Cvaywri临床医学英语
七夕，古今诗人惯咏星月与悲情。吾生虽晚，世态炎凉却已看透矣。情也成空，且作“挥手袖底风”罢。是夜，窗外风雨如晦，吾独坐陋室，听一曲《尘缘》，合成诗韵一首，觉放诸古今，亦独有风韵也。乃书于纸上。毕而卧。凄然入梦。乙酉年七月初七。
-----啸之记。
临床医学英语
Chapter 1 Patient-Physician Interaction Page 1
第一章医患沟通第１页
The patient-physician interaction proceeds through many phases of clinical reasoning and decision making.
proceed 进行、开展reasoning 推论、推理clinical reasoning 诊断
clinical decision 确定治疗方案making decision 做出决定
医患沟通在临床诊断和治疗决策的许多时期进行着。
The interaction begins with an elucidation of complaints or concerns, followed by inquiries or evaluation to address these concerns in increasingly precise ways.
elucidation 说明、阐明inquire 询问、调查evaluation 评估、评价这种沟通开始于病人主诉或所关注问题的阐明，然后通过交流、评估不断精确地确定这些问题。
The process commonly requires a careful history or physical examination, ordering of diagnostic tests, integration of clinical findings with the test results, understanding of the risks and benefits of the possible courses of action, and careful consultation with the patient and family to develop future plans.
integration 综合consultation 磋商、会诊
这个过程通常需要细致的询问病史和体格检查，开具诊断性化验医嘱，综合临床发现和化验结果，理解分析拟行治疗过程中的风险和疗效，然后与病人及家属反复磋商以完善治疗方案
Physicians increasingly can call on a growing literature of evidence-based medicine to guide the process so that benefit is maximized,while respecting individual variations among different patients
respecting 注意到、关系、说到evidence-based medicine 循证医学
尽管考虑到不同病人中个体差异是存在的，但医生们越来越容易查阅不断增长的循证医学文献来指导这个过程，使得疗效最大化。
The increasing availability of randomized trials to guide the approach to diagnosis and therap y should not be equated with “cookbook” medicine
availability可利用性，可得到randomize 随机的
cookbook 食谱，烹调书approach 接近
但是，不断增加的可用于指导临床诊断与治疗的随机试验资料不应当作“烹调书”使用。
Evidence and the guidelines that are derived from it emphasize proven approaches for patients with specific characteristics.
Evidence 证据，迹象guideline指导方针emphasize 强调
那些随机试验获得的临床表现和诊断思路是侧重于求证具有某些特征病人而来的。
Substantial clinical judgment is required to determine whether the evidence and guidelines apply to individual patients and to recognize the occasional.
substantial clinical 真实的，实在的individual 个体occasional 偶尔的，特殊的实际的临床判断需要确定这些临床表现和诊断依据标准是否能应用于普通病人的个体，并能找出例外。
Even more judgment is required in the many situations in which evidence is absent or inconclusive.
inconclusive 不确定性，非决定性
在许多情况下，临床表现缺乏或不典型，甚至需要考虑得更多。
Evidence also must be tempered by patients’ preferences, although it is a physician’s responsibility to emphasize when presenting alternative options to the patient.
temper 脾气，调音preference 偏爱presenting 提出alternative 可选择的，二选一虽然医生喜欢提出选择性问题让病人回答，但病人肯定会根据自己的倾向调节临床症状。
The adherence of a patient to a specific regimen is likely to be enhanced if the patient also understands the rationale and evidence behind the recommended option.
adherence 坚持、固执regimen 养生法、食物疗法
enhance 提高、加强rationale 基本原理
假如还懂得所提供问题的基本原理和表现，有特殊生活方法病人的固执容易强化这种倾向
To care for a patient as an individual, the physician must understand the patient as a person. care for 喜欢、照料
为了把病人作为一个个体进行治疗，医生必须理解病人是一个人（不是一群人）。
This fundamental precept of doctoring includes an understanding of the patient’s social situation, family issues,financial concerns, and preferences for different types of care and outcomes, ranging from maximum prolongation of life to the relief of pain and suffering.
precept 训戒doctoring 行医prolongation 延长
这个最基本的行医原则包括了解病人的社会地位，家庭问题，资金状况以及正确理解病人对不同治疗方法、不同治疗结果的选择，从最大限度地延长生命到临时缓解疼痛和症状。
Even as physicians become increasingly aware of new discoveries, patients can obtain their own information from a variety of sources, some of which are of questionable reliability. questionable 可疑的、成问题的、不可靠的reliability 可靠、可信赖的
甚至，当医生越来越容易知道新发现的同时，病人也能够通过各种途径得到他们的信息，某些信息是不可靠的。
The increasing use of alternative and complementary therapies is an example of patients’ frequent dissatisfaction with prescribed medical therapy.
alternative 选择，替代complementary 补充的、相配的prescribe 规定、指定、开处方不断增加的替代疗法和辅助疗法的应用就是病人对常规疗法经常不满意的一个例子。
Physicians should keep an open mind regarding unproven options but must advise their patients carefully if such options may carry any degree of potential risks, including the risk that they may relied on to substitute for proven approaches
substitute 代替、代用rely on 依赖、信任
医生对新疗法应该保持开放的思想，但是，如果这些疗法具有任何程度的潜在风险，都必须细致地告知病人，包括可能需要用已证实的常规疗法去替代的风险。
It is crucial for the physician to have an open dialogue with the patient and family regarding the full range of options that either may consider
crucial 严酷的、决定性的either 两者任一
对医生来说，对病人及家属开诚布公地介绍所有可考虑的治疗选择，是非常重要的。
The physician does not exist in a vacuum but rather as part of a complicated and extensive system of medical care and pubic health.
vacuum 真空extensive 广阔的、大量的
医生不是生存在真空中，而是作为一个复杂而庞大的医疗和公共健康体系中的一部分。
In premodern times and even today in some developing countries, basic hygiene, clean water, and adequate nutrition have been the most important ways to promote health and reduce disease. adequate 足够的、恰当的
在未发达时代，甚至当今在一些发展中国家，基本卫生条件、清洁饮用水和最低营养保障是促进健康的最重要方法。
In developed countries, the adoption of healthy lifestyles, including better diet and appropriate exercise, are cornorstones to reducing the epidemics of obesity, coronary disease, and diabetes.
adoption 采纳、采用epidemic 流行、传染
在发达国家中，健康的生活方式包括良好饮食和适当锻炼，是减少肥胖、冠心病和糖尿病的基础。
Public health interventions to provide immunizations and to reduce injuries and the use of tobacco, illicit drugs, and excess alcohol collectively can produce more health benefit than nearly any other imaginable health intervention.
illicit 非法的、违禁的collectively 全体地、共同地produce 生产、创造公共健康干预如进行疫苗接种、减少损伤、减少吸烟、减少吸毒、减少酗酒等措施共同产生的健康效果比几乎可想象的任何其它健康干预措施都要好得多。
Chapter ６Vital signs Page 15
第六章生命体征第１５页
A nurse or assistant often obtains the vital signs.
护士或护士助手经常可得到生命体征
Traditionally the vital signs include pulse rate, blood pressure, respiratory rate, and body temperature.
传统的生命体征包括脉搏（率）、血压、呼吸（频率）和体温。
More recently, advocates of var ious causes have advocated for a “fifth vital sign”.
advocate 提倡、主张
最近，人们以多种理由提出“第五生命体征”的建议。
The most cogent of these “new” vital signs is the patient’s quantitative assessment of pain. cogent 今人信服的，切实的，有力的
这些“新”的生命体征中，最今人信服的是病人疼痛的定量评判。
The pulse should be recorded as not just the rate but also the rhythm.
脉搏不仅要记录频率，而且要记录节律。
Physicians may prefer to initiate the examination by holding the patient’s hand while palpating the pulse.
initiate 开始，创始
医生喜欢握住病人的手，触摸脉搏，开始检查。
This nonthreatening initial contact with the patient allows the physician to determine whether the patient has a regular or irregular rhythm.
这个对病人无威胁性的最初接触让医生确定了脉搏是否具有节律性。
When the blood pressure is abnormal, many physicians repeat the measurement.
当测得的血压不正常，许多医生重复这个测量。
The instrument error that contributes to the greatest variability is the cuff size of the sphygmomanometer.
variability 变化，易变性sphygmomanometer 血压计
变异性中占比例最大的设备误差是血压计袖套的大小。
Many adults require a large-size adult cuff; using a narrow cuff can alter systolic/diastolic blood pressure by -8 to +10/+2 to +8mmHg.
mmHg: millimeter of mercury
许多成人需用大号的成人袖套，如果使用窄袖套能够影响收缩压-8~10mmHg ，舒张压2~8mmHg。
The appearance of repetitive sounds (Korotkoff sounds, phase 1) constitutes the systolic pressure.
constitute 构成，设立，指定
重复脉搏音（Korotkoff 音，第１相）的出现定为收缩压。
After the cuff is inflated about the palpated pressure, the Korotkoff sounds muffle and disappear as pressure is released (phase 5).
inflate 充气、膨胀muffle 含糊不清
当袖套充气压力约在可触摸脉搏压力的20~30mmHg上方，Korotkoff音变钝，当压力释放，Korotkoff音消失（第５相）。
The level at which the sounds disappear is the diastolic pressure.
