化」不同(註:「用藥大眾化」不代表「價錢平民化」),用藥個人化的著眼點是人不是病。簡單說,便是「對人不對事」。
那麼,在用藥上,人到底有什麼不同呢?
唔……這個,中醫可能會說「體質」、西醫可能會說「基因」。其實不論是體質還是基因,兩者的概念倒是有幾分異曲同工之妙的味道。
在相當程度上,基因決定體質,體質源自基因。
所謂「基因(Gene)」,其實是染色體(Chromosome)上的一段DNA序列,一段DNA上面的密碼子(Codons)經過轉錄(Transcription)、翻譯(Translation)便會轉譯成為對應的氨基酸,進而合成蛋白質。
其中蛋白質能夠合成酵素,至於酵素主要負責協調人體的生理功能,所以不同的基因便可能會生成不同的酵素,在相當程度上,便可能會影響藥物的新陳代謝。
這就是說,就算是同一種藥,不同的人還是可能會產生不同程度的藥性、毒性,從而可能需要調整用藥策略,例如加藥、減藥、停藥、轉藥,保障用藥安全。
舉例說,Carbamazepine是一種鈉離子通道抑制劑(Sodium Channel Blocker),主要用來治療癲癇(Epilepsy),顧名思義,主要在透過抑制細胞膜上的鈉離子通道(Sodium Channel)穩定神經,減少抽搐發作,從而達到抗癲癇的效果。
問題是,在罕見的情況下,Carbamazepine可能會誘發一些較嚴重的皮膚過敏症候群(Hypersensitivity Syndrome),例如史蒂芬—強生症候群(Stevens-Johnson Syndrome, SJS)、毒性表皮溶解(Toxic Epidermal Necrolysis, TEN)。兩者的死亡率分別大約是1至5%、25至35%[1],往往可能會構成性命之虞。
不過不說不知道,兩者的風險原來跟用藥者的基因構成關聯。
其中如果用藥者帶有一種稱為「HLA-B*1502」這種人類白細胞抗原(Human Leukocyte Antigen, HLA)對偶基因(Allele)的話,主要是亞洲人,例如中國人、台灣人、泰國人、印尼人、菲律賓人、馬來西亞人,服用Carbamazepine便可能會大大增加出現史蒂芬—強生症候群、毒性表皮溶解這兩種副作用的機會,風險高達2504倍。[2]
所以如果是上述這些高風險人種的話,美國食品藥物管理局(U.S. Food and Drug Administration, FDA)建議用藥前應該首先進行基因檢測篩檢用藥者體內有沒有HLA-B*1502這種對偶基因並評估用藥風險,目的在減少出現這兩種副作用的機會。
當然,如果呈陰性的話,風險自然一般會較低,不過「低」風險不等於「零」風險,所以還是需要密切追蹤用藥者的動態,留意用藥者有沒有這兩種副作用的跡象。反過來,如果呈陽性的話,風險當然會較大,這時候,除非逼不得已,例如利大於害,否則一般不建議服用Carbamazepine,避免得不償失。
同時也有1部Youtube影片,追蹤數超過98萬的網紅CANACANA family,也在其Youtube影片中提到,寒くなってきましたね♪ まだクリスマスは少し先ですが、ぜひクリスマスカノンで気持ちを温めてくださいね♪ 我が家はクリスマスツリーを息子と一緒に出しました(●’◡’●) 🎹 楽譜(カノン♪) ▶︎https://www.kokomu.jp/sheet-music/3340 ※通常Verを採譜したもの...
food transcription 在 Lee Hsien Loong Facebook 的最佳貼文
By now, you have probably heard about my father’s red box. Minister Heng Swee Keat posted about it last week. The red box was a fixture of my father’s work routine. It is now on display at the National Museum of Singapore in his memorial exhibition.
Some of my father’s other personal items are there too. His barrister’s wig (of horsehair) from when he was admitted to the Bar. And a Rolex Oyster Perpetual watch given to him by the Singapore Union of Postal and Telecommunications Workers after he represented them in the famous postmen’s strike in 1952.
I enjoyed my visit to the exhibition a few days ago. Was happy to hear that many of you went yesterday. The exhibition will be on until 26 April. – LHL
MR LEE'S RED BOX
Mr Lee Kuan Yew had a red box. When I worked as Mr Lee’s Principal Private Secretary, or PPS, a good part of my daily life revolved around the red box. Before Mr Lee came in to work each day, the locked red box would arrive first, at about 9 am.
As far as the various officers who have worked with Mr Lee can remember, he had it for many, many years. It is a large, boxy briefcase, about fourteen centimetres wide. Red boxes came from the British government, whose Ministers used them for transporting documents between government offices. Our early Ministers had red boxes, but Mr Lee is the only one I know who used his consistently through the years. When I started working for Mr Lee in 1997, it was the first time I saw a red box in use. It is called the red box but is more a deep wine colour, like the seats in the chamber in Parliament House.
