PartⅣ Supplementary Practices
Unit 10 New Orientations in Medicine 医学发展新方向
PartⅠ Translation of the Texts
Text A
医学发展新方向
概述
现在越来越明显的是，生物医学正步入最让人兴奋的发展阶段。转化医学概念的出现代表了生物医学研究模式的转变。纳米科学和纳米技术在医学中的应用具有巨大前景。同时，基因组学的发展使医疗实践发生了革命性的变化，让个性化医疗成为可能。最后，“一体化健康”理念有利于更好地理解和解决当前人类、动物和环境领域的一体化融合所面临的健康问题。
转化医学
转化医学不是生物医学的传统学科，但是，它已经成为制药行业和学术界广泛使用的一个流行术语。转化医学的概念是对以下观察到的情形所做的反应：临床前期研究和临床应用渐行渐远，两者间几乎没有跨界转化。转化医学应方便新药品、新医疗器械、新诊断技术实现从临床前期研究到人类应用的无缝衔接，从而有助于促进生物医学从“实验室到临床”的创新。转化医学的同义词包括“实验医学”“发现医学”和“临床医学发现”。临床药理学中涉及药品的方面与转化医学有很多共同特点。
医学知识库呈几何级数增长，但这并没有反映新的治疗方法的大量涌现。很多大病仍有无法满足的医疗需求。例如，冠心病的风险虽然可以降低，但是依然有很多病人在接受“充分”治疗后死于该疾病。还有很多如反复感染、某些癌症、阿尔茨海默病等疾病尽管有控制病情的希望，但是根本无法治愈。特别值得注意的是，制药行业一方面不断抱怨飙升的研发成本，而另一方面新药获得监管许可的通过率稳步下降。学术界及其公共赞助商们也在纠结，为什么在试管和实验动物上获得的研究成果（如转基因学）对现实的医疗实践活动影响如此之小。为了应对政治上/公众对更好治疗方法的需求，药品监管部门如美国食品药品监督管理局已经着手处理该问题。
虽然，“转化医学”一词当前非常时髦，但是就实际内容而言，它既空洞又模糊。事实上，它反映了人们的一厢情愿，而这些人对这个概念所知甚少，只是简单地用它来表述医学应该发展的方向。任何一种新药的发现和开发如果遵循从试管到动物试验再到人类应用这一传统路线的话，该药必定或多或少经历了有效的转化过程。因此，转化医学是所有尝试利用新方法来治疗人类疾病的生物医学学科所“发明的”（虽然不这样称呼）。显然，这个过程历时已久，而且历史文献记载了很多转化过程的例子，如弗莱明在实验室培养皿里观察到的真菌抑制细胞生长这一现象转化成了临床上使用的青霉素。
纳米医学
纳米科学和纳米技术正在缩小我们对物体分子水平特征和大体特性认识上的差距。这一过程对理解和改变世界有着巨大的意义。随着纳米科学和纳米技术在基础医学、转化医学和临床医学研究领域取得更多进展，人们期望纳米医学这个领域将发展壮大。
人们将纳米化的材料用于医学领域有多方面的原因。减小粒子的大小能够增加纳米晶体和乳剂相互作用的面积，从而增加亲水性药物和疏水性药物的溶解度。脂质体、聚合物、表面增容纳米微粒、树枝状大分子和其他小泡通常能够提供更大的有效载荷，表面的化学修饰可适应受体特异性靶向部分。
功能性纳米器件和多功能纳米器件是根据不同的功能需求组装而成。医学纳米器件需满足以下几个关键基本要求：在体液中必须稳定、无毒、生物分布合理、药代动力行为具有可预见性且效果理想并且没有显著的免疫原性。
个体化医学
基因组分析时代让个体特性成为人们关注的焦点。“个体化医学”这一术语源于基因组结构研究、基因测绘和DNA测序，它强调患者之间的遗传差异。药物基因组学在寻求新的生物目标时已经举足轻重，已被用作设计新药和新疫苗的工具。在某些领域（如艾滋病和肿瘤学），基因测试已成为常规的临床实践。有了分子诊断方法和遗传多态性的生物信息学分析，人们能更多地对疾病进行分子水平的分类、对疾病特异性风险进行评估以及对靶向治疗的开发。
然而，个性化医学的初次应用却是在一些罕见的疾病上。对于那些人群中最常见的疾病，转化医学相对来说还没有丁点起色。因此，传统的基因组学必须拓展领域，可借助基于生物标记物的创新“组学”（如转录组学、蛋白质组学和代谢组学）和个性化医学的一些起步点，例如再生医学中的干细胞治疗、利用快速成型技术来生产量身定制的假体和植入物，以及利用自我管理风险算法来进行组织工程或个人健康规划。
一体化健康
虽然“一体化健康”是个较新的术语，但这个理念早已在国内和国际上得到认可。从19世纪以来，科学家们就已经注意到人类和动物疾病过程之间的相似性，但是一直到20世纪，人类医学和兽医学才完全分开。近几年来，由于一些重要人物的支持和一些重大的事件原因，一体化健康理念在公共卫生和动物健康领域得到了越来越多的认可。一体化健康认为人类健康与动物健康和环境息息相关。
有很多例子可以证明人类健康与动物健康和环境之间的联系。例如，动物可以将一些疾病传播给人类，这些疾病称为人畜共患病，狂犬病、沙门氏菌感染和西尼罗河热等就是此类例子。
与人一样，动物也对一些疾病和环境危害有易感性。因此，它们可以作为人类潜在疾病的早期预警信号。例如，在人类感染西尼罗河病毒之前，经常会有很多鸟类死于该病。
近年来，因为许多因素的作用，人类、动物和环境之间的相互作用发生了改变，一体化健康变得更为重要。这些变化导致了很多新现疾病和再现疾病。公共卫生干预措施的成功需要人类卫生、动物健康和环境各方面的共同合作。
Text B
