探险“死亡岛”

去年，舅舅的一位朋友送给他一张旧图，地图的印刷年代已经看不清了，破破烂烂皱皱巴巴，还有一股怪味道。舅舅花了大半年时间，终于弄清楚，这是一张藏宝图!

Diabetes but not insulin is associated with higher colon cancer mortality

AIM： To evaluate whether diabetic patients had a higher risk of colon cancer mortality and its associated risk factors. METHODS： The sex-specific crude and age-standard- ized （to the 2000 World Health Organization popula- tion） mortality rates of colon cancer in the Taiwan Residents general population were first calculated from 1995 to 2006. The trends were evaluated by linear regression. A total of 113 347 diabetic men and 131 573 diabetic women aged ~〉 25 years at recruitment from 1995 to 1998 were followed up until the end of 2006. Age/sex- specific colon cancer mortality rate ratios were cal- culated comparing the mortality rates of the diabetic patients with the average mortality rates of the general population within 12 years （1995-2006）. A sub-cohort of diabetic patients （42 260 men and 49 405 women） was interviewed using a baseline questionnaire and Cox＇s regression was used to evaluate the risk factors for colon cancer mortality in these diabetic patients.RESULTS： The crude and age-standardized trends of colon cancer mortality from 1995 to 2006 increased significantly for both sexes in the general population. A total of 641 diabetic men and 573 diabetic women died of colon cancer, with a mortality rate of 74.4 and 54.3 per 100 000 person-years, respectively. Mortality rate ratios [95% confidence intervals （CIs）] showed a significantly higher risk of mortality from colon can- cer for the diabetic patients compared to the general population, with the magnitude increasing with de- creasing age： 1.65 （1.40-1.95）, 2.01 （1.78-2.27）, 2.75 （2.36-3.21） and 5.69 （4.65-6.96） for /〉 75, 65-74, 55-64 and 25-54 years old, respectively, for men; and 1.46 （1.24-1.72）, 2.09 （1.84-2.38）, 2.67 （2.27-3.14） and 3.05 （2.29-4.06）, respectively, for women. Among the sub-cohort of diabetic patients who had been in- terviewed with the baseline questionnaire, including information on age, sex, diabetes duration, diabe- tes type, body mass index, smoking, insulin use and area of residence, age and smoking were significantly predictive for colon cancer mortality, with respec- tive adjusted hazard ratios （HRs） （95% CIs） of 1.077 （1.066-1.088） and 1.384 （1.068-1.792）. Diabetes dura- tion became a significant factor when those who died of colon cancer within 5 years of diabetes diagnosis were excluded to minimize the possible contamination of diabetes caused by incipient colon cancer, with an adjusted hazard ratio of 1.021 （1.007-1.034）. Sex, dia- betes type, insulin use, body mass index and area of residence were not significant predictors for colon can- cer mortality in the diabetic patients. Although insulin use was categorized into subgroups of duration of use （non-users and users 〈 5 years, 5-9 years and i〉 10 years）, none of the HRs for colon cancer mortality was significant with regards to different durations of insulin use. CONCLUSION： Colon cancer mortality is increasing in Taiwan. A higher risk is observed in diabetic patients. Smoking, but not insulin use, is a modifiable risk factor.

Hand Foot and Mouth Disease Due to Enterovirus 71 in Malaysia

Hand foot and mouth disease is a febrile sickness complex characterized by cutaneous eruption (exanthem) on the palms and soles with simultaneous occurrence of muco-cutanous vesiculo-ulcerative lesions (enanthem) affecting the mouth. The illness is caused by a number of enteroviruses with coxsackievirus A16 and enterovirus 71 as the main causative agents. Human enterovirus 71 (EV71) belongs to the species Human enterovirus A under the genus Enterovirus within the family Picornaviridae. EV71 has been associated with an array of clinical diseases including hand foot and mouth disease (HFMD), aseptic meningitis, encephalitis and poliomyelitis-like acute flaccid paralysis. A large outbreak of HFMD due to highly neurovirulent EV71 emerged in Malaysia in 1997, and caused 41 deaths amongst young children. In late 2000, a recurrence of an outbreak of HFMD occurred in Malaysia with 8 fatalities in peninsular Malaysia. Outbreak of HFMD due to EV71 recurred in 2003 with an unknown number of cases and mortalities. A similar outbreak of HFMD with 2 recorded deaths in young children occurred in peninsular Malaysia in late 2005 and this was followed by a larger outbreak in Sarawak (Malaysian Borneo) with 6 reported fatalities in the early part of 2006. The current on-going outbreak of HFMD started in peninsular Malaysia in epidemiological week 12 of 2010. As with other HFMD outbreaks in Malaysia, both EV71 and CA16 were the main aetiological viruses isolated. In similarity with the HFMD outbreak in 2005, the isolation of CA16 preceded the appearance of EV71. Based on the VP1 gene nucleotide sequences, 4 sub-genogroups of EV71 (C1, C2, B3 and B4) co-circulated and caused the outbreak of hand, foot and mouth disease in peninsular Malaysia in 1997. Two sub-genogroups (C1 and B4) were noted to cause the outbreak in 2000 in both peninsular Malaysia and Sarawak. EV71 of sub-genogroup B5 with smaller contribution from sub-genogroup C1 caused the outbreak in 2003. In the 2005 outbreak, besides the EV71 strains of sub-genogroup C1, EV71 strains belonging to sub-genogroup B5 were isolated but formed a cluster which was distinct from the EV71 strains from the sub-genogroup B5 isolated in 2003. The four EV71 strains isolated from clinical specimens of patients with hand, foot and mouth disease in the Sarawak outbreak in early 2006 also belonged to sub-genogroup B5. Phylogenetic analysis of the VP1 gene suggests that the EV71 strains causing the outbreak in Sarawak could have originated from peninsular Malaysia. Epidemiological and molecular data since 1997 show the recurrence of HFMD due to EV71 in Malaysia every 2 to 4 years. In each of the past outbreaks, more than one sub-genogroup of the virus co-circulate.