關於 stroke prevention ，我們在網路上蒐集到這些相關的討論、資訊與評價

【家庭醫學】~ 自行車頭盔的技術

最近一次和神經外科及急診的朋友去騎車時，他們和我談到腳踏車安全帽的技術，Multi-directional Impact Protection System (MIPS)，覺得很神奇，就去查了一下文獻資料。(然後還手刀下訂了一頂...哈哈哈)

簡單和大家分享一下...

※ 歷史：

1996年，瑞典神經外科醫師 漢斯-馮-霍爾斯特（Hans von Holst）開始評估安全帽的總體結構。

在日內瓦世界衛生組織進行了數年的與頭部外傷有關的研究和工作之後，他確定現有技術不足以防止腦外傷，這通常會對腦部外傷的患者造成嚴重後果。

馮-霍爾斯特（von Holst）與皇家理工學院研究員彼得-哈爾丁（Peter Halldin）共同開發了一項旨在為腦部創傷提供更有效保護的技術。評估之後，結合他們多年的測試和專業知識，馮·霍爾斯特和哈爾丁共同開發了現在稱為MIPS的大腦保護系統

※ 原理：

在配備了MIPS技術的頭盔中，低摩擦層允許頭盔相對於頭部滑動，從而減少了旋轉動量，避免傳遞到大腦內，造成旋轉運動*的拉扯損傷。

*註：旋轉運動，是由於頭部在受到一定角度的撞擊後，突然迅速地停止，大腦繼續移動或伸展的結果。研究人員將諸如：「瀰漫性軸索損傷」（DAI）和「硬腦膜下血腫」（SDH）之類的嚴重腦損傷與有角度的衝擊造成的動能傳遞到大腦有關。輕度創傷性腦損傷（MTBI）或腦震盪也被認為是由旋轉運動引起的

大腦被腦脊髓液包圍，當暴露於有角度的撞擊時，腦脊液可通過讓大腦在顱骨內滑動來保護大腦。MIPS模仿腦脊髓液，增加了一個低摩擦層，可在頭部和頭盔之間沿任何方向進行10~15 mm的相對運動。

※ 研究資料：

找到一篇很有趣的研究報告，比較三種不同的自行車安全帽：

A. 硬質膨脹聚苯乙烯（EPS）：傳統安全帽
B. 多方向碰撞保護系統（MIPS）
C. WaveCel 蜂巢技術

分別測試4種狀況下的撞擊，每個狀況測5頂安全帽：

以4.8 m/s (約17.3 km/hr) 的速度，撞擊與水平面呈不同角度的鐵砧平面
1. 呈30°
2. 呈45°
3. 呈60°

4. 以6.2 m/s (約22.3 km/hr) 的速度，撞擊到45°鐵砧上

結果是傳統安全帽，以6.2 m/s，撞上45°鐵砧，造成的旋轉加速度最大，而不同的新技術則分別降低了：
→ MIPS技術，降低了 22％（p = 0003）
→ WaveCel技術，降低了 73％（p <0.001）

但是，傳統安全帽也不是一無是處，在減少線性加速度上和MIPS技術的安全帽沒有統計學上的差異。而WaveCel則僅在4.8 m/s的撞擊時和傳統安全帽有差異，速度變快時，就沒有統計學上的差異。
(線性加速度和"骨折"會比較有關)

§ 看到這兒，我都覺得這篇是不是拿了WaveCel的贊助；結果最後的致謝是給美國國家衛生研究院！

This research was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health (NIH)

好吧，我承認看太多不知道是不是業配的文章久了，都會有這樣疑神疑鬼，以小人之心度君子之腹。

◎ 結語：

好啦，來做個總結

『速度慢一點，安全多一點』

騎車還是要注意速度，你不撞人，別人也會撞你，甚至自己卡到水溝的縫隙...再神的帽子，在高速度下，也不能保證那麼有效。(而且實驗中最多才用22.3 km/hr去撞，路上的強者，動不動就是40-50 km/hr在巡航)

