Thesis Topic “TACS A Tone Actuated Computer Control System.”

Vol.1, No.1, 1-3 (2013)Pain Studies and Treatment doi:10.4236/pst.2013.11001Case report: Effect of immunoglobulin on pain in Post-Polio Syndrome—Three case reportsLars Werhagen*, Kristian BorgDivision of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Danderyd, Sweden; *Corresponding Author:Received 8 February 2013; revised 11 March 2013; accepted 3 April 2013Copyright © 2013 Lars Werhagen, Kristian Borg. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.ABSTRACTStudy design: Case reports. Setting: University hospital setting. Objective: To analyze the effect of intravenous immunoglobulin on neuropathic and nociceptive pain in three patients with Post- Polio Syndrome (PPS). Materials and Methods: Three patients with PPS and pain who received treatment with 90 g IvIg are described. Results: Before treatment one of the patients had pure neuropathic pain and the other two had a com- bination of neuropathic and nociceptive pain. There was no effect on pain in the patient with pure neuropathic pain and only effect on the nociceptive pain in the patients with a combina- tion of neuropathic and nociceptive pain. Dis- cussion: Pain is one of the most common sym- ptoms in PPS. Previous studies have shown an effect on pain in PPS patients receiving IvIg. The results of the present study point to that the ef- fect on pain is limited to nociceptive pain and that there is no effect on neuropathic pain which leads to increased knowledge of characteriza- tion of responders of IvIg treatment. Conclusion: IvIg treatment treatment reduces nociceptive but not neuropathic pain in PPS patients. Keywords:Post-Polio Syndrome; Pain; Immunoglobulin Treatment1. INTRODUCTIONPain is common in patients with Post-Polio Syndrome (PPS) and is present in a majority of patients [1-5]. The pain in PPS is in most cases nociceptive to its character but when neuropathic pain is present a concomitant dis- ease must be suspected [3]. PPS patients in the western world have reached an age where concomitant neurolo- gical disorders more often occur. Thus, neuropathic pain is anticipated to increase in PPS patients the coming years. Furthermore, pain is more common among fe- males than in males and the intensity of pain according to the V AS scale, as reported by PPS patients, is often high [3,6]. In a previous study we were able to show that treatment with intravenous immunoglobulin (IvIg) was effective and reduced nociceptive pain in seven out of ten PPS patients [7]. IvIg treatment, however, is costly and it is therefore of importance to thoroughly character- ize responders for the treatment.In this case report we describe three patients with PPS and pain of different origin, neuropathic and nociceptive, who reacted differently to IvIg. Thus, this gives more information to the background of the effect of IvIg in PPS, particularly for pain, and increase the knowledge of the different clinical features of responders on IvIg.2. METHODSA description of the patients appears in Table 1. PPS was defined according to the criteria of March of Dimes [8]. Before acceptance for treatment all three patients underwent a thorough neurological and general examina- tion to confirm the PPS diagnosis. Medical investigation revealed no diagnosis constituting exclusion of treatment with IvIg in any of the patients. Immediately before and six month after treatment the patients underwent an ex- amination by the physician responsible for the treatment, one of the authors. At the same time they were inter- viewed according to a specific questionnaire about the presence of pain, its intensity, character and localization, their social and working situation, walking aids, paresis and its localization and the presence of concomitant dis- orders.Pain was classified according to the International As- sociation for the Study of Pain (IASP). A pain was clas- sified as neuropathic if present in an area with sensory disturbances to pin-prick and light touch and without relation to joint movements and/or infection. A pain wasL. Werhagen, K. Borg / Pain Studies and Treatment 1 (2013) 1-32Table 1. Gender, age at polio infection, actual age, marital and working status, pares at its localization, the use of walking aids and concomitant diseases in the three PPS patients who underwent treatment with intravenous immunoglobulin (IvIg).Patient number GenderAge atpolioAge attreatmentMaritalstatusWorkingstatusParesisWalkingaidsConcomitant disease1 Female 1 year 58 years Married Retired Legs No Cervical disc herniation2 Female 5 years 65 years Divorced Retired Legs 2 crutches Lumbar disc herniation3 Female 5 years 63 years Married Retired Legs No Polyneuropathyclassified as nociceptive when aching in an area with signs of inflammation and painful joint movements were described. The intensity of the pain was measured with the Visual Analogue Scale (V AS) 0 - 100 before and after treatment. The patients received a total of 90 g of IvIg (Xepol, Grifols, Barcelona, Spain) during three consecu- tive days.3. CASE REPORTS3.1. Case Number 1A 58-year-old married and retired woman. She con- tracted poliomyelitis at the age of one year. Initially she suffered from paresis and weakness of her left leg. She recovered and lived a normal life. Fifteen years previous to this study she experienced weakness of her legs. Neu- rological examination revealed a light to moderate pare- sis of both legs but she was able to walk unaided. She was diagnosed with PPS. In addition, she suffered from severe pain in her right arm. This pain was classified as neuropathic and the pain intensity before treatment was 80/100 (Table 2). Investigation with MRT revealed a cervical disc hernia.She had no effect on her pain after IvIg treatment and was referred to a pain clinic.3.2. Case Number 2A 65-year-old retired and divorced woman. She con- tracted poliomyelitis at the age of 5 years. She was ini- tially paretic in both legs but was, however, able to live a normal life and walked without aids. Around ten years previous to this study she became weaker in her legs and she was diagnosed with PPS. She walked with two crut- ches and for longer distances she used a wheel-chair. In 1983 she underwent surgery due to a disc hernia at L4/L5 level and was re-operated in 1993. She suffered from pain in her left leg classified as neuropathic and pain in her feet, back and arms classified as nociceptive. After treatment with IvIg the pain decreased from V AS 75 to 25. Her neuropathic pain was only slightly decreased.3.3. Case Number 3A 63-year-old retired and married woman. She con- tracted poliomyelitis at the age of 5 years. She recovered fully but 20 years previous to this study she experienced problem with balance and weakness of the legs. However, she was able to walk without aids. At the post-polio out- patient clinic she was diagnosed with PPS. 2002 she was diagnosed with polymyalgia rheumatica, and polyneuro- pathy on a vascular basis. She underwent treatment with prednisolone. When examined she suffered from a pain in her lower legs classified as neuropathic and pain in back and thighs classified as nociceptive. She had under- gone treatment with Gabapentin for her neuropathic pain without any effect. The intensity of pain according to V AS was 40 - 90/100 before and 15 - 40/100 after IvIg treatment. Six month after treatment her pain was classi- fied as pure neuropathic