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2021-08-25 09:44:55 有 59 人按讚

【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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m phase 在國家衛生研究院-論壇 Facebook 的最讚貼文

By 國家衛生研究院-論壇

2021-08-02 07:30:44 有 7 人按讚

《心血管疾病患者疫情期間之照護應變策略建議》
📣心血管病患須知：
心血管疾病患者或具有心血管疾病危險因子的病患在感染 COVID-19 後的嚴重程度較高，甚至是死亡，已廣為證實。
　
SARS-CoV-2 不僅會導致病毒性肺炎，對心血管系統也有重大影響。心血管或腦血管疾病患者和具有心血管危險因子的族群，如：男性、老年、糖尿病、高血壓和肥胖的病患，已被證實在感染 COVID-19 後發生併發症和死亡的機率會增加。此外，罹患COVID-19的人有相當大的比例可能會發生心臟損傷，而這也預示著院內死亡的風險增加。新冠肺炎造成心臟損傷的情況，除了血栓併發症，如：急性冠心症和靜脈栓塞，心肌炎亦是造成之後心衰竭的重要因素。此外，研究指出廣泛的心律不整會使 COVID-19 的病程複雜化，包括針對 COVID-19 和相關疾病的治療藥物其潛在的促成心律不整作用。由於醫療資源的重新分配，像是再灌注(reperfusion therapy)等的緊急治療可能會受到當地疫情嚴重程度所限制。此外，患者害怕在疫情期間就醫造成心血管緊急狀況的延遲出現逐漸受到關注。
　
基於上述理由，歐洲心臟病學會 (ESC) 召集了一群具有 COVID-19 照護經驗的專家和相關從業人員為疫情期間心血管照護等各方面提供相關指導文件。
　
📣心血管病患照護：
眾所周知，感染 COVID-19 的心血管病患於院內預後不佳的風險更高，這也是為什麼必須有效保護他們避免與COVID-19無症狀或輕症感染者接觸的原因。根據研究建議，因急性心臟病而入院且排除病毒感染的患者，在檢查及住院的過程中應徹底避免與COVID-19病患接觸。門診慢性心臟病患者應盡可能留在家中，而心臟病患者的住院天數應控制在可接受的最短時間內，並強烈建議限制訪客進出。
　
在疫情期間應避免非緊急處置，以維持醫療量能並降低疾病傳播的風險。現況下，為有效降低 COVID-19 傳播的風險，使用遠程醫療有其必要性，特別是針對免疫力較低的族群，如：老年患者。另外，遠程醫療提供各方專家進行共同會診的機會，從而使患者待在家中即可獲得完善的處置。遠程復健(或稱居家復健)亦是出院患者的復健選擇之一。隨著對心衰竭和使用心律調節器患者的遠程醫療越來越標準化，未來將可成為病患列入考慮的醫療照護選擇。遠程醫療有助於控制病毒傳播，同時防止心血管疾病患者因誤診或誤治而導致其病程惡化。
　
除了遠程醫療，在醫師及護理師佩戴適當個人防護裝備的前提下，“居家護理”和“移動診所”亦能讓患者在家接受治療。這兩個方案可防止許多臨床不穩定性的心臟疾病（如：慢性心衰竭）的產生，並確保患者得到長期治療，且有助於形成“以社區為中心”的照護形式，這可能比純粹的“以患者為中心”的照護更有利，如此一來，受感染的住院患者能擁有足夠的醫療資源。
　
當心血管病患因診斷或治療而需要進出醫院時，患者應全程配戴口罩、保持社交距離並以酒精清潔雙手來保護自己。
　
📣在COVID-19疫情期間的治療：
■ 感染COVID-19和長期口服治療的中斷，都有可能對長期心血管疾病的病患造成病情的不穩定，所以在做任何治療的調整之前，應該要先尋求醫生的指示。
■ 用於次級預防動脈粥狀硬化的阿斯匹靈沒有消炎的效果，除非有特殊原因(例如: 持續出血的併發症或是進行手術)，否則有心血管疾病的COVID-19病患，在治療期間不應該自行中斷阿斯匹靈的使用。
■ 有感染COVID-19風險的心血管疾病患者都有使用抑制腎素- 血管收縮素系統(Renin-Angiotensin System, RAS)的藥物，包括：血管張力素轉化酶抑制劑(Angiotensin Converting Enzyme Inhibitors, ACEI)類型的藥物。但是ACEI和血管張力素受體阻滯劑(Ang II type I receptor blockers)並不會阻止或是促進COVID-19病毒透過細胞表面受體蛋白ACE2 (Angiotensin-Converting Enzyme 2, ACE2)進入到細胞內。所以綜合以上因素，病人不應未經醫生指示而隨意停止治療。
■ 當病人進行COVID-19的治療時，對於原本心血管疾病的治療可能需要做調整。
　
📣關於心血管疾病患者的重要資訊：
■ 與他人的互動方面：
☑避免接觸生病的人。
☑人與人之間儘量保持兩公尺的社交距離。
☑勤洗手，並且使用肥皂搓洗至少20秒以上。
☑咳嗽或是打噴嚏時，要用紙巾或手肘內側摀住口鼻。
☑避免用手碰觸眼睛、鼻子和嘴巴。
☑用消毒劑時常消毒手會常碰觸到的地方，例如：門把或是手把。
☑出現發燒、咳嗽症狀，或是有呼吸道感染時，應自我在家隔離。
☑儘量待在家中。
☑維持身體活動以避免靜脈血栓栓塞（venous thromboembolism, VTE），同時也保持身體健康。
　
除了以上幾點之外，有心血管疾病的病人應該要遵照當地的衛生局或是醫生的指示來保持身體的健康。
　
■ 健康的生活習慣：
維持健康的生活習慣，例如: 均衡飲食、戒菸、不要過度飲酒、每天有充足的睡眠、維持運動習慣。長時間在家隔離和身體上的限制，使得運動量減少，可能會導致靜脈血栓栓塞(VTE)或其他併發症的發生風險增加，所以建議在家中也要有基本簡單的運動，或是在戶外有足夠的空間維持社交距離時運動，也建議可以利用網路進行遠距的社交活動。
　
■ 醫療照護建議：
☑有心血管疾病的COVID-19病患要持續的服用常規治療心血管疾病的處方藥物。
☑如果有胸痛或是其他症狀一定要趕快就醫，不要忽視症狀。
☑不要停止追蹤心臟的狀況，當心血管的狀況有惡化的情形時，應立即尋求心臟科醫生的專業建議。
　
📋參考資料
歐洲心臟醫學會：
https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19-Guidance
　
📋參考論文
1. Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, Brown TS, Der Nigoghossian C, Zidar DA, Haythe J, Brodie D, Beckman JA, Kirtane AJ, Stone GW, Krumholz HM, Parikh SA. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic. J Am Coll Cardiol 2020;75(18):2352-2371. https://doi.org/10.1016/j.jacc.2020.03.031.
　
2. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020. https://doi.org/10.1001/jama.2020.1585
　
3. Lee IK, Wang CC, Lin MC, Kung CT, Lan KC, Lee CT. Effective strategies to prevent coronavirus disease-2019 (COVID-19) outbreak in hospital. J Hosp Infect 2020;105(1):102-103. https://doi.org/10.1016/j.jhin.2020.02.022
　
4. Hollander JE, Carr BG. Virtually Perfect? Telemedicine for Covid-19. N Engl J Med 2020;382(18):1679-1681. https://doi.org/10.1056/NEJMp2003539
　
5. Nacoti M, Ciocca A, Giupponi A, Brambillasca P, Lussana F, Pisano M, Goisis G, Bonacina D, Fazzi F, Naspro R, Longhi L, Cereda M, Montaguti C. At the epicenter of the COVID-19 pandemic and humanitarian crises in Italy: changing perspectives on preparation and mitigation. Catalyst non-issue content 2020;1(2). https://doi.org/10.1056/CAT.20.0080
　
6. Rombola G, Heidempergher M, Pedrini L, Farina M, Aucella F, Messa P, Brunori G. Practical indications for the prevention and management of SARS-CoV-2 in ambulatory dialysis patients: lessons from the first phase of the epidemics in Lombardy. J Nephrol 2020;33(2):193-196. https://doi.org/10.1007/s40620-020-00727-y.
　
7. Danser AHJ, Epstein M, Batlle D. Renin-Angiotensin System Blockers and the COVID-19 Pandemic: At Present There Is No Evidence to Abandon Renin-Angiotensin System Blockers. Hypertension 2020;75(6):1382-1385. https://doi.org/10.1161/HYPERTENSIONAHA.120.15082
　
8. de Simone G, ESC Council on Hypertension, On behalf of the Nucleus Members. Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers. https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang (March 13, 2020; date last accessed).
　
9. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corra U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Lochen ML, Lollgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM, Binno S, Group ESCSD. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016;37(29):2315-2381. https://doi.org/10.1093/eurheartj/ehw106
　
(林口長庚紀念醫院PGY何佳樺醫師、國立清華大學醫科系沈昆樺、林口長庚紀念醫院兒童內科部姚宗杰教授、群體健康科學研究所蔡慧如研究員摘要整理)
　
👉更多照護指引文章：
https://forum.nhri.edu.tw/covid19/tag/guideline/
　
林口長庚紀念醫院
國立清華大學
　
衛生福利部
衛生福利部護理及健康照護司
衛生福利部護理諮詢會
台北醫學大學護理學院
高雄醫學大學護理系學生會
高雄醫學大學護理學院
私立高雄醫學大學
台灣護理學會
中華民國護理師護士公會全國聯合會
護理正義
護理人護理魂-hi,I'm CC
　
財團法人國家衛生研究院
國家衛生研究院-論壇