This red box held what Mr Lee was working on at any one time. Through the years, it held his papers, speech drafts, letters, readings, and a whole range of questions, reflections, and observations. For example, in the years that Mr Lee was working on his memoirs, the red box carried the multiple early drafts back and forth between his home and the office, scribbled over with his and Mrs Lee’s notes.
For a long time, other regular items in Mr Lee’s red box were the cassette tapes that held his dictated instructions and thoughts for later transcription. Some years back, he changed to using a digital recorder.
The red box carried a wide range of items. It could be communications with foreign leaders, observations about the financial crisis, instructions for the Istana grounds staff, or even questions about some trees he had seen on the expressway. Mr Lee was well-known for keeping extremely alert to everything he saw and heard around him – when he noticed something wrong, like an ailing raintree, a note in the red box would follow.
We could never anticipate what Mr Lee would raise – it could be anything that was happening in Singapore or the world. But we could be sure of this: it would always be about how events could affect Singapore and Singaporeans, and how we had to stay a step ahead. Inside the red box was always something about how we could create a better life for all.
We would get to work right away. Mr Lee’s secretaries would transcribe his dictated notes, while I followed up on instructions that required coordination across multiple government agencies. Our aim was to do as much as we could by the time Mr Lee came into the office later.
While we did this, Mr Lee would be working from home. For example, during the time that I worked with him (1997-2000), the Asian Financial Crisis ravaged many economies in our region and unleashed political changes. It was a tense period as no one could tell how events would unfold. Often, I would get a call from him to check certain facts or arrange meetings with financial experts.
In the years that I worked for him, Mr Lee’s daily breakfast was a bowl of dou hua (soft bean curd), with no syrup. It was picked up and brought home in a tiffin carrier every morning, from a food centre near Mr Lee’s home. He washed it down with room-temperature water. Mr Lee did not take coffee or tea at breakfast.
When Mr Lee came into the office, the work that had come earlier in the red box would be ready for his review, and he would have a further set of instructions for our action.
From that point on, the work day would run its normal course. Mr Lee read the documents and papers, cleared his emails, and received official calls by visitors. I was privileged to sit in for every meeting he conducted. He would later ask me what I thought of the meetings – it made me very attentive to every word that was said, and I learnt much from Mr Lee.
Evening was Mr Lee’s exercise time. Mr Lee has described his extensive and disciplined exercise regime elsewhere. It included the treadmill, rowing, swimming and walking – with his ears peeled to the evening news or his Mandarin practice tapes. He would sometimes take phone calls while exercising.
He was in his 70s then. In more recent years, being less stable on his feet, Mr Lee had a simpler exercise regime. But he continued to exercise. Since retiring from the Minister Mentor position in 2011, Mr Lee was more relaxed during his exercises. Instead of listening intently to the news or taking phone calls, he shared his personal stories and joked with his staff.
While Mr Lee exercised, those of us in the office would use that time to focus once again on the red box, to get ready all the day’s work for Mr Lee to take home with him in the evening. Based on the day’s events and instructions, I tried to get ready the materials that Mr Lee might need. It sometimes took longer than I expected, and occasionally, I had to ask the security officer to come back for the red box later.
While Mrs Lee was still alive, she used to drop by the Istana at the end of the day, in order to catch a few minutes together with Mr Lee, just to sit and look at the Istana trees that they both loved. They chatted about what many other old couples would talk about. They discussed what they should have for dinner, or how their grandchildren were doing.
Then back home went Mr Lee, Mrs Lee and the red box. After dinner, Mr and Mrs Lee liked to take a long stroll. In his days as Prime Minister, while Mrs Lee strolled, Mr Lee liked to ride a bicycle. It was, in the words of those who saw it, “one of those old man bicycles”. None of us who have worked at the Istana can remember him ever changing his bicycle. He did not use it in his later years, as he became frail, but I believe the “old man bicycle” is still around somewhere.
After his dinner and evening stroll, Mr Lee would get back to his work. That was when he opened the red box and worked his way through what we had put into it in the office.
Mr Lee’s study is converted out of his son’s old bedroom. His work table is a simple, old wooden table with a piece of clear glass placed over it. Slipped under the glass are family memorabilia, including a picture of our current PM from his National Service days. When Mrs Lee was around, she stayed up reading while Mr Lee worked. They liked to put on classical music while they stayed up.
In his days as PM, Mr Lee’s average bedtime was three-thirty in the morning. As Senior Minister and Minister Mentor, he went to sleep after two in the morning. If he had to travel for an official visit the next day, he might go to bed at one or two in the morning.
Deep into the night, while the rest of Singapore slept, it was common for Mr Lee to be in full work mode.
Before he went to bed, Mr Lee would put everything he had completed back in the red box, with clear pointers on what he wished for us to do in the office. The last thing he did each day was to place the red box outside his study room. The next morning, the duty security team picked up the red box, brought it to us waiting in the office, and a new day would begin.
Let me share two other stories involving the red box.
In 1996, Mr Lee underwent balloon angioplasty to insert a stent. It was his second heart operation in two months, after an earlier operation to widen a coronary artery did not work. After the operation, he was put in the Intensive Care Unit for observation. When he regained consciousness and could sit up in bed, he asked for his security team. The security officer hurried into the room to find out what was needed. Mr Lee asked, “Can you pass me the red box?”
