2013年5月31日

向中國開放 陸委會及經濟部昨在立委質詢下被動透露 未徵詢我國業者意見,也無影響評估報告,嚴重衝擊我國卅萬美容美髮從業人員的生存

美容美髮開放中資 衝擊30萬人
兩岸洽簽「服務貿易協議」,將開放中資進入台灣美容美髮市場,不但嚴重衝擊我國卅萬美容美髮從業人員的生存,也會影響目前學習美容美髮的學生未來就業。圖為弘光科技大學美髮系舉行期中考的情形。 (資料照,記者歐素美攝)
〔記者羅添斌、賴筱桐、林相美、盧賢秀/綜合報導〕兩岸即將簽署「服務貿易協議」,陸委會及經濟部昨在立委質詢下被動透露,將開放中資進入台灣美容美髮市場。由於事前未徵詢我國業者意見,也無影響評估報告,嚴重衝擊我國卅萬美容美髮從業人員的生存,立委痛斥亂搞、不負責任。
我從業人員 憂中方低價搶市
美容美髮業界獲悉後指出,台灣市場已很飽和,業者在不景氣中苦撐,若開放中國業者,勢必重創台灣業界。新北市髮型設計師蔡純惠擔心,近年不少新住民投身美容美髮業,到處可見百元美髮店,連鎖店也跟著削價競爭,整個市場被打亂,一旦中國業者以低勞力成本為優勢,低價搶市,恐怕許多業者將被淘汰。
在台北市從事美容美髮業十五年的照偉也說,一旦開放中國業者,市場會更混亂,屆時恐陷入價格戰,低價競爭下,對台灣市場不是好事。基隆美髮業者劉春美則認為,面對中國業者來台,台灣唯一的優勢是技術與服務比較好,必須不斷精進技術才有競爭力。
沒徵詢 立委痛斥馬政府亂搞
民進黨立委陳其邁說,全國美容美髮業約卅萬從業人口,多為小規模經營,「對方如果來十家,我們可能會倒五家」,馬政府如此漠視國內業者及從業人員的權益,令人心痛。
立法院內政委員會昨邀陸委會、經濟部等相關部會,就「兩岸洽簽服務貿易協議對我相關產業及就業影響評估」做專案報告。
經濟部次長卓士昭指出,我方擬開放中方來台設立美容美髮業,規定要投入廿萬美金以上才能進來,但未開放他們的勞工來台,家數也沒有限制,因為規模比較大,不會是個體戶。
立委則駁斥,台灣業者大多是老闆兼洗頭妹,自己辛苦經營,如果中方人士來台開設,也可能是老闆兼洗頭,頂多請一兩位小妹,勢必嚴重衝擊台灣美容美髮業者。
立委追問,政府各部會有沒有先徵詢美容美髮業者意見,各部會代表都搖頭,而且竟連由哪個部會主管也莫衷一是;官員們看來看去,沒有一個部會站出來,會場氣氛尷尬。卓士昭最後說,會儘快協調相關部會向美容美髮公會及從業人員代表做意見徵詢。
服務貿易協議的特定承諾項目中,我方爭取到中方開放六十五項,我則對中開放五十五項。但經濟部不願說明五十五項的具體項目,只在立委質詢時被動回應,問一項說一項。
產業衝擊 官方推稱沒法量化
除先前傳出的金融、醫療、第二類電信及同意中方獨資在台設立旅行社外,根據陸委會先前送到立院的報告顯示,我方對中方開放的還包括養老院、劇院及殯儀館火化場等。昨在立委逼問下,陸委會及經濟部被動說出美容美髮業、小客車租賃業等也會向中國開放。
卓士昭面對立委詢問總體及個別產業會面對的衝擊、影響多少從業人口就業等,都拿不出具體數據,只一再用「沒有辦法量化」來解釋,朝野立委都無法接受。民進黨立委段宜康痛斥,經濟部是產業發展主管部會,怎麼可以自己都搞不清楚!
在野立委最後提案要求譴責陸委會、經濟部及勞委會等參與協議部會,但遭藍營否決。陸委會主委王郁琦回應說,願在三個月內、也就是立法院新會期前,將衝擊評估報告內容加以修正,並送交內政委員會。

2013年5月30日

Bill Gates比爾.蓋茲 財富淨值為729億美元 ,Carlos Slim史林則有678億美元

股價上漲 蓋茲財富再拉大距離

(中央社台北29日電)根據昨天公布的彭博億萬富翁指數(Bloomberg Billionaires Index),世界首富、微軟公司的共同創辦人比爾.蓋茲已拉大與墨西哥電信大亨史林的財富差距達51億美元。
幾乎所有蓋茲的(Bill Gates)投資價值,包括在微軟公司(Microsoft Corp. )的4.8%持股,今年以來急劇增加,但史林(Carlos Slim)主要的持股,墨西哥美洲電信公司(America Movil SAB )44%股份的價值卻下跌14%,美洲電信公司是美洲最大的行動電話業者。
蓋茲投資組合中獲利最大之一是毅康公司(EcolabInc. )。提供衛生和保健服務的毅康今年股價上漲22%,讓蓋茲的財富平白增加4億2300萬美元。蓋茲是透過華盛頓州喀斯喀特投資公司(Cascade Investment LLC)控制他的投資組合。
Stifel Nicolaus & Co.巴爾的摩辦公室分析師羅森邦(Shlomo Rosenbaum)在接受電話訪問時說:「90%他們所生產的產品都是被沖入排水管內,所以你必須一再的購買。他們已經將他們的資產投資組合重新配置在與能源市場關係更密切的資產。我認為這將有助於未來數年他們的收入增長。」
根據彭博社的排名,今年57歲的蓋茲財富淨值為729億美元,而73歲的史林則控有678億美元財富,今年以來史林的財富縮水74億美元,主要是因為美洲電信公司股價下跌。(譯者:中央社簡長盛)1020529

多家企業年獲利百億 稅率(0.2%~3.5%) 低於上班族

多家企業年獲利百億 稅率低於上班族



物價漲,薪水沒漲,但是5月報稅繳的這筆所得稅,可是讓不少民眾叫苦連天,有雜誌調查發現,年獲利百億元的24家企業當中,繳稅的稅率竟然比白領上班族還要低,像是2011年,緯創一毛也不用繳,徐旭東的遠東新世紀稅率0.2%,傳產龍頭台塑化只有3.5%,企業與個人稅率的差距,讓民眾怒批就像是圖利財團,很不公平。
5月報稅倒數計時,但財政部統計,現在仍有4成民眾,200多萬人沒有完成繳稅,只是年年繳稅,小老百姓很不甘心,因為從口袋中掏出的這一筆稅金,很可能比大企業繳得多。
民眾:「圖利財團啊,我對政府是一點信心都沒有。」
民眾:「大企業它那麼輕鬆,那麼多員工幫它賺錢,結果只有繳一點點,這當然不公平啊。」
驚呼不敢相信,但賺越多繳越少的不公平現象,似乎老早有徵兆,根據統計,台灣千大上市櫃公司最近5年實質稅率落在12.2%,這相當於一般中等家庭繳稅的比率,而且2011年當中,有24家的企業獲利超過100億,但這些最賺錢的企業實質稅率只有9.1%,比一個白領上班族的稅率還要低,台灣儼然變相成為企業的低稅天堂。
會計師公會全聯會稅務主委林宜賢:「它可以把利潤做切割,所以你會發現,公司稅之所以繳得少,它的問題是因為它整個交易是可以被切割的很細,那每一段的交易利潤可以放在不同國家的時候,它可以產生出一個極小化的綜效。」
也因此平面媒體報導,在2011年會出現緯創一毛錢也不用繳,徐旭東的遠東新世紀實質稅率不過0.2%,聯電0.3%,甚至台塑化也只有3.5%,長期下來,最直接受到影響的就是台灣的實收稅,從1999年的20%降到2011年的12.8%。
TVBS記者黃宇潔:「其實12.8%這個數字,甚至比鄰近的韓國25.8%,還有中國大陸19%都還要來得低,這其實長期下來,也突顯出台灣稅收不足,導致財政赤字的窘境。」
惡性循環下,台灣想要擺脫悶經濟,顯然還有很大的努力空間,即使政府祭出13項振興景氣措施,從擴大消費支出到提振國內投資都是主要目標,但專家眼中這些都不如「錢留台灣」來得實際。
林宜賢:「海外資金跟22K其實有連動的,因為這個資金你回來後,台灣還要課17%的稅,因此它就不想匯回來去繳17%的稅,但是它資金不回來,台灣就沒有辦法再投資,這個再投資包括徵人和加薪,至少加薪5%~10%的時候,所得稅的財政收入是增加的,大家有錢的話就會去花錢,然後消費就有營業稅5%嘛。」
因此,與其在乎政府訂出的名目稅率,再次突顯企業與個人的稅制不公,還不如深入檢討,怎麼讓企業甘願「錢留台灣」

in Pelaga 台灣指導峇里島農民種蘆筍 幫助他們增加收入、改善生計 Building pride through an unlikely vegetable

台灣指導種蘆筍 峇里人轉運

  • 2013-05-30 19:08
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  • 新聞速報
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  • 【中央社】
     中華民國國際合作發展基金會農技團技師蘇天集3年前赴印尼峇里島教導當地農民種植蘆筍,幫助他們增加收入、改善生計,重拾身為農民的驕傲。
     「雅加達郵報」(Jakarta Post)今天刊登這個故事。培拉佳村(Pelaga)擁有肥沃土壤及豐沛雨量,不過,當地農民習慣種植樹薯、玉米和咖啡等傳統作物,只能帶給他們每月最多10美元的淨收入。迫於生計,有些農民只好出售田地給別墅業者。
     最近培拉佳村農民售地求生存的情形幾乎消失了,原因就是蘇天集把蘆筍栽種引進當地,讓農民有錢賺。
     蘇天集接受中央社記者訪問時表示,他在評估培拉佳村農作條件、農民收益及市場導向後,決定帶領當地農民種植高附加價值的蘆筍。
     他說,以同樣大小的農地而言,當地農民過去種植樹薯、玉米,每年最多只能掙得100萬印尼盾(約新台幣3053元);改種蘆筍後,1年收成3次,收入增加至1200萬至1500萬印尼盾(約新台幣3萬6000元至4萬6000元)。
     談到改變當地農民耕作的方式,蘇天集說,最困難的地方是要扭轉他們的觀念,當地農民過去都是作物種了就不管,也不在意後續的照顧,他可是長久苦口婆心,才灌輸他們正確的農耕觀念。
     幾年下來,培拉佳村現在已經成為峇里島的高級蘆筍產地,頂級的蘆筍1公斤可以賣到5美元。
     當地農民卡圖特(Ketut)說,他種植的蘆筍都賣到超級市場、餐廳,甚至是雅加達,培拉佳村人如今不再視自己為低下的公民了。
     「耕種是最棒的工作」,卡圖特說,培拉佳村民過去常遠離家鄉去外地工作,不看好務農的前途,如今這裡的村民認為在故鄉耕作是全世界最好的工作;那些離鄉背井的村民現在也陸續返鄉加入耕作行列。
     從沒電、沒水的偏鄉孤軍奮戰到今天的成果,最讓蘇天集欣慰的是,培拉佳村民透過種植蘆筍重建身為農民的驕傲;更讓他感動的是,當地農民都知道這是來自台灣的技術和友誼,當地人講起台灣無不豎起大拇指,感謝台灣的幫助。1020530

Building pride through an unlikely vegetable

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Paper Edition | Page: 21
At work: Farmer Ketut Suriani (right) poses with local children at her farm in Pelaga. Asparagus cultivation, only recently introduced in the village, has changed the life of famers here. At work: Farmer Ketut Suriani (right) poses with local children at her farm in Pelaga. Asparagus cultivation, only recently introduced in the village, has changed the life of famers here.
Resting in the saddle formed by Bali’s central mountain range is the village of Pelaga. Hanging here in the space between heaven and earth are farmlands stretching away and up the slopes of the holy Mount Agung, Mount Batur and the Bedugul hill range. Billowy clouds skirt the mountains; their dark peaks above push up and into the realm of the gods.

It is cool and green here in this temperate zone, with soils enriched by past volcanic eruptions and good rainfall. Pelaga appears as a utopia on first discovery — a place to farm crops and raise healthy children.

However, until recently, local farming families struggled to net as much as US$10 a month from their efforts growing cassava, corn and coffee — all traditional foods sold at local markets. In desperation, some of these subsistence farmers sold off their heritage lands. Villas today dot a tapestry formed of ripening rice yellows, dark green channels of corn and the long chocolate lines of rich soil ready for cultivation.

