virtually是什么意思tually在线翻译读音

navigational是什么意思igational在线翻译读音-早稻田大学世界排名

2023年4月19日发(作者：雅思托福换算)Chapter 1 第一段
The patient-physician interaction proceeds through many pases of clinical reasoning
and decision making . The interaction begins with an elucidation of complaints or concerns ,
followed by inquiries or physical examination , ordering of diagnostic tests , integration of
clinical findings with the test results , understanding of the risks and benefits of the possible
courses of action , and careful consultation with the patient and family to develop future
plans . Physicians increasingly can call on a growing literature of evidence-based medicine to
guide the process so that benefit is maximized , while respecting individual variations among
different patients.
医患沟通贯穿于临床推论和临床决策的各个阶段.医患沟通始于主诉的阐述或关心
的表达,并以越来越精确的方式,通过学问或评估得以继续,这一过程通常需要仔细的病史
(采集)和体格检查,安排诊断性实验,并使实验结果与临床发现一体化,以及对可能所采取
行动的风险和好处的理解，与病人及其家庭之间细致的商讨以产生将来的计划。医生越
来越（趋于）访问日益增多的循证医学文献去指导这个过程，以使取得最大的收益，同
时对于不同的病人充分考虑个体的不同变化。

Chapter 8 第四段
Fourth , cognitive impairment increases in prominence as people age. Cognitive
impairment is a risk factor for a wide range of adverse outcomes ,including falls ,
immobilization , dependency , institutionalization , and mortality . Cognitive impairment
complicates diagosis and requires additional care giving to ensure safety .

Chapter 21 第六段
A new device for visualizing the entire gastrointestinal mucosa consists of a small
camera in an ingestable capsule that transmits images to receivers attached to the patient~s
abdomen diagnostic yield of capsule enteroscopy is not yet clear,but this approach may
potentially visualize segments of the small bowel that were previously inaccessible . No
therapeutic maneuvers are possible with the device.

Chapter 22 第二段
An increased drive to ventilate may also cause dyspnea . Such stimuli include
hypoxia , usually when arterial oxygen tensions are less than 60 mm Hg , and stimuli from
inflamed lung parenchyma , as occur in bacterial pneumonia or alveolitis and that drive the
respiratory centers of the brain . These stimuli often lower the resting carbon dioxide pressure
(Pco2) to less than the normal level of 40mm Hg and cause dyspnea , especially on mild
exertion.
过度通气也可以导致呼吸困难。兴奋呼吸中枢的刺激因素有动脉氧分压低于
60mmHg时的低氧以及细菌性肺炎或肺泡炎时肺实质产生的炎性产物。这些刺激因素常
常使静息时的二氧化碳分压降至40mmHg的正常水平以下而导致呼吸困难，在轻微活动
时更加明显。

Chapter 23 第三段
After several years,most diabetic patients exhibit diffuse glomerulosclerosis,although a
minority have pathognomonic Kimmelsteil-Wilson nodular gh pathologic
changes continue to mount throughout the disease,glomerulosclerosis extensive enough to
cause ESRD develops in a minority of patients;in these cases,overt albuminuria (>300mg/day)
begins approximately 15 years after after,following a variable perod on the
order of 3 to 5 years, the GFR begins a relentless decline(>=10ml/min/year),which is
erentually reflected by an increase in serum creatinine. The appearance of massive proteinuria
and often heralds progression to the seratinine rises (reflecting an approximately
50% decline in GFR),ESRD develops in most patients within course is highly
variable,however,particularly in type 2 diabetics,who may exhibit moderate proteinuria for
several years without a substantial deterioration of renal e but useful method
of monitoring progression to renal failure is to plot the reciprocal of the serum creatinine as a
function of technique allows better asses淮阴侯韩信者 sment of both therapeutic interventions and
the time when renal replacement therapy will become necessary.
几年以后，大多数糖尿病患者出现弥漫性肾小球硬化症，而少数患者出现特异性
K-W结节损害。尽管病变进展持续贯穿疾病始终，少数患者肾小球硬化广泛足以引起
ESRD的发展，在这些情况下，糖尿病肾病诊断后15年患者开始出现明显的白蛋白尿
（大于等于300mg/天）。不久，大约3到5年的可逆期过后，肾小球滤过率开始不停下
降（大于等于10ml/分钟/年），最终表现为血清肌酐的上升，在这种情况下，通常大量
蛋白尿和肾病综合症开始出现，并宣告肾病已经进入到ＥＳＲＤ．一旦血清肌酐上升（反
映肾小球滤过率大约降低５０％），大部分患者在１０年内发展成为ＥＳＲＤ．这个过
程是极具可变性的，然而，尤其在２型糖尿病患者，他们可能表现为持续好几年的中等
量蛋白尿而肾功能不恶化．一个简单但有用的监测肾功能衰竭进展的方法是绘制血清肌
酐倒数

