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Replacement therapy is becoming more and more popular in the usa.More than one third of 31000 who are being tested have used such therapy which includes yoga,meditation,herbal medicine,special dieary and even the pary. Experts explain that such therapy against the traditional way may bring the side effects sometimes.

2. 2.体温38.3°C,脉搏89次/分,呼吸18次/分,血压110/65mmHg。患者无明显疼痛,无


T 38.3°C, P 89/min, R 18/min, Bp 20/min.The patient had no significant pain or jaundice all over. Normal sound was heard on auscultation in heart and lungs. Flat abdomen was inspected and normal bowel sound was heard. Tenderness, muscular tension and rebound tenderness in right upper quadrant and right lower quadrant were palpated. There was no evident lump or abdominal external hernia. Limbs were as usual and normal digital examination of anus.

3. 1.替代治疗在美国变得越来越流行。在接受调查的31000人中,超过1/3的人用过替代


Alternative medicine —— including yoga,meditation,herbs(草药)and the Atkins diet (艾特金斯饮食法)and prayer —— appears to be growing in popularity in the United States.

More than a third of American adults used such practices ,according to the government survey of 31,000 people. Experts explain that such therapy which is turning away from conventional treatments may bring side effects sometimes.



The temperature was 38.3°C, the pulse 89 beats per minute, and the respiratory rate 18 breaths per minute. The blood pressure was 110/65 mm Hg.On physical examination, the patient did not appear to be in severe pain, and there was no jaundice. The lungs and heart sounds were normal. The abdomen was flat, and bowel sounds were present. There was tenderness in the right upper and right lower quadrants, with guarding and rebound tenderness. No mass or hernia was detected. The arms and legs were well perfused. No abnormalities were found on rectal examination.

4. 1.呼吸就是摄取氧气和排出二氧化碳。几乎所有生命体都必须施行这一功能以维持生命。


Breathing is the process of taking in oxygen and giving off carbon dioxide.Almost all the living things need to perform this function in order to keep alive.Human's breath is one type of respiration which is also called external respiration,while internal respiration or tissue respiration, another type of respiration, means gaseous interchange between blood and other tissues.


液的微粒。由于这样或那样的原因而未被吸入血流的食物残渣以粪便的形式从体内排出。Life depends on various materials for cytolergy obtained from the outside. All the materials

ingested from the external world,except oxygen, are taken into human body through alimentary system, where they are digested into microparticles small enough to enter the blood. Food debris

which isn't absorbed into the blood for one reason or another will be discharged as stool.



为预防心血管疾病的主要因素。Walking -- like swimming, bicycling and running -- is an

aerobic exercise which builds the capacity for energy output and physical endurance by increasing the supply of oxygen to skin and muscles. Walking at comfortable speed improves the efficiency of the cardio-respiratory system by stimulating the lungs and heart. Such exercise may be a primary factor in the prevention of heart and circulatory disease.




美国。两篇报告一致认为异种器官移植在伦理上是可行的,并审慎地建议应准予施行。Doctors in India have just announced that they have successfully transplanted a heart from a pig into a person. Pressure to increase the number of such xenotransplants(异种器官移植)seems to be growing. In Europe and America, herds of pigs are being specially bred and genetically engineered for organ donation. During 1996 at least two big reports on the subject -- one in Europe and one in America -- were published. They agreed that xenotransplants were permissible on ethical grounds and cautiously recommended that they be allowed.


Transplant surgeons work miracles. They take organs from one body and integrate them into another, granting the lucky recipient a longer, better life. Sadly, every year thousands of other people are less fortunate, dying while they wait for suitable organs to be found. The terrible constraint on organ transplantation is that every life extended depends on the death of someone young enough and healthy enough to have organs worth transplanting. Such donors are few. The waiting lists are long, and getting longer.

1. 解除器官供体少这种制约是每个器官移植医生的希望。迄今为止,制作人造器官的种种努力结果不尽人意,因为天地间万物很难仿造。于是,人们又对设法利用动物器官产生了兴趣,如把猪的心脏移植于人体已获得了成功.

2. 异种器官移植的伦理问题相对来说不用操心。人们为了食用和娱乐已经在杀猪了,看来



1. Freedom from this constraint of lack of enough donors is the dream of every transplant surgeon. So far, attempts to make artificial organs have been disappointing: nature is hard to mimic. Hence ,the renewed interest in trying to use organs from animals, such as transplanting a heart from a pig into a person, which has become a success.