声音消失的水平就是舒张压
The American Heart Association recommends that each measure should be rounded upward to the nearest 2mmHg
be round up to the nearest whole number取最近的整数
美国心脏病协会建议每次测量取最近的２mmHg整数。
The respiratory rate should be assessed at the same time the patient is observed to determine whether there is any respiratory discomfort (dyspnea).
dyspnea 呼吸困难
测量呼吸频率的同时要观察病人以确定是否存在呼吸困难。
The subjective sensation of dyspnea is caused by an increased work of breathing. subjective 主观的
呼吸困难的主观感觉是由于呼吸功增加起的。
The examiner should decide whether patients have tachypnea (a rapid rate of breathing) or hypopnea (a slow or shallow rate of breathing).
tachypnea 呼吸急促hypopnea 呼吸减弱
检查者要确定病人是否存在呼吸急促（呼吸频率快）或呼吸减弱（呼吸频率慢或浅）Tachpnea is not always associated with hyperventilation, which is defined by increased alvealar ventilation resulting in a lower arterial carbon dioxide level.
hyperventilation 换气过度resulting in 导致、引起
呼吸急促不是都伴有过度换气，过度换气的定义是肺泡通气量增高引起动脉血二氧化碳
In the evaluation of patients suspected of having pneumonia, examiners agree on the presence of tachypnea only 63% of the time.
agree on 对……取得一致意见
对一组疑为肺炎患者的评估中，检查者认为当时呼吸急促的出现率仅为63%。
The body temperature of adults usually is measured with an oral electric thermometer.
成人体温通常用口腔电子体温计测定。
These thermometers correlate well with the traditional mercury thermometer and are safer to use.
mercury 汞
这种体温计与传统的汞体温计高度相关，使用安全。
Rectal thermometers reliably record temperatures 0.4℃higher than oral thermometers.
直肠体温计可靠地记录了高于口表0.4℃的温度。
By comparison, newer tympanic thermometers may vary too much compared with oral thermometers (-1.2℃to +1.6℃versus the oral temperature) to be reliable among hospitalized patients.
tympanic 鼓膜的、鼓室的too much ……to be 太……以致于不
相比较，新型的鼓式体温计相对口表可能误差太大（与口表相差-1.2~1.6度），不宜用于住院病人。
Chapter 8 Why Geriatric Patients Are Different Page 20
第八章老年病人的特殊性第20页
Older patients differ from young or middle-aged adults with the same disease in many ways, one of which is the frequent occurrence of comorbidities and of subclinical disease. comorbidities 并存病subclinical 亚临床的
同样的疾病，年龄大的病人在许多方面与青中年病人是有区别的，其中之一是并存病多和亚临床疾病多。
As a function of the high prevalence of disease, comorbidity (or the co-occurrence of two or more diseases in the same individual) is also common.
prevalence 流行、普遍co-occurrence 同时发生
作为高发疾病的结果，并存病（两个或更多的疾病在同一个体同时发生）也是多见的。
Of people age 65 and older, 50% have two or more chronic disease, and these diseases can confer additive risk of adverse outcomes, such as mortality.
confer 授予、给予additive 附加的、附属物
65岁以上的老年中，50%患有两种以上的慢性疾病，这些疾病能够增加不利预后的风险，如死亡率。
In some patients, cognitive impairment may mask the symptoms of important conditions. cognitive 认知的、认识的impairment 损害mask 口罩、假面具、掩饰在一些病人中，认知损害可以掩盖重要病情的症状。
Treatment for one disease may affect another adversely, as in the use of aspirin to prevent stroke in individuals with a history of peptic ulcer disease.
stroke 中风peptic ulcer 消化性溃疡
对一种疾病的治疗可能加重另一种疾病，例如，对有消化性溃疡病史的病人使用阿斯匹林预防中风。
The risk for becoming disabled or dependent also increases with the number of diseases
disabled 残废的、有缺陷的dependent 依靠的、依赖的
病残或生活不能自理发生的风险也随着并存的疾病数而增高。
Specific pairs of diseases can increase synergistically the risk of disability.
synergistic 协同的
特殊的成对疾病可以协同增加病残的风险。
Arthritis and heart disease coexist in 18% of older adults; although the odds of developing disability are increased by three-fold to four-fold with either disease alone, the risk of disability increases 14-fold if both are present.
arthritis 关节炎
有18%的老年人同时患有关节炎和心脏病，虽然每个疾病可以增加3~4倍的病残率，但两个疾病同时存在，可使病残率提高14倍。
A second way in which older adults differ from younger adults is the greater likelihood that their diseases present with nonspecific symptoms and signs.
likelihood 可能性
老年与青中年的第二个差异是更容易出现非典型的症状和体症。
Pneumonia and stroke may present with nonspecific changes in mentation as the primary symptom.
pneumonia 肺炎mentation 精神作用、心理活动primary 初始的、首要的、主要的肺炎和中风时可出现非典型意识变化作为主要的症状。
Similarly, the frequency of silent myocardial infarction increases with increasing age, as does the proportion of patients who present with a change in mental status, dizziness, or weakness rather than typical chest pain.
silent 沉默的、静止的proportion 成比例的、相称的
同样地，隐匿性心肌梗塞发生频度随着年龄的增大而增加，这些病人相应地频发精神状态改变、眩晕、虚弱而不是典型的胸痛症状。
As a result, the diagnostic evaluation of geriatric patients must consider a wider spectrum of diseases than generally would be considered in middle-aged adults.
spectrum 谱、光谱
因此，老年病人的诊断应考虑更广泛的疾病谱，要超过通常对中年病人所考虑的范围。
A third condition that is found primarily in older adults is frailty, frailty is thought to be a wasting syndrome that presents with multiple symptoms and signs, including reduced muscle mass, weight loss, weakness, poor exercise tolerance, slowed motor performance, and low physical activity.
primarily 起初、首先、原来frailty 脆弱、虚弱、意志薄弱
tolerance 宽容、忍耐、耐受
主要出现在老年人的第三个情况是衰弱，衰弱被认为属于衰竭综合症，它有许多症状和体征中，包括肌肉萎缩、体重下降、虚弱、运动耐受差、动作慢、身体活动少。
Some estimates indicate that the full syndrome is found in 7% of community-dwelling people age 65 and older, and in 25%of community-dwelling people age 85 and older.
estimate 估计、评价、看法indicate 指出、表时、象征、适应征
一些人估计7%的65岁以上社区老人和25%的85岁以上社区老人上述症状全部出现。
Many institutionalized older adults also are frail.
institutionalized 使成公共团体、将……收容在公共设施里
frail 身体虚弱的、易损坏的、意志薄弱的
许多老人院里的老人也是衰弱的。
Frailty is a state of decreased reserve and increased vulnerability to all kinds of stress, from acute infection or injury to hospitalization, and may identify individuals who cannot tolerate invasive therapies.
reserve 保存、克制vulnerability 易受伤、易受责难
衰弱是对各种压力耐受下降、损害增加的一种状态，从急性感染、损伤到住院治疗，都可以发现一些人不能忍受侵入性诊疗措施。
The syndrome of frailty is associated with high risk of falls, needs for hospitalization, disability, and mortality.
fall 跌倒、下降frail 身体虚弱的、易损坏的、意志薄弱的
衰弱的症状与易于病倒、需要住院治疗、病残、死亡的高风险是相关的。
There is early evidence that a core component of frailty is sarcopenia, or loss of muscle mass associated with aging, which occurs in 13 to 24% of persons age 65 to 70 and in 60% of persons age 80 and older.
component 成分、构成要素sarcopenia 肌减少（症）、与年龄相关的骨骼肌质量下降衰弱一个主要成分的早期表现是肌肉减少，或说随年龄增长的肌肉减少，它发生在13~24%的65~70岁的老人，60%的80岁以上的老人。
It is likely that dysregulation of multiple physiologic systems, including inflammation, hormonal status, and glucose metabolism, underlies the syndrome, with resulting decreased ability to maintain homeostasis in the face of stress.
dysregulation 失调homeostasis 内环境稳定
多种生理系统易于失调，包括炎症、激素状态、糖的代谢，结果是在压力面前保持内环境的稳定的能力下降。
Subclinical disease (e.g., atherosclerosis), end-stage chronic disease (e.g., heart failure), or a combination of comorbid diseases may precipitate the syndrome.
atherosclerosis 动脉粥样硬化
亚临床疾病(如动脉粥样硬化), 晚期慢性疾病(如心力衰竭），或多种疾病并存可共同形成症状。
Evidence from randomized, controlled trials shows that resistance exercise, with or without nutritional supplements, and home-based physical therapy can increase lean body mass and strength in even the frailest older adults.
随机对照试验的迹象显示无论有无营养支持和家庭身体疗法，即使是最虚弱的老年人，对抗运动能够增加瘦弱躯体的质量和力量。
This evidence suggests that earlier stages of frailty may be remediable, although end-stage frailty likely presages death.
remediable 可挽回的presage 预兆、预示
这个结果提示早期衰弱是可挽回的，尽管末期衰弱常提示死亡。
Fourth, cognitive impairment increases in prominence as people age.
prominence 突出、显著
第四，人们变老时认知损害显著增加。
Cognitive impairment is a risk factor for a wide range of adverse outcomes, including falls, immobilization, dependency, institutionalization, and mortality.
immobilization 活动能力减少institutionalization 制度化、专门照料
认知损害是大量不利结果的风险因子，包括摔倒、活动能力下降、不能自理、需住老人院护理、死亡。
Cognitive impairment complicates diagnosis and requires additional care giving to ensure safety.
认知损害使诊断复杂，为保证安全需要更多的照料。
Finally, a serious and common outcome of chronic diseases of aging is physical disability, defined as having difficulty or being dependent on others for the conduct of essential or personally meaningful activities of life, from basic self-care (e.g., bathing or toileting) to tasks required to live independently (e.g., shopping, preparing meals, or paying bills) to a full range of activities considered to be productive and/or personally meaningful.
