Medical Grand Rounds December 3, 2008 Clinical Vignette

肾内科科室规章制度及流程英文回答：1. Purpose.The purpose of this policy is to provide a comprehensive overview of the policies and procedures for the Nephrology Department. This policy shall apply to all staff members working within the department.2. Scope.This policy applies to all aspects of the Nephrology Department, including but not limited to:Patient care.Research.Education.Administration.3. Responsibilities.The Nephrology Department is responsible for providing high-quality patient care, conducting research, and providing educational opportunities for staff and students. The department is also responsible for ensuring that all policies and procedures are followed in a consistent and efficient manner.4. Patient Care.The Nephrology Department provides a wide range of patient care services, including:Dialysis.Transplantation.Glomerular diseases.Tubulointerstitial diseases.Electrolyte and acid-base disorders.Hypertension.The department is committed to providing compassionate and effective care to all patients.5. Research.The Nephrology Department is actively involved in research, with a focus on the following areas:Glomerular diseases.Tubulointerstitial diseases.Electrolyte and acid-base disorders.Hypertension.Transplantation.The department is committed to conducting high-quality research that will improve the lives of patients withkidney disease.6. Education.The Nephrology Department provides a variety of educational opportunities for staff and students, including:Continuing medical education courses.Grand rounds.Journal clubs.Research conferences.The department is committed to providing high-quality education that will enhance the knowledge and skills of itsstaff and students.7. Administration.The Nephrology Department is administered by a department head and an administrative team. The department head is responsible for the overall operation of the department, including budget, personnel, and quality assurance. The administrative team is responsible for providing support to the department head and staff.8. Quality Assurance.The Nephrology Department is committed to providing high-quality patient care. The department has a quality assurance program in place to monitor and improve the quality of its services. The program includes a variety of measures, such as:Patient satisfaction surveys.Clinical audits.Process improvement initiatives.The department is committed to using the results of its quality assurance program to improve the care it provides to patients.9. Compliance.The Nephrology Department is committed to complying with all applicable laws and regulations. The department has a compliance program in place to ensure that all staff members are aware of their compliance obligations. The program includes a variety of measures, such as:Compliance training.Compliance audits.Legal review of new policies and procedures.The department is committed to using its complianceprogram to prevent and detect compliance violations.10. Confidentiality.The Nephrology Department is committed to protecting the confidentiality of patient information. The department has a confidentiality policy in place to ensure that all patient information is handled in a confidential and secure manner. The policy includes a variety of measures, such as:Secure storage of patient records.Training of staff on confidentiality obligations.Compliance with HIPAA regulations.The department is committed to using itsconfidentiality policy to protect the privacy of its patients.中文回答：肾内科科室规章制度及流程。

2008年全国医学博士外语统一考试英语试题录音原文Paper OnePart ⅠListening Comprehension (30 % )Section ADirections: In this section you will hear fifteen short conversations between two speakers.At the end of each conversation, you will hear a question about what is said. The question will be read only once. After you hear the question, read the four possible answers marked A, B, C and D. Choose the best answer and mark the letter of your choice on the ANSWER SHEET.Listen to the following example.You will hear.Woman: I feel faint.Man: No wonder. You haven' t had a bite all day.Question: What' s the matter with the woman?You will read:A. She is sick.B. She was bitten by an ant.C. She is hungry.D. She spilled her paint.Here C is the right answer.Sample AnswerA B C DNow let' s begin with question number 1.1. W: How many people turned out at the fund raising event?M: Fewer people came than we had expected. It was disappointing, but we made a little money for our organization.W: Sorry, I wasn't able to attend. I intended to.Q: What did the man say about the fund raising event?2. M: The reflux disease is often caused by the relaxation of the sphincter which opens at the wrong time, allowing acid content to flow into the esophagus. What do you think is the result?W: It burns. That' s what causes heart burn, right?Q: What are they talking about?3. W: Exeuse me, I understand that this office helps students with housing, is that right?M:Are you a student in nursing program? May I see your ID card? Urn, yes, we can certainly help you. Where are you staying now?W: I just arrived yesterday, I' m staying at the hotel across the street.M: Will you be living alone or do you have a family, or would you be interested in sharing housing?Q: Where does this conversation most probably take place?4. M: Let's call it a day, we've acted for hours.W: I' m beat too. Let's get something to eat.M: We'd be able to feel better with a little nutrition.Q: How are the speakers feeling?5. W: I heard that you and some friends are organizing a cruise to Maldives.M: It's never really got off the ground.W: That's too bad. It sounded like fun.M: Yeah, I'm still planning to go. Alone if I have to.Q: What is the man planning to do?6. M: Doc, I'm afraid to have the runs.W: Are you going to the toilet often?M: Haven't stopped since very early this morning.W: What did you have for breakfast?M: Just cereal and a few cups of tea.Q: What is the man's problem?7. W: Take off your shirt and I will take a closer look.M- Can you see any bits of glass?W: Yes, I have removed them all, and disinfected the wound. The next thing I should do is to stitch you up. Q: What is the woman going to do next?8. M: Hello, Dr. Carbon here, what seems to be the problem?W: It's Mr. Lindley. I found him in his chair, white as a sheet. I thought he passed out.Q: What can we learn from the conversation?9. W: Jacky is considering attending the University of Texas in Houston.M: Really7 1 thought she was registered at Duke University.W: That's true, But she decided that she didn't want to be so far away from home.Q: What does the woman say about Jacky?10. M: My gosh, you look like you' ye got run over by a truck. What's wrong?W: My boyfriend just dumped me for another girl.Q: What does the woman mean?11. M: The only medicine that will save the patient's life produces a serious allergic reaction.W: The doctors are between Iraq and a hard place now.Q: What does the woman imply?12. W: Did you like the Chanel bag that I got?M: You must have a rich boyfriend because that bag is so expensive.W: I bought it on e-bay. It was only one tenth of the original price. And the purchase online is so easy. Q: What is said about the Chanel bag?13. W: Bring some medicine when you go to picnic. Insects can transmit disease.M. I see. You have said that several times.Q: Which of the following can best describe the man's feeling?14. M: Please look at this car. it's nice.W: This car has a lot of faults. You must think that I was born yesterday if you expect me to buy it.Q: What does the woman mean?15. W: How are you doing these days with your new job?M- Not very well, I'm afraid. I'm feeling lousy.W: Really? Why?M: It's been a tense week.Q: What does the man mean?Section BDirections: In this section you will hear three passages. After each one, you will hear five questions. After each question, read the four possible answers marked A, B, C and D.Choose the best answer and mark the letter of your choice on the ANSWER SHEET.Passage OneW: Well. you'll probably have an operation to remove the bowel, or some of it. It' s too diseased to save, I' m afraid.M: How will I go without a bowel? How can I live without a bowel?W: During the operation, they will fit you externally with a colostomy bag.M: You mean the bag of Shit hanging inside of my clothes?M: Well, that' s perhaps an unnecessarily cruel way of putting it. But, broadly speaking, yes.It is sealed andodor-free. They'll show you how to empty it and change it for yourself. And nobody need ever know that you've got one unless you tell them.M: Well, thanks a lot. Cancer of the bowel! All this time you have been prescribing tablets for heart burn, and it turns out that I got cancer of the bowel? Oh, thanks a million. What next?How long will I go on now? Will I be able to live any kind of normal life? Tell me!W: I prescribed for you on the basis of the symptoms you yourself described to me. Only a colonoscopy can reveal your condition. No doctor could diagnose your condition without the hospital tests that I arranged for you. And yes, you will be able to live a pretty normal life and go work, and everything. Nobody need ever know a thing unless you choose to tell them. And you have full life ahead of you.Questions16. What is wrong with the man?17. What does the doctor recommend the man to do?18. What does the doctor assure the man of?19. What is the man's attitude towards the doctor?20. What does the doctor say about the previous treatment for the patient?Passage TwoFor years researchers have debated the whether smoking effects the lungs in men and women differently. In a most compelling study on the topic to date, researchers determined that women are twice as vulnerable to lung cancer as men. But in a surprising twist, they die at half the rate of men. The study, which was published last week in the Journal of the American Medical Association (J. A. M. A. ), included 9,427 men and'7,498 women from throughout North America who were healthy, at least 40 years old and either current or former smokers. Over the course of more than eight years, a group of investigators led by Dr. Claudia Henschke of the Weill Medical College in New YorkCity identified lung tumors in 113 of the men and 156 of the women. Then the researchers kept track of who lived and for how long, as well as the treatment participants were given. The study showed that both sexes tended to be in their late 60s when they received a lung-cancer diagnosis but that the women usually had smoked considerably less than the men. Still, at each stage of lung cancer, the women lived longer than the men. If the reported results are confirmed, there are a few hints from other research that might explain the sex difference. Women' s bodies appear to have greater difficulty repairing the damage to their genes caused by smoking, but there is also some evidence that estrogen, which is found in women' s lungs as well as their ovaries, may interfere with some tumors' ability to grow. There is one thing about which all investigators are ready to agree: lung cancer is particularly deadly and almost entirely preventable. So the take-home message is clear: Don' t smoke ! If you do smoke,quit!Questions21. What is the talk mainly about?22. What was one of the requirements for the participants of the study?23. Over the course of more than eight years, how many of the participants developed lung cancer?24. Which of the following is one finding of the study?25. What is the consensus among all the investigators on smoking?Passage ThreeJill Kinmont was an avid skier, competing and winning numerous tides in junior and senior national skiing events. As Jill says, "Skiing was it--everything--my world." Jill' s world collapsed on Jan 30th 1955 when she skied off the Alta run and landed helplessly on the slope. Her fourth,fifth, and sixth cervical vertebrae were broken. For days, Jill hovered between life and death. By April, it became clear that she would be paralyzed from the shoulders down. Jill underwent rehabilitation therapy with cheerful determination. She learned to write, to type, and to feed herself. Once she had mastered daily living skills, she enrolled in the University of California at Los Angeles, where she studied art, German, and English. After overcoming yet another personal tragedy, the death of her boyfriend in a plane crash, Jill graduated in 1961. By this time, Jill had chosen a new career goal: teaching elementary school children. Officials at UCLA, however,rejected her application for admission to the graduate school of education because of her paralysis. But she persevered, working with children in the UCLA Clinic School. when her family moved to Seattle, Jill was able to fulfill her new dream. She attended the School of Education at the University of Washington and began her new life' s work as a teacher. She taught school first in Washington, then Beverly Hills in California. Finally moving back to Bishop in 1975 where she taught special education in Bishop Union Elementary School until her retirement in 1996.Questions26. What did skiing mean to Jill before the accident.'?27. What happened to Jill when she skied from the Alta run?28. What did Jill learn during her rehabilitation?29. What did Jill do as her new career?30. What is the most impressive about Jill' s personality?。

2008年12月大学英语三级（A级）真题试卷(题后含答案及解析)题型有：1. Listening Comprehension 2. V ocabulary and Structure 3. Reading Comprehension 4. Translation from English to Chinese 5. WritingPart I Listening Comprehension (15 minutes)Directions：This part is to test your listening ability. It consists of 3 sections.Section ADirections: This section is to test your ability to understand short dialogues. There are 5 recorded dialogues in it. After each dialogue, there is a recorded question. The dialogues and the questions will be spoken only once. When you hear a question, you should decide on the correct answer from the 4 choices A , B, C, and D.1．A．Close the window.B．Open the window.C．Turn off the TV.D．Turn on the radio.正确答案：A解析：M: May I close the window outside?W: Yes, please. It’s too noisyQ: What will the man do?从女士的语气上判断她同意关窗，因此A正确。