2. The ethics of xenotransplantation are relatively unworrying. People already kill pigs both for food and for sport; killing them to save a human life seems, if anything, easier to justify. However, the science of xenotransplantation is much less straightforward

1. 30多年前,在当时美国的卫生局局长路德·L·特里博士发表他上任以来的第一份“有关吸烟与健康的报告”之前,已经有成千上万篇关于吸烟对人体健康影响的文章发表了。

2. 烟草公司对这些旨在表明吸烟和癌症以及其他疾病之间有关系的报告采取抵制的态度——予以否认,并提出分庭抗礼的研究报告。

3. 所以,在1964年,特里和他的吸烟与健康咨询委员会就明白了,在他们宣布“吸烟危害健康,在美国应引起人们足够的重视,有必要采取适当的补救措施”时,他们就踏人了一个争论的大坑中了。

[1]Before Dr. Luther L. Terry, then the Director of Medical Services of the United States, issued his office’s first "Report on Smoking and Health" more than 30 years ago, thousands of articles had already been written on the effects of tobacco use on the human body.

[2] Tobacco companies had countered the reports--which purposed to show links between smoking and cancer and other serious diseases--with denials and competing studies.

[3] So in 1964, Terry and his Advisory Committee on Smoking and Health knew they were stepping into a major pit of controversy when they announced "cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action".


中的大多数——116990人是死于肺癌。疾病防治中心认为,男性烟民死于肺癌的可能性是非吸烟者的22倍。女性烟民死于肺癌的可能性是非吸烟者的 12倍。






1 According to the Disease Control Center, smoking is the leading factor that causes 151,32

2 deaths of cancer patients. Those died of lung cancer account for 116990, making up the majority of the death. The Disease Control Center suggests that compared with nonsmokers, male smokers are 22 times more likely to die of lung cancer while the figure of female smokers is 12.

2 Statistical studies have long suggested that non-smokers live longer than smokers. Furthermore, scientists have found the links between smoking and incidence of lung cancer through statistical data since 1950s.

3 Earlier this year, Gerd ? Pfeiffer of Beckma n Research Institute clearly indicated the natural carcinogens in cigarette smoke through his study. People have found that the targets for carcinogens are some parts of a gene, which is very prominent in certain cancers.

4.In the magazine Science, Pfeiffer wrote that smoking can change p53 genes, which normally can prevent cancer but may enhance cancer when mutated.





1. Another study, published by the American Cancer Society, said that low-tar cigarettes offered no relief from the potential of cancer, and in fact were responsible for a type of cancer that reaches deeper into lung tissue.

2. Other cancers are also affected by cigarette smoke. An American Cancer Society researcher reported earlier this year that smoking increased men’s risk of dying of prostate cancer, while other studies have linked tobacco use to increased risk of other cancers, including throat, breast and bowel cancer.

3. Smoking also has been linked time and again to cardiovascular diseases. Among these, the biggest killer is heart disease: according to the CDC, smoking triples the risk of dying from heart disease among middle-aged men and women.

4. Studies also show an increased risk of death from stroke, aneurysms, high blood pressure, and other cardiovascular illnesses.




抽烟的怀孕女性会通过胎盘把尼古丁和一氧化碳传给胎儿。研究表明,这会妨碍胎儿获得发育所需要的氧气和营养物质,这可能对胎儿造成伤害,引起早产或胎儿体重不足。根据美国肺器官协会的说法,估计有20%至30%的体重不足的婴儿,多达14%的早产以及约 10%的婴儿死亡都是由于女性在孕期吸烟引起的。吸烟的母亲还有可能通过喂母乳把尼古丁传给婴儿。

1. A report recently published in the American Journal of Epidemiology suggested that smoking increased the risk of developing non-insulin-dependent diabetes mellitus (NIDDM) by more than three times.

2. Studies have pointed to smoking as a risk in vision loss among older people,

mental impairment later in life, Alzheimer’s disea se and other forms of dementia.

3. Pregnant women who smoke can pass nicotine and carbon monoxide to their baby through the placenta. Research indicates this can prevent the baby from getting the oxygen and nutrients it needs to grow--potentially leading to fetal injury, premature birth, or low birth weight. According to the American Lung Association, smoking during pregnancy accounts for an estimated 20 to 30 percent of low birthweight babies, up to 14 percent of premature deliveries, and about 10 percent of all infant deaths.Smoking mothers may also pass nicotine to their babies by breastfeeding

1. 研究不光指出了吸烟给烟民自己造成的危害,还指出了非吸烟者显然也会受到他们吸烟的朋友、家人或在他们面前吸烟的陌生人的伤害。

2. 持续不断的报告通过统计数字证明,即使你从来就没有吸过烟,也有患癌症或心脏病的危险。

3. 去年秋季,美国心脏协会发表丁一份历时7年的研究报告,该报告指出,烟民的配偶虽然从不吸烟,但是和那些与非吸烟者生活的配偶相比,他们死于冠心病的危险要高出20%。这项调查进一步推动了在工作场所和公共场所禁烟活动的开展

1. The studies didn’t just point to the ill effects of smoking on those who smoke--non-smokers, too, are apparently affected by the smoke from their friends, family members and strangers who light up in their presence.