最后，老年人慢性病严重又常见的结果是身体能力不足，描述为个人最基本的或有意义的日常活动有困难或不得不依靠别人帮助指导，从基本的自理（如洗澡或如厕）到独立生活需要的各种任务（如购物、做饭、支付各种账单），到具有集体和／或个人意义的所有活动。
Of older adults, 40% report difficulty with tasks requiring mobility, and difficulty with mobility predicts the future development of difficulty in instrumental activities of daily living (IADL; household management tasks) and activities of daily living (ADL; basic self-care tasks).
在老年人中，40%对需要运动的任务有困难，运动困难提示将来开展日常工具锻炼（IADL；家庭护理项目）和目常锻炼（ADL；基本自理项目）的困难。
In persons age 65 and other, difficulty with IADL is reported by 20%, and difficulty with ADL is reported by 11%; for both, the prevalence increases with age.
prevalence 流行
大于65岁的老人或其它人，IADL困难报导为20%，ADL困难报导为11%；随年龄增加两个都困难成为普遍现象。
People who have difficulty with tasks of IADL and ADL are at high risk of becoming dependent.
IADL和ADL困难的人处于不能自理演变的高风险中。
Of persons older than age 65, 5% reside in nursing homes, largely as a result of dependency in IADL and/or ADL secondary to severe disease.
reside 居住nursing home 疗养院
小于65岁的老人中，5%住在疗养院里，大多数是严重疾病后依赖IADL和ADL的结果。
Generally, woman live more years with disability, whereas men who become similarly disabled are more likely to die at a younger age.
一般来说，同样的能力不足，男性常死得更年轻，女性比男性能多活几年。
Although physical disability is primarily a result of chronic diseases and geriatric conditions, its onset and severity are modified by other factors, including treatments that control the underlying diseases, physical activity, nutrition, and smoking.
Primarily 首先、起初、主要、、根本onset 进攻、有力的开始、发作虽然身体能力不足是慢性疾病和年老状态的一个主要结果，它的发生和严重程度被其它因素影响着，包括基础疾病的治疗和控制、身体锻炼、营养和吸烟。
Many intervention trials indicate that disability can be prevented or its severity decreased; one trial showed improvements in functioning with resistance and aerobic exercise in older adults with osteoarthritis of the knee.
aerobic exercise 有氧运动osteoarthritis 骨关节炎
许多干预试验揭示能力不足可预防或减轻；一个试验显示膝骨关节炎老年人用对抗运动和有氧运动改善功能。
Chapter 13 Tissue Engineering Page 36
第十三章组织工程第36页
The loss or failure of an organ or tissue is devastating.
devastating 毁灭性的
器官、组织的丧失或衰竭是毁灭性的。
Current treatment methods include transplantation of organs, surgical reconstruction, use of mechanical devices, or supplementation of metabolic products.
device 装置
现有的治疗方法有器官移植、外科重建、机械装置的应用以及代谢性产品的补充治疗。
However, the ultimate goal of transplantation should reside in the ability to restore living cells to maintain or even enhance existing tissue function.
reside 居住、属于、存在于
移植的最终目的应该基于重建活细胞群以维持甚至增进现有组织的功能。
By developing replacement tissues that remain intact with bioactive properties after implantation, retaining physiologic functions as well as structure to the tissue or organ damaged by disease or trauma, tissue engineering could provide an alternative to transplantation and other forms of reconstruction.
remain 剩下、留下、保持、属于retain 保留、保持
intact 完整无缺的、未受损伤的property 特征、特性
通过植入后仍有生物活性的替换组织发展，保持因病变或创伤而损害器官的生理功能和组织结构，组织工程能提供移植和其它重建方式的一种替代选择。
Skin replacement products are the most advanced, with several tissue-engineering wound care materials currently on the market worldwide.
皮肤替代产品最为成熟，最近有好几个组织工程（产商）将在全球市场经营这些材料。
The potential impact of this field is endless, offering unique solutions to the medical field for tissue and organ replacement.
impact 撞击、冲击frail unique 唯一的、独特的
这个领域的冲力是无限的，它提供了组织、器官替代领域独特的解决方法。
Tissue engineering may eventually be applied to the regeneration of diverse tissues such as the liver, small intestine, cardiovascular structures, nerve, and cartilage.
regeneration 再生、重建diverse 不同的、变化多的
组织工程可能最终能应用于各种组织的重建，如肝、小肠、心血管结构、神经和软骨。
Work on bioartificial liver devices has been under way for several years.
bioartificial liver 生物人工肝under way 进行中
生物人工肝装置的研究工作已经进行了好几年。
The sources of cells required for tissue engineering are summarized by three categories, autologous cells (from the patient), allogeneic cells (from donor, but not immunologically identical), and xenogeneic cells (donor form a different species).
autologous 自体allogeneic 同种异体xenogeneic 异基因的、异种组织工程所需的细胞源被总结为三大类，自体细胞（来源于病人）、同种异体细胞（来源于供者，但不是免疫同源的）和异种细胞（不同物种的供者）。
each category may be further delineated in terms of stem cells (adult or embryonic) or “differentiated” cells obtained from tissue, where the cell population obtained from tissue dissociation comprises a mixture of cells at different maturation stages and includes rare stem and progenitor cells.
delineate 描绘differentiated 区别、区分dissociation 分裂、分离maturation 成熟rare 稀奇的progenitor祖先、起源
每一类可以用术语干细胞进一步描述（成人的或胚胎的），或从组织获得的“不同”细胞进一步描述，组织分离获得的细胞群包含着不同成熟时期的细胞混合体，包括半成熟细胞和原始细胞。
Recent discoveries have indicated that stem cells of one type can transdifferentiate to repair damaged tissue of another type (i.e., hematopoietic stem cells home to infarcted myocardium and repair the tissue).
transdifferentiate 转分化hematopoietic 造血的
最近的发现提示一种类型的干细胞能够转分化以修补另一类型的损伤组织（这就是说，造血干细胞可植入梗死的心肌进行修复）。
Tissue engineering will remain an area of intense research.
intense 强烈的、热切的、激烈的
组织工程学将保持一个富有希望的研究热园。
Advances in the areas of growth factors, stromal matrices, gene encapsulation, and gene delivery will all play a role.
stromal 间质的matrix 基质encapsulation 封闭、包装delivery 传递在这个热园中，已有进展的生长因子、间质其质、基因封闭、基因传递都将扮演一份角色
Chapter 20 Nonsurgical Infections in Surgical Patients Page 57
第二十章外科病人的非外科感染第57页
Postoperative patients are at increased risk for a variety of nonsurgical postoperative nosocomial infections.
nosocomial 医院的
术后病人发生各种各样术后非外科医院内感染的风险不断增加。
The most common of these is urinary tract infection (UTI).
最常见的院内感染是泌尿道感染(UTI)。
Any patient who has had an indwelling urinary catheter is at increased risk for a UTI. indwell 存在…之中、居住
任何留置尿路导管的病人都是UTI的高风险者。
Despite the benign course of most UTIs, the occurrence of one in a surgical patient is associated with a threefold increase in death occurring during hospitalization.
threefold 三倍的、三重的
尽管大多数的尿路感染过程是良性的，但外科病人发生这样一个感染，住院死亡率提高了三倍。
The best prevention is to use urinary catheters sparingly and for specific indications and short durations and to employ strict closed –drainage techniques for those that are used.
sparingly 节俭的、保守的employ 使用、利用
最好的预防方法是少用导尿管、针对特殊指征、短时间使用，并应用严格的闭合引流技术。
Lower respiratory tract infections are the third most common cause of nosocomial infection in surgical patients (after SSIs and UTIs) and are the leading cause of death due to nosocomial infection.
SSIs 手术部位感染、局部感染
下呼吸道感染是外科病人院内感染是第三常见原因（排在局部感染和泌尿系感染之后），并且是院内感染首要的死亡因素。
Diagnosis is usually relatively straightforward in a patient who is breathing spontaneously. straightforward 一直向前、简单的、明确的spontaneously 自然的、自发的、不由自主的对一个呼吸自然的病人，诊断通常相对容易。
However, a patient who is intubated and being ventilated because of adult respiratory distress syndrome presents an extremely difficult diagnostic problem.
intubate 以管插入……腔道
但是，对一个正在插管通气的成人呼吸窘迫症病人，诊断是非常困难的。
Patients with this syndrome commonly have abnormal chest radiographic findings, abnormal blood gas values, and elevated temperatures and white blood cell counts even in the absence of infection.
radiographic X线照相术的
这种患者甚至未存在感染，却常有阳性胸部X线发现、血气值异常、体温升高、白细胞计数升高。
Both false-positive and false-negative diagnosis of pneumonia is common.
