高考机器人
迈向SCI之路：新英格兰杂志Careport全⽂解析driller
作为医学科研狗，当你没有经费，没有数据，统计跟英语都是渣渣的时候怎么样才能发表SCI
呢，除了Meta分析，病例报道（Ca report）可能是你迈向SCI之门的⾸选论⽂模式。
Ca report是通过对⼀两个⽣动的病例进⾏记录和描述，使抽象的⼀般性的疾病表现和诊疗过
程有了具体的形象的内容，试图在疾病的表现、机理以及诊断治疗等⽅⾯提供第⼀⼿感性资料
的医学报告。
总结发现，⼀篇漂亮的Ca report⾄少具备三个特征：
1. 临床意义
⼀篇个案报道最重要的是对临床实践的指导意义，这⼀点需要明确表达出来。2. 引⼈⼊胜
⼀篇个案报道必须写成⼀个简练但引⼈⼊胜的故事，这⼀点可以借鉴别⼈已经发表的东西。注
意：每个⼈都可能有不良习惯，需要借鉴的是学术界内能被⼴泛接受的东西，不能认为 “有⼈这
么写，所以我也这么写”。3. 符合习惯个案报道的语⾔表述必须符合学术界普遍认可的基本
习惯。
举例
⼀位医⽣⽂章第⼀句话是：In September 13, a 56-year-old male was admitted with
a history of DiscTrode radiofrequency treatment ……
编辑分析
第⼀句话需要把⼊院的基本原因（例如双腿肿胀／疼痛2周）写出来。⾄于以前接受
过的治疗（即使被认为是主要症状的原因），需要放在稍后去说。
今天将⽤⼤篇幅从专业⽤词、典型句式、常⽤语法结构等⽅⾯，详细解读⼀篇Ca report，标
题为Thinking Inside the Box，于2010年8⽉发表在新英格兰杂志（The New England Journal
of Medicine, IF 51.658）第363期574-579页(获取这篇⽂献全⽂可分享此⽂到朋友圈，截图发
给⼩编后（微信号mrwxiaobian)即可获得。
A 62-year-old woman prented to a community hospital with naua, vomiting, diarrhea, and fever, all of 1 week's duration.
第⼀句话：主述。要点：写明性别、年龄、以及就医主要原因。句式：A xx-year-old man (woman) prented with ……
She reported no headache, photophobia, dysuria, or cough.
对鉴别诊断有重要价值的阴性信息（没有什么）。
病⼈⾃述句式：He/she reported ……
Her medical history included psoriasis and psoriatic arthritis, hypertension, hyperlipidemia, possible fibromyalgia, and degenerative lumbar disk dia.
既往史：His/her medical history included ……
Her medications included the tumor necrosis factor (TNF) inhibitor infliximab (500 mg intravenously
every 8 weeks), methotrexate (15 mg orally per week), folic acid, atenolol, diltiazem, hydrochlorothiazide, aspirin, simvastatin, and gabapentin, as well as oxycodone for chronic pain.civitas
病⼈服药情况：His/her medications included ……
如果可能的话，交代关键／主要药物剂量、给药途径和⽤药时程。
The patient was an amateur horticulturist and owned veral dogs, cats, and parakeets. She lived in the upper Midwest and had not traveled outside the United States. She was widowed and reported no recent xual contacts or recreational drug u. She drank alcohol occasionally and was a nonsmoker.
交代对诊断／鉴别诊断有意义的⽣活史：例如感染病⼈的疫区旅⾏，性接触史。
On physical examination, the patient was afebrile.
开始交代体检结果句式：On physical examination, the patient ……
Her heart rate was 95 beats per minute, blood pressure 88/53 mm Hg, respiratory rate 20 breaths per minute, and oxygen saturation 98% while she was breathing ambient air.
⽣命体征，句式：His/her heart rate was ……. 不⽤ He has a heart rate of ……
hhmmShe was alert and not in acute distress.
⼀般情况。
There were no lesions in the oropharynx, and her neck was supple. The lungs were clear, and her heart rate was regular, without a murmur.
肺部⽆罗⾳英⽂表述为：The lungs were clear。注意“lung”前⾯必须有定冠词，必须是复数。
Her abdomen was not tender, and there was no organomegaly.
触痛英⽂为 “tender”。
The neurologic examination was unremarkable.