T h e ne w engl a nd jour na l o f medicinen engl j med 358;1 january 3, 200855Mechanisms of DiseaseMajor Depressive DisorderR.H. Belmaker, M.D., and Galila Agam, Ph.D.From Ben Gurion University of the Negev, Beersheba, Israel. Address reprint requests to Dr. Belmaker at Beersheba Mental Health Center, P.O. Box 4600, Beersheba, Israel, or at belmaker@bgu.ac.il.N Engl J Med 2008;358:55-68.Copyright © 2008 Massachusetts Medical Society.Depression is related to the normal emotions of sadness and bereavement, but it does not remit when the external cause of these emo-tions dissipates, and it is disproportionate to their cause. Classic severe statesof depression often have no external precipitating cause. It is difficult, however, to draw clear distinctions between depressions with and those without psychosocial precipitating events.1 The diagnosis of major depressive disorder requires a distinct change of mood, characterized by sadness or irritability and accompanied by at least several psychophysiological changes, such as disturbances in sleep, appetite, or sex-ual desire; constipation; loss of the ability to experience pleasure in work or with friends; crying; suicidal thoughts; and slowing of speech and action. These chang-es must last a minimum of 2 weeks and interfere considerably with work and fam-ily relations. On the basis of this broad definition, the lifetime incidence of depres-sion in the United States is more than 12% in men and 20% in women.2 Some have advocated a much narrower definition of severe depression, which they call melan-cholia or vital depression.3A small percentage of patients with major depression have had or will have manic episodes consisting of hyperactivity, euphoria, and an increase in pleasure seeking. Although some pathogenetic mechanisms in these cases and in cases of major depres-sive disorder overlap, a history of mania defines a distinct illness termed bipolar dis-order.4Depression is a heterogeneous disorder with a highly variable course, an inconsis-tent response to treatment, and no established mechanism. This review presents the major current approaches to understanding the biologic mechanisms of major de-pression.GeneticsStudies comparing concordance rates for major depression between monozygotic and dizygotic twins suggest a heritability of about 37%,5 which is much lower than the heritability of bipolar disorder or schizophrenia. Some aspects of the normal person-ality, such as avoidance of harm, anxiousness, and pessimism, are also partly heritable.6 Kendler et al.7 showed that although depression is due in part to heritable depression-prone personality traits, it is also the result of heritable factors that are independent of personality. Early-onset, severe, and recurrent depression may have a higher heri-tability than other forms of depression.8 It is clear from studies of families that major depression is not caused by any single gene but is a disease with complex genetic fea-tures. Studies of pedigrees with multiple cases of major depression have identified chromosomal regions with linkage to the disorder, and some of these loci have been replicated in more than one study, although no single chromosomal region has been replicated in every family study of genetic linkage in depression. Holmans et al.9 foundCopyright © 2008 Massachusetts Medical Society. All rights reserved.Downloaded from at SOROKA MEDICAL CENTER on January 2, 2008 .T h e ne w engl a nd jour na l o f medicinen engl j med 358;1 january 3, 200856evidence of linkage of recurrent, early-onset de-pression to chromosome 15q25-q26, but the pop-ulation attributable risk was small.No specific molecular risk factor has been reli-ably identified. One common polymorphic variant of the serotonin-transporter–linked polymorphic region (5-HTTLPR ), which affects the promoter of the serotonin-transporter gene, causes reduced uptake of the neurotransmitter serotonin into the presynaptic cells in the brain.10 Some studies have shown that this polymorphism confers a predis-position to depression,11 but it also confers a pre-disposition to an anxious and pessimistic person-ality.10 Brain imaging reveals functional differences in emotion-related areas of the brain among car-riers of the different common polymorphisms of 5-HTTLPR ,12 although a direct relation to depres-sion is unclear. In a large, prospective epidemio-logic study, Caspi et al.13 found that 5-HTTLPR predicted depression only in association with de-fined life stresses. Some environmental factors could confer a predisposition to depression by af-fecting the genome epigenetically — for example, increased maternal care in rodents causes an epi-genetic change in the promoter region of the glu-cocorticoid-receptor gene.14The Monoa mine-DeficiencyHypothesis The noradrenergic and serotonergic systems orig-inate deep in the brain and fan out over almost the entire brain, suggesting a system capable of modulating many areas of feeling, thinking, and behaving. The early antidepressants blocked the reuptake of norepinephrine and serotonin by the presynaptic neuron. The immediate effects of this pharmacologic action are to increase the availabil-ity of norepinephrine and serotonin in the synapse and to increase stimulation of the postsynaptic neuron. Inhibitors of the enzyme monoamine oxi-dase were also discovered to have antidepressant properties. This enzyme catabolizes norepineph-rine and serotonin in their respective presynaptic neurons, and such inhibition could be expected to increase the availability of neurotransmitters. These discoveries led to a major theory of depression known as the monoamine-deficiency hypothesis. Numerous studies of norepinephrine and serotonin metabolites in plasma, urine, and cerebrospinal fluid, as well as postmortem studies of the brains of patients with depression, have yet to identify thepurported deficiency reliably. However, a newly dis-covered form of the enzyme tryptophan hydroxy-lase, designated TPH-2, is specific to the brain 15 and could explain why previous postmortem stud-ies of total enzyme activity did not show differ-ences in tryptophan hydroxylase activity between patients with depression and controls.16 A recent positron-emission tomographic study using a li-gand for brain monoamine oxidase showed a 30% increase of the enzyme in a subgroup of patients with depression.17 A study measuring differences in monoamine metabolites between the internal jugular vein and the brachial artery showed lower production by the brain of norepinephrine metabo-lites in patients with depression than in controls.18 The monoamine-deficiency hypothesis continues to stimulate research whenever a new technical window into the brain is opened.Serotonin and norepinephrine can be depleted experimentally in humans by oral treatments.19 A drink containing all amino acids except trypto-phan stimulates the liver to synthesize proteins and rapidly depletes the plasma (and therefore the brain) of tryptophan. Tryptophan is rate-limiting for serotonin synthesis in the brain. Such oral tryptophan depletion does not induce depression in healthy subjects but will cause a relapse of de-pression in patients who have been successfully treated with a serotonin-reuptake inhibitor.19 Sim-ilarly, α-methyl paratyrosine inhibits tyrosine hy-droxylase, the rate-limiting step in catecholamine synthesis. Treatment with α-methyl paratyrosine does not induce depression in normal subjects but will induce a relapse in patients who have been treated successfully with a norepinephrine-reup-take inhibitor.19 These findings suggest that nor-epinephrine and serotonin have critical roles in the mechanisms of these treatments of depression but that additional neurochemical factors are neces-sary to cause depression.Because direct measurements of monoamine neurotransmission did not yield definitive findings in relation to depression, the downstream effects of monoamine neurotransmission were explored (Fig. 1). The serotonin-1B receptor is located pre-synaptically and regulates the release of serotonin by feedback inhibition. Postmortem studies show that the levels of p11, a protein that enhances the efficiency of serotonin-1B receptor signaling, are decreased in the brains of patients with depres-sion.20 The serotonin-1A receptor is located both presynaptically and postsynaptically to regulateCopyright © 2008 Massachusetts Medical Society. All rights reserved.Downloaded from at SOROKA MEDICAL CENTER on January 2, 2008 .mechanisms of diseasen engl j med 358;1 january 3, 200857serotonin function (Fig. 1). The receptor can be evaluated in patients with depression by injecting specific agonists and measuring specific neuro-endocrine responses, such as elevation of the pro-lactin level.21 Results suggest that the sensitivity of this receptor is reduced in patients with depres-sion.21 The α2-noradrenergic receptor, which is usually presynaptic, modulates norepinephrine re-lease by feedback inhibition (Fig. 1). Heightened receptor sensitivity has been described in patients with depression,22 which is consistent with re-duced norepinephrine release.It is conceivable that the second-messenger sys-tems for serotonergic and noradrenergic neuro-transmission malfunction in depression, and for this reason the phosphatidylinositol and cyclic AMP second-messenger systems have been exten-sively evaluated. Reduced inositol levels have been found in postmortem studies of the brains of per-sons who have died by suicide 23 and in magnetic resonance spectroscopic studies of the frontal cor-tex in patients with depression.24 A blunted cyclic AMP response to stimulation was found in post-mortem studies of the brains of patients with de-pression.25 These reductions in second-messenger function may impair neurotransmitter function even without changes in monoamine levels or re-ceptor numbers. These data indirectly support elaborations of the original monoamine-deficiency hypothesis of depression (Fig. 1).G proteins that mediate signaling between re-ceptors and second-messenger systems have also been investigated in patients with depression, both in postmortem studies of the brain 26 and in stud-ies of peripheral-blood cells.27 Although these systems are clearly affected, no consistent picture has emerged because there are numerous forms of G proteins that vary in different areas of the brain. The cyclic AMP response element–binding protein (CREB) is a transcription factor affected by cyclic AMP in the cell. In an animal model of de-pression, rats with overexpression of CREB in the dentate gyrus behaved similarly to rats treated with antidepressants, but the opposite effect was found when CREB was overexpressed in the nu-cleus accumbens.26,28 Thus, the role of CREB in depression is specific to the region of the brain. Most but not all studies show that long-term treat-ment with antidepressants stimulates CREB func-tion, possibly depending on the type of drug and the dosage.28 Levels of CREB and phospho-CREB were reduced in postmortem studies of the cor-texes of patients who had a major depressive disorder and had not taken antidepressants, as compared with controls.26,28 Many studies of sec-ond-messenger systems and transcription factors in depression were inspired by the belief that it takes several weeks before antidepressant treat-ment has an effect; consequently, the studies were designed to detect time-dependent biochemical changes in the cell. New meta-analyses suggest that antidepressant effects begin rapidly, howev-er,29 thereby supporting the classic monoamine-deficiency hypothesis.A strong point of the monoamine theory has been its predictive power. Almost every compound that has been synthesized for the purpose of in-hibiting norepinephrine or serotonin reuptake has been proved to be a clinically effective antidepres-sant. A behavioral model of depression has been developed in which a rodent is placed in a glass cylinder filled with water, the sheer wall offering no chance of escape. The animal struggles for a while and then floats passively (the forced swim test). A single prior injection of antidepressant in-creases the struggling time; results in this model have excellent predictive validity for new antide-pressants. Other animal models have been devel-oped by selective breeding of rats for depression-like behavior, and these genetically susceptible rodents also have a response to antidepressants.30 Still other models that can be studied biochemi-cally induce depression with the use of long-term mild stress or learned helplessness. However, no animal model of depression captures the periodic change of behavior into and out of depression that is seen in patients with depression.Molecular techniques such as gene knockout partially support the monoamine theory of depres-sion. The serotonin-reuptake–transporter knock-out mouse is excessively anxious and characterized by increased immobility in the forced swim test.31 This effect is similar to that of the low-activity polymorphic variant of the serotonin receptor on human personality 10 but is the opposite of the ex-pected effects of serotonin-reuptake–inhibitor an-tidepressants. However, this inconsistency could be explained by the difference between a chron-ic monoamine abnormality during brain develop-ment 31 and the hypothesized acute monoamine depletion in an adult with depression. Table 1 shows the effects in mice of knocking out genes related to monoamine neurotransmitters.The effects of stimulants on mood indirectlyCopyright © 2008 Massachusetts Medical Society. All rights reserved.Downloaded from at SOROKA MEDICAL CENTER on January 2, 2008 .T h e ne w engl a nd jour na l o f medicinen engl j med 358;1 january 3, 200858support the monoamine-deficiency hypothesis of depression and show that mood can be altered rapidly. Cocaine and amphetamines are powerful releasers of monoamines into the synapse as well as inhibitors of reuptake. Their mood-elevating effects are immediate, but in patients with severe depression they have often been reported to cause agitation rather than relief of depression. This finding could reflect the ability of these stimulants to deplete the presynapse of monoamines and thus cause a “crash” into depression. Recent studies support the theory that an acute response to a single dose of amphetamine predicts a patient’s longer-term response to monoamine-reuptake in-hibitors.46The role of dopamine deficiency in depression is suggested by the frequency of depression in pa-tients with Parkinson’s disease and the effect of reserpine, which depletes serotonin, norepineph-rine, and dopamine, causing a hypoactive state in animals. The antidepressant agent buproprion in-hibits the reuptake of dopamine. Some direct do-pamine-receptor agonists, such as pramipexole, have been reported to be efficacious in the treat-ment of depression, even though they were devel-oped for Parkinson’s disease.47A major liability of the monoamine-deficiency hypothesis is its derivation from the mechanism of currently available antidepressants. Approxi-mately two thirds of patients have a clinical re-sponse to these agents, whereas one third have a response to placebo.48 Perhaps the mechanism of depression is not related to monoamines in two of three cases.Str ess, the Hypothal a mic –Pituitary–Adr enal A xis, and Grow th Factor s Stress 49 is perceived by the cortex of the brain and transmitted to the hypothalamus, where cortico-tropin-releasing hormone (CRH) is released onto pituitary receptors. This stimulus results in the se-cretion of corticotropin into plasma, stimulation of corticotropin receptors in the adrenal cortex, and release of cortisol into the blood. Hypothalam-ic cortisol receptors respond by decreasing CRH production to maintain homeostasis (Fig. 2).There is considerable evidence that cortisol and its central releasing factor, CRH, are involved in depression.50,51 Patients with depression may have elevated cortisol levels in plasma,38 elevatedCRH levels in cerebrospinal fluid,50 and increased levels of CRH messenger RNA and protein in limbic brain regions.50 In studies using dexa-methasone to evaluate the sensitivity of the hypo-thalamus to feedback signals for the shutdown of CRH release, the normal cortisol-suppression re-sponse is absent in about half of the mostse-Copyright © 2008 Massachusetts Medical Society. All rights reserved.Downloaded from at SOROKA MEDICAL CENTER on January 2, 2008 .mechanisms of diseasen engl j med 358;1 january 3, 200859verely depressed patients.52 Antidepressant-induced clinical remission is accompanied by reversal of some of these abnormalities.52Adults with a history of physical or sexual abuse as children have increased levels of CRH in cerebrospinal fluid.53 Adult rodents that were sepa-rated from their mothers or abused as pups show increased immobility in the forced swim test, which is reversed by antidepressant treatment.54 Mice with region-specific knockout of the gluco-corticoid receptor at an adult age have increased activity of the hypothalamic–pituitary–adrenal axis and increased immobility in the forced swim test, both of which are reversed by antidepressants.55 Increased levels of monoamines in the synapse affect the hypothalamic–pituitary–adrenal axis 56 and reverse some of the long-term effects of stress.56 It is possible that antidepressants relieve depression by reducing the secondary stress caused by a painfully dispirited mood rather than by di-rectly elevating mood. An antistress mechanismcould explain the general usefulness of antidepres-Copyright © 2008 Massachusetts Medical Society. All rights reserved.Downloaded from at SOROKA MEDICAL CENTER on January 2, 2008 .T h e ne w engl a nd jour na l o f medicinen engl j med 358;1 january 3, 200860* BDNF denotes brain-derived neurotrophic factor, 5-HT1AR 5-hydroxytryptamine 1A receptor, 5-HT1BR 5-hydroxytryptamine 1B receptor, REM rapid eye movement, and SSRI selective serotonin-reuptake inhibitor.Copyright © 2008 Massachusetts Medical Society. All rights reserved.Downloaded from at SOROKA MEDICAL CENTER on January 2, 2008 .mechanisms of diseasen engl j med 358;1 january 3, 200861sants for a wide variety of psychiatric conditions, including panic disorder, post-traumatic stress disorder, bulimia, premenstrual syndrome, and obsessive–compulsive disorder. CRH-receptor an-tagonists show antidepressant activity in animal models,57 but the results of large clinical trials have been disappointing. A compound that blocks the glucocorticoid receptor has been reported to be efficacious in depression, but only the most severe and psychotic type.58A single test for the cortisol level in blood does not contribute to the diagnosis of depression, since levels of cortisol vary markedly in a circadian rhythm 38 and because the overlap between values in patients and those in controls is considerable. Mild stress induced in the laboratory, such asCopyright © 2008 Massachusetts Medical Society. All rights reserved.Downloaded from at SOROKA MEDICAL CENTER on January 2, 2008 .T h e ne w engl a nd jour na l o f medicinen engl j med 358;1 january 3, 200862Copyright © 2008 Massachusetts Medical Society. All rights reserved.Downloaded from at SOROKA MEDICAL CENTER on January 2, 2008 .mechanisms of diseasen engl j med 358;1 january 3, 200863stress associated with mental arithmetic calcula-tions or simulated public speaking, results in greater changes in plasma cortisol levels than most reported differences between the values in patients with depression and those in controls.38 It is possible that chronic mild elevations of cor-tisol, especially at night, when cortisol levels in normal subjects are very low, have a pathogenic role in depression. It is also possible that periph-eral cortisol elevations are only a reflection of central disturbances in CRH signaling, which me-diate the effects of environmental stress on mood.59 A major liability of the hypothalamic–pituitary–adrenal axis theory of depression is the difficulty of defining the relationship of stress to depres-sion. Some patients have a single lifetime depres-sive episode, whereas a larger proportion have a recurrent or even chronic course. Various types of acute stress, early childhood trauma, or long-term psychosocial problems may be involved and may lead to different responses of the stress sys-tem. Stress may be causative in some cases and secondary to depressed mood in others.Severe stress in rodents does not necessarily model the common stresses of childhood. The association of abuse in childhood with psycho-pathologic disorders, including depression, in adulthood could be due to common factors link-ing family perpetrators of abuse and their victims, including not only shared genes but also a shared environment of poverty, poor nutrition, and poor prenatal care. Depression is not uncommon in people with no psychosocial risk factors. Most patients treated for depression have no evidence of hypothalamic–pituitary–adrenal dysfunction, just as most such patients have no direct evidence of brain monoamine deficiency.The classic teaching is that neurons do not di-vide in the adult mammalian brain, but studies have shown that neurogenesis occurs in several areas of the brain, especially the hippocampus. Neurogenesis is more prominent in rodents than in primates,60 and some have questioned whether it occurs in the human cortex.61 Elevated levels of glucocorticoids can reduce neurogenesis, and this has been suggested as a mechanism for the de-creased size of the hippocampus on magnetic resonance images of the brain in many patients with depression.62 In postmortem studies of pa-tients with depression, cell loss in the subgenual prefrontal cortex, atrophy in the dorsolateral pre-frontal cortex and the orbitofrontal cortex, andT h y r o x i n e a b n o r m a l i t i e sL e v e l s o f t r a n s t h y r e t i n a r e r e d u c e d i n t h e c e r e b r o s p i n a l f l u i d i n p a t i e n t s w i t h d e p r e s s i o n 118T h y r o i d h o r m o n e s m o d u l a t e t h e s e r o t o n e r g i c s y s t e m i n t h e b r a i n 119T h y r o x i n e m o n o t h e r a p y i s i n e f f e c t i v eB r a i n n e u r o g e n e s i s i s d e c r e a s e d a f t e r t h e a d m i n i s t r a t i o n o f t h y r o x i n e i n a d u l t r a t s w i t h h y p o t h y r o i d i s m 120H y p o t h y r o i d i s m i s n o t m a n i f e s t e d i n m o s t p a t i e n t s w i t h d e p r e s s i o nR a t e o f r e s p o n s e t o t r i i o d o t h y r o n i n e i s i n c r e a s e d d u r i n g d e p r e s s i o n 121D y s f u n c t i o n o f s p e c i f i c b r a i n s t r u c t u r e s a n d c i r c u i t sT r a n s c r a n i a l m a g n e t i c s t i m u l a t i o n o f t h e p r e f r o n t a l c o r t e x 122 a n d d e e p -b r a i n s t i m u l a t i o n o f t h e a n t e r i o r c i n g u l a t e a f f e c t m o o d 123I m p l i c a t e d b r a i n a r e a s d i f f e r f r o m s t u d y t o s t u d y G l u c o s e u s e i s r e d u c e d i n t h e p r e f r o n t a l c o r t e x 124 a n d s u b g e n u a l p r e f r o n t a l c o r t e x 125I n c o n s i s t e n t f i n d i n g s w i t h r e s p e c t t o b l o o d f l o w , v o l u m e t r i c , g l u c o s e u t i l i z a -t i o n , a n d p o s t m o r t e m m e t h o d o l o g i e s 63,124,126C i r c u i t d y n a m i c s i n t h e h i p p o c a m p u s a r e a l t e r e d i n a r a t m o d e l o f d e p r e s s i o n 127* A M P A d e n o t e s a l p h a -a m i n o -3-h y d r o x y -5-m e t h y l -4-i s o x a z o l e p r o p i o n i c a c i d , B D N F b r a i n -d e r i v e d n e u r o t r o p h i c f a c t o r , D H E A d e h y d r o e p i a n d r o s t e r o n e , G A B A γ-a m i n o b u t y r i c a c i d , M R S m a g n e t i c r e s o n a n c e s p e c t r o s c o p y , a n d N M D A N -m e t h y l -D -a s p a r t i c a c i d .Copyright © 2008 Massachusetts Medical Society. All rights reserved.Downloaded from at SOROKA MEDICAL CENTER on January 2, 2008 .T h e ne w engl a nd jour na l o f medicinen engl j med 358;1 january 3, 200864increased numbers of cells in the hypothalamus and the dorsal raphe nucleus have been reported.63 These effects resemble the atrophic changes in the brain in patients with Cushing’s disease 64 and in rodents treated with glucocorticoids.65 However, cortisol elevations in depression are much lower than in Cushing’s disease.Restraint in a small container induces stress in rodents, suppressing neurogenesis, and this effect is countered by antidepressant treatment.66 An-tidepressants also enhance neurogenesis in non-human primates.67 Santarelli et al.68 irradiated the hippocampus in mice and abolished neurogene-sis. They found that the radiation also abolished the ability of the animals to respond behaviorally to antidepressant treatment in the forced swim test, but this phenomenon does not occur in every mouse strain studied.69 Henn and Vollmayr sum-marized other studies providing evidence that de-creased neurogenesis is a result of stress and anxiety but may not be behaviorally relevant.70 The relevance of animal models of neurogenesis to clinical studies of depression has been questioned by analogy with studies of neuroprotection strat-egies in stroke, for which numerous findings in animal models have not been replicated in hu-man studies.71Brain-derived neurotrophic factor (BDNF), a neurotrophic peptide, is critical for axonal growth, neuronal survival, and synaptic plastic-ity,72 and its levels are affected by stress 73 and cortisol.74 A postmortem study of patients with depression who had committed suicide showed that BDNF was reduced in the hippocampus.75 Antidepressant drugs and electroconvulsive thera-py up-regulate BDNF and other neurotrophic and growth factors 75,76; a single bilateral infusion of BDNF into the dentate gyrus has antidepressant-like effects.77 One study showed that the hippo-campus was smaller than normal in patients with depression who carried a met166 BDNF allele.78 In an animal model of depression, epigenetic his-tone methylation mediated down-regulation of BDNF transcripts and antidepressant treatment reversed this effect.79 These studies suggest that BDNF is the link among stress, neurogenesis, and hippocampal atrophy in depression. However, a genetic association of the BDNF val166met poly-morphism with depression has not been replicated in most studies,74 and BDNF may be related not only to depression but to multiple psychiatric dis-orders.74 BDNF-knockout mice have behaviors un-related to depression.45 Reduced BDNF levels in the peripheral blood of patients with depression seem to derive almost entirely from blood plate-lets,80 and many artifacts must therefore be con-sidered in interpreting these findings. Inflamma-tion in the brain and some neurotoxins increase brain BDNF levels, suggesting that the actions of BDNF are not uniformly therapeutic.81 Castrén 82 has proposed that antidepressant treatments may increase synaptic sprouting and allow the brain to use input from the environment more effec-tively to recover from depression. This hypothe-sis highlights the role that cognition may play in depression and suggests that biochemical mech-anisms may be nonspecific.Strong epidemiologic data point to an associa-tion between major depressive disorder and in-creased cardiovascular morbidity and mortality.83 In many patients, cardiovascular disorders precede depression, and in others, depression precedes the cardiovascular disorder. Both n −3 fatty acid defi-ciency 84 and elevated plasma homocysteine levels 85 have been implicated in cardiovascular disease and in depression. Elevated cortisol levels in depres-sion could increase the risk of coronary artery disease, since cortisol increases visceral fat.64,86 Antidepressant treatment increases the survival rate among patients who become depressed after coronary occlusion.86 Endothelial-cell signaling plays a crucial role in brain neurogenesis,87 and these cells secrete BDNF; thus, both depression and cardiovascular disease could be examples of an endothelial disorder. Signs of inflammatory processes have been described in major depres-sion 88 and in cardiovascular disease. Some data suggest that exercise has protective or therapeu-tic effects in depression.89 Rodent models support this possibility.90Other Possible Mechanisms Table 2 summarizes possible pathophysiological mechanisms of depression other than those based on the monoamine-deficiency hypothesis or the roles of stress, cortisol, and neurogenesis. Many of these other proposed mechanisms have also been implicated in psychiatric and neurologic dis-orders other than depression. Since the compo-nents of the brain are highly interconnected, it is not difficult to find possible integrative frame-works between two or more of the various theo-ries. Testing the theories in a manner that can re-Copyright © 2008 Massachusetts Medical Society. All rights reserved.Downloaded from at SOROKA MEDICAL CENTER on January 2, 2008 .。