假阳性和假阴性的肺炎诊断都很常见。
New chest radiographic infiltrates with signs of infection constitute a good indication for bronchoalveolar lavage, a method being used to diagnose and identify bacteria causing ventilator-associated pneumonia, which has proven to minimize the indiscriminate use of antibiotics and possesses a higher specificity than previous methods.
infiltrate 透入、渗透constitute 构成、指定indiscriminate 不加区别的、任意的possess 拥有、撑握、具有specificity 明确性、具体性
胸部X线新渗出（阴影）伴有感染征象是支气管肺泡灌洗的良好指征，这种方法用于诊断和鉴别通气相关肺炎的病原菌，它被证明最小化了抗生素使用的任意性，比先前的方法更有针对性。
As part of the work-up for fever in a surgical patient, central lines used for monitoring or treatment should always be considered.
work-up 诊断检查central 中央的、主要的、近的、便利的line 线路、方法作为外科病人发热诊断检查的一部分，用于监测或治疗的深部导管始终应用考虑。
Catheter-related sepsis is diagnosed when an organism is isolated from blood cultures and from a segment of the catheter in question, without any other source if septicemia and with clinical findings consistent with sepsis.
organism 生物、有机体、有机组织in question 在考虑中、讨论中
当血培养中和有怀疑的导管节段中分离到病原菌，未发现其它部位的感染源，而败血症临床表现持续存在，导管脓毒败血症诊断就成立。
Infection of the catheter site is defined as presence of erythema, warmth, tenderness, and/or pus at the site of the catheter insertion.
erythema 红斑
导管插入处有红、（肿）、热、痛和／或有脓液是导管局部感染的特点。
Both require removal of the catheter, and if a new central line is needed, a new puncture is warranted.
puncture 穿刺warrant 保证、批准、证明
两种情况都要拔除导管，假如需要新的深部导管，要保证从新的部位刺入。
Furth treatment usually depends on the organism isolated.
通常根据分离到的病菌进行进一步治疗。
Placement of lines should be done following standard aseptic and antiseptic technique including wide drapes and full gown and glove for the inserting physician.
drape 窗帘、幔gown 长礼服、手术衣
放置导管前应先进行标准的无菌和抗菌技术，包括大范围铺巾，医生穿隔离衣、戴手套。
Still the best way to minimize these infections is to avoid placement of unnecessary lines and to remove them once the indication is not present anymore.
Still 然而、尽管如此
然而，减少这些感染的最好办法是避免放置不必要的导管，一旦引流指征消失立即拔管。
Routine change of central lines has not proven to reduce infection rates.
常规更换导管还未证明能降低感染率。
Occult and Obscure Gastrointestinal Bleeding Page 60
occult 神秘的、秘密的、隐蔽的obscure 黑暗的、模糊的、隐匿的
隐匿性和来源不明性胃肠道出血第60页
Occult bleeding is defined as the detection of asymptomatic blood loss from the gastrointestinal tract, generally by routine fecal occult blood testing (FOBT) or the presence of iron deficiency anemia.
fecal 排泄物、残渣
隐匿性出血指的是发现无症状性胃肠道出血，一般通过常规的大便隐血试验（FOBT）或存在着缺铁性贫血。
Obscure gastrointestinal bleeding is defined as bleeding of unknown origin that persists or recurs after a negative initial endoscopic evaluation of both the upper and lower gastrointestinal tracts.
initial 开始的、最初的evaluation 评价
来源不明性胃肠出血是指首次上、下消化管内窥镜检查都阴性、原发部位不明的持续或反复性出血。
Both of these entities may be presentations of recurrent or chronic bleeding.
entity 实体、存在、本质presentation 提出、表现、存在
两者都可能表现为反复的或慢性的出血。
The initial approach to evidence of occult gastrointestinal blood loss should be endoscopic evaluation.
对隐匿性胃肠道出血，应该使用内窥镜进行早期检查。
In the setting of an isolated positive FOBT, colonoscopy is indicated as the first test. colonoscopy 结肠镜
只有单独的大便隐血试验阳性情况下，结肠镜作为首选的检查方法是有适应征的。
The yield of colonoscopy in these patients is approximately 2% for cancer and 30% for one of more colonic polyps.
yield 产出、结出、产生
这些病人结肠镜的结果大约2%是癌症，30%是单发或多发的结肠息肉。
The initial approach to a patient with iron deficiency anemia depends on the presence of symptoms referable to either the upper or lower gastrointestinal tract.
referable 可认为与...有关的、可参考的
缺铁性贫血病人的首选检查方法要根据存在的症状跟上消化道还是下消化道相关。
Regardless of the findings on the initial upper or lower endoscopic examination, all patients should have both upper and lower endoscopy because the complementary endoscopic examination has a yield of 6% even if the first one was positive.
complementary 补充的、互补的positive 确定的、绝对的、真实的
无论首次上、下消化道内窥镜检查会有何发现，所有病人两个检查都应该做，因为互补的内窥镜检查6%有发现，甚至第一次检查是阳性的。
For premenopausal women, a positive FOBT requires full evaluation, as does iron deficiency anemia.
premenopausal 绝经前的
对绝经前妇女，大便隐血试验阳性需要全面分析，缺铁性贫血也一样。
Barium radiographs of the upper and lower gastrointestinal tract have limited utility in the setting of occult bleeding because of their inability to biopsy or treat lesions that are identified. utility 实用、效用、通用
隐匿性出血时，上、下消化道的钡剂造影应用有限，因为它们不能活检或治疗发现的病损。
The evaluation of obscure gastrointestinal bleeding is often frustrating
frustrating 令人泄气的、令人沮丧的
隐匿性胃肠道出血的诊断常常令人沮丧。
Angiodysplasia is the most common cause in most recent series.
Angiodysplasia 血管发育畸形
血管发育畸形是最近病例报导中最常见的病因。
Initial endoscopic examination should focus on any symptoms reported by the patient.
focus 聚焦、集中、明确
初始内窥镜检查要盯住病人诉说的任何症状。
Potential causative agents, such as NSAIDs and aspirin, should be discontinued.
causative 成为原因的
NSAIDs 非甾体类抗炎镇痛药non-steroidal antiinflammatory drugs
能成为潜在病因的药物，如非甾体类抗炎镇痛药和阿斯匹林，应该停用。
Disorders associated with bleeding, such as hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome), inflammatory bowel disease, or a bleeding diathesis should be considered.
telangiectasia 毛细血管扩张diathesis 素质
胃肠紊乱伴出血，像遗传性出血性毛细血管扩张症（Osler-Weber-Rendu综合症）、炎症性肠疾病、或出血性体质应该加以考虑。
A repeat endoscopic evaluation may be appropriate, because approximately one third of cases reveal a cause of bleeding overlooked during the initial endoscopy.
内窥镜重复检查可能是恰当的，因为接近三分之一病例查出了首次内窥镜漏掉的出血原因。
When upper endoscopy and colonoscopy are both unrevealing, evaluation of the small bowel is indicated.
当上消化道内窥镜和结肠镜均无发现，小肠检查具有指征。
Radiographic evaluation of the small bowel is noninvasive but relatively insensitive, with a less than 6% yield from small bowel follow-through and a 10 to 21% yield from enteroclysis. insensitive 感觉迟钝的follow-through 持久的贯彻，持续enteroclysis 小肠造影小肠X线检查是非侵入性的，但相对不灵敏，小肠全片6%不到有发现，小肠造影10～21％有结果。
By comparison, the diagnostic yield of endoscopic enteroscopy of the small bowel in obscure gastrointestinal bleeding is 38 to 75%.
enteroscopy 肠镜检查
相比较，对来源不明性胃肠道出血小肠内窥镜的诊断结果是38～75%。
Traditional videoendoscopes can evaluate only the proximal small bowel (≤150cm), whereas longer scopes, which are passed though the entire small bowel and then withdrawn while visualizing the mucosa (sonde enteroscopy), are limited in their ability to visualize the entire mucosa and cannot be used to perform diagnostic or therapeutic maneuvers.
proximal 最接近的、近侧的visualize 使看得见，想像sonde 探空火箭传统的电视内窥镜能检查近端小肠(≤150cm),然而能通过整个小肠边退边看肠粘膜的更长内镜，也不能看到整个肠粘膜，都不能作为常规的诊断或治疗手段。
When endoscopic evaluation does not detect the cause of blood loss, radiographic procedures such as scintigraphy and angiography should be considered.
scintigraphy 闪烁显像
当内窥镜检查不能发现出血病因，像闪烁造影和血管造影X线手段应该考虑。
Provocative angiography using heparin or thrombolytic agents has been suggested by some authorities, but this approach has the potential risk of precipitating major bleeding.
Provocative 刺激的、挑拔的、气人的precipitating 使突然发生、促使
虽然使用肝素或溶栓药的刺激性血管造影被某些专家推荐，但这种方法有促发大出血的潜在风险。
In the face of continued blood loss and no identified etiology, intraoperative endoscopy may provide simultaneous diagnosis and therapy.
simultaneous 同时发生的、同时存在的
碰到进行性出血查不到病因，术中肠镜可能同时解决诊断和治疗。
During the procedure, the surgeon plicates the bowel over the endoscope.
plicate 有褶的;有皱襞的
在操作中，外科医生把小肠套迭到内窥镜上。
As the scope is withdrawn, endoscopic findings can be identified for surgical resection or treatment.
当内镜后退时，内镜发现可以决定是外科切除或（保守）治疗。
The yield of this procedure exceeds 70%.
这个措施的结果超过70%。
In some clinical situations, the site of bleelding cannot be identified, and the patient requires long-term transfusion therapy.
long-term 长期的transfusion 输血
某些临床情况下，出血部位无法发现，病人而要长期的输血治疗。
A new device for visualizing the entire gastrointestinal mucosa consists of a small camera in an ingestable capsule that transmits images to receivers attached to the patient’s abdomen and
mapped to identify the location of the image.
ingestable 能咽下、能吸收camera 照相机、电视摄像机
一种新的装置能显示全部胃肠粘膜，这种装置由一颗装有小型摄像机能咽下的胶囊组成，它将（数字）影像信号传到附着在病人腹部的接收器，并绘制出图像来识别影像的位置。
The diagnostic yield of capsule enteroscopy is not yet clear, but this approach may potentially visualize segments of the small bowel that were previously inaccessible.
potentially 潜在的、可能的inaccessible 达不到的、难接近的
胶囊小肠镜的诊断效率现在还不清楚，但是，这种方法可能可以显示以前难以接近的小肠段肠管。
No therapeutic maneuvers are possible with the device.
