最新丘吉尔---英文PPT课件PPT.ppt 86页

丘吉尔---英文PPT WinstonChurchill,wasbornonNovember30,1874,WinstonChurchill,Britishroyalfamily,noblegraduatedfromtheroyalmilitaryacademy.WinstonChurchillformasteringEnglishwordsinthehistoryofvocabularyisoneofthemost(onehundredandtwentythousand).BytheAmericanmagazine"show"overthepastcenturytheworldthemostcompellingoneoftheeightspeakers.In2002,theBBChadaknownas"thegreatest100britons"survey,WinstonChurchillwaselectedasoneofthegreatestBritish.WinstonChurchill LittleChurchillWinstonChurchill‘sfamilybackground:ChurchillwasbornintothearistocraticfamilyoftheDukesofMarlborough(abranchofSpencerfamily).Hisfather,LordRandolphChurchill,wasacharismaticpoliticianwhoservedasChancelloroftheExchequer;hismother,JennieJerome,wasanAmericansocialite.Asayoungarmyofficer,hesawactioninBritishIndia,theSudan,andtheSecondBoerWar.Hegainedfameasawarcorrespondentandwrotebooksabouthiscampaigns. DefeatedbyE.D.MorelatDundeein1922GeneralElectionSuccessfullyelectedtorepresentEppinginthe1924GeneralElection1924--StanleyBaldwin,theleaderofthenewConservativeadministration,appointedChurchillasChancelloroftheExchequer（英国财政大臣）In1929-1931Politicalisolationknownasthe“wildernessyears“ 1939--againappointedtheFirstLordoftheAdmiralty（再次任命为英国海军大臣）1940--becamethePrimeMinister（成为了首相）1945--hebecameLeaderoftheOpposition.(AftertheConservativePartylosttheelection)（他成为了反对党领袖。(保守党失去了选举后)1951--heagainbecamePrimeMinister（他又成了总理）1955--resigned（辞职）1955—1964HeremainedaMemberofParliamentwhenhedidnotseekre-election.（他仍然是一个国会议员时,他不寻求连任。） ChurchillwithhisV Hewasregardedasoneofthegreatestwartimeleadersofthepastcentury,heservedasPrimeMinistertwice(1940–45and1951–55).Anotedstatesmanandorator,ChurchillwasalsoanofficerintheBritishArmy,ahistorian,awriter,andanartist.HeistheonlyBritishprimeministertohavereceivedtheNobelPrizeinLiterature,andwasthefirstpersontobemadeanHonoraryCitizenoftheUnitedStates.achievements 1953NobelPrizewinner,participatedin1940-1945andagainfrom1951to1955yearsduringBritishprimeminister,isrecognizedtwiceWinstonChurchill"sstatueAsthe20thcenturymostimportantpoliticalleaders,oneoftheleadingUKwonthesecondworldwar"svictory WinstonChurchillwasanaccomplishedartistandtookgreatpleasureinpainting,especiallyafterhisresignationasFirstLordoftheAdmiraltyin1915.Hefoundahaveninarttoovercomethespellsofdepressionwhichhesufferedthroughouthislife.AsWilliamRees-Mogghasstated,“ Churchillwasalsoaprolificwriterofbooks,writinganovel,twobiographies,threevolumesofmemoirs,andseveralhistoriesinadditiontohismanynewspaperarticles.HewasawardedtheNobelPrizeinLiteraturein1953"forhismasteryofhistoricalandbiographicaldescriptionaswellasforbrilliantoratoryindefendingexaltedhumanvalues".TwoofhismostfamousworkTheSecondWorldWarandAHistoryoftheEnglish-SpeakingPeoples; ChurchillatthewarHissteadfastrefusaltoconsiderdefeat,surrender,oracompromisepeacehelpedinspireBritishresistance,especiallyduringthedifficultearlydaysoftheWarwhenBritainstoodaloneinitsactiveoppositiontoAdolfHitler. Churchillwasparticularlynotedforhisspeechesandradiobroadcasts,whichhelpedinspiretheBritishpeople.HeledBritainasPrimeMinisteruntilvictoryoverNaziGermanyhadbeensecured. ThefirstpersontobecomeanHonoraryCitizenoftheUnitedStates.1953,ChurchillwasawardedtheNobelPrizeforLiterature.1953,QueenElizabethIIconferredon（授予）himthedignityofKnighthoodandinvestedhimwiththeinsigniaoftheOrderoftheGarterThelargeststatefuneralHonors CharacterevaluationChurchillcalledprophet,inventor,strategist,anddiplomat.Hewasintheearly30sofsomemajortechnicaldevelopmentinthefuturewarseelaterbecameareality;Withhisextraordinarystrikingsensitivityandgreatcourage,riskingpacifistwavepressureand"politicallyalmosthavebeeneliminateddanger",adayalsodon"tgiveuptheChinesewarofpropheticwarnings,makementalpreparationpreparedbytheBritishwarcomes.. Heinwithradarreconnaissanceplanesmethodwasputforwardfouryearsbeforetheformaluseresearchonthisquestion.Fornavalforceforimprovementandconstructionof"landline",makethewheeledarmoredcarsbecamepowerfulmoderntanksandreveredasthe"father"oftanks. Hepresidedoverdevelopedmanystrategicplaninthesecondworldwar.Hepersonallyit.thisisproducedatthetime,andevenaroundtheworldpoliticalpatternoftheAnglo-Americanrelationship FormerBritishprimeministerWinstonChurchilllikecigars.Cigarsalmostalongwithhispoliticalcareer.Relevantpicturesofhim,aprominentfeatureishethatbigfacefatmouth,firmlycontainingabigcigar. funeralChurchill"sfuneralwasthelargeststatefuneralinworldhistory,withrepresentativesfrom112nations;onlyChinadidnotsendanemissary.OnlyIrelanddidnotbroadcasttheserviceliveontelevisioninEurope,where350millionpeoplewatched,including25millioninBritain.BydecreeoftheQueen,hisbodylayinstateforthreedaysandastatefuneralservicewasheldatStPaul"sCathedralon30January1965. Thankyou EliminatedDisease推测：死灰复燃！事实： 结核病Tuberculosis 病因清楚---------结核菌1882年，RobertKoch发现结核菌治有办法---------抗痨药1940s，INH、RFP、PZA的使用防有措施---------卡介苗1920s，BCG的应用▲▲▲ Eachyear,therearemorethan6.5millionnewcasesoftuberculosis.Morethan2milliondeathsfromtuberculosisworldwide.Tuberculosisistheseventhmostimportantcauseofglobalmortalityanddisability-----WHO1997 简介我国3.3亿人感染过结核600余万结核病人0~14岁小儿结核病感染率9.6% 简介Onethirdofworld"population,2billionpeople,areinfectedwithM.Tuberculosis.InfectionratesarehighestinSoutheastAsia,China,India,Africa,andLatinAmerica.------------16thNelsontextbookofpediatrics 简介3月24日世界结核病日 WorldTBDay24March2001"DOTS-TBcureforAll""DOTS:untraitementantituberculeuxpourtous" 什么是小儿结核？