Advanced Seconds---《新概念》个人纪录

 

原磁带录音：2分12秒

个人朗读记录：1分13 秒

Advanced Sec：59秒！

download my record at http://www.zshare.net/audio/45007432af10ef/

When anyone opens a current account at a bank, he is lending the bank money, repayment of which he may demand at any time, either in cash or by drawing a cheque in favour of another person. Primarily, the banker-customer relationship is that of debtor and creditor -- who is which depending on whether the customer's account is in credit or is overdrawn. But, in addition to that basically simple concept, the bank and its customer owe a large number of obligations to one another. Many of these obligations can give in to problems and complications but a bank customer, unlike, say, a buyer of goods, cannot complain that the law is loaded against him.
The bank must obey its customer's instructions, and not those of anyone else. When, for example, a customer first opens an account, he instructs the bank to debit his account only in respect of cheques draw by himself. He gives the bank specimens of his signature, and there is a very firm rule that the bank has no right or authority to pay out a customer's money on a cheques on which its customer's signature has been forged. It makes no difference that the forgery may have been a very skilful one: the bank must recognize its customer's signature. For this reason there is no risk to the customer in the practice, adopted by banks, of printing the customer's name on his cheques. If this facilitates forgery, it is the bank which will lose, not the customer

 

想从一首诗谈谈，东西方智慧对于“无奈”的理解与差别

                                               

                                  －－韦应物《滁州西涧》

 

中唐前期，滁州刺史韦应物是个洁身自好的诗人，也是个关心民生疾苦的好官。在仕宦生涯中，他“身多疾病思田里，邑有流亡愧俸钱”（《寄李儋元锡》），常处于进仕退隐的矛盾。他为中唐政治弊败而忧虑，为百姓生活贫困而内疚，有志改革而无力，思欲归隐而不能，进退两为难，只好不进不退，如无人之舟任其自然。

 

                     －－－（《庄子。列御寇》）

"Lord grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference."                               ---  Saint Francis of Assisi 对同一现象，东西方的智慧角度不同：西方智慧更加深刻与积极。

 

Medical Insight （October 25^th, 2007）

You can download this audio material at http://www.zshare.net/audio/449978330d459c/

Welcome to Medical Insight October 25th, 2007, I’m Dr. Alex Roy. It is true that more and more HIV-Positive Patients emerged during the diagnostic procedure after admission in hospital, so let the doctors beware of this trend. A 49-year-old HIV-Positive man was seen in the Hematology clinic because of rapidly progressive anemia. Five weeks earlier, laboratory testing showed anemia, and treatment with iron and multiple vitamins was initiated. HIV infection had been diagnosed approximately 20 years earlier, and the patient had discontinued antiretroviral therapy eleven months earlier. 6 months before the evaluation for anemia, he saw a nutritionist for evaluation of hyperlipidemia, adopted a low-fat diet, and began treatment with coenzyme Q10 and carnitine. During the next 6 months, he began to feel progressively more fatigued, lightheaded. Two weeks before the evaluation for anemia, he discontinued both medications. On examination, the hemoglobin level was 6 g per deciliter, the hematocrit 16.9%, the reticulocyte count 0.2%, and the white-cell count 2600 per cubic millimeter, with a normal differential count. In the evaluation of a patient with anemia such as this one, the first consideration is the rapidity of onset. The next consideration is to determine whether the anemia is isolated or whether other hematopoietic lineages are affected. In this case discussion, the possible causes of anemia in this patient are reviewed. Final diagnosis: Classic Hodgkin’s lymphoma with HIV-positive

Some old people are oppressed by the fear of death. In the young there is a justification for this feeling. Young men who have reason to fear that they will be killed in battle may justifiably feel bitter in the thought that they have cheated of the best things that life has to offer. But in an old man who has known human joys and sorrows, and has achieved whatever work it was in him to do, the fear of death is somewhat abject and ignoble. The best way to overcome it -- so at least it seems to me -- is to make your interests gradually wider and more impersonal, until bit by bit the walls of the ego recede, and your life becomes increasingly merged in the universal life. An individual human existence should be like a river -- small at first, narrowly contained within its banks, and rushing passionately past boulders and over waterfalls. Gradually the river grows wider, the banks recede, the waters flow more quietly, and in the end, without any visible break, they become merged in the sea, and painlessly lose their individual being. The man who, in old age, can see his life in this way, will not suffer from the fear of death, since the things he cares for will continue. And if, with the decay of vitality, weariness increases, the thought of rest will be not unwelcome. I should wish to die while still at work, knowing that others will carry on what I can no longer do, and content in the thought that what was possible has been done.
Advanced Seconds---《新概念》个人纪录