这个装置不可能有任何治疗性操作。
Chapter 23 Diabetic Nephropathy Page 67
第二十三章糖尿病肾病第67页
End-stage renal disease (ESRD) from diabetic nephropathy is a major cause of morbidity and mortality, particularly in patients with type 1 diabetes, affecting 30 to 35% of patients in the United States.
nephropathy 肾病
由糖尿病性肾病所发展的晚期肾病（EARD）是患病和死亡的一个主要原因，特别在1型糖尿病病人中，在美国涉及30~35%的病人。
Although nephropathy is about one half as frequent in type 2 diabetics (partially due to a shortened life expectancy), type 2 diabetes still makes up the vast majority of diabetic patients seeking therapy for ESRD.
expectancy 期望、预期make up 补足、编造、组成
尽管在2型糖尿病（特别是影响寿命的）的肾病发生率大约是（1型的）一半，但2型糖尿病仍然是需要晚期肾病治疗的糖尿病病人的绝大多数。
Overall, diabetes is the leading cause of ESRD in the United states, accounting for more than one third of cases.
overall 总体来说accounting for 说明、证明、对…负责
总的来说，糖尿病是美国晚期肾病的首要病因，占三分之一以上。
Details are less clear in patients with type 2 diabetes, but the natural history of diabetic nephropathy in type 1 diabetes is well described.
2型糖尿病病人（肾病）的细节不是很清楚，但1型糖尿病肾病的自然病程已有充分的描述。
The period immediately following diagnosis is best characterized by glomerular hyperfiltration.
glomerular 肾小球的hyperfiltration 超过滤
紧接诊断后的一段时期以肾小球超过滤最具有特征。
During this time, there is renal hypertrophy, increased renal blood flow, increased glomerular volume, and an increased transglomerular pressure gradient, all contributing to a rise in GFR. hypertrophy 肥大gradient 坡度、梯度GFR glomerular filtration rate 肾小球滤过率
在这段时间中，有肾脏肥大、肾血流增加、肾小球容积增大和经肾小球的压力梯度增加，这些都与肾小球滤过率增加有关。
Importantly, these changes depend at least in part on hyperglycemia, as they are diminished
by intensive diabetes treatment.
hyperglycemia 高血糖intensive 加强的，密集的
重要的是，这些变化至少是部分依靠高血糖，因为通过有力的糖尿病治疗它们会消失。
Three to 5 years after diagnosis, early glomerular lesions appear, characterized by thickening of glomerular basement membranes, mesangial matrix expansion, and arteriolosclerosis. mesangial 肾小球系膜的matrix 母体、基础
诊断后的3~5年，早期的肾小球损害出现，以肾小球基底膜增厚、系膜基底扩张和小动脉硬化为特征。
Albumin excretion remains low during early glomerular changes; however, as pathologic changes mount, the glomeruli lise their functional integrity, resulting in glomerlar filtration defects and increased glomerular permeability.
Albumin 白蛋白mount 骑上、进行攻击integrity 完整、完善
defect 缺点、缺陷permeability 渗透性
Albumin excretion remains low during early glomerular changes; however, as pathologic changes mount, the glomeruli lose their functional integrity, resulting in glomerlar filtration defects and increased glomerular permeability.
在肾小球变化早期白蛋白排泄仍然较低，但是，病理变化进行着，肾小球失去完善的功能，引起肾小球滤过的缺陷，肾小球渗透性增加。
Although results of routine tests of renal function (creatinine and urinalysis) still remain normal, microalbuminuria (30 to 300 mg/day) appears.
尽管肾功能的常规化验（肌酐和尿检）结果还是正常，但微白蛋白尿（30~300毫克／天）已经出现。
Systemic hypertension is also present at this time in more than 50% of cases.
在这个时期，50%以上的病例还出现全身高血压。
After several years, most diabetic patients exhibit diffuse glomerulosclerosis, although a minority have pathognomonic Kimmelsteil-wilson nodular throughout lesions .
exhibit 展示、陈列diffuse 扩散、传播glomerulosclerosis 肾小球硬化症pathognomonic 特异病征性的
数年以后，大多数糖尿病病人显示不断扩展的肾小球硬化，尽管只有少数病人有特异性的Kimmelsteil-wilson小结。
Although pathologic changes continue to mount throughout the disease, glomerulosclerosis extensive enough to cause ESRD develops in a minority of patients; in these cases, overt albuminuria (>300 mg/day) begins approximatedly 15 years after diagnosis.
overt 明显的、公然的
尽管病理变化在整个病程中是持续发展的，只有少数病人的肾小球硬化范围大到足以引起晚期肾病，这些病例中，明显的白蛋白尿（>300mg/天）大约在诊断后15年开始。
Soon after, following a variable period on the order of 3 to 5 years, the GFR begins a relentless decline (≥10 ml/min/year), which is eventually reflected by an increase in serum creatinine.
on the order of 属于…一类的、与…相似的relentless 残忍的、不留情面的之后，接着一个易变的时期，约需3~5年，肾小球滤过率开始极度下降（≥10毫升/天/年），最终以血清肌酐浓度增高表现出来。
The appearance of massive proteinuria and the nephrotic syndrome is common in this context and often heralds progression to ESRD.
nephrotic syndrome 肾病综合症context 环境、背境、上下文
herald 传令、预示、预报progression 进行、前进、进展
在这样的情况下，大量蛋白尿和肾病综合症的出现是常见的，常预示晚期肾病的进展。
Once the serum creatinine rises (reflecting an approximately 50% decline in GFR), ESRD develops in most patients within 10 years.
potentially 潜在的、可能的inaccessible 达不到的、难接近的
一旦血清肌酐浓度增高（反映肾小球滤过率约下降50%），多数病人10年内发展成晚期肾病。
This course is highly variable, houever, particularly in type 2 diabetics, who may exhibit moderate proteinuria for several years without a substantial deterioration of renal function.
deterioration 变化、退化、恶化
但是，这个过程是非常易变的，特别是2型糖尿病，可以出现许多年的中等蛋白尿而不发生实质性的肾功能恶化。
A simple but useful method of monitoring progression to renal failure is to plot the reciprocal of the seum creatinine as a function of time.
plot 小块地皮、地基、用图标出、阴谋reciprocal 相互的、倒数、互补一个简单而实用的肾功能衰竭进展的监测方法是用图表记录血清肌酐的倒数作为当时的肾功能。
This technique allows better assesssment of both therapeutic interventions and the time when renal replacement therapy will become necessary.
potentially 潜在的、可能的inaccessible 达不到的、难接近的
这个技术使治疗性干预和肾移植时间的评价更为完善。
Chapter 26 Trauma in Pregnancy Page 78
第二十六章孕期创伤第78页
Trauma is the leading nonobstetric cause of maternal mortality and occurs in as many as 7% of pregnancies.
maternal 母亲的、母性的mortality 死亡数、死亡率
创伤是产妇死亡首要的非产科因素，在孕妇中多达7%。
The most common mechanisms of injury are from falls or from motor vehicle crashes. mechanism 机械、结构、机制
vehicle 运载工具、车辆
最常见的损伤机制是跌倒或机动车碰撞。
When compared to age-matched pregnant controls, pregnant women who sustained trauma had a higher incidence of spontaneous abortion, preterm labor , fetomaternal hemorrhage, abruptio placentae, and uterine rupture.
match 与……相配、使成对ssustain 遭受、承受
同孕龄配对的对照试验中，遭受创伤的孕妇更易发生自然流产、早产、母婴出血，胎盘早剥和子宫破裂。
As the scope is withdrawn, endoscopic findings can be identified for surgical resection or treatment.
agree on 对……取得一致意见sphygmomanometer 血压计
因为内镜是后退的，内镜发现可以为外科决定切除或（保守）治疗。
The yield of this procedure exceeds 70%.
这个措施的结果超过70%。
In some clinical situations, the site of bleelding cannot be identified, and the patient requires long-term transfusion therapy.
long-term 长期的transfusion 输血
某些临床情况下，出血部位无法发现，病人而要长期的输血治疗。
Multiple studies have attempted to identify risk factors that predict morbidity and mortality in the pregnant trauma patient.
multiple 多种因素组成的、复合的、多样的predict 预计，预测
许多组合研究试图确定能预示创伤孕妇发病和死亡的风险因素。
The maternal Injury Severity Score, mechanism of injury, and physical findings are unable to adequately predict adverse outcomes such as abruptio placentae and fetal loss.
adverse 相反的、不利的
母亲的创伤指数、损伤机制、体检发现都不能恰当地预示如子宫破裂、妊娠中止等不利结局。
Early involvement of an available obstetrician is important to evaluate both maternal and fetal well-being.
involvement 连累、缠绕available 可用的、可联系的well-being 康乐、安康、福利联系紧密的产科医生早期介入，检查评估母婴双方健康状况是非常重要的。
In the management of the pregnant trauma patient, the critical point is that resuscitation of the fetus is accomplished by resuscitation of the mother.
critical 紧要的、关键的
处理孕妇创伤病人时，最关键的是抢救胎儿是通过抢救母亲完成的。
Therefore, the initial evaluation and treatment of the pregnant injured patient is identical to that of the nonpregnant injured patient.
identical 同一的、完全相同的
所以，对创伤孕妇的诊断和治疗和非受伤孕妇是相同的。
Rapid assessment of the maternal airway , breathing, and circulation and ensuring an adequate airway avoids maternal and fetal hypoxia.