2. A steady stream of reports documented the statistical risks of contracting cancer or suffering from heart disease, even if you’ve never put a cigarette to your lips.

3. The American Heart Association last fall released a seven-year study showing that never-smoking spouses of smokers have more than a 20 percent greater chance of death from coronary heart disease than those who have never smoked who live with non-smokers. That study gave more impetus to the drive to make workplaces and other public areas smoke-free.

1 调查还表明,烟民的孩子也深受吸烟之害。今年年初,比利时布鲁塞尔圣·卢卡大学医院的克劳德·哈内特博士说,吸烟的母亲生下的孩于"应被看作是有吸烟史的人"。

2. 哈内特的研究提请人们注意:年龄越小,吸烟的危害越大。

3. 《英国癌症杂志》发表的一份英格兰伯明翰大学的报告显示,吸烟的父亲与其孩子患癌症比率的增加可能有联系;同时美国的研究则显示吸烟和脱氧核糖核酸受损可能有关系。1. The effects of smoking are hard on the children of smokers as well, the studies say. Dr. Claude Hanet of the St. Luc University Hospital in Brussels, Belgium, said earlier this year that a baby born to a smoking mother "should be considered an ex-smoker",

2. Hanet’s study cautioned that cigarette smoke was more d etrimental with decreasing age.

3. And a University of Birmingham, England, study, published in the British Journal of Cancer showed a possible link between fathers who smoked and an increased incidence of cancers in their children, while studies in the U.S. showed a possible link between smoking and DNA damage.

Since it has proven a double-edged sword for inhibiting a protein kinase, to identify a protein kinase inhibition as a therapeutic target with fewer off-target side effects, more potency and fewer toxicity is very important. The selective inhibition of a protein kinase or protein kinases associated with a specific disease, without affecting protein kinases involved in normal physiology, remains an important goal in the design and use of protein kinase inhibitors as drugs. Off-target side effects of protein kinase inhibitors have diverted efforts from targeting the ATP-binding pocket in order to produce inhibitors that have the potential to be more kinase specific. The requirement for selective phosphorylation of specific protein substrates by each kinase suggests that rational substrate-based design might be a promising alternative approach for the development of kinase inhibitors available for cardiovascular diseases and protein kinase inhibitors should increase the pharmacopeia. It is probably that the next several years of cardiovascular research will feature a great number of clinicaltrials using inhibitors of protein kinase signaling pathways to treat many CVDs.

已经证实,抑制蛋白激酶是一个双刃剑,为了证明蛋白激酶抑制剂作为一个治疗的靶点有更少的靶外的副作用,更多的潜在作用及更少的毒性是非常重要的。选择性的蛋白激酶受体或蛋白激酶相关的特异性疾病,没有受影响蛋白激酶产生普通的生理作用:) ,使用蛋白激酶作为药物是个重要的目标及设计所在。蛋白激酶抑制剂靶外的副作用已经被转向用作为来自atp结合袋,为了产生抑制剂,并能够有潜在的更特异的激酶。对于通过每一个激酶的选择性的特异性的蛋白底物的磷酸化作用的需求,暗示合理的底物设计也许是一个有希望的选择,可选择的蛋白酶抑制剂不仅提供的对心血管疾病的作用,并且蛋白酶抑制剂能丰富处方。很可能未来几年的心血管研究将使用蛋白酶抑制剂信号通路对于治疗CVD作为一个特点。

1 . 在所有和吸烟有关的疾病中,也许人们最容易忽略的就是吸烟上瘾。然而,去年8月,克林顿总统宣布尼古丁为使人上瘾的麻醉药物。今年(指 2000--编者注)3月,生产切斯特菲尔德和云雀牌香烟的利格特集团承认吸烟使人上瘾并会引发癌症,并且同意向22个州支付总额为7.5亿美元的赔偿金,这22个州提起了诉讼,要求烟草公司向治疗与吸烟有关的疾病的医疗补助制度进行赔偿。

2. 马萨诸塞州首席检察官、全美首席检察官协会会长斯哥特·哈什伯杰对记者说,对利格特集团的处理"将带来这样一个信息,那就是,大烟草公司充分意识到了他们出售的产品会使人上瘾,他们出售的产品对大众的健康影响极大"。

3. 很显然,其他烟草公司中没有一家对利格特集团的处理感兴趣。对他们来说,尼古丁仍然是他们所称的无害的提味剂。

1. Of all the diseases associated with smoking, addiction is perhaps the one that receives the least attention. But President Clinton declared nicotine an addictive drug last August. In March, the Liggett Group, makers of Chesterfield and Lark brand cigarettes, admitted that cigarettes were addictive and cause cancer and agreed to pay about $750 million total to 22 states that had filed suit to force tobacco companies to pay for Medicaid for smoking-related illnesses.