医学的未来即今天
华尔街日报
在我们这个及时行乐的时代，医学界就像一个局外人，有点格格不入。把一个有意义的医学发现变为一种有效的治疗方法往往要花上10年甚至更长时间。
然而，就在这个时断时续、时好时坏、最终更上一层楼的过程中，我们获得了能够改变医学发展进程的深刻见解和科技进步。
10年前，人类基因组计划大功告成，这激发了人们的乐观情绪，认为治愈衰竭性疾病的良方就在眼前。目前，良方基本上依然难求，但我们能够以更低的成本和更快的速度来绘制人类DNA图谱，这能够获得大量关于引起疾病的基因方面的数据。一批病人正从中受益。在其他方面，科学技术让病人掌握了更多主动权。同时，研究人员正在研究如何通过人体自身修复和生长能力来与疾病做斗争。
从癌症治疗到医学新手段再到基因疗法，以下为改变我们防治疾病方式的六大医学创新。
心脏生长术
波士顿儿童医院的外科医生已经找到了一种方法，利用人体自身修复和生长的能力来帮助先天只有一半心脏的儿童长出完整的心脏。
美国每年大约有1 000个婴儿出生时患有左心发育不全综合征，它是由一种基因异常所致。患儿的左心室无法正常工作，而左心室是心脏的主要泵血腔室。如果不进行手术修复，这种缺陷几乎是致命的。
该病的标准治疗方案是连续3次心脏直视手术，重建血液循环通路，让右心室能把血液泵至人体器官和四肢。但是，30%或以上的患者无法活至成年。
在外科医生斯塔拉姆·艾玛尼的主持下，他和同事们设计出一套复杂的新的治疗方案，打开阻塞的瓣膜，修复其他畸形，引导血液流向左心室而不是绕道而行，这将触发促进心脏生长的生物过程。
过去10年里，他们精心挑选了34位病人应用了该治疗方案。上个月，他们在《美国心脏病学杂志》发表文章称其中12位病人现在拥有能正常工作的左心室。其中一位9岁的亚莉克莎·兰德，她来自纽约州金斯帕克，至今依然很健康，对她的治疗早在她还在娘胎时就已开始。她的母亲罗萨玛丽亚·兰德说，亚莉克莎既能唱又能跳，还能在跑步机上走很长距离，这使医生感到非常惊讶。
新方案的主要缺点：比传统治疗方案需要平均多进行1次手术，且住院时间要长好多天。艾玛尼博士表示，它的希望在于为病人提供的长远获益将大于住院时间延长所带来的不便。
常规体检中的DNA测序
人类基因组首次测序于2003年完成，花费20多亿美元，自此DNA测序技术的速度提高了、价格降低了、准确度更高了。纳米孔测序仪的应用有望加速使基因测序成为看医生时的一个常规检查项目。
肿瘤药物针对性治疗
随着对人类基因组原理的不断了解，我们正在面临一个新的挑战：如何使用这些数据来改变疾病的发展过程。以癌症为例，通过基因测序仪发现，一些癌症是以至少十几种不同的遗传疾病呈现出来的，其中一些已被证明只对某一特定药物产生反应。那么，问题是治疗癌症的医生如何快速地针对病人的肿瘤找特效药物？
答案之一就是由基础医学公司研发的一个测试方法。这是个新成立的公司，其科技部创始人中有一个人是人类基因组计划的负责人之一。这种测试让医生通过检测一个肿瘤样本就能寻找280种导致肿瘤生长的不同基因突变。
让身体自己抗癌
在癌症治疗领域，没有比激发人体免疫系统来抵御癌症更鼓舞人心的方法了。
汤姆·斯图兹就能说明为什么这样。去年4月，这位72岁的退休律师只能坐在轮椅上苟延残喘，连吃饭这样简单动作都不能自理。他之前诊断出患有皮肤癌，并已经扩散到肺和肝脏。斯图兹说：“老实来讲，我都准备见阎王爷了。
就从4月份起，他开始服用一种名为MK3475的试验性药物。6个星期后，他开始感觉好一些。如今，斯图兹已经摆脱了轮椅，并能在洛杉矶其家附近按时行走一圈，有3.5英里。斯图兹说：“我感觉棒极了。”秋季的一次体检发现到他的肿瘤细胞已缩减了大约65%。
数十年来，癌症研究人员一直想知道为什么免疫系统通常不会把肿瘤细胞作为入侵者并加以攻击。最近，这个谜底已经被解开了一部分：肿瘤通过踩住人体免疫系统的“刹车”来保护自己。
由美国默克集团研发的MK3475是一种新药。这种药能够松开“刹车”，释放千军万马的免疫细胞来追杀癌症。不过，这种药并不是对每个人都有效。激发免疫系统可对正常的细胞造成危害。在对MK3745和类似药物的研究中，一些病人出现了与免疫反应有关的严重副作用，还有一小部分人死亡。
但人们对这种治疗方法的兴趣依然浓厚。免疫疗法让人如此激动的原因之一在于，大多数“实体”肿瘤，如结肠癌、肺癌、乳腺癌、前列腺癌，利用相同或类似的机制来躲避免疫系统的攻击。因此，阻碍这种机制有可能对各种不同的恶性肿瘤的治疗产生广泛的影响。
掌上医疗
很有可能你现在已经拥有了最普遍的医疗创新：一部智能手机。上个月，美国食品药品监督管理局（FDA）公布了iPhone的一款新加载项，让医生几乎在任何地方都能给病人做心电图检查。其他的智能手机应用程序能够帮助放射科医生阅读医学图像，让患者追踪观察身上的痣是否有发展为皮肤癌的迹象。医生说，主流的心电描记器能提供更多的信息，但iPhone版本足以满足许多日常诊断需求。
重新调整你的基因
经过多年的争论，基因疗法有望成为一种可行的选项，用以治疗多种危及生命的疾病，特别是那些由于单个基因缺陷而造成的疾病。上个月，欧盟批准了用于治疗一种罕见的基因疾病的药物阿利泼金，使之成为西方世界首个基因治疗药物。该药的批准基于一系列的研究，表明基因疗法在很多疾病中具有广泛的前景，从罕见的失明症到血友病，再到心力衰竭等。