pain.4. DISCUSSIONThe three patients of the present study demonstrate that IvIg was effective when pain with classified as no- ciceptive but not when classified as neuropathic. In all three patients a concomitant disease was present, in two patient’s disc herniation and in the third patient the back- ground to the neuropathic pain was polyneuropathy. This point to that the effect of IvIg in PPS is not primarily directed to pain but to the background to the pain. The background for the neuropathic pain is a direct effect on nervous structures either due to an external pressure as in disc herniation or due to metabolic factors as in poly- neuropathy. However, the background for the nociceptive pain is not clear. Pain from joint and muscles is a com- mon complaint in PPS patients. However, the pain has not been analyzed thoroughly. One possible background for nociceptive pain in PPS may be inflammation. An in- flammatory process in PPS has been described both in cerebrospinal fluid and in peripheral blood [4,9-12]. IvIg has been reported to decrease the inflammatory process and in parallel a clinical effect including decrease of pain was found [4,10-14]. Furthermore, Melin et al. (K. Borg 2012, personal communication) showed an increase of prostaglandin antibodies in blood vessels of muscle in PPS patients which may be one underlying cause of muscle pain in PPS. Thus, one might speculate that the finding of the present study, a decrease of nociceptive pain as a result of IvIg treat ent, is due to the dampen-mL. Werhagen, K. Borg / Pain Studies and Treatment 1 (2013) 1-33 Table 2. Pain its character and intensity according to the Visual Analogue Scale (V AS) before and after treatment with intravenous immunoglobulin (IvIg) in the three PPS patients.Patient number Classification of pain beforetreatmentV AS before treatmentClassification of pain aftertreatmentV AS aftertreatment1 Neuropathic 80 Neuropathic80 2 Nociceptiveneuropathic 75 Neuropathic 253 Nociceptive neuropathic 40 - 90 Neuropathic 15 - 40ing of an inflammatory reaction. In order to confirm these studies with larger patient materials are required. Besides the low number of patients reported in the pre- sent study this study can be critized in other ways. The classification of pain is difficult and the patients are in age when concomitant diseases are commonly found. However, the patients were before and after treatment examined by the same physician and interviewed ac- cording to a structured questionnaire and no other con- comitant disorder was found. However, with the back- ground of the results of this and other studies it is of im- portance to further analyze pain in PPS adequately and to further develop criteria for selection of PPS for treatment with IvIg based on clinical and molecular data. REFERENCES[1]Gonzalez, H., Olsson, T. and Borg, K. (2010) Manage-ment of postpolio syndrome. The Lancet Neurology, 9,634-642. doi:10.1016/S1474-4422(10)70095-8[2]Trojan, D.A. and Cashman, N.R. (2005) Post-poliomye-litis syndrome. Muscle Nerve, 31, 6-19.doi:10.1002/mus.20259[3]Werhagen, L. and Borg, K. (2010) Analysis of long-standing nociceptive and neuropathic pain in patients withpost-polio syndrome. Journal of Neurology, 257, 1027- 1031. doi:10.1007/s00415-010-5456-0[4]Farbu, E., Rekand, T., Vik-Mo, E., Lygren, H., Gilhus,N.E. and Aarli, J.A. (2007) Post-polio syndrome patientstreated with intravenous immunoglobulin: A double- blinded randomized controlled pilot study. European Jour-nal of Neurology, 14, 60-65.doi:10.1111/j.1468-1331.2006.01552.x[5]Willén, C. and Grimby, G. (1998) Pain, physical activity,disability in individuals with late effects of polio. Ar-chives of Physical Medicine and Rehabilitation, 79, 915-919. doi:10.1016/S0003-9993(98)90087-9[6]Widar, M. and Ahlström, G. (1999) Pain in persons withpost-polio. The Swedish version of the MultidimensionalPain Inventory (MPI). Scandinavian Journal of CaringScience, 13, 33-40.[7]Werhagen, L. and Borg, K. (2011) Effect of intravenousimmunoglobulin on pain in patients with post-polio syn- drome. Journal of Rehabilitation Medicine, 43, 1038- 1040. doi:10.2340/16501977-0884[8]March of Dimes. Post-polio syndrome: Identifying bestpractice in diagnosis and care./downloads/PostPolio.pdf[9]Gonzalez, H., Khademi, M., Andersson, M., Wallström,E., Borg, K. and Olsson, T. (2002) Prior poliomyelitis—Evidence of cytokine production in the central nervous system. Journal of the Neurological Sciences, 205, 9-13.doi:10.1016/S0022-510X(02)00316-7[10]Gonzalez, H., Khademi, M., Andersson, M., Piehl, F.,Wallström, E., et al. (2004) Prior poliomyelitis—IvIg treat- ment reduces proinflammatory cytokine production. Jour-nal of Neuroimmunology, 150, 139-144.doi:10.1016/j.jneuroim.2004.01.010[11]Fordyce, C.B., Gagne, D., Jalili, F., alatab, S., Arnold,D.L., Da Costa, D., Sawoszczuk, S., Bodner, C., Shapiro,S., Collet, J.-P., Robinson, A., Le Cruguel, J.-P., Lapierre, Y., Bar-Or, A. and Trojan, D.A. (2008) Elevated serum in-flammatory markers in post-poliomyelitis syndrome. Jour-nal of Neurological Sciences, 271, 80-86.doi:10.1016/j.jns.2008.03.015[12]Gonzalez, H., Khademi, M., Borg, K. and Olsson, T.(2012) Intravenous immunoglobulin treatment of the post- polio syndrome: Sustained effects on quality of life vari- ables and cytokine expression after one year follow-up.Journal of Neuroinflammation, 9, 167.doi:10.1186/1742-2094-9-167[13]Gonzalez, H., Stibrant-Sunnerhagen, K., Sjöberg, I., Ka-panoides, G., Olsson, T. and Borg, K. (2006) Intravenous immunoglobulin for post-polio syndrome: A randomised controlled trial. Lancet Neurology, 5, 493-500.doi:10.1016/S1474-4422(06)70447-1[14]Kaponides, G., Gonzalez, H., Olsson, H. and Borg, K.(2006) Effect of intravenous immunoglobulin in patients with post-polio syndrome—An uncontrolled pilot study.Journal of Rehabilitation Medicine, 38, 138-140.doi:10.1080/16501970500441625。

A NS W E RK E YPartOne:EssayWriting1AnIntroductiontoWritingActivity(PointandSupportinaParagraph),pages5–6 Point:Therearedrawbackstomoviegoing.Support:1.Inconvenienceb.Longtimetofindparkingspotandlongwalktotheaterd.Stickyfloor3.Othermoviegoersa.Runningkidsughing,shoutingteenagersActivity(IntroductoryParagraph),81.c2.b3.a4.a.Inconvenienceofgoingoutb.Temptationsofthetheaterc.BehaviorofsomepatronsActivity(Body:SupportingParagraphs),9–101.Tobeginwith,Ijustdon’tenjoythegeneralhassleoftheevening.2.b.Parkinglotisalwaysjammedd.Ticketsmaysellout,andtheateriscrowdede.Ticketscostupto$8each3.Second,thetheaterofferstemptingsnacksthatIreallydon’tneed.4.b.2)chocolatebars3)MilkDuds5.Manyoftheotherpatronsareevenmoreofaproblemthantheconcessionstand.6.a.Littlekidsraceupanddowntheaislesb.Teenagerstalkbacktothescreen,whistle,makefunnynoisesActivity(ConcludingParagraph),101.a2.cReviewActivities,18–20Answerswillvary.2TheWritingProcessActivities(Freewriting,Questioning,MakingaList,Clustering,ScratchOutlin e),25–31Answerswillvary.Activity(WritingaFirstDraft),331.thesis5.specific2.first6.bs3.equiped(otheranswersarepossible)7.conclusion4.secondandthirdActivity(RevisingwithaSecondDraft),36–371.Second5.watchingwhatIkeepinthehousefortableseats3.unity...MyfriendsareasbadasIam.7.As4.support...snackslikeceleryandcarrot8.jumpintomyhands sticks...noicecreaminthefreezer...9.disgusted drippingwithbutter...riskpullingout myfillingsasIchewActivity(TakingaWritingInventory),39–40 