【保健知多D】益生菌 vs 濕疹?
首先說到濕疹,總是讓人產生一種既無助又無奈的無力感。
唔……暫時姑且撇開中醫不說,在西醫上,難聽一點,濕疹暫時可以說是一種「不治之症」。這就是說,只能醫治,不能根治。
不過人就是這樣,總是不會放過任何一絲希望。
既然如此,人們便可能會嘗試用自己方法治療濕疹當買一個希望。
其中一種希望便是……
益生菌(Probiotics)。
顧名思義,益生菌是「益菌」。
當然既然有益菌,自然有害菌。
對,益菌的其中一個功能主要是跟腸道裡的害菌「搶地盤」,便可能會減少害菌的數量,從而可能會有助預防一些因為細菌感染而誘發的腹瀉,例如旅行者腹瀉(Traveler's Diarrhea, TD)(俗稱「水土不服」)。
在相當程度上,這是一個「以夷制夷」的策略。
看到這裡,各位看倌可能會感到奇怪:
「咦?藥罐子,你自己不是說了嗎?益生菌不是促進腸道健康嗎?這到底跟濕疹又有什麼關係呢?」
對,誠如看倌所言,就算是朋友,說到底,益生菌算是異物,所以便可能是致敏原,反而可能會誘發濕疹,治病不成反致病,不是嗎?
那益生菌跟濕疹到底又有什麼關係?
唔……一般相信益生菌可能會透過抑制Th2細胞(Th2 Cells)(一種輔助型T細胞(Helper T Cells))、增加調節型T細胞(Regulatory T Cells, Treg Cells)所協調的免疫反應,調節人體的過敏反應[1],調理人體的免疫系統,改善過敏體質,從而可能會紓緩濕疹的症狀。
至於說到濕疹,常用的益生菌一般主要有以下兩種:
一、鼠李糖乳桿菌(Lactobacillus rhamnosus)
有研究指出這種益生菌可能會減少兒童罹患濕疹的機會。[2]
二、胚芽乳酸桿菌(Lactobacillus plantarum)
有研究指出這種益生菌可能會減輕濕疹的症狀。[3]
不過所謂「三歲定八十」,細菌定植(Bacterial Colonization)的時間原來是非常重要的關鍵,愈早贏在起跑線,愈容易「調教」人體的免疫系統。[4]
所以益生菌一般較適用於預防嬰兒、兒童的濕疹。
在副作用上,既然稱為益菌,只會有益無害。對吧?
不過跟人一樣,益菌同樣需要「吃貨」為生,在消化的過程裡,便可能會產生氣體,從而可能會誘發胃氣、腹脹。
(如欲了解更多用藥資訊,歡迎看看「小小藥罐子」網誌。)
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Reference:
1. Rather IA, Bajpai VK, Kumar S, Lim J, Paek WK, Park Y-H. Probiotics and Atopic Dermatitis: An Overview. Front Microbiol. 2016;7:507.
2. Wickens K, Black PN, Stanley TV, et al. A differential effect of 2 probiotics in the prevention of eczema and atopy: A double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2008;122(4):788-94.
3. Han Y, Kim B, Ban J, et al. A randomized trial of Lactobacillus plantarum CJLP133 for the treatment of atopic dermatitis. Pediatr Allergy Immunol. 2012;23(7):667-673.
4. Akelma AZ, Biten AA. Probiotics and infantile atopic eczema. Pediatric Health Med Ther. 2015;6:147-151.
同時也有10000部Youtube影片,追蹤數超過2,910的網紅コバにゃんチャンネル,也在其Youtube影片中提到,...