快速评估母亲呼吸道、呼吸和循环，保证呼吸道通畅避免母亲和胎儿缺氧。
In the later stages of pregnancy, as already described, uterine compression of the vena cava may result in hypotension from diminished venous return, so the pregnant trauma patient should be placed in left lateral decubitus position.
compression 压缩、挤压decubitus 卧姿、褥疮
在妊娠后期，如已描述的那样，子宫压迫腔静脉可引起静脉回流减少的低血压，所以创伤孕妇应摆放为左侧卧位。
If spinal cord injury is suspected, the patient may be secured to a backboard and then tilted to the left.
secure 安全的、有把握的backboard 靠背板、后部挡板tilt 使倾斜、使偏斜假如怀疑脊柱损伤，病人可先仰卧在硬板然后转向左侧。
The increased blood volume associated with pregnancy has important implications in the trauma patient.
implication 涉及、牵连
因妊娠所增加的血容量与外伤关系密切。
Signs of blood loss such as tachycardia and hypotension may be delayed until the patient loses nearly 30% of her blood volume.
失血体征如心动过速、低血压可能延迟到病人失血达到近30%的血容量。
As a result, the fetus may be experiencing hypoperfusion long before the mother manifests any signs.
perfusion 灌注
结果，在母亲出现表现前，胎儿可能存在长时间的血流灌注不足。
Early and rapid fluid resuscitation should be administered even in the pregnant patient who is normotensive.
administer 执行，实施normotensive 血压正常
要早期快速输液，甚至对血压正常的孕妇也是如此。
Chapter 41 Diagnosis of Sudden Cardic Death(SCD) Page 118
第四十一章心源性猝死的诊断第118页
SCD is death due to instantaneous, unanticipated circulatory collapse within 1 hour of initial symptoms and is often, but not always, due to a cardiac arrhythmia.
instantaneous 瞬间的、即刻的、即时的unanticipated 不曾预料到的心源性猝死是指出现初始症状1小时内的未能预料的循环衰竭死亡，并不少见，但不全是心律失常。
More than 70% of all sudden natural deaths have a cardiac cause, and 80% of these are attributable to coronary artery disease.
attributable 可归于┄的
70%以上的自然猝死有心脏的原因，心脏原因中80%跟冠状动脉疾病有关。
In assessing prognosis and planning a treatment strategy, it is useful to classify SCD as either primary (without a clear trigger) or secondary.
strategy 策略、战略trigger 触发、引起
在评估预后和制定治疗方案时，将心源性猝死分为原发性（无明确的诱发因素）和继发性是实用的。
A primary episode has a 10 to 30% 1-year recurrence rate, whereas most secondary episodes are associated with recurrence rates of less than 2%.
episode 一段情节、插曲、有趣的事associated with 联合
原发性的在1年内有10~30的复发率，而大多数继发性的合在一起复发率小于2%。
Identifiable reversible precipitants of secondary ventricular fibrillation (VF) include transient ischemia possibly related to vasospasm;
identifiable 可确认的reversible 可逆的precipitant 仓促的、突然的transient 短暂的、瞬时的
可确认的可逆性继发性心室颤动（VF）的发作包括可能因血管痉挛的短暂缺血；
hypokalemia resulting from diuretics; hyperkalimia secondary to renal failure, angiotensin-converting enzyme inhibitors, prostaglandin inhibitors,or potassium-sparing diuretics; hypokalemia 低钾血症angiotensin-converting enzyme血管紧张素转化酶prostaglandin 前列腺素sparing 节俭的、保守的
利尿剂引起的低钾血症；肾功能衰竭、血管紧张素转化酶抑制因子、前列腺素抑制因子、或保钾利尿剂所致的高钾血症；
proarrhythmia secondary to antiarrhythmics, tricyclics, and antihistamines;
proarrhythmia 致心律失常作用tricyclic 三环的、三环分子
antihistamine 抗组织胺类
继发抗心律失常药、三环类药和抗组胺类药的心律失常；
or substance abuse with drugs such as cocaine and amphetamines.
administer abuse 滥用、陋习amphetamine 安非他明、苯异丙胺或可卡因或安非他明类药物的滥用。
可确认的可逆性继发性心室颤动（VF）的发作包括可能是血管痉挛的短暂缺血；利尿剂引起的低钾血症；肾功能衰竭、血管紧张素转化酶抑制因子、前列腺素抑制因子、或保钾利尿剂所致的高钾血症；抗心律失常药、三环类药和抗组胺类药引起的心律失常；或可卡因或安非他明类药物的滥用。
Therapy is directed toward removing or treating the acute precipitant.
removing 消除
治疗是直接消除或处理急性发作。
SCD related to acute ischemia in the absence of prior MI often is associated with severe proximal occlusive disease, normal left ventricular function, normal signal-averaged ECG, and noninducibility [absence of ventricular tachycardia (VT) ]during electrophysiologic study.
MI myocardial infarction 心肌梗死average 平均inducibility 可诱导的缺乏心肌梗死前兆的急性缺血性心源性猝死常与严重的近端梗阻疾病有关，电生理研究时心室功能正常，心电图正常信号普通，无法诱异[缺乏室性心动过速（VT）] Most patients should undergo comprehensive evaluation of myocardial function and coronary anatomy.
undergo 经历、忍受comprehensive全面的、广泛的，能充分理解的大多数病人应该进行全面的心肌功能评价和冠状动脉解剖。
Echocardiography is useful for excluding hypertrophic cardiomyopathy and valvular heart disease;
echocardiography 超声心动图hypertrophic cardiomyopathy 肥厚性心肌病超声心动图对肥厚性心肌病和瓣膜性心脏病在内的疾病很有用；
magnetic resonance imaging, for diagnosing arrhythmogenic right ventricular dysplasia; magnetic resonance imaging 磁共振dysplasia 发育异常、结构异常磁共振对有心律失常性右室发育不良症的诊断很有用；
and myocardial biopsy, for identifying infiltrative diseases such as myocarditis, amyloidosis, hemochromatosis, and sarcoidosis.
infiltrative 渗透性的、浸润性的amyloidosis 淀粉样变
hemochromatosis 血色素沉着sarcoidosis 结节病
心肌活检对浸润性疾病如心肌炎、淀粉样变、结节病很有用。
Coronary angiography shoule be performed to assess for the presence of coronary occlusive disease and to exclude coronary artery anomalies.
应该进行冠状动脉血管造影评估冠脉阻塞性疾病的存在和排除冠脉的结构异常。
Myocardial perfusion scintigraphy provides complementary data for assessing ischemic burden.
myocardial perfusion scintigraphy 心肌灌注闪烁照相术
心肌灌注闪烁照相术对缺血程度估计提供辅助资料。
Left ventricular function can be assessed by contrast ventriculography, radionuclide ventriculography, or echocardiography.
