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28 January Roy音乐朗读---Galileo reborn背景音乐：雅尼---夜森林
In his own lifetime Galileo was the centre of violent controversy; but the scientific dust has long since settled, and today we can see even his famous clash with the Inquisition in something like its proper perspective. But, in contrast, it is only in modern times that Galileo has become a problem child for historians of science.
The old view of Galileo was delightfully uncomplicated. He was, above all, a man who experimented: who despised the prejudices and book learning of the Aristotelians, who put his questions to nature instead of to the ancients, and who drew his conclusions fearlessly. He had been the first to turn a telescope to the sky, and he had seen there evidence enough to overthrow Aristotle and Ptolemy together. He was the man who climbed the Leaning Tower of Pisa and dropped various weights from the top, who rolled balls down inclined planes, and then generalized the results of his many experiments into the famous law of free fall. But a closer study of the evidence, supported by a deeper sense of the period, and particularly by a new consciousness of the philosophical undercurrents in the scientific revolution, has profoundly modified this view of Galileo. Today, although the old Galileo lives on in many popular writings, among historians of science, a new and more sophisticated picture has emerged. At the same time our sympathy fro Galileo's opponents has grown somewhat. His telescopic observations are justly immortal; they aroused great interest at the time, they had important theoretical consequences, and they provided a striking demonstration of the potentialities hidden in instruments and apparatus. But can we blame those who looked and failed to see what Galileo saw, if we remember that to use a telescope at the limit of its powers calls for long experience and intimate familiarity with one's instrument? Was the philosopher who refused to look through Galileo's telescope more culpable than those who alleged that the spiral nebulae observed with Lord Rosse's great telescope in the eighteen-forties were scratches left by the grinder? We can perhaps forgive those who said the moons of Jupiter were produced by Galileo's spyglass if we recall that in his day, as for centuries before, curved glass was the popular contrivance for producing not truth but illusion, untruth; and if a single curved glass would distort nature, how much more would a pair of them? 27 January Magnetic Drug for lungsMedical Insight （January 28, 2008） Self-made Audio Programme 38(Roy原声) you can download this audio material at
1）inertial impaction 2）sedimentation 3）diffusion A recent study demonstrated a novel mode — the use of a magnetic field to influence the site of deposition. By adding superparamagnetic iron oxide nanoparticles to the solution to be aerosolized, the authors show that deposition in one lung of a mouse can be greatly enhanced over that in the other lung in the presence of a strong magnetic field. 26 January A case of Type 2 Diabetes
Medical Insight （January 26, 2008） Self-made Audio Programme 38(Roy原声) you can download this audio material at
Welcome to Medical Insight January 26, 2008, I’m Dr. Alex Roy. A 55-year-old woman with type 2 diabetes, obesity, and hypertension has been under your care for the past 2 years. Her morning fasting glucose levels have ranged between 6.1 and 7.8 mmol/liter. She has been receiving metformin and glipizide格列吡嗪. Her glycated hemoglobin level is 8.1%, and her creatinine 80 mmol/liter. She seeks advice about the management of her diabetes. Which one of the following treatment options, would you find most appropriate for this patient? 1. Add pioglitazone吡格列酮. 2. Add neutral protamine Hagedorn insulin中性鱼精蛋白锌胰岛素before bedtime. 3. Add exenatide艾塞那肽 twice daily. 24 January My Fabulous Federer !Federer in action
Roger Federer might soon own every record in the sport, but he put a huge one on the board by winning the 2007 US Open title with a dramatic and hard-fought, 7-6 (4), 7-6 (2), 6-4 victory over Serb Novak Djokovic that might not be broken this century: going back-to-back-to-back-to-back at Wimbledon and the US Open four consecutive times. Bird flu
Medical Insight （January 20, 2008） Self-made Audio Programme 37 download Roy audio material at