这个句式（was unremarkable）⾮常有⽤，表⽰没有值得描述的异常情况。
The white-cell count was 8500 per cubic millimeter, with 80% neutrophils, 7% lymphocytes, and 13% monocytes; the hematocrit was 41.1%, and the platelet count was 207,000 per cubic millimeter.
“white-cell count”“ hematocrit”“ platelet”这些表述前⾯必须有定冠词。
The sodium level was 131 mmol per liter, potassium level 3.6 mmol per liter, chloride level 101 mmol per liter, bicarbonate level 22 mmol per liter, blood urea nitrogen level 4 mg per deciliter (1.4 mmol per liter), creatinine level 0.7 mg per deciliter (61.9 µmol per liter), aspartate aminotransfera level 40 U per liter (normal range, 8 to 36), and alanine aminotransfera level 3 U per liter (normal range, 10 to 60).
句⼦中第⼀件事情的描述使⽤完整句⼦（ The sodium level was …），后⾯的描述谓语动词可以省略。达内培训怎么样
The international normalized ratio was 1.1, and the partial-thromboplastin time was 29.1 conds. Urinalysis showed a specific gravity of 1.012; on dipstick analysis, the protein concentration was 30 mg per deciliter. The urine was negative for gluco and nitrites but positive for leukocyte estera, and there was moderate heme. Microscopical examination showed 4 white cells, 19 red cells, and 3+ bacteria per high-power field, without casts.
Chest radiography revealed a small pleural effusion on the right side, with no infiltrate.
“aa 显⽰ bb 病变”的典型句式为：”… revealed ……”
The electrocardiogram (ECG) revealed sinus rhythm, a ventricular rate of 74 beats per minute, left-axis deviation, and a prolonged corrected QT interval (533 mc).
the way of life
这句话的句式同上。开头“The” ⽤法不合适，改成不定冠词更加妥当。绯闻女孩演员
通过这⾥的例⼦可以看出：⽼外，甚⾄专家级的⽼外也不总是⽆懈可击。医学英⽂写作中不定冠词（a）的使⽤⾮常多，⽽定冠词（the）只⽤在特定情况下：1）特指的器官等，例如 “the lungs”；2）前⽂中已经界定过的东西。
After an infusion of 500 ml of normal saline, her heart rate was 78 beats per minute, and her blood pressure was 158/75 mm Hg.
Two ts of blood cultures, as well as stool cultures and tests for Clostridium difficile toxin, legionella urinary antigen, and human immunodeficiency virus antibody, were negative, as were rologic tests for chlamydia, histoplasma, blastomyces, and coccidioides. A test for cytomegalovirus was negative for IgM antibody but positive for IgG antibody. Urine culture was positive for more than 100,000 colony-forming units of Escherichia coli, which were resistant to ampicillin and levofloxacin but nsitive to ceftriaxone. Computed tomography of the chest, abdomen, and pelvis revealed a hazy infiltrate in the left midlung and small, bilateral pleural
effusions; no lymphadenopathy or other clinically significant findings were noted.
“云翳状浸润”英⽂表述为“hazy infiltrate”
The patient was treated with 1 g of ceftriaxone daily for 7 days for the urinary tract infection.
治疗的描述通常⽤“The patient was treated with”或者“The patient received …….”
Her diarrhea diminished, but she continued to have temperatures of up to 40°C (104°F).
症状消减可以⽤“dminish”或者“dissipate”表述。
“仍然”可以⽤“continued to ……”表述，
Becau of her ongoing fever, a lumbar puncture was performed, which revealed 1 white cell and 1 red cell per cubic millimeter; levels of gluco and protein were within normal limits. “reveal”是⼀个⾮常有⽤的动词，含义是“显⽰”。
A transthoracic echocardiogram showed a left ventricular ejection fraction of 45% with no regional wall-motion abnormalities.
中国学者⽤英⽂写作常犯的⼀个错误是：很多该使⽤不定冠词的地⽅错误地使⽤了定冠词。这⾥的“A transthoracic echocardiogram”给了我们⼀点启⽰。
A possible density was noted in the left ventricle, but a follow-up transophageal echocardiogram revealed no vegetations or thrombus.
