英语段落翻译

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.

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 lesions.Although 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 diagosis.Soon 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 ESRD.Once the seratinine rises (reflecting an approximately 50% decline in GFR),ESRD develops in most patients within 10years.This course is highly variable,however,particularly in type 2 diabetics,who may exhibit moderate proteinuria for several years without a substantial deterioration of renal function.Asimple but useful method of monitoring progression to renal failure is to plot the reciprocal of the serum creatinine as a function of time.This technique allows better assessment 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