Added to this tapestry is the soft sage green of a plant that is revolutionizing farming in Pelaga and bringing unexpected wealth to local farmers. Villa land sales have now almost stopped as farmers see a way forward. This newly introduced crop is today ensuring farmers can earn a living wage and rebuilding their pride in farming.

Three years ago, Su Tien Chi from Taiwan’s International Corporation Development Fund (ICDF) arrived in this paradise-in-waiting. An agriculture graduate, Chi saw immediately the potential to expand crop types and modernize local farming. Testing soon proved that asparagus was the ideal crop, offering both year-round harvesting and top-dollar returns to farmers. Within just two short years, Pelaga has become Bali’s center for the valuable and highly saleable asparagus that sells at $5 a kilo for grade-A spears.
Fresh: Baby beans are packed for the market at the cooperative.Fresh: Baby beans are packed for the market at the cooperative.
“It has been a great success and one we would like to see achieved in other parts of Bali. The goal of ICDF is our hope to improve economies,” says Chi via telephone.

Pelaga’s newly developed Mertanadi farmers’ cooperative, founded on the back of asparagus success, is run by a local man, Ketut Sandi. Born into a local farming family, Ketut took off for the bright lights and brighter expectations of Kuta, working in the tourist trade, until he decided the farming life, while tough, might offer a better quality of life.

“I met Mr. Su here in Pelaga and we had this commitment to work together for farmers. We did a year’s research growing broccoli, baby beans, cherry tomatoes and asparagus. Everything grew very well, but the asparagus was perfect and that has become our main crop selling to supermarkets and to restaurants as far away as Jakarta,” says Ketut, stressing that Pelaga farmers no longer see themselves as bottom-rung citizens, but as proud land owners who can save for the future using their newly created income.

“Before the asparagus people were leaving to find work away from the village. There was this feeling that farming was the poorest of all professions because it was hard, dirty work and money was always tight. Now people here see farming can be the best job in the world. Those that left the village are now coming back,” the 32-year-old said.

“We started two years ago with 15 farmers. We now have more than 150 growing asparagus and other high value crops. People are no longer selling off their lands — they know if they do they will feel remorse. They see now a road to a good future. Before they did not understand what they have here,” he added.

Delicious: An employee at the cooperative packs asparagus farmed in the village for shipment to Bali’s supermarkets and restaurants — and to restaurants in Jakarta.Delicious: An employee at the cooperative packs asparagus farmed in the village for shipment to Bali’s supermarkets and restaurants — and to restaurants in Jakarta.Farmer Ibu Ketut Suriani says growing asparagus has changed her life. Gone are the days of worrying over money.

“The result has been very good. Daily I can earn Rp 40,000 (US$4) from my 800 plants. If I had more land I could make far more income. Asparagus can be harvested every day, so we have income every day. From this money I can put aside Rp 10,000 a day, so we are saving money,” the 45-year-old said. “In the past, growing cassava and corn, we only made about Rp 500,000 over four to five months. That was very tough, so we farmers have all benefited very much from what Mr. Su has brought to us.”

Suriani grows broccoli, kale and baby beans, cultivating hedgerows between fields of jackfruit, bananas, papaya and durian.

As a farmer, Suriani also raises chickens, cattle and pigs. “We only need to buy a bit of rice and tempeh and water and power. We grow everything else we need.

“We feel happy every day to see the view of Mount Agung, feel the cool breeze and tend our farms,” she added.

Switching from traditional crops to asparagus that was first grown in Pelaga from root stock imported from California and Taiwan has also changed the life of one of 15 cooperative employees, 32-year-old Kardani. Her husband had long grown cassava, corn and coffee, barely scratching out a living despite many hours of backbreaking toil. Today Kardani’s family is doing well and has a disposable income that gives her greater choice in purchases.

“Life is far better since the asparagus. Mr. Su is a great man for the benefit he has brought our community. In the past we did make ends meet, but only just. We could buy rice, but not much else. These days we can shop for clothes and other things we need, we can buy more so we as a family are more relaxed and happy about the future. I think that’s because we have a better standard of living and we can give that to our kids,” said Kardani.

The cooperative’s goal is to expand asparagus farming across 50 hectares and further increase sales, says co-op head Ketut. Into the future these farmers that have taken a great step forward also hope to export their precious produce, become fully organic farms and share their newfound knowledge with other communities.
Astonishing: Pare, a very rare bitter gourd, is also grown in Pelaga for specialty markets.Astonishing: Pare, a very rare bitter gourd, is also grown in Pelaga for specialty markets.
Mist-skirted mountains: The farmers’ cooperative in Pelaga now has more than 150 farmer members and 15 employees growing and preparing the asparagus that have brought new wealth to local farmers.Mist-skirted mountains: The farmers’ cooperative in Pelaga now has more than 150 farmer members and 15 employees growing and preparing the asparagus that have brought new wealth to local farmers.

— Photos By J.B.Djwan

uilding pride through an unlikely vegetable

A- A A+
Paper Edition | Page: 21
At work: Farmer Ketut Suriani (right) poses with local children at her farm in Pelaga. Asparagus cultivation, only recently introduced in the village, has changed the life of famers here. At work: Farmer Ketut Suriani (right) poses with local children at her farm in Pelaga. Asparagus cultivation, only recently introduced in the village, has changed the life of famers here.
Resting in the saddle formed by Bali’s central mountain range is the village of Pelaga. Hanging here in the space between heaven and earth are farmlands stretching away and up the slopes of the holy Mount Agung, Mount Batur and the Bedugul hill range. Billowy clouds skirt the mountains; their dark peaks above push up and into the realm of the gods.

It is cool and green here in this temperate zone, with soils enriched by past volcanic eruptions and good rainfall. Pelaga appears as a utopia on first discovery — a place to farm crops and raise healthy children.

However, until recently, local farming families struggled to net as much as US$10 a month from their efforts growing cassava, corn and coffee — all traditional foods sold at local markets. In desperation, some of these subsistence farmers sold off their heritage lands. Villas today dot a tapestry formed of ripening rice yellows, dark green channels of corn and the long chocolate lines of rich soil ready for cultivation.

Added to this tapestry is the soft sage green of a plant that is revolutionizing farming in Pelaga and bringing unexpected wealth to local farmers. Villa land sales have now almost stopped as farmers see a way forward. This newly introduced crop is today ensuring farmers can earn a living wage and rebuilding their pride in farming.

Three years ago, Su Tien Chi from Taiwan’s International Corporation Development Fund (ICDF) arrived in this paradise-in-waiting. An agriculture graduate, Chi saw immediately the potential to expand crop types and modernize local farming. Testing soon proved that asparagus was the ideal crop, offering both year-round harvesting and top-dollar returns to farmers. Within just two short years, Pelaga has become Bali’s center for the valuable and highly saleable asparagus that sells at $5 a kilo for grade-A spears.
Fresh: Baby beans are packed for the market at the cooperative.Fresh: Baby beans are packed for the market at the cooperative.
“It has been a great success and one we would like to see achieved in other parts of Bali. The goal of ICDF is our hope to improve economies,” says Chi via telephone.

Pelaga’s newly developed Mertanadi farmers’ cooperative, founded on the back of asparagus success, is run by a local man, Ketut Sandi. Born into a local farming family, Ketut took off for the bright lights and brighter expectations of Kuta, working in the tourist trade, until he decided the farming life, while tough, might offer a better quality of life.

“I met Mr. Su here in Pelaga and we had this commitment to work together for farmers. We did a year’s research growing broccoli, baby beans, cherry tomatoes and asparagus. Everything grew very well, but the asparagus was perfect and that has become our main crop selling to supermarkets and to restaurants as far away as Jakarta,” says Ketut, stressing that Pelaga farmers no longer see themselves as bottom-rung citizens, but as proud land owners who can save for the future using their newly created income.

“Before the asparagus people were leaving to find work away from the village. There was this feeling that farming was the poorest of all professions because it was hard, dirty work and money was always tight. Now people here see farming can be the best job in the world. Those that left the village are now coming back,” the 32-year-old said.

“We started two years ago with 15 farmers. We now have more than 150 growing asparagus and other high value crops. People are no longer selling off their lands — they know if they do they will feel remorse. They see now a road to a good future. Before they did not understand what they have here,” he added.

Delicious: An employee at the cooperative packs asparagus farmed in the village for shipment to Bali’s supermarkets and restaurants — and to restaurants in Jakarta.Delicious: An employee at the cooperative packs asparagus farmed in the village for shipment to Bali’s supermarkets and restaurants — and to restaurants in Jakarta.Farmer Ibu Ketut Suriani says growing asparagus has changed her life. Gone are the days of worrying over money.

“The result has been very good. Daily I can earn Rp 40,000 (US$4) from my 800 plants. If I had more land I could make far more income. Asparagus can be harvested every day, so we have income every day. From this money I can put aside Rp 10,000 a day, so we are saving money,” the 45-year-old said. “In the past, growing cassava and corn, we only made about Rp 500,000 over four to five months. That was very tough, so we farmers have all benefited very much from what Mr. Su has brought to us.”

Suriani grows broccoli, kale and baby beans, cultivating hedgerows between fields of jackfruit, bananas, papaya and durian.

As a farmer, Suriani also raises chickens, cattle and pigs. “We only need to buy a bit of rice and tempeh and water and power. We grow everything else we need.

“We feel happy every day to see the view of Mount Agung, feel the cool breeze and tend our farms,” she added.

Switching from traditional crops to asparagus that was first grown in Pelaga from root stock imported from California and Taiwan has also changed the life of one of 15 cooperative employees, 32-year-old Kardani. Her husband had long grown cassava, corn and coffee, barely scratching out a living despite many hours of backbreaking toil. Today Kardani’s family is doing well and has a disposable income that gives her greater choice in purchases.

“Life is far better since the asparagus. Mr. Su is a great man for the benefit he has brought our community. In the past we did make ends meet, but only just. We could buy rice, but not much else. These days we can shop for clothes and other things we need, we can buy more so we as a family are more relaxed and happy about the future. I think that’s because we have a better standard of living and we can give that to our kids,” said Kardani.

The cooperative’s goal is to expand asparagus farming across 50 hectares and further increase sales, says co-op head Ketut. Into the future these farmers that have taken a great step forward also hope to export their precious produce, become fully organic farms and share their newfound knowledge with other communities.
Astonishing: Pare, a very rare bitter gourd, is also grown in Pelaga for specialty markets.Astonishing: Pare, a very rare bitter gourd, is also grown in Pelaga for specialty markets.
Mist-skirted mountains: The farmers’ cooperative in Pelaga now has more than 150 farmer members and 15 employees growing and preparing the asparagus that have brought new wealth to local farmers.Mist-skirted mountains: The farmers’ cooperative in Pelaga now has more than 150 farmer members and 15 employees growing and preparing the asparagus that have brought new wealth to local farmers.