基因疗法的诱人之处在于一种治疗方法可以通过利用正常基因来替代缺陷基因就有可能治愈一些致命的疾病。治疗过程包括将一个正常的基因嫁接到已经失活的病毒片段上，然后把基因运输到细胞的细胞核内以取代缺陷基因。
PartⅡ Key to the Tasks
Task 10.1
Across
2.trans-
6.hydro-
7.onco-
10.nanoscience
11.liposome
12.poly-
Down
1.dendr-
3.re-
4.nano-
5.philic
8.oncology
9.-less
Task 10.2（No key)
Task 10.3
1.seamless transition；preclinical research；human applications
2.stabile；biodistribution；pharmacokinetic behavior；immunogenicity
3.genetic differences
4.the health of animals and the environment
5.early warning signs；susceptibility
Task 10.4
Task 10.5
1.D 2.C 3.C 4.A 5.B 6.C 7.B
Task 10.6（No key)
Task 10.7
1.biopharmaceutical research and development
2.socialize and use technology
3.detect your blood cholesterol
4.sensors and chips built into them
5.across all disease areas
6.tailored to the type of mutation
7.a metabolism analysis and a protein analysis
8.repair and replace lost or damaged tissue
9.the cells seeded from the patient
10.a very small orphan disease
11.targeted to the right tissue
12.an implantable pump
13.at molecular and cellular levels
14.increase to over$500 billion and$363 billion
15.innovative medicines becoming more accessible to patients
16.innovative medicines being delivered to patients
Task 10.8
1.biomedical
2.translational
3.shift
4.nanotechnology
5.individualized
6.contemporary
7.address
8.academia
9.preclinical
10.applications
11.seamless
12.bedside
13.experimental
14.unmet
15.cost
16.close
17.particle
18.hydrophilic
19.hydrophobic
20.modification
21.multifunctional
22.requirements
23.genomic(https://www.daowen.com)
24.diagnostic
25.bioinformatic
26.targeted
27.therapy
28.regenerative
29.zoonotic
30.reemergence
31.setbacks
32.anomaly
33.open-heart
34.ventricle
35.adulthood
36.long-term
37.challenge
38.mutations
39.wheelchair
40.release
41.cells
42.electrocardiogram/ECG
43.life-threatening
44.gene-therapy
45.failure
PartⅢ Script of the Audiovisual Material
The Future of Healthcare：Where Will We be in 2023
It is difficult to predict what we might be doing in biopharmaceutical research and development in the future,but let's think about some of the types of things we might doing by 2023：intelligent medicines,personalised healthcare,regenerative medicine,gene and Oligo-based therapy,drug delivery systems,and finally the global marketplace.