医院科室词语面面观！children's hospital 儿童医院general hospital, polyclinic 综合医院hospital for lepers, leprosarium 麻风病院maternity hospital, lying-inhospital 产科医院mental hospital, mental home 精神病院obstetrics and gynecology hospital 妇产医院plastic surgery hospital 整形外科医院stomatological hospital 口腔医院tuberculosis hospital 结核病医院tumour hospital 肿瘤医院clinic 诊疗所first-aid station 急救站polyclinic 联合诊疗所quarantine station 防疫站（检疫所）rest home 休养所sanatorium 疗养院medical department 内科surgical department 外科anaesthesiology department 麻醉科cardiology department 心脏病科dental department 牙科dermatology department, skin department 皮肤科department of cardiac su 心脏外科department of cerebral surgery 胸外科general surgery 普通外科neurology department 神经科neurosurgery department 精神外科obstetrics and gynecology department 妇产科ophthalmology department 眼科orthopedic surgery department 矫形外科orthopedics department 骨科otorhinolaryngological department 耳鼻喉科paediatrics department 小儿科pathology department 病理科plastic surgery 整形外科psychiatry department 精神病科thoracic surgery department 脑外科traumatology department 创伤外科urology department 泌尿科X-ray department 放射科registration office 挂号处out-patient department, OPD 门诊部in-patient department 住院部nursing department 护理部consulting room 诊室waiting room 候诊室admitting office 住院处emergency room 急诊室operation room, operation theatre 手术室laboratory 化验室blood bank 血库pharmacy, dispensary 药房ward 病房medical ward 内科病房surgical ward 外科病房maternity ward 产科病房isolation ward 隔离病房observation ward 观察室hospital bed 病床director of the hospital 院长head of the department of medical administration 医务部主任head of the nursing department 护理部主任head of out-patient department 门诊部主任doctor 医生head of the medical department 内科主任head of the surgical department 外科主任physician in charge, surgeon in charge, attending doctor, doctor in charge 主治医生resident physician 住院医生intern, interne 实习医生laboratory technician 化验员nurse 护士head nurse 护士长anaesthetist 麻醉师pharmacist, druggist 药剂师internist, physician 内科医生surgeon 外科医生brain specialist 脑科专家cardiac surgeon 心外科医生cardiovascular specialist 心血管专家dentist 牙科医生dermatologist 皮肤科医生ear-nose-throat doctor 耳鼻喉医生gynecologist 妇科医生heart specialist 心脏病专家neurologist, nerve specialist 神经科专家obstetrician 产科医生oculist 眼科医生oncologist 肿瘤科医生orthopedist 骨科医生paediatrician 小儿科医生plastic surgeon 整形外科医生radiologist 放射科医师radiographer 放射科技师urologist 泌尿科医生dietician 营养医师out-patient 门诊病人in-patient 住院病人medical patient 内科病人surgical patient 外科病人obstetrical patient 产科病人heart disease patient 心脏病病人emergency case 急诊病人 (参见 MEDICINE)这是我们实验室主任要求我们去听的，我自己也听过，所以从理论和实践上都是可行的。

香港醫務委員會T he M edical C ouncil o f H ong K ongD ISCIPLINARY I NQUIRYM EDICAL R EGISTRATION O RDINANCE, C AP. 161Date of hearing: 25 February 2010Defendant: Dr YUEN Chung Cheong (源鎮昌醫生)1. The charges alleged against Dr YUEN Chung Cheong are that:“He, being a registered medical practitioner:(a) was convicted at the Shatin Magistrates’ Courts on 25 April 2008 ofan offence punishable with imprisonment, namely, failing tocomply with traffic signal, contrary to regulations 18 and 61(1) ofthe Road Traffic (Traffic Control) Regulations made under theRoad Traffic Ordinance, Chapter 374, Laws of Hong Kong;(b) was convicted at the Shatin Magistrates’ Courts on 25 April 2008of an offence punishable with imprisonment, namely, drivingwhilst disqualified, contrary to section 12(2)(b) of the Road Traffic(Driving-offence Points) Ordinance, Chapter 375, Laws of HongKong;(c) was convicted at the Shatin Magistrates’ Courts on 25 April 2008of an offence punishable with imprisonment, namely, using avehicle without third party insurance, contrary to sections 4(1) and4(2)(a) of the Motor Vehicle Insurance (Third Party Risks)Ordinance, Chapter 272, Laws of Hong Kong;(d) failed to report to the Medical Council the said convictions within28 days of the conviction, contrary to Part II of the updated Codeas promulgated in Issue 13 – April 2007 of the Newsletter of theMedical Council of Hong Kong, and by reason of the fact allegedhe is guilty of misconduct in a professional respect.”Facts of the case2.The Defendant, Dr YUEN Chung Cheong, has been a registered medicalpractitioner in Hong Kong since 6 March 1996.3.At 2128 hours on 20 February 2008, the Defendant drove a private car with alicence plate number of “EZ9306” and disobeyed a red light traffic signal at the junction of Hung Mui Kuk Road and Chung Pak Road.4.The Defendant was then stopped by the Police in Tin Sum Street. He couldnot produce any driving licence for inspection.5.The Defendant’s driving licence had been suspended since 17 December 2007.He had been disqualified by the Kwun Tong Magistracy under section 8 of the Road Traffic (Driving-offence Points) Ordinance, Chapter 375, Laws of Hong Kong from holding or obtaining a driving licence for all classes of vehicles for3 months commencing from 17 December 2007.6.Meanwhile, the Defendant’s insurance policy did not cover disqualifieddrivers. As such, he was using a vehicle without third party insurance at the time in question.7.Accordingly, on 25 April 2008, the Defendant was convicted at the ShatinMagistrates’ Courts of the following offences, which are punishable with imprisonment:(a)failing to comply with traffic signal, contrary to regulations 18 and61(1) of the Road Traffic (Traffic Control) Regulations made underthe Road Traffic Ordinance, Chapter 374, Laws of Hong Kong;(b)driving whilst disqualified, contrary to section 12(2)(b) of the RoadTraffic (Driving-offence Points) Ordinance, Chapter 375, Laws ofHong Kong;(c)using a vehicle without third party insurance, contrary to sections4(1) and 4(2)(a) of the Motor Vehicle Insurance (Third Party Risks)Ordinance, Chapter 272, Laws of Hong Kong.8.The Defendant reported the above convictions to the Medical Council of HongKong in a letter dated 22 July 2008.Findings of the Council9.The Defendant chooses not to attend this Inquiry. His legal representativeconfirmed that proceeding with the Inquiry in his absence would not causeprejudice to him.10.The facts are obvious from the charges. The Defendant was convicted of thethree criminal offences which are punishable with imprisonment on 25 April2008. Under Part II of the Professional Code and Conduct, the Defendant isrequired to report the convictions to the Medical Council within 28 days, i.e.on or before 23 May 2008. However, he did not do so. He reported theconvictions by a letter dated 22 July 2008 which was received by the MedicalCouncil on 14 August 2008.11.The Defendant admits that he was convicted of the three offences on 25 April2008. On the basis of his admission and the Certificate of Trial, we aresatisfied that the Defendant was convicted as alleged in charges (a), (b) and(c).12.As to charge (d), the Defendant admits that he only made the report to theCouncil in his letter dated 22 July 2008. According to the Medical Council’srecord, the letter was received by the Medical Council on 14 August 2008.No reason for the failure to report within time was advanced by the Defendant.The Defendant admits that the failure to report within time amounts toprofessional misconduct.13.Nevertheless, it is for this Council to determine whether this failure to reportwithin time constitutes professional misconduct. In deciding on this issue,we take into consideration the length of time that he was late in reporting theconvictions and the circumstances in which he made the report. We find thatthe Defendant’s conduct in this respect falls short of the standard expectedamong registered medical practitioners. We are satisfied that this amounts toprofessional misconduct. We find him guilty of charge (d).Sentencing14.The Defendant has a clear disciplinary record. We also give him credit foradmitting the facts of the charges. In relation to charges (a), (b) and (c), our concern is not to punish him for the three traffic offences. He has already been sentenced by the court for those offences. Our concern is the implication of the convictions in relation of charges (b) and (c) on his practice as a medical practitioner.15.In mitigation, the Defendant put forward that at the material time of the trafficoffences he was rushing back home because his domestic helper had not locked the door. We do not accept this as a mitigating factor of any weight, nor do we see any other mitigation of weight.16.We are particularly concerned with the Defendant’s driving whilst beingdisqualified. This is a deliberate disregard of the law in disobeying the order of the court. The conviction of using a vehicle without third party insurance also reflects his disregard of the law’s protection of the public. These are matters which bring disgrace to the profession.17.On the failure to report the convictions within time, we take note that theDefendant voluntarily reported to the Medical Council by sending a letter dated 22 July 2008, which the Council received on 14 August 2008.18.Having regard to the gravity of the case and the mitigation advanced, we makethe following orders:-(i)In respect of charge (a), a warning letter be served on the Defendant.(ii)In respect of charge (b), the Defendant’s name be removed from the General Register for a period of 2 months, and the order be suspended for a period of18 months subject to the condition that he shall not commit any furtherdisciplinary offence during the suspension period.(iii)In respect of charge (c), the Defendant’s name be removed from the General Register for a period of 2 months, and the order be suspended for a period of18 months subject to the condition that he shall not commit any furtherdisciplinary offence during the suspension period.(iv)Both orders in respect of charges (b) and (c) shall run concurrently, as they arose from the same incident.(v)In respect of charge (d), a warning letter be served on the Defendant.(vi)The above orders shall be published in the gazette in accordance with the provisions of section 21(5) of the Medical Registration Ordinance.19. We note that the Defendant is under limited registration. If for any reasonthe suspended removal orders are activated and his limited registration expires during that 2-month removal period, the effect of the removal orders will preclude him from applying for registration or restoration to the General Register until the removal period has expired.Dr CHENG Chi ManTemporary Chairman, Medical Council。