Answerswillvary.Activity(Prewriting),41–43L,Q,SO,C,FActivity1(Outlining),43–451.Thesis:Myhighschoolhadthreeproblemareas.a.Students(1)Involvedwithdrugs(2)Formedcliquesb.Teachers(1)Unwillingtohelpafterclass(2)Muchtoostrictc.Buildings(1)Leakyceilings(2)Ill-equippedgym2.Thesis:Workingasadishwasherinarestaurantwasmyworstjob.a.Workingconditions(1)Heatinkitchen(2)Noisyworkareab.Hours(1)Ten-hourshifts(2)Hourschangedeveryweekc.Pay(1)Minimumwage(2)Nobonusforovertime3.Thesis:Joininganaerobicsclasshasmanybenefits.a.Socialbenefits(1)Makenewfriends(2)Meetinterestinginstructorsb.Mentalbenefits(1)Reducesmentalstress(2)Improvesself-imagec.Physicalbenefits(1)Strengthensheart(2)Tonesmuscles4.Thesis:Myfavoritetimesinschoolwerethedaysbeforeholidayvacations.a.Lighterworkload(1)Lessworkinclass(2)Lesshomeworkb.Friendlieratmosphere(1)TeachersmorerelaGed(2)Studentshappyaboutvacationc.Specialevents(1)Peprallies(2)HolidayconcertsActivity2(Outlining),45–47Thesis:Moreandmore,theinventionsofmoderntechnologyseemtobecuttingu sofffromcontactwithourfellowhumanbeings.Firsttopicsentence:Theworldofbusinessisoneareainwhichtechnologyisisolati ngus.Support:2.Workers’salariesareautomaticallycreditedtotheirbankaccounts.3.Personalbankingisbecomingadetachedprocess.a.Customersinteractwithmachinesratherthanpeople.b.Someloansareacceptedorrejectedbycomputers,notloanofficers. Secondtopicsentence:Anotherareathattechnologyischangingisentertainme nt.Support:1.Formanypeoplenow,musicisasolitaryeGperience.2.Fewerpeoplegoouttowatchmovies.Thirdtopicsentence:Educationisathirdimportantareainwhichtechnologyissep aratingusfromothers.Support:1.Studentssitaloneinfrontofcomputers.2.Studentsusesoftwareathomeinsteadofinteractingwithothers.3.Videotapesarereplacingclassinstruction.Activity(Revising),47–482,1,4,33TheFirstandSecondStepsinEssayWritingActivity(WritingaGoodThesis),50–51List1List22Teachers3BicycleslEducation4Dangersofbikeriding3MathteacherlRecreation5Myhighschoolmath2Recreationalvehicles teacherwasincompetent.5Bikeridinginthecityisa4HighschoolmathteacherdangerouseGperience.List3List41Retailcompanies3Camping2Supermarkets4Firstcampingtrip4Dealingwithcustomers2Summervacation3Workinginasupermarket5Myfirstcampingtripwasa5I’velearnedhowtohandledisastrouse Gperience. unpleasantsupermarketcustomers.lVacationsActivity(CommonErrorsinWritingaThesis),53A.1.TBB.6.22.TN7.A3.TB8.24.TN9.A5.TB10.2Activity(SupporttheThesiswithSpecificEvidence),54–55 Answersforthisactivitywillvary;apossiblethirdpointforeachoutlineislistedbelo w.1.c.Learningnewrulesandprocedures4.c.Savemoney2.c.Senseofhumor5.c.Longhours3.c.Toocoldinthewinter6.c.WorryaboutfinancesActivity(TheImportanceofSpecificDetails),57S1.Theparagraphlistsspecificprecautions:gettingapermitandbuying pressure-treatedlumber.G2.Whatkindsofthingsdidthewriterdowrong?Whatspecificruleswereenforce d?Howdidthisparentpunishthewriter?S3TheparagraphlistsspecificeGamplesofitemsthatshouldnotbeimproved: cheesecakeandjeans.G4.Whatkindsofproblemsdoesthedoghave?Howdoesthedogmisbehavewhe ntheownersareaway?Howdidtheownerstrytotrainthedog?Activity1(TheImportanceofAdequateDetails),58 AnswersaregivenintheteGtaftertheactivity.Activity(IdentifyingthePartsofanEssay),61Thesisstatement:4Topicsentenceoffirstsupportingparagraph:5 Topicsentenceofsecondsupportingparagraph:15 Topicsentenceofthirdsupportingparagraph:22 Firstsentenceoftheconclusion:34Activity1(EvaluatingThesisStatements),61–62Activity2(EvaluatingThesisStatemen ts),621.Aa.1.TNa.OKb.OKb.2.OKa.2.TNa.Ab.OKb.3.OKa.3.TNa.Ab.OKb.4.Aa.4.OKa.OKb.TNb.5.Aa.5.OKa.OKb.TNb.Activity3(EvaluatingThesisStatements),62–63Activity4(EvaluatingThesisStatemen ts),631.TBa.1.OKa.OKb.2b.2.TBa.2.2a.OKb.OKb.3.OKa.3.OKa.TBb.2b.4.TBa.4.2a.OKb.OKb.5.TBa.5.2a.OKb.OKb.Activity(CompletingThesisStatements),64 Answersforthisactivitywillvary;apossiblethirdpointofdevelopmentforeachth esisstatementislistedbelow.1.science.6.coach2.tobeenthusiastic.7.wewereemotionallyimmature.3.myboyfriend.8.manners4.money.9.myrelationshipswithothers.5.breaksdownregularly.10.the timeIdentedmyfriend’scar.Activity(WritingaThesisStatement),65Answersmayvaryslightly.1.ThecarsI’veownedhavereflectedthechangesinmypersonality.2.Attendingatwo-yearcollegehasseveraladvantages.3.Ihavetriedseveralwaystogiveupsnacks.4.Halloweenisnotallfun.5.Threefactorscontributedtomyheartattack.Activity1(LimitingaTopicandWritingaThesis),66Answerswillvary;apossiblethesisforeachlimitedsubjectislistedbelow.1.Sharinganapartmentwitharoommatehelpedmeadjusttoanewcity.2.Decidingtobelesscriticalofyourspousecanhelpamarriage.3.Mymother’stidinessdrivesuscrazy.4.Fast-foodrestaurantsarecheaper,cleaner,andfriendlierthanotherrestaurants.5.MycousinMyrahasseveralbaddrivinghabits.6.RegulareGercisecanhelpeaseemotionalproblems.7.Do-it-yourselfrepairsalwaysendupcosting memoremoneythanthey’resupposedto.8.Thefree-agentsystemhasmadebaseballabigbusiness,notasport.9.BeingasingleparentcanbeeGhausting,frustrating,andintimidating.10.Noisepollutionisagrowingprobleminourcity.Activity2(LimitingaTopicandWritingaThesis),67Answerswillvary;somepossiblelimitedsubjectsandthesisstatementsarelisted below.1.EGoticanimalsaspets PeopleshouldnotbeallowedtokeepeGoticanimalsaspets.2.Teensandbirthcontrol Parentsshouldbenotifiediftheirdaughtersvisitabirthcontrolclinic.3.Thenewseason’sTVprogr amming Thenewtelevisionprogramsarecarboncopiesoflastyear’ssuccessfulshows.puterizedoffices Computersinofficesarecreatingnewhealthproblemsforemployees.5.Majorfieldsofstudy Choosingamajordoesnothavetobedoneblindly.6.Housecalls Doctorsshouldbecompelledtomakehousecalls.7.Summervacations Summeristheworsttimeofyeartotakeavacation.8.Barbecuing Therearethreekindsofpeoplewhowillbefoundbehindabarbecuegrill.9.Children’sallowances Gettinganallowanceteachesachildtoberesponsible,mature,andthrifty. 10.Christmasshopping OneyearImadethemistakeofdoingmyChristmasshoppingmonthsinadvance. Activity(ProvidingSpecificEvidence),68–69Answerswillvary;somepossibilitiesarelistedbelow.1.Guestsarrivedtwohourslate;roastwasburned;hostandhostessgotintoahugefight2.Collectsdeadfrogs,birds,andworms;lovestodunkpizzainhischocolatemilk;combshishairwithhistoothbrush3.Tootired;toohungry;toodisorganized4.Chosemyfriendsforme;chosemyclothesforme;chosemycollegeforme5.Baby-sitting,gardening,bakingcookies6.Newignition,newbrakes,newheater7.Catgotsick;kidsgotsick;roofstartedtoleak8.Sleptathisdesk;gavesiGhoursofhomeworkpernight;hadanastytemper Activity(IdentifyingAdequateSupportingEvidence),69–70AD1.U2.WhatarespecificeGamplesofhowpeoplearethoughtlesstopets?Whatareth eparticularneedsofpetsthatmaybeignored?EGamplesmightincludebathinganimalsregularly,treatingthemforfleas,helpingthemstaycoolinsummer,eGercisingthem,andprovidinganutritiousdiet.U3.WhatarespecificeGamplesofshowsthatareoflittleinteresttopeople?EGactl yhowwouldcommercialsbechanged?Howwouldnetworknewsbemademoreinteresting?EGamplesmightincludethenamesofshows(situationcomedies,gameshows,andsoon)thataren’mercialsmightbechangedbyeliminatingrepetitiousjinglesorcelebrityendorsements(usingeGamplesofcurrentcommercials).AD4.U5.WhatareeGamplesofhowthewomanwassetinherways?Whatdidshesayab outthekindofhairdoshewanted?ForeGample,thewomanmighthaverejectedanysuggestionsotherthanthestyleshewasusedto.Whatdidthewriterdothatwasunsuccessful?Andhowdidthewomanseemtoindicatethatthewriterwasnotdoingwhatshewanted?Forinstance,shemighthaveshookherheadorsighedeverytimethewriterattemptedtopleaseher.Activity(AddingDetailstoCompleteanEssay),70–73 Answerswillvary;possiblesupportingdetailsareincludedintheparagraphsbelo w.Firstofall,withnotelevisiontocompeteforourtime,wefoundplentyofhoursforp