— Photos By J.B.Djwan

http://www.thejakartapost.com/news/2013/05/30/building-pride-through-unlikely-vegetable.html

2013年5月29日

部分中盤商賣的地瓜粉,順丁烯二酸含量高達2159ppm 30毫克順丁烯二酸=15公克地瓜粉含量 一口問題肉圓 毒害腎功能

問題肉圓太誇張 長期食用有害

(中央社記者陳清芳台北29日電)順丁烯二酸酐不得直接添加於食品,日前在肉圓的檢出值達上千ppm,衛生官員和毒物專家直呼誇張,長期食用有健康危害。
台中市衛生局日前查獲,部分肉圓原料將近2成含順丁烯二酸酐化製澱粉,不肖中盤商賣的地瓜粉,順丁烯二酸含量高達2159ppm。
專攻環境及細胞分子毒理的衛生署食品藥物管理局長康照洲、林口長庚醫院毒物科主任林杰樑今天均指出,這種問題肉圓只要吃上半顆、或一口,就超過歐盟的順丁烯二酸人體耐受量。
歐盟評估,成人的每公斤體重每日對順丁烯二酸耐受量是0.5毫克,以60公斤的成人計算,每日耐受量為30毫克。假設產品中含順丁烯二酸濃度400ppm,每日食用30公克產品估計,則每日所攝入順丁烯二酸量約12毫克,仍在安全範圍下。
究竟有多毒?林杰樑認為,腎功能不好的人,食用問題肉圓,就像在服毒。不過,康照洲說,毒不毒,要看食用劑量、食用時間而定,長期天天食用問題肉圓,會有健康危害,如果要吃到短期急毒性,消費者可能「先被澱粉淹死」。
康照洲並指出,人體耐受量與檢出量,是兩個截然不同的觀念,衛生署從未核准順丁烯二酸酐直接添加於食物,或用於食品加工,因此食品「不得檢出」順丁烯二酸,違法添加者,都要依食品衛生管理法懲處。
他說,除非食品包裝材料合法使用順丁烯二酸,食品會接觸到包材,可以容許包材中的順丁烯二酸微量溶出到食品。1020529

http://tw.news.yahoo.com/%E5%95%8F%E9%A1%8C%E8%82%89%E5%9C%93%E5%A4%AA%E8%AA%87%E5%BC%B5-%E9%95%B7%E6%9C%9F%E9%A3%9F%E7%94%A8%E6%9C%89%E5%AE%B3-093435802.html

夏天提前報到! 印度47度破紀錄 2013/05/26 12:00

夏天提前報到! 印度47度破紀錄

2013/05/26 12:00 

進入五月底,夏天的腳步越來越近了,不過在印度北部跟西部地區,熱浪則是提前報到,氣溫直飆到攝氏46度,部份地區甚至創下攝氏47度的高溫錄,民眾幾乎被熱到受不了。
  印度首都新德里豔陽高照,戶外熱氣逼人,連應該站在馬路上值勤的安全人員,也全躲到樹下躲太陽,因為天氣實在太熱了,氣溫飆到攝氏46度,大家熱到受不了,紛紛躺在樹底下乘涼。還有婦女外出,也顧不得美醜,把自己包成蒙面客;至於在人潮擁擠的車站等車的民眾,也是猛拿毛巾扇子搧風;甚至有婦孺不管三七二十一,直接躺在地板上,就為了對抗酷熱的天氣.
熱浪提前報到,印度北部跟西部籠罩在高溫當中,不但民眾受不了,連農作物也快被大太陽烤乾,農民緊急澆水灌溉,就怕自己的心血化為烏有。根據印度的氣象預報,這波熱浪還會持續好幾天,大家還得繼續跟高溫奮鬥一陣子。

日本對外純資產世界第一 連續廿二年居全球首位 中國第二 德國第三

連續22年世界第一-日圓貶 日對外純資產創新高

  • 2013-05-29 01:25
  • 中國時報
  • 【黃菁菁/東京廿八日電】

     日圓貶值使日本截至去年底的對外純資產創下歷史新高,達到逾二百九十六兆日圓(約新台幣八十七兆元)。日本的對外純資產自一九九一年以來,已連續廿二年居世界第一,是排名第二的中國近兩倍。
     日本財務省廿八日公布截至二○一二年底的日本對外資產負債表顯示,日本政府、企業及個人持有的海外資產減去負債後的對外純資產,達到二百九十六兆三千二百億日圓,比一一年年底增加一一.六%,創下了歷史新高紀錄。
     日本政府、企業、個人在海外擁有的資產達六百六十一兆九千零廿億日圓,比上一年增加一三.八%,已連續四年增加。對外負債則為三百六十五兆五千八百八十億日圓,也比上一年增加一五.七%,已連續三年增加。
     這主要是因為到去年底為止日圓持續貶值,使日本投資人在外持有的股票、債券等資產,以日圓換算後金額上漲,日圓貶值也使日本企業對海外併購、投資增加。
     財務省指出,日本對外純資產在主要國家當中,已連續廿二年居全球首位,排名第二的中國擁有的對外純資產約為一百五十兆三千億日圓,德國約為一百廿一兆九千億日圓。

http://news.chinatimes.com/world/110504/112013052900139.html

2013年5月28日

塑化劑事件已過兩年 食管法修正草案 衛生署 立法院


塑毒事件兩年了 食管法草案還躺立院

衛生署表示將加速食品衛生管理法修法,研擬加重罰則,不肖製造業者最高可罰千萬元;業者若明知故犯,使用非法的食品添加物,最高罰三百萬元。
衛生署長邱文達說,食品衛生管理法部分條文已修正,去年八月行政院通過食管法修正草案,今年一月完成大體討論,立法院周四將再度審查,衛署擬加重罰則及業者責任,希望儘速完成修法,以遏止不肖業者違規行徑。
塑化劑事件已過兩年,食管法修正草案仍躺在立法院。食品藥物管理局局長康照洲也很無奈,但表示,食管法已先對非法原料製造商加重罰則從六萬至六百萬元,並納入刑責,一旦有危害健康事實,可處七年以下有期徒刑;若業者使用未經許可的食品添加物,現行法規僅罰三萬至十五萬元。

http://tw.news.yahoo.com/%E5%A1%91%E6%AF%92%E4%BA%8B%E4%BB%B6%E5%85%A9%E5%B9%B4%E4%BA%86-%E9%A3%9F%E7%AE%A1%E6%B3%95%E8%8D%89%E6%A1%88%E9%82%84%E8%BA%BA%E7%AB%8B%E9%99%A2-184100944.html

2013年5月27日

一個體重六十公斤的成年人可耐受三十毫克(0.03g) 順丁烯二酸


超Q粉圓黑輪 驗出工業澱粉

吃的粉圓超Q嗎?小心,你可能已經吃進了工業化製澱粉!用「順丁烯二酸」增加口感
衛生署日前接獲線報指出,部分廠商在製造過程中為增添口感,違規使用工業用「順丁烯二酸」(Maleic acid)化製澱粉,經抽查市售產製品、並循線追查上游原料廠後,發現有兩家製粉廠出售的化製澱粉及地瓜粉驗出超量順丁烯二酸,以致其下游四家業者、共八種產品有問題澱粉,包括粉圓、芋圓、地瓜圓、板條及黑輪等產品都遭到問題化製澱粉污染,甚至各大連鎖超商也都曾進用問題黑輪,但都已下架停售。衛生署下架並封存的問題產品,數量高達廿五噸。
芋圓、地瓜圓、板條也有
衛署食品藥物管理局食品組副組長馮潤蘭指出,已抽查市售澱粉類產品如太白粉、地瓜粉等共二十五件及澱粉相關製品四十九件,其中四十九件澱粉製品中,五件檢出順丁烯二酸,擴大追查發現,一共八種製品違規,但這些問題產品大多並非業者惡意添加,而是用到了有問題的原料澱粉,主要來自協奇澱粉行的「奇奇化製澱粉」及怡和澱粉公司的「地瓜粉」。
衛生署區管中心主任潘志寬指出,協奇澱粉行的經銷處在新北市,製造廠在台南,稽查人員在廠區未發現與順丁烯二酸相關原料,已要求工廠停止製造;怡和澱粉的地瓜粉則為越南進口品,已要求停止進口。
台南市衛生局指出,協奇澱粉行劉姓業者始終否認違規添加順丁烯二酸,並說原料是台北業者提供,現仍積極釐清中。
奇奇化製澱粉部分產品驗出順丁烯二酸濃度將近5000ppm,林口長庚醫院臨床毒物科主任林杰樑指出,這個濃度對人體足以造成傷害。過去動物試驗顯示,狗對於順丁烯二酸較敏感,每公斤體重暴露量大於九毫克,就會造成腎小管壞死、急性腎衰竭等。
歐盟評估,成人每公斤體重順丁烯二酸可耐受量是○.五毫克一個體重六十公斤的成年人可耐受三十毫克。以這次檢出的最高劑量產品劉記粉圓的小粉圓779ppm來算,一天食用超過四十公克就會超量。
嘉義的劉記粉圓懷疑是二月前使用的地瓜粉新配方出問題,希望衛生署早日釐清,讓工廠恢復正常運作。
兩家製粉廠被查獲超量
高市衛生局食品衛生科科長謝秀琪表示,高雄長勝食品業者被檢出關東煮黑輪和冷凍正宗黑輪有問題,業者在四月二十八日自行送驗,發現有順丁烯二酸成分,已主動銷毀二萬五千公斤原料,衛生局調查該業者都有落實自主管理,研判應非蓄意增添。
新北市政府衛生局昨晚表示,已查封一萬二千多公斤違規原料及產品,包括建美食品公司的美濃板條,但賞味佳食品公司製售的九份芋圓及地瓜圓共一百六十公斤均已銷售完畢,消費者恐已吃進肚裡。自由時報0513

南檢訪談王老師


南檢訪談王老師 王堅持:依我的方法不會有毒

  • 2013-05-27 22:04
  •  
  • 新聞速報
  •  
  • 【中廣新聞/劉怡伶】

    毒粉事件引發恐慌,被指為傳授配方的關係人「王老師」,下午接受台南地檢署檢察官「訪談」,南檢表示本案是否構成刑罰或僅止於行政罰階段,還有討論空間,檢方考慮行政單位稽查深度有限,因此指揮相關單位調查,王老師堅稱他的方法製造的修飾澱粉不會有毒。
    警方其實一早就登門找「王老師」,不過王老師在友人陪同下,出門去走走,警方撲了個空;根據友人表示,王老師前一晚接受媒體訪問後,情緒很差,一整天都沒有吃飯,隔天一早身體不太舒服,所以先前往就醫,直到下午四點多才回家。
    臺南地檢署檢察官周盟翔於27日下午4時30分,帶同書記官並會同臺南市衛生局人員,前往長榮路王老師住處,除了想進一步了解毒粉事件外,也針對住處進行初步勘查;周檢察官表示,王老師的身分並非嫌疑人。
    南檢指出,本案是僅止於行政罰的階段?還是有刑罰構成的空間,尚有相當的灰色地帶,因此從案發開始至今,仍是以衛生主管機關為主、檢察官的協助為輔。但專案小組考慮到衛生行政機關稽查的深度有限,且可能涉及食品衛生管理法、刑法公共危險罪的可能,衛生局函由檢方指揮偵辦協助調查。
    根據檢察官訪談初步結果,王老師是中興大學化學系畢業民國60年初任教於北門高中時研發出添加「順丁烯二酸酐」在澱粉的技術;任職北門高中時,曾到將軍鄉某公司技術指導二個月;王老師堅持用他的方法製造修飾澱粉不會有毒性。
    http://news.chinatimes.com/focus/130501/132013052701334.html



訪王東清 檢疑嫡傳協奇散毒

  • 2013-05-28 01:14
  •  
  • 中國時報
  •  
  • 【黃文博、程炳璋、洪榮志/台南報導】
     毒澱粉案危害層面擴大,台南地檢署昨前往訪談王東清。王坦承率先以順丁烯二酸酐作為添加劑配方,並於四十二年前擔任協奇澱粉公司「技術指導」二個月。而台南衛生局則對協奇開罰,並將該公司移送檢方偵辦,檢方也將毒澱粉擴散源頭則指向協奇。
     昨日下午四時卅分,檢察官周盟翔率書記官、會同台南市衛生局食品藥物管理科人員前往王東清住處約談王東清。
     指導二個月 王與協奇鬧翻
     辦案人員透露,此案經台南地檢署檢察官與衛生局研究,目前尚屬行政罰階段,要納入刑罰範圍尚有相當的灰色地帶,即擬依法追究刑責仍有障礙,找不到法條可傳喚王東清;昨天是在民意代表壓力下,檢方不得不約談王東清。
     台南市政府衛生局則決定,近日正式函請地檢署,由檢察官周盟翔指揮偵辦,協助衛生主管機關調查。
     周盟翔昨日訪談王東清,得知他曾到台南縣將軍鄉協奇澱粉公司進行為期二個月技術指導,只領了十萬元技術指導費,雙方就鬧翻,王即不再提供技術指導。
     衛生局約談 協奇交代不清
     王東清仍然向檢察官堅持,他研發出來的順丁烯二酸經水洗去酸後,是無毒的配方,坊間後來發展出毒澱粉,與他原本的技術已有落差。
     台南地檢署、台南市衛生局約談王東清後,種種跡證顯示,毒澱粉配方的擴散,協奇澱粉公司扮演關鍵性角色。衛生局除對協奇開罰十三萬元外,也將該公司移送檢方偵辦。
     衛生局約談協奇業者時,對方承認修飾澱粉配方來自王東清,但對配方是否外流、有否依原先配方生產修飾澱粉等諸多細節,始終交代不清。
     檢衛人員查出協奇是王東清唯一「嫡傳」廠商,在沒有王東清曾販賣或親自指導其他廠商生產修飾澱粉的證據出爐前,協奇成為毒澱粉擴散的關鍵廠商。
     含毒量差異甚大 製程各異
     檢衛人員還懷疑,外傳王東清以高達五十、一百萬元的代價四處兜售毒澱粉配方,但迄今沒有廠商指證曾向王購買配方,或請他親自指導。而所有聲稱配方來自「王教授」的廠商生產出來的修飾澱粉,被驗出順丁稀二酸的含量也差異甚大,從八百ppm到四千ppm都有,顯然每家廠商的毒澱粉製程也有差異。
     檢衛人員推測,王東清的修飾澱粉配方極可能從協奇外流,但將配方外流者,對部分關鍵技術及順丁稀二酸用量沒有掌握得很好,導致外流的技術被濫用成為危害大眾的毒澱粉。檢方將循此一管道,擴大追查協奇員工及離職人員的涉案程度。