Tags: m phase

國家衛生研究院-論壇

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近年台灣面臨人口老化、少子化、人口移動頻繁、貧富差距的社會現象，為因應此現象，政府成立衛生福利部，以有效彙整醫藥衛生與社會福利之資源與服務，提供整合性的服務措施及全方位的照護體系，給予民眾多方向的全人服務。完整說明，詳：https://bit.ly/3bjItNv )

國衛院論壇提供溝通平台，結合國內外專業人力，針對衛生醫療及社會福利問題之探討與增進國民健康福祉。

m phase 在 Facebook 的最讚貼文

2021-07-28 17:41:27 有 117 人按讚

混打疫苗～～

對 COVID-19 疫苗混打的興趣來自於在接種 ChAdOx1-S 的人群中出現了罕見但嚴重的血栓形成事件並伴有血小板減少症。這些不常見的副作用在年輕人中更為常見，導致幾個歐洲國家的衛生當局和加拿大等，修改其國家免疫策略並為老年人保留 ChAdOx1-S (AZ)疫苗。因此，包括瑞典、法國、德國、挪威和丹麥在內的一些國家建議 BNT162b2 應作為 AZ施打後的加強疫苗之策略。

混打疫苗一篇以Correspondence論文發表，而另外三篇則是以預印本的形式暫時發表。四篇論文都是探討AZ和BNT的組合。最近一篇論文是NEJM的Correspondence論文，也是第一篇AZ+Moderna的混打試驗。