  原磁带录音：2分26秒

个人朗读记录：1分 22 秒

Advanced Sec：64秒！

download my record at

http://www.zshare.net/audio/4411350216bbf0/

Medical Insight （October 22^nd, 2007）

 

Self-made Audio Programme 17(本人原声)

you can download this audio material at

http://www.zshare.net/audio/4367407a6ca6ad/

 

Welcome to Medical Insight October 22nd, 2007, I’m Dr. Alex Roy. Reliable estimates of the effectiveness of influenza vaccine among persons 65 years of age and older are important for informed vaccination policies and programs. To provide an estimate of vaccine effectiveness, a study from University of Minnesota US analyzed data from 18 cohorts of community dwelling elderly persons during 10 influenza seasons.There were more than 713,000 person-seasons of observation. Most high-risk medical conditions that were measured were more prevalent among vaccinated than among unvaccinated persons. Vaccination was associated with a 27% reduction in the risk of hospitalization for pneumonia or influenza and a 48% reduction in the risk of death. During 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and, in the risk of death among community-dwelling elderly persons. Vaccine delivery to this high-priority group should be improved. In an editorial, John Treanor from the University of Rochester Medical Center in New York writes that: Overall, this study provides additional support for the current strategy to vaccinate elderly adults. There is no doubt that influenza is harmful and that the vaccine is beneficial and should be used widely. Influenza vaccine is less immunogenic, and probably less effective, in older persons than in young healthy adults, and the development of safe but more immunogenic and effective vaccines for the elderly is an important goal. In the meantime, influenza cannot develop in elderly persons if they are not exposed to influenza virus from others.Ultimately, the key to optimal control of the devastating effects of influenza in elderly persons may be found in our ability to effectively vaccinate the youngest members of the population.

Technology trends may push Silicon Valley back to the future. Carver Mead, a pioneer in integrated circuits and a professor of computer science at the California Institute of Technology, notes there are now work-stations that enable engineers to design, test and produce chips right on their desks, much the way an editor creates a newsletter on a Macintosh. As the time and cost of making a chip drop to a few days and a few hundred dollars, engineers may soon be free to let their imaginations soar without being penalized by expensive failures. Mead predicts that inventors will be able to perfect powerful customized chips over a weekend at the office -- spawning a new generation of garage start-ups and giving the U.S. a jump on its foreign rivals in getting new products to market fast. 'We're got more garages with smart people,' Mead observes. 'We really thrive on anarchy.'
And on Asians. Already, orientals and Asian Americans constitute the majority of the engineering staffs at many Valley firms. And Chinese, Korean, Filipino and Indian engineers are graduating in droves from California's colleges. As the heads of next-generation start-ups, these Asian innovators can draw on customs and languages to forge righter links with crucial Pacific Rim markets. For instance, Alex Au, a Stanford Ph. D. from Hong Kong, has set up a Taiwan factory to challenge Japan's near lock on the memory-chip market. India-born N.Damodar Reddy's tiny California company reopened an AT & T chip plant in Kansas City last spring with financing from the state of Missouri. Before it becomes a retirement village, Silicon Valley may prove a classroom for building a global business.
Advanced Seconds---《新概念》个人纪录

 

原磁带录音：2分40秒

个人朗读记录：1分 35 秒

Advanced Sec：65秒！

download my record at http://www.zshare.net/audio/43299002d33168/

 

Medical Insight （October 18^th, 2007）

Self-made Audio Programme 16 (本人原声)

you can download this audio material at http://www.zshare.net/audio/42977619cfa2bc/

 Welcome to Medical Insight October 18th, 2007, I’m Dr. Alex Roy. Abdominal Pain is a very common and complex complaining symptom in patients who went to the emergency room. Its differential diagnosis can reflect a physician’s analytic ability and his clinical experiences. A 41-year-old man was admitted to the hospital because of abdominal pain, nausea, and an elevated serum creatinine level. Six days before admission, chills and malaise had developed. He took Ibuprofen(布洛芬) every 6 hours for three or four doses. His symptoms persisted, and weakness, abdominal pain, nausea and anorexia developed. He went to an emergency room, where elevated serum creatinine and urea nitrogen levels were noted. The urinary sediment contained granular casts. A renal biopsy was perform. The differential diagnosis in this complex case with acute multisystem involvement includes the possible causes of acute kidney injury: prerenal, intrarenal, and postrenal factors are discussed. A key feature in this case was the urinalysis. Final diagnosis: Acute tubular necrosis and glomerular podocyte injury, caused by NSAIDs.