何謂馬來酸酐

塑膠物語: 何謂馬來酸酐

Materials  │ Compounding  │ Basic  │
 compounding, blend, mix, composite, polymer, co-polymer, coupling, crosslink, agent, compatilizer
PlasTerm.Figure   ..PIKE

 
順丁烯二酸酐 (Maleic anhydride)  又名馬來酸酐或失水蘋果酸酐﹐常簡稱 順酐。無色結晶﹐有強烈刺激氣味﹐凝固點 52.8℃﹐沸點 202℃﹐易昇華。主要由苯或碳四餾分中的正丁烷或丁烯氧化而製得﹐是生產不飽和聚酯及有機合成的原料。

 
沿革
順酐已有 160 多年歷史。早在 1817 年曾由蘋果酸脫水蒸餾製得順酐。1933年﹐美國國民苯胺和化學品公司實現了苯氣相催化氧化製順酐的工業生產。1960年﹐美國石油-得克薩斯化學公司建 立了由丁烯氧化生產順酐的工業裝置。首先以正丁烷為原料生產順酐的﹐則是1974年美國孟山都公司所建立的工廠。用 C4 烴為原料的比例雖有增長﹐但目前以苯為原料的裝置的生產能力仍佔 60% 以上。1984 年﹐世界順酐的生產能力是  630 kt。


生產方法
除以苯為原料和 C4 烴為原料兩條路線外﹐用或二甲苯生產鄰苯二甲酸酐時也副產順酐﹐生產每噸鄰苯二甲酸酐大約可回收 50kg 的純順酐。反應方程式為﹕
         


苯氧化法
苯氧化為順酐是在催化劑存在下進行的。常用催化劑的活性組分均為釩的氧化物(見金屬氧化物催化劑)﹐為抑制苯被完全氧化﹐常加入鉬﹑磷﹑鈦﹑鎢﹑銀及鹼金屬等元素的氧化物為添加劑﹐並採用低比表面的惰性物質為催化劑載體﹐如 σ -氧化鋁﹑剛玉等。反應在常壓下進行﹐溫度 350~400℃。工藝過程由苯的氧化﹐順酐的分離和提純兩大部分組成(見下圖: 苯氧化生產順丁烯二酸酐流程 )。苯蒸氣和空氣能形成爆炸混合物﹐所以進入反應器的混合氣中﹐苯的濃度應在爆炸極限之外﹐一般為 1%~1.4%(摩爾, mole)。苯氧化為強放熱反應﹐工業上常採用列管式固定床反應器﹐有很大的傳熱面﹐管外為冷卻系統﹐反應熱可用於產生高壓蒸汽。離開反應器的氣體中含順酐約 1%(摩爾)﹐用冷卻的辦法可將其中所含一半左右的順酐冷凝為液體﹐其餘部分則用吸收法回收。吸收劑用水或惰性有機溶劑﹐大多數工廠採用的是水。所得到的吸收液是順丁烯二酸的水溶液﹐濃度 35%~40%(質量)﹐需用共沸溶劑(例如二甲苯﹑苯甲醚)進行脫水﹐把酸重新轉化成酸酐。脫水也可在膜式蒸發器中進行。粗酐經減壓精餾可得成品。以苯計算﹐整個過程的順酐收率為92%~96%(質量)。




C4 烴氧化法
正丁烷與丁烯均含有與順酐相同的碳原子數﹐是生產順酐的理想原料。由於正丁烷價格較其他原料低廉﹐用正丁烷更為有利。其流程與苯氧化法基本相同﹐催化劑為釩-磷-氧體系﹐添加劑有鐵﹑鉛﹑鋅﹑銅﹑銻等元素的氧化物。可用固定床反應器或用流化床反應器﹐反應溫度約 400℃。正丁烷-空氣混合物中正丁烷濃度為1.0%~1.6%(摩爾)。整個過程的順酐收率按正丁烷計約為 50%。由於 C4 烴氧化的選擇性較低﹐因此設備投資較以苯為原料時為高﹐且後加工不能採用部分冷凝﹐而必須將反應氣體中的順酐全部用吸收法回收﹐從而使能耗加大。但由於正 丁烷價格比苯便宜﹐而且苯毒性大。因此﹐以正丁烷為原料是有吸引力的﹐對本法所用催化劑的改進工作﹐各國都在大力進行中。


用途
順酐的主要用途是生產熱固性樹脂﹑不飽和聚酯。此外﹐也有較大量的順酐用於生產反丁烯二酸﹑酒石酸及蘋果酸﹐以及作為農藥馬拉硫磷(殺蟲劑)及有機藥物長效磺胺(見磺胺藥)的原料。順酐也是生產醇酸樹脂﹑油漆﹑染色助劑﹑增塑劑 (如順丁烯二酸二丁酯)﹑潤滑油添加劑以及脂肪和油脂的防腐劑等的原料。

顺丁烯二酸酐(maleic anhydride,简称MA)俗称马来酐或马林酸酐

 http://www.hnkingway.com/zh-cn/product_5_21.html

顺酐
顺丁烯二酸酐(maleic anhydride,简称MA)俗称马来酐或马林酸酐,是一种重要的基本有机合成原料,主要用于制造不饱和聚酯树脂、THF、反-丁烯二酸(fumaric acid)、苹果酸
、润滑油添加剂、纸张处理剂、合成树脂涂料、PVC安定剂、可塑剂、界面活性剂、农药和其它特种化学品等。
  马来酐一般属工业级,由于利用其转换纯化可制造出多种产品,因此进一步区分为医药级及食品级。马来酐之分子式为C4H2O3、分子量98.06、比重1.509、外观呈白色,以针
状、杆状、片状、块状、煤球状结晶或熔融等状态存在,自燃温度476℃、熔点为53℃、沸点为202℃、闪火点为101℃。马来酐具有升华性,与水化合时对皮肤组织及眼睛具强刺激性>,空气容许量为0.25ppm;可溶于水、丙酮、酒精和1,4-dioxane,部份溶于氯仿和苯;加水分解成马林酸;加醇分解成酯类。
二、马来酐之用途
  马来酐为可作多样变化的单体或化学品中间体,而有多种用途,其中用于不饱和聚酯树脂,几乎占有其一半的消耗量,其它尚可应用为添加剂、醇酸树脂、反-丁烯二酸或苹>果酸及农药化学品等。最近几年马来酐也成为制造1,4-丁二醇(1,4-BDO)的原料。1997年西欧国家开始使用此法生产1,4-丁二醇,南韩、日本及美国业者也陆续跟进。目前我国所>产制的马林酐大约有90%是用于生产不饱和聚酯,少部份用于生产松香皂及其它产品。
三、马来酐的制造
  基本上马来酐系由碳氢化合物在触媒下进行气相氧化而制成。在1975年以前几乎都是以苯为原料,1976年Amoco首先发展以正-丁烷(n-butane)为原料的制程。基于环保及经济
的考量,目前全球生厂商大多采用正-丁烷为原料,如美国的马来酐厂商目前都采用以正-丁烷为原料之气相氧化制程,西欧则有67%的产能采用正-丁烷或丁烯,但日本是68%的产>能采用苯,只有30%采用C4 馏份或正-丁烷为原料。因丁烷价格较低,近年来马来酐厂商也有以丁烷为制程原料者。
在反应槽方面,1989年以前都是使用固定床反应器,主要技术授权者有Lonza、Huntsman及Scientific Design。于1990年代后期,西欧、远东及南美的新厂开始采用流体化床生产
,主要授权者有ALMA及BP,三菱化学亦与英国的BOC公司合作开发新型流体化床触媒,称为气体回收制程(gas recycle process)。
  四、我国马来酐之供需情况
合兴石化及成国化学为我国生产马来酐的两家厂商,产能分别为2万公吨/年与2.7万公吨/年。主要用于生产1,4-丁二醇、不饱和聚酯树脂、醇酸树脂,及转化为富马酸或苹果酸。
五、全球之供需状况与未来展望
 2000年全球马来酐的需求量将近1百万公吨,约为1994年的二倍,分析家并预测在2004年后,其需求量还会再有二倍的成长。促使马林酐需求成长的原动力来自于1,4-丁二醇的制
程转换。近年来欧美日等先进国家,纷纷改用以马来酐为原料的1,4-丁二醇制程。据SRI的分析,到2004年时,1,4-丁二醇的需求量平均每年将以23%的速率成长,另外,仅占有马
来酐少量用途的马来酸,在未来数年内的需求成长率大约也在17%/年。为因应全球对马来酐需求的逐年增加,全球马来酐的生产商均在高开工率下生产马来酐,2000年的开工率大
约为80%,推估未来十年将提高为89~93%。预测到2005年期间,马来酐生产量之年平均成长率为7%,而后到2010年间,成长稍缓,呈5%/年的速率增加。在1,4-丁二醇之外,THF(tetrahydrofurane)及其它衍生物将逐渐发展成为马来酐的主要用途。
全球在2000年时马来酐的产能约为130万公吨,其中23%分布在亚洲地区、49%在欧洲,而23%在北美(图三)。SISAS、Huntsman、DuPont 、Lonza、Ashland、Bayer、BP 及Tonen(东
燃化学) 是全球生产马来酐的八大厂商,合计产能占有全球的59%(图四)。但其中东燃化学已于2001年6月底将其生产设备停工,未来可能造成亚洲地区的供需紧迫。
六、结论

  整体而言,未来全球马来酐需求量增长的关键因素之一在于1,4-丁二醇市场。马来酐是生产1,4-丁二醇最具竞争力的原料之一,特别是现在丁烷的价格相当低,而新的丁烷/>马来酐制程较传统制程便宜,若1,4-丁二醇的制造厂选择马来酐为原料,将对拓展马来酐的市场极为有利。

王東清(2008) : 修飾澱粉即可以完全替代傳統甘薯粉在於肉圓之粉皮、冬粉、粉粿、粉條等製造,且更優於原有甘薯粉之澱粉性、風味及口感,進而改善現有甘薯粉價格昂貴、產量少之情況

由上述實施步驟製造而得之修飾澱粉即可以完全替代傳統甘薯粉在於肉圓之粉皮、冬粉、粉粿、粉條等製造,且更優於原有甘薯粉之澱粉性、風味及口感,進而改善現有甘薯粉價格昂貴、產量少之情況。

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食品用修飾澱粉之製造方法
MANUFACTURING PROCESS FOR MODIFTING STARCH FOR FOOD PRODUCTS
MANUFACTURING PROCESS FOR MODIFTING STARCH FOR FOOD PRODUCTS
  [21] 申请号
TW200800112557  [22]  申请日 20080407
  [11] 公开号
TW200942553
 [43]  公开日
20091016
  [11] 授权号

 [24]  授权日
  [30] 优先权 TW200800112557 20080407;
  [58] 技术领域 淀粉衍生物的制备 Preparation of chemical derivatives of starch     查看同类专利
  [64] 同族专利 查看同族专利
  [71] 申请人
王東清  WANG, TUNG CHING 
 [71]  地址
臺南市東區長榮路2段32巷156號3樓 TW 
  [72] 发明人
王東清 WANG, TUNG CHING   [52]  欧洲/日本 分类 C09D011/02B  C09D007/00D  D06M015/11  D06P001/38  D06P001/44B  D06P001/48  D06P003/00R  D06P005/00B 
  [51] 国际主分类 C08B031/00   [51]  国际分类 C08B031/00 
  [52] 美国主分类 536/102   [52]  美国分类 536/102 
  [57] 摘要