第一篇正式發表的論文是：〈混合新冠疫苗接種：初步反應原性數據〉(Ref 1) 2021-5-29發表在Lancet correspondence。這項研究的主要是以AZ+BNT組合。研究發現，副作用的發燒比例：
AZ + BNT (110名) 34% vs AZ + AZ (112名) :10%（差異 24%，95% CI 13-35%）；
另一組，
BNT + AZ (114名): 41% vs BNT + BNT(112名): 21% (差異 21%，95% CI 8-33%）

至於其他副作用，例如發冷、疲勞、頭痛、關節痛、不舒服和肌肉酸痛，則沒有差別。至於「混打疫苗」是否有效，這項研究並沒有探討。

✅ 西班牙的混打研究：

其實最先的臨床混打論文應該是#西班牙Alberto M Borobia他們原先以預印本的形式於6月時暫時發表。後來在七月十日正式發表在Lancet的論文，是完成二期試驗的結果。

此篇針對在18-60歲、在篩查前8-12週接種單劑 ChAdOx1-S(AZ)且無 SARS-CoV-2 感染史的663 名參與者（試驗組 n=441，對照組 n=222）進行了一項2期、開放標籤、隨機、對照試驗。參與者被隨機分配 (2:1) 接受單次肌肉注射 BNT162b2 (0·3 mL)（試驗組）或繼續觀察（對照組）。
主要結果是 14 天的免疫原性，通過對 SARS-CoV-2 棘蛋白和受體結合域 (RBD) 的免疫測定來測量。使用假病毒中和試驗評估抗體功能，並使用乾擾素-γ 免疫試驗評估細胞免疫反應。
AZ+ AZ: 疫苗試驗組的數據顯示，第二劑 ChAdOx1-S 後，與一劑相比，體液反應與抗 SARS-CoV-2 棘蛋白 IgG增加10倍。

在第二劑 BNT162b2 後，RBD抗體10.5倍；中和抗體增加15倍。在1/2期 CX-024414 試驗中，在第二次疫苗接種後2週，RBD 抗體增加6倍。
有其它兩項研究以及牛津 COVID 疫苗試驗組四項隨機試驗的分析，指出第一劑和第二劑 ChAdOx1-S 之間的間隔越長，SARS-CoV-2 IgG 棘蛋白特異性反應就越高。這種效果在55歲以下的個體中更為明顯。

關於副作用與不良事件，
AZ + BNT: 頭痛(44%)、肌痛(43%)和不適(42%) 。其他全身性不良反應，包括發燒(2%)，不太常見。最常報告的局部反應包括：注射部位疼痛(88%)、硬結(35%)和紅斑(31%)。
該研究的局限性是缺乏完成同源的AZ + AZ的對照組。在臨床試驗設計時，AZ的使用已在西班牙暫停。考慮到其他疫苗形式的供應尚無法滿足現有需求，作者他們使用 BNT162b2，因為他們擁有的供應足以在現實生活中潛在應用研究產生的最終結果。原作者承認，他們不知道在研究中觀察到的免疫原性反應是否會導致更好的療效和有效性，這也是在考慮疫苗接種計劃的結果時應該考慮到的事實。由於樣本量小和觀察期短，此研究中的不良事件也可能被低估。

✅ 另外兩篇預印論文：(Ref 3, 4)
Ref 3:
它的結論是：
# 混打疫苗會引發有效的體液免疫反應及T細胞反應，
# 混打疫苗所產生的抗體可以中和變種病毒 B.1.1.7、B.1.351 和 B.1.617 ，# 混打疫苗沒有出現嚴重不良事件。

Ref 4:
混打疫苗引發稍微較高的免疫力，同時具有安全性。

✅ 最近一篇就是AZ + Moderna的臨床試驗 (Ref 5)
此篇結論：
1⃣️ 88位醫護有近八成是女性，2⃣️ 平均年齡：
AZ+AZ:46歲，
AZ+Moderna:40歲；
3⃣️ 因此免疫反應較強，高達四成有發燒。
4⃣️ 混打組觀察到第一劑和第二劑都有將近四成的機會發燒及全身無力，但可換較佳的保護力。

詳細內容請參閱：
https://www.facebook.com/clinicalnotes/posts/371100144588415

Ref:
1. Heterologous prime-boost COVID-19 vaccination: initial reactogenicity da ta
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01115-6/fulltext
2. Immunogenicity and reactogenicity of BNT162b2 booster in ChAdOx1-S-primed participants (CombiVacS): a multicentre, open-label, randomised, controlled, phase 2 trial. Lancet. 2021 10-16 July; 398(10295): 121–130.

3. Heterologous ChAdOx1 nCoV-19 and BNT162b2 prime-boost vaccination elicits potent neutralizing antibody responses and T cell reactivity. https://www.medrxiv.org/content/10.1101/2021.05.30.21257971v1

4. Safety, reactogenicity, and immunogenicity of homologous and heterologous prime-boost immunisation with ChAdOx1-nCoV19 and BNT162b2: a prospective cohort study
https://www.medrxiv.org/content/10.1101/2021.05.19.21257334v2

5. Heterologous ChAdOx1 nCoV-19 and mRNA-1273 Vaccination
https://www.nejm.org/doi/full/10.1056/NEJMc2110716?query=TOC

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m phase 在 NotebookSPEC Youtube 的最讚貼文

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2021-06-19 21:30:17 有 3,815 人看過有 80 人喜歡

