illness Puzzles ?

Pertuzumab加Trastuzumab + Docetaxel藥物對轉移性乳腺癌的療效

2012-01-20T19:36:00.000-08:00

Pertuzumab加Trastuzumab + Docetaxel藥物對轉移性乳腺癌的療效
Pertuzumab plus Trastuzumab plus Docetaxel for Metastatic Breast Cancer
資料來源：http://www.nejm.org/doi/full/10.1056/NEJMoa1113216?query=TOC
José Baselga, M.D., Ph.D., Javier Cortés, M.D., Sung-Bae Kim, M.D., Seock-Ah Im, M.D., Roberto Hegg, M.D., Young-Hyuck Im, M.D., Laslo Roman, M.D., José Luiz Pedrini, M.D., Tadeusz Pienkowski, M.D., Adam Knott, Ph.D., Emma Clark, M.Sc., Mark C. Benyunes, M.D., Graham Ross, F.F.P.M., and Sandra M. Swain, M.D. for the CLEOPATRA Study Group

N Engl J Med 2012; 366:109-119January 12, 2012

背景Background：
抗人類表皮生長因子接受體2型（HER2）的單株抗體藥物 trastuzumab，提升了人類表皮生長因子接受體2型（HER2）陽性的轉移性乳癌患者的療效。
The anti–human epidermal growth factor receptor 2 (HER2) humanized monoclonal antibody trastuzumab improves the outcome in patients with HER2-positive metastatic breast cancer. 然而，大多數轉移性乳癌病例，抗人類表皮生長因子接受體2型（HER2）的單株抗體藥物Pertuzumab，會抑制人類表皮生長因子接受體2（HER2）的二聚化（dimerization），對人類表皮生長因子接受體2（HER2）陽性的轉移性乳癌患者，在第2階段臨床試驗，在兩種抗體藥物Trastuzumab + Docetaxel追加和Trastuzumab抗體藥物相輔相成的抗人類表皮生長因子接受體2型（HER2）的單株抗體藥物Pertuzumab，其混合療效是有前瞻性和可接受的藥物安全性。
However, most cases of advanced disease eventually progress. Pertuzumab, an anti-HER2 humanized monoclonal antibody that inhibits receptor dimerization, has a mechanism of action that is complementary to that of trastuzumab, and combination therapy with the two antibodies has shown promising activity and an acceptable safety profile in phase 2 studies involving patients with HER2-positive breast cancer.

方法Methods
將人類表皮生長因子接受體2型（HER2）陽性的轉移性乳癌808例患者隨機分配成服用安慰劑加上trastuzumab和docetaxel兩種抗體藥物（對照組），與服用pertuzumab加上trastuzumab和docetaxel兩種抗體藥物（pertuzumab試驗組）接受作為第一線治療，直到進到毒性期無法進行有效管理。
We randomly assigned 808 patients with HER2-positive metastatic breast cancer to receive placebo plus trastuzumab plus docetaxel (control group) or pertuzumab plus trastuzumab plus docetaxel (pertuzumab group) as first-line treatment until the time of disease progression or the development of toxic effects that could not be effectively managed. 主要終點是獨立評估無病變存活期（progression-free survival）。次要終點包括評估總存活期，無病變存活期的調查，有效反應率（objective response rate）和安全評估。
The primary end point was independently assessed progression-free survival. Secondary end points included overall survival, progression-free survival as assessed by the investigator, the objective response rate, and safety.