2. Scott Harshbarger, the Massachusetts attorney general and president of the National Association of Attorneys General, told reporters that the Liggett deal "will produce information that indicates major tobacco companies were fully aware that the product they were selling is addictive, that the product they were selling had great impact on public health".

3.Other tobacco companies are clearly none too keen on the Liggett deal. For them,

nicotine remains what they call a harmless flavor enhancement.

1. 这并未阻止一些研究人员发扬这种具有挑战性的学说——很多酒精和药物成瘾的人受到被称为奖励缺乏症的先天性疾病的折磨。

2. 由于目前在治疗早老性痴呆病上还没有什么好办法,因此,研究人员的注意力集中于试图使这种病侵蚀大脑的速度放慢,推迟其开始发作的时间。

3. 人口增长的主要原因与其说是由于出生率上升的缘故,倒不如说是由于医疗条件的改善而导致死亡率下降的缘故。

1. This has not stopped some researchers from promoting the provocative theory that many people who become alcoholics and drug addicts suffer from an inherited condition dubbed the reward-deficiency syndrome.

2. With no cure for Alzheimer’s disease in sight, researchers have concentrated on trying to slow the rate at which it corrodes the brain and to postpone its onset.

3. The chief reason for the population growth isn’t so much a rise in birth rates as a fall in death rates as a result of improvements in medical care.

1. 神经系统症状是大多数正常人每天都能体验到的一些情况。像口误(slips of the tongue)、头痛、背痛和其他疼痛、头晕、肌肉抽搐或抽动、痉挛性震颤等,都是完全健康




2. 很多老人都在关心自己或其配偶是否已有或正在发生Alzheimer病(早老性痴呆)和中风;面老人几乎都有的震颤,则会带来Parkinson病的忧虑。很多年龄较轻的病人关心自己



1. The symptoms of nervous system diseases are a part of everyday experience for most normal people. Slips of the tongue, headaches, backache and other pains, dizziness, muscle convulsions or twitches , and spastic tremors all occur in totally healthy persons. Mood swings with feelings of elation and depression, paranoia, and displays of temper are equally a part of the behavior of completely normal people. The rapid increase in information about neurologic diseases coupled with the intense interest of people in all walks of life in medical matters has focused public attention on both common and rare neurologic conditions.

2. Most older people are concerned that they or their spouse have or are developing Alzheimer's disease(dementia praesenilis) or stroke or both. The almost ubiquitous tremor of the elderly prompts concern about Parkinson's disease. Many younger patients are concerned about multiple sclerosis or brain tumor, and few normal people lack one or more symptoms suggesting the diagnosis of a serious neurologic disease. For most of these and other common diagnoses, imaging and other tests are typically normal when symptoms first appear and should not be obtained to reassure the patient or physician.






积极追查和冶疗,但是很难使无症状病人得到改善的一般性规律,是应该记住的。Moreover, the availability of neurodiagnostic imaging and electrophysiologic, biochemical, and genetic testing has detected "abnormalities" in many young and most elderly persons. In evaluating a patient's symptoms, it is imperative that a clinical diagnosis be reached without reference to a neurodiagnostic laboratory finding. Patients with disorders such as headache, anxiety, or depression usually do not have abnormal laboratory studies. Abnormalities that are noted on various neurodiagnostic studies are often incidental findings whose treatment may be justified and necessary but will not improve the patient's symptoms. Abnormalities detected incidentally that do not have signs or symptoms may, as for disorders such as hypertension, require aggressive evaluation and treatment, but in general, the adage that it is difficult to improve the asymptomatic patient should be kept in mind.


The neurologic history is the most important component of neurologic diagnosis. A careful history frequently determines the cause and allows one to begin localizing the lesion(s), aiding in the determination whether the disease is diffuse or focal. Symptoms of acute onset suggest a vascular cause or seizure; symptoms that are subacute in onset indicate a mass lesion such as a tumor or abscess; symptoms that have a waxing and waning course with exacerbations and remissions suggest a demyelinating cause; symptoms that are chronic and progressive suggest a degenerative disorder


Listen carefully to the patient for as long as it is necessary. A good rule of thumb is to listen initially for at least 5 minutes without interrupting the patient. The patient often volunteers the most important information at the start of the history. During this time, the examiner can also assess mental status, including speech, language, state of knowledge, and affection, and observe the patient for facial asymmetry, abnormalities of ocular movements, and an increase or a paucity of spontaneous movements as seen with movement disorders


Patients with dementia or altered mental status are usually unable to provide exact details of the history, and a family member may provide key details needed to make an accurate diagnosis. This is especially true for patients with dementia and certain right hemispheric lesions with various agnosias that may interfere with their ability to provide a cogent history. Surrogate historians also provide missing historical details for patients with episodic loss of consciousness, such as syncope and epilepsy


Summarizing the history is an effective way to ensure that all details were covered sufficiently to make a tentative diagnosis. Summarizing will also allow the physician to fill in historical gaps that may not have been apparent when the history was initially taken. In addition, the patient or surrogate may correct any historical misinformation at this time.