Welcome to Medical Insight January 20, 2008, I'm Dr. Alex Roy. The unprecedented epizootic of avian influenza A (H5N1) viruses among birds continues to cause human disease with high mortality and to pose the threat of a pandemic. Avian influenza A (H5N1) viruses are entrenched among poultry in parts of Asia and Africa, and perhaps the Middle East. The highly pathogenic avian influenza H5 hemagglutinin has evolved into many phylogenetically distinct clades and subclades, that generally correlate with antigenic differences that must be considered in the selection of candidates for H5N1 vaccines. Despite widespread exposures to poultry infected with avian influenza A (H5N1) viruses, influenza A disease in humans remains very rare. Since May 2005, the numbers of both affected countries and confirmed cases of influenza A (H5N1)virus infection (340 cases as of December 14, 2007) have increased, in part because of the spread of clade 2.2 viruses across Eurasia and to Africa. Currently, illness due to influenza A (H5N1) viruses typically manifests as severe pneumonia that often progresses rapidly to the Acute Respiratory Distress Syndrome. Detection of viral RNA by means of conventional or Real-Time Polymerase Chain Reaction remains the best method for the initial diagnosis of influenza A (H5N1). This update summarizes recent information including research on the transmission and pathogenesis of the infection and on the current strategies for treatment and prevention. 18 January A bad idea for sepsis treatment
Medical Insight （January 18, 2008） Self-made Audio Programme 36(Roy原声) you can download this audio material at
Welcome to Medical Insight January 10, 2008, I’m Dr. Alex Roy. Optimal glucose control and fluid resuscitation in patients with septic shock remain a challenge. In this study involving more than 500 patients, the potential benefit of maintaining euglycemia血糖正常through intensive insulin therapy and optimal fluid resuscitation with either Penta-starch合成蛋白胶体液or Ringer’s lactate was assessed. The trial was stopped early for safety reasons. Among more than 500 patients, the mean morning blood glucose level was lower in the intensive-therapy group (112 mg per deciliter) than in the conventional-therapy group (151 mg per deciliter). However, at 28 days, there was no significant difference between the two groups in the rate of death or the mean score for organ failure. The rate of severe hypoglycemia (glucose level,≤40 mg per deciliter) was higher in the intensive-therapy group than in the conventional-therapy group (17.0% vs. 4.1%), as was the rate of serious adverse events (10.9% vs. 5.2%). Hydroxyethyl-Starch羟乙基淀粉therapy was associated with higher rates of acute renal failure and renal-replacement therapy than was Ringer’s lactate. The use of intensive insulin therapy placed critically ill patients with sepsis at increased risk for serious adverse events related to hypoglycemia. As used in this study, Hydroxyethyl-Starch was harmful, and its toxicity increased with accumulating doses. Roy音乐朗读---The sculptor speaks
15 January Roy音乐朗读之五---Exploring the sea-floor背景音乐---《水边的阿狄丽娜》
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Our knowledge of the oceans a hundred years ago was confined to the two-dimensional shape of the sea surface and the hazards of navigation presented by the irregularities in depth of the shallow water close to the land. The open sea was deep and mysterious, and anyone who gave more than a passing thought to the bottom confines of the oceans probably assumed that the sea bad was flat. Sir James Clark Ross had obtained a sounding of over 2,400 fathoms in 1839, but it was not until of deep soundings was obtained in the Atlantic and the first samples were collected by dredging the bottom. Shortly after this the famous H. M. S. Challenger expedition established the study of the sea-floor as a subject worthy of the most qualified physicists and geologists. A burst of activity associated with the laying of submarine cables soon confirmed the challenger's observation that many parts of the ocean were two to there miles deep, and the existence of underwater features of considerable magnitude. Today, enough soundings are available to enable a relief map of the Atlantic to be drawn and we know something of the great variety of the sea bed's topography. Since the sea covers the greater part of the earth's surface, it is quite reasonable to regard the sea floor as the basic form of the crust of the earth, with superimposed upon it, the continents, together with the islands and other features of the oceans. The continents form rugged tablelands which stand nearly three miles above the floor of the open ocean. From the shore line, out a distance which may be anywhere from a few miles to a few hundred miles, runs the gentle slope of the continental shelf, geologically part of the continents. The real dividing line between continents and oceans occurs at the foot a steeper slope. This continental slope usually starts at a place somewhere near the 100-fatheom mark and in the course of a few hundred miles reaches the true ocean floor at 2,500-3,500 fathoms. The slope averages about 1 in 30. but contains steep, probably vertical, cliffs, and gentle sediment-covered terraces, and near its lower reaches there is a long tailing-off which is almost certainly the result of material transported out to deep water after being eroded from the continental masses. 