結果Results
安慰劑加上trastuzumab和docetaxel兩種抗體藥物對照組的無病變存活期中位數為 12.4個月，比較pertuzumab加上trastuzumab和docetaxel兩種抗體藥物試驗組的無病變存活期中位數為18.5個月（危險比惡化或死亡，0.62；95％可信賴區間，0.51〜0.75，P <0.001）。
The median progression-free survival was 12.4 months in the control group, as compared with 18.5 months in the pertuzumab group (hazard ratio for progression or death, 0.62; 95% confidence interval, 0.51 to 0.75; P<0.001). 整體存活率的中期分析顯示，在pertuzumab加上trastuzumab和docetaxel兩種抗體藥物試驗組的的走勢較強勁。The interim analysis of overall survival showed a strong trend in favor of pertuzumab plus trastuzumab plus docetaxel. 藥物安全性，在兩組相似，無左心室收縮功能不全病例增加； 3級或以上的發熱性嗜中性白血球減少症和腹瀉率，pertuzumab試驗組比安慰劑對照組高。The safety profile was generally similar in the two groups, with no increase in left ventricular systolic dysfunction; the rates of febrile neutropenia and diarrhea of grade 3 or above were higher in the pertuzumab group than in the control group.

結論Conclusions：
與安慰劑加上trastuzumab和docetaxel兩種抗體藥物對照組做比較，使用pertuzumab加上trastuzumab和docetaxel兩種抗體藥物，作為第一線治療人類表皮生長因子接受體2型（HER2）陽性的轉移性乳腺癌，其混合療效有顯著性延長患者無病變存活期，未增加患者的心臟毒性作用。（.霍夫曼藥廠F. Hoffmann–羅氏藥廠La Roche /Genentech基因技術公司研發資金；ClinicalTrials.gov美國政府臨床試驗申請編號，NCT00567190）
The combination of pertuzumab plus trastuzumab plus docetaxel, as compared with placebo plus trastuzumab plus docetaxel, when used as first-line treatment for HER2-positive metastatic breast cancer, significantly prolonged progression-free survival, with no increase in cardiac toxic effects. (Funded by F. Hoffmann–La Roche/Genentech; ClinicalTrials.gov number, NCT00567190.)

骨質疏鬆

2011-12-10T06:05:00.001-08:00

雙光子能量X光吸收儀dual energy X-ray absorptiometry

椎體氣球擴張成型術

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椎體氣球擴張成型術Balloon kyphoplasty（ vertebroplasty）

椎體氣球擴張成型術Balloon kyphoplasty（ vertebroplasty）

兩個高劑量statins（司他汀）類藥方對冠狀動脈硬化病程的療效

2011-12-04T04:32:00.001-08:00

兩個高劑量statins（司他汀）類藥方對冠狀動脈硬化病程的療效
Effect of Two Intensive Statin Regimens on Progression of Coronary Disease