2008年全国医学博士外语统一考试英语试卷Paper OnePart I Listening Comprehension(30%)Section A1. A.It was called off unexpectedly.B.It raised more money than expected.C.It received fewer people than expected.D.It disappointed the woman for the man’s absence.2. A.A thoracic case.thoracic[θɔː'ræsɪk]adj.[解剖]胸的；[解剖]胸廓的B.A nervous disorder.C.A stomach problem.D.A psychiatric condition.3. A.In the housing office on campus. B.In the downtown hotel.C.At a rental agency.D.In the nursing home.4. A.Thrilled.vt.使…颤动；使…紧张；使…感到兴奋或激动n.激动；震颤；紧张vi.颤抖；感到兴奋；感到紧张B.Refreshed[rɪ'freʃ]vt.更新；使……恢复；消除……的疲劳vi.恢复精神；喝饮料，吃点心；补充给养C.Exhausted.exhausted[ɪɡ'zɔːstɪd]adj.疲惫的；耗尽的v.耗尽；用尽；使…精疲力尽（exhaust的过去式）D.Depressed.adj.沮丧的；萧条的；压低的v.使沮丧；使萧条（depress的过去式和过去分词形式）；压低5. A.To travel with his parents.B.To organize a picnic in the country.picnic['pɪknɪk]n.野餐vi.去野餐C.To cruise,even without his friends.n.巡航，巡游；乘船游览vt.巡航，巡游；漫游vi.巡航，巡游；漫游D.To take a flight to the Maldives.6. A.He’s got a revert.[rɪ'vɜːt]vt.使回复原n.恢复原状者vi.回复；重提；返祖遗传；归还B.He’s got nausea.nausea[ˈnɔ:ziə]n.恶心，晕船；极端的憎恶C.He’s got diarrhea.diarrhea[,daɪə'riə]n.腹泻，痢疾D.He’s got a runny nose.流鼻涕用的线7.A.To suture the man’s wound.suture['suːtʃə]n.缝合；缝合处；缝合状vt.缝合B.To remove the bits of glass.C.To disinfect the man’s injured.D.To take a close look at the man’s wound.8. A.Mr.Lindley had got injured. B.Mr.Lindley had fallen asleep.C.Mr.Lindley had fallen off his chair.D.Mr.Lindley had lost consciousness.9. A.She will apply to Duke University.B.She will probably attend the University of Texas.C.She made up her mind to give up school for work.D.She chose Duke University over the University of Texas.10.A.Her boyfriend broke up with her.分手；结束，打碎B.She was almost run over by a truck.C.One of her friends was emotionally hurt.D.She dumped her boyfriend’s truck in the river.adj.废弃的；被甩了的v.倾倒；猛地扔下11.A.The patient will not accept the doctor’s recommendation.B.The doctor lost control of the allergic reaction.C.The doctor finds it hard to decide what to do.D.The medicine is not available to the patient.12.A.It was more expensive than the original price. B.It was given to the woman as a gift.C.It was the last article on sale.D.It was a good bargain.13.A.excited. B.Impatient.C.Indifferent.adj.漠不关心的；无关紧要的；中性的，中立的D.Concerned.14.A.She regrets buying the car. B.The car just arrived yesterday.C.She will certainly not buy the car.D.This is the car she has been wanting.15.A.He is seriously ill. B.His work is a mess.C.The weather is lousy this week.D.He has been working under pressure. Section BPassage One16.A.He has got bowel cancer. B.He has got heart disease.C.He has got bone cancer.D.He has got heartburn.17.A.To have a colonoscopy. B.To seek a second opinion.C.To be put on chemotherapy.D.To have his bowel removed.18.A.A pretty minor surgery. B.A normal life ahead of him.C.A miracle in his coming years.D.A life without any inconveniences.19.A.Thankful. B.Admiring. C.Resentful. D.Respectful.20.A.It was based on the symptoms that man had described.B.It was prescribed considering possible complications.C.I was given according to the man’s actual condition.D.It was effective because of a proper intervention.Passage Two21.A.Smoking and Lung Cancer. B.Lung Cancer and the sexes.C.How to quit smoking.D.How to prevent lung cancer.22.A.Current smokers exclusively. B.Second-hand smokers.C.With a lung problems.D.At age40or over.23.A.156 B.269 C.7498 D.942724.A.Smoking is the culprit in causing lung cancer.B.Women are more vulnerable in lung cancer than men.C.Women are found to be more addicted to smoking than men.D.When struck by lung cancer,men seem to live longer than men.25.A.Lung cancer can be early detected.B.Lung cancer is deadly but preventable.C.Lung cancer is fatal and unpredictable.D.Smoking affects the lungs of men and women differently.Passage Three26.A.A hobby B.The whole worldC.learning experience.D.A career to earn a living27.A.Her legs were brokenB.Her arms were brokenC.Her shoulders were severely injuredD.Her cervical vertebrate were seriously injured.28.A.She learned a foreign language B.She learned to make friends.C.She learned to be a teacher.D.She learned a living skills.29.A.She worked as a skiing coach.B.She was a college instructor.C.She was a social worker in a clinic.D.She worked as elementary school teacher.30.A.Optimistic and hard-bitten. B.Pessimistic and cynical.C.Humorous and funny.D.Kind and reliable.Part II Vocabulary(10%)Section A31.I’m afraid that you’ll have to___________the deterioration n.恶化；退化；堕落of the condition.A.account for对…负有责任；对…做出解释；说明……的原因；导致；（比例）占B.call for要求；需要；提倡；邀请；为…叫喊C.look for寻找D.make for导致；有助于；走向32.Twelve hours a week seemed a generous adj.慷慨的，大方的；宽宏大量的；有雅量的___________of your time to the nursing home.A.affliction n.苦难；苦恼；折磨B.alternative adj.供选择的；选择性的；交替的n.二中择一；供替代的选择C.allocation n.分配，配置；安置（location n.位置（形容词locational）；地点；外景拍摄场地）distributeD.alliance n.联盟，联合；联姻33.Every product is_________tested before being put into market.A.expensivelyB.exceptionally adv.异常地；特殊地；例外地C.exhaustively adv.耗尽一切地D.exclusively adv.唯一地；专有地；排外地34.Having clean hands is one of the___________rules when preparing food.A.potent adj.有效的；强有力的，有权势的；有说服力的B.conditional adj.有条件的；假定的n.条件句；条件语C.inseparable adj.[数]不可分割的；不能分离的n.不可分离的事物；形影不离的朋友D.cardinal n.红衣主教；枢机主教；鲜红色；【鸟类】(北美)主红雀adj.主要的，基本的；深红色的35.The educators should try hard to develop the________abilities of children.A.cohesive adj.有结合力的；紧密结合的；有粘着力的B.cognitive adj.认知的，认识的C.collective adj.集体的；共同的；集合的；集体主义的n.集团；集合体；集合名词ic adj.喜剧的；滑稽的；有趣的n.连环漫画；喜剧演员；滑稽人物36.Mortgage vt.抵押n.抵押房屋抵押贷款___________had risen in the last year because the number of low-income families was on the increase.A.defects n.缺点，缺陷；不足之处vi.变节；叛变B.deficits n.赤字；不足额C.defaults vi.拖欠；不履行；不到场n.违约；缺席；缺乏；系统默认值vt.不履行；不参加（比赛等）；对…处以缺席裁判（fault n.故障；[地质]断层；错误；缺点；毛病；（网球等）发球失误vi.弄错；产生断层）D.deceptions n.欺骗，欺诈；骗术37.The symptoms n.[临床]症状；症候；病徵may be__________by certain drugs.A.exaggerated adj.夸张的，言过其实的v.夸张，夸大B.exacerbated vt.使加剧；使恶化；激怒=aggravateC.exceeded adj.非常的；过度的；溢出的v.超过（exceed的过去分词）；越出D.exhibited adj.展出的v.展出；表现出（exhibit的过去分词）38.Her story was a complete adj.完整的；完全的；彻底的vt.完成_________from start to finish, so nobody believed in her.A.facility n.设施；设备；容易；灵巧B.fascination n.魅力；魔力；入迷（adj.fascinating迷人的；吸引人的；使人神魂颠倒的fascinated着迷的；被深深吸引的）C.fabrication n.制造，建造；装配；伪造物（n.fabric织物；布；组织；构造；fabricator制作者；杜撰者v.fabricated制造，组装；伪造，捏造（fabricate的过去分词）vt.fabricate制造；伪造；装配）D.faculty n.科，系；能力；全体教员39.The police investigating the traffic accident have not ruled out排除；取消；划去；反对；阻止_________.A.salvage n.打捞；海上救助；抢救财货；救难的奖金vt.抢救；海上救助B.safeguard n.[安全]保护；保卫；保护措施vt.[安全]保护，护卫C.sabotage vt.妨害；对…采取破坏行动vi.从事破坏活动n.破坏；破坏活动；怠工D.sacrifice n.牺牲；祭品；供奉vt.牺牲；献祭；亏本出售vi.献祭；奉献40.The government always_________on the background n.背景；隐蔽的位置vt.作…的背景adj.背景的；发布背景材料的of employees who are hired for sensitive military projects.A.takes up拿起；开始从事；占据(时间,地方)B.checks up检查；核对（check out检验；结账离开；通过考核；盖章，结账后离开，结帐后离开，办理退房、出院手续）C.works out解决；算出；实现；制定出；消耗完；弄懂；锻炼D.looks into调查；观察；窥视；浏览；看Section B41.The19th century physiology n.生理学；生理机能was dominated vt.控制；支配；占优势；在…中占主要地位vi.占优势；处于支配地位by the study of the transformations of food energy into body mass体重and activity.A.boosted adj.升高的；升压的；加力的v.提高，推进；宣传（boost的过去式）erned v.管理（govern的过去式和过去分词）；统治；支配C.clarified adj.澄清的；透明的v.阐明（clarify的过去分词形式）；澄清D.pioneered v.倡导；作先驱（pioneer的过去式）42.Surely,it would be sensible adj.明智的合乎情理的通情达理的意识到的，能感觉到的to get a second opinion before taking any further action.采取进一步行动，进一步的行动A.realistic adj.现实的；现实主义的；逼真的；实在论的B.sensitive adj.敏感的；感觉的；[仪]灵敏的；感光的；易受伤害的；易受影响的n.敏感的人；有灵异能力的人C.reasonable adj.合理的，公道的；通情达理的D.sensational adj.轰动的；耸人听闻的；非常好的；使人感动的（economic sanction经济制裁）43.The Chinese people hold the ancestors n.祖先；被继承人in great veneration.n.尊敬；崇拜（Ancestor veneration祖先崇拜）A.recognition n.识别；承认，认出；重视；赞誉；公认B.sincerity n.真实，诚挚C.heritage n.遗产；传统；继承物；继承权D.honor n.荣誉；尊敬；勋章vt.尊敬；[金融]承兑；承兑远期票据44.I worked to develop the requisite skill必要技能（requisite adj.必备的，必不可少的；需要的n.必需品）for managerial adj.[管理]管理的；经理的post.n.岗位；邮件；标杆vt.张贴；公布；邮递；布置vi.快速行进A.perfect adj.完美的；最好的；精通的vt.使完美；使熟练n.完成式B.exquisite adj.精致的；细腻的；优美的，高雅的；异常的；n.服饰过于讲究的男子C.unique adj.独特的，稀罕的；[数]唯一的，独一无二的n.独一无二的人或物D.necessary adj.必要的；必需的；必然的n.必需品45.If exercise is a bodily maintenance activity维修活动and an index n.指标；指数；索引；指针vi.做索引vt.指出；编入索引中of physiological age生理年龄,the lack of sufficient exercise may either cause or hasten aging.二者择一的；要么…要么…A.instance n.实例；情况；建议vt.举...为例B.indicator n.指示器；[试剂]指示剂；[计]指示符；压力计C.appearance n.外貌，外观；出现，露面D.option n.[计]选项；选择权；买卖的特权（potent adj.有效的；强有力的，有权势的；有说服力的）46.The doctor advised Ken to avoid strenuous exercise剧烈运动.（strenuous adj.紧张的；费力的；奋发的；艰苦的；热烈的）A.arduous adj.努力的；费力的；险峻的B.demanding adj.苛求的；要求高的；吃力的v.要求；查问（demand的ing形式）C.potent adj.有效的；强有力的，有权势的；有说服力的D.continuous adj.连续的，持续的；继续的；连绵不断的47.The hospital should be held accountable for负责，对…应付责任the quality of care护理质量it delivers.A.practicable adj.可用的；行得通的；可实行的B.reliable adj.可靠的；可信赖的n.可靠的人C.flexible adj.灵活的；柔韧的；易弯曲的D.responsible adj.负责的，可靠的；有责任的48.Greenpeace n.绿色和平组织（保护动物不遭捕猎等）has been invite to appraise vt.评价，鉴定；估价the environment costs of such an operation.A.esteem vt.尊敬；认为；考虑；估价n.尊重；尊敬B.appreciate vt.欣赏；感激；领会；鉴别vi.增值；涨价appropriate adj.适当的；恰当的；合适的C.evaluate vt.评价；估价；求…的值vi.评价；估价audit,estimate,assess,reckonD.approve vt.批准；赞成；为…提供证据vi.批准；赞成；满意49.The company still hopes to find a buyer,but the future looks bleak.adj.阴冷的；荒凉的，无遮蔽的；黯淡的，无希望的；冷酷的；单调的A.chilly adj.寒冷的；怕冷的B.dismal adj.凄凉的，忧郁的；阴沉的，沉闷的n.低落的情绪C.promising adj.有希望的，有前途的v.许诺，答应（promise的现在分词形式）D.fanatic n.狂热入迷者；盲信者；盲信adj.狂热的；盲信的50.These were vital adj.至关重要的；生死攸关的；有活力的decisions n.决定，决心；决议that bore upon（bear upon）有关；瞄准；对…施加压力the happiness of everybody.A.ensured vt.保证，确保；使安全B.ruined n.废墟；毁坏；灭亡vt.毁灭；使破产vi.破产；堕落；被毁灭C.achieved vt.取得；获得；实现；成功vi.达到预期的目的，实现预期的结果，如愿以偿D.influenced n.影响；势力；感化；有影响的人或事vt.影响；改变Part III Cloze(10%)Are some people born clever and others born stupid?Or is intelligence n.智力；情报工作；情报机关；理解力developed by our environment and our experiences（可数名词：经历；不可数名词：经验）?Strangely___51___,the answer to both these questions is yes.To some extent在一定程度上；在某种程度上our intelligence is given us at birth生下来时（innate adj.先天的；固有的；与生俱来的）,and no amount of即使再大（或再多）的…（也不）special education can make a genius n.天才，天赋；精神___52____a child born with low intelligence.On the other hand另一方面,a child who lives in boring adj.无聊的；令人厌烦的environment will develop his intelligence less than the one who lives in rich and varied surrounding.Thus the___53___of a person’s intelligence are fixed at birth,but whether or not he reaches those limits will depend on his ___54___.This view,not held by most experts can be supported in a number of ways.It is easy to show that intelligence is to some extent在一定程度上；在某种程度上___55___we are born with.The closer the blood relationship血统；血缘关系between two people,the closer they are likely to be in intelligence.Thus if we take two unrelated people___56___,it is likelythat their degrees of intelligence will be completely different.If on the other hand we take two identical twins[遗]同卵双胞胎；[妇产]单卵性双胎they will likely be as intelligent as each other. Relations like brothers and sisters,parents and children,usually have___57___intelligence and this clearly suggests that intelligence depends on birth.___58___now that we take identical twins and put them in different environments.We might send one,for example to a university and the other to a factory where the work is boring.We would soon find differences in intelligence developing,and this indicates vt.表明；指出；预示；象征that environment___59___birth plays a part.This conclusion is also suggested by the ___60___that people who live in close contact with each other.But who are not related at all,are likely to have similar degrees of intelligence.53.A.amounts n.数量，总额（amount的复数）v.总和（amount的第三人称单数形式）B.qualities[统计]品质C.limits n.限制；限度；界线vt.限制；限定D.scores n.分数；二十；配乐；刻痕vt.获得；评价；划线，刻划；把…记下vi.得分；记分；54.A.disposition n.处置；[心理]性情；[军]部署；倾向B.perception n.知觉；[生理]感觉；看法；洞察力；获取C.endowment n.捐赠；捐助；捐款；天资56.A.in advance adv.预先，提前B.for effect为了给人良好的印象；为了得到效果C.at random胡乱地；随便地；任意地D.under way进行中；航行中；在行进57.A.similar adj.相似的n.类似物B.various adj.各种各样的；多方面的C.appropriate adj.适当的；恰当的；合适的vt.占用，拨出D.inborn adj.天生的；先天的Part IV Reading Comprehension(30%)Passage One1.Fourteen-year-old Sean MeCallum lay in a hospital bed waiting for a new heart.Without it, Sean would die.Sean’s case is not unusual.Everyday many people die because there just aren’t enough human organs to go around.四处走动；供应；（消息）流传2.Now scientists say/they can alter the genetic make-up基因组成，遗传构成of certain animals/so that their organs may be acceptable to使...可接受humans.With this gene-altering technique to overcome vt.克服；胜过vi.克服；得胜（come over过来；顺便来访；抓住）our immune rejection免疫排斥to foreign organs,scientists hope to use pig heart for transplants vt.移植；迁移；使移居n.移植；移植器官；被移植物；移居者vi.移植；迁移；移居by the year2008.3.That prospect n.前途；预期；景色vi.勘探，找矿vt.勘探，勘察,however,has stirred up激起；煽动；搅拌；唤起strong opposition n.反对；反对派；在野党；敌对among animal fight activities.They protest vi.抗议；断言vt.抗议；断言n.抗议adj.表示抗议的；抗议性的that the whole idea of/using animal organs is cruel adj.残酷的，残忍的；使人痛苦的，让人受难的；无情的，严酷的and unjust.adj.不公平的，不公正的；非正义的.Some scientists also fear such transplants may transmit vt.传输；传播；发射；传达；遗传unknown diseases to humans.4.Others believe transplanting animal organs into humans is lions of/dollars spent on breeding pigs for their organs could be better spent on health education programs.They believe seventy-five percent of the heart disease cases that lead to a need for organ transplant are preventable adj.可预防的；可阻止的；可防止的.The key is to convince people to eat healthily,and not to smoke or drink alcohol.Scientists could also use research funds to improve artificial adj.人造的；仿造的；虚伪的；非原产地的；武断的organs.5.Still others believe that though new inventions and prevention programs may help,spending money to encourage more people to donate their organs is an even better idea.If enough people were educated about organ donations,everyone who needed an organ could be taken off起飞；脱下；离开the waiting list in a year.61.What is the problem the passage begins with?A.High mortality rate of immune rejection.B.A malpractice n.玩忽职守；不法行为；治疗不当in heart transplantation.C.An unusual case of organ transplant.D.A shortage of human organs.62.Not only is the gene-altering technique a technical issue技术问题,according to the passage but also it_________________________.A.introduces an issue of inhumanity n.不人道，无人性；残暴B.raises the issue of justice n.司法，法律制裁；正义；法官，审判员in medicineC.presents a significant adj.重大的；有效的；有意义的；值得注意的；意味深长的n.象征；有意义的事物threat to human nature人性；人类本性D.pushes the practice of organ transplant to the limits63.Doubtful of the necessity of using animal organs,some scientists___________________.A.are to narrow adj.狭窄的，有限的；勉强的；精密的；度量小的n.海峡；狭窄部分，隘路vt.使变狭窄the scope n.范围；余地；视野；眼界；导弹射程vt.审视of organ transplantsB.switch to v.切换到；转到；转变成t he development of artificial organse up with提出；想出；赶上alternatives to the current problemD.set out to打算，着手,开始purchase n.购买；紧握；起重装置vt.购买；赢得vi.购买东西better ways of treating heart disease64.It can be inferred from推断the concluding paragraph of the passage that __________________.A.the gene-altering technique will help those waiting for organ transplantsB.the present supply of human organs still has potential n.潜能；可能性；[电]电势adj.潜在的；可能的；势的（potent adj.有效的；强有力的，有权势的；有说服力的）to be explored vt.探索；探测；探险C.people prefer vt.更喜欢；宁愿；提出；提升vi.喜欢；愿意the use of animal organs for medical purposes n.目的；用途；意志vt.决心；企图；打算D.the gene-altering technique leaves much to believed65.The information the passage carries is__________________________.A.enlightening adj.使人领悟的；有启发作用的v.启蒙；通知（enlighten的ing形式）B.unbelievable adj.难以置信的；不可信的C.imaginative adj.虚构的；富于想象的；有创造力的（imaginable可能的；可想像的）D.factual adj.事实的Passage Two1.There is a great irony n.讽刺；反语；具有讽刺意味的事adj.铁的；似铁的of21st century global health:While many hundreds of millions of数以亿计people lack adequate adj.充足的；适当的；胜任的food as a result of economic inequities n.不公平，不公正,political corruption政治腐败（corruption n.贪污，腐败；堕落）,or warfare n.战争；冲突,many hundreds of millions more are overweight/to the point of达到…的程度increased risk for/diet-related chronic diseases. Obesity n.肥大，肥胖is a worldwide phenomenon n.现象；奇迹；杰出的人才,affecting children as well as adults and forcing all but/the poorest countries/to divert vt.转移；使…欢娱；使…转向scarce resources稀有资源（scarce adj.缺乏的，不足的；稀有的adv.仅仅；几乎不；几乎没有）away from food security粮食安全；食品安全；食物保障to take care of people with preventable adj.可预防的；可阻止的；可防止的heart disease and diabetes.n.糖尿病；多尿症长难句：Obesity is a worldwide phenomenon,affecting children as well as adults and forcing all but/（the poorest countries）to divert away from/food security to/take care of people with /preventable heart disease and diabetes.2.To reverse n.背面；相反；倒退；失败vt.颠倒；倒转adj.反面的；颠倒的；反身的the obesity epidemic adj.流行的；传染性的n.传染病；流行病；风尚等的流行,we must address vt.演说；从事；忙于；写姓名地址；向…致辞；与…说话；提出；处理n.地址；演讲；致辞；说话的技巧；称呼the fundamental cause根本原因.Overweight comes from consuming more food energy than is expended vt.花费；消耗；用光；耗尽in activity.The cause of this imbalance also is ironic: improved prosperity.People use extra income to eat more and be less physically active.Market economies encourage this.They make people with expendable adj.可消费的；排出的；不重复使用的；可牺牲的n.消耗品income into consumers of aggressively adv.侵略地；攻击地；有闯劲地（侵略=aggress;aggression;invade;invasion）（exaggerated adj.夸张的，言过其实的v.夸张，夸大aggravate vt.加重；使恶化；激怒）marketed foods that are high in energy but low in nutritional value营养价值,and of cars,television set,and computers that promote sedentary adj.久坐的；坐惯的；定栖的；静坐的behavior.Gaining weight are good business.Food is particularly business because everyone eats.3.Moreover adv.而且；此外,food is so overproduced vt.过度生产that many countries, especially the rich ones,have far more than远远超过，多得多的they need-another irony.In the United States,to take an extreme adj.极端的；极度的；偏激的；尽头的n.极端；末端；最大程度；极端的事物example,most adults--of all ages,incomes,educational levels,and census vt.实施统计调查n.人口普查，人口调查categories n.种类，分类；[数]范畴–are overweight.The U.S.food supply provides3800kilocalories per person per day,nearly twice as much as required vt.需要；要求；命令by many adults.Overabundant adj.太充足的；过多的food forces companies to compete for sales through advertising,health claims,new products,large portions.And campaigns vi.作战；参加竞选；参加活动n.运动；活动；战役directed toward children.Food marketing promotes weight gain.Indeed adv.的确；实在；真正地；甚至,it is difficult to think of any major industry that might benefit if people eat less food;certainly not the agriculture,food product, grocery n.食品杂货店,restaurant,diet or drug industries.All flourish n.兴旺；茂盛；挥舞；炫耀；华饰vt.夸耀；挥舞vi.繁荣，兴旺；茂盛；活跃；处于旺盛时期when people eat more.And all employ armies of lobbyists n.说客；活动议案通过者to discourage vt.阻止；使气馁government from doing anything to inhibit vt.抑制；禁止=bar；restrain；control；stay overeating.注：discourage sb from doing阻止某人做某事;阻止做某事;不鼓励;劝某人打消做某事的念头66.The great irony of21st century global public health refers to_____________.A.the cause of obesity and its counteractive adj.反作用的；抵抗的；反对的n.反作用；抵抗，对抗；反对measuresB.the insufficient and superfluous adj.多余的；不必要的；奢侈的consumption of foodC.the scarce natural resource and the negligence of food securityD.the consumption n.消费；消耗；肺痨of food and the increased risk for diet-related diseases67.To address the fundamental cause of the obesity epidemic,according to the passage,is _______.A.to improve political and economic managementB.to cope with处理，应付the energy imbalance issueC.to combat vt.反对；与…战斗n.战斗；争论adj.战斗的；为…斗争的diet-related chronic diseasesD.to increase investment in global health68.As we can learn from the passage,the second irony refers to参考；涉及；指的是；适用于_____________.A.affluence n.富裕；丰富；流入；汇聚and obesityB.food energy and nutritional valueC.food business and economic prosperity经济繁荣；发展生产（prosperity n.繁荣，成功）D.diseases of civilization n.文明；文化and pathology n.病理（学）;异常状态of inactivity69.As a result of the third irony,people_____________________.A.consume3800kilocalories on a daily basisplain about food overproductionC.have to raise their food expensesD.are driven towards朝...方向驱使（Drive Towards The Light驶向光明drive towards south照南开Drive Towards Zero零排放）weight gain70.Which of the following can be excluded vt.排除；排斥；拒绝接纳；逐出as we can understand based on the passage?A.The economic dimension.经济局面（层面）B.The political dimension政治方面（层面）C.The humane adj.仁慈的，人道的；高尚的dimension.人文方面（层面）D.The dietary n.饮食的规定；食谱adj.饮食的，饭食的，规定食物的dimension饮食层面注：dimension n.方面;[数]维；尺寸；次元；容积vt.标出尺寸adj.规格的3-dimension三维Passage Three1.Women find a masculine adj.男性的；阳性的；男子气概的n.男性；阳性，阳性词（muscle n.肌肉；力量vt.加强；使劲搬动；使劲挤出）face with a large jaw n.颌；下巴；狭窄入口；唠叨vt.教训；对…唠叨and a prominent adj.突出的，显著的；杰出的；卓越的brow n.眉，眉毛；额；表情more attractive when they are more likely to conceive vt.怀孕；构思；以为；持有，according to a study published in the June24Nature.Before,during,and just after menstruation n.[生理]月经；月经期间；有月经，however,they seem to be drawn to被…所吸引less angular adj.[生物]有角的；生硬的，笨拙的；瘦削的,more“feminine”adj.女性的；妇女（似）的；阴性的；娇柔的male faces, the researchers report.2.“Other studies of female preference n.偏爱，倾向；优先权,mainly for odors n.气味；名声,show changes across the menstrual cycle生理]月经周期,”says leading author Ian Penton-Voak of the University of St.Andrews on Scotland.“we thought/it would be interesting to look at visual adj.视觉的，视力的；栩栩如生的preferences and see if they changed also.3.The research showed39Japanese women composite n.复合材料；合成物；菊科adj.复合的；合成的；菊科的vt.使合成；使混合male faces that/emphasized masculine or feminine facial features面部特征；面容to differing degrees.The women preferred vt.更喜欢；宁愿；提出；提升images with more masculine features男性特性when they were in the fertile adj.富饶的，肥沃的；能生育的phase n.相；阶段；[天]位相vt.使定相；逐步执行of their menses n.[生理]月经；[生理]行经but favored more feminine features during their less fertile phase.4.The type of face women find attractive also seems to depend on the kind of relationship they wish to pursue vt.继续；从事；追赶；纠缠,according to another experiment.The cyclic preference for偏爱…muscular faces was evident adj.明显的；明白的=obvious/distinct/visible among23 British women asked to choose the most attractive face for a short-term adj.短期的relationship, Penton-Voak says.The26women asked to choose an attractive face for a long-term relationship 长期关系,however,preferred the more feminine features throughout their menstrual cycle.5.Another22women/who were using oral contraceptives[药]口服避孕药/did not show monthly changes/in the faces they preferred even for即使对于short-term relationships, indicating that表明,正在翻译,结果表明(indicat e vt.表明；指出；预示；象征)hormones n.[生理]激素，荷尔蒙might play a role in在……起作用determining vt.决定，确定；判定，判决；限定attractiveness n.吸引力；迷惑力,Penton-Voak says.6.Men/whose faces have some feminine softness n.温柔；柔和/are perceived as“kinder’men/who may make better husbands and partners,he adds,white macho adj.大男子气概的n.强壮男子；大丈夫features may be associated with和…联系在一起；与……有关，与……有关系higher testosterone(睾丸素)levels and good genes.He cautions n.小心，谨慎；警告，警示vt.警告,however,that research hasn’t yet shown a link between a woman’s preferences in such tests and her actual behavior实际行为.71.The researchers made a study on_____________________.A.women’s menstrual cycleB.men’s preferred female imagesC.women’s visual preferences of menD.men’s masculine and feminine features72.Women are drawn to a masculine face,according to the researchers,when they___________.A.grow to be feminineB.are on oral contraceptives[药]口服避孕药C.are ready for conception n.怀孕；概念；设想；开始D.are on menstruation n.[生理]月经；月经期间；有月经73.It was found in Britain that women’s preferred male images were influenced by受…的影响___________.A.their family planningB.the years of marriage they hadC.the length of their menstrual cycle[生理]月经周期D.the term of relationship they seek74.Just because the studies of female preferences show changes across the menstrual cycle,as Penton-Voak implies,does not mean that__________________.A.visual preferences do exist vi.存在；生存；生活；继续存在B.a woman acts this way is reality n.现实；实际；真实C.a man will buy into the phenomenon n.现象；奇迹；杰出的人才D.men and women prefer vt.更喜欢；宁愿；提出；提升the same image75.Which of the following can be the best title for the passage?A.Does a woman judge from a man’s appearance?B.Is there such a thing as beauty in the world?C.Are women more emotional than men?D.Is beauty more than meets the eye?Passage Four1.Well-do they or don’t they?For years,controversy n.争论；论战；辩论has raged n.愤怒；狂暴，肆虐；情绪激动vi.大怒，发怒；流行，风行over whether the electromagnetic fields电磁场produced by power lines电力线;输电线could cause cancer,especially leukemia白血病in young children.But in Britain last week,confusion n.混淆，混乱；困惑reached new heights达到新的高度.2.One team from Bristol announced that/it has evidence to back n.后面vt.支持；后退；背书；下赌注a controversial adj.有争议的；有争论的but plausible adj.貌似可信的，花言巧语的；貌似真实的，貌似有理的theory n.理论；原理；学说；推测which would explain how power lines might cause cancer(Electric fields attract airborne pollutants).Only to be followed/by the release of results/by another group/in London/which suggested/there is nothing to worry about.what is going on?3.Actually,the confusion may be more apparent adj.显然的；表面上的than real.There can be no doubt that/the effects/of power lines on water droplets水滴；微水滴，小水滴,pollutants and naturally occurring radon uncovered vt.发现；揭开；揭露by the Bristol team are real and interesting.But to suggest that/they have anything to do with leukemia in children is prematureadj.早产的；不成熟的；比预期早的n.早产儿；过早发生的事物.The extra n.临时演员；号外；额外的事物；上等产品adj.额外的，另外收费的；特大的adv.特别地，非常；另外exposure n.暴露；曝光；揭露；陈列to pollution for a child living near power lines would be tiny adj.微小的；很少的,and it is not obvious adj.明显的；显著的；平淡无奇的why radon-a gas normally associated with与…有关系；与…相联系lung cancer-would cause leukemia in children.4.The second study,which drew reassuring vt.使…安心，使消除疑虑blank,is the world’s biggest ever probe n.探针；调查vt.探查；用探针探测of the statistical adj.统计的；统计学的link between childhood cancers and magnetic fields of the sort produced by power lines and the electrical appliances日用电器.It is one of several recent studies近代研究that have failed to find a link.Unlike adj.不同的，不相似的earlier research,these newer studies involved vt.包含；牵涉；使陷于；潜心于going into homes to measure the electromagnetic fields.The fields they measured included vt.包含，包括(exclude vt.排除；排斥；拒绝接纳；逐出.preclude vt.排除；妨碍；阻止) input from major power lines if they were nearby.5.Which is not to say the research is perfect.Critics n.评论家；批评者；吹毛求疵的人（critic的复数）argue that/Britain’s childhood cancer study,for example,has not yet taken into account考虑；重视；体谅(take sth into account对某事加以考虑;考虑;把;考虑某事)the surges n.汹涌；大浪，波涛；汹涌澎湃；巨涌v.汹涌；起大浪，蜂拥而来in exposure that might come from,say, switching appliances on and off.And some people might wonder n.惊奇；奇迹；惊愕vt.怀疑；惊奇；对…感到惊讶adj.奇妙的；非凡的why measurements of the electric fields that are also produced by power lines did not figure n.数字；人物；图形；价格；（人的）体形；画像vt.计算；认为；描绘；象征in last week’s study.But neither criticism n.批评；考证；苛求amounts to相当于，总计为a fatal blow.致命的打击.Electrical fields cannot penetrate vt.渗透；穿透；洞察the body significantly adv.意味深长地；值得注目地,for example.6.A more serious concern vt.涉及，关系到；使担心n.关系；关心；关心的事whether the British research provides an all-clear adj.放行；空袭警报信号解除的；无危险信号的signal for such countries such as the US where power lines carry more current and therefore adv.因此；所以produce higher magnetic fields.Pedants(书呆子)would conclude vt.推断；决定，作结论；结束that it doesn’t.But these counties will not have long to wait for answers from a major Japanese study.7.In Britain the latest epidemiological study流行病学研究can be taken as the final word on the matter.If the electromagnetic fields in Britain homes can in some unforeseen adj.未预见到的，无法预料的way increase the risk of cancer,we can now be as certain as science allows that the increase is too tiny to measure.76.Both the question“Well-do they or don’t they?”and the question“what is going on?”suggest _______________.A.the high incidence of LeukemiaB.the advent n.到来；出现；基督降临；基督降临节of bewilderment n.困惑；迷乱；慌张among peopleC.the warning of the worsening air pollutionD.the tense relation between Bristol and London77.What would the author say of the result of the first study?A.Enlightening adj.使人领悟的；有启发作用的v.启蒙；通知（enlighten的ing形式）B.Insignificant adj.无关紧要的C.Reassuring adj.安心的；可靠的；鼓气的v.使放心（reassure的ing形式）D.Apparent adj.显然的；表面上的(parent n.父亲（或母亲）；父母亲；根源)78.What can be suggested from the results of the second study?A.There does exist a danger zone near power lines.B.There is much to be improved in terms of design.。

