這篇是先從 王介立醫師的內科腎臟透析筆記 看到的，王醫師整理的精簡扼要，我是照原文的格式寫成中文。
　
CKD G4-G5D 骨質疏鬆症診斷及治療 - 歐洲共識
http://hanwenliu.blogspot.com/2021/02/CKD-Osteoporosis.html
　
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評估骨折風險
　
◼ 停經後女性或大於 50 歲男性的 CKD G4-G5D 病人，可以考慮做 DXA。目前證據不支持對所有 CKD G4-G5D 病人篩檢 DXA 骨密度。
◼ DXA 測量骨密度的主要部位是髖部和腰椎。
◼ 前臂可以納入 DXA 的測量部位中，不過要小心 DXA 操作和動靜脈廔管造成的誤差。
◼ 骨小樑指數 (Trabecular bone score) 或其他的影像測量技術，因為臨床應用還不廣泛，需要更多的評估。
在所有接受 DXA 評估的病人，以及身高減少 4 公分以上、脊柱後凸 (駝背)、近期或長期口服類固醇治療的病人，建議做脊椎側面骨折定量評估 (Vertebral fracture assessment, VFA) 及/或脊椎側面影像。影像應包含腹主動脈以評估是否有血管鈣化。
◼ FRAX (骨折風險評估工具) 可以預測 CKD 各期的骨折風險。但 CKD 後期的 FRAX 預測值，是否需要做數字上的調整，還需要更多證據才能決定。
◼ 不經過腎臟清除的骨代謝指標，特別是 bone-specific alkaline phosphatase，在 CKD G4-G5D 可能對預測骨折有幫助，但仍需進一步證實。
　
藥物治療的介入閥值
　
◼ 50 歲以上的 CKD 病人，有脆弱性骨折病史 (主要骨鬆性骨折，包含肩膀、手腕、脊椎、髖部) 者，不須先做骨密度即可考慮開始治療。
◼ 若沒有主要骨鬆性骨折，建議以 DXA 測量脊椎或髖部的 T-score -2.5 以下作為治療閥值，用 -2.0 或 -1.5 也許更適合 (因為 T-score 可能低估 CKD 的骨折風險)。
◼ 各國的 FRAX 風險介入閥值也適用 CKD 病人。

以下係我已經喺WhatsApp收咗三次嘅前高等法院英女王御用大律師，Henry Litton (列顕倫)* QC ；給香港市民的一封信:～ (裏便了無新意, 不過有兩個好處. 1) 洋人寫係唔同啲, 仲要係有名望嘅大法官, 特別有說服力 2）啲英文寫得好靚, 仲有中文翻譯可以學習英文。

Henry Litton (列顕倫)* QC was the Judge of the highest Court in Hong Kong. He retired in 2015.

英女皇御用大律師列顕倫(亨利·利頓)QC，是香港最高法院的法官。他於2015年退休。

The following is what he’s written...

以下是他寫的。

There are few certainties in life. One of them is this: The common law system underpinning Hong Kong’s “core values” is destined to expire in 27 years’ time. The One Country Two Systems formula was designed to last for 50 years and no more. Hence Article 5 of the Basic Law. There is no mechanism in the Basic Law for the system to continue beyond 30 June 2047.

生活中很少有確定性。其中之一是：支撐香港“核心價值”的普通法制度將在27年後失效。一國兩制方案的設計時限是50年，之後，再也沒有了。因此，“基本法”第五條清楚指出。2047年6月30日以後，“基本法”中沒有任何機制讓這制度繼續下去。

All the calls for Freedom, Democracy etc have no meaning if the common law crumbles.

如果普通法崩潰，所有要求“自由、民主”等的呼籲都是沒有意義。

If the protesters truly value their professed aims, *their focus should be on demonstrating to Beijing and to the rest of the world that the One Country Two Systems formula works, and to promote an atmosphere in which Beijing feels comfortable with the system – and when the time comes, to extend the Basic Law for another 50 years, 100 years*. Then liberal democratic norms and values might have a chance to flourish.