13 January 2008维也纳新年音乐会指挥家---乔治·普莱特法国指挥家乔治·普莱特(Georges Pretre), 对于中国爱乐者来说是一个传奇式的名字。他出生在法国，在杜埃和巴黎接受音乐教育，起初主学小号，后转向指挥，拜克路易坦为师，先在马赛与里昂等地任助理指挥，1946年在巴黎喜歌剧院正式登台。1959年指挥普朗克的歌剧《人类之声》后成为闻名的现代音乐作品指挥家，担任过许多现代作品的首演，对歌剧也深有研究，成为法国代表性歌剧指挥。这位60年代斯卡拉歌剧院的音乐指导曾经是全球最知名的指挥家之一，他最富盛名的阶段是与玛利亚·卡拉斯的长期合作，这使得他们两人的名字在唱片和海报上成了经典组合。
维也纳爱乐乐团在2007年的第一天就急切地对外公布了2008年维也纳新年音乐会的特邀指挥，法国人乔治·普莱特出人意外地当选。届时，1924年出生的普莱特将以84岁的高龄第一次指挥这个具有悠久历史的年度音乐盛会。这是维也纳新年音乐会上又一位新面孔的“老”艺术家担任指挥。 普莱特在广大乐迷心目中，或许并非当今国际乐坛的顶尖指挥大师，实力却不可小视；他尤其擅长指挥歌剧及法国音乐，担任过巴黎歌剧院交响乐团团长，还曾是维也纳交响乐团的常任指挥，在EMI唱片公司留下过不少有价值的录音唱片。他为听众、观众所知，更多是源自1992年他带领柏林爱乐乐团，指挥了当年主题为“法国之夜”的瓦尔德尼夏季森林音乐会，精彩的演出令人印象深刻。普莱特在艺术风格上会展示出怎样的特色，人们都非常期待，2008年指挥家普莱特所带来的施特劳斯家族作品能够让人感到耳目一新！ 普莱特在1956-1963年期间任巴黎歌剧院交响乐团团长，还与卡拉斯精诚合作，为其指挥歌剧或演唱会。他对法国现代音乐造诣极深，是圣桑、普朗克音乐的权威诠释者。从1986年到1991年期间，普莱特是维也纳交响乐团的常任指挥。在2004年普莱特成为奥地利音乐之友协会的荣誉会员，在他80岁生日的那年还获得了奥地利科学与艺术的十字一级勋章，与维也纳爱乐乐团有着很深的联系。 Aneurysms rupture &. Sudden onset Abdominal pain
Medical Insight （January 10, 2008） Self-made Audio Programme 35(Roy原声) you can download this audio material at
Approximately 3 months before admission, the patient had been admitted to this hospital because of epigastric pain, nausea, and chills that had gradually developed hours after he had been drinking alcohol heavily. His pain resolved; On the day of admission, while lifting an air conditioner, he suddenly experienced severe abdominal pain, along with weakness and diaphoresis. When the patient arrived in the emergency department, he was hypotensive, and appeared to be in severe distress. Considering the suddenness of the onset of symptoms and the tenderness of the abdomen in this patient, a sudden loss of blood from the circulation was the likely cause of shock. In this case, the roles of emergency services, surgery and interventional radiology in the diagnosis and management of Circulatory Shock are discussed. In the initial surgical evaluation of a patient such as this, who appears to be in hemorrhagic shock, the source of bleeding is the primary consideration.In this case, the cause was found to involve an unusual abnormalities in the arteries of the Celiac Axis. Final diagnosis: Celiac-artery stenosis and multiple aneurysms, with rupture. 12 January 个人音乐朗读之四---The hovercraft背景音乐---Rainy Sunday download my mp3 at http://www.zshare.net/audio/639763684a6aa6/ Many strange new means of transport have been developed in our century, the strangest of them being perhaps the hovercraft. In 1953, a former electronics engineer in his fifties, Christopher Cockerell, who had turned to boat-building on the Norfolk Broads, suggested an idea on which he had been working for many years to the British Government and industrial circles. It was the idea of supporting a craft on a' pad ', or cushion, of low-pressure air, ringed with a curtain of higher pressure air. Ever since, people have had difficulty in deciding whether the craft should be ranged among ships, planes, or land vehicles--for it is something in between a boat and an aircraft. As a shipbuilder, Cockerell was trying to find a solution to the problem of the wave resistance which wastes a good deal of a surface ship's power and limits its speed. His answer was to lift the vessel out of the water by making it ride on a cushion of air, no more than one or two feet thick. This is done by a great number of ring-shaped air jets on the bottom of the craft. It 'flies', therefore, but it cannot fly higher--its action depends on the surface, water or ground, over which it rides. The first tests on the Solent in 1959 caused a sensation. The hovercraft travelled first over the water, then mounted the beach, climbed up the dunes, and sat down on a road. Later it crossed the Channel, riding smoothly over the waves, which presented no problem. Since that time, various types of hovercraft have appeared and taken up regular service--cruises on the Thames in London, for instance, have become an annual attraction. But we are only at the beginning of a development that may transport netsea and land transport. Christopher Cockerell's craft can establish transport works in large areas with poor communications such as Africa or Australia; it can become a 'flying fruit-bowl', carrying bananas from the plantations to the ports, giant hovercraft liners could span the Atlantic; and the railway of the future may well be the 'hovertrain', riding on its air cushion over a single rail, which it never touches, at speeds up to 300 m.p.h.--the possibilities appear unlimited. 10 January Depression 2