Int6llig6nt M 6dicin6s
What does intelligent medicines mean？Well,if you think about it,72%of the global population currently have mobile phones.Then consider how many people around social media platforms like Facebook,and how we use websites like Amazon and Google,there is huge opportunity in the way we socialize and use technology today that the healthcare industry could utilize.We already know that,with things like pacemakers and diabetes care,there are remote ways of monitoring cardiac function and blood sugar levels,which is having a dramatic impact in terms of reducing hospitalization rates,but imagine what would happen in a world where your pill had a sensor on it and could detect your blood cholesterol or your blood sugar or your pulse,and could send a message to your smart phone or directly to your physician about whether you need to increase or decrease your dose.This is not beyond the realms of the reality.Pills and medicines are starting to have these types of sensors and chips built into them.2023 may be a little soon.But over the next two decades,it is likely that we will start to see some of these technologies manifesting themselves in the marketplace.
P6rsonalis6d H6althcar6
Great strides have been made in the oncology space with respect to personalized healthcare,but more can be done across all disease areas.There are companion diagnostics now being approved by regulators.And we are starting to see panels of diagnostics being used.This will mean at the start of diagnosis a panel of tests can be performed,so that therapy can be tailored to the type of mutation and make for the better prognosis.This approach will become more commonplace as it becomes more familiar with physicians.We will start to see it being adopted in the emerging markets as well.In the long term,we could see a time when physicians don't just run a genome analysis but also a metabolism analysis and a protein analysis to get a really thorough understanding of what is driving the disease.This could be done using a number of different techniques via a small chip that will give physicians much better clarity at how to tailor available therapies.Although a potential challenge will be the management of the large quantity of data generated from such devices.