然後，碎碎念一下，本來訂了一頂MIPS技術的帽子，看完這篇，找了一下台灣有沒有賣WaveCel技術的...嗯...然後就決定不退貨了。

最後，安全帽的錢真的不要省，只要有碰撞過，即便看起來沒有裂，也還是換一頂吧！比買一些增加心靈瓦數的配件實用多了。

還要致謝一下，謝謝急診的帥賢和神外的廖P，讓我學習新知 (a.k.a 不斷敗家) 呀！公路車的坑，好比馬里亞納海溝那麼深...回頭看看爬山的裝備，突然覺得始前動物都好便宜呢。

參考文獻：

Bliven, Emily, et al. "Evaluation of a novel bicycle helmet concept in oblique impact testing." Accident Analysis & Prevention 124 (2019): 58-65.

https://doi.org/10.1016/j.aap.2018.12.017

○ 下面有人幫我補上台灣也買得到 WaveCel 的安全帽：
關鍵字要用「Bontrager 安全帽」，直接找WaveCel都跳一些國外的網頁

【藥事知多D】亞士匹靈 + Dipyridamole = ？

〈點解有時亞士匹靈有時可能會搭配Dipyridamole呢？〉

有時亞士匹靈(Aspirin)可能會搭配Dipyridamole。

這時候，大家便可能會感到有點奇怪：

「咦？藥罐子，亞士匹靈通血管，我知道，那Dipyridamole又是什麼？」

哦，跟亞士匹靈一樣，Dipyridamole其實同樣是一種抗血小板藥(Antiplatelet)，在藥理上，是一種磷酸二酯酶抑制劑(Phosphodiesterase Inhibitor)，主要抑制磷酸二酯酶(Phosphodiesterase)，從而提高血小板裡面環腺苷單磷酸(Cyclic Adenosine Monophosphate, cAMP)、環鳥嘌呤苷單磷酸(Cyclic Guanosine Monophosphate, cGMP)的水平，從而抑制血小板凝聚，產生「通血管」的效果。

好，問題是，為什麼會刻意一同使用這兩種藥呢？

哦，理論上，同時使用兩種不同作用原理的抗血小板藥，兩路夾擊，便能夠產生「協同效應(Synergic Effect)」，增加「通血管」的功效。

實際上，相較單一使用亞士匹靈、Dipyridamole而言，雙劍合璧能夠加強預防中風的功效。[1]

不過有利自然有弊。

不難想像，藥物愈多，副作用自然愈多。首先同服兩種抗血小板藥，不用問，自然便可能會矯枉過正，反而增加出血的風險。

除此之外，因為Dipyridamole還能夠阻斷腺苷(Adenosine)這種血管擴張劑(Vasodilator)在紅血球的再回收，從而增加血液的腺苷水平，固然能夠舒張血管，同時還可能會舒張體內其他不同的血管，例如頭顱，從而誘發頭痛。

所以一般建議睡前服用，同時還可以採取漸進式加藥，在兩、三天內逐步增加劑量，目的在給予時間讓身體能夠慢慢適應，從而希望能夠減輕頭痛的副作用，不過這種頭痛一般會隨著身體慢慢適應而逐漸消失。[2]

（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. Diener HC, Cunha L, Forbes C, et al. European Stroke Prevention Study 2: Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996;143:1-13.
2. Theis JG, Deichsel G, Marshall S. Rapid development of tolerance to dipyridamole-associated headaches. Br J Clin Pharm. 1999;48:750-755.

https://pegashadraymak.blogspot.com/2021/01/dipyridamole.html

【藥事知多D】亞士匹靈抗性 = ？

有時劑量決定用途。

例如亞士匹靈(Aspirin)。

亞士匹靈一般有兩種技能，其一是消炎止痛藥，消炎止痛；其二是抗血小板藥，預防中風，俗稱「通血管」。

一般建議高劑量的亞士匹靈適用於消炎止痛；低劑量的亞士匹靈適用於預防中風。

其中「消炎止痛」的口服劑量是成人一天不宜服用超過4000mg (4g)的亞士匹靈。[1]