Chapter 25 第四段
Clinical and Pathologic Evaluation
Since all patients with cancer of unknown primary site have advanced disease ,therapeutic
nihilism has been ns subsets of patients with widely diverse prognoses ;some
cancers are highly responsive t中国四大鬼节 o treatment,and some patients may have a substantial chance of
achieving long-term survival with appropriate initial clinical and pathologic
evaluation should therefore focus on identifying a primary site when possible and on
identifying patients for whom specific theatment is indicated.
临床和病理评估．由于所有原发灶不明肿瘤患者都会到疾病晚期，姑息治疗就变得
很普遍．然而，现在很显然的是这些特殊病人有很多不同的结局．有些癌症对治疗高度
敏感，这使得有些病人通过适当治疗可能存活很长时间．因此最初的临床和病理评估应
该集中于在可能的情况下识别原发灶以及识别那些需要特殊治疗的病人．

Chapter 26 第二段
In the management of the pregnant trauma patient,the critical point is that resuscitation of the
fetus is accomplished by resuscitation of the ore the initial evaluation and
treatment of the pregnant injured patient is identical to that of the nonpregnant injured
assessment of the maternal airway,breathing,and circulation and ensuring an
adequate airway avoids maternal and fetal the later stages of pregnancy,as already
described,uterine compression of the vena cava may result in hypotension from diminished
venous return,so the pregnant trauma patient should be placed in left lateral decubitus
spinal cord injury is suspected the patient may be secured to a backboard with
pregnancy has important implications in the trauma of blood loss such as
tachycardia and hypotension may be delayed until the patient loses nearly 30% of her blood
a result, the fetus may be experiencing hypoperfusion fluid resuscitation should be
administered even in the pregnant patient who is normotensive.
在处理孕期创伤病人时，关键点是胎儿的复苏能够通过母亲的复苏来实现．因此，
孕期创伤病人最初的评估和治疗跟非孕期受伤病人是一样的．对孕妇气道、呼吸和循环
的快速评估并确保足够的通气能够避免母婴低氧血症。在妊娠晚期，如被描述的那样，
子宫压迫腔静脉使静脉回流减少可导致低血压，所以孕期创伤病人应该置于左侧卧位。
如果怀疑脊髓受损，那么应该把病人固定在脊骨矫正板上后再向左侧倾斜。妊娠期血容
量增加在外伤病人中是一个重要暗示。失血体征比如心动过速和低血压直到病人失血量
达到全血的30%才会出现。这样一来，胎儿可能在母亲出现任何征象之前很久就已经处
于低灌注状态了，补液复苏甚至在血压正常的妊娠病人中也应尽早和尽快地执行。

Chapter 28 第一段

Postoperative surgical complications represent one of the most frustrating and difficult
occurrences experienced by surgeons who do a significant volume of less of
how technically gifted,bright,and capable a surgeon is,surgical complications are a virtually
guaranteed aspect of cost of surgical complications in the United States today runs
into millions of dollars and is associated with lost work productivity,disruption of normal
family life,and unanticipated stress to employers and society in ntly,the
functional results of the operation are compromised by complications;in some cases,the
patient never recovers to the preoperative level of most significant and difficult
part of complications is the suffering borne by the patient who enters the hospital anticipating
an uneventful operation but is left suffering and compromised by the complication.
第一句。。。。无论一个外科医生如何有天赋、如何聪明、如何有能力，在其生涯中
外科并发症其实是不可避免的一个方面，在美国外科并发症所引起的费用已达到数以百
万计，并引起劳动生产力的损失，扰乱正常的家庭生活，对雇主和社会带来预想不到的
压力。由于手术并发症，手术后功能恢复大打折扣，有些病例其功能永远不能恢复到术
前水平。（发生）并发症的最重要和最困难的方面是遭受痛苦的病人，他（她）进入医
院是期待做一个顺利的手术，但却（被迫）处于遭受痛苦和受并发症侵害的境地。