ersonalinterests.WeallreadmorethatweekthanwehadreadduringthesiGmont hsbefore.DadintroducedMomtohisfavoritemysterywriter—DorothySayers—anditwaspleasanttoseethemsittingonthesofatogether,eachoneabsorbedina book.Luella,seriousasalways,readnovelsbyCharlesDickens,whileIsettledmod estlyforthedailynewspapers.W eeachalsoenjoyedsomehobbieswehadignore dforages.MomandDaddidcrosswordpuzzlestogether,Ludustedoffherstampc ollection,andIfinishedknittingthesweaterIhadstartedlastSeptember.Inadditi on,mysisterandIbothstoppedprocrastinatingwithourhomework.Insteadofpu ttingoffourEnglishandmathassignmentsuntilourfavoriteshowswereover,wet ackledthemrightaftersupperandfoundthat,withoutthesoundoftheTVblaringi nourears,wecoulddotheminacoupleofhours—farmorequicklythanweeGpected.Second,wedidchoresthathadbeenhangingoverourheadsfortoolong.The reweremanyjobsaroundthehousethathadneededattentionforsometime.Mo mfiGedafaucetthathadbeendrippingforweekswhileDadpatchedthecrackedp lasterinthediningroom.LuandIcleanedourclosets,findingrecords,tapes,andm agazinesthathadbeenmissingformonths.Bytheendoftheweek,thehousewasi ntidiershapethanithadbeensincewemovedin.Wealsohadachancetodosomel ong-postponedshopping.MomandDadpickedoutanewsofafortheden;Lubou ghtsomenewbooks,andIwentthroughawholestackofcatalogsandfinishedall myChristmasshoppingbymail.Andeachofusalsodidsomeletterwritingorother paperworkthatwaslongoverdue.MomandDadstruggledwiththisyear’sinco metaGforms,LuwrotetoJohnny,afriendshemetatSpiritLakelastsummer,andIw roteathank-younotetoAuntElsieforlettingmestaywithherduringmyweekendi nNewYorkCitylastmonth.Finally,andprobablymostimportant,wespenttimewitheachother.Insteadofbei nginthesameroomtogetherwhilewestaredatascreen,weactuallytalkedforma nypleasanthours.Momtoldusabouttheprogrammingprojectshehasbeendoin gatwork,andwehadfunplanningthetriptoBostonwearegoingtotakethissumm er.Moreover,forthefirsttimeinyearsmyfamilyplayedsomegamestogether.We playedseveralgamesofScrabble,andweevengotouttheMonopolysetandplaye dagamefollowingtherulesourfamilyhasmadeupovertheyears.Andbecausew edidn’thavetoworryaboutmissingthisorthatshow,wehadsomefamilyfriends overacoupleofeveningsandspentanenjoyabletimewiththem.WeweregladtoseehowmuchtheOverholtchildrenhadgrown,andJoeandSandyCipriannikeptu slaughingalleveningwiththeirstoriesaboutfiGinguptheoldhousetheybought. 4TheThirdStepinEssayWritingFill-ins(CommonMethodsofOrganization),75–76 ThetopicsentencesintheessayusethewordsTo begin with,NeGt,andFinallytohelpshowtimeorder. Theparagraphusesthefollowingwordstohelpshowtimeorder:NeGt, first, Then, After,andFinally. ThetopicsentencesintheessayusethewordsFor one thing,In addition,andMost importanttohelpshowemphaticorder. ThewordsWorst of allareusedtomarkthemostemphaticdetailintheparagraph. Activity(CommonMethodsofOrganization),77A.1.timeorderB.time;emphatic;time;emphatic2.emphaticorderbinationoftimeandemphaticorderActivity(Transitions),78–801.Additionsignals:One,Also,Another2.Timesignals:After,First,NeGt,Finally3.Spacesignals:NeGt[to],Totheright,Near4.Change-of-directionsignals:But,however5.Illustrationsignals:ForeGample,suchas6.Conclusionsignals:Finally,thereforeActivity(TransitionalSentences),81Answersmayvaryslightly. Inadditiontoteachingmeabouttheimportanceoffamilysupport,myparentstaughtmethevalueofhard work. Alongwiththevalueofhard work,myparentsemphasizedthebenefitsofa good education.Activity(OtherConnectingWords),831.fourtimes2.he3.ironrange;throbbingswellings;frigidActivity(IntroductoryParagraph),86-87Activity(ConcludingParagraph),891.BStartingwithanopposite1.P/R2.FQuotation2.Q3.AGeneraltonarrow3.SActivity(Titles),90–91Answerswillvary;eGamplesoftitlesaregivenbelow.1.ChoosingMcDonald’s2.ADineratMidnight3.AudiencesatRockConcertsActivity1(OrganizingThroughTimeOrder),91–931.12.33.1313222Activity2(OrganizingThroughEmphaticOrder),95–961.22.33.2113321Activity(ProvidingTransitions),93–94Firstofall,therearethepeople...ForeGample,therearetheones... Anothertypeofnervous...However,neitherofthese... Asecondcategoryofpeople...Onthecontrary,theyfeelcompelled...Asaresult,noonehears... Aftertheyhavebeentothetheater...Thentheywillstart...Lastofall,therearethepeoplewhotalk...Inaddition,itisimpossible...ButifeverIamgranted...Activity(IdentifyingTransitionsandOtherConnectingWords),95–96 S1.T9.P2.RW10.T3.S11.S4.T12.P5.P13.RW6.RW14.P7.T15.P8.Activity(CompletingTransitionalSentences),96–97Thesis1:Aftermakingcertainthatyour house conforms to state regulations,youmustobtainlegalpermits...Finally,onceyouhavethenecessarylegal permits,youcanbegintoadvertise... Thesis2:Inadditiontosavingmemoney,watchingthegameathomeismorecomfortablet hansittinginastadium... Evenmoreimportantthancostandcomfort,though,isthetechnologywhichmak esatelevisedgamebetterthanthe“realthing.”...Activity(IdentifyingIntroductionsandConclusions),97-99Pair1:DIncidentorstoryIPredictionorrecommendationPair2:EQuestion(s)GSummaryandfinalthoughtPair3:FQuotationGSummaryandfinalthought5TheFourthStepinEssayWritingActivity(UseParallelism),101–102Answersmayvaryslightly.1.Thenoveltystoresellshandbuzzers,plasticfangs,andfake insects.2.Manypeoplesharethesamethreegreatfears:beinginhighplaces,workingwithnumbers,andmaking speeches.3.Todecideonacareer,peopleshouldthinkcloselyabouttheirinterests,hobbies,andskills.4.Atthebodyshop,thecarwassandeddowntothebaremetal,paintedwithprimer,andsprayed withredenamel.5.Inordertobecomeadancer,Lolaistakinglessons,workinginamateurshows,andauditioningforprofessionalcompanies.6.Juan’slastjobofferedsecurity;his new joboffersabetterchanceforadvancement.7.Peopleint oday’sworldoftentrytoavoidsilence,whetheronthejob,inschool,orat home.8.Becausethedyingwomanwasdignifiedandcourageous,shewoneveryone’srespect.9.Thepoliticiantrustednoone,rewardedloyalty,anddependedonlyonhisowninstincts.10.Ifwe’renotcareful,we’llleavethen eGtgenerationpollutedair,contaminatedwater,anddying forests.Activity(ConsistencywithVerbs),1031.arrivearrived6.floatedfloats2.asksasked7.grabsgrabbed3.slicedslices8.swoopedswoops4.wentgoes9.rechargedrecharge5.tipstipped10.burnsburnedActivity(ConsistencywithPronouns),104–1051.yourtheirhealth6.youIcanown2.youIneverknow7.youherindigestion3.youwehaveifyouwe8.you wedon’tdare4.theiritsaggressive9.wetheycanlearn5.oneyoushouldplan10.oneyoushoulddressActivity1(UseSpecificWords),106–107Answerswillvary;followingareeGamples.1.Potatochips,pretzels,andsaltedpeanuts...2....papers,books,andmagazines...3....aTV,aCDplayer,andacomputer.4.Thecomics,thesportspages,theobituaries,andthesocietypage...5....mythroat,myears,andmylungs...Activity2(UseSpecificWords),107–108Answerswillvary;followingareeGamples.1.TherustyoldBuicksputtered,whined,andrefusedtostart.2.Themathematicsfinalwasfilledwithtricky,bafflingproblems.3.LittleRobbiewassoeGhaustedthathecouldscarcelykeephiseyesopen.4.Mycluttered,jumbled,dustybedroomneedstobesweptout,scrubbed,andreorganized.5.Abroken-downcitybusblocked MainStreetandstoppedtrafficforanhour.Activity(UseActiveVerbs),1091.ThetypicalAmericandietincludesmanyunhealthyfoods.2.Hundredsofbitingantsinvadedthefamilypicnic.3.Doctorsuseantibioticstotreatmanyinfections.4.Adrunkdrivercausedthefataltrafficaccident.5.Theinstructorwilldeterminefinalgradesonthebasisofclassperformance.Activity(UseConciseWords),110–111Answerswillvary.1.Iwillconcludebysummarizingmymajorpoints.2.Everyday,parentsmus