本發明係有關於一種食品用修飾澱粉之製造方法,尤其係指一種將樹薯粉經由氧化、酯化、還原

與凝結之程序,以製成完全替代傳統甘薯粉之修飾澱粉。
按,澱粉是一種自然存在,可大量獲得的有機醣類,在各種綠色植物,如:樹薯、甘薯、馬鈴薯、玉米及小麥等的根、莖、果實種子內皆可尋獲,是供應人們生活上的重要能量來源,在生活裡扮演非常重要的角色。
而由澱粉再加工的食品,更是多不勝數,有粉條、粉粿、米苔苜、麵線、冬粉、米粉等各式麵食類及蘿蔔糕、豬血糕、年糕等糕式點心,或湯圓、肉圓之粉皮等。
在各式製成澱粉的原料中,就以樹薯的價格最為便宜,曾有業者將樹薯製成澱粉加入水中,再加入次氯酸鹽加以氧化後製得之澱粉,用以替代產量少、價格貴的甘薯粉,而此經過化學或物理性加工處理而得之澱粉,即稱之為「修飾澱粉」。
然,此由樹薯澱粉再經過次氯酸鹽氧化後製得之修飾澱粉,無論在澱粉性、風味及口感上仍不及甘薯粉,並且於製造過程中殘留之次氯酸鹽僅藉由乾燥時之分解效果,並無法完全去除乾淨,因此,其食用安全性著實勘慮。
緣是,本發明者有鑑於上述樹薯澱粉之物性轉化成優於甘薯粉製作方法上的缺失,乃藉其多年於相關領域的製造及設計經驗和知識的輔佐,並經多方巧思,針對該現有之「修飾澱粉」製法做更新的研發改良,務期發揮其更高的實用效益性。
本發明係有關於一種食品用修飾澱粉之製造方法,其主要實施目的係為了提供一種將樹薯粉之物性轉化成優於甘薯粉之修飾澱粉的製法。
於是,本發明人為達上述實施目的,乃研擬如下製作步驟:a.氧化:將樹薯粉放入水中,以形成澱粉乳,再加入氧化劑,產生氧化反應。
b.酯化:氧化反應後,繼在澱粉乳中加入馬來酐(maleic anhydride),而與澱粉結合形成馬來酸澱粉。
c.還原:酯化完成後,繼續加入還原劑,以中和氧化劑。
d.凝結:復加入明礬類,使澱粉中分子收縮結合。
據此,經由上述實施步驟製造而得之修飾澱粉即可以完全替代傳統甘薯粉在於肉圓之粉皮、冬粉、粉粿、粉條等製造,且更優於原有甘薯粉之澱粉性、風味及口感,進而改善現有甘薯粉價格昂貴、產量少之情況。
而為令本發明之技術手段、發明目的及達成功效能夠有更完整且清楚的揭露,茲詳細說明如下,並請一併參閱所附之圖式及圖號。
首 先,請參閱第一圖所示,為本發明之食品用修飾澱粉之製造方法,其實施步驟係包含如下:a.氧化:將樹薯粉放入水中,以形成濃度為35~40%的澱粉乳,再 於常溫下約25~30℃加入氧化劑,該氧化劑之使用量約為澱粉乾量的0.06~0.12%,係以次氯酸鹽為主,該次氯酸鹽又包含次氯酸鈣與次氯酸鈉,而次 氯酸鈉主要係使用於紅皮樹薯,當澱粉乳呈現粉紅色時,則以次氯酸鈉作為漂白之用。
繼之,攪拌3~5小時,使大部分的氧化劑與澱粉產生反應。當澱粉與氧化劑反應後,澱粉產生糊化容易、黏度降低、穩定性高、顏色潔白、透明度高、成膜性佳等變化,而此變化經煮泡後可以更明顯表現。
又,為了形成較多量的羧基,係把酸鹼(PH)值設定在微鹼性8.0~9.5之間,以藉由羧基降低鏈澱粉的凝沈性,更進一步改進澱粉性質,而其化學反應式,請參閱第二圖所示。
b. 酯化:氧化反應後,為增強澱粉之硬度、彈性,係繼在澱粉乳中徐徐加入馬來酐(maleic anhydride),同時加入稀氫氧化鈉溶液,以維持其酸鹼(PH)值在7~11間[最適當的是在酸鹼(PH)值8.0~8.5的微鹼性],以促進其解 裂而與澱粉結合形成馬來酸澱粉,其反應式係如第三圖所示。
又,馬來酐(maleic anhydride)的使用量為澱粉乾量的0.5~5.0%,徐徐加入到加完的時間大約15~30分鐘,加完後繼續攪拌2~3小時,此時,澱粉乳濃度約35~40%。
c. 還原:經酯化完成後,繼續加入還原劑,該還原劑係可以為亞硫酸鈉、重亞硫酸鈉(或稱亞硫酸氫鈉)、保險粉(或稱低亞硫酸鈉)等,其中,以重亞硫酸鈉 (Sodium metabisulfite)最為適當,不但將第一步驟所加入的殘存氧化劑,如次氯酸鹽中和掉,同時多餘的重亞硫酸鈉係破壞馬來酐(maleic anhydride)之雙鍵而與之結合,其化學反應式係如第四圖所示,此時,澱粉糊係變得更硬、更具彈性。
d.凝結:復加入明礬類,其中以鉀明礬最為適宜,於加入明礬類後,澱粉中分子間的收縮結合效果,係構成類似甘薯粉糊的硬度,並且其彈性、粉性更優於甘薯糊。
據此,由上述實施步驟製造而得之修飾澱粉即可以完全替代傳統甘薯粉在於肉圓之粉皮、冬粉、粉粿、粉條等製造,且更優於原有甘薯粉之澱粉性、風味及口感,進而改善現有甘薯粉價格昂貴、產量少之情況。
再 者,本發明人係進一步提供其實作上之實例參考,係如下所述:實例一、將樹薯粉5000公斤加入6000公升水中,製成澱粉乳,攪拌調整至酸鹼值為8.5左 右,然後,加入65%之次氯酸鈣4公斤,於常溫下繼續攪拌3小時後,滴加濃度3%之氫氧化鈉液,同時加入馬來酐,以保持酸鹼值在8.0~8.5,約 20~30分鐘加完馬來酐50公斤,攪拌2.5小時後,加入重亞硫酸鈉55公斤,此時,酸鹼值約在6.0~6.5,以稀鹽酸調整酸鹼值為6.0,攪拌4小 時後加入鉀明礬38公斤,調整酸鹼值為4.5,攪拌過後,脫水過濾、水洗、乾燥、包裝即得產品。
實例二、樹薯粉2000公斤加入2400公升水 中,製成澱粉乳,攪拌下加入10%之次氯酸鈉30公斤,於常溫下繼續攪拌3小時後加入濃度3%之氫氧化鈉液,同時加入馬來酐,以保持酸鹼值在 7.0~8.5,約20~30分鐘加完馬來酐24公斤,攪拌2.5小時後,加入重亞硫酸鈉18公斤,此時,酸鹼值約在6.0~6.5,以稀鹽酸調整酸鹼值 為6.0,攪拌4小時後加入鉀明礬14公斤,調整酸鹼值為4.5,攪拌過後,脫水過濾、水洗、乾燥、包裝即得產品。
實例三、樹薯粉2000公斤加 入2400公升水中,製成澱粉乳,攪拌下加入10%之次氯酸鈉30公斤,攪拌3小時後加入濃度3%之氫氧化鈉液,同時加入馬來酐,以保持酸鹼值在 8.0~8.5,約20~30分鐘加完馬來酐12公斤,攪拌2.5小時後,加入重亞硫酸鈉9公斤,此時,酸鹼值約在6.0~6.5,以以稀鹽酸調整酸鹼值 為6.0,攪拌4小時後加入鉀明礬13.5公斤,調整酸鹼值為4.5,攪拌過後,脫水過濾、水洗、乾燥、包裝即得產品。
實例四、樹薯粉2000公斤加入2400公升水中,製成澱粉乳,於常溫下加入10%之次氯酸鈉30公斤,攪拌3小時後,與實例2製得的澱粉乳各一半混合後,再脫水、水洗、乾燥,也可以製成類似實例三之產品。
經由以上的實施說明,可知本發明具有數多優點,如:1.本發明係將樹薯粉經氧化、酯化、還原及凝結之程序,而得到之修飾澱粉無論於澱粉性、風味及口感上皆優於傳統甘薯粉。
2.本發明係將樹薯粉加入氧化劑,以使澱粉糊化更為容易、黏度降低、穩定性提高、顏色潔白、透明度高、成膜性佳。
3.本發明係於樹薯粉氧化後,再於澱粉乳中徐徐加入馬來酐,同時加入稀氫氧化鈉溶液,以增強澱粉之硬度、彈性。
4.本發明係於最後加入明礬類,以收縮結合澱粉中分子,使樹薯粉糊的硬度、彈性、粉性更優於傳統甘薯粉糊。
綜上所述,本發明實施例確能達到所預期之使用功效,又其所揭露之具體構造,不僅未曾見諸於同類產品中,亦未曾公開於申請前,誠已完全符合專利法之規定與要求,爰依法提出發明專利之申請,懇請惠予審查,並賜准專利,則實感德便。
第一圖:本發明之流程圖
第二圖:本發明之化學反應式圖(一)
第三圖:本發明之化學反應式圖(二)
第四圖:本發明之化學反應式圖(三)

2013年5月26日

腎戰危機 ──全民防治腎臟病 Land of Dialysis? Kidney Disease in Taiwan

2005 年6月第088頁

腎戰危機 ──全民防治腎臟病

文•張瓊方 圖•紀秋吉





含有圖片的版本(適合較高頻寬用戶) 未含圖片的版本(適合低頻寬用戶)

根據台灣腎臟醫學會的統計,2002年台灣末期腎臟病的盛行率高居世界第二位,平均每650人中就有1人洗腎,發生率更是全球第一,每年增加8000多人。
2003年國人十大死因中,腎炎、腎徵候群及腎變性病則名列第八位,當年因此死亡的人數達4306人。腎臟病已然成為台灣的「新國病」。為何如此?又該怎麼防治?
清晨7時,街道上還靜悄悄的,位於台北市八德路上的安德聯合診所就開始忙碌起來,老先生、老太太在兒女的陪伴下,走進隱身大樓中的洗腎中心。
安德聯合診所有60床洗腎病床,分早、中、晚3班,從早上7點開始到晚上十點半,川流不息地為一百多位洗腎病患做血液透析。和一般洗腎中心一樣,洗 早班的通常是年紀較大的老人家;洗中班的病人比較少,通常是兼差或非固定工時的病人;洗晚班的多是上班族,下了班就提著公事包來報到。
令人驚訝的是,洗腎中心裡的氣氛一派輕鬆,有人閉目養神,有人邊洗邊看書、看電視,還有人一邊洗腎,一邊吃便當......。

三班制洗腎

為了因應總數高達四萬多名的台灣洗腎病友的需求,堪稱全國規模最大的林口長庚醫院洗腎中心,180床洗腎病床,一個月能洗一萬人次。台北市則以新光醫院的80床規模最大。
除了醫學中心、區域醫院外,台灣中小型洗腎診所林立。根據中華民國腎臟基金會的統計,目前全台共有429家洗腎中心,一萬一千多台洗腎用的人工腎臟,堪稱台灣奇景。
洗腎是末期腎病患者替代腎臟功能、維持生命的一種療法。說是洗腎,其實洗的不是腎,而是血液,因此又名「血液透析」。
一般來說,病人一次療程平均為4至4.5小時。安德診所醫師楊夢儒指出,目前洗腎技術提昇,排毒和淨化血液的功能比以前好,但與24小時全年無休的 腎臟相比仍有差距。洗腎時間長短攸關洗腎的品質和存活率,只要洗的時間夠長、次數足夠,存活二、三十年幾乎不成問題。以安德聯合診所兩百八十多位病人為 例,目前最「資深」的已經有將近30年的洗腎史,洗腎時間超過15年的也有70位。
39歲開始洗腎的遲淑玉,洗腎已屆15年。和多數洗腎病人一樣,遲淑玉當年也無法接受自己要洗腎的事實,四處尋求偏方,每天過著暈頭轉向、噁心、食慾不振、彷彿重感冒的日子,拖了一年多,直到身體水分無法排除導致肺積水,才不得不面對現實。
「那時候我每天怨天尤人,宛如世界末日,」遲淑玉回想開始洗腎時,動手術造動靜脈廔管、躺在洗腎病床上看著血液從自己體內抽離出來......,那 種打從心底無法接受的感覺,外人實在很難體會。第一、二年,除了心情沮喪,身體上也不太適應,整天腦袋昏昏,再加上洗腎時體內水分會被抽得很乾,導致嚴重 的便秘,使得她生活作息大受影響。