จัดหนักมาให้ชาว NBS ในช่วงนี้สำหรับพีซีแรงๆ เพื่อคอเกม ครั้งนี้เป็นคิวของประกอบคอมเล่นเกมสายโหดจาก Gigabyte AORUS ที่จัดทัพของแรง มาเป็นเซ็ตให้สัมผัส ไม่ว่าจะเป็นซีพียู Intel Core i9-11900K และกราฟิกการ์ด Gigabyte RTX 3070 Ti Gaming OC 8G กับการเล่นเกมระดับ 4K รวมถึงเหล่านักสร้างคอนเทนต์ Content Creator แคสเกม สตรีมเมอร์ และยูทูปเบอร์ แบบเครื่องเดียวจบ เล่นเกม บันเทิง ทำงานครบ ด้วยซีพียูตัวท็อป และเหล่าฮาร์ดแวร์ระดับแนวหน้าจาก AORUS เป็นอีกเซ็ตที่เล่นแล้วไม่อยากวางเมาส์เลยทีเดียว

อุปกรณ์ที่นำมาประกอบคอม
Intel Core i9-11900K
Gigabyte Z590 AORUS MASTER
Gigabyte RTX 3070 Ti Gaming OC 8G
AORUS RGB DDR4 3200
AORUS SSD 1TB M.2 PCIe 4.0
AORUS P850W 80+ Gold
AORUS AC300
AORUS WaterForce X240

Intel Core i9-11900K
ถ้าจะว่ากันที่ซีพียูตัวท็อปๆ บนแพลตฟอร์มพีซี Intel Core i9-11900K รุ่นนี้ ก็ดูจะตอบโจทย์คอเกม และคนทำงานได้ดี ไม่เป็นรองใคร กับโปรแกรมที่ต้องใช้ Core/ Thread เยอะๆ ในปัจจุบัน ไม่ว่าจะเป็น Adobe Premier หรือ Lightroom และงานด้านกราฟิกวีดีโออื่นๆ ก็ตาม กับการทำงานแบบ 8 core/ 16 thread ความเร็วสูงสุด 5.3GHz พร้อมกับการเป็น "K series" #Overclock

AORUS WaterForce X240
ชุดน้ำปิด AIO แบบ 2 ตอน ที่ให้ทั้งความเย็นสำหรับซีพียู และความสวยงาม เรียกว่าคนที่อยากได้ของประดับเคส ที่ระบายความร้อนไปในตัว ไม่น่าพลาด จุดเด่นอยู่ที่ปั้มน้ำ ที่มาพร้อมกราฟิกและแสงไฟ รายงานสถานะของระบบได้อีกด้วย รองรับการปรับแต่ง RGB FUSION 2.0 โดยรองรับซีพียูได้ทั้ง Intel และ AMD ในเกือบทุกซ็อกเก็ต

Gigabyte Z590 AORUS MASTER
เมนบอร์ดเกมมิ่งในเซ็ตนี้เป็น Z590 AORUS MASTER จัดเป็นเมนบอร์ดในซีรีส์โปร ดังนั้นจะเห็นได้ว่า มีการวางฟังก์ชั่นมาให้แบบครบครัน ไม่ว่าจะเป็นเรื่องของ ภาคจ่ายไฟขนาดใหญ่ 18+1 Phase เพื่อใช้ร่วมกับซีพียูตัวท็อปๆ ที่เป็น Intel Gen 10 และ Gen 11 ได้เต็มที่ เหมือนกับซีพียู Core i9 ในวันนี้ และเพื่อเพิ่มประสิทธิภาพในการโอเวอร์คล็อกได้ดีขึ้น

รองรับแรม DDR4 ได้สูงสุดถึง 5400MHz กับความจุ 128GB สำหรับ 4 สล็อตนี้ และยังใส่ Armor มาในทุกสล็อต ส่วนที่ชอบฟีเจอร์นี้ เพราะไม่ต้องกังวลเรื่องถอดใส่แรมบ่อยๆ สล็อตดูแข็งแรงขึ้น

Gigabyte RTX 3070 Ti Gaming OC 8G
นับว่าจัดจ้านในย่านนี้ และถือเป็นซีรีส์ใหม่ ที่ออกมาตอบโจทย์คอเกมได้ในช่วงที่การ์ดจอเล่นเกมขาดแคลนเช่นนี้ กับขุมพลัง GeForce RTX 3070 Ti ที่ใส่สเปคมาไม่ธรรมดา นอกเหนือจากชุดระบายความร้อนขนาดใหญ่ แบบ 3 พัดลม กับฮีตซิงก์แบบ 3 สล็อต พร้อมแสงไฟ RGB ปรับแต่งได้ ผ่านทาง RGB Fusion 2.0 ได้อีกด้วย
#RTX3070Ti #AORUS

AORUS RGB DDR4 3200
สำหรับแรมรุ่นนี้ AORUS RGB หลายคนน่าจะคุ้นตากันดีอยู่แล้ว ซึ่งในครั้งนี้เราจัดชุด Kit 16GB DDR4 3200 (8GB x2) ค่า CL 16-18-18-38 เปิด XMP 3200MHz ใช้งานได้ทันที จากข้อมูลเป็น Samsung B-Die น่าจะไปต่อได้อีก มาพร้อมแรม Dummy เพื่อให้เต็มสล็อตทั้ง 4 แถว และแสงไฟ RGB ที่ดูสวยงาม ปรับแต่งได้ด้วย RGB Fusion เช่นกัน โดยเมนบอร์ดสามารถอัพเกรดได้ถึง 128GB พร้อมอัพเกรดได้เสมอ