如果抗議者真的誠心誠意的重視他們宣稱的目標，*他們的重點、重心，應該是向北京和世界其他地方展示“一國兩制”的方案是有效的，並推展“一國兩制”的成功實施。令北京對這一制度感到寛心舒泰的環境下 - 當時機成熟時，說服北京將“基本法”再延長50年，100年*。那麼，自由、民主的模式、準則和價值觀還可能有延續蓬勃、活躍的機會。

Crunch time is not 27 years away. It is just round the corner. For Hong Kong to continue as one of the world’s greatest financial and trading centres, planning for the future must necessarily look 20 -30 years ahead. So the hard question will soon be asked: is the common law system to continue beyond June 2047 ? The answer lies in Beijing and nowhere else.

擔心不安的時刻不是27年後的事。就在拐角處。要使香港繼續成為世界上最大的金融和貿易中心之一，對未來的規劃必須著眼於未來20-30年。因此，我們很快便會提出一個棘手的問題：普通法制度是否會延續至2047年6月以後？答案就在北京，而不是其他任何地方。

The last time this issue arose – back in 1982 – Hong Kong had the backing of Great Britain. This time Hong Kong stands alone. And, up to this point, Hong Kong has demonstrated for all the world to see that the One Country Two Systems formula is extremely fragile: and, if the unrest continues, it would surely fracture beyond any hope of recall.

回顧1982年，上一次被問到這個問題的時候，當時香港是得到了大英帝國的支持。而這一次，香港只能孤掌難鳴。到目前為止，香港已經向全世界展示了“一國兩制”這方案是極其脆弱的：如果動亂繼續下去，它肯定會褫奪，無望地被撤銷。

It is beyond the power of the Hong Kong SAR government to devise the governing model for the future. Pressing the Hong Kong government to promote greater democracy is futile. Rightly or wrongly, that power lies in Beijing. Nowhere else. Hong Kong enjoys freedoms found nowhere else in China. To think that unlawful assemblies and demonstrations, and violence in the streets, would soften Beijing’s attitude towards Hong Kong is absurd. Common sense suggests it would have the opposite effect.

為未來設計治理模式，是超出了香港特別行政區政府的權力範圍。要迫使香港政府促進更大的民主是徒勞的。不管是你喜歡也好。不喜歡也好。權力就是在北京。沒有別的地方了。香港現在享有中國其他地方沒有的自由。認為非法集會示威和街頭暴力會軟化北京的對香港的態度是荒謬的。常識表明，它只會產生相反的效果。

But there are deep social issues which the SAR government can redress, having regard in particular to the huge foreign currency reserves it holds:USD425 billion – by far the largest in the world, enough to guarantee public servants’ pensions hundreds of times over. And yet Hong Kong’s social services are crumbling, hospitals are understaffed, public education is poor, teachers are ill-paid, young people cannot afford to rent even the most substandard apartment, the gap between rich and poor is ever-widening.

但是，有一些深層次的社會問題是特區政府可以解決的，特別是考慮到特區政府擁有世界上最龐大的外匯儲備：4,250億美元 - 是政府公務員的長俸所需要的保證金額的數以百倍。然而，香港的社會服務卻每況愈下，醫院人手不足，全民所需的教育不論在質素及資源都極差，教師薪酬偏低。年輕人怎都難以負擔租用即使是最不合標準的居所，社會上，貧富差距在不斷拉大。

The laissez-faire policy of the colonial government has been carried to extremes by the SAR government in the past 20-odd years. The rich have prospered in the meanwhile whilst the bulk of the people suffered. The influx of Mainlanders under the One-Way Permit system has caused great strain on all services. The people’s needs have been neglected. The young see little prospect of a fulfilling future and even university graduates find difficulty in meaningful employment.

大英帝國殖民地政府的自由放任政策在過去二十多年來一直被特區政府極端化。與此同時，大多數富人們卻在此期間更加繁榮昌盛、更加富裕起來，而相反普通市民却受苦了。在單程證制度下，內地人士大量湧入，對所有服務造成更大壓力。市民的需求、需要被忽視。年輕人看不出有向上游、向上流的任何富圖的希望。甚至大學畢業生也很難找到有合識、合意的工作。

These, I suggest, are the deep-seated ills which sustain the fire of discontent in the wider community, and bring hundreds of thousands to march in the streets. These are not matters which a commission of inquiry can resolve.