Chapter 30 第二段
Epidemics occur almost exclusively during the winter months in temperate areas,but influenza
activity may continue year-round in the aks may occur in tour groups (land or
ship) and in facilities during summer months,particularly after the appearance of a drift
al outbreaks are expidemics,the overall attack rates typically
average 5 to 20% in rates of 40 to 50% are not uncommon in closed
populations,including those in hospitals and nursing homes,and in certain highly susceptible
age different strains within a single subtype,two different influenza A
subtypes(H1N1 and H3N2),or both influenza A and B viruses may
addition,simultaneous outbreaks of influenza A and respiratory syncytial viruses have been
found. Strains circulating at the end of one season`s outbreak (the so-called herald wave
phenomenon).Furthermore,other than the association of influenza outbreaks with colder
seasons,the factors that allow an epidemic to develop or those responsible for the tapering off
of an epidemic when only some susceptible persons have been infected are unknown.
温带地区流感几乎都发生在冬天的几个月，但在热带地区流感活动却常年不断。流
感爆发可能发生在夏季的旅行团和设施建筑里，尤其在漂移变异出现以后。流感爆发流
行的发生在时间和数量上的地区差异是很常见的。在流行期间，成人的总发病率通常是
5-20%。在人口密集地方包括医院和小型医院以及某一高度易感人群中，发病率达
40-50%也不罕见。单一亚型内的两个不同菌种之间，A型流感病毒的两个不同亚型
（H1N1和H3N2）之间，以及A型流感病毒和B型流感病毒之间均可以互相转染。另
外，我们也已经发现A型流感病毒和呼吸道合孢病毒同时爆发。某一季节疾病流行末期
传播的菌种有时对下个季节的疾病爆发有一定的影响（所谓先驱波现象）。此外，除了
流感爆发跟寒冷季节有关外，流行病的诱发因素或者那些引起流行病逐渐减少至只有少
数几个易感者发生感染的因素均不得而知。

Chapter 35 第三段

How should the chice between CT or ultrasonography be made in a patient who presents with
acute abdominal pain?More specifically,when is it appropriate to move directly to CT?In
general,if the pain is no唐雎不辱使命原文和翻译和注释 t biliary in character,an obese patient,CT is preferred because it often
reveals imaging choices 登岳阳楼拼音 exist: (1)no imaging study;(2) a plain radiographic series of the
abdomen (technically and economically similar to the chest radiograph but generally not as
useful);and (3)MRI of the abdomen or pelvis (usually reserved for more complex situations or
after failure to diagnose with other methods).Other than identifying free intraperitoneal air
(perforated viscus),gas patterns of bowel obstruction,and radiodense ureteral calculi,the
traditional abdominal series,although the least expensive test,is considered generally inferior
to CT and has been largely replaced by CT. A current-generation multislice helical CT scanner
can generate 5-mm sections of the entire abdomen and plvis in about 1 is helpful to
use oral and intravenous contrast material to opacify (and identify)loops of bowel and
vascular structures.
对急性腹痛病人来说，超声波检查和CT检查该怎么选择呢？更具体地说就是什么
时候把病人直接送去做CT更合适？一般来说，如果疼痛性质不像在胆囊，不定位在右
上腹，或者发生在肥胖病人上，CT更可取，因为它常常可以发现先前未知的异常。至
少还存在三种其他成像方式可选择：（1）（2）腹部扫描系列（技术上和经济上与胸片相
似，但通常不够有用）；（3）腹部或骨盆MRI（通常在更复杂的情况或用其它方法无法
诊断的时候才用）。除了能识别腹部游离气体（内脏穿孔），肠梗阻的气体形态和输尿管
结石的密度增高影，尽管传统的腹部扫描系列是最廉价的试验，但它通常比CT差，而
且大部分被CT所取代。现代多层螺旋CT扫描可以在一秒钟那产生腹部和骨盆的每5mm
一层的截面。口服或静脉给予造影剂对XX（而且识别）肠袢和血管结构很有用的．
Chapter 41 第二段
In assessing prognosis and planning a treatment strategy, it is useful to classify SCD as either
primary (without a clear trigger) or secondary . A primary espisode has a 10 to 30% 1-year
recurrence rate ,whereas most secondary episodes are associated with recurrence rates of less
than 2%.Identifiable reversible precipitants of secondary ventricular fibrillation (VF) include
transient ischemia possibly related to vasospasm;hypokalemia resulting from
diuretics;hyperkalemia secondary to renal failure ,angiotensin-converting enzyme
inhibitors,prostaglandin inhibitors,or potassium-sparing diuretics;proarrhythmia secondary to
antiarrhythmics,tricyclics,and antihistamines; or substance abuse with drugs such as cocaine
and y is directed toward removing or treating the acute
related to acute ischemia in the absence of prior MI often is associated with severe proximal
occlusive disease,normal left ventricular function,no流行老歌曲大全100首 rmal signal-averaged ECG,and
noninducibility [absence of ventricular tachycardia(VT)] during electrophysiologic study.
在评估预后和计划治贺新郎辛弃疾疗时，对SCD分为原发性（没有明显诱因）或继发性是有益
的。原发性SCD的I年内有10-30％的复发率，但多数继发性SCD的1年复发率不到2％。
由继发性室速导致明确可逆转的SCD，常由下列原因引起；冠脉痉挛相关的短暂缺血，
利尿剂引起的低钾血症、继发于肾功能衰竭的高钾血症、血管紧张与转换酶抑制剂/前列
腺抑制剂、保钾利尿剂、抗心率失常药引起的致心律失常作用、三环类抗抑郁药、抗组
胺药，或者可卡因、苯异丙胺等药物的滥用等。治疗上应针对去除或处理这些引起急性
事件（的诱因）。在缺少早期心梗表现的急性缺血相关的SCD常常与下列情况相关，严
重的冠脉近端的阻塞性疾病，左室功能正常，正常均值信号心电图，以及电生理检查中
的不可诱导性（不能诱导出室速）。