小升初简历空白表格
“was noted”是⼀个很常⽤的表述，含义是“发现”。
The patient continued to have neutrophilia with intermittent lymphocytopenia. “intermittent”-间断发作／出现的。
A bone marrow biopsy showed a predominance of granulocytic precursor cells without morphologic abnormalities. Smears of the marrow aspirate for routine, acid-fast, and fungal organisms were negative; cultures for the organisms were obtained.
prefer to“bone marrow biopsy”前⾯是不定冠词。
On the 13th hospital day, the patient reported chest tightness, and an ECG revealed ST-gment elevations of 2 to 3 mm in leads II, III, and aVF.
“chest tightness”意为胸闷。
The cardiac troponin I level was 1.10 ng per milliliter (normal range, 0.006 to 0.780).
给出数化的检测结果时同时给出正常范围，这样不是专家的读者也能看懂。
Cardiac catheterization revealed nonobstructive coronary artery dia. She was treated medically with a heparin infusion and a beta-blocker. The troponin level and the degree of ST-gment elevation decread.
注意“heparin infusion”和“ beta-blocker”前⾯的不定冠词。
The patient was transferred to a tertiary care hospital.
“tertiary care hospital”是专科医院，通常仅接受“referral －转诊”，不是“三级医院”。
Her temperature was 38.9°C (102°F), blood pressure 112/62 mm Hg, heart rate 87 beats per minute, respiratory rate 22 breaths per minute, and oxygen saturation 94% while she was receiving 2 liters of oxygen by nasal cannula. The results of a physical examination were unchanged except that alopecia and a faint erythematous rash over her no and cheeks were now noted. Her white-cell count was 20,000 per cubic millimeter, with 85% neutrophils, 6% lymphocytes, 8% monocytes, and 1% basophils. Her hemoglobin level was 9.5 g per deciliter. Tests of renal and liver function were nor
mal. The erythrocyte dimentation rate was 96 mm per hour. Two peripheral-blood cultures were ordered.
“开化验单”英⽂表述是“order ….”
Chest pain recurred, with runs of nonsustained ventricular tachycardia and polymorphic ventricular tachycardia requiring defibrillation. The patient had ST-gment elevations of 1 to 2 mm in the inferior leads. The troponin level was 1.54 ng per milliliter (normal range, 0.0 to
0.29); the creatine kina level was 89 IU per liter (normal range, 26 to 180), and the creatine kina MB fraction was 8.3 ng per milliliter (normal range, 0.0 to 4.9).
A transthoracic echocardiogram revealed an ejection fraction of 15% and a mobile, multilobulated soft-tissue mass, 7 mm by 25 mm, attached to the midpoint of the interventricular ptum in the left ventricle. A review of the previous transophageal echocardiogram revealed a mass in the left ventricle that was consistent with the findings. Cardiac catheterization showed 80% atherosclerotic narrowing of the left anterior descending artery (and this finding was consistent with the results of the prior catheterization on review). No intervention was performed, since the stenosis did not correlate with the ECG changes. A heparin infusion was started for probable thrombus and to
treat probable myocardial infarction. Additional laboratory findings included an antinuclear antibody titer of 1:640 dilution (normal range, <1:80) and="" an="" anti–double-stranded="" dna="" antibody="" level="" of="" 15.6="" iu="" per=""
milliliter="" (normal="" range,="" 0.0="" to="" 7.0).="" tests="" for="" antibodies="" to="" antiphospholipid,="" β2-glycoprotein,="" and="" extractable="" nuclear="" antigens="" were="" all="">
“Additional findings included …”这个句式很有⽤。
Methylprednisolone (20 mg given intravenously every 8 hours) was started for a presumed diagnosis of SLE induced by TNF-inhibitor therapy, with associated myocarditis. The patient was afebrile and felt better after the initiation of corticosteroid therapy.
“a presumed diagnosis of ….”和上⽂中的“probable myocardial infarction”⼤家可以借鉴。
The following day, pulless electrical activity developed, and the patient died despite resuscitation attempts. When cultures of blood obtained 2 days and 1 day earlier came back, two of the five culture bottles showed a gram-positive rod.
“⾰兰⽒阳性杆菌”的简称（⼤家普遍接受）为“gram-positive rod”
rpwt
An autopsy showed rupture of the posterior wall of the ventricle associated with a focal area of suppurative myocardial necrosis with bacilli.
注意“an autopsy”的使⽤，不是“the autopsy”
来源：长青藤编辑