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1110874
背景Background：
降低膽固醇的藥物statins（司他汀）類藥物可降低心血管不良結果，並延緩冠狀動脈硬化病程，能降低低密度脂蛋白（LDL）膽固醇的作用。Statins reduce adverse cardiovascular outcomes and slow the progression of coronary atherosclerosis in proportion to their ability to reduce low-density lipoprotein (LDL) cholesterol. 然而，很少有做強化statins（司他汀）類藥物治療研究評估，以達到冠狀動脈硬化病程的消退或以服用最大劑量的statins（司他汀）類藥物的治療做替代方案比較。However, few studies have either assessed the ability of intensive statin treatments to achieve disease regression or compared alternative approaches to maximal statin administration.
方法Methods：
我們對1039例冠狀動脈疾病患者分成2組，每天以atorvastatin, 80 mg(商品名：Lipitor立普妥膜衣錠80毫克)，或每天以rosuvastatin, 40 mg(商品名：CRESTOR冠脂妥膜衣錠40毫克) 做分組治療104週後，進行一系列血管內超音波檢查，We performed serial intravascular ultrasonography in 1039 patients with coronary disease, at baseline and after 104 weeks of treatment with either atorvastatin, 80 mg daily, or rosuvastatin, 40 mg daily, 來比較這兩個高劑量的statins（司他汀）類藥方對冠狀動脈粥樣硬化病程的療效，以及評估其藥物的安全性和副作用。 to compare the effect of these two intensive statin regimens on the progression of coronary atherosclerosis, as well as to assess their safety and side-effect profiles.
結果Results：
分組治療104週後，每天服用rosuvastatin, 40 mg(商品名：CRESTOR冠脂妥膜衣錠40毫克) 這一組的低密度脂蛋白（LDL）膽固醇比每天服用atorvastatin, 80 mg(商品名：Lipitor立普妥膜衣錠80毫克) 的一組還要低（62.6比70.2毫克每分升[1.62 - 1.82每公升毫摩爾]，P <0.001），但高密度脂蛋白（LDL）膽固醇比每天服用atorvastatin, 80 mg(商品名：Lipitor立普妥膜衣錠80毫克) 的一組還要高（50.4比48.6毫克每分升1.30與每升1.26毫摩爾]，P = 0.01）。
After 104 weeks of therapy,the rosuvastatin group had lower levels of LDL cholesterol than the atorvastatin group (62.6 vs. 70.2 mg per deciliter [1.62 vs. 1.82 mmol per liter], P<0.001), and higher levels of high-density lipoprotein (HDL) cholesterol (50.4 vs. 48.6 mg per deciliter [1.30 vs. 1.26 mmol per liter], P = 0.01). 主要療效終點，冠狀動脈粥狀瘤體積百分比（PAV）：服用atorvastatin, 80 mg(商品名：Lipitor立普妥膜衣錠80毫克) 的一組降低0.99％（95％信賴區間 [CI]，-1.19到-0.63）服用rosuvastatin, 40 mg(商品名：CRESTOR冠脂妥膜衣錠40毫克) 這一組降低1.22％（95％信賴區間 [CI]，-1.52到-0.90）。
The primary efficacy end point, percent atheroma volume (PAV), decreased by 0.99% (95% confidence interval [CI], −1.19 to −0.63) with atorvastatin and by 1.22% (95% CI, −1.52 to −0.90) with rosuvastatin (P = 0.17).
次要療效終點，正常化的總冠狀動脈粥狀瘤體積（TAV），服用rosuvastatin, 40 mg/天組比服用atorvastatin, 80 mg/天組更有療效：−6.39 mm3 (95%信賴區間CI, −7.52 to −5.12), 比較 −4.42 mm3 (95%信賴區間CI, −5.98 to −3.26) (P = 0.01).
The effect on the secondary efficacy end point, normalized total atheroma volume (TAV), was more favorable with rosuvastatin than with atorvastatin: −6.39 mm3 (95% CI, −7.52 to −5.12), as compared with −4.42 mm3 (95% CI, −5.98 to −3.26) (P = 0.01). 這兩組藥物對大多數受試患者冠狀動脈硬化病程消退的療效：服用atorvastatin 組為63.2％和服用rosuvastatin 組為68.5％，冠狀動脈粥狀瘤體積百分比（PAV）：（P = 0.07）分別為64.7％和71.3％，正常化的總冠狀動脈粥狀瘤體積TAV（P = 0.02）。Both agents induced regression in the majority of patients: 63.2% with atorvastatin and 68.5% with rosuvastatin for PAV (P = 0.07) and 64.7% and 71.3%, respectively, for TAV (P = 0.02). 這兩組藥物的副作用都在可接受範圍，其在實驗室發生異常和心血管疾病的發生率均較低。 Both agents had acceptable side-effect profiles, with a low incidence of laboratory abnormalities and cardiovascular events.
結論Conclusions：
最大劑量的rosuvastatin(商品名：CRESTOR冠脂妥膜衣錠40毫克/天)和atorvastatin(商品名：Lipitor立普妥膜衣錠80毫克/天)對冠狀動脈硬化病程消退有顯著的療效。Maximal doses of rosuvastatin and atorvastatin resulted in significant regression of coronary atherosclerosis. 儘管在rosuvastatin組的治療可降低低密度脂蛋白膽固醇濃度和提高高密度脂蛋白膽固醇濃度，觀察2組藥物對冠狀動脈粥狀瘤體積百分比（PAV）的消退有類似程度的療效。（由AstraZeneca製藥公司的資助研究； ClinicalTrials.gov臨床試驗編號：NCT000620542）Despite the lower level of LDL cholesterol and the higher level of HDL cholesterol achieved with rosuvastatin, a similar degree of regression of PAV was observed in the two treatment groups. (Funded by AstraZeneca Pharmaceuticals; ClinicalTrials.gov number, NCT000620542.)