我認為，這些水深火熱的社會問題及弊病，這些憤懣之火已經廣泛地蔓延在整個社會，並促使數以十萬人走上街頭。這些都不是一個所謂諮詢委員會可以解決。

The media here is full of Hong Kong stories, and of course footage of the riotous behaviour on the streets: what empty slogans, meaningless rhetoric the protesters display ……….In watching these events I am reminded of the prayer attributed to Saint Francis:

今天的媒體充斥著不同形式的香港事件，當然有街頭暴力行為的鏡頭：抗議者們展示的空洞口號和毫無意義的粗言穢語。…當我在觀看這些事件時，‘我想起聖弗朗西斯的禱告：

Pray God give me the courage to change the things I can change, the fortitude to bear the things I cannot change, and the wisdom to know the difference.

願上帝賜給我勇氣去改變我能改變的事情，給我勇氣去承受那些我無法改變的事情，給我智慧去分辨其中的黑白。

I arrive in Hong Kong Thursday 24 October, staying for one month.

我在今年的10月24日星期四抵達香港，逗留一個月。

As ever
如常，祝願香港

H

列顕倫

PS Please feel free to convey these observations to anyone you chose ………….They are *not confidential*.

歡迎隨時將我這些意見傳達給你所選擇的任何人.此文是*不保密的*。

【薦髂關節壓力型骨折】

我很好奇的查了一下Jan Frodeno受傷的部位，他自己本人是寫 " stress fracture in my hip (SI joint)"

SI Joint 全名叫Sacroiliac joint，中文稱為薦髂關節，故名思義，是骨盆裡的薦椎與髂骨所連結的部位，所以他是這個位置疲勞性骨折了

這個位置一般人要受傷，大多是受到撞擊或跌倒造成

但也好發於運動員身上，尤其是長跑者也有不少案例，主因都在於長期重覆的來回跑動，訓練量大、強度高、長期疲勞都有可能產生這問題，且女性得到的比率又比男性高

初期徵兆是活動時，如果在腹股溝處感到不適或疼痛，就應要留意並該休息，若休息後都沒好且持續惡化，就該看醫生了，否則拖下去恐不妙....

以上，是個人不負責任鍵盤閒人所google來的資訊，有問題還請找專業醫生協助，不過這裡專業醫療從業者也相當多，若本人所寫的東西有錯誤，還請指正，感謝！

資料來源：https://eorthopod.com/stress-fracture-of-the-hip/

Nasal Fractures - Dr. Hung Che Wai Terry@FindDoc.com
Source: https://www.finddoc.com/en

Background: Mr. Ko's face was hit by a basketball while he was playing basketball with his friends. Mr. Ko started having nosebleed and feeling pain shortly after the hit. He thought he could recover after some rest; however, after two days, Mr. Ko was having persistent nasal congestion. He also noticed that his nasal bridge was slightly out of position.

(1) How can one distinguish between a minor nasal injury from nasal fractures? How can the doctor diagnose? 0:25

(2) What sequelae could develop from nasal fracture? 2:26

(3) What treatments are available for nasal fracture? 3:45

(4) If Ken’s nose is hit again after recovery, will it complicate his recovery? 5:03

瀏覽中文版本短片：
http://youtu.be/HnnhAnS2PKI

Search Doctor information:
https://www.finddoc.com/

Let's Connect:
https://www.facebook.com/FindDoc
https://plus.google.com/102821364210960788806/posts

Nosebleed - Dr. Hung Che Wai Terry@FindDoc.com
Source: https://www.finddoc.com/en

Background: Mr. Kan, a non-smoker, is 38 years old and leads a regular life. In recent years, he suffer nosebleeds for unknown reasons. This symptom seems to get more frequent recently.

(1) What could cause Mr. Kan’s nosebleeds? 0:21

(2) What kinds of checkups can be done? 2:08

(3) What treatments are available for nosebleed? Can it be cured? 2:58

(4) Are there any special attentions for seniors and small children? (FindDoc Medical information) 4:19

(5) What should we do when nosebleed happens? (FindDoc Medical information) 5:47

瀏覽中文版本短片：
http://youtu.be/HnnhAnS2PKI

Search Doctor information:
https://www.finddoc.com/

Let's Connect:
https://www.facebook.com/FindDoc
https://plus.google.com/102821364210960788806/posts