至於「通血管」的理想劑量暫時還是眾說紛紜，各國有各自的答案，其中一個參考答案是每天服用75至150mg的亞士匹靈。[2]

話雖如此，不過有時用藥者還是可能需要服用高劑量的亞士匹靈來預防中風。

這話怎麼解？

不說不知道，服用亞士匹靈原來可能會出現「亞士匹靈抗性(Aspirin Resistance)」這個問題。

在概念上，「亞士匹靈抗性」其實跟「耐受性(Drug Tolerance)」倒是有幾分異曲同工之妙的味道，簡單說，是指就算達到「通血管」的建議劑量，亞士匹靈還是不能抑制血小板凝聚，往往需要透過增加藥物的劑量，達到「通血管」的效果。[3]

各位看倌可能會問：

「噯！藥罐子，與其增加劑量，倒不如直接轉藥，不就行了嗎？」

對，如果命運能選擇……

遺憾的是，綜觀常用的抗血小板藥(Antiplatelet)，裡面其實沒有太多選項，來來去去，不是這個，便是那個，一般只有三種：亞士匹靈、Clopidogrel、Dipyridamole。

其中相較Clopidogrel、Dipyridamole而言，亞士匹靈一般還是首選。

所以暫時姑且撇開價格、副作用這些因素不說，要是增加劑量便能夠解決問題，何樂而不為？

問題是，一個人無緣無故為什麼會出現亞士匹靈抗性？

唔……其中一個常見的原因是相互作用。

舉例說，服用亞士匹靈前，要是先服用布洛芬(Ibuprofen)這種非類固醇消炎止痛藥(Non-steroidal Anti-inflammatory Drugs, NSAIDs)，便可能會跟亞士匹靈進行競爭，阻斷亞士匹靈跟環氧化酶(Cyclo-oxygenase)結合，從而抗衡亞士匹靈抑制血小板凝聚的功能，削弱「通血管」的效果。[4]

所以服用布洛芬前，有人建議服藥前至少兩小時便要服用亞士匹靈或者服藥後待到至少四小時後才能服用亞士匹靈，盡量避免出現亞士匹靈抗性的機會。

（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. British National Formulary. BMJ Group and RPS Publishing. 56th ed. 2008:228-229.
2. Charles Warlow. Aspirin Should Be First-Line Antiplatelet Therapy in the Secondary Prevention of Stroke. Stroke. 2002;33:2137-2138.
3. Eikelboom JW, Hankey GJ. Aspirin resistance: A new independent predictor of vascular events? J Am Coll Cardiol. 2003;41:966-968.
4. Catella-Lawson F, Reilly MP, Kapoor SC, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med. 2001;345:1809-1817.

Episode 5: CYCLING IN SINGAPORE TOUR WITH GOPRO HERO 9 Health benefits of regular cycling
Health benefits of regular cycling

Cycling is mainly an aerobic activity, which means that your heart, blood vessels and lungs all get a workout. You will breathe deeper, perspire and experience increased body temperature, which will improve your overall fitness level.

The health benefits of regular cycling include:
increased cardiovascular fitness
increased muscle strength and flexibility
improved joint mobility
decreased stress levels
improved posture and coordination
strengthened bones
decreased body fat levels
prevention or management of disease
reduced anxiety and depression.
Back to top
Cycling and specific health issues

Cycling can improve both physical and mental health, and can reduce the chances of experiencing many health problems.
Obesity and weight control

Cycling is a good way to control or reduce weight, as it raises your metabolic rate, builds muscle and burns body fat. If you’re trying to lose weight, cycling must be combined with a healthy eating plan. Cycling is a comfortable form of exercise and you can change the time and intensity – it can be built up slowly and varied to suit you.

Research suggests you should be burning at least 8,400 kilojoules (about 2,000 calories) a week through exercise. Steady cycling burns about 1,200 kilojoules (about 300 calories) per hour.