Medical Insight （January 9, 2008） Self-made Audio Programme 34(Roy原声) you can download this audio material at
Welcome to Medical Insight January 9, 2008, I’m Dr. Alex Roy. Depression is a heterogeneous disorder with a highly variable course, an inconsistent response to treatment, and no established mechanism. 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 sexual desire; constipation; loss of the ability to experience pleasure in work or with friends; crying; suicidal thoughts; and slowing of speech and action. These changes must last a minimum of 2 weeks and interfere considerably with work and family relations. No single mechanism can account for all the clinical variations in this condition. The Monoamine hypothesis of depression postulates a deficiency in serotonin 5-羟色胺or norepinephrine去甲肾上腺素neurotransmission in the brain. The monoamine oxidase theory can explain many of the actions of antidepressants, but genetic factors, stress, and psychosocial factors also play a part in depression. The Hypothalamic–Pituitary–Cortisol hypothesis of depression postulates that abnormalities in the cortisol response to stress may underlie depression. However, major depressive disorder is likely to have a number of causes. This review of major depressive disorder is a comprehensive account of the genetic, biochemical, and neurophysiological changes that have been implicated in the disorder. 09 January 个人音乐朗读之三--- Patients and doctors背景音乐：Yanni---Reflections of passion
This is a sceptical age, but although our faith in many of the things in which our forefathers fervently believed has weakened, our confidence in the curative properties of the bottle of medicine remains the same a theirs. This modern faith in medicines is proved the fact that the annual drug bill of the Health Services is mounting to astronomical figures and shows no signs at present of ceasing to rise. The majority of the patients attending the medical out-patients departments of our hospitals feel that they have not received adequate treatment unless they are able to carry home with them some tangible remedy in the shape of a bottle of medicine, a box of pills, or a small jar of ointment, and the doctor in charge of the department is only too ready to provide them with these requirements. There is no quicker method of disposing of patients then by giving them what they are asking for, and since most medical men in the Health Services are overworked and have little time for offering time-consuming and little-appreciated advice on such subjects as diet, right living, and the need for abandoning bad habits etc., the bottle, the box, and the jar are almost always granted them. Nor is it only the ignorant and ill-educated person who was such faith in the bottle of medicine. It is recounted of Thomas Carlyle that when him in his pocket what remained of a bottle of medicine formerly prescribed for an indisposition of Mrs. Carlyle's. Carlyle was entirely ignorant of what the bottle in his pocket contained, of the nature of the illness from which his friend was suffering, and of what had previously been wrong with his wife, but a medicine that had worked so well in one form of illness would surely be of equal benefit in another, and comforted by the thought of the help he was bringing to his friend, he hastened to Henry Taylor's house. History does not relate whether his friend accepted his medical help, but in all probability he did. The great advantage of taking medicine is that it makes no demands on the taker beyond that of putting up for a moment with a disgusting taste, and that is what all patients demand of their doctors -- to be cured at no inconvenience to themselves. 06 January Lymphopenia &. B-cell DeficiencyMedical Insight （January 6, 2008） Self-made Audio Programme 33(本人原声) you can download this audio material at
