【課文翻譯】Antibiotic Resistance1.In the past we have managed to develop new antibiotics to replace those that had become ineffective，but that has changed now that some bacteria have become resistant to all available drug treatments.過去，我們一直努力開發新的抗生素，來取代那些已經無效的抗生素。然而，現在這種情況變了，這是因為有些細菌已對現有的抗菌素治療都產生了抗藥性。2.We are safe while these bacteria remain sensitive to erythromycin or tetracycline but，given the experience with their hospital-based cousins，it will only be a matter of time before these become ineffective too.當這些細菌還對紅霉素或四環素敏感時，我們是安全的，但鑒于我們對它們那些在醫院的同類的經驗得知，這些抗菌素變得無效也只是時間問題了。3.In the US，outbreaks of multi-resistant strains have occurred in both health settings and prisons，causing the deaths of many who came into contact with the original infected person.在美國，廣泛耐藥性的菌屬已出現在醫療保健場所和監獄，導致許多與感染者接觸的人員死亡。4.Antibiotics have made a huge difference to this condition，but we are now getting to the stage where we no longer have effective and proven therapy that works against some of these higher level resistance strains.抗生素使這種狀況大為改變，但是我們現在正在回到這種狀態，即再也沒有有效治療對付那些高耐藥性的細菌感染了。5.We need the equivalent of the discovery of penicillin by Fleming and its development by Florey to be repeated every 10-20 years if we want to keep ahead of bacterial infections.如果我們想走在細菌傳染的前面，那么每10-20年，我們就需要有像Fleming發現青霉素，Florey發展青霉素那樣的發現發展新藥的過程。6.In addition to the developmental costs，there has been general complacency on the part of the community，medical profession and pharmaceutical industry during the 1980s.除了開發方面的高投入費用，還有就是我們社會方面、醫療行業及制藥企業方面自上世紀80年代以來普遍的自我滿足。7.While research and development has been winding back，the pace of bacterial adaptability has been accelerating.抗菌素研發方面的進展一直在放慢，而細菌的抗藥性的速度卻一直在加快。8.The development of new chasses of antibiotics is obviously vitally important but it is not the only means we should use to manage antibiotic resistance.新一代抗菌素開發固然十分重要，但這并不是我們用來對付抗生素耐藥性的唯一方法。9.We are frequently using antibiotics when they are unlikely to give any benefit，such as the treatment of viral respiratory tract infections.我們經常使用抗生素治療，而好多這些治療并不能給我們帶來益處，如：對病毒性呼吸道感染的治療。10.While there are commercial and economic benefits to this，the cost in the form of antibiotic resistance is very high.雖然這樣做會在商業和經濟上帶來好處，但由此帶來的抗生素耐藥性的代價卻是巨大的。Hello Dolly!1.Given that there does not appear to be any scientific reason why cloning techniques can not be applied in the human context, this raises the possibility of producing human clones not only from the DNA of living human beings, but also from dead ones.由于似乎沒有科技原因阻礙克隆技術用于人類，所以就有可能不僅從活的人體中提取DNA，也有可能從死的人體中提取DNA克隆。2.Animal welfare issues，as well as the possible benefits to humans of employing cloning techniques in various non-human contexts，have taken a back seat to outpourings of fear and howls of protest.使用克隆技術對動物的好處，以及各種非人體克隆技術可能對人類帶來的好處，都被人們的極度恐懼和憤怒所淹沒。3.Since then, bioethicists and scientists have largely dropped the topic because cloning of mammals did not seem technically feasible, and was therefore thought to be a matter better suited for science fiction than for earnest scientific or philosophical discussion.自那時起，生物倫理學家和科學家也基本上不關注這類話題，因為克隆哺乳動物在技術上似乎還不可行。由此認為，克隆人與其說是認真嚴肅的科學或哲學話題，不如說更適合于科幻小說。