宛如重生

洗腎七、八年後,遲淑玉才真正走出陰霾,恢復工作,復歸社會。五十多歲、至今未婚的她,每天打扮得光鮮亮麗,白天她是金寶山企業的業務員,為顧客們 處理將來的「身後事」,下了班的二、四、六晚上,則固定到洗腎中心報到,靠血液透析來維持自己的生命。「我不說,沒有人看得出我是洗腎病人,」她笑著說。
在船務公司擔任業務部副總的康燦裕,取得老闆的諒解,二、四、六的下午固定到光復南路上的秀傳洗腎中心報到。他表示,雖然洗腎時躺在那裡感覺很無 助,偶而還會有血壓下降、小腿抽筋(人體短時間內流失過多水分導致)等不舒服的症狀,洗腎後水分、毒素排除所造成的「不平衡症候群」,讓人宛如剛跑完一場 激烈的馬拉松,感覺虛脫、疲累,必須睡一覺起來才會有精神。但康燦裕的心態較健康,已能接受這個病要跟著自己一輩子的事實,「我覺得自己這條命是靠現代科 技撿回來的,所以比以前更加珍惜,」康燦裕說,他生病前整天應酬,如今生活正常,菸酒都戒了,太太反倒不用擔心他,一家人的感情也更好了。

進步的指標

像遲淑玉、康燦裕這樣靠洗腎來維持生命的,全台灣有四萬多人,而且以每年新增八千多位的速度不斷攀升。榮總腎臟科主任、前台灣腎臟醫學會理事長楊五常估計,到2015年,台灣的洗腎人口可能增加到7萬人左右。
「這是全世界的趨勢,」楊五常指出,人口老化、洗腎病人存活率提升是現代醫療進步的指標,但也因此,世界各國都在為洗腎的龐大支出而傷透腦筋。
以我國為例,洗腎病人一人一年平均花費六十多萬元洗腎費用健保為此給付的費用一年高達兩百三十多億(佔給付總額的6.18%),是重大傷病項目中最大宗的支出,對健保局來說負擔越來越沈重。
這也正是洗腎與一般醫療行為最大的差異所在:一般疾病若治療成功,可以減少後續資源的耗費,但洗腎一洗就是一輩子,照護品質越提升,病患平均餘命延長,卻反倒要耗費更多的醫療資源,甚至成為健保「不可承受之重」。
台灣如此,對歐美先進國家來說,情況同樣嚴重。面對此一龐大的醫療支出,英國學界和醫界不斷爭論洗腎應該洗到幾歲為止?甚至還有人主張,65歲以上應終止洗腎給付,只是在人道、人權上爭議太大,無人敢做進一步探討。

「一人洗腎全家哭」

雖說洗腎人口增加是世界趨勢,但台灣竄升速度之快,堪稱世界第一,卻也透露出值得重視的訊息。
台灣洗腎的盛行率(某一時間點的透析人數)為百萬分之1548人,換句話說,每650人就有一個人洗腎,目前僅次於日本,高居世界第二名。至於台灣洗腎的發生率(一年間新增加的病人數)為百萬分之365人,等於一年增加八千多人,更在2002年超越美國,躍居世界第一位。
近年台灣洗腎人口的竄升,其實是拜全民健保實施之賜。
創辦於民國72年的中華民國腎臟基金會,是腎臟病友團體。從「一人洗腎全家哭」的請願年代,帶領腎友一路辛苦走過來的秘書長張書光感觸最深。
回顧當年,張書光指出,洗腎這種「腎臟替代療法」引進台灣不過四十多年。民國52年,台大腎臟學泰斗陳萬裕教授引進血液透析治療,當時設備昂貴,費用龐大,加上社會保險尚未建立,多數尿毒症患者無福消受這種高科技的治療。
「當時台灣國民平均年所得只有3000美元,一般人每月的薪水只有一萬多元台幣,尿毒症患者為了籌措每個月五、六萬元的洗腎費用,幾乎是傾家蕩產,更多人則是自我放棄,任憑尿毒引發器官衰竭而過世,」張書光說。

費用普及化

民國84年健保實施後,洗腎納入健保給付,對台灣的腎病末期病人來說,是一大福音。
相較於鄰近的新加坡(洗一次約五千多元台幣)、香港(一次約7000元)等地的自費洗腎,目前台灣的洗腎可謂物美價廉(一次由健保給付4200元),「近年台灣洗腎的普及化,使得病人不僅維持生命,還能回歸社會、正常生活,」張書光說。
一方面經濟障礙破除,使得過去付不起洗腎費用的病患得以接受治療,將過去隱藏的洗腎人口檯面化;另一方面,洗腎品質提升,存活率增加,也使得洗腎的人口越來越多。
從洗腎病人的存活率和住院率,可以看出台灣洗腎品質的提升。
楊五常指出,台灣的洗腎病人住院率並沒有確切的統計數字,但根據榮總、高醫和新光幾家醫院所做的研究,糖尿病的洗腎病人一年平均住院1.1次;非糖尿洗腎病人則只有0.5次;住院天數分別為8天和7天,表示大部分患者並沒有出現併發症或身體機能惡化的現象。
從死亡率來看,楊五常指出,洗腎第一年的死亡率最高,台灣約15%,美加地區更高達25%;洗腎5年以後平均每年的死亡率,台灣為9%,高於日本的7%,但比歐洲的10%、美國的15%低。
究其原因,楊夢儒指出,美國洗腎病人透析時間短(每次3至3.5小時),病人的體型又比東方人高大,因此效率較差,死亡率也就隨之增加。楊五常則認為,死亡率可能與人種差異有關。

不要的世界第一

「台灣洗腎盛行率高是值得稱許的,」楊五常解釋,除了全民健保實施外,人口老化,糖尿病、心血管疾病的死亡率下降、洗腎存活率增加等原因,也都導致 我國洗腎的盛行率高升,這是醫療進步的表徵。然而要注意的是,「洗腎的發生率卻不應該增加,」楊五常說:「台灣洗腎的發生率高居世界第一位是沒有道理 的。」
洗腎發生率的增加,與「次發性」病人增加有關。
據估算,洗腎病人中屬於原發性腎臟疾病者約佔4成,人數大致維持穩定;但因糖尿病、高血壓等疾病牽連導致洗腎的「次發性」比例,近年卻越來越高。(non-conclusive)
林口長庚醫院腎臟科教授兼毒物科主任林杰樑表示,此一現象反映出醫師的照護和病人保健常識不足的問題。
以糖尿病、高血壓為例,由於早期症狀不明顯,病人很容易掉以輕心,但如果沒有做好衛教和控制,長期的高血壓會破壞腎臟的微細血管,糖尿病患的末稍微血管也會逐漸硬化,破壞腎臟功能,導致尿毒症。
此外,台灣的醫生開藥、病人用藥都不夠小心謹慎。像止痛藥、退燒藥、非類固醇消炎藥劑、電腦斷層掃瞄及血管攝影檢查時常用的顯影劑等等,都會對腎臟造成負擔。林杰樑指出,普拿疼和阿斯匹靈混用會導致腎臟受損,各國醫界都嚴禁混用,在台灣卻沒有限制。
楊五常也指出,非類固醇消炎藥會抑制前列腺素賀爾蒙的分泌,造成腎臟血管的收縮而影響血液循環,如果服藥期間水分攝取不足,很容易損害腎功能。可怕 的是,除了民眾小病痛時習慣隨手買成藥服用外,國內很多醫師開消炎止痛藥一開就是十天、半個月,完全沒有追蹤腎功能,也沒有告知病人可能的風險。他認為, 各不同專科間缺乏交流學習和問題意識,才會讓做為身體最後排毒防線的腎臟成了「替死鬼」。
西藥的濫用之外,特別值得一提的是台灣的特殊情況──服用中藥導致腎衰竭,即所謂的「中藥腎病」。新光醫院前年在第18屆生物醫學聯合學術年會中提出的「中藥腎病」報告,推測馬兜鈴酸是引起中藥腎病的主要原因
新光醫院針對該院洗腎及換腎病患的腎切片研究發現,28%為糖尿病併發症、27%為中藥腎病;而病人提供的25個中藥檢體中,高達8成驗出含有早已被列為禁藥的馬兜鈴酸。
林杰樑也指出,台灣B型肝炎人口較多,有人服用中藥「龍膽瀉肝湯」導致馬兜鈴酸中毒,不到一年就要洗腎了。

一腎難求

一般人聽到洗腎總是能逃就逃,恐懼的是一日洗腎就得終身洗腎。事實上,的確是如此。
台北秀傳醫院洗腎中心醫師蔡明宏指出,洗腎目的在維持生命,並不能挽救腎臟,而且即使透析了4小時,也只能達到正常腎臟的功能1/12而已,因此,洗腎病人等於長年處在體內毒素偏高的風險中,需要靠運動和飲食控制來輔助。
腎功能替代療法都只能治標,真正要治本,恢復腎臟的功能,唯有腎臟移植一途。
一般來說,換腎的存活率較高,生活品質也比洗腎好。楊五常指出,換腎初期因免疫力低,感染的危險性較高,死亡率相對較高,但3個月以後死亡率就和洗腎相當,到第8個月,換腎的死亡率較洗腎低25-30%。
換腎存活率高,所耗費的醫療資源也較少。一年以後,換腎者所需的醫療費用比洗腎少一半。
「經濟上許可的話,我鼓勵病人換腎,」楊五常指出,台灣目前等待換腎的洗腎病人有四、五千人。
然而,現階段腎臟移植的問題並不比洗腎少。
首先必須要有器官來源。台灣器官捐贈的風氣不盛,一年大約只有3%的洗腎病人可以換腎,相較於美國的15-20%、西班牙的30-40%,確實是明顯地偏低。
器官來源不足,再加上必須經過白血球組織抗原配對,誰的條件符合,可以說要憑運氣。然而,就算幸運地等到腎臟移植,後續還必須終身服用抗排斥藥,而抗排斥藥降低人體免疫力的副作用,又增加了換腎者感染及罹患癌症的風險。有些換腎者甚至得再度回去洗腎。
一位每個月靠吃止痛藥來度過月經疼痛的女性,年紀輕輕就腎功能衰竭,必須洗腎度日。十幾年前她幸運地配對成功得以換腎,雖然幾度因感染進出醫院,但 總算獲得較好的生活品質。沒想到換腎10年後,腎臟又不行了,醫生建議她再回來洗腎,但她始終抗拒,不願意再過洗腎的日子,最後病情惡化,去世時還不到 40歲。

難以承受之重?

前些日子,競爭激烈的洗腎中心為招攬病人,推出專車接送、洗腎送禮品等優惠,因而有人批評台灣洗腎太過隨便,甚至懷疑醫生有「鼓勵」病患洗腎以換取健保給付的嫌疑。事實上,台灣洗腎標準訂得比美國還要嚴格。在嚴格的標準下,就算已達洗腎標準,病人一開始仍舊抗拒。
「我幾乎沒有看過任何病人是心甘情願洗腎的,」楊夢儒說,所有病人聽到醫生說自己已達洗腎條件時,第一件事不是準備洗腎的廔管,而是去找偏方、中草藥,一直拖到肺水腫、酸中毒,或尿毒素太高陷入昏迷時才緊急送醫。
對於洗腎耗費太多醫療資源的指責,楊五常有話要說。
「死亡是降低慢性重症病患醫療費用的唯一方法,但是誰能判洗腎病人死刑?」楊五常質疑,重症或臨終急救的呼吸照護一年同樣耗費健保兩百多億元,相較之下,6成以上的洗腎病人都能正常工作,具有生產力。用兩百多億元來維持四萬多個家庭的正常生活,難道不值得嗎?
問題的答案當然是斬釘截鐵的「Yes」,但這不應該是討論的重點,如何減少洗腎病人的發生,才是大家應該努力的方向。

http://www.taiwan-panorama.com/show_issue.php?id=200569406088C.TXT&table=1&cur_page=1&distype=text