有限的人與人間的新型流感病毒A型H3N2的傳播流行

2011-11-30T05:13:00.000-08:00

有限的人與人間的新型流感病毒A型H3N2的傳播流行－美國愛荷華州，2011年11月的通報 Limited Human-to-Human Transmission of Novel Influenza A (H3N2) Virus — Iowa , November 2011

2011年11月20日，美國疾管局證實在愛荷華州兩個縣的3例兒童感染起源自豬流感的三重基因片段重組的A型流感（H3N2）（S - OtrH3N2）病毒。On November 20, 2011, CDC confirmed three cases of swine-origin triple reassortant influenza A (H3N2) (S-OtrH3N2) virus infection in children in two counties in Iowa . 3例兒童均未住院治療，每例都從輕度發燒性呼吸症狀發作而康復。None of the children were hospitalized, and each has recovered from a mild episode of febrile respiratory illness. 這三例都因相互接觸而感染，三例最近都未接觸到豬隻。All three were in contact with one another, and none had a known recent exposure to swine. 在愛荷華州未檢測出其他的人感染這種病毒，也沒有證據顯示S - OtrH3N2病毒持續的人對人傳播感染存在。No additional human infections with this virus have been detected in Iowa, and no evidence of sustained human-to-human transmission of this S-OtrH3N2 virus exists; 自2009年以來持續監測有18例確診人類感染源自豬流感A型（H3N2）病毒。surveillance is ongoing.Eighteen human infections with swine-origin influenza A (H3N2) viruses have been identified since 2009 (1,2). 最近10例，包括其中在這份愛荷華州通報的三例感染A型S - OtrH3N2流感病毒是帶有從2009年大流行的A型（H1N1）豬流感病毒（pH1N1）的基質蛋白（matrix M）基因組片段。The most recent 10 cases, including the three Iowa cases described in this report, were infections with S-OtrH3N2 viruses containing the matrix (M) gene from the pandemic 2009 influenza A (H1N1) virus (pH1N1). 這A型S - OtrH3N2流感病毒被認定是從源自北美養豬場流行的豬流感A型（H3N2）病毒和pH1N1流感病毒間的基因組片段重組而成的新病毒。These viruses are considered reassortant viruses between a swine-origin influenza A (H3N2) virus circulating in North American swine and a pH1N1 virus. 在2011年，已經從四個州通報：賓夕法尼亞州（3例），緬因州（2例），印第安納州（2例），愛荷華州（3例）感染A型S - OtrH3N2流感病毒的所有人類病例均帶有豬流感A型（pH1N1）的基質蛋白（matrix M）基因組片斷。All cases of human infection with S-OtrH3N2 virus containing the M gene from the pH1N1 virus have occurred in 2011 and have been reported from four states: Pennsylvania (three cases), Maine (two), Indiana (two), and Iowa (three) (3).

資料來源：http://www.cdc.gov/mmwr/PDF/wk/mm60d1123.pdf?source=govdelivery

影像輔助式胸腔鏡手術

2010-12-30T17:31:00.000-08:00

影像輔助式胸腔鏡手術(VATS)

Video Assisted Thoracoscopic Surgery影像輔助式胸腔鏡手術, often referred to as VATS縮寫VATS, is performed using a small video camera that is introduced into the patient's chest via a scope.是使用從病患胸腔切口插入一薄管狀內含一針孔攝機儀器進入胸腔內 With the video camera, the surgeon is able to view the anatomy along with other surgical instruments that are introduced into the chest via small incisions or "ports".從病患胸腔幾個切口插入的薄管狀針孔攝機及薄管狀外科器械可讓外科醫生透過影像監控器來檢查您胸腔內的臟器.