4.But what is this “right” and can it sit comfortably with the fact that some of our fellow humans are already “clones” and do not, in that sense, have a unique genetic identity?但是，什么是這個所謂的正確身份呢？這種說法難道對我們人類中一些已經遭到“克隆”并（按這種說法）失去了唯一遺傳身份現象卻能不聞不問嗎？5.False expectations about the “resurrection” of a beloved dead child might well deprive the new child of the opportunity to unfold in his or her own distinctive way, and prevent it from experiencing love, affection and acceptance as a unique individual and person.對于復活死去的心愛孩子，錯誤期待會剝奪這個新生孩子展示他或她各自不同的人生道路的體會，以及會妨礙她作為一個獨一無二個體經歷親情、愛情和被他人接受的體驗。6.A repugnant scenario? Perhaps. But is it a more repugnant scenario than the destruction of countless foetuese in abortions for reasons often more trivial than the saving of peoples lives?一個令人作嘔的景象？也許是，但這比起做人流時無數胎兒被摧殘的景象難道會更令人作嘔嗎？而做人流的最大理由也同樣不過是為了挽救人的生命。這是一個令人作嘔的景象嗎？也許是。但是那些為了相比救人生命而言微乎其微的理由而常常毀滅無數發育完全的胚胎7.The danger with regard to the regulation of cloning is that the easiest political reponse to the recent outpourings of fears and fantasies is a total ban of the practice in the human context.有關控制克隆的危險是針對最近人們對此極度恐懼和不正確的想象而作出的最簡單的政治反應那就是全面禁止人類背景下的克隆研究實踐。Stress1. It was vital once-an innate response to danger，inherited directly from the primeval veld down to our own lifetimes，where it causes nothing but trouble.人類從遠古草原/時期直接遺傳下來的應急機制曾經（對生存）至關重要，而如今卻只能帶來麻煩。2. Research has revealed that mens and womens bodies process stress differently,and provided disturbing evidence about how stress affects child development from the earliest weeks of life.研究依據顯示，男女機體對壓力的反應不同，并令人揪心地向我們展示了壓力是怎樣從孩子出生的頭幾周就開始影響孩子的發育發展。3. Stressors are, in short-hand, whatever youre trying to avoid: an electric shock, if youre a lab rat; the sight of a predator, if youre a prey animal; a 500 point drop in the stock market, if youre an investor.簡要來說，壓力源就是你想方設法要避免的事情，比如，如果你是一只實驗老鼠，壓力源就是電擊；如果你是獵物，壓力源就是看見捕獵者；如果你是股民，壓力源就是大盤下降500點。4. The fats contribute to the plaques that form inside blood vessels,which can lead to heart disease or strokes; high levels of glucose are a step in the direction of diabetes.脂肪導致血管內形成斑塊，可造成心臟病和中風，而高血糖往往又會導致糖尿病。5. Researchers still dont understand why the body should suppress immunity during times of stress-if anything, the opposite would seem to make sense.而研究人員仍然不理解，為什么在壓力下身體會壓制免疫反應。如果有起作用的話，應當是相反，那樣才有道理。6. Sure enough, fat cells in the abdomen appear to be especially sensitive to glucocorticoids, and people with a high concentration of those hormones tend to accumulate fat around their middles-a potbelly-even if the rest of their bodies are thin.肯定的是，腹部的脂肪細胞對糖皮質激素顯得特別敏感，因此，那些糖皮質激素水平較高的人，往往會在腹部周圍積累脂肪，形成啤酒肚，盡管身體的其余部分是瘦的。7. Theyll come in with abdominal pain, urinary frequency, headaches a whole variety of complaints which could be mistaken for medical problems and often are.他們來就診時都往往有腹痛、尿頻、頭痛等一系列常常會被誤認為器質性病變的主訴。Complementary and Alternative Medicine（補充和替代醫學）1.The most recent term for these approaches,integrative medicine,signals the hope that conventional medicine can embrace any modality that proves to be safe and effective, regardless of its origins,under a more inclusive health care umbrella.