tcontroltheirchildren’stelevisionwatching.3.Iamshy.4.Magazineadvertisingcontainscleverhiddenmessages.5.Myworstmistakelastweekwastohurtmybrother’sfeelingsandnotapologize.6.Intoday’suncertaineconomy,themiddleclassfindsithardtosave.7.Welikedlastnight’stelevisionshow,butourparentsdidn’t.8.Theschooldistrictcanceledclassesbecauseofthebadweather.9.Iregretnothavingstudiedwordprocessinginhighschool.10.Peopleareharmedbyemotionalaswellasbyphysicalabuse.Activity(RevisebyAddingaSecondCompleteThought),112–1131....sandwiches,forheisallergic...2....sleep,butthethought...3....bakery,andithas...4....soggy,forrainwaterhad...5....present,soIoffered...Activity(RevisebyAddingaDependentThought),114–115 Answersmayvary.1.BecauseIhadforgottentolockthefrontdoor,I...2.Whenthebearturnedovertherottenlog,fat...3.AfterKevinhadsentawayforasetoftools,he...4.Becausesomepeopleareallergictowool,they...5.Eventhoughanolderwomaninmytypingclasscantypealmostonehundredwordsaminute,she...Activity(RevisebyBeginningwithaSpecialOpeningWordorPhrase),1161.Reluctantly,Shirleysignedtherepaircontract.2.Toimprovetheirchancesofpromotion,theinternsvolunteeredtoworkovertime.3.Duringthetrial,theaccusedmurderergrinnedatthewitnesses.4.Crowdedwithnervouspets,thevet’sofficewasnoisyandconfusing.5.Tryingtofindsomethingworthwatching,Barryflippedfromchanneltochannel.Activity(RevisebyPlacingAdjectivesorVerbsinaSeries),117–118 Answersmayvary.1.Thebabytoddledacrosstherug,pickedupabutton,andputthebuttoninhismouth.2.Brown,foul-tastingwaterdribbledoutoftherustymetaltap.3.By6A.M.,IhadreadtheteGtbookchapter,takennotesonit,studiedthenotes,anddrunkeightcupsofcoffee.4.TheeG terminatorapproachedthelarge,paperywasps’nestshangingundertheoldwoodeneaves.5.Slimbrownreedsborderedthestagnantgreenpond.Activity(Proofreading),120–1211.26.112.47.133.58.144.69.165.910.17Corrections(methodsofcorrectionmayvary):1.anashtraywhichImade6.myfather,whosmoked2.theprideIfeltwhenIpresented7.brightpurple,myfavoritecolor3.ashelf;itisaremarkably8.itsrim;theyarecoloredneongreen.4.circle.Unfortunately,9.loveme,Ilook5.orcigar,soImade10.uglyashtray;theanswerReviewTest1(UsingParallelism),1221.filledwithsuspensesuspenseful6.sellingtoystoysalesperson2.furniturefortheoffice7.foodonthetableputtingfoodonthetable officefurniture8.tocramcramming3.mykitchenworkinginmykitchen9.bagsareputonthembagged(or:putintobags)4.preparingtoprepare10.withfriendlinessaswellandhisfriendliness5.beingkindkindnessReviewTest2(UsingParallelism),1231.tobuybuying6.werewhisperingwhispered2.showsonsciencescienceshows7.tostartstarting3.porchfurniturethatwasrotted8.paythatisgoodgoodpay rottingporchfurniture9.wasputtingput4.hershirtwastornatornshirt10.losinglost5.takingtake(or:climbing...taking)ReviewTest1(UsingaConsistentPointofView),1241.iswastaken6.getsgotthechicken2.arewerenotonthesameshelf7.realizesrealizeditcontained3.proceedsproceededslowly.8.transferstransferredthegroceries,4.decidesdecidedtopickup9.noticesnoticedthatthebarbecuedchicken5.parksparkedhisshoppingcart10.sayssaidtotheclerk,ReviewTest2(UsingaConsistentPointofView),1251.youtheywork.6.oneIcanmeet2.youIcouldhear7.weretoyoume.3.youwearesupposed8.youIdrive4.oneImustcomplete9.youtheyhaveturnedin5.youhecouldnottell10.andaskedtohelpyouher.ReviewTest1(UsingSpecificWords),126Answerswillvary;eGamplesareshown.1....Ifeltsad,angry,andworried.2.Thelukewarmsoup,stalesandwiches,andlimpsalads...3.Ants,moths,andspiders...4....itrainednonstop,withabone-chillingwind.5....abrokenarm,twobrokenribs,andaconcussion.ReviewTest2(UsingSpecificWords),127Answerswillvary;eGamplesareshown.1.Thehaughty,scowlingsalesmantoldusnottowastehistimewithstupidquestions.2.Bettydugherfistsintohereyesandshookwithsobs.3.ThethirdgameoftheWorldSerieswasatensepitchers’duel.4.Theairportloungewasthrongedwithholidaytravelers.5.Thewomaninthefrontseatwasmutteringtoherselfandtrembling. ReviewTest(UsingActiveVerbs),1281.Thehealthinspectorclosedthepizzarestaurant.2.Theworkersinthelibrarysortedhugestacksofdonatedbooks.3.Avirusinfectedmycomputer.4.Oilcompanieswillnotincreasegasolinepricesthiswinter.5.Ourairplanesdroppedhigh-poweredbombsontoenemybases.6.Thetelephonecompanyplacedanadditionalchargeonourphonebill.7.Agroupofvandalsdamagedthecommunitycenter.8.Physicalactivity,meditation,andrelaGationrelievestress.9.ThefederalgovernmentwillraisetaGestopayforhighwayimprovements.10.StudiesshowthatwatchingviolentTVprogramsincreasesviolentbehavior. ReviewTest1(UsingConciseWords),129Answersmayvary;eGamplesareshown.1.Ifinallydecidedtolookforanewjob.2.Becauseherprinterwasoutofpaper,Reneewenttobuysome.3.Tamikarealizedsuddenlythatherdatehadstoodherup.4.OurteacherdoesnotyetknowifshewillreturnneGtyear.5.Thesalespersonadvisedustowaituntilthepricedroppedbeforebuyingourcomputer.ReviewTest2(UsingConciseWords),130Answersmayvary;eGamplesareshown.1.Ourcompanyallowstwofifteen-minutecoffeebreaks.2.Yourlineofcredithasbeenincreased.3.Iprefercandytofruit.(Or:Ithinkcandytastesbetterthanfruit.)4.Lynnrarelyadmitsthatshehasmadeamistake.5.Manypeoplethinkthatchildrenshould,bylaw,attendschooluntilagesiGteen. ReviewTest1(VaryingYourSentences),131Answerswillvary;eGamplesareshown.1.Sophiehadrepairedherbrokenwatchbandwithapaperclip,buttheclipsnappedandthewatchslidoffherwrist.2.ThephysicaltherapistwatchedasJulietriedtostandonherweakenedlegsandtheycrumpledunderher.3.Althoughtherewereparkingspacesonthestreet,RichiepulledintoaneGpensivegaragebecausehedidnotwanttoriskdamagetohisnewcar.4.Speeding,thebrowntruckskiddedonsomeiceandalmosthitastartledyoungpoliceofficer.5.Asuddenterriblerainstormfloodedourbasement,knockedslatesofftheroof,anduprootedayoungtree.ReviewTest2(VaryingYourSentences),132–133Answerswillvary;eGamplesareshown.1.Whenasuddencoldfronthitthearea,temperaturesdroppedthirtydegreesinlessthananhour.Iwasnotwearingawarmjacket,somyteethbegantochatter.2.Vernworksasamodel,sohehastolookhisbest.Whenhegainedtenpoundsrecently,hehadtotakeofftheeGtraweight,orhewouldhavelosthisjob.3.Astheballgamewasabouttobegin,adogranontothefieldandbegannippingtheinfielders’ankles.Thegamehadtobedelayeduntilthedogw aschasedaw ay.4.Thehungrylionwatchedtheherdofgazelleclosely.Ifayoungorsickanimalwanderedawayfromthegroup,thelionwouldmoveinforthekill.5.Sufferingfromarthritis,myauntdecidedtofindahelpfulformofeGercise.Shelearnedthatswimmingisveryhealthfulbecauseitworkseverymusclegroupin thebodywithoutstrainingthemuscles.ReviewTest3(VaryingYourSentences),134Answerswillvary;aneGampleisshown. LenaandMileswantedanice,quiet,relaGingvacation,sotheyrentedasmalllakesi decabin.Theirfirstdaytherewasverypeaceful,butthesituationquicklychanged whenalargefamilymovedintoanearbycabin.Theyplayedmusicattopvolumean dracedaroundinaspeedboatwithaloudwhiningengine.LenaandMiles,nolong erveryrelaGed,packeduptheirthings,droveoff,andreturnedtotheirquietapart ment.6FourBasesforRevisingEssaysActivity(RevisingforUnity),138Thefollowingsentencesshouldbecrossedout:Paragraph3:Weareclosenow,though.Infact,Eddierecentlypaintedmynewapart mentforme.Paragraph4:NowIrealizethatteenagedrinkingisdangerous.Ireadrecentlythatth enumberonekillerofteenagersisdrunkdriving.Activity(RevisingforSupport),141Answerswillvary.Activity(RevisingforCoherence),144Answerswillvary.Activity(RevisingforSentenceSkills),147–1481.Inwordgroup14,are shouldbe is tomaketheverbagreewith way.2.Inwordgroup19,quite shouldbe quiet.3.Inwordgroup22,5shouldbespelledout.4.Inwordgroup22,began shouldbechangedtothecorrectformoftheverb,begun.5.Inwordgroup23,thereshouldbequotationmarksaround“Bugs.”6.Inwordgroup23,aneGclamationpointisneededforanendmark.7.Inwordgroup24,Dumpingthefoodinthedisposal isadanglingmodifier.Itshouldbechangedto They’llalldumptheirfoodinthedisposal,jumpintothecar, and...8.Inwordgroup24,makeabeeline isacliché.Itshouldbechangedto headquickly.9.Inwordgroup24,mcdonald’s shouldbecapitalized.10.Wordgroup29isarun-on.Itcanbecorrectedthus:...simple.Coworkers,... Activity(RevisinganEssayforUnity),148–150 “PlayingontheBrowns”—Irrelevantsentences:15,24,28 “HowtoConanInstructor”—Irrelevantsentences:11,19,24,33Activity(EvaluatingEssaysforSupport),156–158 “FormulaforHappiness”—Supportingdetailsneededaftersentences7,13,16 ,20,21 “ProblemsofaForeignStudent”—Supportingdetailsneededaftersentences 12,17,24Activity(RevisingEssaysforCoherence),152–155“NoisePollution”1.sentence65.sentence192.cannedmusic6.rubble3.sentence127.siGtimes4.sentence188.4,2,3“WeightLoss”1.sentence85.sentence162.sentence96.fat3.sentence127.fourtimes4.mybestfriend’sfamily8.3Activity(RevisingEssaysforAllFourBases),155–158“Chiggers”7A版优质实用文档Paragraph2:a(“Iamdefinitely...andconcrete.”)Paragraph3:cParagraph4:d(“Mainly...summertime.”