If you cycle twice a day, the kilojoules burnt soon add up. British research shows that a half-hour bike ride every day will burn nearly five kilograms of fat over a year.
Cardiovascular disease and cycling

Cardiovascular diseases include stroke, high blood pressure and heart attack. Regular cycling stimulates and improves your heart, lungs and circulation, reducing your risk of cardiovascular diseases.

Cycling strengthens your heart muscles, lowers resting pulse and reduces blood fat levels. Research also shows that people who cycle to work have two to three times less exposure to pollution than car commuters, so their lung function is improved. A Danish study conducted over 14 years with 30,000 people aged 20 to 93 years found that regular cycling protected people from heart disease.
Cancer and cycling

Many researchers have studied the relationship between exercise and cancer, especially colon and breast cancer. Research has shown that if you cycle, the chance of bowel cancer is reduced. Some evidence suggests that regular cycling reduces the risk of breast cancer.
Diabetes and cycling

The rate of type 2 diabetes is increasing and is a serious public health concern. Lack of physical activity is thought to be a major reason why people develop this condition. Large-scale research in Finland found that people who cycled for more than 30 minutes per day had a 40 per cent lower risk of developing diabetes.
Bone injuries, arthritis and cycling

Cycling improves strength, balance and coordination. It may also help to prevent falls and fractures. Riding a bike is an ideal form of exercise if you have osteoarthritis, because it is a low-impact exercise that places little stress on joints.

Cycling does not specifically help osteoporosis (bone-thinning disease) because it is not a weight-bearing exercise.
Mental illness and cycling

Mental health conditions such as depression, stress and anxiety can be reduced by regular bike riding. This is due to the effects of the exercise itself and because of the enjoyment that riding a bike can bring.

Health benefits of regular cycling

Cycling is mainly an aerobic activity, which means that your heart, blood vessels and lungs all get a workout. You will breathe deeper, perspire and experience increased body temperature, which will improve your overall fitness level.

The health benefits of regular cycling include:
increased cardiovascular fitness
increased muscle strength and flexibility
improved joint mobility
decreased stress levels
improved posture and coordination
strengthened bones
decreased body fat levels
prevention or management of disease
reduced anxiety and depression.
Back to top
Cycling and specific health issues

Cycling can improve both physical and mental health, and can reduce the chances of experiencing many health problems.
Obesity and weight control

Cycling is a good way to control or reduce weight, as it raises your metabolic rate, builds muscle and burns body fat. If you’re trying to lose weight, cycling must be combined with a healthy eating plan. Cycling is a comfortable form of exercise and you can change the time and intensity – it can be built up slowly and varied to suit you.

Research suggests you should be burning at least 8,400 kilojoules (about 2,000 calories) a week through exercise. Steady cycling burns about 1,200 kilojoules (about 300 calories) per hour.

If you cycle twice a day, the kilojoules burnt soon add up. British research shows that a half-hour bike ride every day will burn nearly five kilograms of fat over a year.
Cardiovascular disease and cycling

Cardiovascular diseases include stroke, high blood pressure and heart attack. Regular cycling stimulates and improves your heart, lungs and circulation, reducing your risk of cardiovascular diseases.

Cycling strengthens your heart muscles, lowers resting pulse and reduces blood fat levels. Research also shows that people who cycle to work have two to three times less exposure to pollution than car commuters, so their lung function is improved. A Danish study conducted over 14 years with 30,000 people aged 20 to 93 years found that regular cycling protected people from heart disease.
Cancer and cycling

Many researchers have studied the relationship between exercise and cancer, especially colon and breast cancer. Research has shown that if you cycle, the chance of bowel cancer is reduced. Some evidence suggests that regular cycling reduces the risk of breast cancer.
Diabetes and cycling

The rate of type 2 diabetes is increasing and is a serious public health concern. Lack of physical activity is thought to be a major reason why people develop this condition. Large-scale research in Finland found that people who cycled for more than 30 minutes per day had a 40 per cent lower risk of developing diabetes.
Bone injuries, arthritis and cycling

Cycling improves strength, balance and coordination. It may also help to prevent falls and fractures. Riding a bike is an ideal form of exercise if you have osteoarthritis, because it is a low-impact exercise that places little stress on joints.