Advanced Seconds---《新概念》个人纪录

 

原磁带录音：2分24秒

个人朗读记录：1分 21 秒

Advanced Sec：63秒！

download my record at

http://www.zshare.net/audio/425529552319ef/

 Alfred the Great acted his own spy, visiting Danish camps disguised as a minstrel. In those days wandering minstrels were welcome everywhere. They were not fighting men, and their harp was their passport. Alfred had learned many of their ballads in his youth, and could vary his programme with acrobatic tricks and simple conjuring.
While Alfred's little army slowly began to gather at Athelney, the king himself set out to penetrate the camp of Guthrum, the commander of the Danish invaders. There had settled down for the winter at Chippenham: thither Alfred went. He noticed at once that discipline was slack: the Danes had the self-confidence of conquerors, and their security precautions were casual. They lived well, on the proceeds of raids on neighbouring regions. There they collected women as well as food and drink, and a life of ease had made them soft.
Alfred stayed in the camp a week before he returned to Athelney. The force there assembled was trivial compared with the Danish horde. But Alfred had deduced that the Danes were no longer fit for prolonged battle: and that their commissariat had no organization, but depended on irregular raids.
So, faced with the Danish advance, Alfred did not risk open battle but harried the enemy. He was constantly on the move, drawing the Danes after him. His patrols halted the raiding parties: hunger assailed the Danish army. Now Alfred began a long series of skirmishes -- and within a month the Danes had surrendered. The episode could reasonably serve as a unique epic of royal espionage!

小伦(周杰伦饰)与父亲(黄秋生饰)相依为命，父亲是淡江艺术中学的音乐老师，小伦自小在他的熏陶下，拥有非凡的音乐才华。这天是小伦转读淡江艺术中学的第一天，当他跟着同学小依(曾恺玹饰)参观校园时，突被一段神秘的钢琴乐曲吸引。小伦随着琴音引领，走进一间百年琴室，发现弹琴者是一位清秀脱俗的女生小雨(桂伦镁饰)，两人虽然没有交谈，但在四目交投之间，双方都泛起微妙的感觉...（ download小伦与小雨的四手联弹

http://www.zshare.net/audio/4247607b76ea23/  ）

《不能说的秘密》虽然有明显受《海上钢琴师》（见：http://alexander1983drlluo.spaces.live.com/blog/cns!96E45BB15B4ECE9A!599.entry）影响的痕迹，但里面的“双人斗琴和四手联弹”却别有新意，引人入胜。当然，very romantic indeed...看完当晚，心潮澎湃，半夜1点坐在钢琴面前，踩着消音，伏键良久。。。

A 50-year-old man had a 30-year history of end-stage renal disease. After a second renal transplant failed 8 years ago, the patient began to undergo dialysis through a left brachiocephalic arteriovenous fistula, which became severely aneurysmal over the next 6 years (Panel A). The patient underwent an elective resection of the arteriovenous fistula, owing to the possibility of life-threatening hemorrhage if the fistula continued to increase in size. The surgical result was satisfactory (Panel B). A subsequent arteriovenous fistula was created in his contralateral arm, progressed in a similar manner over the next 18 months, and also required surgical resection. For the past 12 months, the patient has undergone hemodialysis through a third arteriovenous fistula that is currently nonaneurysmal.

Advanced Seconds---《新概念》个人记录

 

原磁带录音：2分18秒

个人朗读记录：1分 18 秒

Advanced Sec：60秒

download my record at http://www.zshare.net/audio/41882977e97c43/

infection or non-infection cause 

Become pregnant 

         ↓     （Reproductive Dept./ Infertility Clinic.)

 Embryo/Fetus          

         ↓                (Obstetric Dept.）

     Delivery

         ↓

   Infant/child   

         ↓                 (Paediatric Dept.)

   youth/adult

     ↓      ↓      

     ↓    Female       (Gynecology Dept.)