参考答案I. 1. explorer 2. brave 3. preserved 4. present 5. adventurous6. result7. times8. nothing9. shortly 10. qualifiedII. 1. B 2. A 3. C 4. B 5. B 6. C 7. A 8. A 9. B 10. D 11. C 12. A13. A 14. C 15.III.16题可见前文有smiled at each other，所以很明显是一起together。

17题出现了破折号，表示後文是对前文的解释，找到能概括后半句一个词即可，也就是goals, 目标。

18题可以参看Challenge的题目Egg Drop所以很自然选dropped over。

19题为固定搭配，抹butter cream, spreading。

20题空后有个词container，而在37题时，破折号后出现了protective container to keep an egg ……表明container是盛装egg并protect egg的，所以40题很明显选择egg，而同时21题即选择protect。

22题属于词义题，将篮子上系上降落伞，attach绑上，附加上。

23题在空前出现了一个表程度的little，因而它所修饰的名词也应该和它表示的程度相一致，从而选fight(口角)而不是challenge（对抗）。

24题通过引号发现应该是前文The parachute is better than that stupid idea的一个引述，即stupid。

25题考查前后两句的关系，这两句不是转折和顺承关系即but和and排除；而while表示时间点，而since 表示时间段，後文作者的friendship仍在被challenged，而不是仅发生在words had been out这一时间点上，因此选since。

EBM术语中英文对照表Aabsolute benefit increase, ABI 绝对效益增高absolute risk reduction, ARR 绝对危险度降低absolute risk increase, ARIaccreditation 认证accuracy 准确度action threshold 行动阈值adverse drug reaction，ADR 药物不良反应adverse effect 不良反应adverse event 不良事件allocation concealment 分配隐藏alternative hypothesis备择假设applicability 实用性arithmetic meanassessment of study quality 评价文献质量assembly bias 集中性偏倚attrition bias 退出偏倚Bbaseline analysis基线分析before-after study 自身前后对照研究benefits 收益，效益blindness 盲法Ccase-control study 病例-对照研究case report 个例报告case series 病案系列CBMdisc 中国生物医学文献光盘数据库categorical variable 分类变量CD-ROM retrieval 光盘检索center for reviews and dissemination database, CRDD 评价与传播中心数据库chance 机遇因素chance node 概率节点choice node 选择结citation bias 引用偏倚clinical controlled trial database 临床试验数据库clinical databases 临床资料库clinical decision analysis, CDA 临床决策分析clinical economic evaluation 临床经济评价clinical epidemiology 临床流行病学clinical evidence, CE 临床证据clinical pathway 临床途径clinical practice guideline，CPG 临床实践指南clinical research methodology 临床科研方法学Cochrane collaboration Cochrane协作网Cochrane controlled trials register Cochrane对照试验注册资料库Cochrane Library Cochrane图书馆coefficient of variation 变异系数cognitive dissonance 认知无共振cognitive resonance 认知共振cohort study 队列研究co-intervention 干扰collaborative review groups, CRG 协作评价组completed review 全文评价，全面评价compliance bias依从性偏倚complimentary medicine 补充医学concealed random allocation 隐藏随机分组confidence intervals, CI 可信区间confounders 混杂因素consolidated standards of reporting trial, CONSORT 临床试验报告指南construct validity 结构效度contamination 沾染content validity 内容效度continuous quality improvement, CQI 持续质量改进continuous medical education, CME 继续医学教育control event rate, CER 对照组事件发生率cost-benefit analysis, CBA 成本-效益分析cost-effectiveness analysis, CEA 成本-效果分析cost-identification analysis, CIA 成本-确定分析cost-minimization analysis, CMA 最小成本分析cost-utility analysis, CUA 成本-效用分析criteria-related validity 效标效度critical appraisal 严格评价c ronbach’s alphaα系数cross-over study design 交叉对照研究cumulative meta-analysis 累积Meta-分析database of abstracts of reviews of effectiveness, DARE 干预疗效评价摘要数据库“dec hallenge-rechallenge”study“脱离接触-再接触”研究decision tree 决策树descriptive statistics 统计描述detection bias 测量偏倚diagnostic criteria 诊断标准diagnostic test 诊断试验direct costs 直接成本direct medical costs 直接医疗成本direct nonmedical costs 直接非医疗成本disease-adjusted life years, DALYs 伤残调整生命年doer 最佳证据提供者EEBM teaching 循证医学教学effect size 效应量Embase Datebase Embase数据库event rate 事件发生率evidence-based clinical practice 循证临床实践evidence-based medicine 循证医学evidence-based management 循证管理evidence-based medicine reviews, EBMR 循证医学评价evidence-based medicine web sites 循证医学网站excluding criteria 排除（剔除）标准experimental event rate, EER 试验组事件发生率exploratory trial 探索性临床试验exposure 暴露Fface validity 表面效度fixed effects model 固定效应模型follow up 随访foreground questions 前景问题funnel plot analysis“倒漏斗”图形分析Ggeneration of the allocation sequence 随机序列产生generic quality of the instrument 普通生命质量量表gold standard 金标准grand rounds 大查房health technology assessment，HTA 卫生技术评估health-related quality of life, HRQL 健康相关生命质量heterogeneity 不齐性，异质性historical control trial 历史性对照研究hypothesis testing 假设检验Iinception cohort study 截距性队列研究including criteria 纳入标准incremental analysis增量分析indirect costs 间接成本individual patient data, IPD 单个病人的资料inferential statistcs 统计推断intangible costs 隐性成本intention-to-treat analysis, ITT 意愿治疗分析internet retrieval 因特网检索intraclass correlation coefficients, ICC 组内相关系数JJadad scale 量表journal club 文献交流俱乐部KKappa value Kappa值Lleading time bias领先时间偏倚length bias 病程长短偏倚lifelong education 终身教育likelihood of being helped versus harmed, LHH 受益与危害的似然比，利弊比likelihood ratio, LR 似然比language bias 语言偏倚locating studies检索文献location biases 定位偏倚Mmagnitude 强度making decision analysis决策分析matching 配对mean difference 均差measurement bias 测量性偏倚median survival 中位生存时间Medical Subject Headings, MeSH 医学主题词表Medline-Index Medicus Online 医学索引在线MeSH Browse 医学主题词浏览器Meta-analysis 汇总分析migration bias迁移性偏倚mixed effect model 混合效应模型model analysis模型分析multiple publication bias 多次发表偏倚multivariable analysis 多变量分析NN of 1 trials 单病例随机试验negative likelihood ratio 阴性似然比negative predictive value, NPV 阴性预测值non-randomized concurrent control trial 非随机同期对照研究null hypothesis 无效假设number needed to diagnosis, NND 需要诊断的人数number needed to harm, NNH 需要多少患者接触致病因素才能产生1例额外的不良反应number needed to screen, NNS 需要筛检的病人数number needed to treat, NNT 预防1例不良事件的发生，需要治疗的总例数Oodds ratio, OR 比数比（比值比）opinion-based practice 经验医学outcome research 结局研究Pparallel test 平行试验patient’s expected event rate （PEER）病人预期事件发生率performance bias 实施偏倚Permuted Index 医学主题词轮排表per protocol, PP 按方案分析pooling 合并positive likelihood ratio 阳性似然比positive predictive value, PPV 阳性预测值post-test probability 验后概率practice EBM 循证医学实践Practice Guideline 实践指南precision 精确性，精度pre-clinical students 临床前期的医学生predictive value 预测值pre-test probability/prevalence 验前概率/患病率prevalence 患病率prognosis 预后prognostic factor 预后因素proportion 构成比protocol 研究方案publication bias 发表偏倚publication type 文献类型Qqualitative systematic review 定性系统评价quality adjusted life years，QALYs 质量调整生命年quality of life, QOL 生命质量Quality of reporting of Meta-analyses statement Meta-分析质量评价指南(QUOROM) quality scales and components 质量量表与构成quantitative systematic review 定量系统评价quartile 四分位数间距Rrandom allocation 随机分配random effects model 随机效应模型randomization 随机化randomized control trial, RCT随机对照试验reaction 反应性receiver operator characteristic curve ROC曲线relative benefit increase, RBI 相对效益增高（率）relative risk/risk ratio, relative risk, RR 相对危险度relative risk increase, RRI 相对危险增高（率）relative risk reduction, RRR 相对危险度减少（率）reliability 信度，可靠性reproducible 可重复性restriction 限制retrospective 回顾性review manager: Revman 系统评价管理软件risk difference 率差/危险差risks 风险Sscale 量表screening test 筛查试验selecting bias选择性偏倚selecting studies 选择文献sensitivity 敏感性sensitivity analysis 敏感性分析sequential trial 序贯试验serial test 序列试验severe adverse event, SAE 严重不良事件significance test 显著性检验size of test 检验水准specific quality of life instrument 专用生命质量量表specificity 特异性split-half reliability 折半信度standard deviation 标准差stratification 分层stratify factor 分层因素stratify randomization 分层随机法subgroup analysis 亚组分析subheadings 副主题词survival curve 生存曲线survival rate 生存率systematic review 系统综述Ttest-retest reliability 重测信度test threshold 诊断阈值treatment shreshold 治疗阈值time frame 时间框架total quality management, TQM 全面质量管理Uuser 最佳证据应用者utility 效用Vvalidity 效度，真实性Wweighted mean difference, WMD 加权均数差“worst-case”scenario“最差情况”演示分析Zzero time 零点文- 汉语汉字编辑词条文，wen，从玄从爻。