—fragm ent;“Iwill...redspeck.”—run -on)“TheHazardsofBeinganOnlyChild”Paragraph2:a(“Someonlychildren...writingordrawing.”)Paragraph3:d(“Andwho...morning.”—fragment;“Afterall...secrets.”—run-on)Paragraph4:b(“...familydecisions,either.”)7A版优质实用文档31。

托业2022考试试题题库托业考试（Test of English for International Communication，简称TOEIC）是一项国际性的英语能力测试，主要评估非英语母语者在国际商务环境中使用英语进行沟通的能力。

托业考试分为听力和阅读两个部分，每个部分满分为495分，总分为990分。

以下是一份模拟的托业2022考试试题题库，供考生练习使用。

# 听力部分听力理解（Part 1 Photo Description）1. What is the man doing in the picture?- A. Reading a book- B. Cooking food- C. Fixing a car- D. Painting a wall2. What can be inferred about the woman in the photo?- A. She is a teacher.- B. She is a student.- C. She is a doctor.- D. She is a secretary.听力对话（Part 2 Question and Response）3. What is the woman asking the man for?- A. Directions to the bank.- B. The time of the meeting.- C. A recommendation for a restaurant.- D. Help with her luggage.4. What does the man suggest the woman do?- A. Take a taxi.- B. Wait for the bus.- C. Walk to the next street.- D. Call her friend.听力对话（Part 3 Conversations）5. What are the speakers mainly discussing?- A. A business proposal.- B. A marketing strategy.- C. A new product launch.- D. A company's financial report.6. What is the man's opinion about the current situation? - A. He thinks it's a good opportunity.- B. He is concerned about the risks.- C. He is not interested in the project.- D. He is unsure about the potential outcomes.听力短文（Part 4 Talks）7. What is the main topic of the talk?- A. The importance of teamwork.- B. The benefits of remote working.- C. The challenges of managing a global team.- D. The future of the office environment.8. What does the speaker recommend to improve communication? - A. Using video conferencing.- B. Sending regular emails.- C. Holding face-to-face meetings.- D. Encouraging open feedback.# 阅读部分阅读理解（Part 5 Incomplete Sentences）9. The company's new policy on flexible working has been_______ by the employees.- A. rejected- B. embraced- C. ignored- D. criticized10. Despite the economic downturn, the company managed to_______ its profits.- A. increase- B. maintain- C. reduce- D. fluctuate阅读理解（Part 6 Text Completion）11. According to the text, which of the following is NOT a benefit of using renewable energy?- A. Reducing carbon emissions.- B. Creating new jobs.- C. Lowering energy costs.- D. Increasing dependence on foreign oil.12. The author suggests that the government should _______ to support the renewable energy sector.- A. impose higher taxes- B. provide subsidies- C. limit research funding- D. enforce stricter regulations阅读理解（Part 7 Reading Comprehension）13. What is the main purpose of the article?- A. To discuss the history of renewable energy.- B. To argue for the adoption of renewable energy.- C. To compare different types of renewable energy.- D. To describe the process of energy production.14. The author cites several examples to support the argument. What is one of these examples?- A. The economic benefits of renewable energy.- B. The environmental impact of fossil fuels.- C. The technological advancements in renewable energy.- D. The political support for renewable energyinitiatives.综合练习（Part 8 Listening and Reading）15. In the listening passage, the speaker mentions a new project. What is the main objective of this project?- A. To develop a new type of solar panel.- B. To increase the use of wind energy.- C. To reduce the reliance on nuclear power.- D. To improve the efficiency of hydroelectric power.16. The reading passage discusses the challenges of implementing renewable energy. Which of the following is NOT mentioned as a challenge?- A. The high initial cost of renewable energy technologies.- B. The lack of public awareness about renewable energy. - C. The limited availability of natural。

医药讨论课题英文作文英文：Today, we are going to discuss a topic that is very important in the field of medicine – the use of antibiotics. Antibiotics are a type of medication that is used to treat bacterial infections. They are very effective in killing bacteria and preventing the spread of infection. However, the overuse and misuse of antibiotics have led to the development of antibiotic resistance, which is a major public health concern.One of the main reasons for the overuse of antibiotics is the misconception that they can cure all types of infections, including viral infections. This is not true, as antibiotics only work against bacterial infections. In fact, taking antibiotics when they are not needed can actually harm the body by killing off the good bacteriathat help keep us healthy.Another reason for the overuse of antibiotics is the pressure from patients to prescribe them. Patients often demand antibiotics even when they are not necessary, which can lead to the inappropriate use of antibiotics. As healthcare providers, it is important for us to educate our patients about the proper use of antibiotics and to only prescribe them when they are truly needed.To combat antibiotic resistance, it is important to use antibiotics only when they are necessary and to use them correctly. This means taking the full course of antibiotics as prescribed, even if you start feeling better before the medication is finished. It also means not sharing antibiotics with others or using leftover antibiotics from a previous illness.In conclusion, the overuse and misuse of antibiotics have led to the development of antibiotic resistance, which is a major public health concern. As healthcare providers, it is our responsibility to educate our patients about the proper use of antibiotics and to only prescribe them when they are truly needed.中文：今天我们要讨论的话题是医学领域非常重要的一个话题——抗生素的使用。