這些治療方法的最新稱呼綜合醫學，示意著在更廣泛的衛生保健概念下，無論傳統醫學的起源如何，它都可以和任何一種已證明是安全有效的醫學方法相結合。2.Complementary and alternative medicine includes healing approaches that presently are not considered an integral part of conventional medicine as practiced in developed nations.補充和替代醫學所包含的療法雖已在發達國家開展，但仍未被視為正統醫學不可分割的部分。3.The theory of homeopathy is that infinitesimal doses of a substance that causes particular symptoms in higher concentrations relieve similar symptoms,regardless of their cause.順勢療法的理論是不管癥狀的起因如何，采用極小劑量的某種物質以緩解這種特定的癥狀，而此種物質在高濃度時會引起相似的癥狀。4.Naturopathic medicine derived from the early 19th century German concept of natural healing (i.e.,the body possesses an inherent ability to heal itself).The purpose of this approach is to guide the patient toward self-healing with gentle and nontoxic measures, proper diet, and a variety of other approaches.自然療法醫學派生于19世紀初德國的自然康復概念，（即體內擁有一種固有的自愈能力）。這種做法的目的是引導病人通過適當控制飲食和其他各種溫和、無毒的方法，以達到自愈。5.The extraordinary popularity of these products，for which Americans spend billions of dollars each year，rests at least in part on the prevalent assumption that a nature product is healthy，whereas synthetic chemicals often are not.這些超人氣產品，使美國人每年花費數十億美元，至少要歸因于一種普遍的認識，即天然產品等于健康，而合成藥物則常常不是。6.Both fields originally proposed that vertebral misalignments contribute to many diseases，each of which could be treated by appropriate manipulations.脊柱指壓和正骨這兩個領域最初都認為，可導致許多疾病的各種椎體錯位均可以通過適當的手法治療來解決。7.Osteopathic medicine also may use manipulative techniques，but historical differences between Osteopathic medicine and allopathic medicine otherwise have disappeared.正骨醫學也可以采用手法治療技術，但骨科醫學與對癥治療醫學在其它方面曾有的如今已不復存在。8.Ancient peoples postulated that health depends on the proper balance and flow of life energies，termed Qi （pronounced “chee”）in Chinese system or the doshas in Ayurveda. Many strategies were developed with the goal of restoring the vitality and balance of a peoples energies.古老的民族認為，健康依賴于生命能量適當的平衡和流動，漢語稱為氣（發音為“氣”），生命呋陀醫學稱之為能量。許多治療策略的發展是以活力恢復和能量平衡為目標。9.Acupuncture involves insertion of needles into empirically derived points on the body，or meridians，across which streams of energy are said to flow. 針灸涉及針插入身體中由經驗而得的穴位，或經脈，并使能量流動其中。10.The broad range of complementary and alternative options available and the inundation of the public with unsubstantiated claims about them challenge physiciansabilities to guide their patientschoices.補充和替代醫學療法的寬廣選擇面，以及公眾對他們非理性的狂熱，對于醫生引導患者做選擇的能力而言是一種挑戰。11.That many complementary and alternative medicine practices are rooted in ancient health care systems and may involve natural products has been taken as ample proof of at least their safety if not also their effectiveness.許多補充和替代醫學實踐根植于古代衛生保健制度，并涉及天然產品，這一點如果不能作為其有效性，至少可以作為其安全性的充足證據。12.With the increased awareness of the use and potential hazards of complementary and alternative medicine，more practitioners and institutions have begun to incorporate relevant questions into routine patient interactions.隨著對于補充和替代醫學的用途及潛在危害的認識日益提高，更多的醫生和醫院開始將相關的問題納入日常的醫患交談之中。13.Desperation has long driven people to seek alternative and even radical therapies. A glimmer of hope, however faint, can be appealing；a mere anecdote can prove persuasive.