2020届山东省实验中学高三6月模拟考试英语试题学校:___________姓名：___________班级：___________考号：___________一、阅读选择Four things that you can't miss in Macao.Macao Tower AJ Hackett Bungee JumpThe Macao Tower, 338 meters tall, is the world's 10th highest tower, with a variety of activities, such as gambling, eating and entertainment. One of the acclaimed activities is the bungee jump. The AJ Hackett Macao Tower Bungee Jump is 233 meters high, making it the highest commercial bungee jump in the world. Raise your arms and off you go! If you are not daring enough to jump that height, you can try the skywalk on the 57th floor --- it's still remarkable.Grabbing a traditional Portuguese dinnerMacao was colonized by Portugal before 1999. As a result, Portuguese culture is deeply immersed into many comers of Macao. Many Portuguese settled and opened Portuguese restaurants in the special administrative region, but the flavor is more adaptable to Chinese people.Marking at the Ruins of St. PaulThe Ruins of St. Paul is the signature landmark of Macao. The ruins consist of the St. Paul's College and the Church of St. Paul, built in 1583. However, after three intense fires in 1595, 1601 and 1835, the church was seriously damaged. It is beyond belief that after the vigorous cycles of rebuilding and fires, the huge surface and the front stairway remain unburned.Visiting a museumMacao, as a tiny city with only an area of 30.5 square kilometers, has 23 eye-catching museums. Due to its unique history, both Eastern and Western historical sites can be found. Many of them are preserved for cultural heritage, tourist spots or museums, such as the Grand Prix Museum, Maritime Museum and Wine Museum.1．Which activity will be popular with adventurous visitors?A．Going Bungee Jumping.B．Grabbing a traditional Portuguese dinner.C．Marking at the Ruins of St. Paul.D．Visiting a museum.2．What is incredible about the Ruins of St. Paul?A．It has a unique culture.B．It serves as a symbol of Macao.C．It partly stays undamaged after fierce fires.D．It is a combination of a college and a church.3．What do "'Grabbing a traditional Portuguese dinner" and "Visiting a museum" have in common?A．Taking a selfie in it.B．Finding historical sites.C．Enjoying a breathtaking experience.D．Feeling both eastern and western cultures.I was seven when I first questioned my imagination. I remember watching the first Harry Potter film and my friend was complaining that the characters weren't how she imagined them to be. I couldn't understand what she meant because, in my mind, they had never been images at all, just concepts. When l shut my eyes, I see nothing. I have no visual imagination.I thought everyone's minds worked this way until about two years ago, when I came across a text about aphantasia, a condition where you lack a functioning mind's eye. I was 23, and it blew my mind to learn that others could visualize things. It was clear I had aphantasia, too, and a lot of things started to make more sense. For me, imagination had always been impossible. If someone asked me to close my eyes and picture myself by the sea, I would see nothing.I am currently studying for a PhD in biology at college. A good little test for me is drawing. I can copy things almost like for like if they are in front of me, but if I were to draw from my imagination it would look terrible. It doesn't mean you cannot be creative; you just have to adapt. Regardless of how many times I read a technique, it didn't make sense. But when I came to do it in the lab, I understood it immediately. If you have a visual imagination, you can look at a diagram and it triggers your memory; but I learn by repetition or physically doing something.I'd love to experience life with a mind's eye. I think it'd be cool and beneficial to imagine things so vividly. If you offered me a day with a visual imagination, I'd be excited. I think it'd beso brilliant that I wouldn't want to give it back.4．After watching the first Harry Potter film, the author ______.A．misunderstood what her friend saidB．became a huge fan of the Harry Potter filmC．found it impossible to picture its characters in her mindD．complained its characters different from what she imagined5．How did the author know she had aphantasia?A．Her friend told her the fact.B．She read about aphantasia.C．She had a medical examination.D．Her life experience made it clear.6．What can we learn about the author?A．She lacks creativity.B．She always draws terribly.C．She learns by hands-on practice.D．She gets benefit from techniques.7．What is the author's attitude towards her disability?A．Uncertain. B．Uncaring. C．Upset. D．Positive.For years, the U.S. has experienced a shortage of registered nurses. The Bureau of Labor Statistics projects that while the number of nurses will increase by 19 percent by 2022, demand will grow faster than supply, and that there will be over one million unfilled nursing jobs by then.So what's the solution? Robots.Japan is ahead of the curve when it comes to this trend. Toyohashi University of Technology has developed Terapio, a robotic medical cart that can make hospital rounds, deliver medications and other items. It follows a specific individual, such as a doctor or nurse, who can use it to record and access patient data. This type of robot will likely be one of the first to be implemented in hospitals because it has fairly minimal patient contact.A robot's appearance affects its ability to successfully interact with humans, which is why the RIKEN-TRI Collaboration Center for Human-Interactive Robot Research decided to develop a robotic nurse called Actroid F. It is so human-like that some patients may not knowthe difference. This conversational robot companion has cameras in its eyes, which allow it to track patients and use appropriate facial expressions and body language in its interactions. During a month-long hospital trial, researchers asked 70 patients how they felt being around the robot and "only three or four said they didn't like having it around."It's important to note that robotic nurses don't decide courses of treatment or make diagnoses, though robot doctors and surgeons may not be far off. Instead, they perform routine and laborious tasks, freeing nurses up to attend to patients with immediate needs. This is one industry where it seems the interaction of robots will lead to collaboration, not replacement. 8．What does the author say about Japan?A．It ranks top in future robotics technology.B．It takes the lead in offering robotic nursing.C．It is in desperate need of registered nurses.D．It provides the best medication for the elderly.9．Which of the following best explains “implemented'' underlined in Paragraph 3? A．Cancelled. B．Constructed. C．Improved. D．Applied. 10．What do we know about the robot Actroid F?A．It has no difference from a human nurse.B．It gets favorable remarks from all the patients.C．It interacts with patients like a human companion.D．It uses body language even more effectively than words.11．What can be inferred from the last paragraph?A．Cooperation will not be replaced.B．Nurses will still play their roles.C．The robotics industry will be promising.D．Robots can meet patients' immediate needs.Why should most of us hate spiders when we know deeply how much good they do? Is it because they somehow seem so alien? After all, what other land creatures on earth have eight legs? What other creatures spin silk webs in which to catch and wrap their prey to preserve it for the future, much as we put food in the fridge to eat later? I do not personally suffer from arachnophobia, the name given to an abnormal fear of spiders, but I can't say that I like the little beasts. However, some people do, and they actually keep them as pets!There is a wide variety of spiders in the world. In fact it has been estimated that there are some 35,000 species——from little "money spiders" that live in your back garden, to the "black widow spider", and the “tarantula” ，the spider that is now sometimes kept as a pet.A tarantula can be any one of a large hairy spiders family and there are about 800 species of them. While experts can tell the difference between species at a glance, most are usually described in reference books as “rather slowly" with “a strong bite which may be poisonous”. They are covered with hairs which can cause a rash （皮疹）if they are handled.No one has calculated the number of human deaths caused by a bite from a tarantula perhaps because it has never happened, or happened so rarely, and indeed a tarantula will do no harm to anyone if handled correctly. Their disgusting image cannot belie their gentle nature but experts tell us not to handle a tarantula without expert advice.Tarantulas are popular as pets and it requires very little space to maintain them in excellent condition. They should be kept singly in a glass container, which need not be very large but should have a layer of stones in the bottom. They feed on insects, and while young tarantulas eat twice a week, adults will often eat no more than once every 10 days.You might like the idea of keeping a tarantula, but personally I am content with just watching them at a distance.12．According to the text, why do most people dislike spiders?A．They are abnormal beasts.B．They take food from fridges.C．They have unpleasant appearance.D．They make people suffer from arachnophobia.13．What do we know about the tarantula?A．It must be kept in groups.B．It feeds on poisonous insects.C．It doesn't belong to hairy spiders.D．It has mild nature if handled properly.14．What does the underlined word “it” in Paragraph 4 refer to?A．The death caused by a tarantula.B．The number of human deaths.C．The bite from a tarantula.D．The rash caused by hairs.15．What's the best title for the text?A．Never judge a book by its cover.B．Nothing seek, nothing find.C．No sweet without sweat.D．Once bitten, twice shy.二、七选五Choosing the right career can be hard. Many people graduate from school or college not knowing what to do with their lives, and get a job without really thinking about it. For some, things work out fine. 16．Your working life lasts an average of forty years, so it's important to find a job you like and feel enthusiastic about. Luckily, there are many ways you can get help to do this.The Australian website, , compares choosing a career with going to the movies. Before you see a movie, you find out what films are showing. 17．— find out what jobs are available and what your options are. Next, decide which movie you like best; if you're not a romantic person, you won't want to see a love story. In other words, with your career, you should decide which job will suit your personality. 18．Meanwhile, you should find out where the theater is before you go. With your career, you need to find information about where you can work, how much you will earn, and how to get a job in that profession.So, how do you start? Begin by asking yourself some questions. 19．Have you travel overseas? Do you have any extra certificates besides your degree, such as a first aid license, for example? Your physical state and build can also affect which jobs you can do. A person, for example, who is allergic to cats would probably never become a veterinarian. Flight attendants, firefighters, and police officers have to be over a certain height, and be physically fit. 20．Are you outgoing and extroverted, or shy and introverted? If you like working alone, a job that requires lots of teamwork might not suit you.A．Your personality matters, too.B．Finally, decide how to get movie tickets.C．The site suggests you do the same with your career.D．Choosing a career can take time and a lot of thought.E.Some jobs require you to have certain life experiences.F.But others often find themselves stuck in a job they hate.G.When you know you can work in your dream job, you'll be glad.三、完形填空Pennsylvania is full of mysterious places! One of those is an old turnpike （收费高速公路）21 for decades. My dad loves history, and he learned it was open to the public.22 , when I was 14, we took a bike trip to 23 this road!My dad chose a 16-mile 24 of the road for us to ride. Part of it included an old tunnel called Sideling Hill which is over a mile long! To 25 , we checked our tires and made sure our lights had batteries. In the morning, we loaded our bikes into the car and set off. As we approached the tunnel, I felt 26 as it was absolutely black inside! But Dad encouraged me. He said he would be beside me. He reminded me to stay 27 and keep my light on!When we 28 the tunnel, the sound of our bikes was heard through the darkness. I shined my flash light around and saw walls 29 in graffiti （涂鸦）.And I felt like I was being 30 ! I was pretty scared, but 31 on following Dad helped me relax. After riding half-way through, I could see light coming from the other end, motivating me to keep going. And I was so delighted to ride out into the bright afternoon!Whenever going through 32 in life, I remember this trip. It reminds me that my father is always beside me. He turns on the light of hope in my 33 , as well as gives me 34 to keep riding through life's 35 tunnels.21．A．designed B．destroyed C．abandoned D．locked 22．A．However B．Otherwise C．Therefore D．Meanwhile 23．A．explore B．construct C．protect D．repair 24．A．tunnel B．section C．block D．course 25．A．participate B．register C．cooperate D．prepare 26．A．excited B．nervous C．annoyed D．exhausted 27．A．silent B．curious C．cautious D．positive 28．A．approached B．observed C．constructed D．entered 29．A．covered B．buried C．absorbed D．dressed 30．A．forced B．watched C．abused D．judged 31．A．depending B．surviving C．calling D．focusing 32．A．accidents B．hardships C．regulations D．incidents33．A．chest B．trip C．work D．heart 34．A．courage B．pride C．excitement D．enthusiasm 35．A．difficult B．distant C．dark D．long四、用单词的适当形式完成短文阅读下面短文，在空白处填入1个适当的单词或括号内单词的正确形式。