AORUS SSD 1TB M.2 PCIe 4.0
SSD ในแบบ M.2 NVMe PCIe Gen4 x4 ความเร็วสูง แม้จะไม่ได้มาพร้อมไฟวิบวับ แต่ก็จัดซิงก์อะลูมิเนียมเท่ๆ ช่วยระบายความร้อนมาเต็มสูบ เช่นเดียวกับความเร็ว ในการอ่านเขียนข้อมูล ในระดับ 5,000MB/s (Read) และ 4,400MB/s (Write) โดยใช้ 3D TLC NAND เพื่อให้อัตราทรูพุตในการจัดการข้อมูลที่เร็วขึ้น ด้วยความจุ 1TB นี้ ก็เพียงพอต่อการใช้งาน และการเล่นเกมได้อย่างพอเหมาะเลยทีเดียว 3-4 เกมระดับ AAA เอาอยู่ โดยค่า MTBF หรือ Mean time between failure อยู่ที่ 1.7 ล้านชั่วโมง และการรับประกัน 5 ปี #SSD1TB

AORUS P850W 80+ Gold
จัดสเปคมาอย่างแรง จะไม่เตรียมเพาเวอร์ซัพพลายดีๆ ก็ดูจะแปลกๆ วันนี้เลยมี AORUS P850W เรียกว่าเป็นอีกหนึ่งซีรีส์ที่จับต้องได้ และฟีเจอร์เหมาะกับเหล่าเกมเมอร์และโอเวอร์คล็อก กับการเป็นเพาเวอร์ระดับ 850W ในแบบ Full-modular ที่ถอดสายได้ทั้งหมด พัดลมขนาด 135mm ในแบบ 2 Ball-Bearing เลือกใส่เฉพาะที่ต้องการได้ตามสะดวก ที่สำคัญยังใช้ 100% Japanese Capacitors ที่มีความทนทาน จ่ายไฟ +12V ในแบบ Single Rail ให้ซีพียูและการ์ดจอรุ่นใหญ่ๆ ได้เต็มที่ 70.5A 846W ที่สำคัญคือ ได้การันตี 80+ Gold เพื่อการจ่ายไฟอย่างมีประสิทธิภาพอีกด้วย พร้อมการรับประกัน 10 ปี
#จัดสเปคคอม #คอมเล่นเกม

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m phase 在 [email protected] Youtube 的最讚貼文

By [email protected]

2021-06-09 15:02:35 有 8,755 人看過有 0 人喜歡

兒童及青少年濕疹－陳欣永兒科專科醫生＠FindDoc.com

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（一）濕疹如何影響兒童及青少年？ 00:08

（二）有什麼治療方法？ 01:03

（三）家長如何幫助兒童及青少年面對濕疹？ 03:03

(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. Brenninkmeijer, E. E., Legierse, C. M., Sillevis Smitt, J. H., Last, B. F., Grootenhuis, M. A., & Bos, J. D. (2009). The course of life of patients with childhood atopic dermatitis. Pediatric dermatology, 26(1), 14–22. https://doi.org/10.1111/j.1525-1470.2008.00745.x
2. Oh, S. H., Bae, B. G., Park, C. O., Noh, J. Y., Park, I. H., Wu, W. H., & Lee, K. H. (2010). Association of stress with symptoms of atopic dermatitis. Acta dermato-venereologica, 90(6), 582–588. https://doi.org/10.2340/00015555-0933
3. Ricci, G., Bellini, F., Dondi, A., Patrizi, A., & Pession, A. (2011). Atopic dermatitis in adolescence. Dermatology Reports, 4(1), 1. doi:10.4081/dr.2012.e1
4. Camfferman D, Kennedy JD, Gold M, Martin AJ, Lushington K. Eczema and sleep and its relationship to daytime functioning in children. Sleep Med Rev. 2010 Dec;14(6):359-69. doi: 10.1016/j.smrv.2010.01.004. Epub 2010 Apr 14. PMID: 20392655.
5. 濕疹的治療方案. (n.d.). Retrieved March 24, 2021, from https://www.hkasthma.org.hk/hk/about-allergies/%E6%B2%BB%E7%99%82%E6%96%B9%E6%A1%88-2
6. Fabbrocini G, Napolitano M, Megna M, Balato N, Patruno C. Treatment of Atopic Dermatitis with Biologic Drugs. Dermatol Ther (Heidelb). 2018 Dec;8(4):527-538. doi: 10.1007/s13555-018-0258-x. Epub 2018 Sep 4. PMID: 30182182; PMCID: PMC6261117.
7. Senner, S., Seegräber, M., Frey, S., Kendziora, B., Eicher, L., & Wollenberg, A. (2020). Dupilumab for the treatment of adolescents with atopic dermatitis. Expert review of clinical immunology, 16(7), 641–650. https://doi.org/10.1080/1744666X.2020.1801420
8. Simpson, E. L., Paller, A. S., Siegfried, E. C., Boguniewicz, M., Sher, L., Gooderham, M. J., Beck, L. A., Guttman-Yassky, E., Pariser, D., Blauvelt, A., Weisman, J., Lockshin, B., Hultsch, T., Zhang, Q., Kamal, M. A., Davis, J. D., Akinlade, B., Staudinger, H., Hamilton, J. D., Graham, N., … Bansal, A. (2020). Efficacy and Safety of Dupilumab in Adolescents With Uncontrolled Moderate to Severe Atopic Dermatitis: A Phase 3 Randomized Clinical Trial. JAMA dermatology, 156(1), 44–56. https://doi.org/10.1001/jamadermatol.2019.3336
9. The struggle is real: A parent's guide to caring for kids with eczema. (2020, October 23). Retrieved March 29, 2021, from https://nationaleczema.org/parenting-eczema-kids/

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m phase 在 ANGELAMIUZ Youtube 的最佳貼文

By ANGELAMIUZ

2021-05-06 22:30:07 有 8,771 人看過有 325 人喜歡

ANGELAMIUZ

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of M phase cytoplasm, whereas oocytes are naturally arrested in G2 or early meiotic prophase and lack active MPF, making them convenient recipients.