絕望長期以來推動人們尋求替代、甚至是激進的療法。然而，即使一線微弱的希望，也是有吸引力的；僅僅一個奇聞也能讓人信以為真。14.For reasons that might be cultural or even biologic，however，patients respond better to practitioners who listen well，care enough to touch them，and explain their findings and decisions.可能是文化甚至生物的原因，患者對那些能很好傾聽他們、充滿關愛的接觸他們并能對他們的發現和決定進行解釋的醫生有更好地回應。15.When published case series and pilot trials suggest that the product might be benefical and there is little to indicate it is unsafe，the physician might be comfortable with the patients wish to use it，especially if the patient is not neglecting more important health issues and proven effective therapies，if the patient can afford it，and if the complementary and alternative medicine seems to help and not cause side effects.當已發表的一系列案例和試點試驗都表明草藥產品可能是有益的，并且沒有表明草藥產品是不安全的時，醫生對愿意用草藥的患者使用起草藥產品也變的心安理得了，尤其是在假如患者不會忽略更重要的健康問題并證明其確有療效的情況下，或是患者可以負擔得起，再或者補充和替代醫學似乎對患者有幫助而不會引起副作用。16.Nonetheless，careful laboratory investigations have shown the induction of opioid-dependent brain pathways by which acupuncture might mediate an analgesic effect.雖然如此，嚴謹的實驗室研究表明，針刺可能在阿片依賴腦通路的誘導中介導了止痛效應。17.Conventional medical practice may not evolve，as some have espoused，to a system in which patients are greeted routinely in a multimodality practice by a team of homeopaths，chiropractic and Ayurvedic physicians，herbalists，and spiritual counselors as well as by conventional physicians and nurses.正如某些人所支持的那樣，正統醫學實踐可能不會發展成這樣一種醫學系統模式，即通?；颊叱丝梢赃x擇正統醫師及護士提供的治療，還可以選擇由順勢療法醫生、脊柱指壓治療師、印式按摩師、中醫師、精神導師組成的治療團隊提供的復合治療方式。18.The willingness of practitioners to commit adequate time，to listen carefully to patients，and to touch them physically and emotionally must remain part of conventional medicine.從業人員為患者提供充足的時間、仔細聽取患者主訴、觸摸他們的身體和情感的種種意愿。必須保留傳統醫學。19.It is unreasonable to expect physicians to master the rudiments of disciplines such as acupuncture or Ayurveda，but they should understand the essential claims of these disciplines and know how to access the evidence base.期望內科醫生掌握例如針灸或阿育呋陀等學科的基本原理是不切實際。但是醫生應該了解這些學科的重要主張，并知道如何使用這些學科的證據基礎。20.It is preferable to comprehend the movement and address its tenets as fairly and rigorously as possible, rather than risk alienating from mainstream health care institutions people who find it appealing.更為可取的是盡可能公正嚴格地理解其發展并闡明其原則，而不是冒險讓為之所吸引的人疏遠主流衛生保健體系?！綛ody System】1.心血管系統 The cardiovascular system2.呼吸系統 The respiratory system 3.消化系統 The digestive system4.泌尿系統 The urinary system5.生殖系統 The reproductive system6.內分泌系統 The endocrine system7.免疫系統 The immune / lymphatic system8.骨骼肌肉（運動）系統 The musculoskeletal system9.外皮系統 The integumentary system10.神經系統 The nervous system11.感覺系統 The Sensory systemPS： Levels of structure organization of the human body： Cells Tissues Organs Body System【Antihypertensive drugs降壓藥】1. 受體阻斷劑 -blockers2. 鈣通道阻滯劑（鈣離子拮抗劑） calcium channel blockers3. 利尿劑 diuretics4. 血管緊張素轉換酶抑制劑 angiotensin converting enzyme inhibitors5. 