     ↓

   Male               (Sexual Dysfunction Clinic.)

         ↓

      Elderly            (Aged ill expert clinic)

      ＾＾＾

(Internal Medicine/Surgery/Dermatology

/Dentistry/Ophthalmology...)

Advanced Seconds---《新概念》个人记录

 

原磁带录音：2分18秒

个人朗读记录：1分 18 秒

Advanced Sec：60秒

download my record at http://www.zshare.net/audio/41069626faa5c4/

Medical Insight （October 7^th, 2007）

Self-made Audio Programme 15 (本人原声)

you can download this audio material at

http://www.zshare.net/audio/40634939e0fd95/

 

Welcome to Medical Insight October 7th, 2007, I’m Dr. Alex Roy. Cough is one of the most common symptoms for which patients see their primary care physicians. The differential diagnosis for cough is broad, and encompasses disorders that range from those that are relatively benign to those that are potentially life threatening. The duration of cough at the time of presentation is a useful first step toward narrowing the differential diagnosis. This case describes an important but often overlooked cause of cough.A 73-year-old man presented to the emergency department with a 4-day history of nonproductive cough that worsened at night. He did not have fever, nasal congestion, sore throat, hemoptysis, chest pain, or dyspnea. The patient had a history of coronary artery disease, hypertension, and possible aortic stenosis. He reported none of his medications had been started recently. His vital signs were normal, and the chest X-ray was normal. The emergency department physician thought the patient’s cough was probably related to the use of Lisinopril(赖诺普利) and advised that the drug be replaced with an Angiotensin Receptor Blocker. One week later, the patient returned to the clinic and reported that, despite the change in medication, the cough had worsened. It was present throughout the day but remained particularly bothersome at night and disrupted sleep. One week later, pertussis was reported to have been isolated from the nasopharyngeal specimen obtained at the previous clinic appointment. The patient was treated with oral erythromycin(红霉素) for 14 days, and final diagnosis: Pertussis Infection

Advanced Seconds---《新概念》个人记录

 

原磁带录音：2分11秒

个人朗读记录：1分 12 秒

Advanced Sec：59秒

download my record at

http://www.zshare.net/audio/40303453c03485/

Advanced Seconds---《新概念》个人记录

 

原磁带录音：2分21秒

个人朗读记录：1分 21 秒

Advanced Sec：60秒！

download my record at

http://www.zshare.net/audio/40075474692591/

Medical Insight （October 3^rd, 2007）

Self-made Audio Programme 14 (本人原声)

you can download this audio material at

http://www.zshare.net/audio/3990238cc7b188/

 

Welcome to Medical Insight October 3rd, 2007, I’m Dr. Alex Roy. To end-stage kidney failure patients, uremia can be a big problem. A review article from Stanford Unversity School of Medicine well organized the relation between unremia and dialysis. Today the term “uremia” is used loosely to describe the illness accompanying kidney failure that cannot be explained by derangements in extracellular volume, inorganic ion concentrations, or lack of known renal synthetic products. We now assume that uremic illness is due largely to the accumulation of organic waste products, not all identified as yet, that are normally cleared by the kidneys. The features of uremia identified in patients with end-stage kidney failure may be present to a lesser degree in people with a glomerular filtration rate (GFR) that is barely below 50% of the normal rate. However, early symptoms of uremia, such as fatigue, are nonspecific, making the condition difficult to identify. At present, moreover, we can slow progression to kidney failure but can treat uremia only by replacing kidney function. Current treatment with dialysis carries a high price and leaves a persistent burden of disability. Although both the side effects of dialysis and the coexisting conditions in patients receiving this treatment contribute to the residual illness, retained solutes that are poorly cleared by standard treatment are still an important part of the problem. In this review the pathogenesis and cause of uremia is considered.

Advanced Seconds---《新概念》个人记录

 

原磁带录音：2分21秒

个人朗读记录：1分 21 秒

Advanced Sec：60秒！

You can download my record at

http://www.zshare.net/audio/3968191c642eeb/

Advanced Seconds---《新概念》个人记录

 

原磁带录音：2分23秒

个人朗读记录：1分 21 秒

Advanced Sec：62秒！

download this record athttp://www.zshare.net/audio/393773740d3c6a/