国外数字医疗著名融资案例国外数字医疗融资案例1. Babylon HealthBabylon Health是一家英国的数字医疗公司，提供在线医疗咨询和预约服务。

2019年，该公司通过一轮融资筹集了5500万美元的资金。

融资方包括Sawiris家族，他们是埃及最富有的家族之一，以及斯诺克斯集团，该集团是一家全球领先的健康科技投资公司。

2. Modern HealthModern Health是一家美国的数字心理健康公司，提供企业员工心理健康解决方案。

2020年，该公司进行了一轮融资，筹集了5100万美元的资金。

融资方包括Founders Fund和John Doerr等知名投资机构。

3. TempusTempus是一家美国的人工智能和数据分析公司，专注于癌症治疗。

2018年，Tempus进行了一轮融资，筹集了8亿美元的资金。

融资方包括劳伦斯·埃里森（Larry Ellison）和亚马逊创始人杰夫·贝索斯（Jeff Bezos）等知名投资者。

4. Oura HealthOura Health是一家芬兰的数字健康公司，主要生产智能戒指来监测用户的睡眠和身体健康状况。

2020年，Oura Health进行了一轮融资，筹集了2.8亿美元的资金。

融资方包括亚马逊和捷普集团等投资机构。

5. 23andMe23andMe是一家美国的基因测试和个人基因组分析公司。

2015年，23andMe进行了一轮融资，筹集了1.15亿美元的资金。

融资方包括红杉资本和新天域资本等知名投资机构。

6. Livongo HealthLivongo Health是一家美国的慢性病管理平台，通过数字化工具帮助患者管理糖尿病、高血压等慢性病。

2019年，Livongo Health进行了一轮融资，筹集了5.5亿美元的资金。

融资方包括KKR和贝恩资本等投资机构。

7. Grand RoundsGrand Rounds是一家美国的医疗导航和二次诊断公司，帮助患者寻找合适的医生和医疗方案。

关于中国人过洋节的态度英语作文高中全文共3篇示例，供读者参考篇1The Clash of Cultures: Chinese Perspectives on Western HolidaysAs an inquisitive high school student in China, I have closely observed the fascinating interplay between traditional Chinese customs and the influx of Western cultural influences, particularly manifested in the diverse attitudes towards celebrating Western holidays. This complex dynamic has sparked thought-provoking discussions and highlighted the intricate process of cultural exchange and adaptation.One of the most prominent Western holidays that has gained significant traction in China is Christmas. Once considered a purely religious celebration confined to Christian communities, Christmas has transcended its religious boundaries and evolved into a widely embraced cultural phenomenon. The streets of major cities are adorned with dazzling lights, festive decorations, and the unmistakable presence of Santa Claus figurines, creating an atmosphere of wonder and merriment.However, the Chinese approach to Christmas celebrations is often met with a unique blend of curiosity, adaptation, and occasional skepticism. For many, Christmas represents an opportunity to partake in the joy and festivity without necessarily adhering to the religious underpinnings. Exchanging gifts, indulging in elaborate meals, and adorning homes with twinkling lights have become cherished traditions, embraced by both the young and old alike.Interestingly, the commercialization of Christmas in China has also sparked debates and critiques. Some argue that the excessive consumerism and materialistic aspects of the holiday have overshadowed its original spiritual essence. Others perceive it as a harmless opportunity for family gatherings, shared experiences, and cultural exchange.Another Western holiday that has garnered significant attention in China is Valentine's Day. Once predominantly celebrated in the West as a day of romantic love, Valentine's Day has taken on a unique Chinese twist. While the exchange of gifts, roses, and heartfelt gestures between couples remains a central aspect, the celebration has also expanded to encompass expressions of affection among friends and family members.In Chinese cities, the lead-up to Valentine's Day is marked by extravagant displays in shopping malls, with various products and promotions tailored to the occasion. Restaurants and cafes offer special menus and romantic ambiances, catering to couples seeking a memorable evening. However, some traditionalists view this holiday as an unnecessary importation of Western values, arguing that it undermines China's rich cultural heritage and promotes excessive materialism.The Halloween celebration, while not as widely embraced as Christmas or Valentine's Day, has also found its way into the Chinese cultural landscape, particularly among younger generations. Halloween parties, costume contests, and pumpkin carving activities have become increasingly popular, especially in urban areas with a strong expatriate presence and international communities.However, the reception of Halloween in China is often met with a mixture of fascination and apprehension. While some view it as a fun and harmless opportunity for creativity and social gatherings, others express concerns about the potential promotion of superstitious beliefs or the perpetuation of negative stereotypes associated with the holiday's origins.Amidst these diverse perspectives, it is essential to acknowledge the resilience and adaptability of Chinese culture. Just as China has assimilated and reinterpreted various cultural elements throughout its rich history, the approach to Western holidays reflects a willingness to embrace new traditions while maintaining a strong sense of cultural identity.Chinese families and individuals have found creative ways to integrate Western holiday celebrations into their lives, often imbuing them with unique Chinese characteristics and interpretations. For instance, some families have adopted the tradition of exchanging red envelopes with monetary gifts during Christmas, blending Western and Chinese customs.Moreover, the rise of social media and global connectivity has played a pivotal role in shaping Chinese attitudes towards Western holidays. Online platforms have facilitated the sharing of diverse perspectives, allowing for cross-cultural dialogues and the exchange of ideas. Chinese youth, in particular, have embraced these opportunities to explore and experience different cultural traditions, fostering a greater understanding and appreciation for diversity.As a student witnessing these cultural intersections firsthand, I am struck by the complexity and nuances of the Chineseapproach to Western holidays. It is a delicate balance between embracing new traditions and preserving cultural authenticity, a journey of adaptation and negotiation.While some may perceive the adoption of Western holidays as a threat to Chinese cultural identity, others view it as an opportunity for cultural enrichment and mutual understanding. Ultimately, the diverse attitudes towards Western holidays in China reflect the dynamic nature of cultural exchange, where traditions are constantly evolving, blending, and finding new forms of expression.As I navigate this intricate cultural landscape, I am reminded of the importance of maintaining an open and inquisitive mindset. By embracing the richness of diverse traditions and fostering respectful dialogues, we can deepen our appreciation for cultural diversity while preserving the essence of our own heritage.The Chinese approach to Western holidays is a fascinating tapestry, woven with threads of curiosity, adaptation, and cultural pride. It is a testament to the resilience of Chinese culture and its ability to selectively integrate and reinterpret foreign influences, creating a harmonious fusion that celebrates the beauty of diversity while honoring the roots of tradition.篇2The Curious Case of Western Festival Celebrations in ChinaAs an international student from China, one of the aspects of life abroad that has intrigued me the most is the way Western festivals and holidays are celebrated – or perhaps more accurately, embraced – within my home country. From the Christmas markets that spring up in every major city to the Valentine's Day specials advertised by restaurants and stores, it seems that commemorating traditionally European or American occasions has become thoroughly woven into the cultural fabric of modern China.This phenomenon was not lost on me growing up, but I must admit that I did not devote much thought to examining its origins or implications until I experienced my first few months living overseas. Surrounded by Canadian and American friends who regard holidays like Thanksgiving as quintessentially defining traditions, it dawned on me how commercially-driven and culturally incongruous the supposed Chinese "versions" of these celebrations truly are.Christmas, in particular, stands out as the most ubiquitous and corporatized Western festival in China today. One canscarcely avoid its unmistakable sights and sounds in any urban center come December –twinkling lights and garlands adorn shopping malls, restaurants promote lavish "Christmas Eve" set menus, and it has even become common for offices and schools to organize secret Santa gift exchanges. Considering that only a tiny percentage of Chinese are actually Christian, this spectacle inevitably raises questions about the underlying motives.From a purely economic perspective, the widespread adoption of Christmas in China makes complete sense as a commercial enterprise. With hundreds of millions of consumers demonstrating an eagerness to take part, savvy businesses have understandably seized on the opportunity to drive sales through holiday marketing and promotions. Decorations, themed products, and the normalization of lucrative seasonal spending have proven to be an incredibly effective way to generate revenue. Global corporations like Starbucks and McDonald's were among the first to hop aboard the Christmas bandwagon in China, with domestic companies swiftly following suit.Yet I cannot help but feel that there are cultural forces at play beyond mere capitalism and profit motive. For many among China's burgeoning middle class, the allure of Christmas lies not just in the chance to spend money, but in the perceivedopportunity to partake in a quintessentially Western tradition. Celebrating Christmas, by this rationale, is synonymous with embodying the trappings of wealth, sophistication and worldliness so eagerly sought after by many urban professionals and youths in today's China. The grand Christmas displays and festivities organized in cities like Shanghai and Beijing are thus emblematic of the nation's rapidly shifting values and aspirations as it continues its dizzying ascent onto the global stage.Of course, the Chinese people's attitude towards Western festivals is by no means monolithic or univocal – a fact that becomes abundantly clear when examining the discourse surrounding these celebrations. Traditionalists and cultural commentators routinely decry the "worshipping of foreign fads" exemplified by hyper-commercialized Christmas festivities in particular. Every year around December, impassioned op-eds reasserting the importance of maintaining Chinese traditions and rejecting the hollow materialism of Western imports make their rounds through social media and newspapers.Still, critics of this nature appear to represent an increasingly marginalized viewpoint, especially among younger generations. While Cultural Revolution-era rhetoric railing against the "spiritual pollution" of bourgeois foreign influences may still findsympathetic audiences in some quarters, they now coexist alongside a rapidly swelling pro-Western sentiment – particularly in relation to Christmas. Far from perceiving the holiday as a threat to Chinese values, many urban youth seem to regard its celebration as a mark of progressiveness and cosmopolitan identity.Notably, universities across China have emerged as among the most prominent facilitators of bringing Christmas "celebrations" into the mainstream over the past couple decades. Dormitory decorating contests, campus lighting displays, Santa costume parties and other institutionally-organized events have become annual fixtures that few question or decline to participate in. Indeed, the ubiquity of such activities is a prime contributor to my generation's perception that marking Christmas is nothing out of the ordinary – just another way to have fun and bond with friends.This normalization of Western festivals like Christmas in collegiate social life is likely an outgrowth of China'sdecades-long project to rapidly modernize and internationalize its system of higher education. As Chinese universities increasingly began recruiting foreign faculty, hosting international students, and partnering with prestigious Westerninstitutions in the 80s and 90s, administrations simultaneously sought to immerse domestic students in globally "mainstream" cultural practices. Organizing Christmas activities on campuses across the country was a highly visible way to help cultivate the cross-cultural perspectives and experiences demanded by China's new educational paradigm.My personal views on this entire phenomenon have admittedly evolved over the years spent ricocheting between China and the West for studies. I'll admit that early on, I harbored some reflexive unease about importing foreign festivals simply for their chic factor and commercial possibilities. Witnessing older relatives scoff at Christmas consumption made me skeptical of participation based solely on trendiness.Longer exposure and firsthand experiences celebrating with foreign friends, however, have imbued me with a more nuanced perspective. While I retain immense pride in China's ancient traditions, I've realized there is no intrinsic harm or threat posed by also embracing new cultural practices – so long as it is done with intentionality and self-awareness rather than blind mimicry and materialism. Celebrating Christmas or other Western holidays in China need not come at the expense of one's cultural identity. If ushered in with authenticity and open-mindedness,these occasions can even serve as means for inter-cultural exchange and bridging divides between East and West.Indeed, long-standing Chinese values of pragmatism and reinventing tradition may ultimately be the most compelling philosophical justifications for adopting celebrations like Christmas into the national repertoire. After all, the Chinese people boast an extensive history of absorbing and domesticating foreign cultural influences to forge new hybrid traditions – one need look no further than the indelible mark left by Buddhism's entrance from India for a salient example. Cosmopolitan "Christmas" customs arising in today's China could therefore represent merely the latest reinvention in this long process of cultural melding and adaptation.Moving forward, my hope is that the Chinese people can develop a relationship to Western festivals that is both enthusiastic and discerning – embracing these holidays' capacity for intercultural connection and revelry while consciously forging unique localized iterations imbued with Chinese characteristics. As China's global integration and influence continue deepening, the nation's evolving attitude towards celebrating the world's diverse traditions will remain a dynamic story worth watching.篇3The Intermingling of Eastern and Western Traditions: Exploring Chinese Attitudes Towards Celebrating Western HolidaysAs a high school student born and raised in China, I have witnessed firsthand the fascinating interplay between our ancient Eastern traditions and the increasingly globalized world we inhabit. One area where this cultural exchange manifests itself is in the celebration of Western holidays, which have gradually seeped into the Chinese consciousness and sparked a diverse range of reactions and attitudes.Growing up, I vividly remember the excitement that would fill the air as Valentine's Day approached. Despite its Western origins, this celebration of love and romance has found a warm embrace among many Chinese youth. Shops would be adorned with heart-shaped decorations, and classmates would exchange small gifts or heartfelt notes. However, I also recall the disapproving glances from some elders who viewed this practice as a foreign intrusion, a departure from our traditional ways of expressing affection.The dichotomy of perspectives surrounding Western holidays is not unique to Valentine's Day. Christmas, for instance, has sparked heated debates and varying levels of acceptancewithin Chinese society. While some families have wholeheartedly embraced the festive spirit, decorating their homes with twinkling lights and exchanging gifts, others remain steadfast in their belief that this Christian tradition holds little relevance to our cultural heritage.Perhaps the most intriguing aspect of this phenomenon is the manner in which certain Western holidays have been adapted and re-interpreted through a distinctly Chinese lens. Take, for instance, the case of Halloween. While the origins of this autumn celebration lie in Celtic and Christian traditions, its modern commercialized form has found a unique expression in China. Rather than embracing the haunting elements of ghosts and goblins, many Chinese have transformed Halloween into a light-hearted occasion for costume parties and social gatherings, stripping it of its more macabre undertones.As I navigate these cultural crossroads, I find myself pondering the deeper implications of this East-West fusion. On one hand, the embrace of Western holidays can be seen as a testament to China's increasing global integration and openness to diverse cultural influences. It reflects a willingness to explore and appreciate traditions beyond our own, fostering a spirit of curiosity and inclusivity.However, there are also valid concerns about the potential erosion of our rich cultural heritage. Some argue that the widespread adoption of Western holidays could dilute the significance of our own time-honored celebrations, such as the Lunar New Year or the Mid-Autumn Festival. There is a fear that younger generations may become disconnected from the profound symbolism and historical roots that underpin these traditional events.Personally, I find myself walking a delicate line between these two perspectives. While I cherish the opportunity to experience the joy and festivity of Western holidays, I also deeply value the preservation of my cultural identity. It is a constant balancing act, one that requires open-mindedness and a willingness to embrace the best of both worlds.One approach that resonates with me is the concept of "harmonious coexistence." Rather than viewing Eastern and Western traditions as inherently incompatible, we can strive to find common ground and appreciate the unique beauty in each. Just as the yin and yang symbolize the complementary forces of the universe, perhaps we can embrace the coexistence of diverse cultural practices, allowing them to enrich and inform one another.In this spirit, I have witnessed heartwarming instances where families have creatively blended Eastern and Western elements in their celebrations. For instance, during Christmas, some households incorporate traditional Chinese dishes alongside Western fare, creating a delightful fusion of culinary delights. Others may decorate their Christmas trees with intricate paper lanterns or incorporate elements of feng shui into their holiday decorations.Furthermore, I believe that the selective adoption of Western holidays can serve as a catalyst for deeper cultural exchange and understanding. By engaging with these traditions, we open ourselves to learning about their historical and symbolic significance, fostering greater empathy and respect for diverse belief systems and practices.Ultimately, the discourse surrounding Western holidays in China is a microcosm of the larger global conversation about cultural identity in an increasingly interconnected world. As a student and citizen of this dynamic nation, I recognize the inherent challenges and complexities that arise from this cultural intermingling. However, I also see immense potential for growth, understanding, and the creation of new shared experiences that transcend boundaries.Perhaps the true essence of this phenomenon lies not in the outright rejection or wholesale acceptance of Western holidays, but rather in our ability to thoughtfully navigate these cultural intersections. By maintaining a strong connection to our roots while embracing the richness of diverse traditions, we can forge a path that celebrates our unique heritage while simultaneously embracing the beauty of our global community.As I look towards the future, I am filled with hope and optimism. I envision a world where the boundaries between East and West blur, where cultural exchange flows freely, and where we can collectively revel in the tapestry of human expression, weaving together the vibrant threads of our collective experiences. It is a world where the joy of Valentine's Day can coexist harmoniously with the reverence of the Lunar New Year, and where the twinkling lights of Christmas can illuminate the ancient wisdom of our ancestors.In this journey of cultural exploration, it is incumbent upon us, the younger generation, to approach these intersections with open hearts and open minds. We must be willing to question long-held assumptions, to respectfully challenge traditions that no longer serve us, and to forge new pathways that celebrate the diversity of our global village.For now, as I walk the halls of my high school, surrounded by the lively discussions and debates that this topic inevitably sparks, I am reminded of the incredible richness that lies within the merging of cultures. It is a tapestry woven with threads of joy, tradition, curiosity, and a shared human experience that transcends borders and boundaries. And it is my sincere hope that, through open and respectful dialogue, we can continue to weave this tapestry, creating a future where the boundaries between East and West dissolve, and where we can all celebrate the beautiful mosaic of human expression.。

医师英文个人简历模板personal details :name : dr _________________address: ___________________email: _______________________date of birth: _______________________age: ________marital status : _________sex : ________nationality: ________medical registration :full registered with ___________ medical council which is affiliated to medical council of _____________.registration no.: ________registration date : _________qualifications :professional qualifications :posgraduate studies:______________qualification obtained:________________________year completed:________________________________universtiy of education organization:__________________________________basic qualifications :undergraduation studies___________________________________________________________ _____________high school studies___________________________________________________________ _____________educational achievements:first class marks in english in state a level examination1976.secured25th rank out of15,000 girl candidates in state medical entrance examination1978.english test:ielts (academic module) date23/05/2023with following bands:listening:, reading:, writing:, speaking:,(overall band:)oroet date with following subtests:listening:b, reading:b, writing:b, speaking:bclinical skills and experiencestatement of skills and experience:i worked for8months in out patient department of hospital ________. i was involved in diagnosis and treatment of day to day general out patient problems. referred serious and high risk cases to respective specialities after initial management and with prior appointment. also conducted followup clinics for diabetes, asthma, hypertension, psychiatry patients under supervision of respective specialists. mainly involved in gp and family practice.i was actively involved in cme and teaching programme. at hospital _____ i worked in the department of medicine for8months. i was mainly involved with clerking, relevant investigations, presentation to specialist and management of acute emergencies and chronic cases. i did on call duties on1:4rota basis.subsequently, i worked in outpatient department of hospital _____ for16months. i was mainly involved in gp community based practice same as hospital ________________. generalpractice:i was actively doing general practice and resumed the same after returning from __________. my gp clinic is locatedin outskirts of the city. this is the first point contact clinic where i am doing treatment for routine daytoday problems, followup of chronic cases, minor surgical procedures under la, nebulizer for asthmatic patients, advice for male female contraceptives, emergency contraception, iucd ion, its followup removal / change, gynaecological examination carried out for routineproblems.breastexamination:includes a) teach women breast self examination on regular basis b) clinical examination c) advice for mammography, fnac, etc. counseling about menopause and care for elderly and ageing women its related problems, advice for estrogen replacement therapy hrt.____ hospital research centre, _______________this is a modern hospital of town having various departments including radiology pathology. it has an attached college of nursing. i have worked for3years in this hospital as chief medical officer. i was mainly involved in inpatient care, ward duties and post operative care in obstetrics gynaecology, surgery, medicine and paediatrics.i was mainly involved in conducting gp clinic. i was involved in teaching programme and cme.the surgery hospital, ________________this is a well equipped hospital with radiology and pathology facilities. i worked as resident medical officer for4years in all major specialties. also conducted gp clinic on daily basis__________ hospital research centre, _______________ it is another well equipped hospital of town. i worked in this hospital for a period of4years as a resident medical officer in o g under supervision of o g consultant. i did clerking of cases, ward rounds, conducted antenatal clinics, labour and assisted in surgical work to the consultant. i did on call duties twice a week.also i was independently conducting family planning pap smear clinics, iucd ion. i was actively involved in cme. ___________ hospital (________________ hospital), ___________ is the biggest hospital of central _____. it isa1000 bedded hospital attached to mgm medical college, _________. it is a tertiary care hospital having various departments including24hours radiology, pathology, blood bank and casualty. i took rotating training in all major specialties and their allied branches plus preventive and social medicine posting.teaching experienceactively involved in teaching undergraduates and nursing staff during my internship and residency.imparted community health education during internship in preventive and social medicine as well as during residency. practical proceduresi/v cannulation / venepuncturebladder catherterisationair way managementsuturingwound debridement and careincision and drainage of abscesscpr / blsassisted lscs 1000 approximatelytah / bso 200 approximatelytubal ligation 500 approximatelyappendicectomylaparotomyconducted independently normal labour, episiotomy suturing.speculum examination, pap smear.conference, seminar workshopattended regional seminar on child survival and safe motherhood organized by ______ medical association ; sponsored by ministry of health family welfare, government of _______ in october1995.attended workshop on safe abortions, sponsored by fogsi (federation of obstetrics gynaecological societies of ______), ministry of health family welfare (government of _______) and who ; organized by indore obstetrics gynaecology society of indore, india + department of o+g, mgm medical college _______, india on8th december2023.。

儿童感染科进修医生工作总结英文回答：Pediatric Infectious Disease Fellowship Progress Report.As a Pediatric Infectious Disease Fellow, I have gained invaluable experience and knowledge that has significantly enhanced my clinical skills and understanding of infectious diseases in children. Throughout my fellowship training, I have actively participated in various aspects of patient care, research, and education.Clinical Rotations:Inpatient Consult Service: I have provided comprehensive consultations for hospitalized children witha wide range of infectious diseases, including sepsis, meningitis, pneumonia, and surgical site infections. I have collaborated with attending physicians to develop and implement appropriate antibiotic regimens and managementplans.Outpatient Infectious Disease Clinic: I have managed patients with acute and chronic infectious diseases, including respiratory tract infections, urinary tract infections, skin and soft tissue infections, and travel-related illnesses. I have provided patient education, prescribed medications, and made referrals for specialized care as needed.Emergency Department: I have evaluated children with suspected or confirmed infectious diseases in the emergency department. I have performed triage, ordered diagnostic tests, and initiated treatment protocols.Research:I have actively participated in ongoing research projects related to pediatric infectious diseases. I have assisted with data collection, analysis, and manuscript preparation. My contributions have furthered our understanding of the epidemiology, management, andprevention of infectious diseases in children.Education:I have served as a clinical instructor for medical students and residents, providing bedside teaching and supervision on the inpatient and outpatient services. I have also participated in departmental educational conferences and grand rounds, presenting case reports and sharing my knowledge of infectious diseases.Professional Development:I have attended national and international conferences to stay abreast of the latest advancements in pediatric infectious diseases. I have obtained board certification in Pediatric Infectious Diseases and am a member of the Pediatric Infectious Diseases Society.Goals for the Remaining Fellowship Period:Continue to provide high-quality patient care andparticipate in ongoing research projects.Enhance my proficiency in advanced diagnostic techniques and management strategies for complex infectious diseases.Develop my skills in medical education and research mentorship.中文回答：儿童感染科进修医生工作总结。