Traditional surgical approaches have utilized a single large incision (cut) that is placed between the patient's ribs. The ribs are then spread apart, allowing the surgeon to look directly into the patient's chest. The surgery is then performed via this single large opening.These incisions are known as thoracotomies, and while very safe, are uncomfortable. By utilizing VATS, this large incision is avoided, thereby sparing the patient some of the post-operative pain and assisting them with a potentially quicker recovery.傳統的切開肋骨的開膛剖胸大開放傷口,才能讓外科醫生直接目視檢查您胸腔內的臟器,讓病患相當不舒服,利用小切口的影像輔助式胸腔鏡手術,可減輕病患手術後的疼痛及小切口較快速康復!

In this video, the surgeon uses small instruments that have been introduced into the patient'schest via small (1/2-inch) ports. The surgeon views a video screen that shows the camera image.本影使用小薄導管針孔攝機及小薄導管外科器械從病患胸腔(1/2吋=1.25公分)切口插入,讓外科醫生透過影像監控器來檢查您胸腔內的臟器.
There are 4 parts to this video:本影片分4片段:

In Part 1, the surgeon is "exploring" the chest using VATS technology. The device that looks like a fan is used to move the lung around.片段一:外科醫生執行影像輔助式胸腔鏡手術,扇形外科器械用來撥開肺葉檢查.

In Part 2, the patient has recurrent collection of fluid in the chest secondary to a cancer, which is referred to as a "malignant pleural effusion". In the video, you see the surgeon sucking out the fluid. The white flashing light is actually sterile talcum powder being introduced into the chest. The talcum powder causes the lung to adhere to the chest wall, hopefully not allowing fluid to collect in this space.片段二:患者因癌症而引發惡性肋膜積水,故定期做肋膜抽水。在影片您會看到外科醫生做肋膜抽水.白色閃光燈其實是以導管導入胸膛消過毒的滑石粉,滑石粉會造成肺沾粘胸壁，及不希望在這空間抽到肋膜水。
In Part 3, the surgeon is sampling a lymph node from the lung to get a biopsy, to see if cancer has spread to the lymph nodes.片段三:外科醫生以外科器械導管從患者肺部採集淋巴結活體做切

In Part 3, the surgeon is sampling a lymph node from the lung to get a biopsy, to see if cancer has spread to the lymph nodes.片段三:外科醫生以外科器械導管從患者肺部採集淋巴結活體做切片檢查,看是否癌細胞擴散至淋巴結?

In Part 4, the surgeon is removing an abnormal mass from the lung. The mass was being removed to see if it was a cancer. It is placed in a small plastic bag to prevent any cancer cells from coming into contact with the chest wall as it is removed through a small (1/2 inch) incision.片段四:外科醫生以導管外科器械從患者肺部切除異常腫瘤做切片檢查,看是否癌細胞?並將切除異常腫瘤放入小塑膠袋,以免導管外科器械從(1/2吋=1.25公分)切口移出異常腫瘤時,讓癌細胞接觸到胸壁.

In Part 4, the surgeon is removing an abnormal mass from the lung. The mass was being removed to see if it was a cancer. It is placed in a small plastic bag to prevent any cancer cells from coming into contact with the chest wall as it is removed through a small (1/2 inch) incision.片段四:外科醫生以導管外科器械從患者肺部切除異常腫瘤做切片檢查,看是否癌細胞?並將切除異常腫瘤放入小塑膠袋,以免導管外科器械從(1/2吋=1.25公分)切口移出異常腫瘤時,讓癌細胞接觸到胸壁.

http://www.cts.usc.edu/lpg-thoracoscopy-thethoracoscopyprocedure.html

耶誕快樂

2010-12-21T16:30:00.000-08:00

阻塞性肥厚心肌症和重度二尖瓣異常患者的二尖瓣膜修復

2010-11-03T01:56:00.000-07:00

阻塞性肥厚心肌症和重度二尖瓣異常患者的二尖瓣膜修復

Mitral-valve repair in patients with HOCM and severe mitral anomalies

http://www.theheart.org/documents/sitestructure/en/content/editorial/1138915/interviews/video.html

美國疾管局抗藥性試驗互動影片Antimicrobial Susceptibility Testing

2010-09-17T00:51:00.000-07:00

美國疾管局抗藥性試驗互動影片Antimicrobial Susceptibility Testing

無線醫學

2010-07-07T02:30:00.000-07:00

點選字幕選擇View subtitles→再點選簡體中文chinese(simplified)。

舞虎拜年!