Chapter 45 第三段
Some patients with clear findings of the acute badomen may be treated without surgical
operation. For example,patients with perforated duodenal ulcer who seek attention late in the
course of their disease after they have been sick for several days may be treated best by
careful supportive care including nasogastric suction , intravenous fluids ,and pain relief.
Certain patients with empyema of the gallbladder , especially those with other serious
concomitant illnesses , can be treated by percutaneous drainage of the infected 钟山只隔数重山 gallbladder
and careful supportive care rather than with cholecystectomy.
有些腹痛原因明确的病人也可以进行非手术治疗。举个例子，有些穿孔性十二指肠
溃疡患者，在发病几天以后才寻求治疗，那时最佳的治疗就是细心的支持护理包括胃肠
减压、静脉补液和减轻疼痛。某些胆囊积脓尤其是那些有合并症的病人，可以通过对感
染胆囊经皮穿刺引流和细心的支持护理来治疗，不必采取胆囊切除术。

Chapter 54 第二段
The studies that compared enteral and parenteral nutrition in the trauma population , as
discussed earlier ,concluded that enteral nutrition was superior because of an attenuated
inflammatory response and a decrease in septic morbidity. When these studies are examined
moue closely it is clear that patients who were fed enterally usually received significantly less
calories than those fed parenterally. This discrepancy of “relative overfeeding” in the TPN
groups in many instances led to hyperglycemia , presumably predisposing patients to immune
dysfunction and nosocomial infection . Thus ,poor glucose control alone may account for the
observed differences in outcome . In more contemporary studies where feeds are carefully
advanced in a manner that avoids hyperglycemia and groups are fed equivalent protein and
calories , there appears to be little difference in clinical outcome between ent十二楼中尽晓妆望仙楼上望君王 eral and
parenteral routes of feeding . Enteral nutrition also can endanger patient safety in unique
ways . Deaths in jpersons receiving enteral putrition are often due to aspiration , for example
when gastric motility suddenly is impaired with the onset of sepsis . One death from
aspiration is equivalent to the mortality over 2 to 3 years of a well-operat雨水节气的谚语 ed parenteral
nutrition program , despite the danger of catheter sepsis , which in well-operated units is now
less than 1% to 3%.
如早些时候讨论的，肿瘤病人肠内营养和肠外营养的比较研究得出肠内营养在减少
炎症应答和降低脓毒血症的发生率上是优于后者的。更进一步地审查这些研究时我们发
现肠内营养的病人比肠外营养的得到更少的更有效的卡路里。全胃肠外营养组赞美老师善于育人的诗句 “相对进
食过多”的差异在很多情况下导致了高血糖，推测这些病人由于免疫功能不全和院内感
染而被预先处理。因此，单个简单的葡萄糖控制就会使观察结果发生改变。在更多的同
期研究中，预先仔细地准备避免高血糖的饮食并给以等量的蛋白质和卡路里，肠内营养
和肠外营养组之间几乎没有临床结果的差别，肠内营养也会在特别的方面危及病人的安
全。接受肠内营养的病人其死亡主要在于误吸，比如败血症使得病人的胃运动功能突然
受损时就会发生。尽管有导管相关败血症的危险，置管很好的肠外营养程序中超过2到
3年才发生一例误吸死亡，而现在有了良好的装置其发生率更是降低至1-3％。