肚子不舒服肠鸣声很大英语作文The Symphony of Intestinal Discomfort.The symphony of intestinal discomfort, a cacophony of gurgling and rumbling, reverberates within the depths of my abdomen. It's an unwelcome orchestra, a chorus of discontent that announces to the world the turmoil within.Intestinal gas, the culprit behind this sonic assault, is a byproduct of digestion. As our bodies break down food, bacteria in our digestive system feast upon theindigestible remnants, producing gases such as hydrogen, carbon dioxide, and methane. These gases accumulate in the intestines, and when they reach a critical volume, they seek release through the path of least resistance: our rear ends.While flatulence is a normal part of digestion, excessive gas production can be a sign of underlying digestive issues. Certain foods, such as beans, lentils,and cruciferous vegetables, are known to promote gas formation due to their high fiber content, which isdifficult for bacteria to digest. Other potential culprits include lactose intolerance, irritable bowel syndrome (IBS), and celiac disease.Lactose intolerance, a condition that affects about 65% of the world's population, occurs when the body lacks the enzyme lactase, which is necessary to break down lactose, the sugar found in milk and dairy products. When lactose-intolerant individuals consume these products, bacteria in the intestines ferment the undigested lactose, producinggas as a byproduct.Irritable bowel syndrome (IBS) is a common functional bowel disorder that affects the large intestine. It's characterized by abdominal pain, bloating, and alteredbowel habits. While the exact cause of IBS is unknown, it's believed to be related to abnormalities in the gut-brain axis, the communication pathway between thegastrointestinal tract and the brain.Celiac disease is an autoimmune disorder that triggers an immune response when gluten, a protein found in wheat, rye, and barley, is consumed. This immune response damages the lining of the small intestine, impairing its ability to absorb nutrients. Gas is a common symptom of celiac disease due to the malabsorption of food and the subsequent fermentation of undigested carbohydrates by bacteria in the intestines.Excessive intestinal gas can not only be embarrassing but also uncomfortable and disruptive to daily life. It can cause abdominal pain, distension, and a feeling of fullness. In some cases, gas can also lead to nausea and vomiting.Managing intestinal gas requires a multipronged approach that includes dietary modifications, lifestyle changes, and, in some cases, medication. Dietary interventions involve identifying and limiting the intakeof gas-producing foods. This may include reducing the consumption of beans, lentils, cruciferous vegetables, and dairy products for lactose-intolerant individuals.Lifestyle changes that can help reduce gas production include eating smaller meals more frequently, chewing food thoroughly, and avoiding carbonated beverages, which can contribute to swallowed air. Additionally, regular exercise can help promote intestinal motility, reducing the opportunity for gas to build up in the intestines.In some cases, over-the-counter medications, such as simethicone or activated charcoal, may be used to relieve gas symptoms. Simethicone works by breaking down gas bubbles in the intestines, while activated charcoal absorbs and traps gas.If excessive intestinal gas persists despite dietary modifications, lifestyle changes, and over-the-counter medications, it's important to consult a healthcare professional to rule out any underlying medical conditions that may be contributing to the problem.。

神经病学常见名词（英－中对照）Aabducent nerve 展神经(第2章第1节)abnormal sensation 感觉异常(第2章第2节）abstract thinking 抽象思维（第3章第2节)accessory nerve 副神经(第2章第1节）ACh 乙酰胆碱（第17章第1节)AChR 乙酰胆碱受体(第17章第1节)aciclovir 阿昔洛韦（第9章第2节）acquired immuno-deficiency syndrome 获得性免疫缺陷综合征（第9章第8节）acute disseminated encephalomyelitis,ADEM 急性播散性脑脊髓炎(第10章第2节）acute onset 急性发病（第3章第1节)acute inflammatory demyelinating polyneuropathy, AIDP 急性炎症性脱髓鞘性多发性神经病（第6章第3节）acute motor sensory axonal neuropathy，AMSAN 急性运动感觉性轴索型神经病（第6章第3节)acute motor axonal neuropathy，AMAN 急性运动性轴索型神经病(第6章第3节）acute myelitis 急性脊髓炎(第7章第2节）acyclovir 无环鸟苷(第6章第3节)affect 情感（第3章第2节）affective disorders or mood disorders 情感(心境)障碍(第20章第1节）agiaphia 失写（第3章第4节）agnosia 失认症（第3章第4节)akinetic mutism 无动性缄默（第3章第3节)Akineton 安克痉(第11章第2节)Alzheimer disease，AD 老年性痴呆(阿尔茨海默病）(第14章第3节)Amantadine 金刚烷胺(第11章第2节)ambulatory EEG monitoring 可动式脑电图描记（第4章第3节)amobarbitalum 异戊巴比妥(第12章)amphetamine 苯丙胺（第12章)amipaque 甲泛葡胺（第4章第2节）amyloid precursor protein，APP 淀粉样蛋白前体基因(第14章第3节）amyotrophic lateral sclerosis, ALS 肌萎缩侧索硬化（第14章第2节)ancrod 安克洛酶（第8章第4节）anesthesia 感觉缺失（第2章第2节)anhedonia 快感缺失（第20章）anticipation 遗传早现现象（第15章第2节）apallic syndrome 去皮质综合征(第3章第3节）apiaxia 失用症(第3章第4节）apolipoprotein E4，ApoE4 载脂蛋白E4 （14章第3节）Argyll—Robertson pupil 阿罗瞳孔(第2章第1节）Arnold—Chiari malformation 阿诺德-基亚里畸形(第7章第6节)aspirin 阿司匹林(第8章第3节）ataxia 共济失调（第2章第3节）atenolol 阿替洛尔（第13章）athetosis 手足徐动症(第2章第3节）ATP 三磷酸腺苷(第17章第1节, 第8章第4节)atrial fibrillation, AF 心房纤颤(第8章第2节）atypical absences 不典型失神发作(第12章)automatism 自动症（第12章)autonomic nervous system 自主神经系统（第19章第1节）autosomal dominant cerebellar ataxia，ADCA 常染色体显性小脑共济失调(第15章第2节）autosomal dominant nocturnal frontal lobe epilepsy 常染色体显性遗传夜间额叶癫痫（第12章)axonal degeneration 轴突变性（第6章第1节)azathioprine 硫唑嘌呤(第10章第3节）B 返回顶部Babinski sign 巴宾斯基征（第7章第1节)baclofen 氯苯胺丁酸（第15章第2节,第10. 章第3节）basal nucleus 基底核（第2章第5节)basilar impression 颅底凹陷症又称颅底压迹（第16 章第4节）bat wing 蝙蝠翅样（第10章第6节）batroxobin 巴曲酶（第8章第4节）bengin neonatal convulsion 良性新生儿惊厥(第12章）bengin myoclonic epilepsy in infancy 良性婴儿肌阵挛性癫痫(第12章）benign familial neonatal convulsion 良性家族性新生儿惊厥（第12章)benign neonatal familial convulsion 良性新生儿家族性惊厥（第12章）benign childhood epilepsy with centro—temporal spike 有中央—颞部棘波的良性儿童癫痫（第12章) Binswanger disease 慢性进行性皮质脱髓鞘脑病（第10章第1节）biphasic dyskinesia 双相运动障碍（第11章第2节）border zone infarction 边缘带梗死边缘带梗死（第8章第4节）botulinum toxin type A，BTX A型肉毒毒素(第6章第2节)brachial neuritis 臂丛神经炎(第6章第3节）bradykinesia 运动迟缓（第11章第2节）brain stem 脑干（第2章第5节）brittle crisis 反拗危象（第17章第2)bromocriptine 溴隐亭（第11章第2节）Brown—Sequard syndrome 布朗—塞卡尔综合征（第7章第1节）burning feet 烧灼足(第16章第3节）C 返回顶部cabergoline 卡麦角林（第11章第2节）calcitonoin gene—related peptide 降钙素基因相关肽（第13章）calculation 计算力（第3章第2节）carcinomatous necrotizing myelopathy 坏死性脊髓病(第18章）carpal tunnel syndrome 腕管综合征（第6章第1节）cdk5 cyclin—dependent kinases 5 细胞周期依赖性激酶5 （第14 章第4节）central pontine myelinolysis,CPM 脑桥中央髓鞘溶解症(第10 章第6节）cerebellum 小脑（第2章第5节)cerebral amyloid angiopathy，CAA 淀粉样脑血管病（第8章第5节)cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy, CADASIL 脑常染色体显性遗传脑动脉病伴皮质下梗死及白质脑病(第16章第1节)cerebral amyloid angiopathy, CAA 脑淀粉样血管病（第7章第6节，第8章第5节)cerebral watershed infarction，CWSI 脑分水岭梗死（第8章第4节）cerebral infarction 脑梗死（第8章第4节）cerebral cysticercosis 脑囊虫病（第9章第6节)cerebral paragonimiasis 脑型肺吸虫病（第9章第6节）cerebral malaria 脑型疟疾（第9章第6节）cerebral schistosomiasis 脑型血吸虫病（第9章第6节）cerebral palsy 脑性瘫痪（第16章第3节）cerebral blood flow，CBF 脑血流量（第8章第1节）cerebral ischemic stroke 缺血性脑卒中(第8章第4节）cerebral embolism 栓塞(第8章第4节）cerebrospinal fluid,CSF 脑脊液（第4章第1节）cerebrovascular disease 脑血管疾病（第8章第1节)ceruloplasmin，CP 铜蓝蛋白（第11章第5节)Charcot—Marie—Tooth disease，CMT 腓骨肌萎缩症(第15章第4节)chief complaint 主诉（第3章第1节）childhood absence epilepsy 儿童期失神癫痫（第12章）childhood epilepsy with occipital parosysms 具枕区放电的良性儿童癫痫（第12章）cholinergic crisis 胆碱能危象（第17章第2节）chore minor，CM 小舞蹈病（第11章第3节)choreic hand 舞蹈病手姿(第11章第3节）choreic movement 舞蹈样运动（第2章第3节）chronic or insidious onset 慢性发病（第3章第1节)chronic inflammatory demyelinating polyneuropathy，CIDP 慢性炎症性脱髓鞘性多发性神经病（第6章第3节)cidafovir 西多福韦（第9章第2节)clobazam 氯巴占（第12章）cocaine 可卡因(第12章）cochlear nerve 蜗神经（第2章第1节）coma 昏迷（第3章第2节）coma vigil 睁眼昏迷（第3章第3节）common peroneal nerve palsy 腓总神经麻痹（第6章第3节）communicating hydrocephalus 交通性脑积水（第16章第2节）computed tomography,CT 电子计算机体层扫描(第4章第2节）Comtan 柯丹（第11章第2节）Conduction aphasia 传导性失语(第3章第4节）confabulation 虚构（第3章第2节）confusion 错乱(第3章第2节）congenital Diseases of the Nervous System 神经系统先天性疾病(第16 章第1节）congenital myotonia 先天性肌强直症(第17章第6节）congenital hydrocephalus 先天性脑积水（第16章第2节）corticosteroids 皮质类固醇（第6章第3节）cranial nerves 脑神经（第2章第1节)crossed hemiplegia 交叉瘫（第2章第3节）cryptococcus neoformans 新型隐球菌（第9章第4节）cryptococcus meningitis 新型隐球菌脑膜炎(第9章第4节）cryptococcus meningitis 隐球菌性脑膜炎（第9章第4节)cryptogenic 隐源性的（第12章）cyclophosphamide 环磷酰胺(第10章第3节）cyclosporine A 环孢素A （第17章第2节)cyproheptadine 赛庚啶(第13章）cytoprotective time window, CTW 神经保护时间窗（第8章第4节）cytosine arabinoside 阿糖胞苷(第9章第5节)D 返回顶部Decerebrate rigidity 去大脑强直(第3章第3节）deep brain stimulation 深部脑刺激（第11章第2节）deep reflexes 深反射(第2章第4节）defibrase 降纤酶(第8章第4节)degenerative disease of the nervous system 神经系统变性疾病(第14章）delirium 谵妄（第13章第2节）depreny 丙炔苯丙胺(第11章第2节）depression without psychotic symptoms 无精神病性症状的抑郁症(第20 章第2节)depression with psychotic symptoms 有精神病性症状的抑郁症（第20 章第2节）depressive representation of nervous system disease 神经系统疾病的抑郁表现（第20章第1节）depressive episode 抑郁发作（第20章第2节）desesthsia 感觉倒错（第2.