艾弗森英文简介艾弗森简介Allen Iverson, born June 7, 1975 in Hampton, Virginia, former US professional basketball player, the guard (double guard), nicknamed Answer / AI, Former United States team dream team captain.Alan Iverson in the 1996 NBA draft in the first round of the first one by the Philadelphia 76ers selected to become the NBA draft pick. In the 14 years of his career, Allen Iverson played for the 76ers, the Nuggets, the Grizzlies and the Pistons four NBA teams, rookie season won the rookie and rookie Challenge MVP, 4 times won the NBA scoring Wang, 3 times won the NBA steals, 2000 to 2010 11 times selected NBA All-Star team and won 2 NBA All-Star MVP, 3 times selected NBA best team, 3 times selected NBA best team two, 2006 Year selected NBA best team three array. 2000-2001 season, Iverson played a career best performance, won the regular season MVP trophy, and help the 76 team into the NBA Finals, but did not win.On October 30, 2013, Allen Iverson officially announced his retirement. His NBA career played 41.1 minutes, won 26.7 points, 6.2 assists and 2.2 steals. March 1, 2014, Iverson No. 3 jersey in the 76ers home to the Wizards midfielder rest when retired.April 4, 2016, Allen Iverson was officially selected 2016 Nai Smith basketball celebrity memorial hall.艾弗森运动生涯76 people periodEarly (1996-2000)At the 1996 NBA Draft, Allen Iverson was selected by the Philadelphia 76ers in the first round of the first round, becoming theshortest pick in NBA history and signed with the team for three years, $ 9 million contract. In the rookie Iverson in his debut will be alone scored 30 points, and in its new year to the annual NBA rookie, NBA rookie challenge the most valuable players and other awards in the bag. April 12, 1997, 76 against the Knights of the game, Iverson full game scored 50 points, and 5 rebounds and 6 assists, which is his career for the first time scored 50 points.1997-1998 season, Iverson also played well, but the team has been no improvement in the record, so the Philadelphia 76ers decided to replace the coach, by Larry Brown as head coach. In the season, Iverson was named to the leagues first team, and with the help of Larry Brown, for the first time in the playoffs.1998-1999 season, Iverson averaged 26.8 points to get the season scoring, and lead the team once again after eight years into the playoffs.1999-2000 season, Iverson averaged 28.4 points, 3.8 rebounds, 4.7 assists, 2.1 steals and 0.1 blocked shots were elected to the annual second team, while the 76 people also re-enter the playoffs.Vertex (2000-2001)2000 - 2001 season, Brown coach decided to only six feet of Iverson to change the shooting guard, the results of 76 people in the season made ten straight season season, and the end of the season is also the head of the first seed into the playoffs The And Iverson this season is a great success to 31.1 points per game, 3.8 basket, 4.6 assists, 2.5 steals and 0.3 blocked shots won the league MVP, and also won the scoring , Steals the king, and re-elected league first team.February 7, 2001 2000-2001 All-Star Game, Iverson led the Eastern All-Star victory over the Western All-Star, Iverson was also selected as the All-Star Game MVP, the whole game he contributed25 points 5 assists and 5 steals.2001 playoffs, the first round of the first three rounds of the Indiana Pacers, but the 76 people finally succeeded in defeating each other. Into the second round, 76 people have to face the Windsor with the Toronto Raptors, Iverson in the second and fifth respectively, 54 and 52 points, becoming the second after Michael Jordan in the playoffs With the series, two scoring more than 50 points of the players. In the decisive seventh game, the Raptors on the Iverson implementation of the audience double double team, but Iverson has used this opportunity for his teammates continue to create scoring opportunities, and ultimately he led by 16 assists Beat the Toronto Raptors into the Eastern Conference Finals. In the Eastern Conference final with the Milwaukee Bucks, the first two sides win one, but Iverson at this time unfortunately injured, so that 76 people in the third game was defeated, then Iverson back injury, the series The game again into the first seven games. Iverson scored 44 points in the winning streak, led the 76ers to win the Eastern Championship, reached the finals. Finals first face the Lakers, Iverson full game he grabbed 48 points 6 assists and 5 steals, led the team to win the finals of the first victory, but because they can not stop the Lakers Shaquille ONeal in the restricted area Raging, 76 people then lost four in the case of the end of the finals.Later (2002-2006)Iverson in the late 76 people, the team failed to continue strong, although Iversons personal data is still dazzling, but the team scores are year after year. 2001-2002 season, Iverson once again won the scoring and selected the second team of the year, but 76 people in the first round of the playoffs. At the same time Iverson missed the team training once again aroused Larry Browns strong dissatisfaction,the relationship between the two deteriorated again, resulting in Larry Brown in the 2003 season after the end of the Detroit Pistons coach.2002-2003 season 76 people broke through the first round of the playoffs, which Iverson in this series first scored 55 points, a new high in the playoffs. 76 people in the second round encounter Detroit Pistons, 76 people finally lost to the Pistons. 2003-2004 season Iverson missed the half-season because of injury, and the lack of Iverson 76 people since the first time in 98 years for the first time failed to enter the playoffs,2004-2005 season, 76 team management has seen bleak results, so the introduction of Chris Weber to assist Iverson. Unfortunately, the fame of the power forward has been in the late career, can not give Iverson too help. February 12, 2005, 76 people challenge the magic, that game Iverson audience 36 vote 17, free throws 27 penalty 24, grabbed 60 points 6 assists 5 steals, this is his career highest score this season Iverson is very prominent in the data, averaging 30.7 points, 4.0 basket, 7.9 assists, 2.4 steals and 0.1 blocks. In addition to taking off his fourth scoring throne, and the third year of the first team, but also became the first in the history of NBA scoring, assists and steals are included in the first five players, and Iverson also in the All-Star The second time in the race won the MVP. But unfortunately 76 people in the playoffs once again lost to Larry Brown led Detroit Pistons.2005-2006 season, Iverson personal scoring high score, up to 33 points, but 76 people can not enter the playoffs. 76 team management team saw the team results for a long time without a breakthrough, and Iverson and the team management there is a contradiction, so in December 20, 2006, he was sent to the Denver Nuggets to exchange Andre Miller, Joe Smith and two first-round draft picks. Ended Iverson in the 76-year-old ten-year career.Nuggets periodDecember 20, 2006, Iverson was exchanged to the Denver Nuggets and headed star Cameron Anthony became a gold double gun.2006-2007 season, Iversons arrival did not bring substantial help to the Nuggets. He can not play the whole team can not mix the whole team. 06-07 season, Iverson averaged 24.8 points and 7.2 assists, although this data can not and his peak period of the same day, but it can and then the leagues first-class defender comparable. Season, the Nuggets to 45 wins and 37 losses record barely squeezed into the playoffs, then in the first round will be eliminated.2007-2008 season, Iverson is still continuing all-around play, although the Nuggets record has improved to 50 wins and 32 losses, but the team still did not escape the first round of the playoff nightmare. After two seasons of the experiment, the Nuggets gradually realized that the introduction of the original Iverson is a beautiful mistake, AI style is not suitable for the Nuggets, he can not lead the way to go beyond Denver.November 2008 Nuggets high-level cut fast, in the season began and the Pistons soon reached a deal, sent away Iverson, ushered in the MVP level after the field Chauncey Billups.Piston periodIn November 2008, Iverson was traded to the Pistons, the performance of eye-catching, and defeated the opening 11 consecutive unbeaten Lakers. At the end of the seasons regular season, Iverson broke with the team due to dissatisfaction with the decision of the piston coach Michael Curry to replace the bench, and the Pistons management excuse him from the playoffs Outside the list (due to the number of reasons for admission to enter the list, but never played).Because of his style of play with the emphasis on team cooperation with the Pistons completely discord, resulting in the team gradually from the Eastern Conference League No. 4, No. 5, gradually went to the first 7, 8. And then to February, also appeared from the 1994-1995 season after the first 8-game losing streak in the first eight defeated, Iverson also because of back injury early end, but the magic is that he did not play after the game, the Pistons down Eastern League 3rd Magic, ending 8-game losing streak, and defeated the Eastern League 2nd Celtics after the match, the third league of the Western Conference, after the game Iverson became the first six people, This also makes him very unhappy, to the last month of the regular season, Iverson because of recurrence of back injury early summer vacation, and the Pistons to the Eastern Union 8 seed into the playoffs, in the first round was Cavaliers 4 -0 swept home.GrizzliesSeptember 9, 2009, Iverson accepted the Memphis Grizzlies made a one-year $ 3.5 million offer, Memphis became Iversons fourth career career. The season ended Nov. 8 Iverson played a total of three games for the Grizzlies, the team in all three games lost to the opponent. In the three games Iverson all played as a bench, averaging 22.3 minutes to play for the team to contribute 12.3 points and 3.7 assists, shooting 57.7%, 12 times on the free throw line hit 6 balls, gray Bear record for 1 wins and 5 losses in the southwest Division bottom. November 16 Grizzlies executives decided that the team had terminated a one-year contract with Iverson. Iverson once again become a free agent.November 26, 2009, Alan Iverson issued an open letter announced his retirement. A day later, Allen Iverson withdrew the decision to retire.Back to PhiladelphiaDecember 3, 2009, Iverson announced with the Philadelphia 76ers signed a one-year non-guaranteed contract and Andre Iguodala together to play the playoffs, the answer back to the game again. Pui Phi 3. Tears press conference site.December 7, 2009, the 76ers home against the Nuggets, Iverson after a lapse of three years after returning to Philadelphia after the first show, but not in the best state Iverson can not help the team win, 76 to 83 -93 lost to the Nuggets, Iverson 11 vote 4 scored 11 points, 6 assists and 5 rebounds.At the beginning of 2010, Iverson because of the little daughter suffering from illness, high fever, missed the All-Star and the game, Iverson to take care of her daughter, with 76 people lifted the 2010 season remaining contract.July 6, 2010, Iverson in his microblogging statement that hope to return to the NBA.European tourOctober 25, 2010, Iverson agreed to $ 4 million worth of Turkey Besiktas basketball club for two years. In the 2010-11 season, in the campaign when the European Cup, Iverson played 7 times, played a total of 67 minutes, a total of 28 points and 9 rebounds, and 9 assists. This three games, he scored 7 of 7 shots in seven, three-pointers 5 vote 3, free throws 10 penalty 5.January 12, 2011, due to Iverson injured in the turntable in the Turkish league, he was ready to leave Turkey to return to the United States for surgery, takes 6 to 8 weeks of rest time. Eventually, Iverson chose to return to the United States for surgery and quit the basketball. At the same time, it ended his career in Turkey.Declared retiredOn October 30, 2013, Allen Iverson officially announced his retirement.March 1, 2014, Iverson No. 3 jersey in the 76ers home to the Wizards midfielder rest when retired.July 22, 2015, Allen Iverson was elected by the BET radio and NBA players union jointly organized by the first player selected by the game change award。

Patients Have Rights, but Doctors Have Rights, tooEd Newman1. Anyone who watches any amount of television on a regular basis has noticed that TV commercials repeat themselves. Sometimes tiresomely. Whether it’s cars or burgers, soft drinks or detergents, marketing gurus across America believe that without repetition, their messages will quickly be lost amidst the forty-two zillion other messages competing for our half-attentive minds. And to a large extent they are right. We often need to hear a message repeated, because we often don’t “get it”the first time. Either we failed to notice it, or we failed to realize its significance.2.For this reason, we are returning to the subject of living wills, patient rights and self-determination in terminal health care.3. In December 1991 the Federal Patients Self Determination Act went into effect. In essence, this piece of legislation mandates that all hospitals, nursing homes and home health care providers are required to inform patients of their rights as patients and their ability to make an advance directive (living will) regarding their health care prior to treatment.4. A living will is a document which tells your physician or health care provider what types of treatment you want if you become terminally ill. It can outline the types of treatment you want and what you don’t want. In addition, it can also name a person as a proxy to make these health care decisions for you.5. It is noteworthy, however that while living wills have been widely discussed for years, and that Minnesota has had an Adult Health Care Decisions Act in force since 1989, there are still many questions and concerns about what living wills mean. And many people still have fears about the implications of putting their wishes in writing. Perhaps some clarity can be brought to the situation by understanding when and how these advance directives are used.6. Doug Lemons, Director of Social Services at St. Luke’s Hospital, explained. “Keep in mind the context for which the Living Will was developed. It is not in the emergency room, it is not in the operating room, but it is after the fact,when the patient is perhaps out of intensive care and being kept alive with machinery. It is that situation for which living wills were created.”7. According to the law, a living will becomes legally enforceable when the patient can no longer decide treatment decisions for himself or herself and is terminally ill. This means that the patient is in an incurable or irreversible condition for which treatment would only prolong dying.8. “Some people,”said Mr. Lemons, “fear that if they should have a car accident and they are in the emergency room, the doctor would say, ‘Oh, he’s got a living will. Just let him die.’“That can’t happen and it won’t happen, because as people move into the emergency room, they are there for emergency care. The living will doesn’t apply at that point. The living will applies once the patient gets to his room on a respirator.”9. Another situation where living wills are not enforced is in the realm of surgery. To illustrate, Mr. Lemons shared this example. “Recently someone came into the hospital for surgery who has a terminal condition, and she came in for an operation to relieve some of her pain. In order to get through the operation she was put on a respirator—and her living will says she does not want to be kept alive on a respirator. Her proxy came up into the ICU and here is this person being kept alive on a respirator. Is that a violation of the living will? No. It is a continuation of the surgery. In order to get through the surgery, because the heart had stopped—and this is typical sometimes in this situation—she had to have help in breathing. 24 hours later she was awake, and 72 hours later she was returning to her pre-operative state.”10. “Was the respirator a violation of her living will? No. She came into the hospital to relieve some of her pain. This procedure was necessary to achieve this goal.”11.“If, however, we later could not wean her from the respirator, then the decision would have to be made by her proxy, because she did not want to be kept alive on and on and on and on. So here, at this point, we follow her dictates as specified in her living will.”12.While the trend in health care over the past twenty years has been toward patient empowerment, physicians are still ultimately responsible for thehealth care decisions made in a patient’s treatment. Some people are surprised to learn that a physician is not required to follow the dictates specified in an advance directive. “nder our living will statute your health care provider can choose not to follow all or part of your living will,” said Legal Aid Officer Dale Lucas, senior attorney for the Senior Law Office. “You have two choices then. You can choose to stay with that medical provider or you can choose to find a different one. But that medical provider has to tell you about this right away when you provide a copy of your living will to the medical provider.”13.The reason for this becomes clearer when one recalls the history of physician/patient relationships.14. At one time, the typical model for medical care was the Theocratic Model.“It was as if the physician was God,” says Carolyn Schmidt, “and had all the answers. That became somewhat more gentle as care became more sophisticated. We entered what might be called the Paternal Period, where the physician was like a father who knew what was best for his patient.”15.As medical care became still more technical, the model changed to what we might call an Engineering Model. In this scenario, the physician was approached in much the same way as one would contract an engineer. Because the engineer has more knowledge than you, you trust him to take over and do what is correct.16.More recently, said Ms. Schmidt, “a realization has been made—especially among the younger doctors who are graduating from medical schools now—that health care consumers are much more sophisticated and aware due to the spread of knowledge through the media. The ideal model has now become a Cooperative Model where the physician and the patient both have input about the nature of that care.”17.In this new approach to health care, patient and physician work as a team. The benefit to health care consumers is an empowerment to a degree that has never been experienced before. However, just as there are limits to free speech—we are not permitted to shout ‘Fire!’ in a crowded theater—so there are limits to patient rights.18.In the Cooperative Model, Ms. Schmidt said, “you are working in ateam. And whenever you work in a team, you are two persons, and both of those persons have rights. Patients know what they want done to their own bodies, and those are very real rights. But the physician knows what he is able or willing to do, both in accordance with his own personal morality and with his knowledge of the practice of sound medicine. It would do real violence to him to have to go against either of those.”19.The bottom line is that there are times when the expressed directives in a living will cannot be carried out in good conscience by one’s physician, and the physician is not obligated to do so. It is the doctor’s right to refuse a particular service.20.Nevertheless, if this were to happen, the law states that your doctor is required to indicate this. “The medical provider has to tell you and document this in his file that he can’t follow all or part of the living will,” said Mr. Lucas. THE DURABLE POWER OF ATTORNEY OPTION21.Some people have wondered if a living will is necessary at all, since Durable Powers of Attorney are a legitimate option for health care decisions. (A durable power of attorney is a signed, dated and witnessed paper naming another person to make decisions for you. Any competent person over 18 can be chosen. The person does not have to be attorney.)22.According to Dale Lucas, one advantage of the durable power of attorney is that you don’t have to be terminal for it to go into effect. However, since the durable power of attorney was created chiefly for financial matters, Mr. Lucas adds, “I wouldn’t feel totally secure that the durable power of attorney for medical care would be followed.” The purpose of this document is specifically for appointing someone to be an agent on your behalf.23.Why, then, have a living will? “The reason people have a living will,” said Mr. Lucas, “is that they don’t want to place that tremendous burden of responsibility on a loved one to make that decision. Other people think they do want a proxy decision maker. So there are two schools of thought on that. It’s an individual decision that has to be made. I, for instance, have a living will and did not name a proxy decision maker.”HOW DOES ONE MAKE A LIVING WILL?24.In Minnesota, there is a Living Will Form which has been approved by law and should be available from your doctor, health care provider or attorney. This form asks questions to help you clarify what you want and do not want in the realm of terminal health care.25.You are not required to have all the statements filled out. For example, if desired you may skip everything and simply indicate the name of your proxy, the person who will speak on your behalf should become incapable of making your treatment decisions known.26.After the living will is completed, it must be signed by you and two witnesses or a notary public to become legal. Witnesses who will benefit from your estate are not valid. Finally, you must give your living will to your doctor or health care provider and you should ask your doctor to write out an order to carry out the terms of your living will.MISCELLANEOUS CONCERNS27. A lot of people equate a living will with “pulling the plug.” But according to Mr. Lemons, “A living will does not mean ‘Pull the Plug.’ It can also mean Tape the Plug to the Wall, put the tubes in, do everything possible, because it’s your will.”28.Another concern being raised has to do with the effect one’s living will might have on insurance premiums. Can one’s insurance rates go up if they request total care instead of minimal care during their final days? Will insurance companies have a low option plan that encourages people to request No Code Blue or DNR on their charts? “In the state of MN the law says no insurance company can adjust their rates based upon a living will,”said Mr. Lemons. “That’s good news.”29. A living will does not have to be complicated. It may, in fact, be a simple statement such as this: “If in the opinion of two doctors I am brain dead I do not want to be kept alive.” Having one’s intentions spelled out in black and white helps clarify what one truly believes.30.You may feel that a living will is not for you at all. It’s not, in fact, required by law. It is simply a tool to help ensure that you get the kind of health care you want. If you do not have a living will, your nearest of kin will beconsulted. In any case doctors are still committed to utilizing their training and experience toward making the best decisions possible in every aspect of your care. Whether you wish to use this tool is an option, only you can decide.。

中西医结合护理Chinese Journal of Integrative Nursing2023 年第 9 卷第 9 期Vol.9， No.9， 20231例以中医理论为指导的老年慢性肾衰竭患者医护一体化查房体会李秀丽， 李媛媛， 谢璇， 邓建华（北京中医药大学东方医院 肾病科， 北京， 100078）摘要： 本文总结1例以中医理论为指导的老年慢性肾衰竭患者医护一体化护理查房体会。

首先组建查房团队，对患者的病因、病机、护理问题、护理目标、护理措施及护理效果进行汇报、讨论，以此为慢性肾衰竭患者的治疗和护理提供更完善的方案。

关键词： 中医理论； 慢性肾衰竭； 医护一体化； 护理查房； 辨证施护中图分类号： R 473.5 文献标志码： A 文章编号： 2709-1961（2023）09-0058-05Integrated medical and nursing ward roundsfor an elderly patient with chronic renalfailure guided by TraditionalChinese Medicine theoryLI Xiuli ，LI Yuanyuan ，XIE Xuan ，DENG Jianhua（Department of Nephrology ， Dongfang Hospital Beijing University of Chinese Medicine ， Beijing ， 100078）ABSTRACT ： This paper summarized the practice of integrated medical and nursing ward roundsfor an elderly patient with chronic renal failure guided by Traditional Chinese Medicine （TCM ） theory. Doctors and nurses in charge reported etiology ， pathogenesis ， nursing issues ， goals ， mea⁃sures and outcomes evaluation ， and discussed the key issues and existing problems observed dur⁃ing the integrated ward rounds. Integrated ward rounds provides best practice for improving treat⁃ment of nursing of patients with chronic renal failure.KEY WORDS ： Traditional Chinese Medicine theory ； chronic renal failure ； integrated medical and nursing ； nursing ward rounds ； nursing by syndrome differentiation 慢性肾衰竭是临床中老年人群较为常见的疾病类型［1］，是由于各种因素引起的进行性肾实质损伤，从而导致肾脏萎缩及长期水钠潴留、酸碱失衡等［2］，进而累及到全身各个系统，导致患者的记忆力降低、认知功能发生障碍以及脂代谢紊乱等，严重影响患者的生活质量［3］。