Even at that point, Mr Lee’s first thought was to continue working. The security officer rushed the red box in, and Mr Lee asked to be left to his work. The nurses told the security team that other patients of his age, in Mr Lee’s condition, would just rest. Mr Lee was 72 at the time.
In 2010, Mr Lee was hospitalised again, this time for a chest infection. While he was in the hospital, Mrs Lee passed away. Mr Lee has spoken about his grief at Mrs Lee’s passing. As soon as he could, he left the hospital to attend the wake at Sri Temasek.
At the end of the night, he was under doctor’s orders to return to the hospital. But he asked his security team if they could take him to the Singapore River instead. It was late in the night, and Mr Lee was in mourning. His security team hastened to give a bereaved husband a quiet moment to himself.
As Mr Lee walked slowly along the bank of the Singapore River, the way he and Mrs Lee sometimes did when she was still alive, he paused. He beckoned a security officer over. Then he pointed out some trash floating on the river, and asked, “Can you take a photo of that? I’ll tell my PPS what to do about it tomorrow.” Photo taken, he returned to the hospital.
I was no longer Mr Lee’s PPS at the time. I had moved on to the Monetary Authority of Singapore, to continue with the work to strengthen our financial regulatory system that Mr Lee had started in the late 1990s. But I can guess that Mr Lee probably had some feedback on keeping the Singapore River clean. I can also guess that the picture and the instructions were ferried in Mr Lee’s red box the next morning to the office. Even as Mr Lee lay in the hospital. Even as Mrs Lee lay in state.
The security officers with Mr Lee were deeply touched. When I heard about these moments, I was also moved.
I have taken some time to describe Mr Lee’s red box. The reason is that, for me, it symbolises Mr Lee’s unwavering dedication to Singapore so well. The diverse contents it held tell us much about the breadth of Mr Lee’s concerns – from the very big to the very small; the daily routine of the red box tells us how Mr Lee’s life revolved around making Singapore better, in ways big and small.
By the time I served Mr Lee, he was the Senior Minister. Yet he continued to devote all his time to thinking about the future of Singapore. I could only imagine what he was like as Prime Minister. In policy and strategy terms, he was always driving himself, me, and all our colleagues to think about what each trend and development meant for Singapore, and how we should respond to it in order to secure Singapore’s wellbeing and success.
As his PPS, I saw the punishing pace of work that Mr Lee set himself. I had a boss whose every thought and every action was for Singapore.
But it takes private moments like these to bring home just how entirely Mr Lee devoted his life to Singapore.
In fact, I think the best description comes from the security officer who was with Mr Lee both of those times. He was on Mr Lee’s team for almost 30 years. He said of Mr Lee: “Mr Lee is always country, country, country. And country.”
This year, Singapore turns 50. Mr Lee would have turned 92 this September. Mr Lee entered the hospital on 5 February 2015. He continued to use his red box every day until 4 February 2015.
(Photo: MCI)
food transcription 在 CANACANA family Youtube 的最佳貼文
寒くなってきましたね♪
まだクリスマスは少し先ですが、ぜひクリスマスカノンで気持ちを温めてくださいね♪
我が家はクリスマスツリーを息子と一緒に出しました(●’◡’●)
🎹 楽譜(カノン♪)
▶︎https://www.kokomu.jp/sheet-music/3340
※通常Verを採譜したものです
🎹 Sheet Music(Canon♪Eng only)
▶︎https://www.mymusicsheet.com/canacanafamily/12659
※It is a transcription of normal Ver
【カノン】
▶︎https://youtu.be/esBkFrwm4aI
【カノン1時間】
▶︎https://youtu.be/ZrmqqFUVT8Y
映像:motion elementsにてロイヤリティフリーのものを利用
ピアノ以外の音楽:artlist
♬CANACANA HP▶︎https://canacanafamily.com
♬Instagram▶︎http://instagram.com/canacana_piano
♬twitter▶︎http://twitter.com/CANACANA_broth
🌟他のチャンネルです
♬ 🎹CANACANA magic - CANACANAが弾く光るピアノ
▶︎https://www.youtube.com/channel/UC5o1iHRS_1uyF74aPNa280w
🎻🎸W Strings - ギターとバイオリンのチャンネル
▶ https://m.youtube.com/channel/UCRTaEHxtLAG8otd6I4dU6Ow
🍜Food Traveler - 食と旅のチャンネル
▶︎ https://m.youtube.com/channel/UCSEvmUvRId_ZIPozWgIYhvA
📩お仕事の依頼については下記メールアドレスより承っています♪
【mail address】brothfamily1@gmail.com
ピアノ担当: CANACANA 動画担当: 弟

food transcription 在 Explaining food security warning signals with YouTube ... 的推薦與評價
In this work, we propose a spatio-temporal analysis of unconventional textual data (i.e., YouTube transcriptions and articles from local news ... ... <看更多>