#16. The Cell Cycle, Its Phases and Checkpoints - an overview - PHI

An image showing four stages of the mitotic cell cycle phase. The nucleus opens up A cell during the M phase. (1) The nuclear membrane breaks down to ...

#17. Definition And Phases of Cell Cycle - Byjus

M phase – This is the mitotic phase and is divided into prophase, metaphase, anaphase and telophase. Cytokinesis – In this phase the cytoplasm ...

#18. Cucurbitacin E Induces Cell Cycle G2/M Phase Arrest ... - PLOS

Cucurbitacin E Induces Cell Cycle G2/M Phase Arrest and Apoptosis in Triple Negative Breast Cancer. Yanjie Kong ,.

#19. The Cell Cycle | CancerQuest

This is the phase of the cell cycle in which the DNA is copied or replicated. M stands for mitosis. This is the stage of the cell cycle in which the cell ...

#20. M Phase: What Happens in this Phase of the Cell Cycle?

The M phase of a cell cycle is also called mitosis. This is a form of asexual cell reproduction in eukaryotes, equivalent in most respects ...

#21. Activation and inactivation of M-phase promoting factor (MPF ...

Newly synthesized cyclin B associates with CDK1. The complex is phosphorylated on Thr-161, becomes active and provokes M-phase entry. At the end of M-phase, ...

#22. The Cell Cycle - Phases - Mitosis - TeachMePhysiology

In this article we will explore in detail each stage of the cycle and its ... M phase. Mitosis followed by cytokinesis (cell separation); Formation of two ...

#23. Cinobufagin Induces Cell Cycle Arrest at the G2/M Phase and ...

The results showed that cinobufagin arrested A375 cells at the G2/M phase of the cell cycle and effectively induced apoptosis.

#24. cell cycle | Description, Stages, & Checkpoints | Britannica

The cell cycle is a four-stage process in which the cell increases in size (gap 1, or G1, stage), ... or G2, stage), and divides (mitosis, or M, stage).

#25. CDC25C - M-phase inducer phosphatase 3 - UniProt

M -phase inducer phosphatase 3. Gene. CDC25C. Organism. Homo sapiens (Human). Status. Reviewed- ...

#26. Phases Of Cell Cycle G0 G1 S G2 M - Mitosis - MCAT Content

The cell cycle has two major phases: interphase (G0, G1, S, G2) and the mitotic phase (M). The cell cycle is an ordered series of events involving cell ...

#27. Evaluation of the Safety and Immunogenicity of a SARS-CoV ...

Part 1 (Phase 1) of the study is designed to evaluate the safety and immunogenicity of SARS-CoV-2 rS nanoparticle vaccine with or without Matrix-M adjuvant ...

#28. Phase 3 Studies Comparing Brodalumab with Ustekinumab in ...

BackgroundEarly clinical studies suggested that the anti–interleukin-17 receptor A monoclonal antibody brodalumab has efficacy in the ...

#29. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine ...

Pedro M Folegatti, MD * ... Following initiation of a phase 1 clinical trial in the UK (COV001) on April 23, 2020, three further randomised ...

#30. Mitosis | Cell Cycle | Cell Division - PMF IAS

Interphase == Phase between two successive M phases. M Phase [Mitosis phase] == Actual cell division or Mitosis. interphase-mitosis-m-phase. In ...

#31. distinguish between interphase and m phase | w102q2b11

Interphase. M phase. It the phase between two successive M phases. It is the phase during which actual cell division takes place.

#32. definition of M-phase by Medical dictionary

The period between mitotic divisions is called interphase, and mitosis itself occurs in four phases: prophase, metaphase, anaphase, and telophase. adj., adj ...

#33. Cell Cycle - Life Sciences Cyberbridge

Interphase is divided into three phases: G1, S, and G2. The subsequent mitotic (M) phase consists of two processes: mitosis, the process of nuclear division ...

#34. What Happens in the G1 and G2 Phases of The Cell Cycle?

The growth phases, G1 and G2, of the cell cycle prepare the cell for DNA replication at S phase and cell division and M phase, respectively.

#35. m phase 中文- 細胞核有絲分裂期… - 查查在線詞典

m phase 中文::M期;細胞核有絲分裂期…，點擊查查權威綫上辭典詳細解釋m phase的中文翻譯，m phase的發音，音標，用法和例句等。

#36. Cell Cycle Synchronization at the G2/M Phase Border by ...

Recently, a selective CDK1 inhibitor, RO‑3306, has been identified that reversibly arrests proliferating human cells at the G2/M phase border ...

#37. Cyclin-dependent kinase 1 (Cdk1) is essential for cell ... - PNAS

M. Kasim Diril, Chandrahas Koumar Ratnacaram, V. C. Padmakumar, +4 , Tiehua Du, ... The loss of Cdk1 does not affect S phase progression but results in DNA ...

#38. 7.3: Mitotic Phase - Mitosis and Cytokinesis - Biology LibreTexts

The process in which the nucleus of a eukaryotic cell divides is called mitosis. During mitosis, the two sister chromatids that make up each ...

#39. On the Variability of Phases with Extraction and Ellipsis - jstor

NOW I'M A PHASE, NOW I'M NOT A PHASE 29 answered in a satisfactory manner. To address the question, a number of or implicitly argued that phasehood is ...

#40. Cell cycle - AccessScience from McGraw-Hill Education

M phase, which follows interphase, consists of mitosis (nuclear division) and cytokinesis (cell division). The proteins that regulate DNA synthesis, ...

#41. Time-resolved single-cell sequencing identifies ... - eLife

For instance, reduced expression of G2 and M phase cell cycle genes ... view of mRNA levels as cells progress from M phase into G1 phase, ...