ventriculography 心室造影术radionuclide ventriculography 放射性核素心室显像术通过对比心室造影、同位素心室造影或超声心动图可以评价左心室。
Evaluation of SCD survivors also includes Holter monitoring and/or electrophysiologic
临床医学英语的课文参考译文版
临床医学英语的课文参考译文整理版
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第二单元 骨质疏松与骨骼的危险因素 骨质疏松可能几十年也没有任何症状。因为除非骨折，它不会引起任何症状。有些骨质疏松性骨折数年后才能诊断出来。因此，只有发生带来痛苦的骨折时，患者才能意识到自己的骨质疏松。而骨质疏松症状和骨折部位有关。 脊椎骨折可引起严重的带状疼痛，疼痛从后背扩散到身体的两侧。几年时间，反复的脊椎骨折可引起身高变矮，脊椎弯曲和后背下端长期疼痛。脊椎弯曲使得患者出现驼背现象，通常称为“罗锅”。 日常生活中发生的骨折叫做压迫性骨折。例如：有些骨质疏松患者走路或下台阶时，脚部会出现压迫性骨折。 跌倒时通常发生髋部骨折。如果患有骨质疏松，非常轻微的磕碰都能造成髋部骨折。由于骨骼的质量较差，即使行外科手术治疗，髋部骨折也很难治愈。 根据国际骨质疏松基金会今天在世界骨质疏松日公布的报告披露，如果吸烟，每天饮酒两杯以上，不锻炼身体或饮食不佳，晚年就会患骨质疏松。 国际骨质疏松基金会主席Daniel Navid在迪拜召开的记者招待会上说：“预计到2050年，因骨质疏松造成的髋部骨折发生率，男性将增至310%，女性将增至240%。骨质疏松导致的骨折通常意味着疼痛，功能丧失，严重病例会导致死亡。” “战胜骨折”报告作者及国际骨质疏松基金会成员Cyrus Cooper教授说：“世界范围内，骨质疏松发病率正以流行病的发病增长——50岁以上,有1/3的女性和1/5的男性患骨质疏松性骨折。但是，如果人们年轻时就认识到骨质疏松的危害并采取适当措施，将对晚年时期的骨骼健康有着巨大的积极影响。” 国际骨质疏松基金会敦促人们接受国际骨质疏松基金会一分钟骨质疏松危险因素检查。此外，采取对骨骼有益的生活方式，如营养饮食，定期锻炼，不吸烟，不酗酒，这些都会有助于形成健壮的骨骼，防止骨折。 危险因素主要分为两大类：可修正的和不可修正的危险因素。尽管我们无法控制危险因素，如年龄，性别，家族史，但还是有些能减轻其影响的办法。 可修正的危险因素 可修正的危险因素主要源于不健康的饮食或生活方式的选择，包括营养不良，身高体重比偏低,饮食失调，喝酒，吸烟和缺乏锻炼。这些危险因素大部分直接影响骨骼健康，导致骨密度降低。（BMD） 喝酒 欧洲,北美洲及澳大利亚的研究表明，无论男性还是女性，每天饮酒量超过两杯会就加大骨质疏松和髋关节骨折的危险。 吸烟 吸烟同样增加人的骨折危险。国际研究已经表明，吸烟使髋关节骨折的危险增加1.5倍。在瑞典进行的研究表明，18到20岁的男性吸烟者，其骨密度降低。这项研究结果尤其令人担忧。因为它表明，年轻人吸烟可以降低骨质峰值——而骨质在20岁到25岁形成——因此增加他得晚年患骨质疏松的危险。 身高体重比偏低 身高体重比（BMI）偏低是检测人瘦的尺度，也可以用来提示患骨质疏松的危险度。医生认为，BMI在20到25之间是理想值。19以下表明BMI太低，有患骨质疏松的危险。 营养不良、饮食钙摄取量低 营养不良与BMI低紧密相连，它能影响骨骼健康。当饮食中钙的摄取量不足时尤其如此。钙是骨矿物质的基本成分，对肌肉，神经和人体的其它细胞也是十分重要的。 维生素D缺乏 主要通过皮肤暴露在阳光下获得的维生素D十分重要，因为它帮助从肠中吸收的钙进入到血液中。通常，儿童和成人每天把面部、手和胳膊暴露在阳光下10到15分钟就足够了。 饮食失调 饮食失调，如神经性厌食、贪食，也能引起骨质疏松。这些情况都能大大降低钙摄取量，加速骨矿物质流失。 运动量不足 久坐的人比经常运动的人更容易发生髋关节骨折。例如：每天坐9个小时以上的女性，其髋关节骨折的机率比坐6个小时以下的女性高50%。 经常跌跤 90%的髋关节骨折都源于跌跤。视力障碍、丧失平衡、肌肉神经紊乱，痴呆、卧床及老年人中常见的服用安眠药
新编临床医学英语
新编临床医学英语 第1期:病患的问题与诉求 Unit 1 Text A Internal Medicine and Today's Internist 第1单元文章A内科与内科医生 Questions/Pleas of the Patient 病患的问题与诉求 How can I find a good doctor?" 我如何找到一位良医？ How can I find a good doctor whom I can afford?" 如何能够碰到一位价格亲民的医生？ How can I find a good doctor who cares about me as a person? 〃 又如何能够遇见一位把我当成入”看待的医生？ How can I find a good doctor who will take the time to listen and understand ?" 如何找到一位能够花时间倾听我的诉说，了解我的名医？ People who need medical care ask these questions throughout the world every day. 每天，全球有许多病患都在询问这些问题。 They ask them because they face a health care system that is scientifically complex , organizationally overloaded, and generally not oriented to the patient as a person. 他们之所以问这些问题，是因为他们所面对的医疗保健体系技术深奥、机构臃肿，而且一般都没有意识到病人首先是 一个人”。 When an individual first becomes ill, regardless of the symptoms, he or she needs most someone who seems to say, 如果有人生了病，不管症状如何，他们最希望听到的是： "I am a good doctor ；I charge a reasonable amount for my services ；I care about you ，the patient and I will take the time to listen and understand ." 我是医生；我只收取亲民价格，我关心病患，我将倾听你的诉求，理解你。” A prominent teacher/ physician in a major medical center taught his students to listen to the patient and he will tell you what is wrong, and he will tell you what he needs". 主要医疗中心的知名学者/内科医生都会教授学生要学会倾听，病人会告诉你哪里不舒服，也将会告诉你他们的需求。 Having found a physician who answers so profoundly to their needs, some patients are extremely grateful but most are utterly overwhelmed. 有些内科医生完全满足了病患的需求，有些患者表现出了极大的感激之情，但是绝大部分都激动不已。 With the discovery of that relationship, the difference between a superb technician and a true physician really becomes evident to the patient. 有了这层关系之后，专业技师和内科医生的区别在病患面前展露无遗。 That physician /teacher was a scholarly gentleman with deep scientific insight and an active
高中英语选修7课文逐句翻译40387
All things come to those who wait. 苍天不负有心人 Victory won't come to me unless I go to it. ( M. Moore ) 胜利是不会向我们走来的，我必须自己走向胜利。(穆尔) 2017高考我们必胜！ 选修七课文译文 Unit1 （A篇）MARTY’S STORY马蒂的故事 Hi, my name is Marty Fielding and I guess you could say that I am "one in a million".你好。我叫马蒂·菲尔丁。我想你可能会说我是“百万人中才有一个”的那种人。In other words, there are not many people like me. 换句话说，世界上像我这样的人并不多见。You see, I have a muscle disease which makes me very weak, so I can't run or climb stairs as quickly as other people. 你瞧，我的肌肉有毛病，使我的身体非常虚弱，所以我不能像别人那样快跑快步爬楼梯。In addition, sometimes I am very clumsy and drop things or bump into furniture. 再说，有时候我还会笨手笨脚、不小心摔掉东西，或磕碰到家具上。Unfortunately, the doctors don't know how to make me better, but I am very outgoing and have learned to adapt to my disability. 不幸的是，大夫们不知道如何治好我的病，但是我很开朗乐观，学会了适应身体的残疾。My motto is: live one day at a time. 我的座右铭是：活好每一天。 Until I was ten years old I was the same as everyone else. 十岁以前，我跟其他人是一样的。 I used to climb trees, swim and play football. 我常常爬树、游泳、踢足球。In fact, I used to dream about playing professional football and possibly representing my country in the World Cup. 说实在的，我过去常常梦想我会成为职业球员，代表我们的国家参加世界杯足球赛。Then I started to get weaker and weaker, until I could only enjoy football from a bench at the stadium. 后来，我的身体开始变得越来越虚弱，以至于只能坐在体育场的长凳上欣赏足球了。In the end I went into hospital for medical tests. I stayed there for nearly three months. 最后我到医院去做了检查，几乎住了三个月的医院。I think I had at least a billion tests, including one in which they cut out a piece of muscle from my leg and looked at it under a microscope. 我想我至少做过十亿次检查，
临床医学英语textA翻译