R6g6n6rativ6 M6dicin6
Regenerative medicine is to repair or,more accurately,help the body repair and replace lost or damaged tissue rather than to just destroy or remove the damaged or diseased tissue or to replace it with nonbiological materials.There are already heparin sulfate analogues that are being used for wound healing.And scientists today can,for example,make trachea out of the cells seeded from the patient.One of the first stem cell drugs has been approved for graft-versus-host rejection,and there are more stem cell therapies entering clinical development right now.This is a dramatically changing research and also how regulators have to think.This is a whole new space.We have to start developing cells now and growing cells consistently in order to make the regulators comfortable with that consistency and also to think about how we are going to make these therapies commercially viable and available around the world.There are a lot of very complex issues to deal with,but our understanding of how to use stem cells is growing year by year.And we'll start to see stem cells being used in regenerative medicine in the cardiovascular space for heart disease,and to regenerate pancreas and other organs.This is a space to watch but there will be a lot of complexity from regulatory perspective going forwards.
G6n6 and Olig-bas6d Th6rapy
Let's look at genomics and gene-based therapies.Gene therapy has long been seen as a promising way to treat numerous diseases.But it was only in 2012 that EU granted the first regulatory approval of a drug for a very small orphan disease.It will likely be a long time before regulators get comfortable with the risk-benefit ratio for gene-based therapies.However,as the regulators get more comfortable with this approach,it will be easier for the researchers to move these therapies forward.There are now multiple Oligonucleotideplatform-based therapies.With compounds in development that are showing evidence and proof of mechanism,these Oligonucleotide DNA-based therapies are now entering clinical development and getting to patients.The challenge in the future will be to develop delivery vectors that allow efficient entry into a cell and for them to be targeted to the right tissue.
Drug D6liv6ry Syst6ms
Imagine if it is possible to have an implantable pump,the size of a matchstick,to deliver medication for the diabetes patients for a year.Those are the kinds of pumps and devices that we are starting to see now and they can really transform the quality of life of the patients.We are also now starting to see nanomedicines that detect changes and problems at molecular and cellular levels and begin to treat them before the expression of the traditional symptoms.There are early examples from a number of device companies around the world,and ultimately these highly targeted therapies will help with risk-benefit profiles and the ability to treat difficult diseases.
Finally,Global Mark6tplac6
The geography of biopharmaceutical business is going to continue to change.Look at what's happening in China and Brazil.The middle classes are growing,and healthcare spending in these regions is going to increase to over$500 billion and$363 billion respectively in these two countries alone.As developing countries develop further,we will start to see a shift away from just thinking about the developing world and much more business being done with innovative medicines becoming more accessible to patients in these areas.And of course,with the aging population,there is a rise of chronic diseases such as Alzheimer's and cardiovascular disease.And so the unmet need is to going to remain high around the globe in terms of innovative medicines being delivered to patients.
The next couple of decades will be very exciting,and we expect to see great advances in healthcare.
PartⅣ Supplementary Practices
Practice 10.1 Terminology
Choose the best for each of the following.
1.The suffix-less as in seamless means________.
A.with B.without C.inside D.outside
2.Liposome can be defined as“a particle formed by________”.
A.muscles B.enzymes C.proteins D.fats
3.Oncology is the scientific study of________.
A.kidney B.eye C.liver D.tumor
4.The prefix poly-as in polymorphism is close in meaning to________.
A.mono- B.multi- C.meta- D.micro-
5.________medicine aims to facilitate new therapies and medical procedures by implementing the findings in basic research in patient care.
A.Translational B.Transcriptional C.Transitional D.Transformational
6.We are at the forefront of a new medical research________that is focused on the individual rather than the collective.
A.parallel B.paradigm C.parasite D.paralysis
7.Examining clinical variation in medical________is an important step to measuring efficiency and effectiveness in care delivery.
A.practice B.behavior C.activity D.action
8.Health information technology is increasingly being applied to_________communication between health care provider and caregiver of pediatric patients.
A.accumulate B.deliberate C.facilitate D.obligate
9.Like many life-threatening diseases,brain tumors originate from altered biological processes at the________level.
A.articular B.reticular C.molecular D.particular
10.The________of the drug should be thoroughly studied by means of single dose studies and also repeated dose studies.