養成良好生活習慣 可避免洗腎危機

文林家瑜
在洗腎室服務半年多的時間,看到洗腎病患總是讓我感觸良多,因為每兩天我就會服務相同的病患一次,而一週有3次的時間我們都會見面。
病患就像捐血一樣,每次都會準時來洗腎,而且還必須提早來排隊搶位子,有時稍微晚到,就必須等1、2個小時才能洗腎,也因此他們常是早上6點多就來排隊, 有時甚至比我的上班時間還早。看到他們每次如此「辛苦」地洗腎,而且每次都要3、4個小時,我便會告訴自己要好好地保護自己的腎臟。(洗腎真是很可憐啊,人生就此開始灰暗了。)
在服務病患的過程中,我都會和他們閒話家常,瞭解他們洗腎的原因,除了先天性的遺傳病外,最多的還是因為年輕時沒有好好的保護腎臟所致,像是工作時憋尿、 少喝水、晚上熬夜不睡覺,或是食用多鹽、多糖、多油的食物等,而有少部分的病患則是因為聽信偏方服用來路不明的藥物,結果腎臟不堪負荷而必須洗腎。(這些都不是真正造成洗腎的原因所在,台灣人愛亂吃西藥跟維他命,這才是造成腎臟衰竭的主要原因啊。)
洗腎的原因林林總總,但大部分都是可以預防和避免的,像是多喝水、多吃蔬菜、不熬夜、不憋尿、不抽菸和喝酒等等,更重要的是,不要聽信偏方和服用來路不明的藥物。如果大家都能有良好的生活習慣,才會減少腎臟出問題的機率,也才能避免洗腎。(要避免洗腎,唯一的方式就是不要再吃西藥與維他命了。)
洗腎的歲月是漫長的,而且必須等到有人捐贈才能脫離洗腎的日子,期盼大家都能保護好自己的腎臟。(作者為淡水公祥醫院洗腎室護士)
評論
    我在美國臨床多年, 美國每天約又數十萬人在洗腎,而造成腎臟衰竭的原因千篇一律的都是吃西藥與維他命,沒有人吃偏方或是來路不明的藥物,在美國不會有來路不明的藥物,只有台 灣才有,所以洗腎原因非常明確的是西藥廠造成的惡果,民眾如果已經在洗腎,可以就近找馬路邊的中醫來治療,治不好腎臟病衰竭的病人不是真正的中醫,除非你的腎臟已經完全被西藥破壞掉,才須要換腎臟,否則都有希望恢復過來,大家不要失去信心,現在腎臟還正常的民眾,請立刻停止吃西藥與維他命,這樣你就不會得到腎臟衰竭了。
http://www.hantang.com/chinese/ch_Articles/kidney35.htm

腎臟衰竭 秀傳醫院
血液透析中心提供

  當腎臟無法行使正常功能時,會導致廢物(毒素)和水份堆積在體內,此時稱之為 " 腎衰竭 " 。腎衰竭可分為急性和慢性兩種。
急性腎衰竭 (ARF)
急性腎衰竭可發生在失血過多、嚴重腎臟感染或其他各種腎臟疾病時,腎臟會突然失去正常功能,但通常在治療後可恢復正常。
慢性腎衰竭 (CRF)
慢性腎衰竭意指腎臟組織已損壞了一段相當長的時間──通常是數月或數年,許多人在剛開始未能察覺,直到腎臟受損已超過百分之十七以上才被發覺。即使早期發現(由血液或尿液檢查),通常也無法治療,但早期治療(飲食及藥物)可以減緩發展為末期腎臟病的速度。
引起慢性腎衰竭的原因:
    1.腎絲球腎炎
    2.糖尿病
    3.高血壓──因高血壓引起的腎損傷
    4.多囊腎──腎組織被囊腫破壞
    5.腎盂腎炎
    6.止痛劑引起的腎病變──由於過量服用止痛劑引起的腎損傷
    7.痛風
    8.結締組織病變──狼瘡性腎炎、硬皮症 (Scleroderma)
             多發性動脈炎結節 (Polyarteritis Nodosa)
    9.先天性及遺傳性異常
    10.結石及其他阻塞性病變
    11.逆流性腎病變──因尿液逆流引起的腎損傷
末期腎臟病 (ESRD)
當腎功能只剩不到百分之十,而需要依賴透析或腎移植才能維持生命時,稱為末期腎臟病。您的腎病可能接近或已在此階段,而您目前正接受的保守治療(藥身、飲食和水份限制)目的是在減輕受損腎臟的負擔以及減少廢物和液體積聚在體內。   此時您可能會有的症狀:
    ● 因體液積聚所導致的呼吸短促或全身水腫
    ● 疲勞
    ● 高血壓、頭痛
    ● 記憶力減退
    ● 煩燥
    ● 失眠
    ● 感覺虛脫
    ● 皮膚癢
    ● 飲慾欠佳、
    ●心及胃部不適
    ● 體重減輕
    ● 性慾減退
如果您目前所接受的保守治療,仍無法有效控制上述症狀時,您就必須接受透析治療。


慢性腎衰竭的病人能避免洗腎嗎?

http://www.kmu.edu.tw/~kmcj/data/8806/4252.htm
腎臟內科 顧進裕 副教授(88年6月)

罔腰是一個長期的糖尿病病人,服藥經常不規則;順水則在十年前因水腫及泡沫尿而被發現有嚴重的蛋白尿,但他拒絕了醫生建議他所做的腎臟切片檢查,服藥也經 常不規則,最近兩人因看到第四台的廣告,都去買了一些「腎臟病的特效藥」來吃,結果兩人都因月亮臉、嚴重高血壓及水腫而來腎臟內科住院。檢查的結果兩人的 血清肌酸酐都高達10mg/dl,超音波也都發現他們的腎臟都已經縮小了,因此診斷是「慢性腎衰竭」,兩個人在一 個月後都因貧血、少尿、呼吸困難等而被診斷為「尿毒症」,並接受了長期血液透 析治療。
類似以上的病例在台灣各醫院中不斷的上演,這也是造成台灣的洗腎病人逐年增加的重要原因之一;事實上這種悲劇是可以避免的,像罔腰的糖尿病如果能與醫生配 合並好好控制,順水的蛋白尿如果能在十年前接受腎臟切片檢查而對症下藥,且不濫用藥物,則兩個人的腎臟功能(愈差血清肌酸酐愈高)都可能維持數十年而不一 定要接受洗腎治療的。
在台灣,慢性腎衰竭及尿毒症最常見的原因是慢性腎小球腎炎(如順水),第二是糖尿病(如罔腰),第三則是高血壓,但不管什麼原因,一旦血清肌酸酐大於正常 值,就表示病人的腎臟功能只剩下不到一半,而且每一個病人腎功能惡化的速度都是固定的,但是若病人像此二人一樣不規則服藥,而去服用偏方的話,則速度會變 快,反之若病人與醫師合作且治療得當,則速度會變慢,甚至可能慢到數十年才變成尿毒症,亦即該病人在有生之年都不需要洗腎,因此就腎臟科醫師的眼光看起 來,該病人已經可以算是「痊癒」了。
究竟有什麼治療方法這麼神奇而可以使慢性腎衰竭病人免於洗腎呢?這得歸功於最近基礎及臨床醫學的進步,已經使這種醫生以前認為遲早「一定要」洗腎 的疾病的治療露出一線曙光了,因此此種病應早期去看腎臟專科醫師,並與醫療人員密切配合,如此才能達到最好的治療效果,畢竟病人若能不需要洗腎,則對國家、社會、家庭及個人都是一個很大的幫助的。
慢性腎衰竭的治療方法如下:
(一)避免下列可能惡化腎功能的因素:例如濫用藥物(類固醇、感冒藥水、止痛劑、X光對比劑、某些抗生素、不明來歷的藥物等)、脫水、心臟衰竭、低血壓或休克、泌尿道阻塞、感染、電解質不平衡等。
(二)低蛋白質飲食:每天每公斤體重攝取0.6公克的高生理價質蛋白質(如:動物性蛋白質、蛋、乳等)。
(三)若有高血壓、心臟衰竭或嚴重水腫,則必須攝取低鹽飲食(每天3公克食鹽),但若無這些情形,則鹽份的攝取量就必須依據病人每天尿液的鹽份排泄量來決定,因此坊間傳言的「腎臟病病人必須吃低鹽飲食」是不對的。
(四)若有少尿(尿液每天少於500毫升)及嚴重腎衰竭,則必須攝取低鉀飲食。
(五)治療原發性疾病:例如糖尿病及免疫性腎小球腎炎等。
(六)嚴格控制高血壓:若蛋白尿每天大於2公克,則治療目標為125/75mmHg,若蛋白尿每天少於2公克,則治療目標為130/85mmHg。
(七)若尚未嚴重腎衰竭(例如:血清肌酸酐小於4mg/dl),則可以使用血管張力素轉換脢抑制劑或血管張力素第一型受器抑制劑治療。
(八)降低蛋白尿:控制高血壓及血管張力素轉換脢抑制劑都有很好的治療效果。
總之,慢性腎衰竭的治療在最近幾年有了長足的進步,而醫學界對於此症也不像以前那麼悲觀了,現在的腎臟科醫師已經可以更積極的治療這些病人,如果能再加上病人本身高度的合作,則本文題目的答案應該是肯定。

Land of Dialysis? Kidney Disease in Taiwan


According to statistics for 2002 from the Taiwan Society of Nephrology, Taiwan ranks second globally in the prevalence of end-stage renal disease (ESRD), with one out of every 650 people undergoing dialysis. Taiwan also has the highest incidence of ESRD, as more than 8,000 additional people require this treatment each year.
In 2003, kidney diseases such as nephritis (kidney inflammation), renal syndrome and nephrosis were the eighth leading cause of death among Taiwanese. In that year, 4,306 persons died of kidney disease, making it Taiwan's "new national scourge." Why is this the case? And how can kidney disease be prevented?
It's 7 a.m. and the streets remain tranquil, but An-Der Medical Clinic and Hemodialysis Center on Taipei's Pate Road is already getting busy. Accompanied by their offspring, elderly men and women walk into the dialysis unit hidden within the building.
An-Der has 60 beds for dialysis patients. Beginning at 7 a.m. and continuing until 10:30 p.m., the clinic performs the hemodialysis procedure on more than 100 patients in morning, afternoon, and evening shifts. As at other dialysis centers, the clinic's morning shift sees mostly older patients, while afternoon patients-who are typically part-time workers or those without regular work hours-are fewer in number. Patients who come in during the evening shift are mostly office workers, who arrive after getting off work, carrying their briefcases.
Surprisingly, the atmosphere inside the dialysis center is relaxed. Some people close their eyes meditatively, while others read books or watch television as their dialysis proceeds. Still others eat from take-out boxes as they receive treatment.

Dialysis in three shifts

In order to meet the needs of dialysis patients-who number more than 40,000 in Taiwan-the island's largest dialysis center, in the Linkou Medical Center of Chang-Gung Memorial Hospital, offers 180 beds and performs 10,000 dialysis procedures a month. Taipei City's largest facility is Shin Kong Wu Ho-Su Memorial Hospital with 80 beds.
Besides medical centers and regional hospitals, Taiwan also has numerous smaller dialysis clinics. According to statistics from the National Kidney Foundation ROC, there are currently 429 dialysis facilities in Taiwan providing more than 11,000 artificial kidneys to perform dialysis-another Taiwanese peculiarity.
Dialysis is a type of treatment for ESRD patients that serves to replace lost kidney function and thereby keep the patient alive. Though the Chinese term translates literally as "kidney washing," what is actually cleansed is not the kidneys, but the blood.
Generally speaking, a single treatment for one person requires an average of four to 4.5 hours. Yang Meng-ju, a physician at An-Der, points out that the time spent on dialysis affects its quality and the patient's survival. But if adequate time is allotted for each treatment and the procedure is performed often enough, then survival for 20 or 30 years presents no real problem. Of An-Der's 280-plus patients, the most "senior" has been receiving dialysis for nearly 30 years, while there are 70 other patients who have been getting the treatment for more than 15 years.
Chih Shu-yu, who began dialysis when she was 39, has been receiving the treatment now for 15 years. Like most dialysis patients, when she first heard that she would have to undergo dialysis, she resisted and desperately sought out alternatives. Every day, she suffered symptoms like those of a severe cold, with dizziness, nausea, and loss of appetite. After delaying for more than a year, by which time her body's inability to expel water led to pulmonary edema, she finally had no choice but to face facts.
"I cursed my fate every day, and it seemed like the end of the world," Chih recalls. When she first began dialysis, surgery was first performed to create an arterio-venous shunt. As she lay on the dialysis bed watching the blood being siphoned out of her body, she experienced the utter unwillingness to accept reality that those who haven't undergone dialysis would find it difficult to understand.

Born again

It was only after seven or eight years of dialysis that Chih escaped from the shadow of her illness, returning to work and society. In her fifties and never married, Chih does herself up brightly every day, working as a salesperson for cemetery operator ChinPaoSan Group during the day, helping clients handle preparations for the hereafter. On Tuesday, Thursday, and Saturday evenings after work, she makes her routine appearance at the dialysis center, using the center's treatment to keep herself alive.
Teddy Kang, vice president for sales at a shipping company, having obtained the consent of his boss, goes to Show Chwan Hospital's dialysis center every Tuesday, Thursday, and Saturday afternoon. He explains that although there is a feeling of helplessness while he lies there receiving dialysis, and occasionally he will experience discomfort from falling blood pressure or cramps in his calves (caused by an excessive loss of water from the body over a short period of time), he has a healthy attitude, enabling him to accept the fact that his illness will be with him for his entire life. "I feel that my life was restored to me by modern technology, so I cherish it more than I once did," Kang says. Before he became ill, he spent the entire day entertaining customers, but now his life is more regular. He has quit smoking and drinking, and his wife now finds that she no longer needs to worry about him. His family has become closer as well.