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產檢的常見問題中,妊娠癢疹排在前幾名,有些產婦求診許多醫療院所,問題還是沒有解決。
長期的抓癢會使皮膚破皮,流血,二度細菌感染。患處表皮增厚,苔蘚化,嚴重者會導致失眠,疲憊,憂鬱而影響工作與生活。
妊娠癢疹泛指與懷孕有關的皮膚搔癢,常伴隨孕期結束而病情逐漸消退。好發的高峰期落在懷孕中末期。影響約十分之一的孕婦。
妊娠癢疹在臨床上有許多可能的鑑別診斷 如 多形性癢疹,異位性癢疹,搔癢性毛囊炎,肝內膽汁鬱滯性疹或妊娠水泡疹 (“類天疱瘡疹“)
其中最常見的是多形性癢疹:它的特徵是在妊娠紋上出現搔癢的丘疹及蕁麻疹狀皮膚斑。約一半的初產婦會從腹部擴展至胸部及背部,沒有波及到臉部及肚臍。通常不會發生在手或腳的末端。我們通常都會給予局部藥膏治療。
雖然大部分與妊娠有關的癢疹對母體及胎兒無影響,但是也有少部分癢疹有潛在的母胎風險,及下一胎孕期復發的可能。如上述分類中的妊娠水泡疹 (“類天疱瘡疹“),它屬於一種罕見的自體免疫性疾病,長全身性水泡,可能生下低體重新生兒,早產或新生兒疱疹性皮膚炎。應及早給皮膚科醫師檢查與治療。還有肝內膽汁鬱滯性疹: 孕婦膽汁酸過高,肝功能異常,血中維他命K濃度低(容易產後大出血),有可能發生早產或胎兒缺氧,羊水胎便染色,甚至死產或造成新生兒呼吸窘迫症候群。有這樣疑慮的時候會做更多的檢查並可能需要住院觀察與肝膽內科會診。
雖然只是癢,但下次記得告訴您的婦產科醫師,我們願意傾聽任何的”小問題“。
註:皮膚疹的圖片不甚討喜,謹將我認為較有公信力的網站附上,供大家參考。
https://dermnetnz.org/topics/skin-problems-in-pregnancy/
=========================================
Itchy rash is one of the most common complaints that I see at prenatal clinics. Some women’s itchiness persists despite multiple treatments and doctors’ opinions. Whilst chronic scratching may lead to skin thickening or recurrent infections, itchiness can severely affect the quality of life of mothers by causing insomnia, tiredness and even depression.
Itchy rash of pregnancy most commonly occurs during second to third trimesters, then improves postpartum. It affects about 10% of the pregnant women.
The differential diagnosis of these itchy rashes is broad, including but not limited to polymorphic eruption of pregnancy (its long acronym is “PUPPP” but I won’t bore you with this), atopic eczema, prurigo of pregnancy, cholestatic pruritis and pemphigoid gestationis. Other diagnoses like contact dermatitis or scabies are not uncommon during pregnancy but I consider them as diagnoses not specific to pregnancies.
The ones that i see the most are polymorphic eruption of pregnancy, it is characterised by raised rash of multiple shapes (polymorphic) especially over the striaes on the tummy. In about half of the mothers with first baby the rash will extend to the chest and the back, however, the face and the belly button are often spared. Also it does not affect hands or feet. Treatment is usually topical.
Although most itchy rashes of pregnancy are not serious, some (although rare) can be quite serious that requires close monitoring and consultation with dermatologists or internal medicine physicians. For example, “pemphigoid gestationis” is a rare autoimmune skin disease during pregnancy that causes bullous eruption all over the body. This is due to formation of antibodies against mother’s skin, and sometimes these antibodies can cross the placenta and affect the babies. Another serious skin condition is cholestatic pruritis, it is due to build up of bile salts in the body from abnormal liver function, which can sometimes lead to a myriad of systemic and fetal complications if not treated.
Remember to tell your obstetrician and gynaecologists about your itchiness. We are here to listen to all of your concerns and worries.