Cycling does not specifically help osteoporosis (bone-thinning disease) because it is not a weight-bearing exercise.
Mental illness and cycling

Mental health conditions such as depression, stress and anxiety can be reduced by regular bike riding. This is due to the effects of the exercise itself and because of the enjoyment that riding a bike can bring.

認知障礙症 －黃德祥老人科專科醫生＠FindDoc.com

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（一） 早期診斷認知障礙症的重要性和方法？00:07

（二） 慢性病會導致認知障礙症？00:55

（三） 認知障礙症照顧者應該注意什麼？01:35

（四） 透過改善生活習慣與適時使用藥物控制病情？02:32

(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. Galvin, J.., Sadowsky, C.(2012). Practical Guidelines for the Recognition and Diagnosis of Dementia. The Journal of the American Board of Family Medicine May 2012, 25 (3) 367-382; DOI: https://doi.org/10.3122/jabfm.2012.03.100181 Retrieved from https://www.jabfm.org/content/25/3/367#sec-3
2. Anstey, K.J., Lipnicki, D.M., Low, L.F. (2008) Cholesterol as a Risk Factor for Dementia and Cognitive Decline: A Systematic Review of Prospective Studies With Meta-Analysis. Am J Geriatr Psychiatry May 2008, 16:5. Retrieved from https://www.researchgate.net/profile/Kaarin_Anstey/publication/5403325_Cholesterol_as_a_Risk_Factor_for_Dementia_and_Cognitive_Decline_A_Systematic_Review_of_Prospective_Studies_With_Meta-Analysis/links/576b54ac08ae5b9a62b3aa81/Cholesterol-as-a-Risk-Factor-for-Dementia-and-Cognitive-Decline-A-Systematic-Review-of-Prospective-Studies-With-Meta-Analysis.pdf
3. Sun, M.-K., Alkon, D.L. (2006). Links between Alzheimer's disease and diabetes. Drugs Today 2006, 42(7): 481. Retrieved from https://journals.prous.com/journals/servlet/xmlxsl/pk_journals.xml_summary_pr?p_JournalId=4&p_RefId=973588&p_IsPs=N
4. Starkstein,S.E., Almeida, O.P. (2003). Understanding cognitive impairment and dementia: stroke study. Curr Opin Psychiatry, 16, 615-620. Retrieved from https://journals.lww.com/co-psychiatry/Abstract/2003/11000/Understanding_cognitive_impairment_and_dementia_.3.aspx
5. 葵涌醫院 (2016)。照顧患有認知障礙症長者　家傭照顧手冊。香港：醫院管理局。Retrieved from https://www.swd.gov.hk/dementiacampaign/sc/doc/Caring-for-Elderly-with-Dementia-Guide-to-Foreign-Domestic-Helper_TC.pdf
6. Lam, L.C.W., Chan, W.M., Kwok, T.C.Y., Chiu, H.F.K. (2014) Effectiveness of Tai Chi in maintenance of cognitive and functional abilities in mild cognitive impairment: a randomised controlled trial. Hong Kong Med J 2014;20(Suppl 3):S20-3. Retrieved from https://www.hkmj.org/system/files/hkm1403sp3p20_0.pdf
7. Müllers, P., Taubert, M., & Müller, N. G. (2019). Physical Exercise as Personalized Medicine for Dementia Prevention?. Frontiers in physiology, 10, 672. https://doi.org/10.3389/fphys.2019.00672 . Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563896/
8. Lam, L. C., Chan, W. C., Leung, T., Fung, A. W., & Leung, E. M. (2015). Would older adults with mild cognitive impairment adhere to and benefit from a structured lifestyle activity intervention to enhance cognition?: a cluster randomized controlled trial. PloS one, 10(3), e0118173. https://doi.org/10.1371/journal.pone.0118173 。 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380493/



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