血管緊張素II受體阻滯劑 angiotensin receptor blockers【Hypertension高血壓】收縮壓 Systolic blood pressure舒張壓 Diastolic blood pressuremmHg millimetre(s) of mercury【Key words for digestive system】pharynx（咽） esophagus（食管） pancreas（胰腺） liver（肝臟） gallbladder（膽囊） duodenum（十二指腸） colon（結腸） stomach（胃） appendix（闌尾） rectum（直腸）【Digestive Diseases】ulcer（潰瘍） appendicitis（闌尾炎） hepatitis（肝炎） cirrhosis（肝硬化） pancreatitis（胰腺炎）【Abdominal regions and quadrants】Right upper quadrant（右上腹） Left upper quadrant（左上腹）Right lower quadrant（右下腹） Left lower quadrant（左下腹）Right hypochondriac（右季肋區） Epigastric（上腹部） Left hypochondriacRight lumbar（右腰區） Umbilical（臍區） Left lumbar（左腰區）Right iliac（右髂區） Hypogastric（腹下區） Left iliac（右髂區）【Abbreviation縮寫】C/O complain of（主訴、抱怨）；chief complaint、chief concern（主訴）2/52 2 weeks SH social historyPH past history nil nothingFH family history a&w alive and wellOE on examination CXR chest X-ray【Ward Rounds in Gastroenterology消化查房】Main Contents（主要內容）First，the overnight nurses on duty gives the overall situation of the ward over the past day，including the total number of patients in the ward，any new admissions as well as the particular condition of any patients in critical condition.These new admissions and critical patients are reported in detail.On-call residents and attending doctors will give supplemental reports and comments on the diagnosis and management，if needed.首先，通宵值班護士報告過去一天病房的整體情況，包括病房患者的總人數，任何新入院的患者，以及任何危重病人的特殊情況。新病人及危重病人要詳細報告。如果需要，在線住院醫師及主治醫師將給出對于診斷和管理的補充報告和評價。Resident Report（住院醫匯報）Total number of the patients is 96，including 2 new admissions，1critical patient. 病人總數96名，包括2名新病人，1名危重病人。The new admission in Bed 12 is Mr. Smith. He is a 25-year-old male whose chief complaint is “black stool for 5 days”. On physical exam，the patient was awake，alert and oriented with stable vital signs.The patient appeared mildly anemic. His abdomen was soft，with mild epigastric tenderness and active bowel sounds. Initial impression is upper GI bleeding from a peptic ulcer？Famotidine was given intravenously. The patient is now stable，with no bowel movement yet.12床新病人是史密斯先生。他是一個25歲的男性，其主訴是“黑便5天”。體檢：病人神志清和生命體征穩定?；颊叱尸F輕度貧血貌。腹部柔軟，有輕度上腹部壓痛及腸鳴音活躍。初步印象是消化性潰瘍導致的上消化道出血？法莫替丁靜脈滴注。病人沒有排便，現在病情尚穩定。Ms. Kant is new admission in Bed 50. She is a 70-year-old female whose chief complaint is “I swallowed a fish bone by accident 2 hours ago.”An emergency barium swallow radiogragh demonstrated a bone located in the upper part of the esophagus lodged transversely. This bone was removed through endoscopy. There was no bleeding during or after the operation.50床的Kant（康德）女士是新新病人。她是一名70歲的老年女性，其主訴是“2小時前我吞了一根魚刺?！本o急鋇餐X線檢查表明魚刺橫行卡于食道上段。內鏡下取出魚刺。術中及術后無出血。The patient in Bed 30 is in critical condition. He has post-hepatitis cirrhosis with major upper-GI bleeding. The patient vomited 300ml of “Coffee-ground” fluid over the past 24 hours. He also had 4 episodes of black，tarry stools totaling about 500ml. Urine output over the past 24 hours has been 800ml.Vital signs this morning were：pulse 100 peats per minute，respirations 26 per minute，and blood pressure 140/100mmHg. There were 1750ml of fluid in and somatostatin was given continuously IV.30床病人是個危重患者。他有肝炎后肝硬化伴有較多的上消化道出血。在過去24小時里，病人嘔吐 “咖啡色渣狀”液體300ml。柏油樣黑便4次，共約500毫升?；颊咴谶^去的24小時尿量有800ml。今晨生命體征：脈搏100次/每分鐘，呼吸26次/每分鐘，血壓140 /100mmhg。進液量1750ml并連續予生長抑素靜脈滴注。The patient in bed 45 is in critical condition. He is diagnosed with portal hypertension secondary to hepatic cirrhosis.