1. 据美国医学协会说,我们大多数人的体重随着年龄的增长而增加――25岁之后平均每年增加一磅(相当于 0.454公斤)。而且,所增加的重量成分很可能主要是脂肪组织,而不是精瘦的肌肉。

2. 随着年龄的增长,我们大多数人变得不太爱动,而身体的基础代谢率也逐年有所减慢。这样,我们对食物能量的需求,即为维持体重而需要的卡路里数量也减少了。比如,人在20岁时每天可能需要消耗2500卡热量,35岁时为2000卡,到50岁时则只需要1800卡了。

1. For most of us, body weight goes up with age —an average of one pound (0.454kg)

a year after 25, according to the American Medical Association. What’s more, added weight is likely to be composed primarily of fat tissue, not lean muscle .

2. As we age, most of us become less active, and the body’s basal metabolism rate slows a little each year. So our food-energy requirements —the number of calories needed to maintain weight-decrease.. For example, a man might require 2,500 calories a day at age 20, 2, 000 at 35 and only 1,800 at 50.





年纪大了,锻炼起来觉得比以往吃力。我们的肌肉可能早在20岁时就开始丧失力量和弹性。到了40岁,心肺的机能已经开始降低,关节和韧带不太灵活,身体变得比较容易受伤。1. Starting in our 20s, the proportion of muscle mass to body fat tends to decline. The body of an average 20-year-old woman is 26.5 percent fat. By 35, it is 33 percent; at 50, a disheartening 42 percent

2. .Exercising becomes harder with age. Our muscle can begin to lose strength and elasticity as early as age20. By 40, heart and lung power has begun to drop, joints and ligaments to stiffen, and the body becomes more injury — prone.





1. Now for the good news, every one of these changes can be significantly arrested, slowed, or even reversed through exercise, according to the National Institute on Aging. Add the right dietary habits, and you can look and feel still younger and slimmer than your actual years.

2. The No.1 fat fighter is exercise. Being active obviously burns calories —200 or more an hour during brisk walking, for instance. But exercise also revs up the metabolic rate.

1. 上了岁数以后,我们的体重出现了两方面的问题。一方面,我们需要的热量较少,极容易把任何过剩的卡路里储存起来;另一方面,我们的机体消化食物和吸收营养的效能会变得不如以前。因此,一个45岁的人的食量可以同一个比他年轻20岁的人的食量相等。可是,尽管他体重增加了,营养状况却反而较差.

2. 解决的办法是选用高营养饮食。我们大多数人应当少吃脂肪(不超过卡路里摄入量的30%),少吃蛋白质(10%-15%),多吃复合碳水化合物(45%-60%)。

1. As we grow older, our weight problem becomes double —edged. On the one hand, we need fewer calories and find it incredibly easy to hoard any excess. On the other, our bodies can become less efficient at processing foods and absorbing their nutrients. Consequently, a 45-year-old person would eat the same amount of food as one 20 years younger, yet put on more weight and be less well-nourished.

2. The solution: a nutrient-dense diet. Most of us should be eating less fat (not more than 30 percent of calorie intake), less protein (10 to 15 percent) and more complex carbohydrates (45 to 60 percent).

1. 碳水化合物还是纤维素的一种优良来源。而纤维素有助于加快食物通过消化道的速度,减少热量的吸收,并一路带走脂肪,因此被吸收的脂肪就少了。

2. 多项研究报告还表明,你的体重减得越快,原来的体重很可能恢复得越快。根据动物研究得出的结论,反复实行急剧减肥甚至会降低以后节制饮食的效果。为了避免这样的失误,不可企求每周减肥超过1磅或2磅。

1. Carbohydrates are also an excellent source of fiber, which helps speed food through the digestive system, reducing calorie absorption and picking up fats on the way, so that less fat is absorbed.

?2. Studies also shows that the more quickly you drop weight, the more quickly the pounds are apt to return. Repeated crash dieting can even make future dieting less effective, according to animal-research findings.To avoid such pitfalls, don’t try to lose more than one or two pounds a week.


? 2.不要不吃早餐(但要使早餐少含胆固醇而且有益于健康),要不然你在中午或晚上就有可能吃得过多,而且你会感到精力不足

? 4.最后一餐要吃得少。晚上我们往往不怎么活动,因此热量的消耗也少一些。

1. Eat several small meals a day — as many as six. Studies show that frequent nibblers weigh less than three-meal-a-day eaters.

