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

//Blinken’s predecessor as secretary of state, Mike Pompeo, formally designated as “genocide” Beijing’s treatment of more than 1 million Uighurs in concentration camps. Pompeo thereby made national policy of a judgment that candidate Biden voiced in August 2020, and that Blinken affirmed during his confirmation hearing.//

Comment by a colleague: A laudatory piece by the conservative George Will on Biden's position on China thus far. Many in Hong Kong made a big deal of Pompeo's pronouncement of China's treatment of Uighurs as "genocide" in January, but Will reminds us it was Biden who first made that pronouncement as candidate in August, and it is Blinken, the current Sec of State, who now implements that position.

Finally, a systematic, as well as systemic, standing up to the bully of East Asia! The previous admin lobbed scattershot incendiaries but otherwise legitimated the bullying with cowering silence.

酒糟是慢性皮膚發炎疾病，最近有不少文獻探討酒糟跟心血管、消化道、神經系統、自體免疫疾病，還有精神問題有關，甚至有研究認為酒糟越嚴重，跟那些系統性疾病的關聯性越大，但目前仍未有定論。

2015年台灣研究指出，跟酒糟病人顯著有關的心血管問題是血脂異常、冠狀動脈心臟病跟高血壓。去除高血壓、血脂異常、糖尿病因素後，發現冠心症是獨立跟酒糟相關的疾病，而且男性的酒糟患者比女性患者有更高機率合併這些系統性疾病。

後來在一個大規模的研究中發現，最常見跟酒糟有關的問題是憂鬱，再來依序為高血壓、心血管疾病、焦慮症、血脂異常、糖尿病、偏頭痛、類風濕性關節炎、幽門桿菌、潰瘍性結腸炎等等。至於精神問題中的憂慮跟焦慮在酒糟病人最常見，推論可能跟有同樣的發炎機轉有關。心血管疾病中，則以冠狀動脈心臟病跟酒糟病人最為相關，因此酒糟被認為是冠心症的獨立危險因子。然而，腸胃道疾病以目前的資料無法確切證實關聯性。

今年最新發表的一個統合性研究指出，在50442位酒糟病人中，有較高機率有血脂異常還有高血壓的情形，但並未發現跟缺血性心臟病、中風和糖尿病的關聯性。目前認為神經血管調節異常是酒糟跟高血壓的共同機轉，先前也有研究發現某些血壓藥可以舒緩酒糟症狀，或是讓酒糟變嚴重。如果酒糟病人罹患高血壓，首選降壓藥物會是carvedilol和spironolactone ; 降壓藥中的鈣離子阻斷劑會讓血管擴張，酒糟患者不宜使用。此外，酒糟病人的慢性發炎反應可能和血脂異常有關，因此有學者強烈建議若是酒糟病人同時有高血脂問題，首選藥物是statin類的藥，因為除了降血脂外，還有抗發炎的功效 ; 然而statin類的藥可否改善酒糟病人的皮膚症狀則有待更多研究。

那酒糟是癌症的危險因子嗎？西方國家的學者認為酒糟跟某些癌症的致病機轉有關，例如：非黑色素細胞癌的皮膚癌、甲狀腺癌、乳癌和肝癌，但以台灣今年發表的研究結果(65526位酒糟病人)看來，似乎沒找到酒糟跟特定癌症的相關性，或許跟不同種族的基因變異性有關。

整合以上文獻，台灣的酒糟患者在血壓、血脂和冠狀動脈心臟病方面似乎有多加注意的必要，當然其他系統問題也不能忽略。總之，美麗不只有外在的皮相，內在的健康也要多注意喔！

Ref :

1. Is rosacea a risk factor for cancer: A population-based cohort study in Taiwan. Dermatol Sin 2020;38:15-21.

2. Association Between Rosacea and Cardiometabolic Disease: A Systematic Review and Meta-Analysis. J Am Acad Dermatol. 2020 Apr 28;S0190-9622(20)30729-5.

3. Comorbidities in Rosacea: A Systematic Review and Update. J Am Acad Dermatol. 2018 Apr;78(4):786-792.e8.

4. Rosacea Is Associated With Chronic Systemic Diseases in a Skin Severity-Dependent Manner: Results of a Case-Control Study. J Am Acad Dermatol. 2015 Oct;73(4):604-8.

5. Cardiovascular Comorbidities in Patients With Rosacea: A Nationwide Case-Control Study From Taiwan. J Am Acad Dermatol. 2015 Aug;73(2):249-54

#酒糟

#共病症

#高血壓

#血脂異常

#冠狀動脈心臟病

#林政賢皮膚科

#從名畫看皮膚科

矽谷超市公司找Product Manager、Process Engineer（有軟體工程背景的Operation Manager）、Merchandising Director ，有興趣可以直接聯繫獵頭 sarah@globalcareerpath.com ，需要有能在美國工作的身份。

Process Engineer的JD如下👇
• Measure, propose, and implement key initiatives to improve how our warehouses and cross-docks handle, receive, store, and fulfill inventory
• Design, test and execute operational and system process improvements that can be applied across the network to increase quality and on-time performance, and reduce costs
• Work closely with our Product team to identify opportunities for systematic changes to improve the flow of inventory across the network including (but not limited to) how we communicate inventory data, how inventory is prepared and documented for receiving, and how order information is used to impact picking and outbound efficiency
• Work with our warehouse partners to create and implement tools to audit efficiency and identify cost reduction opportunities including increasing fulfillment and storage capacity
• Collaborate with highly technical cross-functional teams to ensure that we achieve desired efficiencies with the lowest possible costs
• Be a subject matter expert and a key warehouse proponent in strategy and rollout discussions involving large-scale changes that affect our warehouses' day-to-day operations
• Help define and prioritize resolution of systemic problems, contributing directly to roadmaps for our Engineering and Growth teams
＿

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