Measuring progress

In all of Taiwan, there are more than 40,000 people who, like Chih and Kang, rely on dialysis to stay alive. Moreover, the number of people added to their rolls each year continues to increase, and currently is more than 8,000. Yang Wu-chang, chief of the Section of Nephrology at Veterans General Hospital and former director of the Taiwan Society of Nephrology, estimates that by 2015, the number of dialysis patients in Taiwan may increase to around 70,000.
"This increase is in keeping with a worldwide trend," Yang says. He points out that the aging of populations and the rise in the survival rates of dialysis patients are indicators of the progress of modern medicine. However, because of these advances, countries around the world are confronted with the enormous expense associated with dialysis.
In Taiwan, for example, an average of more than NT$600,000 per dialysis patient is spent on dialysis fees each year. For one year, the National Health Insurance (NHI) program covers costs of NT$23 billion (accounting for 6.18% of all payments) related to dialysis treatment. Expenses for dialysis are the single largest item among all payments for major illness and injury, and an ever-growing burden on the Bureau of National Health Insurance.
It is the need to continue dialysis indefinitely that sets it most apart from typical medical treatments. When most diseases are treated successfully, subsequent drains on health care resources are reduced. However, once dialysis is begun it must be continued for a lifetime. The better the quality of care, the longer the patient's life can be extended, a situation that results in a further drain on health care resources, and even their becoming an "unbearable burden" for the NHI program.
While Taiwan faces this dilemma, advanced Western nations confront the same challenges. Faced with such enormous medical expenses, the British academic and health care communities have been locked in a controversy about what age dialysis should be continued until. There are even some people who propose that payouts for dialysis should be halted for those over 65 years of age. But the human rights and ethical issues involved are so profound that nobody has been willing to explore the proposal further.

A family affair

Although an increase in dialysis patients is a worldwide trend, the number of such persons is rising faster in Taiwan than anywhere else. The situation reveals some facts that deserve attention.
The prevalence of dialysis (the number of persons receiving the treatment at any given time) in Taiwan is 1,548 per million. In other words, for every 650 persons, there is one receiving dialysis. Currently, Taiwan has the world's second-highest prevalence, with only Japan's figure higher. As for Taiwan's incidence of dialysis (the number of new patients during a year), this is 365 per million, or more than 8,000 people in a year. Taiwan's incidence surpassed that of the US in 2002, taking over as the world's highest.
In recent years, the rapid rise in the number of people receiving dialysis can actually be traced to the implementation of the NHI program.
Founded in 1983, the National Kidney Foundation ROC (NKF) is a support group for kidney disease sufferers. Having provided guidance to patients since an era when petitions had to be made and an entire family would have to beg so that a member could win the right to receive dialysis treatment, the foundation's chief director Chang Su-kuang has the deepest awareness of the situation.
Recalling those times, Chang points out it has been little more than 40 years since "renal replacement therapies" were introduced into Taiwan. In 1963, noted nephrology authority Professor Chen Wan-yu of National Taiwan University introduced hemodialysis. At the time, the equipment was extremely expensive, and treatment fees enormous. In addition, social insurance programs had not been established at that point, meaning that the majority of uremia patients did not have the good fortune to receive this high-tech treatment.
"At the time, national income per capita in Taiwan was only US$3,000. A typical person's monthly salary was less than NT$20,000. In order to scrape together the NT$50,000 or NT$60,000 monthly cost of dialysis, uremia patients had to pour the entire family's resources into it. Many more people simply gave up on themselves, and allowed the accumulating toxins in the blood to cause organ failure and death," Chang says.

Return to society

When the NHI program was instituted in 1995, dialysis was a covered medical procedure. This was a huge piece of good news for Taiwanese with ESRD.
On the one hand, economic obstacles had been removed, allowing patients who would not otherwise have been able to afford dialysis to receive the treatment, and bringing the once-hidden population of dialysis patients out into the open. On the other hand, an increase in the quality of dialysis and rise in survival rates led to an ever-increasing number of such patients.
The survival and hospitalization rates of dialysis patients testify to improvement in the quality of dialysis care in Taiwan.
Veterans General Hospital's Yang Wu-chang points out that according to studies carried out by several hospitals such as VGH, Kaohsiung Medical University Hospital, and Shin Kong Wu Ho-Su Memorial Hospital, patients receiving dialysis because of diabetes are hospitalized an average of 1.1 times each year. Non-diabetic patients are hospitalized an average of only 0.5 times. The average length of their hospitalization is eight and seven days, respectively, an indication that most patients did not exhibit complications or a deterioration in physical functioning.
Examining mortality rates, Yang says, deaths are most frequent during the first year of dialysis-about 15% in Taiwan, and even higher at 25% in North America. After five years of dialysis, the average yearly mortality rate is 9% in Taiwan, higher than Japan's 7%, but lower than Europe's 10% and America's 15%.

An unwelcome #1 ranking

"Taiwan's high prevalence of dialysis is actually a good sign," Yang explains. Besides implementation of the NHI program, other reasons that the prevalence of dialysis is rising are an aging population, a decrease in mortality rates for diabetes and cardiovascular disease, and an increase in survival rates for dialysis patients. It is a symbol of advances in health care. However, what should be a source of concern is that "the incidence of dialysis should not be increasing," Yang says. "That Taiwan ranks number one in the world in the incidence of dialysis doesn't make sense."
The increase in the incidence of dialysis is related to an increase in patients with "secondary" illnesses.
According to estimates, approximately 40% of dialysis patients suffer from primary kidney disease, and the number of such patients is roughly steady. However, the number of patients receiving dialysis due to secondary kidney disorders caused by diseases such as diabetes and high blood pressure has been on the rise in recent years.
Lin Ja-liang, a professor of nephrology and director of the Division of Clinical Toxicology at the Chang Gung Memorial Hospital's Linkou Medical Center, states that this situation reflects the problems with the care provided by physicians and patients' inadequate knowledge about how to stay healthy.
Because the early symptoms of diabetes and high blood pressure are not obvious, patients may easily overlook them. However, if adequate monitoring and control is not achieved, long-term high blood pressure will damage the delicate blood vessels in the kidneys. Diabetics' capillaries will gradually harden, destroying kidney function and leading to uremia.
In addition, Taiwan's physicians prescribe medications-and patients use them-incautiously. Substances such as analgesics, antipyretics, non-steroidal anti-inflammatory drugs (NSAIDs), and the contrast agents commonly used in CAT scans and angiograms all create an extra burden for the kidneys.
Yang Wu-chang also points out that NSAIDs inhibit the secretion of prostaglandin, causing dilation of renal blood vessels and influencing blood circulation. If water intake is insufficient while the drug is being taken, it can easily lead to impaired kidney function. Alarmingly, besides the habit of many Taiwanese of buying medication without a doctor's prescription, local physicians often prescribe enough analgesics for ten days or half a month at a time, without checking the patient's kidney function, and without informing the patient of the potential risks. He believes that the lack of information sharing between different medical specializations and lack of awareness of potential problems are turning the kidneys, the body's last defense against toxins, into martyrs.
Besides the overuse of Western medications, another situation unique to Taiwan is especially worthy of mention-the use of Chinese medicine causing kidney failure, or what is called "Chinese herb nephropathy". At the 18th Joint Annual Conference of Biomedical Sciences two years ago, Shin Kong Hospital presented a report on this syndrome, hypothesizing that aristolochic acid was the main culprit.
Shin Kong Hospital's study of kidney biopsies from the hospital's dialysis and kidney transplant patients found that 28% showed signs of diabetes complications, and 27% of Chinese herb nephropathy. And of the 25 tests on patients for Chinese medicine ingredients, 80% showed positive results for aristolochic acid, which was long ago banned.
Lin makes particular mention of Taiwan's large population of people with hepatitis B. Some of these people are poisoned by aristolochic acid from taking the Chinese medicine long dan liver tonic, and within a year must begin dialysis.

Finding a good kidney

When most people hear that they will have to undergo dialysis, they try to avoid it if possible, afraid that once they start, it will mean a lifetime of dialysis. And in fact, they are not mistaken.
Tsai Ming-hung, a doctor at Taipei Show Chwan Hospital's dialysis center, points out that the objective of dialysis is to maintain life, and it cannot save the kidneys. Moreover, even four hours of hemodialysis can only achieve 1/12th of the effect of healthy kidneys. Therefore, dialysis patients are subject to the risks of elevated levels of toxins within their bodies over a period of many years, and thus need to rely on exercise and controlled diets to compensate.
Renal replacement therapies can only treat effects; the only way to treat the root cause and restore kidney function is a kidney transplant.
Generally speaking, kidney transplant patients have a higher rate of survival than dialysis patients, and their quality of life is also better. Yang Wu-chang points out that during the initial period after a transplant, the risk of infection is higher due to lowered immunity, and the mortality rate is correspondingly higher. However, after three months, the mortality rate for these patients is the same as for those receiving dialysis, and by the eighth month, the mortality rate for those receiving transplants is 25% to 30% lower.
The survival rate for kidney transplants is higher, and the drain on health care resources is also smaller. After one year, the medical expenses required by kidney transplant patients are half those of dialysis patients.
There are presently four or five thousand people in Taiwan awaiting kidney transplants. But at the present stage, the problems associated with kidney transplants are not less than those of dialysis.
First, there must be a source of organs. There is little enthusiasm for donating organs in Taiwan. Each year, only 3% of dialysis patients are able to receive transplants, markedly lower than the 15 to 20% who can do so in the US, and the 30 to 40% in Spain.
In addition to a shortage in the supply of organs, there is also the problem presented by human leukocyte antigen (HLA) matching. It is simply a matter of luck whether a kidney will prove tissue-compatible with a potential transplant recipient. And even if a patient is fortunate enough to have a compatible kidney available, for the rest of his life he will have to take anti-rejection drugs, which have the effect of reducing the body's immune response, in turn increasing the risk of infections and cancer. Some kidney transplant recipients even have to return to dialysis.
One woman, who had been taking painkillers to deal with the discomfort of her menstrual period, suffered from kidney failure when she was young, and had to receive dialysis. More than ten years ago, she was matched to a donor kidney and received a transplant. Although she was hospitalized several times due to infections, her quality of life nevertheless improved. Unexpectedly however, ten years after the transplant, the new kidney failed. Her physician recommended that she return to dialysis, but she resisted, unwilling to once again pass her days undergoing the treatment. In the end, her condition deteriorated and she died, not yet 40 years old.

An unbearable burden

Not long ago, in order to attract more patients, intensely competitive dialysis centers introduced incentives such as a pick-up and delivery service and giveaways upon receiving a treatment. Some people criticized such practices, asserting that dialysis in Taiwan was undertaken too casually, even giving rise to suspicions that doctors might be "encouraging" patients to receive dialysis so that the doctors could obtain NHI payouts. In fact, Taiwan's standards for determining whether dialysis is called for are stricter than those applied in the US. Even with these strict standards, when patients find that they meet the criteria for receiving dialysis, they initially resist.
"I have almost never seen a patient willing to undergo dialysis," says An-Der Clinic's Yang Meng-ju. When patients hear that they need dialysis, the first thing they do is not to prepare the dialysis shunt, but seek out folk remedies and Chinese herbal medicines. They delay the inevitable, until they suffer from pulmonary edema and uremia, or go into a coma because of excessive levels of blood urea nitrogen and are rushed to the hospital for emergency care.
As for the assertion that dialysis expends too many health care resources, Veterans General Hospital's Yang Wu-chang has something to say.
"Death is the only way to reduce medical expenses for patients with severe chronic diseases. But who has the right to sentence dialysis patients to death?" he asks. Yang suspects that respirator care for critical illnesses or life-saving attempts also consume NT$20 billion in NHI payouts in a year. By comparison, more than 60% of dialysis patients can work normally, and lead productive lives. Is spending NT$20 billion to maintain the normal lives of more than 40,000 families not warranted?
Of course the answer is that it is very much worthwhile. However, this should not be the focus of discussions. Rather, everyone should put their effort into thinking about how to reduce the occurrence of conditions that cause people to need dialysis in the first place.