A.opacity B.elasticity C.toxicity D.plasticity
11.The purpose of________is to safeguard humans and animals from illnesses and death caused by infectious diseases.
A.vaccines B.dosages C.enzymes D.proteins
12.A new study has shown that food allergies are more________in children living in urban areas as opposed to rural settings.
A.virulent B.violent C.purulent D.prevalent
13.Over the past few decades,many advances in hip replacement have been made and several types of________are available.
A.syntheses B.parentheses C.hypotheses D.prosthesis
14.Poor nutrition increases________to HIV by lowering immune function.
A.predictability B.accountability C.susceptibility D.affordability
15.Antibiotic overuse and abuse do present a（n)________to human health.
A.impact B.accident C.hazard D.complaint
16.Since my childhood I have been interested in animals and their biology,so I chose to study________medicine.
A.veterinary B.vegetarian C.visionary D.vertebral
17.The four________of the heart allow blood to pump in and out to specific locations.
A.spaces B.hollows C.chambers D.vacancies
18.Sadly,the profit motive is a root cause of the alarming increase in deaths due to________medication errors.
A.dental B.fatal C.natal D.total
19.Genetic________in human cells are thought to be one of the primary reasons for cancer initiation and/or progression.
A.mutations B.indications C.generations D.alternations
20.Cancer,also called________,is an abnormal cellular proliferation.
A.consistency B.complacency C.malignancy D.discrepancy
Practice 10.2 Translation
Translate the following into English,using the stock phrase given.
1.It is becoming increasingly clear that...……越来越清楚（P162L2）
随着医疗保健改革的继续推进，医院需要注重提高医疗服务质量，这一点越来越清楚。
2.The concept of...has developed in response to...……概念是基于……产生的（P162L13）
管理式医疗的概念是基于应对不断上升的医疗成本发展而来。
3.share many of the characteristics of...具有诸多相同特点（P163L19）
研究者们发现吸毒和酗酒与其他慢性疾病有很多相同的特点。
4.close the gap between...and...缩小……与……之间的差距（P163L45）
新通过的政策旨在缩小有保险与无保险人之间的差距。
5.have enormous significance in...对……有重要影响（P163L46）
这些食物通常对我们的健康和寿命有重要影响。
6.enter routine clinical practice进入临床实践（P164L66）
利用人体造血干细胞治疗癌症于20世纪90年代末开始进入临床实践。
7.have gained more recognition...得到更多的认可（P164L82）
在过去几十年间，安乐死已经获得了更多的认可。
8.The standard treatment is...标准治疗方案是……（P169L22）
标准治疗方案是手术切除癌症，然后进行化疗。
9.The long-term benefits outweigh...长远利益超过……（P170L36）
有机食品可能更贵，但其长远获益大于付出。
10.There's a good chance that...很有可能……（P171L79）
如果你严重超重，那么就很可能会得糖尿病。
11.After years of controversy...经过多年争论之后……（P171L86）
经过多年争论后，新疗法最终被美国食品药品监督管理局批准。
PartⅤ Key to the Supplementary Practices
Practice 10.1
1.B 2.D 3.D 4.B 5.A 6.B 7.A 8.C 9.C 10.C
11.A 12.D 13.D 14.C 15.C 16.A 17.C 18.B 19.D 20.C
Practice 10.2
1.As healthcare reform continues,it is becoming increasingly clear that hospitals need to focus on improving the quality of care delivery.
2.The concept of managed care has developed in response to the rising health care costs.
3.The researchers found that drug addiction and alcoholism share many of the characteristics of other chronic illnesses.
4.The newly adopted policy is aimed to close the gap between the insured and uninsured.
5.These foods normally have enormous significance in our health as well as influencing our lifespan.
6.The use of adult haematopoietic stem cells for the treatment of cancer started to enter routine clinical practice in the late 1990s.
7.Euthanasia has gained more recognition in the past decades.
8.The standard treatment is to surgically remove the cancer,usually followed by radiation.
9.Organic foods might be more expensive,but the long-term benefits outweigh the costs.
10.If you are substantially overweight,there's a good chance that you will develop diabetes.
11.After years of controversy,the new therapy was finally approved by U.S.Food and Drug Administration.