2. Don’t skip breakfast (but make it a healthful, low-cholesterol one ). Otherwise, you’re more likely to overeat later in the day; and you’ll have less energy.

3. Make the last meal of the day a small one. In the evening we tend to be least active, and therefore burn fewer calories.




1. A variety of foods is important for good health, but limit the choice of foods at any one sitting.

2. Eat slowly. Include soup of other time-consuming foods in meals. Eat artichokes, for instance, instead of creamed corn; apples instead of applesauce;

hard rolls instead of white bread.

3. Eat less than you want . Then wait 20 minutes, the time it takes the brain to register satiety signals. You may no longer be hungry


It is estimated that there are nearly 50 million hypertensives in the USA (systolic BP >= 140 mm Hg and/or diastolic >= 90 mm Hg, or taking antihypertensive medication). For unknown reasons, the prevalence of hypertension seems to be decreasing in the USA. Hypertension occurs more often in black adults (32%) than in white (23%) or Mexican American (23%) adults, and morbidity and mortality are greater in blacks. Diastolic BP increases with age until age 55 or 60.


Insomnia is more than just being unable to fall asleep. It is a subjective condition of insufficient or nonrestorative sleep despite an adequate opportunity to sleep. The American Institute of Medicine and most current studies place the prevalence of insomnia at 30% to 40% in the general adult population. Although the need for sleep does not necessarily decrease with age, the incidence of sleep disturbances appears to increase with age, particularly among women. Actually, the elderly are more prone to sleep maintenance problems, whereas younger people tend to have trouble falling asleep.

1. 失眠是某种潜在疾病的一种症状,失眠本身并不是一种病质。睡眠和觉醒是众多复杂因素相互作用的结果,如人体内生物钟、脑干网状激活系统及其他各种可以影响正常睡眠周期的因素,如灯光、焦虑等。诊断时应该认清各种因素的影响力,并根据病史及其他特殊检查确定失眠原因。

2. 与失眠相关的最严重的潜在问题是阻塞性睡眠呼吸暂停。如不治疗,会并发血氧饱和度下降、高碳酸血症和呼吸减慢,从而导致严重的心血管疾病(如系统性和肺动脉高压、肺心病和右心室衰竭)。

1. Insomnia represents a symptom of an underlying problem and is not in itself

a disease entity. Sleep and alertness are regulated by a complex interaction between the body's internal biologic clocks, the reticular activating system, and various

influences such as light or anxiety that can interfere with the normal sleep cycles. The approach to diagnosis should recognize the potential for various causes and use history and special studies to determine the cause of the insomnia.

2. Potentially, the most serious problem associated with insomnia is related to obstructive sleep apnea. If left untreated, it is associated with oxygen desaturation, hypercapnia, and hypopnea, which can lead to significant cardiovascular problems (e.g., systemic and pulmonary hyper tension, cor pulmonale, and right ventricular failure).

1. 服用咖啡因或其他兴奋剂,特别是含有麻黄碱或盐酸基丙醇胺的非处方药会影响睡眠。晚间锻炼也有兴奋作用。酒精有助入睡,但干扰快速眼球运动睡眠相,导致早醒和睡后精力未恢复。

2. 情感变化、悲伤、无助和营养机能变化引发的一些体征,如体重减轻,可提示抑郁症,它是最常见的失眠相关精神病。如果失眠持续数周,其诊断就更确凿无疑。焦虑症导致入睡困难,抑郁症病人则容易入睡,也易早醒。

1. Use of caffeine or other stimulants, especially over-the-counter medications that may contain ephedrine or phenylpropanolamine could affect sleep. Late evening exercise can also be a stimulant. Alcohol may help induce sleep, but it interferes with REM sleep and leads to nonrestorative sleep and early awakenings

2. Affect changes, sadness, hopelessness, and vegetative signs such as weight loss should suggest depression, the most common psychiatric disorder associated with insomnia .This is especially true if the insomnia persists for weeks. Anxiety disorders cause difficulty with getting to sleep, whereas patients with depression may fall asleep more readily but have early awakening



1. The diagnosis of unexplained insomnia may involve testing in a sleep laboratory using polysomnography. This provides the opportunity to monitor such parameters as the electroencephalogram (EEG),'breathing, oxygen saturation, and body movements during sleep. Polysomnography can determine the disturbances in chronobiologic rhythms and loss of normal sleep-awake patterns associated with circadian rhythm disorders.

2. The key to diagnosing insomnia and other sleep disorders is history and sleep

laboratory monitoring. Short-term problems related to difficulty with initiating sleep may be situational or environmental. Long-term problems with sleep_, lasting weeks to months, may be more psychophysiologic such as with chronic anxiety or depression.