2010-02-13T03:19:00.000-08:00

影片改編自tw.yahoo首頁(非商業用途)，恭賀新年快樂！

諾華流感疫苗製造影片下載(非廣告non commercialized purpose)
http://tw.myblog.yahoo.com/shehtou1/article?mid=1158

新竹城隍聖籤

2010-01-13T19:54:00.000-08:00

光天利求簽遊戲
http://www.kokolo.com.tw/v2/game/cfortune_telling.html

國光流感疫苗(AH1N1)仿單

2009-12-29T04:18:00.000-08:00

國光a (h1n1) 新流感疫苗臨床試驗結果

2009-12-29T03:10:00.000-08:00

聖誕節&新年快樂!

2009-12-23T00:40:00.000-08:00

請點壓聖誕樹! 開始播放動畫!

祝賀您聖誕節&新年快樂! 心想事成!

美國2009年新流感H1N1單價疫苗含汞量計算器

2009-11-17T21:50:00.000-08:00

step1 第一步,鍵入名字
step2 第2步,鍵入體重
step3 第3步,鍵入年齡
step4 第4步,下拉點選疫苗
美國2009年新流感H1N1單價疫苗
2009年季節性流感3價疫苗
step5 第5步,點選calculation計算疫苗含汞量
step6 第6步,評估結果:
點選mercury calculation chart疫苗含汞量和環保局安全值柱狀圖
點選your custom vaccination records您的疫注記錄:點選create vaccination record產生記錄

http://www.vaccine-tlc.org/calc.html

H1N1病毒對年輕人最危險

2009-11-04T00:30:00.000-08:00

美國CBS新聞-60分鐘-豬流感：H1N1病毒
H1N1病毒對年輕人最危險
片頭有15秒廣告後，才是正片。

美國CBS新聞-60分鐘-豬流感：H1N1病毒
H1N1病毒對年輕人最危險
H1N1: Most Dangerous To Young People
99％感染新流感H1N1的人，在家裡忍受幾天輕度症狀後，便會自癒。但是，對於不到百分之一感染新流感H1N1的人，大多是因重症在急診室就醫，對他們而言H1N1病毒可能是致命的。Ninety-nine percent of the people who get it suffer just a few miserable days at home. But it is also true that for something less than one percent, H1N1 can be fatal. And many of them are the last people you'd expect to see rushing to an emergency room. 10月7日，15歲的盧克杜瓦爾（Luke Duvall）被用直昇機送醫降落在阿肯色州、小石城的兒童醫院。他的生命跡象逐漸消失。盧克無法呼吸需用呼吸器。 On Oct. 7, 15-year-old Luke Duvall landed at Arkansas Children's Hospital in Little Rock. His life was slipping away. Luke was on a ventilator, not breathing on his own.
米歇爾莫斯醫師(Michele Moss)她懷疑個案感染H1N1病毒。她已失去了一位感染H1N1病毒的病人。醫師解釋：“個案他現在非常脆弱，他的血壓是非常脆弱，可以在任何幾秒內失去生命。所以他是一個患有非常嚴重疾病的年輕人”。 Dr. Michele Moss suspected H1N1. She had already lost one patient to the virus. "He's extremely fragile right now. His blood pressure is very tenuous and could go down at any second. So he's a very, very sick young man," she explained.
盧克（Luke）發病前是位完全健康的人。他曾破了美國的國家舉重紀錄。在上週五，足球比賽後，盧克生病。 Luke had been perfectly healthy before. He had broken a state record in weightlifting. After a football game on Friday, Luke got sick.