Welcome to Medical Insight January 6, 2008, I’m Dr. Alex Roy. This week, our topic is Lymphopenia &. B-cell deficiency. A 52-year-old man presented to his primary care physician with dyspnea and cough. For the past 15 years, he had recurrent episodes of cough that were relieved only by intermittent courses of oral corticosteroids. He had been treated on three occasions during the past year with 20 mg of prednisone daily for 2 weeks. In the previous 3 weeks, his cough had increased in frequency, and severe dyspnea had developed. This time, 2 weeks of prednisone had not provided relief. He had occasional chills but no fever. His cough was productive of yellow sputum. The patient’s medical history included complete resection of a thymoma 5 years earlier. The patient was admitted to the hospital. Chest X-ray showed bilateral alveolar infiltrates. The patient was started on moxifloxacin莫西沙星for Community-Acquired Pneumonia. Gram’s staining of a sputum specimen showed gram-positive diplococci with many leukocytes; two blood cultures grew penicillin-sensitive Streptococcus pneumoniae. The patient was switched to intravenous penicillin G but continued to be hypoxemic. Chest X-ray showed no improvement after 5 days of therapy. Clinical improvement with pneumococcal pneumonia is generally observed within 3 days after the initiation of appropriate therapy, and the limited improvement in the patient’s condition was a concern. When a patient’s condition does not improve despite appropriate therapy, the clinician must reconsider the course of action. This requires critical appraisal of the original diagnosis and a thorough investigation of possible causes of treatment failure.The final diagnosis: Lymphopenia &. B-cell Deficiency 个人音乐朗读之二---The "Vasa"The "Vasa"
(背景音乐:雅尼---Ninghtingale)
From the seventeenth-century empire of Sweden, the story of a galleon that sank at the start of her maiden voyage in 1628 must be one of the strangest tales of the sea. For nearly three and a half centuries she lay at the bottom of Stockholm harbour until her discovery in 1956. This was the Vasa, royal flagship of the great imperial fleet. King Gustavus Adolphus, 'The Northern Hurricane', then at the height of his military success in the Thirty Years' War, had dictated her measurements and armament. Triple gun-decks mounted sixty-four bronze cannon. She was intended to play a leading role in the growing might of Sweden. As she was prepared for her maiden voyage on August 10, 1628, Stockholm was in a ferment. From the Skeppsbron and surrounding islands the people watched this thing of beauty begin to spread her sails and catch the wind. They had laboured for three years to produce this floating work of art; she was more richly carved and ornamented than any previous ship. The high stern castle was a riot of carved gods, demons, knights, kings, warriors, mermaids, cherubs; and zoomorphic animal shapes ablaze with red and gold and blue, symbols of courage, power, and cruelty, were portrayed to stir the imaginations of the superstitious sailors of the day. Then the cannons of the anchored warships thundered a salute to which the Vasa fired in reply. As she emerged from her drifting cloud of gun smoke with the water churned to foam beneath her bow, her flags flying, pennants waving, sails filling in the breeze, and the red and gold of her superstructure ablaze with colour, she presented a more majestic spectacle than Stockholmers had ever seen before. All gun-ports were open and the muzzles peeped wickedly from them. As the wind freshened there came a sudden squall and the ship made a strange movement, listing to port. The Ordnance Officer ordered all the port cannon to be heaved to starboard to counteract the list, but the steepening angle of the decks increased. Then the sound of rumbling thunder reached the watchers on the shore, as cargo, ballast, ammunition and 400 people went sliding and crashing down to the port side of the steeply listing ship. The lower gun-ports were now below water and the inrush sealed the ship's fate. In that first glorious hour, the mighty Vasa, which was intended to rule the Baltic, sank with all flags flying--in the harbour of her birth. 04 January Neuromuscular disease
Medical Insight （January 1, 2008） Self-made Audio Programme 32(本人原声) you can download this audio material at
Happy New Year,everyone！Welcome to Medical Insight January 1, 2008, I’m Dr. Alex Roy. This week let’s take a look at Neuromuscular disease. A 38-year-old, right-handed man was seen in the neuromuscular unit of the hospital because of weakness of the hands. Shaking of the hands had begun 8 months earlier and was followed by cramping痉挛 and progressive weakness of the hands as well as weakness of the arms and legs. Electrophysiological studies showed changes suggestive of motor neuron disease. However, motor neuron disease and multifocal motor neuropathy多灶性运动神经病 share many electrophysiological features. Multifocal motor neuropathy is a rare acquired motor neuropathy that may simulate motor neuron disease. Recognition of the disorder is important, since, unlike motor neuron disease, it is treatable. This case illustrates a common problem in the neuromuscular specialty clinic. |
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