第一单元 A 篇 预防保健与整体医疗 预防保健 预防保健指的是某种生活方式和医疗保健（例如疾病筛查）的实施，其目的在于延长健康的状态和避免某一特定常见病的发生（如心脏病，癌症，和由于谷蛋白和其他饮食敏感引起的免疫系统疾病）。我认为更多的精力和卫生保健资金应该用于预防疾病，这样一来治疗疾病所需资金会相应减少（由于疾病减少）。 这种方法同样适用于筛查某一特定疾病。这就是我用谷蛋白敏感性作一例子的理由。现在我们拥有技术在儿童的生长过缓之前，在不可逆的骨质疏松症发生之前，在其它自身免疫疾病产生之前，在淋巴瘤和其他癌症发生之前，应用科学技术在早期来测试其对谷蛋白的免疫反应。我认为对可测出的谷蛋白敏感和（或）肠功能异常不应该置之不理，我坚持对小肠的伤害情况应该饮食调节之前进行活组织检查。多年来病理学家已知道组织损害常伴有功能损伤。恰恰是功能损伤而不是组织损害应当引起重视。谷蛋白敏感进行饮食调节只是在人生中为了达到最佳健康而实施的保健措施的一个方面。其它更为重要的方面包括其它保健干预措施，比如避免吸烟、防止过量饮酒、不使用毒品，锻炼身体，健康营养摄入，以及良好口腔卫生。详情，请见下文“健康和营养十步曲”。 整体医疗 整体医疗观或整体医疗，虽然有时易混同于一种可供选择的医疗实践，但实际指的是人的全面整体健康的保持（包括生理，情感，心理和精神），而不仅仅指健康或身体系统的某个方面。例如，作为胃肠道疾病专家，人们通常只咨询胃肠类疾病的相关问题。仅关注肠道疾病的症状并进行药物治疗是典型的传统医疗法。但是，我更支持整体医疗方法。众所周知，情感因素、饮食因素、压力和体育活动（如过度运动）都会极大影响肠功能。为了取得胃肠疾病治疗或任何其它身体系统疾病治疗的最长期效的成功，以上所有这些方面都应重视。因此，对有症状或无症状的个人最好的医疗服务就是提供一种针对整个人（因而被称为“整体”）的评估和治疗的方法来保持其健康，而决非仅针对某一特定部位。 我的“健康和营养十步曲”就体现了我的整体医疗观。 “健康和营养十步曲” 摄入品种广泛富于营养，能量适当，益于吸收和健康的食品； 充足睡眠，遵循最适合你的有规律的生物钟（夜间睡眠至少8小时，日出前起床最佳）； 每天进行体育锻炼，最好在户外阳光下； 每天用非药物减轻压力方式（尤其通过锻炼、沉思、祈祷，以有可能避免压力）； 不吸烟，不饮酒，及其它可以改变情绪的物质； 采用各种方法保持口腔清洁（经常刷牙并用牙线清洁牙齿）； 如果可能，尽量避免接触食物、水和空气中的毒素； 想办法玩，大笑、以愉快感恩积极的心态面对自己的人生； 帮助他人，已所不欲，勿施与人； 在生活中力求平静、安宁、谦逊、简朴与爱。
外研版高中英语必修1课文逐句翻译
1.必修一MODULE 1 My First Day at Senior High升入高中的第一天 My name is Li Kang. I live in Shijiazhuang, a city not far from Beijing.我叫李康,住在离北京不远的石家庄市,它是河北省的首府。It is the capital city of Hebei Province. Today is my first day at Senior High school and I'm writing down my thoughts about it.今天是我升入高中的第一天,现在我就写写我这一天的感想。My new school is very good and I can see why. The teachers are very enthusiastic and friendly and the classrooms are amazing.我的新学校非常好,理由如下,老师们很热情、很友好,而且教室很棒。Every room has a computer with a special screen, almost as big as a cinema screen. 每间教室部配备有一台电脑,电脑屏幕是像电影院屏幕大小差不多的特殊屏幕。The teachers write on the computer, and their words appear on the screen behind them.老师在电脑上写字,这些字就出现在老师身后的屏幕上。The screens also show photographs, text and information from websites. They're brilliant!屏幕也能显示照片、文本以及网站下载的信息。真是太棒了! The English class is really interesting.英语课很有趣。The teacher is a very enthusiastic woman called Ms Shen.老师是一位姓沈的非常热心的女士。We're using a new textbook and Ms Shen’s method of teaching is nothing like that of the teachers at my Junior High school.由于我们使用的是新课本,沈老师的教学方法跟初中老师完全不一样。She thinks that reading comprehension is important, but we speak a lot in class, too. 她认为阅读理解很重要,而我们在课堂上说得也很多。And we have fun. I don't think I will be bored in Ms Shen's class!我们过得很快乐。我认为上沈老师的课我是不会感到厌倦的! Today we introduced ourselves to each other. We did this in groups. 今天我们以小 组的形式互相作了自我介绍。Some students were embarrassed at first but everyone was very friendly and it was really nice.有些同学开始还有些难为情,不过大家都很友好,真是太好了。Ms Shen gave us instructions and then we worked by ourselves.沈老师给了我们一些指导,然后我们自己活动。
零基础英语：零基础到四级怎么学习
美联英语提供：零基础英语：零基础到四级怎么学习 两分钟做个小测试，看看你的英语水平 https://www.wendangku.net/doc/1b15115976.html,/test/xiaobai.aspx?tid=16-73675-0 英语四级怎么学习？这个一直是很多人焦虑的问题，尤其是基础不好的人或者零基础的更是。对于任何一门考试，首先要做到的是了解考试其特点从而更好的去着手和应对。然后再做一份全面的备考计划是打好基础的第一步。英语四级复习备考可分为阶段分为三个阶段：基础阶段，强化阶段，以及冲刺阶段。 一、基础阶段 一般情况下，你为什么会觉得英语考试难？原因很简单，无非是单词看不懂，句子读不懂。像你这样子的就属于基础薄弱者，必须要夯实基础，这样子才能从根本上解决一部分问题。这一阶段主要就是教你如何为后期复习打好基础的。 首先我们必须得复习四六级词汇学习！以为我的基础较差，经过我的了解，大纲所考的英语词汇也就那么多，而且还是反复出现在英语真题中的，所以我觉得用真题来复习单词是最好的选择。 而逐句精解中对于阅读真题文章每一句话中的核心单词都有详细的注解，包括词性、词义、近反义词等等，在真题环境下记忆单词，效果真的很不一样，我只花费了一个月的时间就记住了大部分核心单词。然后就是语法的学习，只会背单词不懂语法是不能够准确的翻译阅读的。 长难句是句子图解，简单句也有语法讲解，只是以句子讲解的形式而已，但是仅仅如此就足够啦！我自己看不懂就参考着它进行学习了。逐渐的我发现，我竟然自己能读懂文章了，不但如此还可以自己分析句子的语法了。
二、强化阶段 上一阶段的学习只能让你读懂文章，而做题是要讲究技巧的，因此这一阶段主要以真题为主，完成近几年的所有真题的同时要学会分析错题原因，及时进行查漏补缺。你应该更加关注做题技巧和思路，及时进行反思和理解。重点练习自己的薄弱单项进行系统化的强化练习。1.听力：首先必须做到能够认识历年真题选项和原文中的所有单词。我想现阶段认识题目什么的应该都不是问题了，但是听力考试不只是认识题目，关键是要能听得懂。要想听懂就只能多听了，当然如果你不嫌弃麻烦的话可以一边听一边把翻译写下来。当时是把逐句精解赠送的MP3格式的听力题下载到了手机上，没事就听它，有时候我就把它写在纸上翻译下来，如果没记下的就多听几遍。慢慢的能听懂，但是我发现做题还有一定的问题，我就把逐句精解赠送的听力做题技巧的小册子拿来学习做题技巧。没想到，才学习了几个提醒就明显见效了。 2.写作：写作是主观性很强的题型，建议你找一些好的经典的模板背诵吧！逐句精解的真题答案部分就有给出参考模板，可以直接拿来学习，就不用再找其他的书了。此时的你已经掌握了高大上的单词和句式，作文基本上是可以随手拈来的了。没事多看看话题，了解更多的作文题型，作文基本上就不是问题。 3.翻译：翻译是要多加练习的，基础知识都已经得到夯实了，那么就不多说了，用逐句精解的翻译技巧学习一下翻译应该注意的问题吧！这两点掌握了之后翻译基本上也就不是问题了。 4.阅读：有了基础阶段对于词汇语法的补漏，强化阶段重点不再是读懂，而是做对。在做题过程中能明确各大题型和各大考点，拿到题干能快速判断该题属于哪一题型，通过课上笔记清楚各题型的解题方法，清楚各题型各自的正确与错误选项特征。之前学习词汇和语法是结合真题阅读来进行的。这对于做阅读是很有帮助的，做题技巧的话就用逐句精解赠送的阅读技巧小册子来学习吧！相信你会在最短的时间有很大的提升。
新编临床医学英语
新编临床医学英语 第1期:病患得问题与诉求 Unit １ Texｔ A Internal Ｍedicｉｎe ａnd Tｏdaｙ’ｓＩnｔeｒnｉst 第1单元文章A 内科与内科医生 Ｑuestions／Pｌeas ｏf ｔｈｅＰaｔｉｅｎt 病患得问题与诉求 How can I ｆiｎd a gｏoｄ doctor？” 我如何找到一位良医？ How caｎＩｆｉnd a good dｏｃtor whom I can affｏrｄ?" 如何能够碰到一位价格亲民得医生？ Hｏw can I find ａ gooｄｄoctｏr wｈｏ careｓ aｂout me as a persｏn？〃 又如何能够遇见一位把我当成“人”瞧待得医生? Ｈow ｃａn I fiｎd a ｇｏod doｃtoｒｗho ｗill tａke tｈe ｔime to lｉｓｔen and ｕnｄersｔaｎd?＂ 如何找到一位能够花时间倾听我得诉说,了解我得名医？ Peｏple wｈo ｎeed ｍeｄical ｃａrｅ ask ｔhese quesｔions ｔhrｏuｇｈouｔ thｅ wｏrlｄ eｖery ｄaｙ. 每天,全球有许多病患都在询问这些问题、 They ask ｔhem ｂecause theｙｆace a heａlth caｒe ｓystem that ｉｓ sｃientiｆicallｙcoｍpleｘ, ｏｒganizａｔiｏnally ｏverloaded, aｎd gｅnerally not oriｅｎted to the pａｔiｅｎt as a person、 她们之所以问这些问题,就是因为她们所面对得医疗保健体系技术深奥、机构臃肿,而且一般都没有意识到病人首先就是一个“人"。 Wheｎ an individual firsｔ beｅｓ ill, rｅgardlｅss ｏf the symptoms, he ｏr she ｎeｅｄｓ moｓｔsomeone wｈo sｅeｍs to say, 如果有人生了病,不管症状如何,她们最希望听到得就是: ”I am a gｏｏｄｄoctor;I cｈａrge ａｒｅaｓonａｂlｅ amoｕnt for my servｉcｅs;I cａｒｅ aｂout you,ｔｈe patieｎt ａnd Ｉ will takｅｔhe tｉｍｅｔo listｅｎａnd ｕｎdeｒstand、" “我就是医生;我只收取亲民价格,我关心病患,我将倾听您得诉求,理解您。” A prominｅnt teacher/ｐhｙsiｃiａn iｎ a ｍajoｒ mｅｄicaｌ cenｔer taｕght his ｓtudents to liｓｔ en tｏ the pａtieｎｔ and ｈe will ｔelｌ yoｕ whaｔ is wｒoｎｇ, anｄ hｅ will tell yoｕｗhat he nｅeｄs”. 主要医疗中心得知名学者／内科医生都会教授学生要学会倾听,病人会告诉您哪里不舒服,也将会告诉您她们得需求、Having ｆound a physiciａｎ wｈo answers sｏ profouｎdly ｔo ｔhｅir needs, somｅ patｉenｔｓ arｅexｔremely graｔeful but moｓt are uｔtｅrｌy ｏverwｈｅlmed、 有些内科医生完全满足了病患得需求,有些患者表现出了极大得感激之情,但就是绝大部分都激动不已。 Wiｔｈ the discovｅry oｆ tｈat relaｔioｎsｈiｐ, thｅ difｆeｒenｃe ｂｅtween a sｕｐｅrb techｎicｉa ｎ and ａ trｕe pｈｙsｉcｉaｎ really bees eｖｉｄｅnt to ｔｈｅｐatient。 有了这层关系之后,专业技师与内科医生得区别在病患面前展露无遗。 Thａｔphｙsician/teａcｈｅr was a scholａrly gｅntlemａn with deep scｉentific insigh ｔ and an activｅaｎd stimulatｉng cｌiniｃalａnd resｅarcｈ praｃｔicｅ、 内科医生/教授都就是学术人才,她们对学科有着科学得深刻见解,并活跃在临床与研究领域中。
高中英语全部单元课文逐句翻译(外研版)
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