瘋牛症

2009-11-04T00:17:00.000-08:00

片頭有15秒廣告後，才是正片。

2004年6月8日CBS60分新聞記者：懷亞特安德魯斯(Wyatt Andrews)報告：美國華盛頓州的一頭牛可能得到瘋牛病。如果是這樣，這將是在美國本土首次出現的牛腦部病變。有關官員說：糧食供應是安全的。A single Washington state cow may have mad cow disease. If so, it will be the first appearance of the brain-wasting illness on U.S. soil. Officials say the food supply is safe, Wyatt Andrews reports.

流感大流行的特殊徵兆

2009-07-15T00:06:00.000-07:00

拜讀H1N1新流感中心-新英格蘭醫學期刊的流感大流行的特殊徵兆-對策意含The Signature Features of Influenza Pandemics — Implications for Policy

http://content.nejm.org/cgi/content/full/NEJMp0903906

發覺此次H1N1新流感很類似過去流感大流行如下圖表，最初高傳染性低毒性輕症感染流行（適應宿主大量複製傳播），南半球澳洲正值秋冬季節性流感，導致H1N1流感確認病例攀升，會增加H1N1流感和秋冬季節性流感產生的基因交換更頻繁

【新流感H1N1從1997-2009年的豬（藍、紅色）-人（綠色）-鳥（黃色）－不知來源（灰色）的基因片斷重組的進化動畫。】

累積至10月份換北半球秋冬季節性流感，讓H1N1更加速進化，如果病毒的毒性不幸歷史重演變成強毒性？是否會像過去流感大流行的多波大流行及後續波毒性轉強造成高死亡率如下圖表？令人憂心！？ 疫苗才是預防傳染病最好的根本！

過去流感大流行時連續幾波流行時間的平均死亡率分佈。Mortality Distributions and Timing of Waves of Previous Influenza Pandemics. 縱軸：表平均死亡率，橫軸：表年月時間。 淺粉紅陰影條柱狀欄圖是顯示正常的季節性流感流行期。

（A組）在1889-1892年，倫敦，1890年1-3月第一波流感大流行平均死亡率10%，1891年3-6月第二波流感大流行平均死亡率45%，1891年12月-1892年3月第三波流感大流行平均死亡率45%。

（B組）1918-1919年，哥本哈根，1918年7-8月第一波流感大流行平均死亡率5%，1918年10-12月第二波流感大流行平均死亡率60%，1918年12月-1919年4月第三波流感大流行平均死亡率35%。

（C組）1957至63年，美國，1957年10月-1958年4月第一波流感大流行平均死亡率43%，1959年12月-1960年4月第二波流感大流行平均死亡率28%，1962年12月-1963年4月第三波流感大流行平均死亡率29%。

（D組）1968 - 1970年，英格蘭和威爾士，1968年1月-4月第一波流感大流行平均死亡率15%，1968年12月-1969年2月第二波流感大流行平均死亡率85%。

過去四次流感大流行，每次每波相關的流感所佔的死亡比例承載總數如上圖所示的藍色條柱狀圖。

Proportion of the total influenza-associated mortality burden in each wave for each of four previous pandemics is shown above the blue bars.當每次流感大流行時，連續幾波流行時間中顯示的死亡率。

Mortality waves indicate the timing of the deaths during each pandemic.。1918年的流感大流行（ B組）在夏季的第一波只有輕症感染流行，接著冬天是兩波重症感染流行。The 1918 pandemic (Panel B) had a mild first wave during the summer, followed by two severe waves the following winter. 在1957年的流感大流行（C組）最初五年的冬季有三波流行。 The 1957 pandemic (Panel C) had three winter waves during the first 5 years. 在1968年的流感大流行（D組）在英國第一波只有輕症感染流行，接著冬天是第二波重症感染流行。 The 1968 pandemic (Panel D) had a mild first wave in Britain, followed by a severe second wave the following winter. 陰影條柱狀欄圖是顯示正常的季節性流感。The shaded columns indicate normal seasonal patterns of influenza.

流感大流行的特殊徵兆-對策意含

The Signature Features of Influenza Pandemics — Implications for Policy

http://content.nejm.org/cgi/content/full/NEJMp0903906