章第2节）diamox 乙酰唑胺（第12章）diencephalon 间脑(第2章第5节）diffuse myelitis 播散性脊髓炎(第7章第2节)difusion-weighted Imaging，DWI 弥散加权成像（第4章第2节）digital subtraction angiography, DSA 数字减影血管造影（第4章第2节)diplopia 复视（第2章第1节）disorders of the Autonomic Nervous System 自主神经系统疾病（第19章第1节）distal symmentric sensory neuropathy 远端对称性感觉性神经病(第9 章第8节)distal axonopathy 远端轴突病(第6章第3节）disturbance of body image 体像障碍（第3章第4节）disturbance of cranial nerve 脑神经障碍(第3章第1节)doll's eye phenomenon 娃娃眼现象（第3章第3节）drop attack 跌倒发作跌倒发作（第8章第3节）dyskinesia 运动障碍（第11章第2节）dystonia musculorum deformans 变形性肌张力障碍(第11章第6节)dystonia 肌张力障碍(第11章第2节）dystrophin 肌萎缩蛋白(第15章第1节）dystrophin 抗肌萎缩蛋白（第17章第5节）E 返回顶部electroencephalography 脑电图（第12章）electromyography，EMG 肌电图（第4章第3节）encephalo-facial angiomatosis 脑面血管瘤病（第15章第5节)end of dose deterioration 剂末恶化（第11章第2节）endocrinopathy 内分泌病（第6章第3节）epilepsy 癫痫（第12章）epilepsy with myoclonic—astatic seizures 具肌阵挛-失张力发作性癫痫（第12章）epilepsy with generalized tonic—clonic seizure on awaking 觉醒时全身强直—阵挛性癫痫（第12章) epilepsy with myoclonic absences 有肌阵挛失神发作的癫痫（第12章）epithalamus 上丘脑（第8章第5节）erythromelagia 红斑肢痛症(第19章第3节）essential tremor，ET 特发性震颤（第11章第7节)etiologic diagnosis 定性诊断（第5章）event-related potential, ERP 事件相关电位(第4章第3节）evidence-based medicine, EBM 循证医学（第8章第1节）exacerbation 加重（第3章第1节）experimental autoimmune encephalomyelitis，EAE 实验性自身免疫性脑脊髓炎（第10章第3节）F 返回顶部facial spasm 面肌痉挛(第6章第2节）facial nerve 面神经(第2章第1节)familial Alzheimer disease，FAD 家族性Alzheimer病（第14章第3节）familial amyotrophic lateral sclerosis fALS 家族性肌萎缩侧索硬化（第14章第2节）fasciculation 肌束震颤（第6章第1节）fast twitch fibers 快缩肌纤维（第11章第2节)felbamate 非氨酯（第12章）fibrillation 肌纤维颤动（第17章第1节）fibrinogen，Fg 纤维蛋白原（第8章第2节)flunarizine 盐酸氟桂嗪（第8章第3节)fluoxetine 氟西汀(第13章）focal neuropathy 局灶性神经病（第6章第3节)Foville syndrome 脑桥内侧综合征(第8章第4节）Froin syndrome 弗洛因综合征(第4章第1节）frontal lobe 额叶（第2章第5节）frontal lobe epilepsy 额叶癫痫（第12章）functional magnetic resonance image, fMRI 功能性磁共振成像（第4章第2节)furosemide 速尿（第8章第4节）G 返回顶部GABA γ—氨基丁酸（第1 2章）gabapentin，GBP 加巴喷丁（第12章）gancilovir 刚昔洛韦（第9章第2节)gene therapy 基因治疗（第15章第1节)generalized epilepsy with febrile seizures plus 全面性癫痫伴热性发作重叠综合征（第12章）genetic disease 遗传性疾病（第15章第5节)glossopharyngeal nerve 舌咽神经（第2章第1节）granular electron dense osmiophilic material，GOM 颗粒性电子致密嗜锇物质（第8 章第8节）Guillain-Barré syndrome, GBS 吉兰-巴雷综合征(格林-巴利综合征)（第6 章第3节）H 返回顶部hamartin 错构瘤蛋白（第15章第5节)headache 头痛（第3章第1节）hemiballismus 偏身投掷运动（第2章第3节）hemiglobe 大脑半球（第2章第.5节）hemiplegia 偏瘫（第2章第3节）hemorrhagic infarction, HI 出血性梗死（第8章第4节）heparin 肝素（第8章第3节)hepatolenticular degeneration, HLD 肝豆状核变性（第11章第5节）hereditary ataxia 遗传性共济失调（第15章第2节）hereditary ataxia with muscular atrophy 遗传性共济失调伴肌萎缩(第15章第4节）hereditary spastic paraplegia, HSP 遗传性痉挛性截瘫(第15章第3节)heriditary motor sensory neuropathy，HMSN 遗传性运动感觉性神经病（第6 章第3节) herpes simplex virus，HSV 单纯疱疹病毒（第9章第2节）herpes simplex virus encephalitis,HSE 单纯疱疹病毒性脑炎(第9章第2节）hippocampus 海马（第14章第3节）homocysteine, Hcy 同型半胱氨酸（第8章第2节）Horner syndrome 霍纳综合征(第7章第1节）human immunodeficiency virus,HIV 人类免疫缺陷病毒（第9章第8节)Huntingtin 亨廷素（第11章第4节）Huntington disease，HD 亨廷顿病（第11章第4节）Huntington chorea 亨廷顿舞蹈病（第11章第4节）hyperesthesia 感觉过敏（第2。

2024-2025学年上外版英语高三上学期期末模拟试卷及解答参考一、听力第一节（本大题有5小题，每小题1.5分，共7.5分）1、W: Which book are you reading, John? M: I’m reading Twilight. It’s very interesting. W: Can I have a look at it? M: Certainly. You can read it now. Q: What are the two speakers talking about?•A: A movie. (Wrong: They were discussing a movie.)•B: A book. (Correct: John is reading a book called Twilight, and they are discussing this book.)•C: A TV show. (Wrong: They were not talking about a TV show.)2、M: I wonder what you think of this new board game. Do you take an interest in it? W:I haven’t tried it, but I think it’s not a good one. It is quite difficult and boring. M: That sounds bad. Q: What does the woman think of the game?•A: It’s interesting. (Wrong: The woman thinks the game is difficult and boring.)•B: It’s difficult and boring. (Correct: The wom an thinks the game is difficult and boring.)•C: It’s not enjoyable. (Correct: The woman considers the game difficult and boring, which means it’s not enjoyable.)The questions are designed to test the students’ ability to understand conversations indifferent contexts and to infer the speakers’ thoughts and feelings based on the dialogue.3.W: I can’t find my textbook. Do you think it could be in the library?M: I think you should check your bag first. We left it there this morning.Question: Where does the conversation hint that the textbook was last seen?A)In the library.B)In the speakers’ bag.C)During the morning.Answer: B) In the speakers’ bag.Explanation: The man suggests that the woman first checks her bag, implying that they left the textbook there earlier that morning.4.M: How was your job interview? Did everything go smoothly?W: It went okay, but I didn’t get the job. The company is looking for someone with more experience than I have.Question: What is the main concern expressed by the woman about the job interview?A)She believes the interview didn’t go well.B)She didn’t receive any feedback on the interview.C)She doesn’t have the required experience.Answer: C) She doesn’t have the required experience.Explanation: The woman explicitly states that the company is looking for more experienced candidates, indicating that her lack of experience is the concern that prevented her from getting the job.5、听下面一段对话。

唐山“PEP”2024年11版小学4年级上册英语第二单元寒假试卷[含答案]考试时间：90分钟（总分:120）A卷考试人：_________题号一二三四五总分得分一、综合题(共计100题)1、听力题：The main gas in the atmosphere is _____.2、听力题：The Great Barrier Reef is found off the coast of __________.3、填空题：The engineer, ______ (工程师), builds bridges.4、听力题：The sun sets in the ___ (west/east).5、听力题：A chemical reaction that occurs in living organisms is called ______.6、听力题：The capital of Uzbekistan is __________.7、听力题：The Earth's surface is shaped by both internal and external ______.8、填空题：The __________ (文化表达) reflects identity.9、填空题：The horse gallops across the ______.10、What is the main purpose of a school?A. To playB. To learnD. To sleep11、听力题：The ancient Egyptians built ________ to honor their dead.12、What do you call the person who teaches you at school?A. DoctorB. TeacherC. EngineerD. Chef答案: B13、What do you call the person who flies a plane?A. PilotB. DriverC. CaptainD. Sailor答案:A14、听力填空题：I think it’s essential to have goals in life. They give us direction and purpose. I set goals for myself by __________ and tracking my progress.15、What do we call the story of someone's life?A. FictionB. BiographyC. NovelD. Poem16、Which of these is a type of cloud?A. CumulusB. OceanusC. MountainusD. Forestus17、听力题：A solution with a pH of is considered ______.18、填空题：The __________ (文化遗产) of a country is important to preserve.19、How do you say "mother" in French?A. MèreB. MadreD. Mama20、How many continents are in the world?A. 5B. 6C. 7D. 821、听力题：The chicken lays _____ eggs.22、听力题：A trench is a deep ______ in the ocean floor.23、填空题：We should _______ (保持)我们的环境干净。