#42. The M phase of the cell cycle consist of A G1 S and class 11 ...

The M phase of the cell cycle consist of A G1 S and G2 phase B Prophase metaphase anaphase telophase C Interphase prophase metaphase anaphase telophase D ...

#43. The cell cycle - Knowledge @ AMBOSS

M phase · Definition: the process of cell division from the distribution of DNA to the budding of a cellular body · Duration: ∼1 h (shortest ...

#44. protein coding gene - wee1 (SPCC18B5.03) - PomBase

03) - M phase inhibitor protein kinase Wee1. Welcome to PomBase. A comprehensive database for the fission yeast Schizosaccharomyces pombe, providing structural ...

#45. Cell Cycle Phase Detection and Analysis for Cell Lines

At this stage, the cells contain twice the number of chromosomes (4n) that are found in G1. M (M=Mitosis) phase. Cell division. At the end of ...

#46. PP2A and Aurora differentially modify Cdc13 to promote ...

標題: PP2A and Aurora differentially modify Cdc13 to promote telomerase release from telomeres at G2/M phase (vol 5, 5312, 2014). 作者: Shen, Z. J.

#47. Evidence and Evaluation | The White House

Policy Guidance · M-21-27 Evidence-Based Policymaking: Learning Agendas and Annual Evaluation Plans (June 30, 2021) · M-20-12 Phase 4 Implementation of the ...

#48. Cell cycle modification during the transitions between meiotic ...

M phase, there is no evident interphase between the two meiotic M phases (metaphase I (M I) and metaphase II (M II)). The lack of DNA replication.

#49. What phase is between two successive M-phase? - Tardigrade

Solution: The phase between two successive M-phases is called interphase. The M-phase represents the phase when the actual cell division or mitosis occurs ...

#50. G2 phase chromatin lacks determinants of replication timing

M. . 2008 . Polycomb group protein-associated chromatin is reproduced in post-mitotic G1 phase and is required for S phase progression.

#51. The Science Behind Radiation Therapy - American Cancer ...

M phase (mitosis): In this phase, which lasts only 30 to 60 minutes, the cell actually splits into 2 new cells that are exactly the same.

#52. Mitosis - Definition and Examples - Biology Online Dictionary

Find out more about mitosis definition, phases, and importance here. ... the mitotic phase, the cell has a control mechanism called G2-M DNA ...

#53. M phase - CBSE NCERT Notes Class 11 Biology Cell Cycle ...

M phase · Since the number of chromosomes in the parent and progeny cells is the same, it is also called as equational division. Mitosis is divided into the ...

#54. Rates of DNA synthesis during the S-phase of HeLa cells.

cycle phases to the replication of DNA, we have examined the ... of cells in the G,, S, and G2 + M phases of the cell cycle according.

#55. Phase Diagrams and Conductivity Behavior of Poly(ethylene ...

Phase Diagrams and Conductivity Behavior of Poly(ethylene oxide)-Molten Salt Rubbery Electrolytes. S. Lascaud; ,; M. Perrier; ,; A. Vallee ...

#56. COVID-19 vaccine tracker and landscape - WHO | World ...

... Provides analysis and visualization for several COVID-19 vaccine candidate categories;; Tracks the progress of each vaccine from pre-clinical, Phase 1, ...

#57. NASA Awards $500K in First Phase of $5M Watts on the Moon ...

NASA has awarded $500000 to seven winning teams in Phase 1 of the agency's Watts on the Moon Challenge. The technology design competition ...

#58. Australia's COVID-19 vaccine national rollout strategy

previous phases. Population numbers are current estimates for each category. Phase 1a – up to 1.4m doses. Phase 1b – up to 14.8m doses.

#59. Preparation - BIOdotEDU

In a typical mitotic cell division these 4 copies (of the DNA and genes) would be reduced down to 2 copies (the diploid number) by the end of M-phase ...

#60. MOZAMBIQUE - DEPUTY FIELD COORDINATOR - ReliefWeb

Operations were suspended after the emergency phase and the mission closed. The evolution of the situation in Cabo Delgado province, ...

#61. Time Limits for Entering National/Regional Phase under PCT ...

Designated/Elected Office Designated/Elected Office Chapter I; (under PCT Article 22) Cha... AE United Arab Emirates 30 30 AG Antigua and Barbuda 30 30 AL Albania 1 31 31

#62. Zellzyklus • Phasen, Interphase, Kontrollpunkte - Studyflix

Zellzyklus: Einfach erklärt ✓ Zellzyklus Phasen: M-Phase und Interphase ✓ G1 Phase, S Phase, G2 Phase, Mitose, Cytokinese ✓ mit kostenlosem Video.

#63. Structural evolution and skyrmionic phase diagram of the ...

The magnetic properties of these two phases are computationally shown to be very different, with the Imm2 phase exhibiting uniaxial ...

#64. The Cell Cycle of Growth and Replication - ThoughtCo

In eukaryotic cells, this process includes a series of four distinct phases. These phases consist of the Mitosis phase (M), Gap 1 phase (G ...

#65. Big Ridge Announces First Results from Hope Brook Phase I ...

Big Ridge Announces First Results from Hope Brook Phase I Drill Program Intersects 5.84 g/t Au Across 14.8 M at Shallow Depths. Newsfile Corp.

#66. Massachusetts' COVID-19 vaccination phases | Mass.gov

Learn more about the groups in each phase of the COVID-19 vaccine distribution timeline.

#67. The Cell Cycle | Biology for Majors I

The cell cycle has two major phases: interphase and the mitotic phase (Figure 1) ... The mitotic phase (also known as M phase) is a multistep process during ...