是一种慢性传染病，感染结核菌所致。全身各个脏器均可受累，但小儿时期以原发性肺结核最为常见. 病因 结核杆菌（Mycobacteriumtuberculosis）属分支杆菌属，革兰染色阳性，具抗酸性，抗酸染色为红色---抗酸杆菌。对人类致病的主要为人型和牛型，其中，人型是人类结核病的主要病原体。本菌在固体培养基上生长缓慢，37℃培养4~8周后始能观察结果。 病因传播途径：主要传播途径为呼吸道少数经消化道皮肤和胎盘亦可传播，罕见 病因传播途径：小儿常见的传播源为家庭成员、密切接触的亲属、保姆、邻居，尤其是辅乳期母亲患开放型肺结核。 发病机制 发病机制机体免疫功能，尤其是细胞免疫细菌数量、菌群和毒力是否发病，取决于： 发病机制----------细胞免疫结核杆菌进入体内（胞内寄生）致敏T淋巴细胞（细胞免疫，4~8周）释放cytokines/lymphokines激活巨噬细胞吞噬和杀灭结核杆菌 免疫反应变态反应同一细胞免疫免疫过程中的两种不同表现发病机制----------细胞免疫 发病机制----------体液免疫结核抗体（PPD-IgM、IgG）不具有保护作用具有辅助诊断价值 发病机制----------遗传因素人种HLA单卵双生儿 诊断 诊断--------病史性别：女性多见，尤成年人年龄：~5岁，多见5~14岁为“favoredage” 诊断--------病史结核中毒症状结核接触史卡介苗接种史既往病史 诊断--------病史结核中毒症状低热、盗汗、乏力、食欲减退、消瘦等 诊断--------病史结核接触史尤其是开放性肺结核接触史。年龄愈小，意义愈大。 诊断--------病史卡介苗接种史询问预防接种史检查卡痕 诊断--------病史既往病史既往结核病史近期有无急性传染病史：麻疹、水痘等结核过敏症状：疱疹性结膜炎、结节性红斑、一过性关节炎 诊断--------症状和体征因病而异 诊断--------辅助检查病原学诊断结核菌检查（查痰液、胃液等） 诊断--------辅助检查病理学诊断淋巴结穿刺液涂片组织活检纤维支气管镜检查 诊断--------辅助检查免疫学诊断结核菌素实验结核菌素接种后，多长时间观察结果？接触结核后，多长时间结素试验出现反应？ELISA实验（PPD-IgM、IgG） 诊断--------辅助检查分子生物学技术PCR探针杂交X线和CT检查 早期诊断最为重要。诊断不单是发现病灶，还须决定它的性质，范围和是否排菌，从而确定其活动性，作为预防和治疗的根据。 原发型肺结核PrimaryPulmonaryTuberculosis 结核病的临床分型（我国，1978年）Ⅰ型：原发性肺结核Ⅱ型：血行播散型肺结核Ⅲ型：浸润型肺结核Ⅳ型；慢性纤维空洞型肺结核Ⅴ型：结核性胸膜炎 定义原发型肺结核为结核菌初次侵入肺部后发生的原发感染。原发型肺结核是小儿肺结核的主要类型，占儿童各型肺结核总数的85.3%。 病理改变病变部位：肺上叶底部和下叶上部，右肺较多见。 病理改变渗出：炎症细胞、单核细胞、纤维蛋白为主要成分增殖：结核结节、结核性肉芽肿坏死：干酪性坏死基本病变： 病理改变特征性病理改变：上皮样细胞结节、Langerhans细胞浸润 病理转归吸收好转进展恶化 病理转归吸收好转：病变吸收，钙化或硬结（隐伏或痊愈）出现钙化提示病变至少有6~12个月 病理转归进展：原发灶扩大，产生空洞；支气管淋巴结周围炎，形成淋巴结支气管瘘，支气管内膜结核或干酪性肺炎；支气管淋巴结肿大，造成肺不张或阻塞性肺气肿；结核性胸膜炎。 病理转归恶化：血行播散，粟粒性结核病 临床表现起病情况：多缓慢起病或隐匿起病婴幼儿可急性起病结核中毒症状：营养不良：体重不增、生长发育障碍结核过敏症状：肺部表现：痉挛性咳嗽、喘鸣 体征浅表淋巴结肿大，尤以颈部明显肺部体征：多无明显体征叩诊可为浊音听诊呼吸音减低听诊少许湿罗音 诊断病史临床表现结合菌素实验血清学检查（ELISA方法）X线检查纤维支气管镜检查 诊断X线检查原发综合征：原发病灶淋巴管炎淋巴结炎呈典型哑铃状双极影 原发综合征：哑铃状双极影 诊断X线检查支气管淋巴结结核炎症型结节型微小型 支气管淋巴结结核：肺门影增浓 无细菌培养条件下小儿肺结核的诊断标准①有与成人结核、尤其开放结核接触史；②持续两周以上的咳嗽，抗生素治疗有效；③结素试验阳性：无卡介苗接种史者>10mm有卡介苗接种史者>15mm④符合肺结核诊断的X线征象；⑤抗结核治疗有效（两个月后体重增加10%以上，症状好转）。---------具有以上两点或两点以上条件 判断小儿结核病具有活动性的参考指标①结素试验≥20mm；②<3岁、尤<1岁未种卡介苗结素试验阳性；③有发热及其他结核中毒症状；④找到结核菌；⑤胸片显示活动性原发性肺结核改变者；⑥血沉增快而无其他原因可解释者；⑦纤维支气管镜检显示明显支气管结核病变 治疗 WorldTBDay24March2001"DOTS-TBcureforAll""DOTS:untraitementantituberculeuxpourtous" DOTSDirectlyObservedTreatment,Short-course直接督导下的短程化疗 儿童原发性肺结核的短程化疗方案①药物敏感者：2HRZ/4HRor9HR②药物耐受者：治疗开始阶段，使用三种以上的杀菌药物INH-resistant:9REZRFP/INH-resistant：HREZ/9HRE(9H3R3E3) 最坏的治疗是单一用药标准化疗方案：2HRZ/4HR或9HR；推荐日剂量顿服提倡直接督导下服药。原发性肺结核治疗的注意点： 临床病案男孩，3岁无明显不适颈部有“砣”、“肿块”平素容易感冒体查：除颈部淋巴结增多、增大，无明显阳性体征辅助检查：？ 结核感染 由结核菌感染引起的结核菌素试验阳性和（或）血清PPD-IgM抗体或IgG抗体阳性，而全身找不到结核病灶者，称为结核感染。 Childrenwithasymptomatictuberculousinfectionreactivetuberculinskintestnormalchestradiographnormalphysicalexamination 治疗：6~9个月的INH或6~9个月的INH+RFP（EMB）目前：3个月INH+RFP2个月INH+RFP+EMB