1. 康复医学:集理疗、工疗、言语治疗、心理咨询和社会工作为一体,旨在帮助病人维持和恢复体能的医学。

2. 康复治疗可以在急诊保健医院进行,但那里鲜有系列性康复治疗方案。康复医院通常可以提供最广泛、深入的保健服务,有潜力、能参与剧烈项目的病人(如能耐受每天3小时及以上治疗的病人)可考虑进行康复医院治疗。许多疗养院都有康复项目(一般为每天1小时,每周不超过5天),因此更适合那些只需要一般性康复治疗的病人(如体弱或老年病人)。一些种类较少、次数不多的康复项目也可以在门诊或病人家中进行,很多病人适合这种方式。

1. Rehabilitation: A combination of physical, occupational, and speech therapy; psychologic counseling and social work,directs toward helping patients maintain or recover physical capacities

2. Rehabilitation may begin in an acute care hospital, but organized rehabilitation programs rarely exist there. Rehabilitation hospitals usually provide the most extensive and intensive care and should be considered for patients who have the most potential and who can participate in aggressive intervention (eg, patients must be able to tolerate therapy for >= 3 h/day). Many nursing homes have programs that are less intensive (generally 1 h/day, < 5 days/wk) and, thus, are better suited to those who need more gentle rehabilitation (eg, frail or elderly patients). Rehabilitation programs with less variety and frequency of services may be offered in outpatient settings or at home and are appropriate for many patients 1. 晕厥是一种令人担忧的常见病,占急诊病例的3%,住院病例中可达6%。虽然晕厥的病因可能危及生命(如室性心动过速),并会产生严重后果(如髋部骨折),但说得清楚的晕厥却不到一半。晕厥的复发率大约为20%每年,初发率则为2%。

2. 晕厥是暂时性意识丧失并跌倒,它是因为血流减少或神经损伤而造成一过性大脑功能失调而引起的。根据诱发机制,晕厥可以分为几类。从诱因看,最常见的有血管迷走神经性(占18%)、心率不齐性(14%)、神经性(10%)、直立性低血压性(8%)和环境因素引起的晕厥(5%)。1. Syncope is a common and concerning medical problem, which accounts for 3% of emergency room visits and up to 6% of hospital admissions. Although the cause of syncope can be life-threatening (e.g., ventricular tachycardia) and the result can be devastating (e.g., fractured hip), a definitive explanation for syncope is found less than one half of the time. Syncope recurrence is approximately 20% per year compared with an incidence of 2% for an initial episode of syncope.

2. Syncope is a brief loss of consciousness with collapse resulting from transient

brain dysfunction based on decreased blood flow or neurologic insult. Syncope can be categorized based on the causative mechanism .The most common causes are vasovagal (18%), arrhythmia (14%), neurologic (10%), orthostatic hypotension (8%), and situational (5%).

1. 诊断晕厥的关键是病史、体格检查和ECG,诊断率可达45%。病史和体检的重点是心脏、神经和药物相关问题。定向检查可使诊断效率提高5%,进一步区分年龄和有无器质性心脏病有助于突出评价和治疗。

2. 虽然多数晕厥患者可在门诊部检查,但对器质性心脏病、胸痛、有或疑有心律失常患者、或神经学症状体征提示有暂短性心肌局部缺血和中风发生,建议住院检查。器质性心脏病严重程度是死亡率的决定因素,应指导检查并治疗。尽管有广泛的评估检查,但仍有40%的复发性晕厥患者会漏诊,幸运的是,这些病人的死亡率和发病率都很低。

1. The keys to the diagnosis of syncope are the history, physical examination, and ECG, yielding a diagnosis 45% of the time. The history and physical should focus on cardiac, neurologic, and medication-related issues. Directed testing can add 5% to diagnosis. Further classification by age and presence of organic heart disease can help focus evaluation and treatment.

2. Although most syncope patients can be evaluated in the outpatient setting, hospitalization is recommended for those with organic heart disease, chest pain, a history or suspicion of arrhythmia, or presence of neurologic symptoms or signs suggesting transient ischemic attack or stroke. The extent of severity of the organic heart disease is the key determinant of mortality and should direct evaluation and therapy.

1. 电生理检查是一种有创心脏监测与心律失常诱发手段,对器质性心脏病或ECG异常患者进行检查时,其诊断率为50%(无器质性心脏病患者的诊断率为10%)。它是心律失常诊断的金标准。只是价格贵,且是有创性的。对射血分数小于40%及束支传导阻滞或房性纤颤的阳性检查效果最好。

2. 在排除心律失常或器质性心脏病并怀疑有神经心源性晕厥时,就需要进行倾斜试验,以对不明原因复发性晕厥作出诊断。此项检查的敏感性为67%~83%,特异性是90%。

1. Electrophysiologic studies is an invasive method of cardiac monitoring and arrhythmia induction procedure,which gives a 50% diagnostic yield for those with organic heart disease or abnormal ECG (compared with 10% if no organic heart disease). This is considered the gold standard for arrhythmia diagnosis but it is expensive and invasive. Powerful predictors of a positive test are an ejection fraction less than 40%, bundle branch block, or atrial fibrillation.