#68. 10 how many chromosomes will the cell have at g1 phase ...

How many chromosomes will the cell have at G1 phase, after S phase, and after m phase? In mitosis in onion root tip cells. Dec 11, 2019, 10:53: ...

#69. Guide to the Learning Phase - Facebook

During the learning phase, the delivery system is exploring the best way to deliver your ad set so performance has not yet stabilized. The learning phase ...

#70. Merck and Ridgeback's Investigational Oral Antiviral ...

... Robert M. Davis, chief executive officer and president, Merck. ... The Phase 3 portion of the MOVe-OUT trial was conducted globally, ...

#71. Tuition Incentive Program - State of Michigan

Phase I. TIP Phase I provides tuition assistance to eligible students enrolled in a certificate or associate degree program and taking classes within the ...

#72. Kinetics of Phase Change. I General Theory - AIP Publishing

The theory of the kinetics of phase change is developed with the experimentally supported assumptions ... M. Volmer and M. Marder, Zeits. f.

#73. Plots for Sale in Bahria Town Phase 8 - Block M Rawalpindi

Find plots and land for Sale in Bahria Town Phase 8 - Block M Rawalpindi through Zameen.com, Pakistan's largest website for plots.

#74. Explain Cell Division: Meiosis, Mitosis, Cell Cycle & Diagrams

Cell Division; Phases of Life Cycle of a Cell. Interphase; M Phase (Mitosis Phase). Significance of Mitosis. Points to Remember. Meiosis.

#75. Automatic Control in Aerospace 1989: Selected Papers from ...

Table 2 Performance of optimal regulator and LQG controllers Gain M. Phase M. h (m/s') g (des) Cost (dB) (des) e (u) # (des/s) J Control off - - 1,986 - 41 ...

#76. COVID-19 Vaccine - covidLINK | Maryland Department of Health

The following Marylanders are currently eligible for a COVID-19 booster: Marylanders 12+ who received their second Pfizer COVID-19 dose at least five months ago ...

#77. Challenges and burden of the Coronavirus 2019 (COVID-19 ...

Jörg M. Fegert,; Benedetto Vitiello, … ... Phase one or the preparation phase: Governments enforce social distancing, shutdown and general ...

#78. Graduate Student Gabby Budziszewski receives her PhD!

... the Vaccinia-related kinase (VRK1) and M-phase phosphoprotein 8 (MPP8)” on March 23, 2022 , under the direction of Dr. Robert McGinty.

#79. Evaluating the performance of the two-phase flow solver ...

Evaluating the performance of the two-phase flow solver interFoam ... [15] Saha A A, Mitra S K, Tweedie M, Roy S and McLaughlin J 2009 ...

#80. About | SBIR.gov

The SBIR and STTR Programs; Mission; Eligibility; The Three Phases of SBIR/ ... at the time of Phase I and II awards, which specify the following criteria.

#81. Definition of TNM staging system - NCI Dictionary of Cancer ...

T describes the size of the tumor and any spread of cancer into nearby tissue; N describes spread of cancer to nearby lymph nodes; and M describes ...

#82. Transcript: Mayor Eric Adams Announces and Kicks Off First ...

Transcript: Mayor Eric Adams Announces and Kicks Off First Phase of "Care" ... I'm CEO of the city's Economic Development Corporation, EDC, ...

#83. amigo.geneontology.org/cgi-bin/amigo/go.cgi?view=d...

沒有這個頁面的資訊。

#84. End-stage renal disease - Symptoms and causes - Mayo Clinic

When kidneys no longer function well enough to meet a body's needs, treatment involves kidney dialysis or kidney transplant.

#85. final date sheet of semester mode may/june-2022 - University ...

Final Date sheet for Second Phase Odd Semester Examinations Under Choice Based Credit System ... M.A./M.Sc. Mathematics (Regular & NCWEB) Semester I/III ...

#86. COVID-19: Information for Household and Close Contacts

How will I know if I'm a Household Contact? ... What does it mean if I'm a Close Contact? ... Close contacts are not required to isolate during Phase 3.

#87. The-Influence-of-the-R-Phase-on-the-Superelastic-Behavior ...

Finally, a stress-induced M ) R ) M sequence will be discussed. Keywords Martensite Б NiTi materials Б Mechanical behavior Б Pseudoelasticity Б Superelasticity ...

#88. Phase 1A - Minnesota Department of Health

has provided the following guidance for those involved in planning for and administering the vaccine. 1 Dooling K, McClung N, Chamberland M, ...

#89. Welcome to NJEDA - NJEDA

NJEDA Approves Enhancements to Sustain & Serve NJ Program and Announces Plans to Open $10M Phase 3. TRENTON, N.J. (February 9, 2022) – The New Jersey ...

#90. Phase-amplitude Coupling

The second form is amplitude independent phase locking between n cycles of high frequency oscillation and m cycles of low frequency one.

#91. Phase space: geography, relational thinking, and beyond

Crang, M. 2005: Time: space. In Cloke, P. and Johnston, R. , editors, Spaces of geographical thought, London: ...

#92. Belite Bio hits go on IPO to fund late-phase vision loss clinical ...

Belite Bio wants public investors to bankroll late-phase clinical trials of a ... ponying up $57M to tackle a big barrier to gene therapy.

#93. New labs and offices to rise at Navy Yard as part of recently ...

... as part of recently chosen team's first $400M phase of development ... of a first phase of development under the deal that Ensemble and ...

#94. 250 jobs, $325M investment just Phase 1 for Bulloch plant

Aspen Aerogels has planned the $325 million factory it will build in Bulloch County's Southern Gateway Commerce Park to be expandable, ...

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