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The President’s Executive Order on Hong Kong Normalization
Issued on: July 14, 2020
By the authority vested in me as President by the Constitution and the laws of the United States of America, including the United States-Hong Kong Policy Act of 1992 (Public Law 102-393), the Hong Kong Human Rights and Democracy Act of 2019 (Public Law 116-76), the Hong Kong Autonomy Act of 2020, signed into law July 14, 2020, the International Emergency Economic Powers Act (50 U.S.C. 1701 et seq.) (IEEPA), the National Emergencies Act (50 U.S.C. 1601 et seq.) (NEA), section 212(f) of the Immigration and Nationality Act of 1952 (8 U.S.C. 1182(f)), and section 301 of title 3, United States Code,
I, DONALD J. TRUMP, President of the United States of America, determine, pursuant to section 202 of the United States-Hong Kong Policy Act of 1992, that the Special Administrative Region of Hong Kong (Hong Kong) is no longer sufficiently autonomous to justify differential treatment in relation to the People’s Republic of China (PRC or China) under the particular United States laws and provisions thereof set out in this order. In late May 2020, the National People’s Congress of China announced its intention to unilaterally and arbitrarily impose national security legislation on Hong Kong. This announcement was merely China’s latest salvo in a series of actions that have increasingly denied autonomy and freedoms that China promised to the people of Hong Kong under the 1984 Joint Declaration of the Government of the United Kingdom of Great Britain and Northern Ireland and the Government of the People’s Republic of China on the Question of Hong Kong (Joint Declaration). As a result, on May 27, 2020, the Secretary of State announced that the PRC had fundamentally undermined Hong Kong’s autonomy and certified and reported to the Congress, pursuant to sections 205 and 301 of the United States-Hong Kong Policy Act of 1992, as amended, respectively, that Hong Kong no longer warrants treatment under United States law in the same manner as United States laws were applied to Hong Kong before July 1, 1997. On May 29, 2020, I directed the heads of executive departments and agencies (agencies) to begin the process of eliminating policy exemptions under United States law that give Hong Kong differential treatment in relation to China.
China has since followed through on its threat to impose national security legislation on Hong Kong. Under this law, the people of Hong Kong may face life in prison for what China considers to be acts of secession or subversion of state power –- which may include acts like last year’s widespread anti-government protests. The right to trial by jury may be suspended. Proceedings may be conducted in secret. China has given itself broad power to initiate and control the prosecutions of the people of Hong Kong through the new Office for Safeguarding National Security. At the same time, the law allows foreigners to be expelled if China merely suspects them of violating the law, potentially making it harder for journalists, human rights organizations, and other outside groups to hold the PRC accountable for its treatment of the people of Hong Kong.
I therefore determine that the situation with respect to Hong Kong, including recent actions taken by the PRC to fundamentally undermine Hong Kong’s autonomy, constitutes an unusual and extraordinary threat, which has its source in substantial part outside the United States, to the national security, foreign policy, and economy of the United States. I hereby declare a national emergency with respect to that threat.
In light of the foregoing, I hereby determine and order:
Section 1. It shall be the policy of the United States to suspend or eliminate different and preferential treatment for Hong Kong to the extent permitted by law and in the national security, foreign policy, and economic interest of the United States.
Sec. 2. Pursuant to section 202 of the United States-Hong Kong Policy Act of 1992 (22 U.S.C. 5722), I hereby suspend the application of section 201(a) of the United States-Hong Kong Policy Act of 1992, as amended (22 U.S.C. 5721(a)), to the following statutes:
(a) section 103 of the Immigration Act of 1990 (8 U.S.C. 1152 note);
(b) sections 203(c), 212(l), and 221(c) of the Immigration and Nationality Act of 1952, as amended (8 U.S.C. 1153(c), 1182(l), and 1201(c), respectively);
(c) the Arms Export Control Act (22 U.S.C. 2751 et seq.);
(d) section 721(m) of the Defense Production Act of 1950, as amended (50 U.S.C. 4565(m));
(e) the Export Control Reform Act of 2018 (50 U.S.C. 4801 et seq.); and
(f) section 1304 of title 19, United States Code.