2. Tilt table testing is indicated for unexplained, recurrent syncope when arrhythmia or organic heart disease is excluded and neurocardiogenic syncope is

suspected. In this setting, the sensitivity is 67% to 83% and specificity is 90% 1. 查房前的充分准备对向患者提供高效和高质量的诊治非常重要!准备工作不充分不仅延



2. 工具对检查极其重要。任何一个医生在开始查房时至少要有听诊器和笔式电筒,也许他




1. Adequate preparation for patient rounds is essential for efficient, quality patient care. Poor preparation not only prolongs patient rounds, but worse it may delay “timely” decisions concerning the patient

treatment, and even delay recovery and discharge. Ultimately it may compromise the quality of medical care and ominously even result in premature death!

2. “Tools” are extremely necessary to perform a proper physical exam. No physician should ever begin rounds without a stethoscope and penlight in his coat pocket. Although he may not always carry a tongue blade, chopsticks or a teaspoon could be substituted for the oropharyngeal exam. Inspection of the oral mucosa may faciltate diagnosis of such diseases as pharyngitis, tonsillitis, mucositis, oral candidiasis or oral ulcerations, each of which may present clues to such diseases as SLE, HIV infection, herpes simplex, leukemia, megaloblastic anemia, or Behcet’s disease.

1. 查房时,住院医生必须将护理记录拿到床边,这样有利于查房小组很容易地了解患者有



2. 最后需要强调的是,医生的着装必须符合职业的特点。白大褂是医生的校准职业装,但医生常常忽略衣服所沾上的血迹、钢笔水、小便甚至大便。穿着这样的衣服工作不仅使病



1. During patient rounds the resident should bring the nursing record to the bedside where the team can readily review pertinent patient data such as vital signs, fluid volume intake and urine output during the previous 24 hrs. The current medication list and the nurse's notes that may report frequent changes in the patient’s condition must also be reviewed. Often several medications may be discontinued or switched to the oral route.

2. Finally, the physician’s attire and clothing must bear a professional

appe arance. Usually white coats are the standard physician’s attire. However, frequently physicians neglect to change their coat when it becomes “soiled” with blood, ink, urine or even fecal matter. This not only presents an unpleasant appearance to the patient, but also poses a risk of transmitting infection. An identification badge that identifies the physician’s name and level of training (attending, fellow, resident) must be clearly visible to the patient. This is important not only to identify the physician, but also for security reasons 1. 总之,查房前准备充分对实施有效、有序和富有成果的病人护理是至关重要的。它不仅有助于促进医疗工作,而且会增强患者对于医务人员的信任。相反,查房准备不足导致患者信息的遗漏,损害患者的治疗及安全。

2. 有出汗副作用的新药常常是盗汗的魁首。病人可能需要停药及给予一段药物清除时间。盗汗也可能是某种疾病发展的早期症状,因此观察等待是有用的。应指导病人留意体重变化、发烧及睡眠和情绪变化。病人可填写一份症状日志,它对临床医师确定是否作进一步检查很有帮助。

1. In summary, adequate preparation for patient rounds is essential for efficient, organized and productive patient care. It not only facilitates efficient care, but also will engender patient confidence and trust in the physician team. Furthermore, poor preparation for patient rounds often leads to the omission of pertinent patient information and thus compromises the quality and safety of patient care.

2. A new medication, with perspiration as a side effect, is the culprit. Patients may need cessation of the medication as well as a washout period. Night sweats might be an early symptom of a developing illness so watchful waiting is useful. Patients need to be instructed to watch for weight changes, fevers, and sleep and mood changes. Patients can complete a symptom diary, which is very helpful to the clinician in determining the need for additional evaluation.

1. 很多情况下护理记录常常会被忽略。而护理记录可给医生提供过去24小时内病人的病情变化,其中应特别记录生命体征包括血压、脉搏、体温和呼吸。

2. 由于护士在病人床边的时间比医生更长,所以她们对病人的观察和记录具有非常重要的价值,不应被忽视。应该尊重并礼貌地和护士相处,因为她们也是医疗小组中不可缺少的一员,常能在医疗服务中提供重要的信息和帮助。

1. All too often a review of the nurses’ notes is neglected. Such information allows the clinician to follow patient progress during the previous 24 hrs. period. Particular note should be made of the vital signs; blood pressure, pulse, body temperature and respirations.

2. Since the nurse spends much more time at the patient's bedside than the physician, her monitoring and report of the patient's condition is extremely valuable and should