Sec. 3. Within 15 days of the date of this order, the heads of agencies shall commence all appropriate actions to further the purposes of this order, consistent with applicable law, including, to:
(a) amend any regulations implementing those provisions specified in section 2 of this order, and, consistent with applicable law and executive orders, under IEEPA, which provide different treatment for Hong Kong as compared to China;
(b) amend the regulation at 8 CFR 212.4(i) to eliminate the preference for Hong Kong passport holders as compared to PRC passport holders;
(c) revoke license exceptions for exports to Hong Kong, reexports to Hong Kong, and transfers (in-country) within Hong Kong of items subject to the Export Administration Regulations, 15 CFR Parts 730-774, that provide differential treatment compared to those license exceptions applicable to exports to China, reexports to China, and transfers (in-country) within China;
(d) consistent with section 902(b)(2) of the Foreign Relations Authorization Act, Fiscal Years 1990 and 1991 (Public Law 101-246), terminate the export licensing suspensions under section 902(a)(3) of such Act insofar as such suspensions apply to exports of defense articles to Hong Kong persons who are physically located outside of Hong Kong and the PRC and who were authorized to receive defense articles prior to the date of this order;
(e) give notice of intent to suspend the Agreement Between the Government of the United States of America and the Government of Hong Kong for the Surrender of Fugitive Offenders (TIAS 98-121);
(f) give notice of intent to terminate the Agreement Between the Government of the United States of America and the Government of Hong Kong for the Transfer of Sentenced Persons (TIAS 99-418);
(g) take steps to end the provision of training to members of the Hong Kong Police Force or other Hong Kong security services at the Department of State’s International Law Enforcement Academies;
(h) suspend continued cooperation undertaken consistent with the now-expired Protocol Between the U.S. Geological Survey of the Department of the Interior of the United States of America and Institute of Space and Earth Information Science of the Chinese University of Hong Kong Concerning Scientific and Technical Cooperation in Earth Sciences (TIAS 09-1109);
(i) take steps to terminate the Fulbright exchange program with regard to China and Hong Kong with respect to future exchanges for participants traveling both from and to China or Hong Kong;
(j) give notice of intent to terminate the agreement for the reciprocal exemption with respect to taxes on income from the international operation of ships effected by the Exchange of Notes Between the Government of the United States of America and the Government of Hong Kong (TIAS 11892);
(k) reallocate admissions within the refugee ceiling set by the annual Presidential Determination to residents of Hong Kong based on humanitarian concerns, to the extent feasible and consistent with applicable law; and
(l) propose for my consideration any further actions deemed necessary and prudent to end special conditions and preferential treatment for Hong Kong.
Sec. 4. All property and interests in property that are in the United States, that hereafter come within the United States, or that are or hereafter come within the possession or control of any United States person, of the following persons are blocked and may not be transferred, paid, exported, withdrawn, or otherwise dealt in:
(a) Any foreign person determined by the Secretary of State, in consultation with the Secretary of the Treasury, or the Secretary of the Treasury, in consultation with the Secretary of State:
(i) to be or have been involved, directly or indirectly, in the coercing, arresting, detaining, or imprisoning of individuals under the authority of, or to be or have been responsible for or involved in developing, adopting, or implementing, the Law of the People’s Republic of China on Safeguarding National Security in the Hong Kong Administrative Region;
(ii) to be responsible for or complicit in, or to have engaged in, directly or indirectly, any of the following:
(A) actions or policies that undermine democratic processes or institutions in Hong Kong;
(B) actions or policies that threaten the peace, security, stability, or autonomy of Hong Kong;
(C) censorship or other activities with respect to Hong Kong that prohibit, limit, or penalize the exercise of freedom of expression or assembly by citizens of Hong Kong, or that limit access to free and independent print, online or broadcast media; or
(D) the extrajudicial rendition, arbitrary detention, or torture of any person in Hong Kong or other gross violations of internationally recognized human rights or serious human rights abuse in Hong Kong;
(iii) to be or have been a leader or official of:
(A) an entity, including any government entity, that has engaged in, or whose members have engaged in, any of the activities described in subsections (a)(i), (a)(ii)(A), (a)(ii)
(B), or (a)(ii)(C) of this section; or
(B) an entity whose property and interests in property are blocked pursuant to this order.
(iv) to have materially assisted, sponsored, or provided financial, material, or technological support for, or goods or services to or in support of, any person whose property and interests in property are blocked pursuant to this section;
(v) to be owned or controlled by, or to have acted or purported to act for or on behalf of, directly or indirectly, any person whose property and interests in property are blocked pursuant to this section; or
(vi) to be a member of the board of directors or a senior executive officer of any person whose property and interests in property are blocked pursuant to this section.
(b) The prohibitions in subsection (a) of this section apply except to the extent provided by statutes, or in regulations, orders, directives, or licenses that may be issued pursuant to this order, and notwithstanding any contract entered into or any license or permit granted before the date of this order.
Sec. 5. I hereby determine that the making of donations of the types of articles specified in section 203(b)(2) of IEEPA (50 U.S.C. 1702(b)(2)) by, to, or for the benefit of any person whose property and interests in property are blocked pursuant to section 4 of this order would seriously impair my ability to deal with the national emergency declared in this order, and I hereby prohibit such donations as provided by section 4 of this order.
Sec. 6. The prohibitions in section 4(a) of this order include:
(a) the making of any contribution or provision of funds, goods, or services by, to, or for the benefit of any person whose property and interests in property are blocked pursuant to section 4(a) of this order; and
(b) the receipt of any contribution or provision of funds, goods, or services from any such person.
Sec. 7. The unrestricted immigrant and nonimmigrant entry into the United States of aliens determined to meet one or more of the criteria in section 4(a) of this order, as well as immediate family members of such aliens, or aliens determined by the Secretary of State to be employed by, or acting as an agent of, such aliens, would be detrimental to the interest of the United States, and the entry of such persons into the United States, as immigrants and nonimmigrants, is hereby suspended. Such persons shall be treated as persons covered by section 1 of Proclamation 8693 of July 24, 2011 (Suspension of Entry of Aliens Subject to United Nations Security Council Travel Bans and International Emergency Economic Powers Act Sanctions). The Secretary of State shall have the responsibility of implementing this section pursuant to such conditions and procedures as the Secretary has established or may establish pursuant to Proclamation 8693.
Sec. 8. (a) Any transaction that evades or avoids, has the purpose of evading or avoiding, causes a violation of, or attempts to violate any of the prohibitions set forth in this order is prohibited.
(b) Any conspiracy formed to violate any of the prohibitions set forth in this order is prohibited.
Sec. 9. Nothing in this order shall prohibit transactions for the conduct of the official business of the Federal Government by employees, grantees, or contractors thereof.
Sec. 10. For the purposes of this order:
(a) the term “person” means an individual or entity;
(b) the term “entity” means a government or instrumentality of such government, partnership, association, trust, joint venture, corporation, group, subgroup, or other organization, including an international organization;
(c) the term “United States person” means any United States citizen, permanent resident alien, entity organized under the laws of the United States or any jurisdiction within the United States (including foreign branches), or any person in the United States; and
(d) The term “immediate family member” means spouses and children of any age.
Sec. 11. For those persons whose property and interests in property are blocked pursuant to this order who might have a constitutional presence in the United States, I find that because of the ability to transfer funds or other assets instantaneously, prior notice to such persons of measures to be taken pursuant to section 4 of this order would render those measures ineffectual. I therefore determine that for these measures to be effective in addressing the national emergency declared in this order, there need be no prior notice of a listing or determination made pursuant to section 4 of this order.
Sec. 12. The Secretary of the Treasury, in consultation with the Secretary of State, is hereby authorized to take such actions, including adopting rules and regulations, and to employ all powers granted to me by IEEPA as may be necessary to implement this order. The Secretary of the Treasury may, consistent with applicable law, redelegate any of these functions within the Department of the Treasury. All departments and agencies of the United States shall take all appropriate measures within their authority to implement this order.
Sec. 13. The Secretary of the Treasury, in consultation with the Secretary of State, is hereby authorized to submit recurring and final reports to the Congress on the national emergency declared in this order, consistent with section 401(c) of the NEA (50 U.S.C. 1641(c)) and section 204(c) of IEEPA (50 U.S.C. 1703(c)).
Sec. 14. (a) Nothing in this order shall be construed to impair or otherwise affect:
(i) the authority granted by law to an executive department or agency; or
(ii) the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(b) This order shall be implemented consistent with applicable law and subject to the availability of appropriations.
(c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.
Sec. 15. If, based on consideration of the terms, obligations, and expectations expressed in the Joint Declaration, I determine that changes in China’s actions ensure that Hong Kong is sufficiently autonomous to justify differential treatment in relation to the PRC under United States law, I will reconsider the determinations made and actions taken and directed under this order.
DONALD J. TRUMP
THE WHITE HOUSE,
July 14, 2020.
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